(Photo credit: Wikipedia)Under the Affordable Care Act, millions of new patients will have access to the health care system. One concern – where will all of these people obtain their health care? Because of fee for service and the inequitable tilt toward specialty care, the primary care system in our country has been decimated and will take years to rebuild.
Fortunately, the ACA puts a lot of money and effort toward correcting this imbalance. But even with all the dollars in the world, it would take many years to repair decades of damage. The section of the ACA intended to repair our primary care system thankfully started rolling out right after the law was passed. Primary care physicians are working hard to become certified medical care homes, which expands the role of staff and ancillary providers to pick up the workload of important but mundane tasks that do not require the work of a physician brain. This will increase capacity, but there is still so much that has to be done to handle the new patients coming into the system.
There is hope for the newly insured. One gem of our health care system is the vast network of community health centers. Community health centers as we know them today started in 1965 to provide health care access to poor and medically underserved communities. Today, according to the National Association of Community Health Centers, greater than 20 million patients are served in over 8,000 locations around the country. These groups provide care for anyone – those without insurance pay on a sliding scale. They also take Medicaid and private insurance.
Although not widely stated, it was expected that the majority of new patients entering the health care system would be served by community health centers. With the initial funding provided by the ACA, these centers were set to expand their capability to 40 million patients by 2015 – that is double their current number! Unfortunately, base funding for these centers was significantly cut by both the states and the federal government – they put some money in one hand and took it out of the other. Because of this, community health centers pared their projections back to serving 30 million people by 2015.
Being simplistic, which is always my goal, of the estimated 30 million new people who will enter the entire health care system, 20 million would have been seen in the community health centers and the other 10 million in private physician offices. Now those numbers will have to flip flop, because the decreased funding of the community health centers will only allow for 10 million more patients then they are currently serving.
This is a shame. Unfortunately, the decrease in funding is shooting our country in the foot. Why? Community health centers are very efficient at providing primary care and preventive care. Nationally, it costs $610 per year to provide comprehensive primary care to a patient in community health centers and $964 per year in other physician settings. This would save $354 per patient per year over the 10 million patients who now have to be seen by the private sector – that could have been a total savings of $3.54 billion per year. This doesn’t take into account the added savings of keeping people healthy and out of emergency departments and hospitals. To put this into perspective, the total federal base budget for community health centers was $2 billion per year before funding was cut by $600 million last year. States also cut funding by about another $200 million per year. So basically, we cut $800 million per year between the two and could have saved $3.54 billion per year? My financial planner brain cannot wrap itself around that one. Am I missing something?
There is another twist to this sordid tale. The insurance breakdown of patients seen in community health centers is about 40% uninsured and 40% on Medicaid, with the remaining 20% on other insurance. About 80% of patients seen at community health centers are under 133% poverty level and would have qualified for Medicaid under the Affordable Care Act. The community health centers were excited about this – their funding would improve and not be at the whim of state and federal politicians. Governors in six states so far are refusing the federal dollars to expand Medicaid, so the community health centers in those states will still have to spend significant time and energy lobbying their legislatures for money. This seems like a counterproductive waste of time.
Some states are also refusing other funding allocated by the ACA. I spoke with Andy Behrman, President and CEO of the Florida Association of Community Health Centers, regarding the challenges in his state. Florida has 48 community health centers with over 320 sites that provide care for 1.17 million patients. Eight of the centers rely on state funding – so they are at the mercy of the state politicians. Governor Scott has refused ACA funding to expand and improve Florida’s eight state funded community health centers. Florida community health centers are very efficient – it costs $510 per person per year to provide comprehensive primary care including lab and x-ray services. Thank goodness only eight of the 48 centers rely on Governor Scott’s whims.
A strong health care system is important for our country’s resiliency and is a matter of national defense. It would be great if we could cut the $500 billion per year worth of wasted overhead from our health care system, and divert just a couple of billion per year to community health centers. We would be much better for it.
Questions or comments? Please post here, reach me on Twitter @CarolynMcC, or at Carolyn.mcclanahan@gmail.com.
