A few months before the 2016 election Hillary Clinton announced an ambitious proposal to double federal funding for community health centers.
Reportedly part of a deal to finally clinch Bernie Sanders’ endorsement in advance of the Democratic National Convention, Clinton’s proposal—and its focus on these community health centers—was seen by many (including myself) as a “first step in a true health-care revolution.” There’s lots of evidence on the efficacy of community health centers, as I wrote at the time:
Numerous studies have confirmed that community health centers provide excellent care. They reduce infant mortality rates, reduce mortality rates for older Americans, reduce racial and ethnic disparities in health outcomes, and more successfully deliver preventative care to high-risk patient populations than non-community health center providers. Their ability to erase deeply entrenched racial health disparities is particularly impressive.
Two new papers out in the latest issue of Health Affairs explore a different question, one that’s particularly interesting in light of the looming repeal or reform of the Affordable Care Act: How did the ACA Medicaid expansions affect community health centers?
The ACA included a few different mechanisms with the potential to improve the fates of community health centers. First, it allocated substantial additional funding in federal grants to the facilities; second, as the chart to the left (from the Kaiser Family Foundation) illustrates, community health centers disproportionately serve low-income patients, exactly the sort of people who were newly eligible for health insurance under the ACA’s Medicaid expansions.
In the first paper, the researchers Xinxin Ha, Qian Luo, and Leighton Ku found that community health centers did indeed benefit from the Medicaid expansions, in the form of more capacity and a higher proportion of patients with insurance. Between 2014 and 2015, community health centers in states that expanded Medicaid “had a 5 percent higher total patient volume, larger shares of Medicaid patients, smaller shares of uninsured patients, and increases in overall visits and mental health visits, compared to centers in non-expansion states,” the researchers write. Meanwhile, the larger federal grant funding associated with the ACA was a bonus, and was associated with “increases in numbers of patients and of overall, medical, and preventive service visits,” according to the paper.
The second paper — by Megan Cole, Omar Galárraga, Ira B. Wilson, Brad Wright, and Amal N. Trivedi — found that the Medicaid expansions did more than just increase the capacity of health centers and the likelihood that patients would have the necessary health insurance to pay for their care; it actually increased the quality of care provided to those patients. Cole and her co-authors found that, in states that expanded Medicaid, patients at the centers received better medical care along four metrics: “asthma treatment, Pap testing, body mass index assessment, and hypertension control,” as they detail in their paper.
The benefits of these facilities are many: They provide high-quality care to patients who other providers can’t, or won’t, serve; they’re governed by and accountable to the very communities they serve; and they’re often a valuable source of jobs in disadvantaged neighborhoods. And while it’s not yet clear how community health centers will fare under an ACA repeal or reform process, it’s certainly a topic that merits discussion.