The Health Care Safety Net – going… going…
What has happened and is happening to Planned Parenthood Centers is a direct assault on the strands of the nation’s health care safety net. However, there is a very real threat to a significant amount of the “fabric” – federally supported community health centers. Almost 40% of community health center patients are uninsured. Nearly all of these patients will qualify for reduced fees. The fees that are charged are a fraction of the cost of actually providing the care (assuming they are collected). At the center nearest me, the lowest fee is $25. Nationally, the number of Medicaid and State Child Health Insurance Program (SCHIP) patients represents another 37% of health center patients. According to the association of community health centers 1 in 8 Medicaid recipients is a patient of a community health center.
Here lies the real threat to health centers and our health care safety net as people discuss cutting the budget… further. Federally supported health centers receive enhanced Medicaid reimbursement for their Medicaid patients. They get, based on their documented costs of providing care, what is known as a prospective payment system (PPS) rate – a set reimbursement per visit. This rate is capped at different levels based on whether the center is in a rural or urban location. In essence, the reimbursement allows the health center to capture a majority of their cost of providing care to Medicaid recipients. Health centers get this rate as a result of their designation as a federally supported health center.
Many private physicians do not see Medicaid patients because the reimbursements they receive do not begin to meet their overhead costs and are less than the reimbursements received by a community health center. As an aside, this is why private physicians and their interest groups go crazy over annual attempts to cut Medicare reimbursement. And they should. Unlike private practices, community health centers cannot limit the number of uninsured or Medicaid patients they see. So, a community health center is often the only option for Medicaid recipients (much less the uninsured) to receive coordinated, quality health care. The only other option is if there is a local hospital where the patient could go to the emergency room. This is not a good option for many reasons. If you have followed me this far, close to 80% of community health center patients are either uninsured, on Medicaid, or children with insurance through SCHIP.
If states limit or cap Medicaid eligibility, many health center patients who are covered by Medicaid would no longer be eligible and the proportion of uninsured patients will rise dramatically. Most of the “pie” will be the uninsured. The result will be less reimbursement to community health centers. If states reduce the benefits available for Medicaid recipients some health center services may be eliminated as a required benefit. Gone may be reimbursement for basic services such as immunizations(!), mammograms(!), or other services basic to prevention of illness and disease. And perhaps the biggest issue is if states eliminate or revise the way they currently reimburse for Medicaid services. Gone may be the PPS rate for health centers. If this were to happen health centers will essentially be in the same boat with private health care providers with the exception of not being able to limit the number of Medicaid patients. This for all practical purposes will cause health centers to implode as you can’t have nearly 80% of your patient base reimbursing either directly or through Medicaid for services significantly under your cost to provide care. Capping Medicaid, whether through state or congressional action will have disastrous consequences (think of those disaster movies where a tidal wave hundreds of feet high bears down on a city). The real scenario is hospital Emergency Departments will resemble mass disaster triage centers because there will simply be no other place to go. Don’t fall for the old trick of “block granting” Medicaid payments to the states. The astute readers of this site know that this is a dog whistle for cuts.
Many people believe budgets are moral documents. And many people think we are a moral nation. Are we? I’m not so sure anymore. I just know we can’t go down without fighting for those who are all too often forgotten and swept aside. You can let your representatives know that you know more than they think you do about how the safety net functions in this country and maintaining Medicaid and Medicare as we have known them are vital to being even a semblance of a moral nation. And if you are fortunate enough to have health insurance you can help out the uninsured and those on Medicaid by considering getting your health care at a community health center. They believe health care is a right and not a privilege. And so do I because a long time ago someone wrote we have the right to life, liberty and pursuit of happiness.