Data Affirms It: Health Centers Key to Healthcare Access

Data collected from the nation's 1,300 federally qualified community health centers shows a significant rise in the number of health center patients who are covered by health insurance.

Data compiled from the first year of the Patient Protection and Affordable Care Act is starting to trickle out and it's burnishing the legacy of federally qualified community health centers as a focal point for access to healthcare in poor and underserved areas.

According to the 2014 Uniform Data System, which collects patient and healthcare information from the nation's 1,300 FQHCs, the number of health center patients with health insurance rose by more than 2.3 million, a 17% increase, while the number of uninsured patients declined by 1.2 million, a 16% decrease.

The total number of patients served rose by more than 1.1 million, a 5% increase. Since 1996, the total number of patients served at federally funded health centers has nearly tripled, from slightly more than 8 million to almost 22.9 million patients served by 2014.

The findings were compiled in a report from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative. The director of the collaborative and a coauthor of the report, Peter Shin, says the data provides a "first glimpse" of how health centers are impacting access in the first full year of federal health reform in 2013.

"If anything, it continues to show that these are very strong programs that are very effective in reaching out to low income populations," he says. "They are in these federally designated underserved communities, reaching the population that they are mandated to reach."

Shin says the data reflects both Medicaid expansion states and the 20 states that have declined to expand Medicaid. He says the collaborative will work in the coming weeks to flesh out the differences.

'A No-Brainer'
"We are just getting into the data now to look at some of the comparative numbers between the two groups," he says. "I don't have anything to show you, but we are expecting that the numbers will be considerably higher among the insured population for the expansion states versus the non-expansion states. That is a no-brainer."

Obviously, the major growth in insurance coverage can be credited to the PPACA's Medicaid expansion. Because patients at health centers tend to be poor, Medicaid accounted for 79% (1.8 million people) of the 2.3 million increase in insured patients served by health centers. The number of privately insured health center patients also rose from 3.1 million to 3.6 million, an increase of 16% and by far the greatest increase in private insurance coverage over the 1996 to 2014 time period, according to the UDS data.

"I don't want to gloss over the fact that there were also significant efforts from health centers doing outreach and enrollment for the patient populations," Shin says. "Health centers helped 10 million people get coverage in one way or another, whether it was through the health centers or through another provider. Regardless, health centers did a tremendous job. [They] are going to try to make sure patients are connected as much as possible and find a medical home as much as possible. That is one piece of the story that has helped, particularly for getting patients more educated and aware of the coverage options they may have."

Shin says it's too early to determine if the PPACA and near-universal coverage has changed the patient mix at FQHCs on a national level.

"For that we'd have to look at the Massachusetts experience," Shin says. "They only have about a 3% uninsured rate and we are finding that their health centers are still not only a provider of choice for the insured population, but they are still key safety net providers for the uninsured and now serve about one-in-two uninsured in Massachusetts, which is about double what it was before health reform up there."

Shin says he expects those story lines to vary among Medicaid expansion states as the PPACA rollout continues to change the coverage landscape.

'A Significant Economic Boost'
"Obviously it will be more or less the status quo for non-expansion states," he says. "In expansion states we are going to find a tremendous boost in access, which will impact disparities in heath and which will impact local economies as well. We are going to see a lot of this play out over the long run as a real major advantage coupling not only Medicaid expansion but these investments in health centers. That is going to be tremendous boost for the local economies."

While the collaborative report does not address the economic impact of the Medicaid expansion, Shin says the community benefit is apparent.

"It is an $18 billion program, and we are just talking about expenditures," he says. "That is going back to the communities and reflects some of the new jobs, because obviously they have hired new people. We are talking about a significant economic boost or a lot of these economically disenfranchised communities."

"People forget there were also significant investments in health centers under the ARRA (American Recovery and Reinvestment Act), where they were trying to create more jobs in health centers and did just that," Shin says. "They were reaching out to the people who normally would not be afforded that opportunity. Health centers are trying to affect not only the daily lives of the population but also providing some opportunities. A lot of the hires are from the communities. A lot of doctors who have been trained in underserved communities come back."

Shin says the UDS data prompts follow up questions, and the collaborative will spend the next few months looking for answers.

"We will look at access issues to see if health centers might have the appropriate staffing levels given that they have significant recruiting and retention challenges in these isolated communities," he says.

"We are going to look at impact on quality, the changes that are affected by having patients who are now newly converted to being insured; to what extent they are seeing sicker patients or might be able to move the dial on making the general patient population a lot healthier. We have quite a few things to look at in terms of operations, performance, quality of care, financial and economic impact. We will look at all of these sectors. We will be able to tell a lot from this data."