The nation's 1,200 federally qualified community health centers would be hit hard by a possible U.S. Supreme Court ruling this month eliminating premium subsidies for federal exchange-plan enrollees.
Such a ruling would have a major effect on the clinics, which are required by law to serve all patients for free or on a sliding-scale basis. They then would have to provide far more uncompensated care, clinic leaders say. Given the shortage of primary-care physicians, community health centers have been key primary-care providers for Americans who have received expanded private and Medicaid coverage under the Affordable Care Act.
“The vast preponderance of people with exchange coverage who are getting care at health centers are low income, below 200% of the federal poverty level,” said Dan Hawkins, policy director for the National Association of Community Health Centers. “If they lose that subsidy, they lose the ability to afford their coverage.”
If the court strikes down the subsidies in the King v. Burwell case, it's estimated that 6.4 million Americans would lose subsidies. It's expected that many of those people would drop coverage because it would become unaffordable. Hawkins estimated that community health centers nationally are serving nearly 1 million patients covered by plans purchased through the federal exchanges.
The clinics' loss of revenue from privately insured patients would come on top of a decline in state funding for the centers over the past few years. According to the NACHC, annual health center funding per uninsured patient was $344 in 2012, compared with a per-patient cost of $687.