On May 25, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing entitled, “A Review of Community Health Centers: Issues and Opportunities.”
In his opening remarks, Chair Ed Whitfield (R-KY) highlighted the “invaluable service” provided by community health centers. He argued that more attention should be focused on the role of community health centers in providing primary services in order to control health care costs and questioned whether there would be opportunities for expanding the program in the future. Ranking Member Bart Stupak (D-MI) called community health centers “one of the few success stories in the health care field,” and expressed his concern that future cuts to Medicaid would have an adverse effect on their ability to provide quality health care.
Administrator of the Health Resources and Services Administration at the Department of Health and Human Services Elizabeth Duke explained that community health centers “provide primary health services, including those related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology, that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives. Additional required basic health services include diagnostic laboratory and radiological services and a series of preventive health services, including prenatal and perinatal services; appropriate cancer screening; well-child services; immunizations against vaccine-preventable diseases; screenings for elevated blood lead levels; communicable diseases and cholesterol; pediatric eye, ear, and dental screenings; voluntary family planning services; and preventive dental services.” Highlighting the success of community health centers, she said that in 2003 they “provided more than 49 million encounters, 220,000 mammograms, over 1.4 million pap tests, and 2.27 million encounters for immunizations, as well as nearly 400,000 HIV tests and counseling, perinatal and delivery care for 332,000 women, and translation services to more than 3.5 million patients.”
Dr. Duke explained that the administration’s FY2006 budget called for an additional $277 million over FY2005 “to complete the President’s five year Health Centers Initiative by increasing the number of health center sites by 275 and significantly expanding 303 existing sites to increase the number of people served by 2.4 million above 2005 levels, for a total of more than 16.3 million patients.” She also noted that the budget “includes $26 million to open new health center sites in 40 of the Nation’s poorest counties and will support 25 planning grants as well,” adding, “The goal of the initiative is to leverage the success of the current program to poor counties that can support a Health Center and provide access to primary and preventive health care services particularly in poor communities that are medically underserved.”
Roderick Manifold, executive director of Central Virginia Health Services, Inc., said that high poverty rates, severe health care disparities, and lack of access to health care services “are all reasons why health centers are needed in central Virginia,” adding, “In the Central Virginia Health Services sites in 2004, for example, more than half (51%) of our patients were minorities, 30% were below the federal poverty guideline, and 31% were completely uninsured. These numbers of high need are not unusual for a community health center. In fact, in one of our urban centers, over 50% of our patients are uninsured and fully 70% are below the federal poverty guideline.” Mr. Manifold highlighted the achievements made by community health centers in central Virginia, including one center servicing Farmville and Prince Edward County: “In the mid-1980s, the Piedmont Health District serving these two localities and the surrounding counties had one of the highest infant mortality rates in the Commonwealth of Virginia. In 1985, Central Virginia Health Services, the Virginia Department of Health, and the federal government collaborated to open the Women’s Health Center in Farmville. This OB-Gyn practice started small with one physician and a tiny group of support staff. The Health Center for Women and Families, as it is called today, now provides the only obstetric services in this rural community. Our center there has two full-time OB-Gyn physicians, one full-time family practice physician, and one part-time nurse midwife doing deliveries in the local hospital and, along with a full-time nurse practitioner, they also provide virtually all of the prenatal care for the community.” He added, “While several community hospitals in Virginia have recently closed down their labor and delivery service due to skyrocketing malpractice insurance and other factors, Southside Community Hospital, with our assistance, has been able to not only keep its community obstetric program, but to make it grow and thrive. By the way, the infant mortality rate has gone down over the past twenty years and the community and its families are all the better for that positive outcome.”
Expressing his concern that Congress may cut Medicaid funding in the future, Mr. Manifold stated, “If Medicaid primary care benefits are reduced, our patients will still need those services. We will just have to use the federal grant, which is designed to serve the many uninsured patients in our centers, to ‘subsidize’ the Medicaid program and its patients. Furthermore, if Medicaid eligibility limits are lowered, and more patients are moved off the Medicaid rolls, we in health centers will still serve those patients, only they will join the ranks of the uninsured. Reductions in benefits and/or eligibility levels for Medicaid will be a real double whammy to health centers and their patients, and could well bring about drastic reductions in programs and services exactly the opposite of the goal for the President’s Initiative.”
