Health Center Federal Policy, Uncategorized

NACHC Nugget – Health Centers as Essential Community Providers

nachc-nuggetsBy Lupita Salazar Letscher

Community Health Centers are engaged as full partners in heath reform: not only as participants in the reform process, but also as guaranteed participating providers, or Essential Community Providers, in the network of insurance plans that may exist in a post-reform environment.

The House and Senate bills passed out of committee would all establish a nationwide framework under which all insurance plans would operate. The House bill (HR 3200) calls this framework an Exchange, the Senate HELP Committee calls it a Gateway. The Exchange/Gateway is intended to provide affordable and full health insurance coverage to uninsured and other individuals not covered by a large employer’s group plan. People would be able to purchase insurance through a national network of insurance plans where every available plan would have to meet certain standards, offer a basic benefit package, provide and report information to consumers and the government, and contract with certain providers. This is where Community Health Centers fit in.

Provisions in both the Senate HELP and House Tri-Committee identify 340B participants as “Essential Community Providers,” requiring that all plans selling insurance to people through the Gateway/Exchange contract with any and all of these providers who are located in their service area. As 340B participants, Community Health Centers would be among these Essential Community Providers, and our providers would be guaranteed full participation in the insurance plans offered through the  Exchange/Gateway. This is great news for health centers, and for our patients, since it would protect our communities from being redlined and ensure that individuals can receive covered care at their local health center, regardless of how their insurance may change.