Reform could strain community health centers

Key Attributes of a Federally Qualified Health Center

• Located in or targeted to a community that is medically underserved;
• Must be a nonprofit, public or tax-exempt organization;
• Governed by a board that is comprised of a majority of health center patients who represent the population served;
• Provides comprehensive primary health care;
• Provides services to all with fees based on the ability to pay;
• Meets federal performance and accountability requirements.

Source: U.S. Health Resources and Services Administration.

These centers, which have seen their caseloads increase significantly with the growing number of uninsured Americans and the economic tumult of the recent recession, appear to be in line for a major rise in federal support and likely a corresponding crush in patients seeking treatment if a health care overhaul is passed.

The health reform bill approved by the Senate Health, Education, Labor and Pensions Committee and a similar measure put together in the House by Democrats would sharply boost funding for the centers.  In addition, the legislative proposals would expand coverage through Medicaid, the state-federal plan for the poor, and would provide subsidies for millions of Americans to buy coverage on new insurance exchanges.

Sara Rosenbaum, chairwoman of the department of health policy at George Washington University in Washington, says it is crucial to increase funding for the centers because they fill “an urgent need that is going to continue well into health reform.”

The reason: Experience suggests that if more people get insurance coverage, more will seek care. When Massachusetts in 2007 became the first state to require that residents be insured, patients—many of whom did not have established relationships with private practitioners—inundated health centers. Soon the centers were struggling to keep up with demand, with some patients ending up on waiting lists.

'A Health Care Home' For The Underserved

"After you give everyone an insurance card, where are these people going to go?" says Dan Hawkins, policy director for the National Association of Community Health Centers. Often a community clinic is the only option, he says, given the national shortage of primary-care doctors.
Congress appears to be responding to that argument. The Senate health committee bill authorizes funding for health centers to rise from about $2.2 billion this year to $8.3 billion in 2015. The House has a similar, albeit somewhat slower, rise.

In material submitted to the Senate Finance Committee, Hawkins estimated that expanding the efforts of the community health care system would provide “a health care home for 60 million people in underserved communities within the next six years.”

Supporters of the programs applaud the legislative proposals authorizing more funds but point out that actually getting that money could still prove difficult since no additional funds have been appropriated.

“I’m just afraid that they’re not going to have the necessary funding long term,” said Joel Miller, senior vice president of operations for the National Coalition on Health Care, a nonpartisan alliance of health care organizations working toward health care reform. Centers, he added, could end up “at the mercy of funding problems that we’ve seen in the past."

The House bill seeks to address that issue by establishing a funding source for community health centers — a new Public Health Investment Fund. The Senate bill, although it does provide discretionary funding through 2015, does not provide a permanent source of money for the centers.

Not Just For The Uninsured

The federal community health center program, which began more than 40 years ago as part of Lyndon Johnson’s war on poverty, provides comprehensive, primary care services to more than 18 million people — generally from low-income communities, migrant and seasonal farmworkers and the homeless. Services are provided on a sliding scale that depends on the patient’s ability to pay. Figures from 2007 show that 39 percent of all health center patients were uninsured, 35 percent were covered by Medicaid and 16 percent had private insurance, although many had only limited coverage, according to the National Association of Community Health Centers. The rest of the patients were covered by Medicare or other public plans.

Officials at Walker-Jones said their health center is likely to serve 10,000 people this year, double last year’s number.

Maisha Challenger, 33, of the District of Columbia, is one of those patients. She said she never expected to seek care in a health center. “I have been working my whole life so I usually am used to going to a doctor’s office,” she said. But early this year, she lost her job as an education lobbyist, and the health insurance that came with it.

Another patient, Melissa Pullins, 58, who receives regular care and medication for her diabetes at Walker-Jones, said the center makes a difference for people facing such changes in job and insurance status.

“Nobody knows when that day will come that you will be handed a pink slip,” said Pullins, who lives on a fixed income and is not eligible for Medicare or Medicaid. “And if you don’t have employer-paid health care, clinics like Walker-Jones become critical.”

The Obama administration also has signaled its support for the work done at community health centers with First Lady Michelle Obama’s recent visits to two programs—one in Bowling Green, Va., and one in Washington.

Congress and the White House moved earlier this year to meet some of the more urgent needs of the community health centers. The stimulus package signed into law in February included $2 billion, which will be doled out over two years, to help provide care for an additional three million patients by 2011. Some of the funding will go to building as many as 126 new clinics. Other money will be used to maintain or increase the number of doctors, nurses and other staff who work at the centers, according to the Department of Health and Human Services.

Recruiting more physicians and medical staff is a key goal for the centers, which traditionally have trouble meeting staffing needs, many say.

Often, because of the lower pay, doctors don’t perceive clinic work as part of their career path and instead choose private practice, typically in a specialized field, said Kurt Mosley, vice president of business operations for Staff Care and Merritt, Hawkins & Associates, companies that recruit physicians to fill temporary and permanent positions at hospitals and community health centers.

The health bills in Congress also address some of that need, adding millions of dollars to the National Health Service Corps to attract doctors to work in clinics and help them pay off their student loan debt.

The effort to recruit staff is an important addition to the health care proposals, officials said.

“It’s challenging,” said Vincent Keane, chief executive officer of Unity Health Centers, a nonprofit umbrella organization that supports Walker-Jones and 30 other Washington area facilities. “We’re trying to do more in retention.”

Links:

Planned new community health centers in the U.S. 

A list of health center awards by state  

Find a health center near you

By Andrew Villegas, The Kaiser Family Foundation