Nurse practitioner Martha Brinsko helps a lot of patients manage their diabetes at the听听in North Carolina.
鈥淢ost mornings when you check your sugar, what would you say kind of the average is?鈥� Brinsko asked patient Diana Coble.
Coble hesitated before explaining she ran out of the supplies she needs to check her blood sugar levels, and she didn鈥檛 have the gas money to get back to the clinic sooner. Brinsko helped Coble stock up again.
The staff at the Charlotte Community Health Clinic: Nancy Hudson (left), Maria Elena Solanilla, RN; Tonya Luna, CMA; Lisa Ortiz-Fraticelli, RN; Charm May Agustin, CMA; Martha Brinsko, FNP; Tamara Withers-Thompson, RN.
(Photo by Michael Tomsic/WFAE)
鈥淚f you need to get more than one box, get more than one box,鈥� Brinsko said. 鈥淏ut you need to check them every morning so that we can adjust things.鈥�
Coble, who is unemployed, lives with her sister and can鈥檛 afford insurance even now that the health law is in place, relies on the clinic for health care.
鈥淭hey do a great job with everything,鈥� Coble said. 鈥淚 couldn鈥檛 do without them.鈥�
Nancy Hudson was the clinic鈥檚 director as Obamacare rolled out and now consults for the clinic. She expected the insurance exchange, or marketplace, established under the Affordable Care Act would reduce the number of uninsured patients the clinic sees. The opposite happened, she says.
鈥淲hat we found within our patient population and within the community is that a lot of the advertisement and information about the marketplace brought people [in who] didn鈥檛 know anything about free clinics and did not qualify for any of the programs within the ACA marketplace,鈥� Hudson says.
And now they get free or low-cost care at the clinic, which is designated by the government at an FQHC, or federally qualified health center.
The health law was designed to cover the poorest people by expanding Medicaid, the federal-state program for low-income people. But the Supreme Court made that optional. The result in states that didn鈥檛 expand Medicaid is a听, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies. In , about 319,000 people, like Coble, fall into the Medicaid gap.
鈥淥ver half of the people that we see would鈥檝e been eligible for Medicaid expansion had the state elected to exercise that option,鈥� says Ben Money is president of the association that represents North Carolina鈥檚 community health centers.
North Carolina is among听, including many in the South, that are听currently saying no to Medicaid expansion. Louisiana is another.
Dr. Gary Wiltz, the CEO of in the southwestern part of Louisiana, says demand has surged. 鈥淲e鈥檝e gone from 10,000 patients to 20,000 in the last six or seven years, so we鈥檝e doubled,鈥� he says.
Wiltz says other things are at play, too. The economic recovery hasn鈥檛 reached many of the poorest people, and some who do qualify for Obamacare subsidies say their options are still too expensive.
鈥淭he need keeps increasing, and I think that鈥檚 reflected throughout all the states,鈥� he says.
Wiltz, who also heads the board of directors for the听, says clinics are packed even in states that expanded Medicaid. After all, most of the clinics treat Medicaid patients too.
The Charlotte clinic鈥檚 Nancy Hudson says there鈥檚 another part of the health law helping fuel the growth:听听for community health centers.
Hudson found out last week her clinic is getting about $700,000 to expand in partnership with Goodwill.
鈥淢any of their clients did not have any access to health care,鈥� she says. 鈥淭hey can鈥檛 train and sustain a job if they don鈥檛 have the basic needs taken care of, and health care is one of them.鈥�
Nationwide, the federal government estimates听听will lead to about 650,000 people getting better access to health care.
This story is part of a reporting partnership with NPR, and听.