In my role as Director of Community Health and Service Learning at the University of Chicago’s Pritzker School of Medicine, I helped facilitate a discussion for first year medical students about the ethics of student run free clinics. This got me thinking about their future.
Student run free clinics are society’s stop-gap measure for the uninsured, a place for those without the means to see a doctor to connect with a physician via the intermediary of a student.
Providing acceptable-quality care to the patients who receive their care through student run free clinics will include providing information on how to sign up for health insurance through the exchanges. Ethical care will be connecting patients to the medical homes they need.
What will happen to student run free clinics when there are no more uninsured? The impoverished uninsured may be those most likely to use the clinics now, and those most likely to be covered by Medicaid’s expansion in the states where Medicaid is expanding in the future. Is it fair for people who could be connected to a medical home, to instead be seen in a student clinic with a rotating cast of provider-learners? Ethical practices would need to have volunteers signing up eligible patients for health insurance through Medicaid or the exchanges.
The people who would still be seen in free clinics would be impoverished undocumented immigrants, who aren’t covered by Medicaid expansion and would be unable to afford the premiums themselves. And the healthy working uninsured, who make too much money to qualify for Medicaid, and consider themselves too healthy to make the cost of health insurance worthwhile. Would student-run free clinics turn into sites where the Immigration and Naturalization Service could go to identify the undocumented immigrants, one stop shopping to find the undocumented uninsured?
There are many unknowns with unpredictable consequences as health care reform unfolds. That’s what makes it exciting, and what makes it scary. How will our immigration system intersect with our health care system? How will our patients be funneled to access the best care possible for them?
Time will tell—and soon!