Why Do Those With Insurance Get to Decide Who Gets Care?
For 51 years community health centers (CHC) have delivered care to the underserved and the job is not getting easier. Regardless of your political affiliation, you should celebrate the movement of routine medical care from our nation’s emergency rooms to community health centers. You can argue against a national health plan, but in reality, the use of emergency rooms for the delivery of primary care is a national health plan.
Perhaps one of the most significant flaws of the Obama Administration was their national rhetoric. The Affordable Care Act (ACA) (Obamacare) did so much more than mandate insurance coverage. The ACA significantly expanded the CHC network and revenues. States with Medicaid expansion saw substantially more insured patients than those who opted not to expand Medicaid. In 2015, 1,375 health centers delivered care to 24.3 million people including 1 in 6 Medicaid patients. Yet, the debate about the future of Obamacare remains centered on mandated insurance.
Additionally, the ACA set up a federal grant fund, that is essential to the existence of CHCs. In 2015, this trust fund provided 20% of the funding to these centers and allowed them to deliver care to those that are without any insurance or assistance.
Congress, in an amazing bipartisan action, extended the ACA, health center trust fund until September 30, 2107. But, what happens then???
The discourse in America now about the future of the ACA fails to look beyond the surface to the progress made toward a more cost effective delivery of healthcare to the underserved.
I meet and work for so many physicians and administrators who work exceptionally long hours, for very little pay, to ensure that our most underserved have a chance. There is no question that the delivery of routine care dramatically reduces the number of emergency room visits or length of hospital stays. The providers who work in what we call “mission-minded medicine” do so because of the size of their heart, not the size of their paycheck.
They must not be left to soldier on alone.
Luckily for most of you reading this, and certainly for our elected officials, we have insurance coverage. We don’t need to find our nearest community health center.
I am not advocating for more assistance or for a national health plan, yet all we seem able to do is argue about our difference. We desperately need incentives to encourage physicians to work in our CHCs, because they certainly are not compensated adequately. We struggle to find doctors willing to work in rural or urban community centers because they are unable to pay their insurance and student debt.
Because of the laws regarding federally underserved areas, we funnel our foreign trained physicians in need of a J1 Visa Waiver to these communities, but we offer no incentives for them to remain in these areas once their waiver obligation is met. Resulting in communities with no continuity of care and the added expense and disruption of hiring a new provider every three years.
This year as we celebrate the 51 years of community medicine, stop and take a stand. Consider that the care must be delivered somewhere and someone must pay for it. Demand that your elected officials stop arguing about the inane and instead focus on: incentives for physicians to serve this community, incentives for physicians to choose primary care careers, and the extension and expansion of the funding needed to continue community medicine.
Whatever your political affiliation, we all benefit from a strong community health center system. And many, many thanks to the men and woman who serve on the front lines. We all owe you a debt.