Free Clinics as Safety Net Providers for Hispanic Immigrants

• Author: Saltanat Liebert,Carl F. Ameringer
• DOI: http://doi.org/10.1111/puar.12720
• Published date: 01 March 2017
• Date: 01 March 2017

310 Public Administration Review • March | April 2017

Public Administration Review,

Vol. 77, Iss. 2, pp. 310–311. © 2017 by

The American Society for Public Administration.

DOI: 10.1111/puar.12720.

Free Clinics as Safety Net Providers for Hispanic Immigrants

Saltanat Liebert is associate professor

at the L. Douglas Wilder School of

Government and Public Affairs at Virginia

Commonwealth University in Richmond,

VA. Her research focuses on immigration

policy, comparative governance, and civil

service reform. She is author of

Irregular

Migration from the Former Soviet Union to

the United States

(2009) and coeditor of

Public Administration in Post-Communist

Countries: Former Soviet Union, Central and

Eastern Europe, and Mongolia

(2013).

E-mail: sliebert@vcu.edu

Carl F. Ameringer is former professor

and Blue Cross Blue Shield of Nebraska

Chair of Health Care Administration and

Policy, University of Nebraska at Omaha.

He is also author of

The Health Care

Revolution: From Medical Monopoly to

Market Competition

(2008) .

E-mail: cfameringer@gmail.com

Communication

W e agree that the first half of the following

statement contained in the abstract—“Free

clinics do not receive any public funding

and thus face reduced government regulation”—should

have been more precise. We should have said the

following or something like it: “Free Medical Clinics

are often supported through charitable donations

and typically receive little or no regular government

support. Rather, they raise funds by securing grants

and donations from the community through annual

fundraising drives and outreach to individuals,

businesses, foundations, and other organizations”

(emphasis added). This statement comes directly

from the Legal and Operational Guide for Free Medical

Clinics (American Health Lawyers Association 2015,

16). There is nothing wrong with the second half of

our statement, however. Unlike federally qualified

health clinics (FQHCs), free clinics are not creatures

of statute and do not have a recognized source

of government or public funds. As the Legal and

Operational Guide indicates, free clinics operate as

nonprofit organizations, and as such, are subject to

applicable federal and state laws concerning corporate

formation and reporting, licensure, and taxation.

We stand by our second statement—“Free clinics do

not receive any federal funding; instead, they rely on

community-based or faith-based financial and other

support from private individual donors, foundations,

and corporations.” This statement seems consistent

with the language in the Legal and Operational Guide .

Perhaps we should have included the word “direct”

before “federal funding,” but we are not aware that

free clinics, either those in the study or any others,

receive any funds from the federal government. That

would be inconsistent with the CHC program which

the federal government oversees and supports through

grants and other means, such as Public Health Service

personnel. We further note that neither of the free

clinics that the reader mentions, CrossOver Health

Care Ministry and Fan Free Clinic receive federal

funds. In fact, CrossOver ’ s website contains the

following disclaimer:

“CrossOver receives NO direct federal funding

and accepts no public or private insurance.

We are solely dependent upon the generosity

of philanthropic minded supporters in order

to continue to provide high quality services

and create a healthy community. Every dollar

donated to CrossOver Healthcare Ministry

helps to treat the uninsured in Richmond.”

http://crossoverministry.org .

We appreciate the reader ’ s making us aware of public

funding for the Fan Free Clinic, the smaller of the two.

We see that Fan Free ’ s total revenues for fiscal year

2014 ($7,893,254) included a grant from the City of

Richmond for $535,047 and from the Virginia Health

Department for $494,107. There is no indication in the

audit statement, however, of federal government support.

We were also not aware that there were strings attached

to the receipt of state government dollars as contained in

any MOA. As the reader indicates, however, no audit is

conducted to insure compliance with any agreement to

exclude undocumented immigrants.

We close with the following statement contained on

page 4 of the Legal and Operational Guide :

“Implementation of the Patient Protection and

Affordable Care Act (ACA) will not diminish

the need for Free Medical Clinics. In fact, the

non-partisan Congressional Budget Office

estimates that anywhere from 29-31 million

Americans will remain uninsured following

full implementation of the ACA, largely

because they are unable to afford care; they are

undocumented immigrants; or they are eligible

for Medicaid but reside in a state that chose not

to expand the Medicaid program. Additional

millions will continue struggling to access

health care because of long-standing barriers

that existed long before the ACA became law,

such as lack of transportation options, poor

health literacy, high cost of medications, and

lack of dental and mental health care access.”

Carl F. Ameringer

University of Nebraska at Omaha

Saltanat Liebert

Virginia Commonwealth University