Reauthorization Strengthens Primary Care Infrastructure

Congress has reauthorized two key primary care-related programs, providing each with a renewed sense of direction and focus, while laying out a plan to substantially increase the funding levels for these programs during the next five years.

In late September, Congress reauthorized the federal community health centers, or CHCs, program and the National Health Service Corps, or NHSC, for the next five years. The reauthorizations were included as part of H.R. 1343, (at the THOMAS Web site, type "H.R. 1343" in the search box after selecting "Bill Number") known as the Health Care Safety Net Act of 2008, which passed both chambers of Congress as of Sept. 25. President Bush, a strong proponent of CHCs, is expected to sign the legislation.

"This reauthorization underscores the long standing bipartisan congressional support for health centers and the National Health Service Corps," said Dan Hawkins, policy director for the National Association of Community Health Centers, or NACHC. "It essentially constitutes Congress saying, 'We want to grow these programs to make sure more care is available in more communities where it is needed.'"

Community health centers, which are funded at about $2.1 billion this year, deliver care to more than 18 million patients at about 6,600 sites throughout the country, says a recently released NACHC study (40-page PDF; About PDFs). In this capacity, the centers serve as patient-centered medical homes for a patient population that is disproportionately low-income and predominantly uninsured or underinsured.

The NHSC, funded at $125 million this year, provides financial assistance to medical students who agree to practice primary care in medically underserved areas after graduation.

Congress last reauthorized CHCs and the NHSC in 2002 for four years, leaving the programs unauthorized for nearly two years. The current reauthorization bill calls on Congress to increase the funding levels for CHCs to $3.3 billion by the year 2012, and it proposes increasing NHSC funding to $186 million during the same time frame.

"This is the first time since 1981 the health centers program and the National Health Service Corps have been reauthorized with specific funding levels for each of the five years," said Hawkins.

The reauthorization measure makes relatively few changes to the current structure of the two programs, but it provides an impetus for Congress to increase their respective funding levels, Hawkins said. Although CHCs and the NHSC were never in imminent danger of being defunded, he added, without reauthorization, Congress did not have a clear sense of the direction of each program and, perhaps more importantly, what each program needed in terms of funding levels. Such a lack of focus, said Hawkins, can increase the chances of funding losses.

With the reauthorization, Congress has defined the needs of the programs, giving clear direction to appropriators, he said.

The House and Senate passed H.R. 1343 without a single dissenting vote, a margin that clearly demonstrates the overwhelming support for the programs in both chambers of Congress. But in a larger sense, Hawkins said, the unanimous passage of H.R. 1343 reflects concern about the nation's health care system in general and the shortage of primary care providers in particular.