Com­mu­nity health cen­ters face ma­jor fund­ing loss

Modern Healthcare - - NEWS - By Steven Ross John­son

Mil­lions of low-in­come Amer­i­cans would lose ac­cess to pri­mary health­care if an ex­pir­ing fund­ing pro­vi­sion in the Pa­tient Pro­tec­tion and Af­ford­able Care Act is not ex­tended, a study warns.

Ad­vo­cates for ex­ten­sion say the im­pact of let­ting the pro­vi­sion ex­pire on Sept. 30, 2015, would be felt across the health­care sys­tem in the form of higher rates of emer­gency depart­ment uti­liza­tion and hos­pi­tal ad­mis­sions.

Not ex­tend­ing the ACA fund­ing pro­vi­sion could lead some of the coun­try’s 1,300 cen­ters to shut down, said Leighton Ku, a pro­fes­sor of health pol­icy at Ge­orge Wash­ing­ton Univer­sity. “We know that there is a grow­ing short­age of pri­mary-care physi­cians,” Ku said. “If health cen­ters aren’t there, it will mean that this be­comes that much worse and it will prin­ci­pally af­fect low-in­come peo­ple.”

The num­ber of Amer­i­cans served by com­mu­nity health cen­ters could drop from 25.6 mil­lion in 2014 to 18.8 mil­lion by 2020 if no ad­di­tional states were to ex­pand Med­i­caid by 2020 and if the manda­tory fund­ing al­lo­cated by the ACA is not ex­tended, ac­cord­ing to Ku’s study re­leased last week by Ge­orge Wash­ing­ton Univer­sity.

The cen­ters, which have about 9,000 sites across the coun­try, are con­sid­ered a key source of pri­mary care for many Amer­i­cans who gain in­surance un­der the Af­ford­able Care Act, as well as for the unin­sured, since they serve peo­ple re­gard­less of abil­ity to pay. The cen­ters are de­pen­dent on two ma­jor fund­ing streams—fed­eral, state and lo­cal grants and con­tracts, and Med­i­caid, each of which made up ap­prox­i­mately 39% of the $15 bil­lion in to­tal rev­enue clin­ics re­ceived in 2012, ac­cord­ing to the study.

The bulk of grant fund­ing that com­mu­nity health cen­ters re­ceive comes from the fed­eral Bu­reau of Pri­mary Health Care in the form of Sec­tion 330 grants un­der the Pub­lic Health Ser­vice Act. An ACA pro­vi­sion pro­vided a cu­mu­la­tive to­tal of $11 bil­lion in manda­tory fund­ing from 2011 to 2014 in ad­di­tion to the regular an­nual dis­cre­tionary ap­pro­pri­a­tions for the cen­ters.

“The grant is kind of like the foun­da­tion that holds up the house,” said Daniel Hawkins, vice pres­i­dent for fed­eral, state and pub­lic af­fairs for the Na­tional As­so­ci­a­tion of Com­mu­nity Health Cen­ters. “The grant re­ally ends up cov­er­ing the cost of care for the unin­sured and the un­der­in­sured.”

On av­er­age, 36% of pa­tients at com­mu­nity health cen­ters are unin­sured, while 40% are cov­ered through ei­ther Med­i­caid or the Chil­dren’s Health In­surance Pro­gram, ac­cord­ing to NACHC es­ti­mates. About 14% are pri­vately in­sured and 8% are cov­ered through Medi­care. Over­all, about 72% of health cen­ter pa­tients are low­in­come, earn­ing up to 100% of the fed­eral poverty level.

But the manda­tory ACA fund­ing, which Hawkins es­ti­mates makes up as much as 70% of the to­tal fed­eral grant al­lo­ca­tion health cen­ters re­ceive, is set to ex­pire next year. Not ex­tend­ing it would cre­ate a bud­get hole many cen­ters would be un­able to fill. They ei­ther would have to re­duce their scope of ser­vices or raise their slid­ing-scale charges, which would cre­ate bar­ri­ers to ac­cess, Hawkins said. The big­gest im­pact would be in states that have not ex­panded Med­i­caid to adults earn­ing up to 138% of the fed­eral poverty level.

“Some com­mu­nity health cen­ters will have to close sites and lay off staff, and some of our smaller health cen­ters would have to close, pe­riod,” said Robert Pugh, ex­ec­u­tive direc­tor for the Mis­sis­sippi Pri­mary Health Care As­so­ci­a­tion, rep­re­sent­ing 21 com­mu­nity health cen­ters that an­nu­ally pro­vide care for more than 300,000 res­i­dents at more than 170 sites.

“The only other op­tion many would have to re­ceive care would be to re­ceive those ser­vices in­ap­pro­pri­ately at hos­pi­tal emer­gency rooms, or go with­out ser­vices and wait un­til they have an emer­gency.”

Pugh said the cen­ters are vi­tal in manag­ing chronic dis­eases among low-in­come peo­ple, who have higher rates of can­cer, stroke, heart dis­ease, di­a­betes and hy­per­ten­sion than more af­flu­ent peo­ple.

Com­mu­nity health cen­ters tra­di­tion­ally re­ceived strong bi­par­ti­san sup­port in Congress, and Pres­i­dent Ge­orge W. Bush was a big backer of us­ing them to ex­pand care for low­in­come and unin­sured Amer­i­cans. But Repub­li­can sup­port has waned since the Obama ad­min­is­tra­tion ex­panded fund­ing for the cen­ters through the 2009 bud­get stim­u­lus pack­age and the health­care re­form law.

MARISOL MUR­PHY-BAL­LAN­TYNE

A nurse works with a pa­tient at Mary’s Cen­ter in Wash­ing­ton D.C., one of 1,300-plus com­mu­nity health cen­ters that could face se­vere bud­get cuts.

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