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Obamacare helps, but community clinics work to fill the gaps

Like generations of New Orleans residents, 53-year-old Ruben Williams had known only one kind of health care before Katrina ravaged the city in 2005.
Avanna Parent of New Orleans, LA, holds her two year-old son Leo as Dr. Kim Davis (L) takes a blood pressure test on her five year-old daughter Paige (R) at the New Orleans Communities Are Responding Everyday (C.A.R.E.) Clinic, at the Ernest N. Morial...
Avanna Parent of New Orleans, LA, holds her two year-old son Leo as Dr. Kim Davis (L) takes a blood pressure test on her five year-old daughter Paige (R) at...

Like generations of New Orleans residents, 53-year-old Ruben Williams had known only one kind of health care before Katrina ravaged the city in 2005. You got it from Charity Hospital, a decrepit hulk in the middle of town, and it wasn’t set up to keep you healthy. You showed up when you needed care right away, and you never got turned away. “My mama was born there,” he said fondly.

The hurricane ended that era in a day, ruining what was left of Charity and thrashing the city’s already-frayed medical safety net. The trauma is still fresh, and the city’s health care system is still a work in progress. But for Ruben Williams and countless other folks of modest means, the new system may yet prove more humane, more effective and more sustainable than the one Katrina washed away.

When Williams and his family returned to their Algiers neighborhood after several weeks in an evacuation center, the buildings and streets were in shambles, but a free clinic had sprung up at a neighborhood mosque on Teche Street, under a banner proclaiming COMMON GROUND. Eight years later, the Common Ground clinic is a thriving local institution, and Williams has something he’d never experienced before: an affordable source of routine primary health care.

Common Ground is one of dozens of community-based health centers that have blossomed in Katrina’s aftermath. On Wednesday, they’ll gather at New Orleans’ Ernest N. Morial Convention Center and open their collective doors to anyone who needs to see a doctor. The National Association of Free and Charitable Clinics (NAFC) is hosting the all-day clinic to expose the continuing gaps in America’s health care system, and to highlight the critical role that street-level clinics can play in filling it. msnbc is co-sponsoring the event, and PoliticsNation will broadcast live from New Orleans to cover it.

Some 46 million Americans lacked health insurance in 2012, according to new figures from the Centers for Disease Control and Prevention, and 34 million of them had been uninsured for more than a year. Children’s coverage has improved dramatically with the expansion of the national Children’s Health Insurance Program (CHIP), but health coverage has become an unaffordable luxury for millions of adults who are neither old enough for Medicare nor poor enough to qualify for Medicaid.

Twenty-nine states will soon expand their Medicaid programs through the Affordable Care Act, placing primary care within reach for millions of uninsured Americans. But Republican lawmakers have blocked Medicaid expansion in many of the country’s poorest, sickest states—including Louisiana. And even the states that strengthen their safety nets will leave many vulnerable people uninsured. “At least 30 million people will still lack coverage when health care reform is fully enacted,” said NAFC Director Nicole Lamoureux. “States that don’t expand Medicaid will be our biggest challenge. But every state will still need free and charitable clinics next year.”

The clinic: A neighborhood treasure

Most of the 1,200 clinics in Lamoureux’s network are small facilities that survive on private donations and volunteer labor. They take no payment from patients, and they offer no continuing care. Their role is to catch people who fall through the safety net, address their acute needs, and link them to providers who can help them sustain their health.

That’s a formidable task in a place like New Orleans, where 23% of working-age adults are uninsured (compared to 18% nationally) and where injuries, infections and chronic illness are rampant. Wednesday's convention-center event will likely draw 1,000 to 1,800 patients, many suffering from conditions that have gone untreated for years. The city’s free clinics draw hundreds just like them every day of the year. They’re not the lazy "takers" Mitt Romney demonized during his presidential campaign. By Lamoureaux’s count, more than 80% of them are low-wage workers who simply can’t afford the care they need.

They’re the people Diane Amos sees at the Dream Center, the church-affiliated clinic she runs out of a FEMA trailer near Calliope Street. Her center has 75 clinical volunteers with specialties ranging from medicine and dentistry to nutrition and chiropractic care, and its most popular service is tooth extraction—a critical but pricey procedure that even Medicaid patients have trouble finding. Last year alone, Amos’s volunteer dentists pulled 874 diseased teeth from 480 patients, saving them $240,000 in dental bills. “We’ve had patients come 90 miles from Franklinton to get a tooth pulled,” she says.

Mental health care is equally sought-after, and even harder for uninsured patients to find. “A lot of mental health providers moved to Memphis or Dallas or Birmingham after the storm,” said Dr. Robert Lancaster, a retired psychiatrist who stayed behind and now volunteers at the Luke’s House clinic in Central City. Dr. Bob, as he’s known to his colleagues, gets four or five walk-ins every Tuesday night. He's the city’s only no-fee psychiatrist.

No one denies the need for clinics like the Dream Center and Luke’s House, but their impact will always be modest. When Amos took her FEMA trailer to the nearby Hispanic community of Kenwood to run a daylong clinic last spring, 47 people got a one-time chance to see a nurse or a doctor, but 350 had to be turned away. As Lamoureaux said, “the job of providing basic care shouldn’t fall to charitable clinics. We can only help so many people, and we’re not set up to manage their health.”

That’s why the Common Ground Clinic has embarked on a new path. For months after Katrina, it ran on pure idealism. Responding to a distress call from a charismatic activist named Malik Rahim, volunteer relief workers showed up from around the world bringing food, water, clothing and medicine. “We had 100 volunteers living in a three-bedroom house with one bathroom,” said Sharon Johnson, a co-founder of the clinic. “Everybody harassed us—the police, the military, the vigilantes, even the Red Cross—but we stood together and the community came back to life.”

By 2008, Common Ground had moved out of the mosque to establish a permanent clinic in a shuttered Haitian grocery store. And as life returned to normal in the neighborhood, its directors saw an opportunity to move beyond emergency relief into something more sustainable. In 2009, they started the slow transition from “free clinic” to “federally qualified health center”—a neighborhood facility that can provide primary care at low cost and get reimbursed for it.

Common Ground now employs two doctors and two nurse practitioners. They see 55 to 60 patients a day, nearly half of them covered by Medicaid or GNOCHC, a local program funded through a federal grant. The 40% who have no coverage pay nominal fees for continuing primary care.

When I met Ruben Williams there last week, he had just had his monthly check-in and renewed his prescription for a generic blood-pressure medicine. He recalled how sick he felt after Katrina, when he rushed back to his job replacing light bulbs in traffic signals. By performing a simple blood-pressure test, a Common Ground street medic had diagnosed him with life-threatening hypertension and put him on treatment.

Pre-Katrina, Williams would have had gone untreated until he suffered a stroke, and the doctors at Charity would have done their best to save him. Today, he’s managing his condition for pennies a month, and feeling good. “There’s nothing but sliced bread that’s better than a neighborhood place dedicated to healthy bodies and healthy minds,” he said. “People are relaxed. No one’s embarrassed. You chip in what you can, and it strengthens the whole community.”