By Susan Dickson
The Supreme Court decision affirming the Patient Protection and Affordable Care Act last month made clear, under law, that a vast number of uninsured Americans should obtain health coverage, one way or another, by 2014.
For community health centers, whose mission is to provide affordable primary care to everyone â€“ including those who canâ€™t pay for it â€“Â that expansion of coverage would bring many of their uninsured patients into some type of health coverage, be it Medicaid â€“ the joint state-federal insurance program for low-income Americans â€“ or health insurance subsidized under the PPACA.
But given the courtâ€™s ruling that the actâ€™s provision expanding Medicaid eligibility will be optional for states, that coverage remains somewhat in limbo.
Community health centers receive federal funding to provide care to the uninsured. When the PPACA was signed into law by President Obama in 2010, the $11 billion community health center fund was established, paving the way for the expansion and construction of health centers across the country. The funding was scheduled to be provided over a five-year period, to coincide with the increase in patients the health centers are projected to see as more Americans become insured by 2014.
And in 2016, after various provisions of the PPACA are in place â€“ including the Medicaid expansion â€“ federal funding to health centers is set to decrease, given that many health center patients would no longer be uninsured, said Benjamin Money, president and CEO of the North Carolina Community Health Center Association.
â€œMost of the patients that we would see that are uninsured would be covered by the Medicaid expansion,â€ he said. â€œThen we would need less federal funding to cover the uninsured because they would have an insurance source â€“ Medicaid.â€
However, should the state decide against expanding Medicaid, many patients will remain uninsured, but the federal funding provided to help pay for their care will no longer exist, Money said, creating a serious challenge for the stateâ€™s community health centers.
The provision to expand Medicaid eligibility would include anyone making less than 133 percent of the federal poverty level. For North Carolinaâ€™s community health centers, the Medicaid expansion would provide coverage for 40 percent of health center patients, with an additional 15 percent covered by subsidized insurance, Money said.
Given that 52 percent of their patients are uninsured, the expansion of coverage means a lot to the stateâ€™s community health centers, he added.
â€œOne of the challenges is, because the Affordable Care Act is a lot of moving parts, if you take out one of the parts â€¦ itâ€™s not going to work,â€ Money said.
An influx of patients
North Carolinaâ€™s 34 community health center organizations, with 160 sites statewide, provided care for about 450,000 patients in 2011. With the Medicaid expansion â€“ should North Carolina lawmakers opt in â€“Â and large numbers of newly insured patients, the NCCHCA expects that number to grow to nearly 800,000.
Brian Toomey, CEO of Piedmont Health, a Carrboro-based community health center organization with seven locations in the Piedmont region, said his organization has been working to expand over the past couple of years, given that demand is already so high that they turn people away each day. Fifty-nine percent of Piedmontâ€™s patients are uninsured, a percentage that would drop sharply with the Medicaid expansion.
Piedmontâ€™s Carrboro location is especially busy, Toomey said, and the organization has begun looking for a second site in the Carrboro-Chapel Hill area. That site will be needed even more as the PPACA goes into place.
â€œOur challenge is going to be making sure we have facilities,â€ Toomey said, noting that Piedmont is also ramping up its recruitment program and adding jobs.
In addition, Piedmont is focusing on strengthening its partnerships within the community, Toomey said, like those with UNC and the Orange County Department of Health.
â€œAlone, none of us can do this,â€ Toomey said. â€œWhen we leverage [partnerships], the community is much better served.â€
Money said community health centers, while not yet prepared for the projected increase in patients, will continue to provide care to everyone.
â€œAre we prepared in North Carolina? No. Will we figure it out? Yes,â€ Money said.
â€œThereâ€™s going to be some growing pains,â€ he continued. The increase in patients seeking care that theyâ€™d likely deferred for some time will inflate costs initially.
â€œItâ€™s really that built-up demand and built-up need,â€ he said, adding that further deferring care would only drive up eventual costs more.
At this point, Money said he hopes state lawmakers and others will get onboard with the PPACA.
â€œIf youâ€™ve got people that have a focus of dismantling health reform at all costs, regardless of who wins the election, if thereâ€™s a dismantling effort going on as youâ€™re trying to roll it out, thatâ€™s like trying to drive the car down the road while someoneâ€™s trying to take the tires off.â€