ARLINGTON, Va. — Every month, a hundred or so people crowd the lobby of the Arlington Free Clinic, clutching blue tickets to enter a health care lottery. Uninsured and ailing, they hope to be among the two dozen who hit the jackpot and are given free care.
Some might think the lottery’s days are numbered, given that the insurance expansion under President Obama’s health care law will take effect in January. But clinic officials say the lottery will remain, because demand for services is likely to be as high as ever. ‘‘We will be business as usual,’’ said Nancy Sanger Palleson, the clinic’s executive director.
The Affordable Care Act, the most sweeping health care program created in a half century, is expected to extend coverage to 25 million Americans during the next decade, according to the most recent government estimates. But that will leave a projected 31 million people without insurance by 2023.
Those left out include undocumented workers and poor people living in the 21 states, including Virginia, that have declined to expand Medicaid under the statute.
‘‘The law will cut the number of the uninsured in half,’’ said Matthew Buettgens of the Urban Institute. ‘‘This is an important development, but it certainly isn’t the definition of universal.’’
While hospitals and other providers prepare for an influx of Americans who will be newly insured as of Jan. 1, many of the nation’s 1,000 free clinics, which help the uninsured and are financed mostly by private donors, are increasing efforts to aid those bypassed by the law.
The trend shows both the limits of the law and the way it is affecting nearly every part of the health care system, sometimes in little-noticed ways.
Some of free clinics plan to increase help to undocumented workers, who will not be permitted to buy insurance from new online marketplaces and are expected to become a larger share of the uninsured. Other clinics, seeking to fill what they see as a major gap in the law, may offer free dental care.
Andre Sokol, 59, an unemployed carpenter, is an example of someone who will not be helped by the law and will continue to need the Arlington clinic, which provides care to about 1,600 people.
He lost his health benefits when he left his job in the construction industry to care for his girlfriend, who was diagnosed with ALS, or Lou Gehrig’s disease, and his mother, who was battling dementia. Two years ago, the women died within two months of each other. Sokol had no job, no income, and no place to live.
In January, Sokol had quadruple bypass surgery at Virginia Hospital Center, which absorbed the costs. He did not qualify for Medicaid because Virginia does not permit single men, no matter how poor, to be covered by Medicaid unless they are disabled. The state has one of the strictest eligibility standards in the nation. That would change if the state expanded its program under the health law.
In addition, Sokol’s income is too low to allow him to get federal subsidies to help pay for a private policy on the exchange. (The law assumed that people with incomes below 100 percent of the poverty level, or about $11,500, would be covered by Medicaid, but many states balked at enlarging programs after the Supreme Court said expansions were optional.)
Arlington Free Clinic officials said about half of their patients are in the same situation: They are below the poverty line but are not eligible either for Medicaid or subsidies to buy insurance.
After Sokol had surgery, the Arlington clinic agreed to take him as a patient as part of an agreement with Virginia Hospital Center. The arrangement is one way people can become patients at the clinic; others come in via the lottery or referrals from shelters.
‘‘Most of our members would love to go out of business and close their doors if there was a program that ended uninsurance,’’ said Nicole Lamoureux Busby, executive director of the National Association of Free and Charitable Clinics. ‘‘But this isn’t universal health care. We’re not planning to see a dramatic decrease in our patients.’’