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People Who Are Still Uninsured May Turn To Community Clinics

If you're uninsured, you may have run out of time. Monday was the official deadline to sign up for health insurance on the marketplaces or face a penalty, unless you were already in line for enrollment.

Still, people who missed the cutoff have options to get the health care services they need, though they may not be simple or assured.

About 16 percent of Americans still lack health insurance, according to a Gallup survey conducted in February. As of mid-March, 50 percent of the uninsured said they didn't plan to buy insurance, according to the Kaiser Family Foundation's poll. The survey also found that six in 10 of the uninsured didn't know the deadline to buy a plan was approaching.

At Alexandria Neighborhood Health Services, a community health center with 11 sites in Northern Virginia, seven enrollment counselors have been working to get people signed up for coverage, with mixed results.

"Some people looked at the premiums and said, 'I can't afford this,' " says Martha Wooten, executive director. "That's a choice each individual has to make. The least expensive of those plans come with very high deductibles or copays."

People who did not buy individual coverage can look to the network of 9,300 federally funded community health centers that last year served 22 million people. The centers are slated to receive more than $9 billion in funding under the health law through 2015 to help them to expand to meet the needs of the newly insured.

The centers, which typically provide primary care and family planning services, as well as dental and behavioral health care, can be used by anyone, insured or not. They provide a very economical option for low-income people who are uninsured.

People with incomes up to 200 percent of the federal poverty level ($23,340 for an individual in 2014) pay for services based on a sliding scale. Above that level, patients pay the full cost for doctor visits, lab work, imaging and pharmacy costs.

But getting those services may require a long wait, depending on the center and the type of care someone needs.

"If you're just calling to establish care and have minor problems, it can be a several-week wait," says Wooten. Someone who's been recently discharged from a hospital and has more serious needs would likely be seen much more quickly, she says.

Community health centers don't provide specialists or hospital care, however. "Clinicians have to beg and cajole their colleagues" outside the centers to see uninsured patients, says Dan Hawkins, policy director at the National Association of Community Health Centers.

Organizations like the Patient Advocate Foundation will continue to work with uninsured patients with chronic and life-threatening illnesses to get the care they need. But their services have limits.

"We can't help people with accidents or injuries," says Erin Moaratty, an official at the foundation.

The health law requires most health plans to provide a range of preventive health services, including contraceptives, at no charge to patients. But those services are free only to people who have insurance.

Planned Parenthood and other women's health clinics will continue to provide reduced-cost reproductive health services for uninsured people, among others, and some lower-income women will qualify for Medicaid family planning services, says Adam Sonfield, senior public policy associate at the Guttmacher Institute, a reproductive health research and policy organization.

"It fills a gap, but it's not nearly as good as having insurance," says Sonfield.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

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