When the Patient Protection and Affordable Care Act (P.L. 111-148) is fully implemented, the need for free healthcare clinics should diminish greatly; however, I am skeptical about whether this will actually happen. This new law mandates that most U.S. citizens and legal residents have health insurance. Medicaid coverage will be expanded to include those 133% above the Federal Poverty Level. People who do not qualify for Medicaid or Medicare and do not have health insurance through their employers will be required to purchase health insurance, but there will be tax incentives to help alleviate the cost. Those who do not purchase health insurance will be required to pay a tax penalty starting in 2014. However, there are several exemptions to this health insurance mandate, including financial hardship. A summary of the new healthcare reform law can be found at http://www.kff.org/healthreform/8061.cfm.1

In 2007, 45 million Americans had no health insurance and 89% of the uninsured lived in families headed by workers.2 Most of those without health insurance are the working poor. They make too much money to qualify for Medicaid and do not receive health insurance through their employers. They often have difficulty meeting their monthly expenses and are unable to afford health insurance. Although the new healthcare reform law includes tax benefits to offset the cost of purchasing health insurance, monthly payments will most likely be necessary. When a choice must be made between paying the monthly health insurance bill or buying groceries, basic human needs will take precedence. It appears that once again, this vulnerable group may have difficulty securing affordable health insurance. Hopefully, the provisions within the new law will help most of the working poor to purchase affordable coverage.

It has been my experience that many patients who use free healthcare clinics have recently lost their jobs and health insurance. These patients may eventually qualify for Medicaid; until then free healthcare clinics provide a way to receive primary healthcare services. Applying for Medicaid is difficult for those with transportation issues and physical and/or cognitive limitations. I foresee that implementing the new healthcare law may be burdensome and time-consuming to new enrollees. Free and accessible healthcare will still be needed when life situations such as unemployment occur.

Although I have expressed some pessimism toward the new healthcare reform law, it is a step in the right direction. Clearly, other options besides employment-based health insurance must be made available. Those of us caring for patients in free healthcare clinics see the struggles they face every day. Because the need for free healthcare exists and will for the foreseeable future, I encourage all NPs and other providers to locate the free clinics in their area and volunteer their services. These clinics cannot exist without the support of healthcare providers such as NPs. Helping those in need is extremely gratifying. Not only do individual patients benefit from services provided, but also the community as a whole becomes a healthier place to live.

My hope is that in the near future, all Americans will have access to affordable, quality healthcare and the need for free clinics will cease. Until that time, NPs need to assume leadership roles in our evolving healthcare system. NPs have the knowledge and skills to effect change in healthcare policy, and now is the time to formulate a plan with other policy makers to meet the needs of the most vulnerable members of society.

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