This article was reprinted with permission from Virginia Mercury.
Jobs come and go, but free health clinics have been something Florence Roane-Bell could always count on.
The lifelong Richmond resident has tapped into the Health Brigade — formerly known as the Fan Free Clinic — when she needed it. It was there that she was diagnosed with fibromyalgia (after previous doctors ignored her pain, she said). It’s also where health care workers helped her tackle her prediabetes, high blood pressure and mental health strain.
A bipartisan cohort of lawmakers has been touring the state in recent months to hear from community members like Roane-Bell and health care providers. They’ll compile legislative proposals by the end of the year that the General Assembly could take up in the 2025 session.
Virginia clinics act as ‘safety net to the safety net’
Roane-Bell’s mental health challenges in recent years took her by surprise, she said as her voice cracked in a recent phone call. Therapy has helped her cope with grief and the COVID-19 pandemic.
“I didn’t realize how damaged I was,” she said as she paused to steady her emotions. “Through the pandemic, I lost a lot of people. I also lost myself, and I didn’t even realize it.”
Roane-Bell said she might have taken care of her mental health a little sooner if she’d felt open-minded to it. Now 60 years old, it’s just not how her generation was raised, she said, or a common topic in Black communities.
“Black and brown folks, we don’t want to accept or don’t think we need mental health care,” she explained.
Growing up in public housing in Gilpin Court, Roane-Bell also didn’t feel exposed to resources or more education of the role nutrition plays in health disorders. As an adult, she’s been able to remedy prediabetes through nutrition education. This is another area she said the Health Brigade has been helpful for her.
“We don’t know a lot of things, because nobody even exposed us to them, you know. As far as health care, we don’t know where to go to get free health care — so we wind up having diabetes that was never treated or high blood pressure that was never treated,” Roane-Bell explained.
She’s among many under or uninsured people around Virginia to rely on a free clinic. There are over 70 such clinics around the state, and about 30 of them serve patients in rural areas, Virginia Association of Free and Charitable Clinics CEO Rufus Phillips said at a June rural health care committee meeting in Farmville.
The group’s tour has highlighted the need for increased state funding to bolster free clinics statewide. As more and more people have been visiting free clinics in recent years, clinics haven’t received an increase in state funding since 2016.
Phillips hopes the state can allocate an additional $5 million. This, he said, would pretty much put the clinics back at the 2016 funding levels, considering the state of inflation.
Free clinics typically service uninsured people and people whose income is 200% below federal poverty levels. But others have tapped into the clinics as they’ve found themselves between jobs, facing long appointment wait times through Medicaid, or as people have become ineligible for Medicaid this year.
Usually, Medicaid recipients have their eligibility checked annually — a process that had been on pause amid the pandemic. But this year began an “unwinding” process as the eligibility checks were restored. About 500,000 people were disenrolled in Virginia this year while 1.5 million had their coverage renewed.
There’s also the added factor of inflation and the rising cost of living placing some health care options out of reach.
“We are the safety net to the safety net,” Phillips said of the clinics.
According to Rebecca Butler, VP of communications at the association, operating costs are up 170% from 2016 to 2023. Clinic usage was also up 28% in fiscal year 2023 from 2022.
Pandemic pinch
Meanwhile, Phillips said, another contributing factor to the rise in use of free clinics is what are dubbed “ALICE patients” — or asset-limited, income-constrained, employed people.
“[This demographic] contributed to patient uptick before [the] pandemic,” he said. “The pinch is much greater on what we used to know as the middle class.”
And the pinch has been felt by Virginia’s free clinics too, as they’ve served more patients over time, exacerbated by the pandemic.
As the pandemic subsided and restrictions eased, Phillips said the ALICE demographic and others began to rely on the clinics more as “people had put off care” during lockdowns. He also noted the rise in mental health concerns that had, in some cases, been exacerbated by the pandemic too.
Even in periods when Roane-Bell had insurance, she’s felt the weight of copays and understands how it leads to putting off care.
“It’s like ‘hold up — Do you put gas in the car? Do you buy something to eat? Or do you pay your co-payment?’” she asked. “And guess what happens?”
Of course, health care can’t be put off forever, and people eventually find their way to free clinics if they have nowhere else to turn.
And though the Virginia Association of Free and Charitable Clinics is asking the state for more money, Phillips said his organization is also in support of other policies at the state, local and federal level, such as improving Medicaid reimbursement. This could help other providers accept Medicaid patients in the first place and take some strain off of free clinics.
“It’s been a relatively new phenomenon,” Phillips said of patients who seek out care at free clinics because they have had trouble finding providers who accept their Medicaid. “Clinics don’t want to hold onto those patients if they can find a Medicaid provider.”
