English 
Español From Craig O’Conner, Member of the CEHC Board:
What might health reform mean to Clinica Esperanza and to our patients?
Health reform will have several positive effects on increasing number of people with health care coverage.
2 – For people below certain incomes (possibly as high as 400% Federal poverty level – $88K for family of four) there will be subsidies to help them pay for it, if bought through the “exchange”
3 – Medicaid will be expanded to 133% or 150% FPL allowing many more low-income (even childless) adults to become covered by Medicaid.
4- CHIP (Children�s Health Insurance Program) will be around for at least a few more years, maybe even secured until 2019 – this mean RIte Care should be relatively safe
5 – Some of the insurance regulation will help people get and keep insurance since it prohibits denial based on pre-existing condition.
6 – There should be money for expansion of community health centers.
7 – Some form of mandate on employers will exist, though the final form is far from certain.
8 -Children will be able to stay on parents insurance until age 27 or 28.
These are all moving parts, so the final bill could be somewhat different than this.
Possible negative things: the Rhode Island state budget is bad, so once federal stimulus money goes away, there could be cuts to RIte Care; some people may still not be able to afford coverage with subsidies; undocumented won’t be eligible to receive subsidies (and may not even be able to buy insurance through exchange with own money).
Will the types of people in need of free health care be the same or change under health reform?
For now, we believe the people seeking care at our clinic will remain the same – since most of the programs in health reform won’t really kick in until at least 2013 or 2014, and it will be years beyond that until we hit the 95% insured mark (if we ever do). The same people will fall through the cracks in the system, and even if they may eventualy be eligible, it will take a while.
Will there still be a need for free clinics in the future?
We can see ourselves as providing this service as health reform kicks in over the next 3-5 years, and, inevitably, to those who fall between the cracks. In addition to undocumented immigrants, the people who will fall through the cracks are likely to be exactly the same people we see now - people who still can’t afford coverage despite subsidies, which even at their most generous won�t be enough for some families.
One of the populations that may suffer under reform are CHIP families – if CHIP is not reauthorized beyond 2014, then we will see a large number of families thrown into the world of private insurance, and these are the families that may have trouble buying coverage.
While the reform being worked on now will help, it will do little to control costs, which means once we hit the peak of 95% covered (if we hit it…) then it is likely things will turn downwards again, unless something else is done. So, sadly, we will continue to need free clinics for the foreseeable future.
You just have to look north on 95 to see our future. The free clinics in Massachusetts are still needed, despite health reform there, which is similar in many ways to the national model likely to pass.
Craig O’Connor