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Arlington Connection: Diagnostic Double-Down - Arlington Free Clinic conducts monthly lottery for health care. Print

BY Michael Lee Pope

Created: Thursday, May 26, 2011

The crowd starts gathering at the Arlington Free Clinic hours before the doors open. Tension builds as dozens of men, women and children crowd the waiting room to full capacity, spilling out into an adjacent hallway. Worried glances focus on a Tupperware container containing letters of the alphabet.

One by one, the letters are announced.

First, it was the letter R. Then it was T. Twenty-two more letters were drawn before the final letter approached. This is when strain was evident on every face, visible in every eye, palpable in the air. This was it — the only chance that many of the people in the room would ever have of getting to see a doctor. Jody Kelly, clinical administrator, told the children how well behaved they were. Then she moved toward finishing this game of chance.

"This next letter will be the last letter," she announced. "The letter B. B as in baby."

The sound of 115 people filled the air. Disappointed people headed for the exits. Some were willing to stop for a moment and share their experience with a reporter. Most wanted to talk about the rules of the lottery and how the operation could be conducted differently, essentially giving a preference to people who came regularly rather than leaving it to chance. Many were willing to accept their fate and wait for health care.

"Well, it’s a lottery and I am not lucky," said Abraham Haile, a recent immigrant from Africa. "So I don’t get it. That is all."

ONE WOMAN who did not want to be named said that she would like to see American citizens given preference over illegal immigrants. That’s a population that could become the dominant consumers of health care here at the Arlington Free Clinic when the Patient Care and Protection Act goes into effect in 2014. That’s when an estimated 400,000 Virginians will be added to the state’s Medicaid rolls.

"It’s so hard the way we do health care in this country," said Nancy Pallensen, executive director of the Arlington Free Clinic. "I think patients get very frustrated. They want us to do what we can’t do. We just can’t take care of everyone."

That’s how the lottery was created about four years ago, when it realized the demand for services was far outstripping the organization’s ability to respond. Most free clinics have waiting lists, and each one has its own way of coping. But the Arlington Free Clinic is the only one in Northern Virginia that conducts a lottery. That waiting list might diminish significantly when the Patient Care and Protection Act goes into effect, though, because many people who regularly attend the lottery will be eligible for Medicaid. That would leave the clinic in the awkward position of providing health care to a group largely made up of illegal immigrants.

"That’s not a problem for us," said Pallensen. "These are our neighbors. They work in our stores and they provide child care. They need health care just like everyone else. That’s our mission."

THE EFFECTS of the health-care reform are still largely unknown. But the challenges are becoming more evident all the time. For starters, the Virginia General Assembly has been consistently reducing the reimbursement rate for Medicaid patients every year. That means fewer and fewer doctors are seeing Medicaid patients, which will be a problem with hundreds of thousands of Virginia patients try to use their new health-care privileges three years from now.

"If people in this room do not get the care they need, where do you think they go?" asked Del. Patrick Hope (D-47). "They end up in the emergency room, costing taxpayers more down the road."