Affordable Care Act Creates Greater Health Care Role for CHCs

One of the provisions of the newly enacted health care reform legislation provides an additional $11 billion in dedicated funding for community health centers, or CHCs, during the next five years. That funding increase will double the size and reach of CHCs by 2015 and give them a much greater role in the evolving health care system, according to analysts interviewed by AAFP News Now.

Currently, the nation's community health centers are funded at $2.2 billion annually and provide care to 20 million people through about 7,000 sites nationwide. The additional $11 billion in funding called for in the Patient Protection and Affordable Care Act (906-page PDF; About PDFs) will allow CHCs to serve 40 million people by 2015 and will double the number of CHC sites.

In their current capacity, the centers serve as patient-centered medical homes for a patient population that is disproportionately low-income and predominately uninsured or publicly insured. Most patients seeking care from the centers are members of a racial or ethnic minority group.

"Underserved people and communities are the biggest winners here," said Dan Hawkins, senior vice president of policy and programs for the National Association of Community Health Centers. "In the end, this is not money for health centers to get rich, fat and sassy. The challenge is they are going to have to put this money to work to serve more people."

"Most of this new money is going to be spent in communities where there are no health centers today," Hawkins added.

The $11 billion in funding for CHCs is part of an overall strategy to revitalize and strengthen the nation's primary care infrastructure. The health care reform law attempts to enhance the role of primary care through a variety of mechanisms, including higher Medicare and Medicaid payments for primary care, innovative payment models to reward value instead of volume, and a substantial investment in the primary care workforce.

In a larger sense, the health care reform act represents an effort to move the country toward a more primary care-based system by supporting the value of prevention and care coordination. However, Hawkins is convinced that the expansion of CHCs will be difficult and perhaps even impossible to achieve successfully without other elements of the health care reform act. "Health centers cannot do this job alone," he pointed out.

By the same token, CHCs are critically important to the success of the health care reform law itself. The Patient Protection and Affordable Care Act will bring a projected 32 million more people into the health care system by 2014, creating an even greater demand for primary care services.

"The question begs to be asked -- where will these 32 million people go for care with a primary care system that is already overburdened and overloaded?" Hawkins asked.

He points to Massachusetts as a case in point. The state enacted its own health care reform measure in 2006, and although Massachusetts has one of the highest primary care provider-to-population ratios in the country, many newly insured Massachusetts residents could not get an appointment with a primary care physician.

"If that is happening in Massachusetts, we can only imagine what is going to happen when 32 million people gain insurance coverage for the first time in 2014," said Hawkins.

In Massachusetts, CHCs grew much faster than the overall system of care because of the state's health care reform act. As a result, the centers became more important in serving the newly insured, as well as the uninsured, said Leighton Ku, Ph.D., M.P.H, a professor of health policy at George Washington University.

"In many cases, (CHCs) had seen patients who were uninsured, and when their patients got insurance, they continued to come to the health centers," said Ku. At the same time, the centers continued to pick up newly insured patients, further enhancing their role in the health care system.

The Nov. 2 midterm elections that returned control of the House of Representatives to the Republicans for the first time in four years could have profound implications for the implementation of health care reform. Many in the Republican leadership have vowed to de-fund key parts of the health care reform law, raising questions about the law's long-term viability.

However, the $11 billion in funding for CHCs is written in the law as mandatory funding, meaning that lawmakers would have to change the bill itself to eliminate the $11 billion -- something that cannot be done through the appropriations process, said Ku. "That money is relatively protected," he noted.

Perhaps even more importantly, CHCs have always enjoyed overwhelming bipartisan support, which is expected to continue in the years ahead. President George W. Bush, for example, was a strong proponent of community health centers, and the number of CHCs increased dramatically under his administration.

"There is lots of evidence that community health centers do good work and provide good, quality primary care," said Ku. "I have never heard anyone say we are spending too much money on health centers," he added.

The biggest threat to CHCs could come from state governments, which provide about $500,000 million annually to the centers. States could decide to reduce or even eliminate that funding, thereby curtailing projected CHC growth. But Hawkins does not expect that to happen.

"Over time as the economy recovers, that is not going to be the case," he said.