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Health clinics expanding, but also cutting services

Clinics that serve low-income patients (like this HealthPoint facility in Auburn) have been sprouting up across the country at a time when the federal funds that subsidize them are drying up.
Photo courtesy of HealthPoint
Clinics that serve low-income patients (like this HealthPoint facility in Auburn) have been sprouting up across the country at a time when the federal funds that subsidize them are drying up.

Health clinics that cater to low-income people have been expanding.

  • The latest ribbon-cutting came earlier this month, in Auburn, where the HealthPoint clinic added a new pharmacy and expanded its primary care. 
  • HealthPoint is breaking ground on another new building, in Bothell, this June.
  • Community Health Care (of Pierce County) is building a new clinic in Tacoma's Hilltop neighborhood.

These clinics are growing because they’re a pillar of the Obama Administration’s plan to help people without insurance find health care. But, they may have hitched their futures too closely to government programs: the money that’s supposed to sustain them is getting cut.
Tom Trompeter, the CEO of HealthPoint clinics in King County, which has 12 locations, says don't focus too much on the buildings.

"Really, what we ought to be talking about is people, and we ought to be talking about people who are in these communities, people who really need the services we are providing that are threatened by the various budget cuts," he says.

HealthPoint is similar to other non-profit clinics that are officially known as Community Health Centers. They operate under a federal law to serve anyone who walks in -- and charge based on people’s ability to pay. 

Most of their clients have some sort of government subsidy, through Medicaid or other programs.  Those subsidies grew dramatically over the past decade – allowing clinics to serve 50% more people. 

Now, the state legislature is poised to trim Medicaid spending, and Congress has begun reining-in future growth (although the big showdown on that is still to come). 

"There will be clinics that will close, there will be services that get cut back, in some place there will be people who get laid off -- which just means less services to the people who are coming to these clinics now," says Trompeter.

Already, a clinic in the isolated Tillicum neighborhood of Lakewood is closing, and those patients are being sent across town, in anticipation of the cuts. Other health centers across Washington are still figuring out how to cope. 

Irony -- or overly optimistic?

In the view of the clinics, this is all a cruel irony, since they just got money to add buildings, through the federal stimulus spending. And, they're supposed to be the model for how health care will be expanded efficiently under last year’s Affordable Care Act. Under that law, the clinics were told to expect a doubling of their patient load in 2014, when the federal government expands subsidies for the so-called "working poor."

But, the clinics have also faced criticism – for growing too fast and building a system that’s dependent on government spending. Republican state Rep. Bill Hinkle of Cle Elum told Jordan Schrader of The News Tribune:

"You go to some of these clinics I’ve visited, and they have doubled or tripled in size, and it’s all built around a system that is on shaky ground financially,” Hinkle said. “As their caseload grew, they grew. Now we’re at the point where we can’t sustain the reimbursement rates for them. We don’t have the money to keep the insurance programs going that government has put together."

Schrader also writes of the lobbying muscle Washington's clinics now employ, since they banded together to form their own insurance arm.

Still, hundreds of thousands remain uninsured in this state, waiting for the federal health law to kick-in. As the clinics cut back, the people they serve will have to either wait longer for appointments, skip preventive care, or turn to emergency rooms.

Keith Seinfeld is a former KNKX/KPLU reporter who covered health, science and the environment over his 17 years with the station. He also served as assistant news director. Prior to KLPU, he was a staff reporter at The Seattle Times and The News Tribune in Tacoma and a freelance writer-producer. His work has been honored by the American Association for the Advancement of Science (AAAS) and the Knight Science Journalism Fellowships at Massachusetts Institute of Technology.