By Jade Ortego

Killeen Daily Herald

President Barack Obama's much-debated health care reform bill has some providers up in arms about what they consider a serious omission.

Multiple versions of his plan are currently moving slowly through the House and Senate, and none include federal funding for any of the more than 1,200 free clinics in the United States.

Free clinics provide medical services to the uninsured, undocumented and economically disadvantaged.

About 4 million Americans are expected to visit a free clinic this year, a 40 to 50 percent increase, just as funding streams to the nonprofits are down 20 percent, according to a press release sent out by Nicole Lamoureux, executive director of the National Association of Free Clinics.

Millions of dollars are being written into the plan to go to community health centers, which are already federally funded, said John Mills, a health care consultant with Texas-based nonprofit Empowering Church Health Care Outreach.

About 65 percent of patients of community health centers are Medicaid or Medicare recipients, or have private insurance.

By contrast, free clinics depend on volunteer work, city and county grants and private donations. Their patients, according to Mills, are totally uninsured.

"Free clinics serve people that have absolutely no point of access other than, for example, a hospital emergency room," he said.

Killeen clinic

The Greater Killeen Free Clinic has the equivalent of four paid full-time staff, but all their physicians are volunteers, said executive director Marlene DiLillo.

The clinic shares a waiting room with a health department office, and people waiting for services often form a long line out the door in the afternoon, she said.

The clinic has 20 volunteer physicians and 20 other volunteer medical staff, such as nurses, and 10 non-medical volunteers. It has one office.

The clinic needs additional funds to build its own facility, DiLillo said. The clinic can't provide care for patients with chronic illnesses because there is no space to provide educational sessions.

"For example, with diabetes, you need to have nutrition sessions. You need to do education when you're dealing with chronic illnesses. We have no space to do that," she said.

The clinic staff also needs funds to start using electronic medical records, which will eventually be required of all medical facilities, she said.

DiLillo said that the reason free clinics may have been omitted is because they aren't federally funded already, and therefore, their legitimacy is suspect.

"I think part of it is that sometimes if it doesn't get federal funding … or if it's not under federal regulation, then maybe there's a discounting of the value of the services we offer," she said.

Free clinics are not included because of the unstated premise that they will no longer be necessary if the plan is successful, Mills said.

"I think that's just bologna. ... Assuming that a great insurance plan became available and all 47 million uninsured suddenly had insurance, they're still not talking about undocumented (people) ... (and) mental health coverage is just sort of lightly mentioned," Mills said. "There's lots of places where there are going to be cracks where free clinics will potentially be there to pick up the pieces."

Putting pressure on

The NAFC and people like DiLillo want to pressure Congress to have free clinics funded in the final version of the bill. Mills is not optimistic.

"It would take a concerted effort by Congress and by free clinics to notify representatives that we are not included in this," he said. "Part of that is our own fault. Free health clinics have very little staff, so we're not good lobbyists."

Obama's plan was written to insure more Americans, partly through government subsidies. His plan also would provide a government-run option to compete with private insurers and require large employers to contribute to health coverage.

Thursday during a speech in Shaker Heights, Ohio, the president acknowledged that the Senate might not have the bill ready by his initial August deadline.

"We just heard today that well, we may not be able to get the bill out of the Senate by the end of August, or the beginning of August," Obama said. "That's OK. I just want people to keep on working. Just keep working."

The Associated Press contributed reporting.

Contact Jade Ortego at or (254) 501-7553.

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