NATIONAL HEALTH CARE REFORM AND COMMUNITY CLINICS & HEALTH CENTERS
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” --Dr. Martin Luther King, Jr.
“We can’t reform health care without solving the problem of access to care. The community-based access you [community clinics and health centers] provide in rural and urban areas is needed now more than ever, and I know that health centers across the country are ready and willing to meet the challenge.” --Senator Ted Kennedy [ fn 1]
Background & HCR Goals
For many months we have witnessed tremendous attention on national health care reform (HCR), including varying legislative proposals in the US Congress, Town Hall discussions between Congressional representatives and constituents, and President Barack Obama’s major address in September to the joint session of Congress on HCR. The core goals of HCR are to expand access to quality health care for all Americans, to control skyrocketing costs of health care services via health insurance reform, and not to increase the federal budget deficit.
CCHCs as Cornerstone of HCR
Community clinics and health centers (CCHCs), including Federally Qualified Health Centers (FQHCs) such as Salud Para La Gente, are dedicated to providing low-cost, comprehensive and high quality primary care to the medically underserved, uninsured and underinsured low-income communities. Delivering quality service at reduced cost, CCHCs constitute the cornerstone of a reformed health care system.
Federally funded health centers, originally created decades ago to serve the poor, are currently seeing a surge of patients as more Americans lose their jobs, lose employer-sponsored health insurance, and struggle financially. The Wall Street Journal reports that nationally such health centers will handle more than 20 million patients this year, up by more than two million from last year, and twice the figure of a decade ago. [fn 2]
That same report by researchers at George Washington University cited in the WSJ article estimated that additional funding for CCHCs could save the health care system billions over the next decade, by reducing the number of hospital visits and referrals to more highly paid private physicians. [fn 3]
CCHCs Key Principles in HCR
CCHCs, including FQHCs, have advocated that the following key principles be included in HCR:
1. Preserve the system of community-based safety-net providers, which provide culturally appropriate, cost-effective primary and preventive health care services including chronic disease management to the uninsured and underinsured, preserving access to care for low-income persons. Cultural and linguistic sensitivity in health care delivery systems are crucial because the populations served by community health centers are culturally diverse and complex.
2. Ensure universal access to health service, available and affordable to all, especially to low-income individuals and families.
3. Emphasize oral health as an integral element of HCR. It has often been said that the mouth is the “gateway” to many vital functions of a healthy body. People without dental insurance often forego or delay routine dental care until the oral condition deteriorates and emergency treatment is needed. Untreated dental disease usually worsens over time and advanced dental disease is costly and difficult to treat. Conversely, if diagnosed and treated promptly, dental disease is almost entirely preventable. [fn 4]
4. Provide for comprehensive insurance coverage which includes medical, dental and behavioral health services, emphasizing prevention and primary care.
5. Require insurance company contracting to include CCHCs in provider networks.
6. Establish & provide access to “medical homes,” meaning the “home base” where a patient can go for all basic health care needs, for high quality, cost effective care and for referrals to specialists as needed. [fn 5]
7. Require adequate compensation to CCHCs, which should include: (A) that all plans in any “insurance exchanges” properly compensate CCHCs for care provided; (B) preservation of the Prospective Payment System (PPS) for FQHCs. Federal law provides for a special Medi-Cal reimbursement rate for FQHCs, called PPS, which reflects the actual cost of care for Medi-Cal eligible individuals. Maintaining the PPS reimbursement will enable FQHCs to continue to serve the poorest and most vulnerable individuals; (C) continued grant funding for CCHCs, to ensure their ability to serve patients who “fall through the cracks” because they and do not qualify for various programs.
8. Increase the supply of primary health care professionals in underserved areas. The shortage in health professionals willing and able to work in underserved communities must be addressed in order to provide access to care for all those in need. This includes (A) additional and expanded funding for the National Health Service Corps (NHSC), wherein top notch medical school graduates are hired as primary care physicians in medically underserved areas for a minimum of two years; in addition there is a “loan repayment program” wherein top medical school grads can get help with student loan repayments in exchange for serving as providers in medically underserved areas. Salud has been very fortunate to receive “NHSC scholars” and “loan repayment doctors” during recent years—a great addition to our staff. (See “Our Providers” page on this web site.) Addressing the workforce shortage issue also includes (B) offering community-based training for residents, to expose them to and interest them in serving in CCHCs.
9. Invest in CCHC infrastructure to expand clinic capacity to serve the increasing numbers of people visiting community clinics.
Current Status
As of this writing, all five committees of jurisdiction in the House and Senate have reported out HCR bills. Significant milestones from the CCHC perspective include the following:
Senate Finance Committee version: (1) the MATCH Act (Medicare Access to Community Health Centers), which would remove the cap on health center Medicare reimbursement, and also provide for an appropriate and predictable Medicare payment to health centers in the future; and (2) a requirement that private insurance plans available for purchase in any federal insurance exchange reimburse health centers no less than the fair and predictable rate currently received under Medicaid.
All three House versions: would create a Public Health Investment Fund, to provide $12 billion in new guaranteed health center funding over 5 years.
Next Steps
Legislators will now seek to “meld” the various versions of the bills in their respective houses of Congress, prepare for a floor vote and potential conference committee, and hope to present a bill to the President for signature by the end of the year.
Conclusion
Whatever the outcome of the HCR endeavors, Salud is committed to providing the high quality, comprehensive health care services to all. We are following with great interest the progress of federal HCR legislation. If you have a question or comment on this subject, please feel free to contact Sara Clarenbach, Salud’s Director of Advocacy, Community Engagement & Media Relations, at (831) 728-8250 ext. 1005 or e-mail her at sclarenbach@splg.org
FOOTNOTES:
FOOTNOTE 1: statement by Senator Kennedy of March 25, 2009 to the National Association of Community Health Centers, reprinted in NACHC’s Community Health Forum special edition summer 2009 Remembering the Honorable Edward M. Kennedy, page 4.
FOOTNOTE 2: Wall Street Journal 9/28/09 “Use of Federal Health Clinics Soars,” by Jared A. Favole online version, page unknown.
FOOTNOTE 3: Wall Street Journal 9/28/09 “Use of Federal Health Clinics Soars,” by Jared A.Favole online version, page unknown.
FOOTNOTE 4: CPCA position paper, August 7, 2009, by Tahira Bazile.
FOOTNOTE 5: Presentation by CPCA (California Primary Care Association) president and CEO Carmela Castellano-Garcia, Esq. April 3, 2009 “Health Care Reform and the role of Community Clinics and Health Centers” and CPCA position paper titled “Health Care Reform Priorities,” June 24, 2009, by Tahira Bazile. See also NACHC (National Association of Community Health Centers) press release 9/10/09, Statement of Tom Van Coverden on President Obama’s Address to a Joint Session of Congress.