The Role of Community Health Centers

Community Health Centers have been around for several decades, funded by federal and state and other grants, and some patient or payer reimbursement.  They provide care to low-income populations that often have difficult access to medical resources.  A new Kaiser Family Foundation report examines the impact of the reform law on these centers and what the future may hold for them.   (KFF Brief)   In 2013 there were about 1200 federally-funded community health centers, with at least one in every state, operating over 9000 delivery sites and serving almost 22 million patients.  There were another 100 similar health centers that were primarily supported with state and local funds.  The federal centers must be located in underserved communities, serve all patients and charge only on the ability to pay, furnish comprehensive primary care and they are governed by boards with at least 51% of the members being patients at the facility.  These centers provide care to a large number of the uninsured and Medicaid patients.  About 75% of patients have incomes below the federal poverty line, about 60% are women and more than half are minorities.  In 2013, 35% were uninsured and 41% were covered by Medicaid.  The number of uninsured patients has likely dropped and the Medicaid share increased. Of the 85 million visits to the centers in 2013, 71% were for primary care, 13% for dental care and 8% for mental or substance abuse.

The number of centers has grown from 730 in 2000 and number of visits has risen from 38 million in that year.  The centers employ about 157,000 full-time workers.  Medicaid accounts for around 40% of revenues for the centers, with grants providing 18% and other payment sources the rest.  Studies generally find that the centers provide good quality health care.  Notwithstanding the centers’ growth, they face continued financial challenges, particularly in states that have not expanded Medicaid.  The centers are an excellent value and in our judgment should be well-supported.  The return to taxpayers on building and operating a center as a method of providing health care is far better than the alternatives.  At the same time, the uninsured who are unable to pay for medical care and Medicaid recipients should be mandated to receive care at the centers unless one is not geographically available or the center can’t provide a service needed by the patient.  People whose care is supported by the public taxpayers should have to receive it from the cheapest possible alternative, which the centers are.  And there is no quality of care reason not to require them to receive care there.  Further support would be provided by mandating that all payers include the centers in their networks.  As long as the federal, state and local governments avoid suffocating the centers with regulations, we should continue to build and expand them as a method of getting low-cost care to those who need it.