Geiger Gibson / RCHN Community Health Foundation Research Collaborative, issuing body.
Geiger Gibson Program in Community Health Policy, issuing body.
George Washington University, issuing body.
Milken Institute School of Public Health. Department of Health Policy, issuing body.
[Washington, D.C.] : Milken Institute School of Public Health, George Washington University, June 19, 2014
Early data indicate that implementation of the Affordable Care Act (ACA) has bolstered health insurance coverage for millions of Americans through enrollment in health insurance marketplaces (exchanges) and Medicaid expansions. An important challenge is to ensure that the capacity of the health care system is sufficient to care for both the newly insured, as well as those who remain uninsured. The Health Resources and Services Administration estimates that 60 million Americans already live in areas with too few primary care providers. Primary care shortages are expected to deepen in coming years, due to overall population growth, aging of the Baby Boomers and the health insurance expansions. Community health centers represent a key safety valve to help guarantee access to care, particularly for those with lower incomes. This brief estimates the effect of federal and state policy decisions on the capacity of community health centers to meet future health care needs, particularly: (1) the level of federal grant funding for community health centers and (2) whether states expand Medicaid coverage. The ACA provided $11 billion in "mandatory" funding which augments discretionary appropriations for Section 330 of the Public Health Service Act (the health center program), but this mandatory funding authority is set to expire after September 30, 2015, creating a potential funding cliff. When the ACA was enacted, it was expected that all states would implement a Medicaid expansion, but a Supreme Court decision gave states the option to expand Medicaid. Both these factors affect future health center revenue and patient capacity. This update of our November 2013 report uses more recent data and estimates the number of patients who could be served in health centers in 2014 and 2020, depending on the outcome of key federal and state policy decisions: whether to support health center funding (either through a continuation of mandatory funding or an increase in discretionary appropriation levels) and state implementation of Medicaid expansion. We estimate the effect of current FY 2014 funding and state Medicaid expansion decisions on changes in patient caseloads from 2012 to 2014. We then illustrate the projected impact of federal and state policy decisions on 2020 patient caseload, considering multiple scenarios: (1) high vs. low federal health center funding after 2015 and (2) about half the states expanding Medicaid (as currently) vs. all states expanding Medicaid. The "high funding" scenario assumes that total federal appropriations remain sufficient to allow for continued support for health center growth through a continuation of mandatory funding and/or higher appropriations levels. The "low funding" scenario assumes that total federal funding is held at the level of discretionary appropriations in 2014 alone, and does not rise after the loss of mandatory funding. The final policy decisions may be different, but these illustrate the range of choices and consequences. We also compare the current scenario in which about half the states expand Medicaid vs. one in which all states expand by 2020.
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