Community clinics are key providers of primary care services for the poor. Treating people for free or for very little money has been the role of community health centers — a type of community clinic — across the U.S. for decades. In 2015, 1 in 12 Americans sought care at one of these clinics; nearly 6 in 10 were women, and hundreds of thousands were veterans. With roughly 1,400 community clinics nationwide, they have also expanded in recent years to serve people who gained insurance under the Affordable Care Act (ACA) and these clinics have been the poster child of the positive impact of the landmark ACA.
In 2015, community health centers served 24.3 million people — up from 19.5 million in 2010. Most of the centers are nonprofits with deep roots in their communities. By meeting the criteria to be a federally-qualified health center, they can qualify for federal grants and a higher payment rate from Medicaid and Medicare. Revenue at many clinics went up overall, and many of the health centers used federal grants to expand their physical facilities and add services, such as dentistry, urgent care, or mental health care.
A November 2016 study in the American Journal of Public Health showed that Medicaid spending was 24 percent lower for patients who received a majority of their primary care from federally-qualified community health centers than for patients who got care in other settings. The savings extended across all services, the study’s authors reported.
Republicans, newly empowered by Donald Trump’s ascendance to the White House, have made clear they plan to repeal large parts of the ACA in short order although the timing of any replacement is still uncertain. Community clinic leaders say they’re focusing on several funding challenges. First is a potential rollback of the ACA’s Medicaid expansion program, which extended new coverage to about 20 million people in the U.S. Some also worry that shifting Medicaid to a block grant system, an idea President Trump has endorsed, would result in cuts to services; or that Congress could decline to reauthorize “330 funding” — an additional $5 billion community clinics receive each year from the federal government. That stream of federal dollars is set to expire in September 2017. However, without clarity about where funding will come from in the future, or how much of it there will be, it’s possible that clinics will “go into hunker-down mode” which could mean limiting hours, reinstating waiting lists for new patients, and cutting promising new programs.
Sources: Becker’s Hospital CFO, American Hospital Association, and Federation of American Hospitals.