Reports Make a Convincing Argument for Community Health Centers

The National Association of Community Health Centers, or NACHC, has found a powerful advocacy tool within the pages of two major reports.

In March, the NACHC and the AAFP’s Robert Graham Center released a report called "Access Denied: A Look at America’s Disenfranchised," (43-page PDF About PDFs) which found that 56 million Americans have inadequate or no access to primary care physicians and, thus, are medically disenfranchised. In early August, the NACHC, the Robert Graham Center and a third organization, Capital Link, unveiled a second report, "Access Granted: The Primary Care Payoff." (24-page PDF: About PDFs) That report documents the savings created by the nation’s community health centers, or CHCs, and the economic benefits the centers provide for local communities.

Both reports make a compelling argument for expanding the nation’s community health centers and both are now at the forefront of the NACHC’s efforts to obtain funding increases for CHCs on the state and federal levels, said Dan Hawkins, senior vice president for policy and programs for NACHC.

The Access Granted report has generated "incredibly positive feedback" from key members of Congress since its Aug. 6 release, said Hawkins. Staff for Sen. Edward Kennedy, D-Mass., chair of the Health, Education, Labor and Pensions, or HELP, Committee, have said they plan to cite from the report as the committee prepares to mark up legislation to reauthorize CHCs for the next five years, according to Hawkins.

The release of the two reports coincides with the NACHC’s efforts to dramatically increase funding for the centers and to greatly expand the number of people covered by the entities. The nation’s 1,100 community health centers, funded at about $2 billion in 2007, provide care to more than 16 million people at 6,000 sites throughout the United States. The NACHC has launched an Access for All America Plan, or Triple A Plan, to increase funding for the health centers by $3 billion and to bring an additional 15 million people under the care of the centers by 2015. This amounts to a 15 percent increase in CHC funding every year for the next eight years.

Hawkins, in an interview with AAFP News Now, acknowledges that the Triple A Plan is an "ambitious initiative," but he insists it is not "beyond the realm of possibility." In the late 1990s, the NACHC also sought a wide expansion of CHCs, and Congress responded by passing a bi-partisan resolution calling for doubling the size of the centers.

President Bush, then a Republican candidate for president, also embraced the NACHC initiative, leading to dramatic increases in CHC funding during the next seven years. In 2000, CHCs provided care to about 9 million people; by the end of 2007, the centers are expected to cover more than 17 million individuals, nearly doubling the size of the program in just seven years, Hawkins said.

As president, Bush proposed $150 million to $200 million increases for the health centers every year for the past several years. But for the 2008 fiscal year, Bush proposed only a $25 million increase, essentially bringing to a close his six-year commitment to significantly expanding the program, said Hawkins. Congress has moved quickly to fill the funding void, providing substantial increases for the health centers in key pieces of legislation moving through the House and Senate.

The House passed an appropriations bill, H.R. 3043, (at the Library of Congress' Thomas web site type "H.R. 3043" in the search bar after selecting "Bill Number") in late July, giving the health centers a $200 million increase in FY 08. The Senate Appropriations Committee, for its part, approved a bill that provides a $250 million increase for the program.

In the meantime, Rep. Gene Greene, D-Texas, and Kennedy have introduced CHC reauthorization bills in the House and Senate respectively, H.R. 1343 and S.B. 901 (at the Library of Congress's Thomas web site type "HR 1343" or "SB 901" in the search bar after selecting "Bill Number"). Both bills call for an increase of about $200 million for the CHCs in FY 2008. The two reauthorization bills also seek an increase in funding of about $1.5 billion during the five-year reauthorization period, sending a "strong signal to their respective appropriations committees that these are the funding levels they want to see for health centers over the next five years," said Hawkins. This is the first time since 1986 that Congress has specified funding levels in CHC reauthorization legislation, according to Hawkins.

Hawkins expects Congress to approve a final reauthorization bill late this fall and to send it to the president before the end of the year.

The NACHC, meanwhile, is working on a third report with the Graham Center that will address current and projected shortfalls of primary care physicians and other providers in the United States through 2020 and what can be done to reverse the trend. The supply of primary care physicians is critical to the success of CHCs and to the NACHC’s Triple A Plan, Hawkins said.

The report, scheduled for release in the spring of 2008, will reverberate within the walls of Congress, spurring lawmakers to action, Hawkins predicts.

"It will be a powerful report, much broader than health centers," said Hawkins. "We are talking about America's entire primary health care system."