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Staying Afloat: The Free Clinic Looks to Adjust to New Economic Realities 

The Cleveland Free Clinic has been providing primary health care to Cleveland's most needy for nearly a half century, as well as initiating a host of other programs, including the syringe exchange, that can be found nowhere else in the city. With the arrival of the Affordable Care Act, the Free Clinic's business changed. This week, we chat with executive director Danny Williams about some of the misconceptions of those changes, as well as medical marijuana and more.

So give people the Cliff Notes version of what you're dealing with.

When the Affordable Care Act looked like it was going to pass, I went to our board and told them that a sea change was coming and that we needed to consider how to reposition ourselves to ride the wave instead of getting engulfed by the wave.

Which side of the wave did you end up on?

There was an article in the Wall Street Journal last Saturday with the headline, "Health law hits free clinics." The key two pieces from that were, one, a lot of our patients from when we were a free clinic have become eligible for Medicaid, but the ramp up has been slower than we thought in that happening. Our patients, those that would qualify, have complicated lives. And two, philanthropic support assumes that it's a snap of a finger, that once the law passed, free clinics have all this new revenue pouring in from Medicaid and insurance, so why do you need their philanthropic support?

It's been a double whammy. We're a relatively new community health center, and they're pulling back when you're still trying to educate patients about what their rights are. And then trying to navigate Medicaid and Medicare, which I'll just say is not an intuitive process, there are just a lot of moving parts when trying to continue our mission of providing high quality healthcare to an underserved health community and trying to figure out the bureaucracy and trying to keep our philanthropic partners from walking away. Also, we're still trying to do progressive stuff, like the syringe exchange, and we'll be holding a forum in the spring on medical marijuana. I think it's coming whether Ohio is ready or not.

How has the reaction from the philanthropic world in Cleveland been so far?

I don't want to characterize it as dropping off a cliff, but we've historically gotten support from 60-plus foundations. Some of the usual suspects, but also some family foundations that you might not have heard of. We've had several meetings with them over the last few months to let them know. Seventy percent or so of the patients that we still see are uninsured. They're usually one and done: They haven't quite gotten signed up yet, we might never see them again, it was just a one-time issue for them. We have to explain that to the foundations that we still need resources.

Do you hope that that changes?

Two years from now, it should be a different story. When you make a business model change, you're operating on reserves and relying on that until new revenues come in. We had no reserves. We were operating at a minor deficit, like we always have. Then you have these partners sitting on the sidelines and you're saying, 'Whoa, whoa, whoa. This is the wrong time to have a look-see.' And for our individual donors, there's no way of knowing really. They're not a monolithic group. The foundations all talk to each other. They come to meetings.

So it hasn't dropped off a cliff but it's bad.

In the Wall Street Journal article, the president of the National Association of Free Clinics, which I used to be a board member of, said her estimation is that free clinics have seen a 20-percent drop in philanthropic support. Those are kind of some of the issues that we're still trying to grapple with as this evolves into a community health center, or the other name you'll see is a federally qualified health center.

How long has the Free Clinic been around?

We're about to celebrate our 45th anniversary next year.

Scene turns 45 next year too.

We're a product of the times. I remember the days, I was in high school and the Free Clinic was just getting started, and one of the first ads on the radio I remember hearing was the Free Clinic saying, 'Listen, there's a lot of tainted marijuana out there. Bring it down and we'll have it tested for you.' I was like, 'They can't say that on the radio, can they?' So, yeah, I think we're both a product of the times, a grassroots progressive thing.

You mentioned the forum on medical marijuana. What are your thoughts on the issue?

My main approach here is, well ... Let me give you some context. This is not the first time I've looked at the issue. I used to be the executive director of the American Cancer Society. Back then, if you said alternative cancer care, all the doctors would just hear 'shark cartilege' or other scam-type things. The reality was the National Cancer Institute was starting to fund studies on complementary care and finding that people were spending as much or more on it than traditional primary care doctors. I went to our board and said, 'Listen, people are doing this. Where do you stand? We need to help people make intelligent choices on alternatives with traditional care. They could make themselves worse off.' My approach now is similar. I don't care where you stand on the issue. How are you going to approach having a drug free workplace? What's the legal limit for driving? How do you prevent kids from having access? I'm not looking forward to a rainy day any more than the next guy, but that doesn't mean I don't own an umbrella.

The reality is 23 states have some form of medical marijuana and there are bills pending in Ohio. It doesn't look like with the Ohio House they're going anywhere now, but there are voter initiatives out there that are coming and catching steam. In 2010, a poll said 73 percent of Ohioans favored some kind of medical marijuana. That number was 80 percent in 2013. It has a good chance of passing and we're woefully unprepared for that. It's a Schedule 1 drug right now, so it's hard to get research dollars for that. All the research is going into its damaging effects, but if you want to look at potential benefits, that's when it's hard to get research dollars.

What do you want people to know about the clinic?

Our core business is still primary care. We also do dental, we have a behavioral health program, and we have a pretty robust HIV/AIDS program. We were one of the first places to open our doors to those patients. Four years ago the forums we had were on workplace wellness. We were so far ahead in that. Now it seems common.

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