America’s Health Centers: Yesterday, Today and Tomorrow

America’s Health Centers:Yesterday, Today and Tomorrow

Presentation to 2006 Fall ConferenceMinnesota Association of CHCs

Dan HawkinsNational Association of Community

Health Centers

October 12, 2006

National Association of Community Health Centers - 2006

First, A Quick Check (-up)How many have 3+ years with CHCs?How many – 3+ PCA Annual Conferences?

3+ NACHC Meetings (P&I, CHI, etc.)?

How many are CHC Advocates at NACHC?A test:

What % of Minnesota CHC staff/Board members are CHC advocates today?

What % of those advocates typically respond to Action Alerts


Brief History of Health Centers

Common Roots: Turn-of-Century Dispensaries, Milk Clinics, Public Health Reforms

Special Heritage: Civil Rights, War on Poverty Efforts to Address Needs of Poor & Minorities

Unique Public-Private Partnership: Resources Directly to Community-Owned Organizations

Health Centers: Two-Fold Purpose - Be Agents of Care in Communities With Too Little of the

Same Be Agents of Change, Giving Communities Control of their

Health Care System


Brief History of Health CentersHealth Centers: Five Basic Characteristics -

Location in high-need areas

Comprehensive health and related services (especially ‘enabling’ services)

Open to all residents, regardless of ability to pay, with charges prospectively set based on income

Governed by community boards, to assure responsiveness to local needs

Held to strict performance/accountability standards for administrative, clinical, and financial operations


Growth of Health Centers: 1970-2005

0

5

10

15

20

1970 1980 1990 2000 2005

Number of Persons Served by Coverage Source

Uninsured Medicaid Private Insurance Medicare


Accomplishments of Health Centers

Health Care Home for 16 Million Americans 1 of 7 Uninsured Persons (6.4 million) 1 of 9 Medicaid/CHIP Recipients (5.7 Million) 1 of 4 Low-Income Children (5.9 million) 1 of 5 Low-Income Births (400,000) 1 of 9 Rural Americans (7.9 Million) 10 Million People of Color, 750,000

Farmworkers, 700,000 Homeless Persons


Location of Community Health Centers


Accomplishments of Health Centers Excellent Quality of Care: More Effective Care, Better Control

of Chronic Conditions, Greater Use of Preventive Care, Fewer Infant Deaths

Major Impact on Minority Health: Significant Reductions in Disparities for Health Outcomes, Receipt of Preventive and Condition-Related Care

Higher Cost-Effectiveness: Lower Overall Costs, Lower Specialty Referrals and Hospital Admissions, Substantial Medicaid Savings

Significant Community Impact: Employment and Economic Effects, Contribution to Community Well-Being, Development of Community Leaders


Recent Recognition of Health Centersby Key Government Agencies

IOM recommended health centers as THE model for reforming the delivery of primary health care (Rapid Advances in Health Reform)

GAO credited CHCs for Collaboratives success and recommended expanding them further

OMB ranked CHC program 1st among all HHS programs and one of the top 10 federal government programs for effectiveness


Health Centers Provide One-Fourth of All Ambulatory Care for Uninsured…

Proportion of Visits by Uninsured, 2004 (N = 70 Million)

Hospital OPDs (11%)

Private Physicians

(36%)

Health Centers (26%)

Hospital ER Units (27%)


…But Millions of Americans Have No Regular Source of Care

35 Million People Have No Regular Source of Care (not even a Health Center)• Half are Uninsured• 40 percent are Members of Minority Groups• In 13 states, they number More Than 1 Million

47 Million People are Uninsured• Three-fifths are in Low-Income Families• One in 3 Latinos is Uninsured


Major Challenges AffectingHealth Centers

Growth in Uninsured: Continue to be Largest and Fastest-Growing Group of Health Center Patients

Decline in Charity Care: Cutbacks by Private Providers Squeezed by Managed Care

Loss of Medicaid and Other Public Funding: Severe “Deficit Reduction” Cuts by States & now Congress

Changing Nature of Insurance Coverage: Growing Shift to Catastrophic/High-Deductible Plans that Cover Little or no Preventive/Primary Care


Growth in Uninsured PopulationServed by Health Centers, 1990-2005

0%

25%

50%

75%

100%

125%

1990 1995 2000

All Uninsured

(47 million; 34% increaseSince 1990)

Uninsured Servedby Health Centers

(6.4 million; 128% increase since 1990)

Percent Increase

SOURCE: Data from 1996-2005 UDS; National estimates from Bureau of the Census.

2005


NACHC’s Legislative Priorities for 2006

1. Reauthorize Health Center ‘330’ law without change

2. Appropriate at least the President’s request for a $181 million increase in FY2006, plus increases for other key programs (eg, NHSC)

3. Medicaid reforms must not hurt people or safety net providers

4. State Flexibility must not violate Congressional intent to protect FQHCs and preserve PPSAlso, revise Medicare FQHC payment cap, make FTCA available for volunteers & emergencies, and allow CHC staff to have FEHBP coverage


ReauthorizationWhat is it and why is it needed?

Core features: location in area of need, open to all, comprehensive services, community-owned and operated

Support for continuation & growth

Who wants to change it? Non-community owned providers (faith-based,

others) who want access to funding, FQHC, FTCA, 340B, VFC, etc.

What is the current status? House passed straight reauthorization (HR 5573)

424-3; Senate action pending on similar bill (S 3771)


Appropriations:Measuring Funding Results

Fiscal Year

Admin. Request

NACHC Target

Final Approp.

Final vs. Target

2007 $+181 $+181 $+206/+145 ????

2006 $+304 $+304 $+48

2005 $+219 $+250 $+117

2004 $+122 $+225 $+113

2003 $+114 $+200 $+161

2002 $+124 $+175 $+175


Medicaid: What Did Congress Do?

The Deficit Reduction Act (DRA) gives states broad new flexibility to re-shape Medicaid:

Benefit Flexibility: States can enroll most beneficiaries in private insurance programs, with fewer benefits [NOTE: The Deal amendment assures continued access to FQHCs and payment at PPS rates]

Cost-sharing: States can increase cost-sharing for all above-poverty beneficiaries, and can charge premiums & deductibles for the first time

New Waivers: States can set up “Health Opportunity Accounts” (HOAs), giving beneficiaries a fixed cash account for preventive/primary care, with back-up coverage only for catastrophic specialty or hospital care

It also requires states to verify the citizenship or legal status of all Medicaid applicants beginning July 1, 2006


State Flexibility: What Does it Mean? States can now change their Medicaid programs without a

waiver, and in most cases without legislative action In most states, the Governor can change Medicaid without asking the

legislature for approval

CMS is actively encouraging states to implement Medicaid reform, promising a quick review of State Plan Amendments

This means that there may be NO public notice or opportunity to review or comment on proposed changes before they’re approved

CMS is also encouraging states to apply for HOA and other waivers, promising quick review & approval also

Here, too, there may be little or no opportunity to review & comment on proposed waivers before they’re approved


What is NACHC Doing About This? NACHC has organized a special program of legal, technical, and

advocacy assistance to PCAs, especially in ‘high-risk’ states Developed & distributed special model state legislation to make sure that any state

Medicaid changes are publicly disclosed and reviewed in state legislatures Identified which of the 50 states currently have no legislative oversight of their

Medicaid programs, and is providing legal & technical assistance to PCAs in these ‘high-risk’ states

Offering strategic advocacy assistance to all PCAs that request it

NACHC’s special Partnership for Medicaid will continue to fight for Medicaid’s future

The Partnership includes public & children’s hospitals, primary care and minority physician groups, nursing homes, the cities and counties, and other safety net providers

It has produced a series of proposals for making Medicaid more efficient & effective, without cutting current eligibility, benefits, or provider payment rates

Working closely with the HHS Medicaid Commission to influence its report to Congress, due at the end of 2006


Other Major Policy Issues

Increase the Medicare Payment Cap 75% of all FQHCs affected, $51M+ in lost revenues Can be fixed administratively, without legislation

Extend FTCA Coverage Allow coverage across state lines in emergencies, and

coverage for providers who volunteer to see patientsAllow CHCs to enroll employees in FEHBP

Multiple plans, excellent benefits, lower costs, but CHCs must pay employer share (75%)


The Future – Our Vision

Grow health centers to become the health care home for all 51 million Americans who need a health care home (51/15/15)

Reform health professions programs to promote Primary Care careers, workforce diversity, and service to underserved via health centers

Preserve the Medicaid guarantee of coverage for low-income, elderly & disabled Americans


The Future – Our Vision (cont’d)

Wire every health center for complete health information technology (HIT)

Lead the way to a high-performing health system, grounded in primary care

Play a central role in emergency preparedness, at the local & national levels


How Health Centers Re-pay the Public Investment

They reduce hospital and ER use (5.8 fewer admits per 1,000; 13 - 38% fewer ER visits) for their patients

Their Medicaid patients cost 30 percent less than those served by other providers, saving Billions of $$$

Their disparities collaboratives are found to reduce health disparities significantly for minority patients

They stand ready to serve more uninsured people with limited support (about $500 annually/person)


Success (and Our Future) WillDepend on Strength of Advocacy

Advocacy is not just a clinical or social work act for individual patients, but a responsibility of leaders for their communities

Advocacy involves full participation in groups that support your cause (PCAs and NACHC)

This means organizational membership (dues support)

Also means active individual participation (grassroots advocacy with state/federal policymakers)


Why Care About Advocacy?

Health centers: a remarkable record of achievement – open access, superior care, cost-effectiveness – we are part of the SOLUTION

= BUT = Not enough people know about us & our record

The challenges we face are daunting –= AND =

The only way we can win is to grow our Grassroots, (100,000 staff/Board members, 16 million patients), speak with one voice, make it count!


What Can You Do to Help?Sign up as a Health Center Advocacy Coordinator or as an

Advocate (go to www.nachc.com for details) By signing up, you will receive regular updates from

NACHC and will be notified when action is needed

Get 5 colleagues/friends to do the same

Invite your Member of Congress and State legislators to visit your health center (especially during recesses, and National Health Center Week, August 5 – 11, 2007 – begin preparing NOW!

Send the message that health centers are part of the solution, and ask them to support our efforts to do even more!

Join the National Association of Community Health Centers and Your State & Regional PCAs

http://www.nachc.com/


NACHC Resources

Visit our improved, expanded web site…

for more information on all issues,

for the latest on federal & state policy developments,

to sign up as an advocate and send a message to your Members of Congress on key Health Center issues

Address is: www.nachc.com

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America’s Health Centers: Yesterday, Today and Tomorrow

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