LEWISTON, Maine - The number of Mainers who purchased insurance in the Affordable Care Act's online marketplace has already sky-rocketed beyond last year's record statistics.
With a little less than a month to go before the enrollment period closes, more than 61,000 have signed up. The goal behind the marketplace is to increase access to care, but some Mainers are still struggling to get the services they need.
Patty Wight visited a recently re-opened free health clinic in Lewiston to find out who is still stuck in the outskirts of the system.
The clinic is in the basement of a church, just a few blocks from downtown Lewiston. This is the home of the Trinity Jubilee Center, a non-religious organization that provides a variety of services.
On a Thursday morning in January, the place is packed. Some sip coffee at tables. Others collect groceries from the food pantry. More than a dozen also sign up for the free health clinic, which is tucked in a cramped back office.
Among them is Jeffrey. He'd rather not share his last name, but doesn't mind explaining why he is here. "I have an abscess in my tooth," he says. "I've been on penicillin for 12 days. And I'm in extraordinary amounts of pain, and any dentist you talk to wants a huge co-pay and I'm reaching dead ends everywhere I've gone."
Jeffrey has Social Security Disability Insurance, but says he has virtually no dental coverage. He came to this free clinic to see if the doctor who runs it - Alice Haines - could help. But after his appointment, he still doesn't see any viable options.
"I mean she really went to bat for me in there, calling different dental clinics and pretty much reaching a dead end wherever she tried," he says.
People come to this free clinic for basic care they can't get elsewhere, either because they're uninsured, or - even if they are - because it costs too much or takes too long to get an appointment.
A lot of people come to check their blood pressure, says Tara Patel. She's a pre-med biology major at Bates College who volunteers at the clinic. "Sometimes people can't afford their meds," she says. "Sometimes they just want to monitor to see how their hypertension is doing."
Dr. Alice Haines says this clinic gives her a chance to help patients, not only in the short term but also the long term, by encouraging them to form relationships with primary care providers.
"A simple example would be I just saw a gentleman who got in a fight yesterday. And a little worried he lost vision in eye, or impaired his hand. Has insurance, but wasn't going to go to ER for this, but we happened to be here so he came in to be reassured," Haines says. "That was a chance to get him involved with his primary care provider and to encourage him to go sooner than he would have gone to engage with that person and perhaps get help for his anger issues."
This free clinic is open for just two-and-a-half hours one morning a week, and operates thanks to the time donated by Dr. Haines and a couple of Bates student volunteers.
"It is the virtual finger in the dyke that provides some relief," says Dr. Wendy Wolf of the Maine Health Access Foundation. Wolf says free clinics provide much needed care for health problems that aren't acute enough for the emergency room. But she says the demand for services reveals shortcomings in the current health system, and in the overall health reform effort.
"Well, I think public health and rural health, frankly, have gotten short shrift in the Affordable Care Act," Wolf says.
Wolf says the Affordable Care Act doesn't devote much in the way of money or resources to promote and integrate public health with healthcare. There are some glimmers of change, she says, including payment reforms that shift from fee-for-service toward global budgets that are used to keep a population healthy. Until then, providers at free clinics, like the one at Trinity Jubilee Center, will connect care as best they can.
"So what it looks like on the third page here, they have this sliding fee application," says Bates pre-med student and clinic volunteer Alex Weissman, as he gives the man with an abscess - Jeffrey - an application to a dental clinic that may pull his tooth at a price he can afford.
Weissman likes helping these patients, but he recognizes the clinic is just a stopgap. "This is a very limited facility," he says, "and if people do have problems that need to be seen on a constant basis, and not just the occasional visit from Dr. Haines, this isn't going to solve them."
What patients need, he says, is an affordable provider that they can turn to consistently, and not just when they develop a health problem that needs immediate attention.
