Community Health Centers Serving More People Now Than Before the ACA

Community health centers (CHCs) are serving millions more people than they did before the passage of the Affordable Care Act (ACA), and the number of uninsured people they serve has declined only slightly, according to a new study. Most policy experts believed that when the ACA was passed, newly insured patients would switch to private providers to use their new health benefits, but this study shows that has not been the case.

The October 2016 Health Policy Brief, by Steven P. Wallace and colleagues at the UCLA Center for Health Policy Research, finds that most CHCs are not only retaining previously uninsured people who do not want to leave existing doctor-patient relationships, but the centers are also attracting newly insured people and treating a larger share of the remaining uninsured. Wallace, associate director of the UCLA center and lead author of the study, said some people felt the quality of care at their CHC was better than what a new private provider offered.

The study’s findings were based on interviews conducted from 2014 to 2016 with the staff of 31 CHCs in areas with high concentrations of uninsured and immigrant populations in 4 case study states: New York and California (where Medicaid was expanded), and Georgia and Texas (where Medicaid was not expanded).

The 2014 findings of the US Health Resources and Services Administration (HRSA) that the number of insured people who used CHCs nationwide increased 35% from 2010 to 2014 (jumping from 12 million to 16.5 million people) was borne out by the UCLA study: California had the biggest increase (61% increase to 2.7 million patients) and Georgia had the smallest (26% increase to 198,000 patients). HRSA data also reported the number of uninsured people who used CHCs remained high at approximately 6 million people nationwide in 2014.

In Georgia and Texas, nearly half of the people who used CHCs were uninsured, followed by California and New York, with 27.5% and 18.6%, respectively. CHCs in California alone provided care to more than 1 million people without health insurance.

The number of immigrants going to CHCs for healthcare grew 12% between 2010 and 2014, to 5.3 million. Immigrants are an increasingly large share of the people using clinics, the study reported, adding that many of them are not eligible for federal funding for health insurance coverage. In California this is an especially important issue because about one-third of CHC users are immigrants, the researchers noted.

“Community health centers are a critical—and sometimes the only—source of care for residents of California who are undocumented,” study co-author Maria-Elena Young, MPH, said in a statement.

The researchers recommend policy changes to address these challenges, including continuing core federal funding, insuring the remaining uninsured, addressing workforce challenges, and preparing CHCs for alternative payment mechanisms.

“The ACA has brought new resources to CHCs but has also reinforced challenges, including the need for stable revenue streams, sufficient staffing support, and assistance in leveraging new reimbursement mechanisms,” the study concluded.

In addition, the study authors reported that CHCs face difficulties recruiting and retaining nurses and doctors because clinic salaries are less competitive than in private industry and the researchers recommend reimbursement of CHCs for essential nonclinical services and help CHCs prepare for changes in Medicaid reimbursement policies.

The study was supported by The Commonwealth Fund.