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Has the ACA Made Community Health Centers Unnecessary?

The Obama administration last week announced that $169 million in Affordable Care Act funding will be used to open 266 new community health centers in underserved areas across the U.S.

Those new centers will be in addition to the 700 CHCs that have opened in the previous few years using ACA funding.

Traditionally, CHCs have provided care to underserved communities, and many of the patients they serve are uninsured.

According to HHS, the ACA’s primary goal is to expand coverage to the uninsured. On that metric, it’s been wildly successful, reducing the uninsured rate to heretofore unheard of rates.

If more people are insured, meaning they likely have access to a more regular source of care, are CHCs still necessary?

History, Purpose of CHCs

The federal government has long played a role in encouraging and funding CHCs. The federal Office of Economic Opportunity in 1965 — in the midst of President Johnson’s “War on Poverty” — funded the first two “neighborhood health centers” in Boston and Mound Bayou, Miss.

In 1975, Congress permanently authorized neighborhood health centers as “community and migrant health centers,” and later added primary health care programs for people who were homeless or resided in public housing. In 1996, lawmakers created a consolidated health centers program, now known as the Community, Migrant, Public Housing and Homeless Health Centers and overseen by HHS.

To receive federal funding, CHCs are required to serve all patients regardless of their ability to pay. They charge uninsured patients based on ability to pay.

ACA Expands Coverage, Increases Providers

Before the ACA took effect, there were about 46 million uninsured U.S. residents at any one time, and the uninsured rate hovered around 15%, according to federal estimates. That number has been steadily declining since the ACA’s coverage expansions took effect. According to the most recent CDC figures, about 25.5 million U.S. residents ages 18 to 64 were uninsured in the first quarter of this year. The uninsured rate was 9.2%.

Meanwhile, the ACA is attempting to increase the number of health care providers, new primary care training programs. The law also helped double the National Health Service Corps from 2009 to 2014. 

Will CHCs Continue To Exist?

With fewer uninsured and (hopefully) more primary care providers on the way, do CHCs need to continue? In speaking with some experts and reviewing research, the answer seems to be yes, for a number of reasons:

CHCs care for more than just the uninsured. CHCs aren’t solely for uninsured patients. In fact, research by the Kaiser Family Foundation from before the ACA fully took effect found that 41% of CHC patients were covered by Medicaid, 14% were privately insured and 8% had Medicare coverage. Just more than one-third were uninsured.

Millions are still uninsured. Even if millions more U.S. residents gained coverage through the ACA, millions more are still uninsured. They don’t stop needing care just because other people are getting covered. In fact, experts have said that convincing the remaining uninsured to gain coverage will be difficult at best and impossible in certain circumstances. Bryan Fisher of Families USA told California Healthline earlier this year that the “more people [who] enroll on the front side, on the back side, it’s going to be harder to get in touch with those people.” CHCs are particularly relevant in states that have chosen not to expand Medicaid under the ACA.

There’s still a provider shortage. Despite ACA initiatives to increase the number of primary care providers, some still say there will be a physician shortage. According to research from the Association of American Medical Colleges, total physician demand is expected to grow by as much as 17%, which could mean a shortage of more than 31,000 primary care physicians by 2025.

CHCs are more than just primary care. Many CHCs also offer dental care, mental health care or substance use disorder treatment. The number of CHCs that offer dental care grew by 22% between 2000 and 2013, while the number that offer behavioral health care increased by 81% during that period. 

CHCs have a proven history. Gary Wiltz, CEO of the Teche Action Clinic and Chair of the Board for the National Association of Community Health Centers, called CHCs “one of the best-kept secrets in the country.” He said, “We were here before the Affordable Care Act, and we were affordable before the Affordable Care Act, and we will continue to be that way.”

CHCs are accountable. According to Wiltz, CHCs “are one of the few programs that … have reporting requirements on how well” they are providing care. “You’re not just throwing money at a problem. We have to prove that we are improving the population health of the people we serve.” He added that CHCs track their patients’ rates of diabetes-related blindness, kidney failure, heart attacks, strokes, controlling high blood pressure, how many women are receiving pap tests and mammograms, cancer prevention screenings, obesity levels, and other factors. Meanwhile, more than 60% of CHCs are certified as patient-centered medical homes by the Joint Commission or the National Committee for Quality Assurance, which Wiltz said is higher than for private providers. CHCs are “way ahead of the curve as far as quality,” Wiltz said.

According to Wiltz, CHCs are a good model for other providers. “When you have a proven track record, the whole idea is to expand it. We have a model that has been proven to work,” he said.

Around the Nation

Here’s a look at other stories making news on the road to reform.

The beginning of the end? Vox has a quick rundown of potential Republican presidential candidate and Wisconsin Gov. Scott Walker’s plan to repeal and replace the ACA.

Death Panels are back. NPR recalls the brouhaha over a proposed provision in an early draft of the ACA in which Medicare would have reimbursed physicians for having discussions with beneficiaries about their end-of-life plans. Although false accusations about the provision led to its demise, the discussion about providing such payments has quietly resumed recently.

Drugs and the ACA. The rapidly rising prices of many prescription drugs might affect your employer-based coverage, according to PBS’ “NewsHour.”

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