Allyson O'Connor

For those keeping a close watch on the nation’s health care landscape, the successes and short-comings of the Affordable Care Act (ACA), or “Obamacare,” seem to fall in stride with the tumultuous state of health care overall. Regardless of the many benefits of the ACA, health care costs are continually on the rise, and it will be a long time before the nation feels the ACA’s cost-control measures. For some people, health care just became affordable thanks to the ACA, but for others, health coverage remains as elusive as ever.

The ACA set out to address the 45 million people in the U.S. who are uninsured and fall into the health insurance coverage gap. Scale this daunting number down to an individual level and we can see the damage and frustration that those without access to affordable care endure on a daily basis. We see it every day at the Moab Free Health Clinic.

The Moab Free Health Clinic (MFHC) is one of over a thousand free and charitable health clinics across the nation acting as a safety net for low-income uninsured and underinsured people. In Moab, earnings are inconsistent and employer-sponsored health care is scarce. The MFHC offers great relief to those in need.

Now that the ACA is in full motion we are often asked whether the MFHC plans to keep its doors open. Our answer, as it is with free clinics across the nation, is a definitive yes. In fact, our services are growing. Despite the ACA’s best intentions, the nonpartisan Congressional Budget Office predicts that 26 million people will continue to be uninsured in 2020.

If the ACA is meant to offer solutions to the health care crisis, then why are so many people still uninsured? Unfortunately, weaknesses in the system hinder people from finding an affordable health care plan. A number of people decide not to purchase health insurance either because of the still-daunting price of monthly payments, or because they are in favor of the seemingly more attractive annual tax penalty. We cannot forget, however, why the ACA passed as law in the first place: everyone needs health care at some point and should be prepared to pay for it.

With the close of the Health Insurance Marketplace’s initial open enrollment session, President Obama reported that 8 million people signed up for coverage nationwide. The most recent Utah enrollment number reported by the Salt Lake Tribune in early May said, “The number of Utahns who found health coverage on Obamacare’s insurance marketplace more than doubled in the last month of its initial sign-up period — bringing enrollment to 84,601.”

While those in favor of the law can rejoice that the ACA is surpassing expected national enrollment numbers, it gets murky when examining the current state of health reform in Utah. In 2012, the Utah Department of Health determined almost 400,000 people were estimated to be uninsured in Utah. Despite the better-than-expected marketplace enrollment numbers, for the remaining hundreds of thousands of uninsured Utahns, free clinics continue on as an affordable health care safety net.

One enduring solution to the health care affordability puzzle is Medicaid. This state-run and federally-sponsored program provides care to low-income people throughout the country. Medicaid is a sizable insurer with 300,000 Utahns currently enrolled. Expanding Medicaid was built into the ACA as a further safety net. Unpopular because of its status as an entitlement program, the future of Medicaid’s scope is still in question in Utah.

For the 110,000 Utahns who would qualify for care under the Medicaid expansion through Governor Herbert’s Healthy Utah Plan, the final decision cannot come soon enough. The Moab Free Health Clinic estimates 76 percent of our clinic’s patient population would qualify for expanded Medicaid. Considering the impact this could have on reducing the number of uninsured in Moab, the MFHC supports Medicaid expansion and is fully invested in getting people insured through the ACA.

How the complex nature of health reform plays out on the Utah stage is yet to be determined. Medicaid expansion as part of the ACA looks inevitable but uncertain. The good news is that in January, Governor Herbert proclaimed that “doing nothing is off the table,” but the view from Moab proves Governor Herbert and his constituents needs more encouragement to move on this life-affecting decision.

Regardless of health reform, as long as people continue to get sick, there will be people who fall into the coverage gap. Free clinics fill the health care gap when other options are scarce and help people avoid the astronomical costs of going to the emergency room for primary care. For the foreseeable future, the MFHC will continue to fight the cycle of poverty by recruiting medical volunteers and rallying community support to care for the most vulnerable among us.