Trump and his party propose to repeal the Affordable Care Act and turn Medicaid into a capped state block grant program with the goal of big federal cost savings. Clinton wants to extend the Affordable Care Act's expansion of Medicaid to low-income adults in all 50 states.
Democratic leaders including Clinton, President Barack Obama, and Vermont Sen. Bernie Sanders speaking at the Democratic National Convention here this week stressed their party's commitment to universal healthcare. But just a few miles away in historically black North Philadelphia, the head of a federally subsidized clinic serving low-income and uninsured patients is watching the election nervously.
The five-clinic Delaware Valley Community Health, a federally qualified community health center, has benefited greatly from the Affordable Care Act and its Medicaid expansion, said Patricia Deitch, the organization's long-time CEO.
Using capital funding from the Obama stimulus package and the ACA, DVCH has renovated its clinics, established a 340B discounted prescription drug dispensary, hired more physicians, incorporated behavioral health into its primary care system, added dental services, established evening hours, and installed an electronic health record system. In addition, federal funding for staff has grown from $3 million to $6 million.
Deitch is worried about the ramifications of the GOP proposal to turn Medicaid into a block grant program. She said “it all depends on who your governor is.” Under Democratic Gov. Tom Wolf, the state government is acting like a real partner for community health centers, she said. In contrast, under the previous Republican governor, Tom Corbett, her center's Medicaid patients struggled under Corbett's conservative Medicaid model that relied on commercial health plans with deductibles and copayments.
She would like to see the Affordable Care Act expanded to provide undocumented residents with a reliable payment source for their care. Of the organization's 43,370 patients in 2015, 9,728 were uninsured, and many of those were low-income undocumented people. It's difficult to arrange specialty care for these uninsured patients.
That's especially an issue at DVCH's clinic in the Norristown area, which has a significant population of Mexican immigrants.
Dr. Greta Stewart, medical director of DVCH's main clinic, there are specialty physicians who would like to treat these uninsured patients, but “their hands are tied by their hospital's policies and they're not able to decide to see the uninsured.”
Deitch is excited about her center's proposed new initiative to provide primary care onsite at a major substance abuse treatment center called the Girard Medical Center. That will mean that these patients, many of whom have multiple chronic conditions, won't have to be moved to receive care. DVCH already offers primary care at a mental health center serving seriously mentally ill patients called Horizon House.
Besides the political threat to Medicaid, DVCH faces a demographic challenge. Gentrification is encroaching, creeping northward from Philadelphia's center city area, and the community health center's low-income patients increasingly are being pushed out of the neighborhood. Another community health center, Greater Philadelphia Health Action in South Philadelphia, faces a similar gentrification challenge.
Deitch said the site of her main clinic is now a valuable property, but even if the organization sold it, it probably couldn't build a new center with the sales proceeds.
“We wonder if we can stay here,” Deitch said. “But we're so busy, we haven't analyzed it closely.”