Senate Bill May Bring Breakthrough for Community Health Centers

By:  John Reichard, CQ HealthBeat Editor
Congressional Quarterly

Tales of crankiness abound on Capitol Hill as Christmas Eve approaches and the Senate remains in session, but Senate staffer David Reynolds was practically giddy with good cheer when reached by telephone Tuesday morning. That’s because the Senate appears to be on the verge of voting to approve a dramatic expansion of community health centers — which could bring badly needed health services to thousands of medically underserved communities across the United States over the next several years.

Asked about the coming vote, Reynolds, the senior health policy adviser to Sen. Bernard Sanders, I-Vt., chuckled in disbelief. “ Oh, we’re very excited,” he said. “I started the first health center in Vermont 35 years ago and never in my wildest dreams imagined we’d be talking about covering 45 million Americans.”

A provision secured by Reynolds’ boss in the Senate health care overhaul bill (HR 3590) would add $10 billion in funding to community health centers, apart from the expanded insurance coverage the legislation would provide. The House-passed bill (HR 3962) allots $14 billion, so any House-Senate conference is likely to bring sharply expanded funding thanks to late negotiations by Senate Majority Leader Harry Reid, D-Nev., to win a “yes” vote from Sanders on the overhaul.

Forty-five million — or thereabouts — is the figure people typically use when they talk about the number of uninsured in the United States. But Reynolds was talking about something else when he used the 45 million figure — the number of people who would get care at community health centers under the legislation.

About 20 million Americans are treated at the centers now, Reynolds said, and the overhaul would add another 25 million, bringing the total to 45 million. Reynolds also said 60 million Americans live in medically underserved areas such as rural America and the inner cities, so the overhaul could do much to fill unmet need for primary care.

Because many Americans live in parts of the country where health care is scarce, expanded insurance coverage alone won’t get the job done, he noted. The centers currently treat both the uninsured and the insured but there aren’t enough of them. Expansion of community health centers works hand in glove with expanded insurance to ensure access to actual care, Reynolds said.

Reynolds also emphasized that the centers are a good value.

In areas that have centers, health care spending per year on people who use centers is $1,000 per year less than for people who don’t because “it gives them an access point” to get care promptly and avoid the need for costlier care later, he said.

Reynolds pointed to a George Washington University study that says spending $14 billion on community health centers and the National Health Service Corps over the next five years would save $23 billion in Medicaid costs alone. “So it’s, what’s not to like, you know?” he said.
The corps, which pays many of the medical education costs for doctors, dentists and nurses who agree to practice for a period of time in underserved regions, accounts for about half of the staff delivering treatment in community health centers.

“We’re talking about covering 30 million people with insurance for a trillion dollars over 10 years,” Reynolds noted. “Look what we’re going to do with $14 billion over five years for 25 million Americans who are going to have access to primary health care that they don’t currently have.”

It’s an apples-and-oranges comparison because the centers don’t provide hospital care. But Reynolds emphasized that the centers reduce the need for costly hospital care. They are “required to have 24-7 response capability” and that “reduces emergency room use,” he added.

A self-avowed socialist, Sanders may seem like a wild-eyed radical to some, but community health centers got strong support from Republicans in the Bush years as well as from Democrats. Reynolds, who wrote his dissertation on the broad political support the centers enjoy, noted that liberals like them because they “empower communities” and conservatives like them because they acknowledge that there are areas where market forces don’t work and that the centers plug the gap.

President George W. Bush did much to bring federal appropriations up to their current level of $2.2 billion a year. The overhaul legislation would layer on a guaranteed stream of funding over five years of up to $14 billion. Sanders, of course, would prefer that number, which was negotiated in the House by Democratic Whip James E. Clyburn of South Carolina.

Reynolds said the added funding would bring either a center or satellite clinic to 10,000 more communities across the United States, up from 7,500 now. The money in the House bill is for operating expenses, but the Senate language provides $1.5 billion for construction costs. In many instances, however, communities are able to convert existing space into centers or doctors get grants to convert their offices into community health centers, Reynolds said.

Of the $14 billion in the House bill, $1.75 billion over five years would go to expand the National Health Service Corps, more than doubling its current yearly budget, he said.