Obamacare is getting closer.

On Thursday, Missouri Gov. Jay Nixon is expected to announce support for a multibillion dollar expansion of Medicaid, the public health insurance program for the poor. He’ll meet with health care advocates in Kansas City and two other cities to discuss the issue.

Also Thursday, the Kansas City Free Health Clinic will announce a decision to remove “free” from its name — because, for the first time in more than 40 years, the clinic will accept patients on Medicaid.

Both announcements are the direct result of changes coming from the Affordable Care Act, the health care reform package considered the central achievement of President Barack Obama’s administration. The most significant parts of Obamacare will go into effect over the next two years.

People now realize “the Affordable Care Act is here to stay,” said Ryan Barker, director of health policy for the Missouri Foundation for Health. “It is going to move forward. It is going to be implemented.”

Nixon’s announcement will likely have the most long-term significance. If he can convince the Republican legislature to expand Medicaid, it would provide new health coverage for more than 150,000 Missourians each year.

But it won’t be easy — Missouri’s GOP leadership opposes the expansion, saying state government can’t afford to enlarge the program.

The Free Clinic’s announcement also shows the ACA is changing the business model for thousands of health care providers here and across the nation.

Founded in 1971, the facility has never accepted patients with insurance — clients who carried coverage were referred to other facilities. Instead, relying on more than 1,000 volunteers, it has provided free services in exchange for voluntary donations, which this year reached $10 a visit.

As Medicaid expands, however, it’s expected to provide insurance coverage for roughly 90 percent of the clinic’s clientele. As a result, the clinic’s board has decided to file claims for those patients — which means that one of the largest free health clinics in the nation will no longer technically be free.

This January, the clinic becomes the Kansas City CARE Clinic instead.

“The health care environment has changed so much. Everyone is looking at their business model,” said Free Health Clinic CEO Sheri Wood, who conceded providing totally free care is getting more difficult.

Accepting Medicaid patients means the clinic must make a good-faith effort to collect any required payments from clients, she said. The clinic plans a discounted fee scale based on income.

Wood emphasized that the largely volunteer clinic will still accept patients who can’t afford to pay anything. That’s been the non-profit’s mission since its beginning as the Westport Free Clinic, when its clientele largely consisted of young people with long hair, illnesses, and no other place to go (“a healthy hippie is a happy hippie” one early clinic poster said.)

Over the years the clinic evolved into a facility for anyone without health insurance. Some referred to the Free Health Clinic as the “safety net’s safety net.”

But the ACA anticipates a major increase in the number of people eligible for Medicaid. By 2014 virtually everyone will be required to carry insurance or pay a penalty. As a result, clinic officials said, almost all of their patients should be covered — and accepting insurance payments will be critical to keeping the clinic operating.

The clinic serves roughly 15,000 patients a year. Its $12.5 million annual budget includes $8 million in grants, contributions and public support, with the balance coming from donated labor and services.

The clinic’s last tax return showed it lost $214,391 in the 12 months after April 2010.

After getting treatment at the clinic Wednesday, Claudette Comer said the facility serves an important role.

“I wouldn’t be able to afford my blood pressure medication or get my back adjusted,” she said. “Such wonderful people here.”

The changing nature of the Free Health Clinic represents a major change for the facility, but experts said it also suggests something else: The important changes in the ACA are starting to kick in, for patients, taxpayers and health care providers.

Had the Free Health Clinic not accepted Medicaid clients, for example, the newly insured might have overwhelmed other area clinics like Samuel U. Rodgers Health Center or Swope Health Services. Instead, the clinic now becomes something of a competitor.

Other, broader ACA changes are on the way:

•  Federal payments to hospitals and other providers to cover care for the uninsured will start dropping next year to help pay for expanded Medicaid.

•  Hospitals, businesses and providers are figuring out how to comply with record-keeping and other requirements.

•  Kansas City is discussing renewal of its health care levy for indigent care. Need for such a tax might decrease if Medicaid is expanded in the state.

•  Missouri and Kansas lawmakers must decide if they’ll make belated attempts to establish health insurance exchanges, as well as whether they will expand Medicaid, as the ACA anticipates. Last summer the Supreme Court left the decision on expanding Medicaid up to each state.

A coalition of health care providers released a report Wednesday concluding an expanded Medicaid would bring Missouri $8.3 billion in federal payments over the rest of the decade, while costing state taxpayers $333 million.

For that spending, the report concluded, the state could increase its Medicaid coverage by 160,000 patients a year — and add 22,000 jobs over the decade in health care and related industries. The new jobs, supporters said, could provide enough in taxes to cover the state’s small fraction of the expansion, at least in its early years.

Nixon’s office did not reveal the specifics of his announcement this morning, but the health care community widely anticipates support for expanded Medicaid. Nixon will appear this morning at Truman Medical Center, and members of the state’s health care industry are expected to join him.

Republicans in the General Assembly are skeptical. Expanding Medicaid, they said Wednesday, could put the state on the hook for hundreds of millions of dollars in the coming decades.

“I don’t think you automatically just have the knee jerk response that we should just expand Medicaid and get all that free money,” said House Speaker Tim Jones, a Eureka Republican.

With or without expanded Medicaid, the state’s health industry faces big challenges as the ACA locks into place. Even the soon-to-be-not-quite-Free Health Clinic needs to upgrade its record-keeping to match ACA standards, said marketing director Kirk Isenhour.

“Clinics across the country are out trying to raise money to implement some of these changes,” he said. “We’re involved in a capital campaign to raise some of that, but we don’t think it will cover any of the staffing we’re going to need.”