Examining President Bush's Expansion Of Community Health Clinics

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President Bush will leave office "with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas," the New York Times reports.

According to the Times, "Bush came to admire the missionary zeal and cost-efficiency of the not-for-profit community health centers" as governor of Texas. In 2001, Bush proposed opening or expanding 1,200 clinics over five years, which he did, and proposed doubling the number of patients served at the centers. The number of people receiving services at the centers actually has increased by about 60%, according to the Times. This expansion reflects the largest since the program was launched during President Johnson's war on poverty, the Times reports.

"Despite the ... unprecedented growth" of these clinics, "wide swaths of the country remain without access to affordable primary care," and the economic recession "has only magnified the need as hundreds of thousands of Americans have lost their employer-sponsored health insurance along with their jobs," according to the Times. "Many centers are finding that federal support is not keeping pace with the growing cost of treating the uninsured," the Times reports.

According to the Health Resources and Services Administration, government grants currently account for 19% of clinic revenues, compared with 22% in 2001, and the Times reports that the largest revenue sources are government-sponsored programs such as Medicaid, Medicare and SCHIP, "making the centers vulnerable to government belt-tightening." In addition, nationwide staffing shortages "have reinforced concerns" about the quality of care at the clinics, while securing follow-up appointments with specialists for uninsured or low-income patients with chronic diseases creates a "deeper frustration" at the centers, according to the Times.

In response to the growing need, congressional Democrats are proposing to increase federal funding of the clinics, effectively "making the centers a likely feature of any health care deal struck by Congress and the Obama administration," the Times reports. Although President-elect Barack Obama "has said little about how the centers may fit into his plans to remake American health care," he was a sponsor of a Senate bill in August 2008 that would have quadrupled federal spending on the program from $2.1 billion to $8 billion, the Times reports.

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Obama's nominee for HHS secretary, former Senate Majority Leader Tom Daschle (D-S.D.), also has expressed support for the centers. According to the Times, if Obama's plan to overhaul U.S. health care, which is estimated to cost more than $100 billion, "runs into fiscal obstacles, a vast expansion of community health centers may again serve as a stopgap while universal coverage waits for flusher times" (Sack, New York Times, 12/26/08).

Editorials

* Chicago Sun-Times: Bush deserves "at least one pat on the back" for doubling federal financing for community health centers over the past eight years, a Sun-Times editorial states. More than 7,000 community health centers serve more than 16 million U.S. residents, according to the Sun-Times. The Sun-Times continues, "In many areas, these clinics are the only provider of vital services, including prenatal care, immunizations and cancer screenings" and "the clinics keep patients out of far costlier emergency rooms." In addition, the editorial notes that "[s]tudies also have shown that the clinics help reduce racial and [ethnic] disparities in medical treatment."

The editorial continues, "The clinics are by no means the solution to the nation's health care woes " but "are an important safety net, serving one of every three poor people and one of every eight uninsured people." The Sun-Times continues, "We believe that outsourcing non-urgent medical problems to neighborhood clinics ... is good health policy," adding, "If done right -- a big if -- these clinics can provide quality care and help contain the escalating costs of medicine that burden all Americans." The editorial concludes, "On this one, President Bush got it right" (Chicago Sun-Times, 12/28).

* New York Times: Bush can "lay claim to some signal achievements in health care -- achievements that we urge President-elect Barack Obama to continue and develop further," a Times editorial states. According to the editorial, Bush's decision to pursue the Medicare prescription drug benefit was "remarkable," as Part D has become "the largest expansion of Medicare in decades and it dragged the program, at long last, into the modern medical era, in which drugs are a cornerstone of treatment." The Times continues, "Less heralded was the Bush administration's willingness to grant Massachusetts a Medicaid waiver to redeploy federal funds to help start a universal health insurance program," adding that the program "by many measures is off to a promising start and could become a model for other states." According to the Times, "Another substantial health achievement came in the form of bricks and mortar, through the president's vigorous support of community health clinics."

The clinic program "has its blemishes," but for "many residents of poor urban neighborhoods and isolated rural areas, this is the only source of care other than possibly a costly hospital emergency room," the Times states. However, the editorial continues, "Bush has done almost nothing to shore up the public insurance programs, notably Medicaid and [SCHIP], that provide the bulk of the clinics' funding through the patients they cover." The editorial concludes, "That is another reminder that despite these solid achievements, the country needs to do a lot more," adding, "It needs full-fledged health care reform that will improve the quality of medical care, reduce its overall cost and provide insurance for everyone, at affordable prices" (New York Times, 1/3).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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