More funding for community health centers improves access to care

"Generally, access to care in the U.S. has been declining over the last decade," due in part to the economic recession, increased unemployment and increases in the number of uninsured adults, said co-author Stephen Zuckerman, Ph.D. of the Urban Institute's Health Policy Center.

"Increased federal funding offset some of the access decline," with community health center funding rising from $1.3 billion in 2002 to $2 billion in 2007. Zuckerman noted that the ACA will continue to expand federal funding for health centers, including $11 billion of mandatory funding for health centers between 2011 and 2015.

The study found that among the uninsured, greater health center funding in an area was associated with a low-income adult being more likely to have a "usual source of care," such as a primary care physician, and with having at least one clinic visit in the past year. Furthermore, in areas with greater health center funding, people with Medicaid were more likely to have a usual source of care and were less likely to rely on the emergency department for care or to delay seeking care due to cost.

Health centers bill insurance companies for services provided as well as offer income based fees for people who are uninsured. "Almost 60 percent of health center users had public or private insurance," a share poised to grow under the ACA, say the authors. Federal funding represents about 20 percent of an average center's income, playing a critical role.

The authors obtained access data for more than 57,000 low-income adults (ages 19 to 64) from the 2001-2008 National Health Interview Surveys. Funding details were from The Bureau of Primary Health Care's Uniform Data System.

Peter Cunningham, Ph.D., of the Center for Studying Health System Change, said that the Congressional Budget Office estimates that in 10 years, 30 million people will still lack insurance. This group will include people who are ineligible due to immigration status and those who pay the penalty for not buying coverage. And while the ACA has expanded Medicaid in some states, many doctors reject Medicaid recipients, said Cunningham, prompting these patients to turn to health centers.

In addition to primary care, community health centers provide behavioral health and dental care. Community health centers are poised to become important centers for dental care in the future, since neither Medicaid nor the policies mandated by the ACA necessarily provide it noted the study authors.

"Some people believe that with the ACA, we no longer need safety net providers such as health centers and public hospitals," said Cunningham, "That is not the case. We still need them."