Detroit — It’s one thing for more people to have health insurance; it’s another matter to ensure people are receiving proper health care.

On June 25, the U.S. Supreme Court ruled the heath care subsidies established by the federal government as part of the Affordable Care Act to help people sign up on the health insurance marketplace are constitutional, ensuring millions of Americans will retain their insurance.

For Kelly Herron, executive director of the Detroit-based St. Frances Cabrini Clinic, upholding the subsidies means thousands of Detroit residents will not have to wonder how they’ll afford needed care.

“We knew (the subsidies) would mean a lot of changes for people who would now be able to get coverage,” Herron said.

In Michigan, Gov. Rick Snyder and the Republican-led legislature established the Healthy Michigan Plan as Michigan’s own version of state-sponsored health care. The Supreme Court ruling is important for the Cabrini Clinic, located at 1234 Porter St. in Detroit, because upholding the state exchanges will make it easier for the federal government to approve the Healthy Michigan Plan through a so-called “second waiver,” keeping 600,000 Michigan residents on the Healthy Michigan Plan.

“This will make it easier for the second waiver from the federal government to be approved,” Herron said. “We met with the Michigan Catholic Conference, who is advocating the state Legislature to push for the second waiver.”

Even with the second waiver, staff at the Cabrini Clinic still feel further reform is needed to improve the situation for lower-income people.

“A lot of people were signed up for Medicaid through the Healthy Michigan Plan, but discovered the medicine they were using wasn’t the approved medicine,” said Alisa Smith, nursing director at the Cabrini Clinic. “Overall, the reforms are doing their job; people getting health insurance is good.”

The U.S. Conference of Catholic Bishops has long supported expanded access to health care, especially for low-income people, even as it’s tangled with the Obama administration on adverse aspects of the broadly sweeping law.

Since the health care law passed in 2010, foot traffic at the Cabrini Clinic has dropped 20 percent, according to Herron, but it decreased 40 percent at one point before people went back to the clinic because they felt comfortable with Cabrini’s atmosphere.

The clinic works with people who have health insurance for the first time in their lives, explaining how to schedule doctor’s appointments and the need for check-ups.

“People received health insurance, but what they didn’t have was health coverage literacy,” Herron said. “People didn’t know how to use or retain health coverage. Last year, we did health care coverage literacy classes to show people how to use insurance.”

The Cabrini Clinic created three, 10-minute visual presentations on how people can use health insurance, partnering with the Greater Detroit Health Council to develop videos in English and Spanish. They plan to translate the videos into French and Arabic in the near future.

“In the fall, we are presenting the videos to Blue Cross Blue Shield,” Herron said. “It’s all about gaining a relationship and trust, through verbal and nonverbal communication. People remember how they were treated, not what they were told. Here at Cabrini, we go through the roots of the clinic, asking them how they feel. Are they hungry? Do they need a bus pass? We have a ministry, we have a mission: Care first.”

The Cabrini Clinic is the oldest free clinic in America, established in 1950 by Fr. Clement Kern to support the immigrant community in Corktown. The clinic traces its roots to the establishment of Most Holy Trinity Catholic Church, which was transformed into a medical facility in 1834 to fight a cholera outbreak, making it the first hospital in the Northwest Territory.

Today, the clinic uses its years of valuable experience to teach other health care facilities best practices when it comes to working with the poor. The Cabrini Clinic also works with agencies and health providers on the extra steps necessary to care for the poor, including providing snacks and warmer clothes for the winter months.

“Cabrini Clinic is adept with helping the people nobody wants,” Herron said. “The health care law didn’t make it easier for bigger places to understand what these people need. We are still needed to help the ones on the margins. There are 600,000 people who now have coverage who have never had it before. They’re now walking into a physician’s office, and the offices have never had to work with people who don’t know to deal with them.”

Only half those eligible for the Healthy Michigan Plan in Detroit are on the insurance roles, missing out on coverage because they fail to reapply for the program every year or become lost in the paperwork shuffle because of their legal status in the county.

“We serve a lot of undocumented immigrants and new immigrants who haven’t been here for the five years required to get the Healthy Michigan Plan,” said Teresa Hernandez, Cabrini Clinic care coordinator. “The Healthy Michigan Plan is a great program; it’s insuring 100,000 who couldn’t afford it before. But for people who work full-time at $8 an hour, they make too much to get the Healthy Michigan Plan. How does the government expect them to be able to pay premiums for private insurance? That’s why we’ll always be here, to serve the underinsured.”