Skip to main content

Cuts to Community Health Centers Hit Rural Americans Hardest

 |  By John Commins  
   March 21, 2012

The federal government's decision to withhold about $600 million in funding for primary care community health centers will have a disproportionately hard effect on rural Americans.

More than 90% of the 20 million people who are served by health centers have incomes that are below twice the federal poverty level. And about 48% the of the nation's 8,100 federally funded community health centers serve rural communities. People in rural areas tend to be older, poorer, and sicker than their urban counterparts. They also tend to have fewer healthcare options and more difficulty accessing healthcare than people in urban areas.

About one-in-seven rural Americans gets their care from a community health center.

With that in mind, it's troubling to see the ambitious plan to double services and access from 20 million people to 40 million through community health centers waylaid by the budget battle, even though the need is growing.

Last year, for example, communities across the nation submitted 1,900 health center grant applications for new sites or services to the Health Resources and Services Administration, which oversees the program, but only 67 applications were approved because of funding shortages.

This seems remarkably short-sighted when almost everyone, regardless of their political leanings, understands that access to primary care, preventive medicine, and disease management are cost-effective alternatives to acute episodes that require hospitalization.  

A report from the National Association of Community Health Centers notes that a lack of access to primary care services and other barriers to healthcare lead invariably to poor health outcomes. That, of course, creates higher healthcare costs as uninsured or underinsured patients—or insured patients with few primary care options—go to the emergency room for non-emergency care. 

Dan Hawkins, senior vice president for policy and research at NACHC, says the grant money, which can be as much as $650,000 per site, typically accounts for about 20% of the operating budget for most community health centers.

"It is the foundational support. It is what allows them to go out and hire staff and secure a facility to begin providing services," Hawkins tells HealthLeaders Media.

"Every payer reimburses after the fact. The rest of it comes from Medicare/Medicaid, private insurance.  About one in six health center patients has private insurance, some state and local support, philanthropic support, and even money from the patients themselves. But the health centers can't get any of that until they're able to get the ball rolling. That is what the grant does. It gives them the ability to get off the ground and get going," he says.

Hawkins says that community and rural hospital leaders "should be working overtime to help make these health centers operational."

He says rural hospitals and other providers should view community health centers not as competitors, but as partners in delivering care. Frequently, hospitals can provide transportation to care, or make home healthcare visits to better monitor patients, or translator services.

"Health centers don't exist to compete with hospitals. They exist to cooperate and partner with hospitals," he says.

For example, health center clinicians are required to follow their patients into the hospital as part of the continuum of care. "That means for a rural hospital [that] additional clinical staff will be adjunct, but with admitting privileges," he says.

While 40% of health center patients are uninsured, the remaining 60% of patients do have some form of coverage, "so for the bulk of patients who rural health centers serve there is a payer source for those patients if they need to be admitted or they need an MRI," he says.

"Secondly, because the health centers are there and generate business for hospitals, they have literally helped to keep hospitals open and they've done the same for nursing homes," he says. "They are often adjunct staff for rural nursing homes who will visit patients in the hospital to provide care and they help to keep things functioning."

"Thirdly, health centers have formed partnerships to secure other kinds of funding for home health agencies and visiting nurses and other kinds of partnerships with hospitals," he says. "So whether it's from a business perspective, from a let's-keep-the-doors-open perspective, or a partnership perspective there are many reasons why rural hospitals should support the opening or rural health centers."

The NACHC report notes that rural counties with community health centers had 25% fewer uninsured in the emergency room for ambulatory care sensitive conditions, compared with counties without a health center.

"Most importantly even if that rural hospital has an emergency room, who wants to see it crowded with people who don't need to be there but they don't have anywhere else to go?" Hawkins says.

The study also found that community health centers generate about $5 billion annually to rural communities through employment and supplier purchases.

It is hard to say if Congress or the White House would respond to a concerted effort by rural healthcare providers to call for the reinstatement of funding levels for community health centers.

But it's not a hard argument to make or to grasp. Rural healthcare providers should make the case for community health centers even if our elected representatives seem immunized against calls for logic and common sense.

It's in everyone's best interest.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Tagged Under:


Get the latest on healthcare leadership in your inbox.