Advocates for Community Health (ACH), a non-profit, non-partisan membership organization of community health centers (CHCs), has issued the following statement regarding Paragon Health Institute’s Policy Brief, “Health Care for a Lame Duck” by Jackson Hammond, published on November 14, 2024:
ACH urges Congress to reject the Paragon Health Institute’s recent lame duck recommendations as we face a fiscal environment where the health care safety net is teetering on the brink of collapse. Instead, we encourage every member of Congress to listen to their constituents, including health center patients and providers who strive to care for their communities every day, and provide robust funding for the Health Center Program.
“The Paragon Health Institute’s recommendation that Congress ’limit the amount of additional funding to CHCs in the Congressional year-end package and ensure that any new financing remains discretionary rather than mandatory‘ is a shortsighted affront to the over 32 million patients who receive primary care from community health centers annually and the hundreds of thousands more who health centers employ,” said ACH Chief Executive Officer Amanda Pears Kelly.
“Too many Americans are struggling to afford basic necessities, including quality, affordable health care. It is negligent and dangerous to advise Congress to cut this key part of the nation’s health care safety net.”
ACH Board Member and Chief Executive Officer at Cherokee Health Systems (CHS) Parinda Khatri, Ph.D. said, “CHS’ commitment to access to high-quality care for all, regardless of ability to pay, has led us to ‘go where the grass is browner’. Most of the 65,000 patients we serve in our rural communities of East Tennessee have no or minimal access to healthcare. A quarter of our patients do not have any health insurance, and even more are underinsured.” Dr. Khatri added, “In 2023, we provided over $11 million in uncompensated care, and this year, we are projecting over $13 million in uncompensated care for people with medical, behavioral health, substance use disorder, vision, and dental needs.” She commented that addressing these health concerns is essential for people in their communities to be productive members of the community, and live fulfilling lives.
ACH welcomes recommendations that include “relaxing current bottlenecks of training” and “allowing non-physician health care providers to do jobs they are already trained to do,” but only in the context of a robust safety net provider system. Based on years of data and research, as well as the experiences of providers on the ground, health centers are the best proven solution to addressing unmet health care needs. If Congress agrees to cut funding for health care, the nation’s largest primary care network would wither, and the 100 million people who live in health professional shortage areas would be left without a source of care.
In a letter delivered to Congressional leaders in September 2024, more than 550 national, state, and local organizations representing all 50 U.S. states and territories outlined the critical need for a robust funding increase for the Community Health Trust Fund, which is set to expire on December 31, 2024, to meet the record-breaking patient volumes and unprecedented financial challenges that health centers are facing.
Since the Health Center Program began 60 years ago, both Republican and Democratic Administrations have invested in health centers as a solution because they have seen the vitally important results – both economic and clinical – in their communities. If we were to reverse this support, the consequences would be devastating. Patients without a regular source of care would crowd emergency rooms, driving up the cost of health care for all patients and taxpayers. Patients in communities where rural hospitals are already closing would be left without any community care options. However, with a reinvestment in the safety net, we could work toward a future where patients have consistent access to high-quality primary care.
Health centers have continually produced measurably improved economic growth, remarkable effectiveness and efficiency, consistent health care access, critical environments for workforce training, and improved health outcomes for patients.
Here are the facts:
- Health Centers Save Money for the Government and Patients: Research shows that, for every $1 invested in primary care like that provided at community health centers, $13 is saved in downstream costs.[1] The Congressional Budget Office found that care provided at community health centers lowers federal spending for the Medicaid and Medicare populations they serve and lowers spending in emergency departments, inpatient hospital settings, and other outpatient services.[2] CHCs were estimated to save $25.3 billion for the Medicaid and Medicare programs in 2021.[3] Health centers have a lower incidence of specialty, emergency department, and hospitalization visits compared with other primary care providers for complex Medicaid managed care beneficiaries.[4]
- Health Centers Are Economic Engines in Communities: In 2022, health centers provided almost 285,000 jobs across the country.[5] In 2019, community health centers generated $63.4 billion in total economic activity, of which $32 billion were indirect economic impacts generated from supporting local businesses. A study by Capital Link has shown that, for every dollar of federal funding invested in community health centers, $11 is generated in total economic activity through increased spending on related health service expenses, food services, transportation, construction, and more.[6]
- Health Centers Provide Care in Rural Communities: In 2023, health centers served 1 in 7 rural residents.[7] CHCs have proven their ability to quickly expand care during the ongoing rural health crisis. Between 2010 and 2021, 136 rural hospitals in the United States closed. Nineteen of these closures occurred in 2020 when the COVID pandemic hit the U.S. However, in areas previously served by a rural hospital, there is a higher probability of new community health center service delivery sites post-closure,[8] and these areas are seeing an increase in access to community health centers.[9] CHCs are poised to do more, and it appears they may have to – in over half of the states, 25% or more of the rural hospitals are at risk of closing, and in 9 states, the majority of rural hospitals are at risk.[10]
- Health Centers are Highly Effective: The care patients receive at a CHC is viewed by patients as an upgrade from previous providers. CHCs are among the most accessible providers – nearly all community health centers offer timely appointments (88%) and expanded hours for patients to receive care (93%).[11] According to the most recent Health Center Patient Survey, 97% of patients would recommend their health center to family or friends.[12] As of 2022, 1,058 community health centers (77%) have been certified as Patient-Centered Medical Homes (PCMH), and community health centers have eight times greater odds of attaining PCMH certification than other types of health care practices.[13] The PCMH model enables community health centers to generate strong patient outcomes at lower costs despite treating patients who are often sicker with more complex health care needs.
- Health Centers Address Complex Patient Needs: Health centers specialize in providing care to the most complex patients; the five most common health center patient diagnoses, often co-occurring, are overweight/obesity, hypertension, diabetes, depression and other mood disorders, and anxiety disorders.[14] All patients receive comprehensive, quality, coordinated care, no matter how and when patient health or insurance status changes.
- Health Centers Train the New Generation of Health Care Providers: HRSA’s National Center for Health Workforce Analysis estimates a projected shortage of 35,260 primary care physicians—including family medicine, general internal medicine, geriatrics, and pediatrics—by 2035. These shortages are projected to be particularly acute in rural areas.[15] CHCs provide one of the best training grounds imaginable for the health care workforce, giving exposure to highly complex patients and experience in comprehensive, patient-centered care. Over 58,000 skilled professionals received training or education at a community health center in 2022.[16] CHCs have trained thousands of new primary care physicians through the Teaching Health Center Graduate Medical Education program and provide first-class experiences to thousands of new physicians through the National Health Service Corps every year. A recent survey of the health center workforce found a lower burnout rate and a higher well-being rate than most other health care settings.[17]
We look forward to continuing to work with Congress to finalize a long-term funding package that reflects what community health centers need to continue investing in their neighborhoods every day, and what patients in under-resourced communities need to stay healthy.
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[1] Gelmon, S., Wallace, N., Sandberg, B., Petchel, S., Bouranis, N., OHSU & PSU School of Public Health and Mark O. Hatfield School of Government, & Portland State University. (2016). Implementation of Oregon’s PCPCH Program: Exemplary practice and program findings. https://www.oregon.gov/oha/HPA/dsi-pcpch/Documents/PCPCH-Program-Implementation-Report-Final-Sept-2016.pdf
[2] Congressional Budget Office. (2024). CBO’s cost estimates explained, CBO describes its Cost-Estimating Process, Glossary. https://www.cbo.gov/system/files/2024-02/s2840.pdf
[3] Nocon, Robert. Kaiser Permanente Bernard J. Tyson School of Medicine. Testimony on Community Health Centers: Saving Lives, Saving Money before the United States Senate Committee on Health, Education, Labor and Pensions Committee. March 02, 2023. Retrieved from https://www.help.senate.gov/imo/media/doc/Testimony-Nocon-CHCs%202023-0228_Final.pdf.
[4] Pourat, N., Chen, X., Lu, C., Zhou, W., Yu-Lefler, H., Benjamin, T., Hoang, H., & Sripipatana, A. (2023). Differences in health care utilization of High-Need and High-Cost patients of federally funded health centers versus other primary care providers. Medical Care, 62(1), 52–59. https://doi.org/10.1097/mlr.0000000000001947
[5]National Association of Community Health Centers. (2024). Community Health Centers: Providers, partners and employers of choice 2024 Chartbook. https://www.nachc.org/wp-content/uploads/2024/07/2024-2022-UDS-DATA-Community-Health-Center-Chartbook.pdf
[6]National Association of Community Health Centers (2024). Health Centers Provide Cost Effective Care, 2015. http://nachc.org/wpcontent/uploads/2015/06/Cost-Effectiveness_FS_2015.pdf.
[7] National Association of Community Health Centers (2024). America’s Health Centers By the Numbers, 2024. https://www.nachc.org/resource/americas-health-centers-by-the-numbers/
[8]Miller, K. E. M., Miller, K. L., Knocke, K., Pink, G. H., Holmes, G. M., & Kaufman, B. G. (2021). Access to outpatient services in rural communities changes after hospital closure. Health Services Research, 56(5), 788–801. https://doi.org/10.1111/1475-6773.13694
[9]Bell, N., Hung, P., Merrell, M. A., Crouch, E., & Eberth, J. M. (2022). Changes in access to community health services among rural areas affected and unaffected by hospital closures between 2006 and 2018: A comparative interrupted time series study. The Journal of Rural Health, 39(1), 291–301. https://doi.org/10.1111/jrh.12691
[10]Center for Healthcare Quality and Payment Reform. (2024). RURAL HOSPITALS AT RISK OF CLOSING. https://chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf
[11]Health Center Patient Survey. (n.d.). https://data.hrsa.gov/topics/health-centers/hcps
[12]Community health centers’ progress and challenges in meeting patients’ essential primary care needs. (2024). www.commonwealthfund.org. https://doi.org/10.26099/wmta-a282
[13]National Association of Community Health Centers. Community Health Center Chartbook 2022. https://www.nachc.org/wp-content/uploads/2022/03/Chartbook-Final-2022-Version-2.pdf.
[14] NCQA-National Committee for Quality Assurance. (2016). Trend of uncontrolled diabetes. In DIABETES BRIEF [Report]. https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/diabetes-brief-7.pdf
[15]Teaching Health Center Graduate Medical Education (THCGME): Expanding the primary care workforce | Bureau of Health Workforce. (2024, September 1). https://bhw.hrsa.gov/funding/apply-grant/teaching-health-center-graduate-medical-education
[16]National Association of Community Health Centers (2024), Community Health Centers: Providers, Partners and Employers of Choice, 2024 Chartbook. https://www.nachc.org/wp-content/uploads/2024/07/2024-2022-UDS-DATA-Community-Health-Center-Chartbook.pdf
[17]Jiri, T. T., Mangione, T. W., & John Snow, Inc. (2023). HRSA Health Center Workforce Well-being National Data Report: Findings from the 2022 HRSA Health Center Workforce Well-being Survey. In HRSA Health Center Workforce Well-being [Report]. HHS/HRSA/OO/OAMP. https://data.hrsa.gov/DataDownload/DD_Files/HRSA%20Health%20Center%20Workforce%20Well-being%20National%20Data%20Report.pdf