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Free and Low Cost Clinics Help the Region's Uninsured Access High Quality Healthcare
By Nancy Kennedy

When the Patient Protection and Affordable Care Act, commonly known as the ACA or Obamacare, went into effect in 2014, it had an immediate and profound impact on the American healthcare system. People who were previously unable to acquire or afford health insurance now had new options for themselves and their families, and as a result there was a dramatic drop in the number of uninsured Americans. But it is far from perfect, and it may come as a surprise to learn that there are still millions of Americans, mostly non-elderly adults, who have "fallen through the cracks" in the healthcare insurance system, and thus lack access to care. For these people, nothing has changed: they do not have insurance coverage for the basics - preventive care, primary care, emergency care and chronic disease management. If they experience symptoms or problems, they are likely to delay seeking help and so their problems often grow worse or complications develop, ultimately leading to a need for urgent – and more costly - intervention or admission.

There are numerous reasons why millions of people remain uninsured or underinsured – meaning that while they may have health insurance coverage, they cannot afford the high deductibles and co-pays. Regional experts offer insights into this continuing crisis and describe how their organizations are reaching out to vulnerable populations, offering them a strong safety net: free or low cost, high quality healthcare.

Sto-Rox Neighborhood Health Center
At Sto-Rox Neighborhood Health Center in McKees Rocks, executive director Father Regis Ryan oversees a full-service healthcare clinic that is open six days a week and is always busy. The Center's clients, he explains, are primarily the working poor – people who have two or even three low-paying jobs, who struggle to make ends meet, and have no employer provided health benefits. "Being uninsured or underinsured is not a choice – this is a misconception," Father Ryan says. "Our clients make too much money to qualify for medical assistance, but not enough money to be able to afford private health insurance. The ACA has not helped these people."

The Sto-Rox Neighborhood Health Center is a non-profit that serves the Sto-Rox communities with a wide range of services. The Center is federally funded and has an excellent track record. "We've been here for 45 years, and I've been here for 41 of those years," Fr. Ryan says. "We began as a child health clinic. Today, we offer comprehensive services for all ages, from prenatal to geriatric care: primary medical care, pediatrics, OB-GYN, podiatry, optometry and dental care. Our staff is paid, not volunteer. We have excellent quality of care provided by expert physicians and nurses. "Everyone is welcome here. Many of the clients are on medical assistance but there are increasing numbers of physicians and dentists who do not accept it; that is one of the many barriers to accessing care."

Community Health Clinic of Butler County
In Butler, Jim Cunningham of the Community Health Clinic of Butler County says that the ACA has made little difference. Cunningham, the director of development for the Clinic, claims that the ACA created a whole new category of clients for his agency: "The ACA is a success in that it brought health insurance to millions. But health insurance is still too expensive for many; if you don't get it, you're supposed to pay a penalty but for a lot of people, paying the fine is easier than paying for health insurance."

The Community Health Clinic of Butler opened its doors in 2008, organized by a group of caring healthcare professionals who recognized the need for free, high quality health care for Butler County residents. Many large companies have left Butler in recent years, creating high unemployment and poverty. Based on Volunteers in Medicine's highly respected model, the CHC welcomes anyone in need of care between the ages of 19 and 64. Cunningham says that the CHC does not receive any government funding or private insurance payments: "We rely on charitable gifts. Both Butler Hospital and UPMC are supportive of us, but funding is an ongoing challenge." Other challenges include spreading the word about the Center and helping people find transportation. The facility is not in a central location, and there is no direct bus service. All of these issues are barriers to care, Cunningham says.

"If you need healthcare, call us," says Cunningham. "We'll work with you to get what you need. We provide free care - medical and basic dental care, preventive care, diabetes education and nutrition education. Our staff is mostly volunteer; we have physicians, nurses, dentists, pharmacists and a physical therapist. We have a free prescription service. We have a special dental service for veterans, many of whom do not get VA dental benefits."

The atmosphere at the CHC is warm and welcoming, Cunningham says. "Our volunteers are incredible; they genuinely care and they are positive and upbeat. Our clients tell us that is a joy to come here, and they are appreciative."

Squirrel Hill Health Center
In the city of Pittsburgh, there are a number of free and low cost health care clinics, and the number is growing to accommodate the need. The Squirrel Hill Health Center, located near The Waterfront, has a mobile unit and has opened a second site in Brentwood. Andrea Fox, M.D., chief medical officer, explains that the Clinic sees a unique population of patients who are refugees and immigrants. "We treat a lot of people who did not sign up for the ACA, due to the cost, but we primarily see newcomers to America. There are people from all over the world in Pittsburgh, many working in our research labs. Their families are here legally. They don't have the money to purchase health insurance for their spouses and children, and they don't qualify for Medicaid. We especially see pregnant women."

The Squirrel Hill Health Center has federal funding and has a paid staff of physicians, nurse practitioners, physician's assistants and nurses, plus therapists and social workers. There are comprehensive services provided, ranging from primary and preventive healthcare to OB-GYN, dental care and behavioral healthcare. In addition, the SHHC offers interpreters and counselors who assist clients to apply for health insurance – a very challenging task for anyone, but especially for those who are new to the U.S. "We help settle new refugees," Dr. Fox says. "Some are brought to us, and we do outreach. We publicize our services through the libraries and community events. We want to emphasize that everyone is welcome; you do not need insurance to come and see us. We're proud of what we do; we did not set out originally to be a provider for newcomers, but that is what we've become and it's a joyful thing."

Birmingham Free Clinic
Mary Herbert, MPH, clinical manager at Birmingham Free Clinic on Pittsburgh's South Side, is also eager to dispel the myths about the uninsured. "There are numerous barriers to accessing healthcare, despite the ACA," she says. "Many of our clients are people who are in transitional circumstances: they are relocating, starting a new job, or coming out of rehab or incarceration. Often, they find the process of applying for Medicaid, which has been expanded in Pennsylvania to make more people eligible, to be daunting. From a systems standpoint, applying is very hard, and their circumstances make it harder, often for practical reasons – they may not have a permanent address yet; they have to submit a lot of documents and those can be hard to locate and copy. Often the clients don't have computers or access to one, or basic computer skills, or transportation to a place where they can use a public computer. Some of our clients have low literacy skills; others have mental health problems. If you had to apply for Medicaid or ACA insurance, you might be surprised at how hard it can be. The process assumes a lot. You really need to have someone sit with the client and walk them through the process."

The Birmingham Free Clinic is open to the public and provides primary and acute care; chronic disease management; preventive care including vaccinations; physical exams for schools, jobs or drivers licenses, and specialty medical services such as dermatology and cardiology as needed. The clinic is part of the Program for Health Care to Underserved Populations (PHCUP) which was founded in 1994 in partnership with The Salvation Army. The mission is accomplished by a mostly volunteer team of clinicians, health professional students, and AmeriCorps National Service members, and the Clinic serves as a training site for students and residents in the health professions. According to Herbert, the staff and volunteers are passionate about the Clinic's mission and focus completely on the client. "We treat the whole person here. We may get the patient in the door for a minor health concern but soon we find that there are numerous bigger problems with their health or their life – maybe they came in to get a physical for a job and we find high blood pressure, depression or diabetes."

The free and low-cost clinics of the Pittsburgh region serve thousands of homeless, uninsured, and economically disadvantaged Pittsburghers every year, through the efforts of committed professionals and volunteers who believe that health care is a human right. Along with medications, treatments, counseling and education, they provide a hefty dose of compassion and care. Clients who come to these clinics are treated with respect and dignity. According to Father Ryan of Sto-Rox Neighborhood Health Center, "There is no such thing as a typical client. You may believe that you will never find yourself in these circumstances, but anyone can lose a job or become incapacitated. It's important to remember that this can happen to anyone; anyone can fall through the cracks and need our services."

Most of the clinics listed offer adult medical care, women's healthcare, dental care, pediatric care and mental health services. Call the specific clinic to determine if the services you need are available. Some centers provide free care while others use a sliding scale, meaning that costs vary according to the client's ability to pay. Some clinics accept walk-ins while others require an appointment. Call for clinic hours.

Catholic Charities Free Health Care Center (Downtown)
212 9th Street
Pittsburgh PA 15222
412-456-6911
www.forstorox.org

Sto Rox Neighborhood Health Center (McKees Rocks)
710 Thompson Ave
McKees Rocks PA 15136
412 771 6462
www.forstorox.org

Squirrel Hill Health Center (East End)
4516 Browns Hill Road
Pittsburgh PA 15217
412 422 7442
www.squirrelhillhealthcenter.org

Birmingham Free Clinic (South Side)
44 S. 9th Street
Pittsburgh PA 15203
412 692-4706

Lincoln Lemington Family Health Center (East End)
7171 Churchland St.
Pittsburgh PA 15206
412 361 8284
Sliding scale
Adult and pediatric primary care, dental care, doula services, drug and alcohol treatment

East Liberty Family Health Center (East End)
6023 Harvard Square
Pittsburgh PA 15206
412 361 8284
Sliding scale
Adult and pediatric primary care, dental care, doula services, drug and alcohol treatment

Garfield Heights Dental Center (East End)
715 N. Highland Ave. 15206
412-441-8774

Howard Hanna Children's Free Care (O'Hara)
119 Gamma Drive
Pittsburgh PA 15238
412 967 9000

Hill House Health Center
1835 Centre Avenue
Pittsburgh PA 15219
412 261 0937
Sliding scale

Community Health Center of Butler (Butler County)
103 Bonnie Drive
Butler PA 16002
724-841-0980
www.butlerhealthclinic.org



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