CLEARWATER — When Janice Turner gets her blood pressure checked at the free clinic here or Joshua Canny sees a doctor for a swollen throat, they could be doing more than finding an affordable solution to their health care woes.
They could be helping Florida deal with its budget woes.
With a dwindling pool of state money available to cover the uninsured, lawmakers are increasingly turning to one of the lowest-cost options of all: charity clinics.
At more than 100 clinics across the state, low-income Floridians can receive health care for much less than it would cost to buy insurance, often for free or a small donation.
"We understand that there is a need in our community and we need to provide access, and these clinics provide service that, unfortunately, is not being provided by others in our state," said Sen. Rene Garcia, R-Hialeah.
With budget negotiations between the House and Senate about to begin, the role of the clinics has been thrust into the spotlight.
Garcia, chairman of the Senate budget subcommittee that oversees health spending, put a $9.5 million grant program for the Florida Association of Free and Charitable Clinics into his spending plan. That money is missing in the House's plan, and Gov. Rick Scott last year vetoed money for the clinics.
"We really need people to understand our role and our impact in their communities," said Nick Duran, executive director of the clinics association.
Matt Hudson, R-Naples, House health budget chairman, did not respond to requests for comment last week.
Those who work in the clinics say their role is significant.
Jeannie Shapiro, executive director of the Clearwater Free Clinic, calculates that every year the clinic does $5 million worth of health care on a $1 million budget.
Every one of her patients and the patients at free clinics across the state live at or below 200 percent of the federal poverty level.
Almost 3 million Floridians are eligible for the clinics' care, and many of them fall into the "coverage gap" of about 850,000 people who make too much money to be eligible for Medicaid but not enough to afford their own health insurance.
"Because medicine and insurance has been so expensive for so long, a lot of low-income people have made the choice not to carry it because they can't afford it," Shapiro said.
For those people, clinics across the state fill much the same role as a primary-care physician. The centers also work with patients to get free or low-cost prescription medications.
Save for a few paid employees, most of the work done at charity clinics is by volunteers, and much of their shoestring budgets are funded by local hospitals.
In Florida City, Good News Care Center has a close relationship with Baptist Health South Florida. The hospital pays for most of the clinic's operations, said Michael Daily, the clinic's CEO.
"It's not purely benevolence," he said. "We have a very effective and formal process for ER diversion."
Uninsured people who go to Baptist but don't have insurance are referred to Good News Care Center.
The Clearwater Free Clinic has a similar relationship with BayCare hospitals in northern Pinellas County, which offer them free services to help patients avoid the emergency room.
That's where the clinics become a central part of the debate over how to pay for health care for the uninsured. Emergency room visits are expensive, and it's much cheaper to manage chronic illnesses like diabetes or congestive heart failure at a doctor's office or clinic.
Daily tells the story of a man who went to the hospital because he was losing his vision.
"He goes to the emergency room not knowing what's wrong and they discover his blood sugar is out of control and probably has been for a long time," Daily said. "To keep that person from going back into the hospital … now this gentleman is a patient at our clinic."
Volunteer medical professionals like the clinics too, Shapiro said.
"Doctors enjoy working here because it's medicine in its purest form. They don't worry insurance doesn't cover it, and the patients are grateful."
Although the governor vetoed money for the clinics in last year's budget, the Legislature in 2014 gave them $4.5 million. The Clearwater Free Clinic received $100,000 of that, which it used to study the feasibility of a new building and to hire someone to collect better data on its impact in the community.
"They were things we wouldn't have been able to do," Shapiro said.
The clinics are asking for $4.5 million again this year, less than half the $9.5 million lawmakers were prepared to give them last year before Scott's veto.
Getting more state funding, Duran said, could help the clinics buy new equipment or hire additional staffers to expand their services.
The Clearwater Free Clinic needs to pay staffers to manage grant programs to bring in additional money and to help patients get free or nearly free medications from drug companies.
Good News Care Center wants to hire people to manage day-to-day care as volunteer doctors come in and out for occasional shifts. "We need continuity of care," Daily said.
The clinics' work is gaining traction.
Among those who have voiced support in recent weeks is Dr. John Armstrong, Gov. Rick Scott's appointed surgeon general. He said that it's important for the state to support the free and charitable clinics.
And state senators say funding the clinics is critical to ensuring everyone in Florida has access to basic care, especially given personnel cutbacks at county health clinics funded by the state Department of Health.
"If you close clinics and reduce staff at clinics, you don't expand Medicaid, you veto free health clinics," said Sen. Oscar Braynon, D-Miami Gardens. "The question is: What do you want people to do at this point?"
Times photographer Douglas R. Clifford contributed to this report. Contact Michael Auslen at firstname.lastname@example.org. Follow @MichaelAuslen.