What Community Health Centers Mean to Economic and Health Security

In our current economic climate, community health centers continue to absorb rising numbers of uninsured patients, providing high-quality and affordable care while generating billions in savings to the health care system. As they struggle to meet ever-growing demands for services, our nation’s largest primary care system also faces deep cuts in federal and state aid—another byproduct of the economy. Reductions in funding for health centers threaten to erode health center capacity and jeopardize access to care for millions of Americans.

What are Community Health Centers?
Health centers have been providing comprehensive primary care to medically underserved communities for more than 45 years. Launched as a small demonstration program during President Lyndon Johnson’s War on Poverty, health centers responded to a staggering need for basic medical care in impoverished communities. At that time, many Americans suffered from the effects of extreme poverty, racial segregation, and high unemployment rates, often resulting in untreated health conditions and unmet needs.

The health center model, founded by physician-activists Jack Geiger and Count Gibson, brought affordable and accessible care to these disenfranchised populations. With a strong emphasis on community development and empowerment, health centers addressed the underlying social, legal, economic, and environmental factors contributing to poor health outcomes. Primary health care and support services, such as education, job training, child care, and transportation, were rendered to all those in need on a “pay as you can” basis.(1) Consequently, health centers played a key role in both improving health and lifting communities out of deprivation.

As Bonnie Lefkowitz notes in her book, Community Health Centers: A Movement and the People Who Made It Happen, health centers are “testimony to the difference one person can make, and to the social contract that many have forgotten.”(2) What started as a few budding health centers, furnishing care from churches and parking lots in some cases, has flourished into a network of 8,000 health center sites operating in every U.S. state and territory.

Today, health centers serve more than 20 million people (and counting). These patients are disproportionately poor, uninsured, and publicly insured compared to the U.S. population at large.(3) Importantly, health centers serve as a critical source of primary and preventive care for millions of low-wage earners employed in agricultural, manufacturing, and hospitality industries, working part-time, doing seasonal work, or working in jobs that do not offer employment benefits.(4)

In the words of one health center director, “we are somewhat of a little different world compared to other providers.”(5) Although every health center is uniquely different in their scope, setting, and patient mix, they share a common set of features that not only set them apart from other primary care practices but also contribute to their effective function as primary care medical homes. Health centers are required to be located in or serving federally-designated medically underserved areas or populations. Additionally, they are governed by a patient majority board, ensuring scope of services are tailored to the needs of the community. Health centers are also mandated to provide comprehensive medical, dental, vision, and pharmacy services, as well as enabling services to minimize geographic, language, and cultural barriers to care.(6)

Impact of Community Health Centers
Health centers have a proven track record of providing high-quality care, reducing health disparities, increasing access to care, and generating health system savings and economic benefits for communities. Despite their location in impoverished communities, health centers represent an advanced system of care that meets or exceeds national quality standards. The range of culturally appropriate health care and enabling services they provide helps to mitigate some of the adverse social determinants of health. Moreover, their ability to improve access to preventive services and effectively manage chronic conditions translates into lower reliance on emergency rooms and fewer readmissions, producing $24 billion in annual cost savings. Finally, health centers help to protect and sustain local economies, generating 190,000 jobs nationwide.(7)

Given this demonstrated impact, health centers are one of few federal programs garnering broad bipartisan support from lawmakers. Recent legislation, in particular, has fueled health center expansion efforts. President George W. Bush doubled the federal investment in health centers (to $2.1 billion in FY 2008) through his Health Center Initiative, President Barack Obama directed $2 billion in stimulus funds to health centers in 2009, and, most importantly, the 2010 Affordable Care Act (ACA) infused $11 billion into health centers over a five-year period for renovation projects, the creation of new health center sites, and expanded primary and preventive health care services. These investments are a firm recognition of the central role health centers play in the primary health care system.

Implications of Reduced Funding
The continuing success of health centers relies heavily on state and federal funding. As of late last year, health centers were gearing up to expand into more medically underserved areas—with support from ACA funds—in an effort to serve the 60 million Americans who remain without access to primary care. Recent (and proposed) state and federal funding cuts to the health center program have prompted them to scale back these efforts.

In addition to low state funding levels, health centers are grappling with a $600 million reduction in FY 2011 federal discretionary funding. These cuts have caused the Health Resources and Services Administration (HRSA) to use portions of ACA funds to maintain existing health center operations, rather than to finance expansion efforts as envisioned by the health care reform law. For example, HRSA was poised to allocate up to $250 million in ACA funds to establish new health center service delivery sites in 350 communities. Due to recent funding reductions, these awards were limited to $28.8 million supporting 67 health center grantees (out of more than 800 applications).

There are profound implications of reducing investments in health centers. For every million dollars in health center cuts, approximately 8,200 Americans are expected to lose access to a regular source of primary care. Additionally, a loss of $1 million translates to approximately 1,800 patients left with unmet needs for cardiovascular disease, 1,000 preschool-age children without access to care, nearly 800 uninsured adults with an unmanaged chronic condition, and about 800 families spending less on food and other basic needs to pay for health care.(8) Based on these projections, a $600 million reduction could result in health centers losing the capacity to serve 5 million patients.

Health centers provide coordinated and managed care at relatively low cost and help generate significant return on cost-savings and the economy. Funding cuts to these primary care safety net providers carry with them the potential of limiting—and even reversing—their scope and impact. As such, reduced investments weaken efforts to address socioeconomic and racial/ethnic disparities and undermine health center capacity to serve low-income children, pregnant women, workers and their families.

References

1. Adashi, E., Geiger, H., & Fine, M. (2010). Health care reform and primary care—the growing importance of the community health center. The New England Journal of Medicine,  362(22), 2047-2050.
2. Lefkowitz, B. (2007). Community health centers: a movement and the people who made it happen (p. vii). New Brunswick, NJ: Rutgers University Press.
3. Shi, L., Lebrun, L. A., Tsai, J., & Zhu, J. (2010). Characteristics of ambulatory care patients and services: A comparison of community health centers and physicians’ offices. Journal of Health Care for the Poor and Underserved,  21(4), 1169-1183.
4. Shin, P., & Rosenbaum, S. (2011). The role of community health centers in addressing the needs of uninsured low income workers: Implications of proposed federal funding reductions. (Policy Research Brief No. 22). Washington, DC: Geiger Gibson/RCHN Community Health Foundation Research Collaborative.
5. From qualitative data collected in Altarum Institute’s Community Health Center Innovation Mission Project.
6. Shin P., Ku L., Jones E., Finnegan, B., & Rosenbaum, S. (2009). Financing community health centers as patient- and community-centered medical homes: A primer. Washington, DC: Geiger Gibson/RCHN Community Health Foundation Research Collaborative.
7. National Association of Community Health Centers. (2011). Access endangered: Profiles of the medically disenfranchised. Bethesda, MD: National Association of Community Health Centers.
8. Estimates based on Shin, P. & Rosenbaum, S. (2011). The health care access and cost consequences of reducing health center funding. (Policy Research Brief No. 21). Washington, DC: Geiger Gibson/RCHN Community Health Foundation Research Collaborative.

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