Community Health Centers Treating Millions More Patients

Community health centers, often beloved institutions in low-income neighborhoods, have thrown a bit of a wrench into the Affordable Care Act's efforts in increasing the ranks of the insured.

A new study by UCLA researchers has concluded that while community health centers are currently treating millions of Americans who were able to obtain insurance as a result of the ACA, many uninsured patients have apparently turned down coverage in order to continue receiving care from such facilities.

The UCLA Center for Health Policy Research examined data from the Health Resources Services Administration (HRSA) and interviewed more than two-dozen community health clinic executives for its study, which was published last week.

Researchers concluded that the ACA definitely gave a boost to the number of insured patients served by such clinics. The number of insured patients receiving care at such facilities rose from 12 million in 2010 to 16.5 million in 2014. That's an increase of 35%. In California, it rose at a much higher rate: From 1.67 million to 2.7 million, an increase of 61%.

California dramatically increased enrollment in Medi-Cal during that time under the wider eligibility guidelines instituted by the ACA. In 2010, it stood at about 7 million enrollees, but grew to about 11 million by 2014, according to data from the Department of Health Care Services.

And while the number of uninsured served by California's community clinics dipped about 24% between 2010 and 2014, it rose 12% nationwide. Most of those are undocumented immigrants, who are barred from applying for Medicaid or enrolling in most state health insurance exchanges for coverage.

“Some people felt the quality of care at their community health center was better than what a new, private provider offered,” said Steven P. Wallace, associate director of the UCLA Center for Health Policy Research and lead author of the study. “They’re sticking with the tried and true.”

Nevertheless, the proportion of uninsured being treated at community clinics in California remained high, at 27.5% last year. Although that pales comapred to the roughly 50% rates reported in Texas and Georgia – neither state has expanded Medicaid eligibility – it is still much higher than the 18.5% rate reported in New York.

The report concluded that while “the ACA has brought new resources to community health clinics,” such as federal grants to improve infrastructre, “it has also reinforced challenges, including the need for stable revenue streams, sufficient staffing support, and assistance in leveraging new reimbursement mechanisms.” The report later noted that “despite new and ongoing sources of funding...few community health clinics have contingency plans for the reduction in enhanced funding scheduled to occur in 2017, as there is no ready source of replacement funds nor any simple way to

reduce expenditures without impairing the ability to serve existing patients. Further, it

is unclear what the financial impact may be on clinics if Medicaid changes from a costbased

reimbursement to a capitation or health outcome-based reimbursement.”