As Annette Fetchko walks the corridors of Catholic Charities’ health clinic in downtown Pittsburgh the head administrator greets everyone she sees. There are doctors, nurses, pharmacists - and there are patients – all hues, shapes and sizes and from all over southwestern Pennsylvania. They’re here for medical care.
Catholic Charities is a free health care center. The people who go there are for the most part, the uninsured working poor. Fetchko explains they make too much to be on Medicaid – the state federal insurance plan for the poor and disabled - but not enough to buy their own insurance.
"A certain percentage of their dollars go to rent, food, clothing, taking care of family...so when it comes to having money at the end of the month to pay for a health care premium its just not there," she said.
One study estimates there are about 75,000 people in the region who fall into this category.
Some of them might soon get insurance depending on how Pennsylvania implements the Affordable Care Act.
But no matter what, there will still be people who fall through the cracks.
Until earlier this year Schoenberger worked as an office manager at a CD and DVD duplication company. With her full-time job came health insurance, which covered the care she needs for her multiple sclerosis. Then she got laid off and lost her medical benefits. She says that was scary.
She tried getting health insurance through public assistance. But she wasn’t eligible and she could not afford insurance from the open market.
Now she’s in limbo waiting to get Medicaid, but she still needs to get her routine medical needs taken care of.
"This is helping me out in the meantime, it really is. I mean I don’t know what I would do without it."
A history of being a safety net
Catholic Charities’ free clinic opened in 2007. They were busy from the start - then came the economic downtown.
Last year, the state program Adult Basic, which provided coverage to those earning less than 200 percent of the federal poverty level, was cancelled, leaving tens of thousands of adults without coverage. And in the last few years, cost-cutting efforts by the Department of Public Welfare have left Medicaid recipients with reduced dental and prescription benefits.
Annette Fetchko said they’ve had an uptick in requests for care from that population but they only provide care to people who don’t qualify for any other free program. In the meantime, the clinic is revisiting that eligibility parameter.
The mostly volunteer-staffed clinic sees about 750 patients a month.
Administrators there say even if Governor Tom Corbett expands Medicaid under the Affordable Care Act, they will still serve people like Deborah Schoenberger – people in beauracratic limbo waiting for health plans to kick in, or people for whom Medicaid’s benefits don’t cover all of their needs. The clinic also helps undocumented immigrants.
Edward Kelly, the center’s Medical Director, sees Pennsylvania’s future current-day Massachusetts. The state requires everyone to be insured but some residents still are not covered.
"People don’t sign up or our demographics might change," he said.
Kelly says one big problem is that people confuse insurance for access – just because someone has insurance doesn’t mean they can actually see a doctor.
There aren’t enough primary care providers.
Fetchko hopes the state will go with the Medicaid expansion. If that happens, the federal government will pay the costs for the first few years and then the state would be expected to start chipping in.
Cost Savings or Increases?
A study released last month from The Urban Institute and The Kaiser Family Foundation says the expansion would cost Pennsylvania 2 billion dollars, compared to other states; which would save money.
Anne Bacharach, the special projects director for the Pennsylvania Health Law Project said that increase would be seen thanks to of all the cuts made to Medicaid in the last few years. In addition to expanding the plan, the state would have to include other health provisions in the “essential health benefits” - requirements on what must be covered on a health insurance plan.
"The thing we expect is that some of the cuts we’ve seen in Medicaid for adults might go away – the limits on prescriptions and the lack of dental services may be addressed in the essential health benefits," she said.
Advocates hope there is parody between the essential health benefits on the health exchange and within the Medicaid program.
Back at Catholic Charities, Annette Fetchko walks through a full waiting room and to an eligibility office where people fill out forms for medical assistance.
Fetchko says people are often surprised to hear that they are not poor enough to qualify for Medicaid despite making so little money.
There is no deadline for states expanding Medicaid. But if Pennsylvania decides to opt in, it would have to allocate resources in its next budget, which starts July 1st.
Meanwhile at clinics like Catholic Charities, they are not sure how the care they deliver will change in the next few years - but they are sure it will.
This story is collaboration between WESA, NPR and Kaiser Health News.