Since we are in a political season, I’ll begin with one of the candidate’s positions on a facet of healthcare: Hillary wants to double funding for Community Health Centers (CHCs) over the next decade.
Is that a good or bad thing? If you’re inclined to think that’s good, please read on; I’ll reinforce your views. If your impulses are in the opposite direction….well, I hope you’ll still read on; I’ll hope to convince you.
By the way, I could find no mention by Trump of CHCs—no surprise there.
The role CHCs play in healthcare has gone largely unheralded for years, eclipsed by sexier health policy topics and debates. But that role has expanded in recent years and become more important than you might think. And not incidentally, CHCs have had broad bipartisan support for many years.
The National Institute for Health Care Management is out with a policy brief on CHCs, authored by Peter Shin. Shin is an associate professor of health policy and management at George Washington University in Washington, D.C. The brief, just a couple pages, presents results from a nationwide survey of CHCs Shin and his colleagues recently conducted.
Shin’s main argument is that CHC’s are not only a critical component of the nation’s healthcare safety net but also have become one main path by which millions of low-income people are gaining insurance coverage under the Affordable Care Act.
The CHC program was launched in the mid-1960s to provide care for the medically underserved and low-income populations, in both urban and rural communities. Today, some 1,400 CHCs serve 24.3 million people nationwide. In 2014, 92 percent of CHC patients had incomes below 200 percent of the federal poverty level and 28 percent were uninsured. CHCs provide a comprehensive set of services, including dental, vision, prescription drugs, and mental health counseling.
Studies consistently show that CHCs improve the health status of communities and patients, and have been linked to reduced emergency room use and hospitalizations, enhanced preventive and chronic care management, and more use of less expensive providers.
Shin found that in 2013-14 about 80 percent of CHCs provided Medicaid application assistance and 90 percent helped people enroll in the ACA health exchanges. And, he says, recent federal data indicate that CHCs have provided such assistance to some 17 million people since ACA enrollments began in 2013.
That means it’s feasible that a sizable number of people who have enrolled in Medicaid or an exchange under the ACA since 2014 did so with help at a CHC.
The Medicaid connection is especially strong since millions of Medicaid beneficiaries already get their primary care at CHCs. Indeed, Shin found that in the first year of Medicaid expansion (in the states that did so) the share of all CHC patients with Medicaid coverage increased from 44 to 53 percent. Not surprisingly, no increase occurred in the 19 states that didn’t expand Medicaid.
So what’s the problem?
It’s this: CHCs don’t have stable or adequate funding, and some must scramble for money to meet the growing demand for their services.
By design, CHCs are not federally funded clinics. They rely on a mix of revenue, including reimbursement from Medicare, Medicaid, and private insurers. But federal grants do account for an important 22 percent of their revenue.
The ACA funded CHCs to the tune of $11 billion from 2011 to 2015, which paid for an increase in the capacity of existing CHCs and dozens of new ones. In 2015, Congress extended funding, but only through 2017.
Shin says that the growth in the number of patients will require CHCs to recruit additional staff and expand their capacity significantly in the years ahead. That’ll especially be the case if some or all of the 19 states that have not yet expanded Medicaid decide to do so in the next few years.
Shin says the CHCs in states that have expanded Medicaid are already feeling the pinch, largely because those were the states with less generous Medicaid coverage for childless adults to begin with.
In addition, the ACA requires private health plans sold in the exchanges to offer a contract to at least one CHC in every county where a CHC exists. As exchange enrollment increases over time, CHC capacity will have to grow.
Despite bipartisan support for CHCs and the additional funding they got in 2015, funding beyond 2017 is no slam dunk, however. And there’s no way to know now how the politics of that will go. A Hillary Clinton White House is certain to support more funding for CHCs but if Congress remains in Republican hands, there’ll likely be a fight. If Trump becomes president—as with almost every area of policy—all bets are off.
Bottom line: 29 million Americans remain uninsured. CHCs are an essential component of the health care safety net that meets their medical needs, as well as the needs of millions of low-income insured people. And CHCs are increasingly helping people gain coverage.
In 2017, Congress must not fail to adequately fund CHCs, and it should provide stable funding for at least five years.
Read the brief. Here’s the link again.
Steven Findlay is an independent journalist and editor who covers medicine and healthcare policy and technology.