David N. Sundwall and John C. Nelson: Now is not the time to close Utah’s safety net clinics

(Rick Egan | The Salt Lake Tribune) Dr. David Sundwall checks out a patient at the Health Clinics of Utah clinic on 1950 West, on Thursday, July 30, 2020.

In a special session of the Legislature this past May, more than a $1 billion were cut from the state’s budget that had been approved just a few months previously, in order to cope with anticipated shortfalls due to the COVID crisis. This prompt action demonstrated leadership and how seriously our state considers balancing our budget.

However, it is now obvious that the cuts made seem to have been arbitrary, “across the board,” with little attempt to prioritize based on needs or impact. One example of what now to seems to have been a mistake is eliminating funding for the Health Clinics of Utah, our state sponsored “safety net” clinics, which provide primary and preventive care to thousands of Utahns who otherwise would likely go without such care.

The patients served in these clinics (located in Salt Lake City, Ogden and Provo) are mostly low income, most are on Medicaid and other forms of public assistance, and many have no insurance and are self-pay. Just as we couldn’t have anticipated the pending pressures on our state’s budget during the 2020 legislative session in January to March, we could not anticipate the extraordinary pressure on our health care system — providers and patients — that this pandemic has caused.

Now is not the time to close our state’s safety net clinics. There are other clinics that serve the medically disadvantaged, including our state’s 13 federally supported Community Health Centers, (which provide services at some 50 sites), others funded by Intermountain Healthcare, and the Maliheh Free Clinic, but together they do not have the capacity to begin to meet the needs.

For example the Health Clinics of Utah located in Salt Lake City has more than 13,000 patients on their roles, and over 10,000 patients were served in 2019. Closing these clinics will leave a huge gap in our ability to serve those most in need of primary care.

This particular budget cut serves as a great example of “penny wise/pound foolish,” in that if these patients can’t be seen in a relatively low-cost clinic, they will go to much more costly urgent care and emergency rooms, at a significantly greater cost to the state. And even more costly will be the many patients with chronic illnesses who will just not get the care they need at all and end up sick enough to require hospitalization, or possibly die from preventable causes of death.

Furthermore, the Health Clinics of Utah do not just see poor patients. They provide service to a number of state employees, convenient to their work, which is cost-effective and contributes to their productivity.

In short, supporting basic primary and preventive health care services for the most vulnerable of our fellow citizens is essential — especially now. More folks than ever qualify for such care, due to Medicaid expansion in our state last year, but even with such insurance coverage, where are they going to get it? Most are simply not able to get care in private clinics.

And with the fear and uncertainty of the COVID pandemic, it is essential that patients with chronic illness continue to be treated to prevent their conditions from getting worse. This unfortunate situation could be corrected with the governor’s office and Legislature working together to provide just enough support to keep these clinics operating through the end of this year, and then working together in the next legislative session to determine an appropriate level of funding to sustain their operations.

Utah has a tradition of compassion and caring for those most in need. Closing public clinics during a time of crisis does not fit with our values nor previous policies. During the urgency to cut the budget a few months ago, such consequences were not apparent — but now we know of the potential for serious and costly problems that will occur due to reducing access to health care. Let’s fix this now!

Dr. David Sundwall

David N. Sundwall, M.D., Salt Lake City, is chief medical officer of Rocky Mountain Care and professor of public health emeritus at the University of Utah.

Dr. John C. Nelson

John C. Nelson, M.D., Salt Lake City, is former president of the American Medical Association.

Both physicians practice part time at the Health Clinic of Utah branch in Salt Lake City.