Health care success cuts revenue to Uptown clinic, forcing it to close

A clinic in Minneapolis that provides medical care to thousands of uninsured and underinsured people is closing its doors next week, in large part because more people are obtaining health insurance through the Affordable Care Act and seeking care elsewhere.

When the Neighborhood Involvement Program shuts down Aug. 29, the 3,000 patients that visit its Uptown clinic will be without a medical provider. But its dental and mental health clinics, as well as its senior and youth programs, will continue operating in Uptown.

But managers of the NIP Community Medical Clinic say many people still need the low-cost care and customer service they provide. Medical bills at the clinic on Hennepin Avenue are as easy to understand as a restaurant check, with a price list like a menu: $10 for a strep test, for example, and $80 for a basic doctor visit. If a patient's monthly income is less than $1,900 dollars, those fees drop considerably.

Known for many of its 42 years as the Uptown Clinic, the facility provided a lifeline for Julie Wethington of Minneapolis — exactly when she needed it. Wethington lost her health insurance when she was laid off from her job a few years ago, about the same time she began having knee problems. She's grateful for the clinic's low prices and flexibility with billing.

"I'd just try to pay it all as I go," she said. "Once in a while I wasn't able to, but then I caught up to it about a week or two later."

Wethington turned 65 this summer and now has Medicare. Nevertheless, she's sad to see the clinic close because she knows there are many people who still need its services. But there aren't as many patients as there were.

Because of the Affordable Care Act, a large number of the clinic's clients now have health insurance through MNSure, the state's online insurance marketplace. That gives them more provider choices than before the law went into effect this year. Others qualified for Medicaid — when the state expanded eligibility to 35,000 low-income adults.

The drop in paying patients has resulted in a 30-percent cut in revenue since January, clinic CEO Patsy Bartley said.

Even with a mostly volunteer staff of doctors and nurses, that's unsustainable.

"That's a huge drop for us to be able to provide our infrastructure to do this work," Bartley said.

Foundation grants have also shrunk because some funders mistakenly believe the federal healthcare law has rendered charitable medical centers obsolete, Bartley said. The clinic took another financial hit from a mandated switchover to electronic medical records.

Some newly-insured patients still visit because they can't afford the deductibles and co-pays that come with their insurance plans, clinic co-director Janet Tolzmann said.

"That was their trade-off for an affordable monthly payment," said Tolzmann, who also is a nurse. "But what happens when you do need to see a provider? All of the sudden they're having monthly payments plus having to figure out how to do the out-of-pocket expenses."

Tolzmann also said the clinic serves some patients who remain without health insurance.

A MNSure spokesman said the agency has helped cut the number of uninsured Minnesotans by more than 40 percent. But that's still not everyone.

Demand for low-cost health care services like those the clinic and others provide will remain, said Nicole Lamoureux, executive director of the National Association of Free and Charitable Clinics. Even after the full implementation of the Affordable Care Act, she said, there will be 243,000 people in Minnesota left without access to health insurance.

"That's great number of people," Lamoureux said. "And that's where you will see that the free and charitable clinics as well as other members of the safety net will continue to provide care."

The uninsured in Minnesota include newly arrived as well as undocumented immigrants and people who find it's cheaper to pay a tax penalty rather than an insurance premium, said Rachel Garfield, a researcher at the Kaiser Family Foundation in Washington, D.C.

Charitable clinics are in a tough spot, Garfield said, as revenue is down because more people have insurance and may choose other providers. But the clinics need to keep their doors open for the uninsured and underinsured.

"What these clinics are facing now is a challenge in trying to maintain revenue sources that they're getting from different subsidies and different private sources, while they're still trying to serve these individuals," Garfield said.