Community health centers vital to any health overhaul

Kaiser Health NewsAugust 11, 2009 

WASHINGTON — While the health care debate rages on Capitol Hill, the Walker-Jones Health Center in northeast Washington is just a mile away, one of about 1,200 federally qualified community health centers across the country that provide free and reduced-cost care to millions of Americans.

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

The health bill that the Senate Health, Education, Labor and Pensions Committee has approved and a similar measure that Democrats in the House of Representatives put together would boost funding sharply 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 health coverage on new insurance exchanges.

Sara Rosenbaum, the chairwoman of the department of health policy at George Washington University in Washington, said it was crucial to increase funding for the centers because they filled "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 didn't have established relationships with private practitioners — inundated health centers. Soon the centers were struggling to keep up with demand, and some patients ending up on waiting lists.

"After you give everyone an insurance card, where are these people going to go?" said Dan Hawkins, the policy director for the National Association of Community Health Centers. Often a community clinic is the only option, he said, given the national shortage of primary-care doctors.

Congress appears to be responding to that argument. The Senate health committee's bill would authorize 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 money, but point out that getting it still could prove difficult since no additional money has been appropriated.

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 would provide discretionary funding through 2015, wouldn't provide a permanent source of money for the centers.

The federal community health center program, which began more than 40 years ago as part of President Lyndon Johnson's war on poverty, provides comprehensive primary-care services to more than 18 million people, generally to low-income communities, migrant and seasonal farm workers and homeless people.

Services are provided on a sliding scale that depends on the patient's ability to pay. Figures from 2007 show that 39 percent of health center patients were uninsured, Medicaid covered 35 percent and 16 percent had private insurance, although many had only limited coverage, according to the National Association of Community Health Centers. Medicare or other public plans covered the rest.

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

Maisha Challenger, 33, of Washington, 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. Early this year, however, 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 made a difference for people who were 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 isn't eligible for Medicare or Medicaid. "And if you don't have employer-paid health care, clinics like Walker-Jones become critical."

The Obama administration has signaled its support for 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 community health centers. The economic-stimulus package that was signed into law in February included $2 billion — which will be doled out over two years — to help provide care for an additional 3 million patients by 2011. Some of the money will go to build as many as 126 more clinics. Some also will be used to maintain or increase the number of doctors, nurses and other staff 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.

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

The health bills in Congress would 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 loans.

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

"It's challenging," said Vincent Keane, the CEO of Unity Health Care centers, a nonprofit umbrella organization that supports Walker-Jones and 30 other Washington-area facilities. "We're trying to do more in retention."

TYPES OF HEALTH CENTERS:

  • Grant-supported federally qualified health centers: These facilities are nonprofit organizations that receive federal funds under Section 330 of the Public Health Service Act.
  • Other nonprofit health centers: Some centers meet the same requirements as grant-supported federally qualified health centers but receive all their support from state and local funding.

KEY ATTRIBUTES OF FEDERALLY QUALIFIED HEALTH CENTERS:

  • Are in or targeted to communities that are medically underserved.
  • Must be nonprofit, public or tax-exempt organizations.
  • Are governed by boards composed of majorities of health center patients who represent the population served.
  • Provide comprehensive primary health care.
  • Provide services to all with fees based on the ability to pay.
  • Meet federal performance and accountability requirements.
  • Source: U.S. Health Resources and Services Administration.

    (Kaiser Health News, an editorially independent news service, is a program of the Kaiser

    Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)

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