Health Center Federal Policy, Uncategorized

What You (And Your Community Health Center) Need to Know About Health Reform

nachc-nuggetsby Alexandra Sange

If you’re engaged in the national dialogue on health reform, you’re hearing pundits and politicians talk about the public option, Medicaid and Medicare, insurance regulation, and employer and individual mandates. If you’re plugged in to NACHC’s grassroots advocacy network updates, you’re hearing about health center growth, and payment and participation in any insurance plan. What you may not be hearing is how these things will affect you, your community, and your community health center.

Broadly, the health reform bills we’ve seen so far will do good things for your community health center, your underserved community and your family.

For you and your family: Everyone could be required to carry health insurance, either provided through an employer or purchased individually through the individual market, otherwise fines could be applied. Everyone will have a limit on the out-of-pocket costs they are required to pay for health insurance each year and, depending on income, individuals could receive subsidies or tax credits to ensure coverage is affordable. Insurance plans will be required to sell an insurance policy regardless of pre-existing conditions, and individuals will probably be able to shop for insurance through an ‘exchange’ or ‘gateway.’ This will be a virtual health insurance marketplace and it could operate nationally, by your state, or by a local entity, where consumers will be able to compare plans, benefits and costs for themselves and their family. Insurance companies that sell plans through an exchange will be tightly regulated and required to provide, at the very minimum, a basic standard benefit package that will probably include coverage for medical, dental and behavioral health services.

For your underserved community: Low income patients at your health center will have expanded access Medicaid – probably up to around 133% of the Federal Poverty Level or $14,400 for an individual in 2009, and there will be no other restrictions on eligibility. About 17 million additional people – single childless adults, children and parents – will be eligible for Medicaid benefits under the proposed Medicaid expansions. Another 16 million people who earn more than $14,400 a year but still qualify as low-income individuals will receive assistance with premiums and cost-sharing so they can afford to purchase their own health insurance through the exchange. Patients with Medicaid, Medicare and exchange insurance plans will no longer have to pay for preventive services. None of the plans will provide any health insurance coverage or assistance to unauthorized immigrants.

For your Community Health Center: Your health center will see several positive impacts from the changes proposed.

  1. Payment. Health centers will receive their enhanced Medicaid reimbursement rate for all of their previously uninsured, now newly eligible Medicaid patients.
  2. Participation. Health centers are granted “Essential Community Providers” status, which requires all insurance plans sold in an exchange to contract with all 340B entities (a broad category that all health centers fall into), in their provider networks. This ensures health centers’ participation in any current or newly created plans and guarantees that our patients, regardless of their insurance plan, have access to a community health center doctor in their neighborhood.
  3. Small Business Protection. Community Health Centers, as small businesses, will have to comply with the ‘pay-or-play’ employer mandate but many health centers will be exempt from this requirement based on either the number of people you employ or your total yearly payroll. Small businesses will receive a tax credit or other premium assistance to offset the cost of providing insurance to their employees.
  4. Growth. Most importantly, the bills that have been proposed so far greatly expand the Health Center Program, putting us on a path of growth that would allow us to serve millions of additional patients in the coming years. Whether we end up with the House bill for expansion or the Senate bill for expansion, or something in the middle, we will see dramatically increased investment in community health centers to support new centers in un-served areas, base grant adjustments for established health centers, and increased funding for expanded services and medical capacity nationwide.


  1. Thank you for your recent summary on the national health care reform issues. I publish a column on health care reform as well. Is it your understanding that Senator Baucus was referring to CHPs, because I wasn’t sure if he was talking about HMOs or CHCs. I do think that Community Health Centers or plans have lower primary care costs than the HMOs and stated that in my publication today.I too agree that this is an opportunity for the community health plans to expand.

  2. Thanks for clarifying this issue. It is important the the FQHC’s continue to be included as comprehensive providers of primary care and funded accordingly.. In Michigan, many FQHC are struggling to become financially viable, because the Medicaid recipients are assigned to a Health Plan without a carve out for the FQHC’s and other safety net providers.

  3. Thank you for clarifying the issue of health care reform. There are too many ups and downs and going around in circles whereas this health care process is concerned. People are not animals and we do need some form of health care. This is a basic neccessity in life, if anyone could determine thier destiny would we go and get sick, think about it, do one go out there and pick up cancer or hypertension to carry around as a past time or as a hobby?
    Regulations are certainly needed.

  4. This summary is so helpful, I’m going to print it off and give copies to board and staff at a Tennessee CHC where I’m training on advocacy tomorrow. Thanks!

  5. I’m in New mexico and our Medicaid coverage is already better than what is proposed. Also, there is no mention of who is going to pay for this program or how much this is going to cist businesses and the few who are paying taxes. Please elucidate if you can.

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