The General Assembly has passed a bill - unanimously - that would distribute funding to replicate the free health clinic model pioneered by Altoona doctor Zane Gates.
The Senate passed the Community-Based Heath Care Subsidy Act in March, and the House - which previously balked because of concerns the measure would undermine Medicaid expansion - passed it Monday.
After a second Senate vote because of a minor House amendment, the measure will go to the governor, who should sign it, having included $5 million in his proposed budget to be allocated on the bill's blueprint.
"It's spectacular news," said state Sen. John Eichelberger, a longtime supporter of Gates, who has lobbied for years for lawmakers to replicate his clinic model. "It's a very rare happening to see [something like that] pass unanimously in both chambers," said Eichelberger, R-Blair.
The bill calls for $4 million to help establish community clinics and $1 million for student loan repayment incentives for doctors to practice in those clinics.
Half the $4 million would go toward setting up hospital-based clinics on the Gates model, which targets the working poor - those who earn too much for Medicaid but not enough to afford insurance.
Twenty-five percent of the $4 million will go for "federally qualified" clinics that provide a medical home for Medicaid recipients, especially in rural areas, and 25 percent would go to "pure free clinics" in facilities like churches, with volunteer practitioners.
The Gates model comprises a paid staff and volunteer doctors, a partner hospital to provide free imaging and tests and a requirement for patients who can afford it to buy inexpensive hospital-only insurance.
The unanimous House vote came after Gates met with Democratic leaders and explained that concerns he'd expressed previously about Medicaid centered on lack of access to doctors who will accept it.
Only 42 percent of doctors do, he said.
He doesn't want his clinic model to replace Medicaid, but to supplement it where access is poor, mainly outside the inner city, he said.
"I think it can be part of Medicaid expansion," provided there's a provision to allow newly qualified clients to access clinics if they don't have access through Medicaid, he said.
For now, the state doesn't plan to expand Medicaid, despite incentives from the federal government.
Expansion now would be a problem because it would generate 650,000 new clients with "shiny cards" and - for many - no place to redeem them, according to Gates.
Among advantages of his clinic model is the virtual elimination of insurance administration, according to Gates.
Nowadays, nurses in doctors offices spend 50 percent of their time dealing with insurance issues, according to one study, he said.
"People need face time," he said. "That's how we get people healthier."
Elimination of insurance administration also standardizes care, freeing medical workers from having to tailor testing, prescriptions and orders based on a patient's insurance card, he said.
For example, Medicaid only allows six prescriptions a month, so a doctor's office needs to figure out which brand-name drugs are on the "formulary" and which may be generic and available for a reasonable price at the local supermarket, he said.
Expansion or not, clinics can be a medical "home" for those who need it, with prevention advice on diet, weight reduction and pharmacy provided by nurses, who are the "cornerstone" of care, according to Gates.
Gates expects there will be an annual allocation from the state to build up the stock of clinics.
Eichelberger hopes the Gates model can become a national one.
"People will realize how good this program is," he said. "I think it's a natural thing for the federal government."