April 2009 U.S. Poverty Action

Health Care Reform Must Address Underserved Communities

April 2009 Domestic Action

Take Action! Urge Congress to Incorporate Community Health Center Expansion into Health Reform Legislation

  1. Introduce yourself as a RESULTS activist and a constituent committed to quality, affordable health care for everyone in the U.S.

  2. Remind them that 46 million Americans have no health insurance and millions more are underinsured, unable to get the care they need.

  3. Point out that 1,100 community health centers serve around 14.3 million people a year, making them the nation’s largest primary care system, and the majority of those cared for in this system are uninsured or on Medicaid. Include information about your local community health center if you can.

  4. Also mention the impact of community health centers on the local economy, particularly the most vulnerable, with over 70 percent of patients have incomes below 100 percent of the poverty line and 91 percent below 200 percent of the poverty line.

  5. Assert that there needs to be an investment in primary care in health reform efforts, particular to care for the underserved. These bills provide for a 50 percent expansion of certified primary health care providers.

  6. Urge your members of Congress to cosponsor the Access for All America Act (S.486 and H.R.1296).

  7. In addition, ask your senators and representatives to urge key policymakers, including Senate Majority Leader Reid (D-NV), Senators Baucus (D-MT), Grassley (R-IA) and Kennedy (D-MA); House Speaker Pelosi (D-CA), Representatives Waxman (D-CA), Barton (R-TX), and Rangel (D-NY), to include the legislation’s provisions in health reform legislation this year.

Note: To find contact information, including telephone numbers and addresses for congressional offices and the names of the health staffer, visit the U.S. Poverty Actions & News page of the RESULTS website (www.results.org), where you can also send e-mails directly to your senators and representatives. For directory assistance, you can contact the U.S. Capitol Switchboard at (202) 224-3121.

Community Health Centers Are a Key Safety Net for Low-Income Families

Community health centers were born out of the sentiment created by the Great Society legislation pushed through by President Lyndon B. Johnson, and the anti-poverty sentiment created by the civil rights movement. As reported by the Kaiser Foundation in 2006:

Health centers are essential to the care of individuals with no health care at all, or those on Medicaid. With the rising numbers of uninsured and underinsured Americans growing by the day, the current network alone can not provide access to all those who need it. Many factors contribute to the need for increased federal money for community health centers, including:

  • Community health centers do not turn away patients who are unable to pay, and thus collect only what the patient is capable of paying;
  • Changes in the Medicare and Medicaid systems under the Bush administration only magnified the problems, including state flexibility of cost-sharing mechanisms and implementation of Medicare Part D;
  • Need has increased in the workforce serving community health centers.

Health centers rely heavily on Medicaid dollars to fund their operations; Medicaid accounts for over one-third of community health centers’ total operating budget. In addition, community health centers get funding through the Labor, Health and Human Services, and Education appropriations bill but these funds contribute less than one-fourth of the needed costs to allow these centers to provide care to their communities. The stimulus package signed by the president earlier this year committed over $2 billion to the expansion of community health centers. This will help, although not solve, the growing need for health services to the uninsured and underinsured.

Looking to the future, the National Association of Community Health Centers (NACHC) hopes to serve 30 million by 2015 (more than doubling Kaiser’s estimates for currently served individuals). The Kaiser Family Foundation estimates that a nearly 50 percent increase in service providers is needed over the next few years to continually serve the current population. A combination of incentives for doctors and health care service providers, along with increased federal funding, is desperately needed for health centers to merely maintain the level of care they have provided their communities thus far.

To better understand the critical role that community health centers play in our safety net, we strongly urge you to visit or call your local community health center and speak to someone about the work they do there and their needs to better care for the underserved.

Access for All (S.486 and H.R.1296) Offers a Blueprint for Needed Investments in Community Health Centers

As the new Congress convened in January 2009, the focus of Congress and the president has turned to universal health care for the over 45.7 million Americans that are currently uninsured. Health care costs were also seen as a necessary problem contributing to the fiscal stability of our nation. With the White House symposium on health care and the regional forums taking place all across the country, health care is now at the top of the nation’s legislative priorities for 2009. Suggestions are streaming in from members of Congress, as well as average Americans, about how best to fix this massive problem. While nothing has been produced as complicated as the 1,400 page document President Clinton’s advisors put together in the early 1990s in the last attempt to make health care a priority, there is a large amount of data and opinions swirling around about how best to fix this health care crisis.

Some, including President Obama, have called for funding community health centers, which disproportionately care for the poor in our society. Senator Bernard Sanders (VT) has introduced a major bill with the backing of Senator Ted Kennedy (MA) and 21 other cosponsors that will increase the federal funding of community health centers. Concurrently, Congressman James Clyburn (SC), the Majority Whip, has introduced identical legislation in the House. The Access for All America Act, S.486 and H.R.1296, would authorize $8.3 billion a year for the expansion of Qualified Health Centers from the current number, just over 1,000, to 4,800 centers across the United States. The bill also addresses the need for doctors and health service providers by increasing the National Health Service Corps budget to $1.2 billion a year, a ten-fold expansion of current funding. These figures may seem large; however, they account for less than 1 percent of total health care expenditures in the U.S. and pay for themselves by reducing medical expenses by 41 percent for patients of community health centers over those patients who receive care elsewhere.

Preview: The Need for Medicaid Expansion within the Health Reform Debate

In addition to our work with community health centers, RESULTS may also engage in efforts to strengthen the Medicaid program within the health reform debate. Many assume that Medicaid coverage extends to at least those individuals who are near or below the poverty line. We want to believe that our nation protects at least the most vulnerable of our society. However, the current Medicaid structure extends coverage only to those individuals over the age of 65, expectant mothers, parents currently caring for one or more dependent children, and the severely disabled. As we consider the 46 million Americans without health coverage, we should bear in mind how many of those individuals are low-income single adults who do not currently receive assistance for health care, and how cost effective in the long term it would be to cover these people before serious disability makes them eligible for assistance. It would be simple to extend basic Medicaid benefits to the most vulnerable of our society on the way to universal coverage.

This year we may push to expand Medicaid eligibility to all those currently in poverty and near poverty, increase funding for Medicaid so that families do not lose coverage during economic downturns, and improve the payment structure to guarantee that Medicaid participants can access quality care in their communities. To help prepare for future advocacy efforts, see recent papers from our allies at the Center on Budget and Policy Priorities, Improving Medicaid as Part of Building on the Current System to Achieve Universal Coverage, and the Georgetown University Health Policy Institute’s Center for Children and Families, Building on a Strong Foundation: Medicaid’s Role in a Reformed Health Care System. Their research and analysis covered primary considerations for building on Medicaid’s existing structure which include eligibility and access, cost and efficiencies, and financing.

We will discuss our Health Care for All by 2010 campaign on the April National Conference Call — Saturday, April 11, at 12:30 pm ET. To participate, call (800) 474-8920 with your group by 12:28 pm ET.