In a surprisingly announcement on Tuesday, December 12, Seattle's 30-year-old, beloved Aradia Women's Health Center said it will be closing its doors this January. The closure takes a lot of people by surprise but "it's been on the table internally for a lot of years," according to board member Amie Newman. Aradia, which provides walk-in HIV testing, health care counseling, and abortion services in downtown Seattle, has had razor thin profit margins for many years, and in 2005 it came up $84,000 short. No CEOs have been getting million-dollar severance packages or anything duplicitous like that (Aradia's executives actually get paid very little; peruse their tax forms yourself). The shortfall is mainly because their insurance provider tripled their malpractice insurance in the last three years and also because more low-income women are using clinic services.

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While Aradia has a cadre of committed donors, it has, since its creation by a group of frustrated women in the 1970s, relied primarily on clinic services for funding. Grants and individual donors foot only 10 percent of its operating costs, while 90 percent comes from women who pay for abortions, gynecological work, or checkups. The money from the clinic not only pays doctors and staff, but funds Aradia's education and advocacy programs. But since the early ’90s, the number of patients on Medicaid has jumped from 55 percent of their clientele to 70 percent in 2004. Yes, nationwide abortion rates are declining—but only among women above the poverty line. Low-income women are still getting abortions at the same rate, but Aradia makes no profit off them. When 70 percent of their customers aren't able to pay, it's easy to see why they'd be in financial trouble.

So if the clinic isn't supporting the organization anymore, why not shift funding focus and try to make up the difference with grants and donations? What it boils down to is this: Aradia's board of directors believes that their health care model (while wonderful! And great for patients!) is not a good business model. There's no way, providing the kind of care they do for the kind of people they serve, that they can ever do more than just tread water financially.

"People have been asking me, 'How much money do you need? How can we save Aradia?'" says Newman, "But even if we received a check for a million dollars, it may keep Aradia open a few more years, but ultimately this model is not sustainable."

They decided they had three options: close, merge with a major health care provider, or remain independent and either axe the advocacy program or the clinic, and slip into bankruptcy more gradually. They decided to close in a large part because they feel women in Seattle won't be underserved if they disappear—a huge Planned Parenthood is just 10 blocks away from Aradia, for example.

But the causes of the closure point to the atrociously failing American health care system, which puts providers in the Catch-22 of either having to serve only those people who can pay or take a hit by giving free service to those who can't. Fourteen percent of Washington State residents are uninsured (that's 824,990 people) and 12 percent are on Medicaid. Nationwide, the number of people on Medicaid, as well the number of uninsured, has grown steadily over the last twenty years (plateauing, sort of, during the late 90s). Nowadays, 13% of people nationwide are on Medicaid and 15.9% are uninsured. So Washington is pretty typical in terms of its health care woes; we're ranked 23rd and 24th in numbers of people uninsured and on Medicaid, respectively.

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The point is, what Aradia is experiencing is part of a major, ominous, nationwide trend. Even though Aradia had community support, an excellent and committed staff, and was in high demand, it proved impossible to provide high quality health care for low-income people without sinking into the red.

Take a second to think about this: What other facilities provide health care to a large slice of the uninsured and low-income population? Nursing homes—and they're seeing a crunch, too, as the baby-boom demographic bump creeps into old age. While Aradia decided to close its doors, nursing homes are dealing with precipitous profits in a more alarming way: providing worse care, according to a report from the Northwest Federation of Community Organizations. Aren't you glad Aradia dropped out instead of flunking out?

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