Magazine article The Christian Century

Saving Money, Saving Lives: Community Health Clinics and Obamacare

Magazine article The Christian Century

Saving Money, Saving Lives: Community Health Clinics and Obamacare

Article excerpt

AS I ENTERED the Inner City Health Center in Denver to greet director Kraig Burleson, a middle-aged Korean man suddenly appeared at the door. With gestures and limited English, he showed Burleson a homemade map indicating the clinic. Then he opened his mouth, showing several rotting teeth. The man's request for health care did not need words.

Although they haven't gotten much press, clinics like ICHC will play a major role in the health reforms launched by the Affordable Care Act. The act includes $11 billion in new funding that goes directly to clinics that serve neighborhoods where access to medical care is limited and where many people are uninsured or underinsured. The drafters of the ACA wanted to double the capacity of community health centers as early as 2015. The act has been tunneling federal money to them since 2011.

For decades, community health clinics existed on the margins of the health-care world. But now, according to Sara Rosenbaum, a health policy expert at George Washington University, they are critical to the system.

Under the ACA, community clinics will expand.

The expansion of community health centers is especially important in the 25 states that have accepted the expansion of Medicaid to people with incomes up to 133 percent of the federal poverty income level. This group includes many single people without children. By the end of March, 4.4 million people had signed up for Medicaid (a number that includes people who discovered their eligibility while seeking insurance on the exchange)--and those millions of people need somewhere to go for medical help. That's where community clinics come in.

Colorado is one of the states that has accepted the Medicaid expansion, so ICHC is poised to receive a considerable amount of new funding in Medicaid reimbursements. ICHC uses a sliding fee scale to allow patients to pay according to ability. In the case of Medicaid patients, however, the clinic can get reimbursed for care, meaning more funds will be available to serve those who remain uncovered. (It's expected that a large number of them will be undocumented residents.)

T. R. Reid, a board member of Colorado Coalition for the Homeless, said the Medicaid expansion has made an enormous difference in the free clinic that his coalition runs.

"We treat everybody who shows up. We used to be paid for 5 percent of our visits. With the Medicaid expansion, it's over 60 percent. We are using the money for a $35 million project to double the size of our health center. Our experience leads me to question why any governor would turn down the Medicaid expansion."

The financial calculus is different at Maple City Health Care Center in Goshen, Indiana, because that state rejected the expansion of Medicaid. Yet the clinic is still expecting to play a major role in the implementation of the ACA and in the future of health care. The reason? Its exemplary role in providing managed care.

In 2011, Maple City director James Gingerich received an unexpected call from the local hospital. Indiana University Health Goshen wanted to give MCHCC a brand new campus, double its capacity to serve patients, and create a long-term partnership. Even without the expansion of Medicaid, IU Health recognized that Maple City provided a model for containing costs--a model that the hospital needed to learn from.

Care at Maple City is driven by relationships with patients, Gingerich noted, whereas care at hospitals has been driven by fees. That model is changing with the implementation of the ACA.

"Instead of hospitals making money from fee-for-service, all of sudden they are getting a fixed amount to manage and cover a certain number of lives," said Gingerich. Hospitals are realizing, he said, that doctors who order lots of tests are going to drive them bankrupt. "All of these paths that used to generate more revenue are no longer going to be generating more revenue. …

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