Health care for the poor at brink of expiration

It has been 52 years since I and my colleague, Dr. Count Gibson, launched the first two community health centers in this country under the auspices of Tufts University Medical School. One was in rural Bolivar County in the Mississippi delta and the second in a Boston public housing project. Since then that model has become the very backbone of the national health safety net in the United States, with over 10,000 sites caring for 27 million people living in or near poverty, and in many cases without health insurance.

Yet now, as a consequence of congressional paralysis, these health centers are faced with a potential loss of billions in federal support. Without action in the next few weeks, 9 million patients will lose access to primary and preventive care; over 51,000 providers and other staff will lose their jobs; health centers will be forced to close at least 2,800 sites; and economically stressed communities will lose $7.5 billion in local health-care investment.

{mosads}Health centers provide a full range of primary care and are designed to emphasize prevention, accessibility, and affordability, and they have been credited with significantly improving the health of both their individual patients and the communities they serve.

They are staffed by internists, pediatricians, family doctors, OB/GYN doctors, dentists, behavioral health professionals for dealing with mental health and addiction problems, nurses and nurse practitioners.

They are owned and operated by non-profit community boards under the supervision of the Federal Health Resources and Services Administration within the U.S. Department of Health and Human Services.

Increasingly, health centers have become part of the opioid addiction treatment strategy, and they are front-line first-responders to virtually every major public health crisis faced by medically underserved communities, from the Zika virus and the Flint water crisis to the devastating aftermath of hurricanes in Texas, Florida and Puerto Rico. Health centers have also become an indispensable part of veterans’ health, now caring for 350,000 veterans.

Patients with some income pay on a modest sliding scale, but no patient is ever turned away for inability to pay. Seven in 10 health center patients live in poverty, while over 90 percent have incomes below twice the federal poverty level. Nearly a quarter are uninsured, and almost half depend on Medicaid or the Children’s Health Insurance Program (CHIP), whose continuation is also threatened.

Rural communities account for half of all health center locations, and health centers are often a leading community employer, accounting for more than 200,000 jobs in 2017. Independent research has documented the cost-savings of community health centers; one estimate shows $24 billion saved annually by preventing hospitalization and by lowering the cost of medicines and diagnostic tests.

Bipartisan support from Congress and successive presidential administrations has greatly expanded the reach of health centers; under Presidents George W. Bush and Barack Obama, the number of health center patients grew by 18 million.

To sustain and grow health centers, Congress created a special Health Center Fund in 2010. In its first five years, the fund was used to invest in new services and new communities. Additional funding for the National Health Service Corps (NHSC) ensured that health centers would have the health-care workforce essential to growth.

In 2015, Congress extended the fund for two years with overwhelming bipartisan support. That extension expired last Sept. 30; now — after yet another urgent, short-term “fix” undertaken by Congress late last month — health centers find themselves in the same position as CHIP, a vital medical care program without critical, sustaining resources. Already, health centers across the country have begun closing sites and laying off staff, with terrible consequences for patients. This simply cannot be allowed to continue.

Having completed historic tax reform legislation, lawmakers must now act swiftly to renew the Health Center Fund and CHIP funding as part of legislation that must be enacted by Jan. 19 to keep the government going. In this always hopeful New Year, no community should have to live with the fear that its health center will close, or that its people will be left without vital access to health care. This is how essential institutions collapse and the lives and health of our neediest people are damaged, often irreversibly.

Dr. Jack Geiger is the Arthur C. Logan Professor Emeritus of community medicine at the City University of New York Medical School at City College.