Monday, February 22, 2010

The President's Health Reform and CHC's

Since the President’s health care reform proposal has just appeared two hours ago, there may be some items that have not come to light. But it appears that the new proposal remains a huge windfall for the Community Health Centers:

“Community health centers play a critical role in providing quality care in underserved areas. About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care. The Senate bill increases funding to these centers for services by $7 billion and for construction by $1.5 billion over 5 years. The House bill provides $12 billion over the same 5 years. Bridging the difference, the President’s Proposal invests $11 billion in these centers.”

At the same time, while Medicaid eligibility is extended, the House’s proposal that Medicaid payments rise to the level of Medicare over three years simply goes unmentioned. In other words, the uneven playing field between private practitioners seeking to give care to the poor on the one hand, and the CHC’s on the other, will become a mountainside, not a playing field at all.

In addition, the CHC’s say that they see many patients now who are uninsured. What will happen now, as many uninsured become insured, and the CHC’s can now collect from them, but they retain their giant funding? It will be a double win.

As a side note, I saw Chris Van Holland, Congressman from Maryland and the Chairman of the Democratic Congressional Campaign Committee, last week. I explained to him the inequity of funding, and how CHC’s got so much more per visit than practitioners. “I did not know that,” he said. “But the House Bill has a rise of Medicaid payments to the Medicare level,” he said. “It will never pass,” said I. Boom goes the dynamite!

Well, why are CHC’s so popular? They have their claque, to be sure. But also, think of this. The Democrats like them because they are for the poor, and they are governmental entities, essentially. Organized, bureaucratic, just like the doctor ordered.

And why do Republicans like them? Even Mike Enzi came out for them last week. I can only think, they like them because the Republicans like the idea of not infringing on the paying population. It’s two class care, very separate, and you can say that you’re doing a lot for the poor, but the waiting rooms of private practitioners won’t be cluttered with them.

But who knows? Maybe CHC’s will turn out better than I think they will. Maybe they will be so successful that they will spread to middle class medical care. But I don’t think so, tell you the truth. I’ll relate my field trip to Kaiser in a post in the next day or two – Kaiser, the great success story that health policy analysts point to – and tell you why I think they are not our future.

At least, that’s what I think today. Who knows, as I always say, I make mistakes every day, and all I can hope for is that they are not big ones.

Budd Shenkin

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