Maria-Elena Young is a graduate student researcher at the Center and lead author of a new policy brief about how federally qualified health centers, also called community health centers (CHCs), formed partnerships to expand coverage to the uninsured. CHCs are the main providers of health care to 25 million low-income and uninsured people in the U.S. In this brief interview, Young discusses how partnerships increased CHCs' capacity to serve patients and how ongoing attempts to repeal and replace the ACA may undermine these efforts.
Q: Community health centers gained under the Affordable Care Act. What do they face if the current administration repeals the ACA? How will forming partnerships help?
A Congressional Budget Office report estimated that 19 million Americans would lose their Medicaid coverage by 2026 if the ACA's Medicaid expansion is repealed. Nationally, most CHC patients are insured through Medicaid — including the Medicaid expansion — and the revenue from insured patients allows CHCs to serve those who still lack insurance. So, the loss of Medicaid funding under an ACA repeal is a major threat to CHCs and the people that they serve.
Partnerships could never fill in the gap, but our findings suggest that CHCs and their partners are a key line of defense for protecting safety net services in the health care system. For example, as highlighted by the advocacy work being done in New York State, CHCs around the country are active in making the case for health care funding and speaking up for their patients. We also saw that non-CHC partners, from hospitals to foundations to local government, recognized the value of funding and supporting infrastructure for CHC-led primary care services.
The more momentum there is to make CHCs integral to the overall health care system, the more support, funding and political will there is to ensure that CHCs and their patients are not thrown under the bus to fund tax breaks for the wealthy.
Q: Instead of competing, your policy brief talks about how some community health centers found success by sharing and collaborating with other CHCs, hospitals and governments. What are some main results?
Community health centers are mission-driven, which means that they seek partnerships that are not only good financially for their organizations, but that will have the most beneficial impact for the people that they serve. While our results show that CHCs were incentivized to partner with others to support their organizational well-being, they were also driven by their mission of making health care available to everyone. We heard over and over again how important it was to find partners that share the same mission to serve the underserved. To make this happen, it was critical to have the opportunities — and the resources — to build relationships with like-minded organizations.
That said, however, CHCs often have limited budgets for relationship building, so partnerships with non-CHCs, such as hospitals or health departments, were the most successful and most easily facilitated when potential partners had a common challenge that benefited from a team approach. CHCs spent time and resources educating potential partners. Our findings are a reminder that individuals and organizations in other parts of the health care system could support building CHC partnerships.
Q: If the ACA is left in place, what is the outlook for CHCs? Can the federal government still cut funding?
If the ACA is left in place, we may see more states expand Medicaid. This would benefit both CHCs and their patients, whether insured or uninsured. The remaining uninsured would have better access to primary care and any needed specialty care. Also by increasing insurance revenue, CHCs can direct resources towards other aspects of their work, such as preventative services or quality improvement, instead of having only enough funding to cover the costs of care for the uninsured. Furthermore, it means more opportunities to expand partnerships. The flexibility in both staffing and financial resources is essential to give CHCs the organizational capacity to develop the innovative types of partnerships that we examined in our policy brief.
The other scenario is that the ACA remains in place but is undermined in order to wreck the program. If that happens, CHCs will be more crucial than ever to handle the overflow of patients needing care.
Regardless of what happens, CHCs receive funding from the Community Health Center Fund that needs reauthorization from Congress. CHCs have historically had bipartisan support, but CHCs and their partners will continue to have to work to ensure that this funding is maintained.
They have to make the case that their services are critical regardless of what health coverage system we have in place.