Community health centers face major funding loss

Millions of low-income patients could lose access to primary healthcare if a funding provision within the Patient Protection and Affordable Care Act set to expire next year is not extended, a study warns.

Advocates for extending the provision say the impact of letting it expire would be felt across the nation's healthcare continuum in the form of higher rates of emergency department utilization and hospitalizations.

“We know that there is a growing shortage of primary-care physicians,” said study author Dr. Leighton Ku, a professor of health policy at George Washington University and director of the school's Center of Health Policy Research. “If health centers aren't there, it will mean that this becomes that much worse and it will principally affect low-income people.” Not extending the ACA funding provision could lead some centers to shut down, Ku predicted.

The centers are dependent upon the receipt of two major funding streams—federal, state and local grants and Medicaid, which accounted for 39% of the $15 billion in total revenue clinics received in 2012.

The number of Americans served by the country's network of community health centers could drop from about 25.6 million in 2014 to 18.8 million by 2020 if no additional states expand Medicaid by 2020 and if funding allocated by the ACA to expand health centers is not extended when it expires in September 2015, according to the study released last week by the Milken Institute School of Public Health at George Washington University.

Community health centers, which provide primary care for a large number of low-income patients and are often located in medically underserved areas, are considered to be a significant part of the country's healthcare safety net, serving clients regardless of their ability to pay.

The bulk of the center's grant funding comes from the Bureau of Primary Health Care in the form of Section 330 grants under the Public Health Service Act. An ACA provision provided $11 billion in mandatory funding from 2011 to 2014 in addition to regular discretionary appropriations for community health centers.

Much of the health impact that will come as a result of health centers closing or scaling back their services will be felt in efforts to manage the prevalence of chronic diseases among low-income populations, which tend to have higher rates of cancer, stroke, heart disease, diabetes and hypertension than higher socio-economic groups.

The result will be higher numbers of patients having to be hospitalized and more visits to the emergency department for treatment of otherwise preventable conditions.

There are roughly 1,300 community health centers that operate in more than 9,000 sites throughout the country. The use of community health centers to address the growing demand for healthcare triggered by an aging population has received bipartisan support in the past from Republican and Democratic leaders. But it's unclear how much of that support remains within the current political climate. The extension could be considered by what may be a Republican-controlled Congress in 2015, which would further complicate the politics of the issue.

Follow Steven Ross Johnson on Twitter: @MHsjohnson