Affordable Care Act

The Affordable Care Act (ACA) was signed into law on March 23, 2010, by President Obama. Since that time the Republican party has tried without success to repeal or partially repeal this program. According to the Centers for Medicare and Medicaid Services, as of  2018, there were approximately 11.8 million consumers that selected or were automatically re-enrolled in Marketplace Healthcare plans.

Community Health Center Funding

In 2010, funds were made available through the ACA and appropriated $11 billion in annual funding to the Community Health Center Fund (CHCF) and the National Health Service Corps (NHSC). This funding was initially approved over a five-year period of FY2011-FY2015. In 2015 it was extended through the Medicare Access and CHIP Reauthorization Act (MACRA). It was once again extended by Congress in 2018 for an additional two years by the Bipartisan Budget Act (BBA). For FY2019-2020, the National Association of Community Health Centers reports that funding provided to community health centers will equal $5.6B.

Role of the Community Health Center

The role of the community health center (CHC) has always been to serve those individuals in their community that are uninsured and underinsured. These CHCs are our nation’s direct source of comprehensive primary medical care for underserved communities and their at-risk residents. Since the inception of the ACA, the number of insured patients being seen at community health centers has grown. But, does this increased funding help to control costs and improve the quality of care with this population?

CHC Utilization

Community health centers have always been the primary care provider for those individuals that were medically underserved. Many of the CHCs have operated in small communities that have felt the impact of changes in their own communities and those that impact the nation. They have always had a mission to serve, many times on a shoestring budget, their community and offer health services and supportive services to anyone that walks through the door, regardless of their ability to pay.

Since the ACA went into effect, these centers have seen an increase in the number of patients that they care for, as well as, an increase in the number of individuals that are now insured through one of the Marketplace Healthcare plans.  According to the NACHC, the number of patients that CHCs serve has increased to over 27 million, that utilize over 10,000 centers. These centers are located in medically needy areas in every state and U.S. territory.

Cost Containment

A study published in the American Journal of Public Health compared the number of Medicaid claims filed for patients that received the majority of their primary health care at a federally qualified health center (CHC), to those patients that received their care at other settings. They found that CHC patients had fewer encounters and spending than non-CHC patients across all services. The statistics from this study have shown that the CHC patients had 22% fewer visits and had overall spending that was 24% lower than the non-CHC patients.

The reason for this may be that CHCs typically offer as many services as possible under one roof. Many of these services can even be utilized at some centers, in one visit. This eliminates the need for referrals, coordination of care and additional follow-up visits. The health care providers at these centers reinforce the importance of primary care and regular visits with their low-income patients. By providing this kind of quality preventative care, CHCs have been able to reduce unnecessary emergency care visits. This ultimately reduces the overall cost of providing healthcare services to Medicaid patients.

Health Outcomes

The American Journal of Preventative Medicine published the results of research that looked at the government-funded community health centers across the country and their ability to provide quality care for patients in high-risk, medically underserved areas. The researchers reviewed records of 73,074 visits to private practices, federally-qualified health centers (CHCs) and Look-alikes that receive enhanced Medicare and Medicaid reimbursement.

The findings of the research show that the medical practitioners in the CHCs performed as well as those in the private practices, in 13 of the 18 federal and professional guidelines that were chosen for review. These 18 points that were reviewed, were related to fairly common practices seen in a primary care office. They included screening for certain diseases and disorders and treatment for specific conditions, as well as diet and lifestyle counseling.

The final 5 categories of the 18 included “use of ACE inhibitors for congestive heart failure, use of beta blockers, use of inhaled corticosteroids for adult asthmatics, blood pressure screening and avoidance of electrocardiograms in low-risk patients”. The review of these five measures showed that CHCs outperformed private practices and look-alikes, by following the federal recommendations at a higher rate.

According to the U. S. Health Resources and Services Administration, all federally funded health centers (including CHCs) are required to report core sets of information annually. These include data on:

• patient demographics
• services provided
• clinical indicators
• utilization rates
• costs, and revenues

The information provided shows that CHCs provide more preventive services than other primary care providers. In 2017, these CHCs exceeded the Medicaid Managed Care Organization High-Performance Benchmark scores in diabetes control, blood pressure control and PAP testing. In fact, 21% of the CHC patients with uncontrolled hypertension received new medication, compared to 5% of the Medicaid patients receiving care through private practices.

Looking at the Future

According to the Centers for Disease Control and Prevention (CDC), the CHC’s role is to act as the safety net provider for society’s most vulnerable populations. These CHCs are not only caring for this population of patients but they are exceeding the goals for Healthy People 2020. If funding would be decreased or eliminated, the CHCs would not be able to provide the services that are currently available and at the same capacity. This could be detrimental to their patients and the community in which they live.