Report on Massachusetts community health center utilization may foreshadow future national trends

By Patrick Donges

Pittsfield, MA – In a report published this month in the health journal Archives of Internal Medicine, researchers found in the years following the 2006 enactment of "Chapter 58" health care reform in Massachusetts the use of federally subsidized community health centers, or CHCs, increased over 30 percent despite more state residents being insured.

Dr. Leighton Ku is the director of the Center of Health Policy Research at George Washington University and lead author of the report.

"The report was trying to examine what happened to health care providers that offer services to low income and vulnerable populations; places like community health centers, public hospitals, some non-profit charitable hospitals."

"When uninsured people are no longer uninsured, many people thought they might go someplace else; they may turn to other providers. Actually, to a great extent they continued to seek care from safety net providers and the demand for care continued to be high."

The report shows between 2005 and 2009, the number of patients receiving care at Massachusetts CHCs increased by 31 percent, while the share of CHC patients who were uninsured fell from 35.5 percent to almost 20 percent.

The report's conclusion that most safety-net patients do not view the facilities as providers of last resort is evident in the Berkshires; Byan Ayars is CEO of Great Barrington-based Community Health Programs, or CHP, one of the state's CHCs.

"In 2006 more than 60 percent of our patients were uninsured, and now just about 13 percent are. We've had a three-fold increase in the number of patients who have insurance. So we went from less than 10 percent to 30 percent."

Ayars said both those numbers and the report are indicative that patients are recognizing the quality and diversity of care available at CHCs; CHP is currently seeing about 200 new patients per month.

Like CHCs across the country, CHP is funded in part through federal grant money and an increased subsidy for providing care to those on Medicare and Medicaid. In return, the centers agree to see anyone regardless of their ability to pay and provide what are known as "enabling services," which could range from translation services to preventative and family support programs.

Both Ku and Ayars said the report could foreshadow a similar national surge in CHC utilization in 2014, when new insurance policies under the 2009 federal health reform act are slated to begin.

In the immediate future, as the newly appointed 12 member Congressional Joint Select Committee on Deficit Reduction begin discussing their charge of making at least $1.5 trillion in cuts by Thanksgiving, Ayars said he is worried that CHC funding could be targeted.

"One of the lynchpins for community health centers is we focus a lot on prevention. The problem is it's really hard to show a return on that investment over the short term, and I'm afraid that Congress will look at short term investments and make cuts largely for populations that don't have a voice; lower income, ethnically diverse, the small employer or the self employed."

Those concerns are shared by CHCs across the country; Dan Hawkins is policy director at the National Association of Community Health Centers.

"There's two areas that we're very focused on. The first is the health centers program, because the federal support is really a core thing. And then there's another program I want to highlight which is crucially important, and that's Medicaid; the last and only affordable form of health insurance coverage for low income Americans. If health reform goes forward, of those 30 to 35 million Americans who will gain coverage, literally half will gain coverage through Medicaid."

Hawkins said that while Medicaid is not subject to the across the board cuts which could result if Congress cannot agree on the recommendations of the joint "super-committee," it is not protected in committee negotiations.

He also noted that while the 2009 federal health reform act included funds to expand the coverage of community health centers to an additional 20 million more people, that funding was reduced earlier this year by between $500 and $600 million

"That's enough money to have expanded care to five million more people, and now that's not going to happen. And so we watch very warily the work of the work of the select committee and what reduction in investments they're going to make."

"For every million dollars that the health center program funding is reduced, $11 million in savings is lost. These are savings to taxpayers and private payers alike because health centers keep people healthy, out of emergency rooms, out of hospitals. And so, it's a little like cutting off your nose to spite your face; we're very hopeful that Congress won't do that."

As of Thursday afternoon all 12 members of the "super-committee" had been announced; the committee is expected to hold their first meeting when Congress returns to Washington after Labor Day.