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Community Health Centers Feeling Pinch of Serving a Growing Uninsured Population

By Emily P. Walker, CQ Staff

January 3, 2008 -- Despite record-setting federal funding for community health centers—which provide care largely for underserved people—the nation's 1,100 centers are feeling the strain of providing quality care for the growing uninsured patient population.

According to a report released by the Centers for Studying Health System Changes (HSC) that culled findings from community health centers (CHCs) in 12 nationally representative communities, patient volumes have shot up from 10 million patients in 2001 to 16 million patients in 2006, most of whom are minorities, low income, uninsured, or Medicaid recipients.

Funding for CHCs in 2006 was nearly $2 billion, a result of the recognition by the Bush administration and many members of Congress on both sides of the aisle that funding public health care "isn't a question of whether to do it, but how to do it," said Craig Kennedy, associate vice president for federal and state affairs of the National Association of Community Health Centers, a nonprofit group dedicated to improving CHCs.

The funding goes toward building new health centers, bolstering capacity of existing centers, introducing new, in-demand services such as mental health and dental care, and providing assistance for general operations.

Still, costs associated with new patients—40 percent of whom are uninsured—have outpaced funding from the federal government, insurance providers, state and local government, local businesses, hospitals, and philanthropists, the report said.

According to the report, the number of uninsured patients has increased because of declining employer-based insurance, rising numbers of immigrants who lack insurance, and Medicaid cutbacks. The rise in uninsured patients is taking a toll on the finances of CHCs, which collectively treated 6 million uninsured patients in 2006, compared with 4 million in 2001.

Additionally, CHCs have experienced an increase in immigrants lacking access to employer-based coverage or public insurance. CHCs cannot, by law, ask about a patient's legal status, the report said.

In addition to reimbursement issues and rising patient volumes, many CHCs struggle to recruit and retain enough nurses, physician assistants, doctors, and other clinical staff with salaries and benefits that don't stack up against those offered by hospitals.

Recruiting new staff relies largely on the National Health Service Corps doctors, nurses, and other health care professionals who receive federal medical school loan repayments for working in underserved areas, said Kennedy.

A draft measure approved by the Senate Health, Education, Labor and Pensions (HELP) Committee in November would add $60 million over a five-year period in additional funds for the National Health Service Corps.

That legislation—sponsored by Orrin G. Hatch, R-Utah—would reauthorize the Community Health Center Program at more than $14 billion for the next five years, starting with $2.2 billion for fiscal 2008.

The program "is the most cost effective way to bring dental, low-cost prescriptions, and mental health care to medically underserved areas," said Bernard Sanders, I-Vt., who is a cosponsor of the legislation.

According to the HSC report, the number of patients seeking mental health care at CHCs has grown by 170 percent between 2001 and 2006, while dental services grew by more than 80 percent during the same period.

At a Senate HELP committee hearing in November, Lisa Murkowski, R-Alaska, spoke strongly in favor of the bill, and emphasized that the program serves entire communities, not just the uninsured.

"It's not just lower-income people using this," she said.

Kennedy said the report shows that the centers are meant to reach a larger slice of the community than the centers currently draw in. It is crucial that CHCs are marketed as an effective, less-costly alternative to hospital emergency rooms for anyone in the community, regardless of insurance status, he said.

According to Kennedy, one "knee-jerk reaction" to community centers aimed at underserved populations is that the care is lesser-quality than hospitals or private providers.

"That's our job to get the facts out there that it isn't lesser care," Kennedy said. "It's high-quality care in the community."

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