A major focus of the current health care debate has been how to help the uninsured. The uninsured are often locked out of access to even the most basic of health care services, simply because they cannot afford care. But just who are these uninsured? There is often a perception in the community that these folks are the down and out, the homeless, and those people who live on the fringe of our society and who just do not care, free-loaders if you will. This could not be further from the truth.
The many faces of the uninsured include the unemployed factory worker, the middle income worker whose employer cannot offer health insurance, the chronically ill who have been turned down by insurance companies and the single mom working two jobs to put food on the table. Often the community thinks “Why don’t these people just get on Medicaid? Isn’t that for poor people?” If you live in Virginia and are an adult you must be blind, pregnant or disabled to receive Medicaid. This narrow sub-group leaves thousands of uninsured with very few options, Federally Qualified Community Health Centers being a major one.
Piedmont Access to Health Services, Inc. (PATHS) operates three Federally Qualified Community Health Centers (FQHC) and a community dental clinic in Southside Virginia. Thanks to the new health care law, our community health centers will be able to continue to provide quality health care for more people.
Community Health Centers have been providing quality, evidenced based medicine for over forty-five years. During this time the frustration has been balancing the needs of the uninsured to a healthy bottom line. The high rate of uninsured patients is directly linked to a center’s ability to be solvent. Because of the history of serving the nation’s low income uninsured, community health centers were on the forefront of supporting health care reform in order that more folks would have access to health insurance. And while the new health care reform bill is not perfect, it hopefully will be the impetus behind a strong, low cost health system in this country.
Federally Qualified Community Health Centers, such as PATHS, receives grant funding from the Department of Health and Human Services to provide health care to those who otherwise would not be able to afford it. These grant funds cover health care cost for about 25% of uninsured patients. PATHS uninsured rate is around 58% on average, and therefore the remaining costs must be made up elsewhere.
Two major challenges of the health care reform bill that will impact how federally qualified community health centers provide care are increasing the capacity of the nation’s primary care system and reducing the long term growth in health care costs. Research indicates that patients who receive care at community health centers have lower medical costs because providing quality primary care services can reduce the need for other ambulatory and hospital-based medical care, thereby lowering overall medical costs. Based on funding levels under the new law, the health centers will benefit in the following ways.
At the minimum level, the number of patients served could rise from 18.8 million in 2009, to 33.8 million by 2015, and double to 36.3 million by 2019. Total national medical costs could be reduced by $181 billion between 2010 and 2019. Individual states will realize a savings of $33 billion in state Medicaid savings. At the higher funding levels, the number of patients served by community health centers could reach 44.1 million by 2015, and 50 million by 2019. Overall national medical savings will total $316 billion over the decade, with $90 Billion in Federal Medicaid and $58 billion in state Medicaid savings. These estimates do not include the $24 million in medical expenses per year already being saved because of the existing numbers of patient care at community health centers.
Other benefits that community health centers will realize under the new health care reform are the expansion of Medicaid to reach all non-elderly people with incomes of 133% of the federal poverty level and the creation of health insurance exchanges. This expansion of Medicaid would allow the payer mix at community health centers to change in a way that would improve their financial status. Also, the creation of health insurance exchanges, coupled with the availability of affordable tax credits whose value is adjusted for families to use to pay for health insurance, will reduce the number of uninsured people by about 32 million by 2019.
While the debate over the health care reform bill continues, community health centers such as PATHS, must ready their organizations for change. They must look at how it will impact their ability to continue to offer quality health care to everyone regardless of their ability to pay or their insurance status. Without healthcare reform, one thing that will not change is the face of the uninsured; look in the mirror because that face could one day belong to you or someone you love.
(Kay Crane is CEO with Piedmont Access to Health Services)