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Op-ed: Health centers can’t replace Medicaid expansion

By Alan Pruhs

First Published Jul 25 2014 05:02 pm • Last Updated Jul 25 2014 05:02 pm

While our policy makers continue to debate Medicaid expansion, Utah’s 13 Health Center organizations struggle to meet the needs and demands of our existing uninsured patients. Some have suggested that Utah does not need Medicaid expansion based on the work of Health Centers. We do not agree. We know expansion is vitally important to the health and well-being of low-income families and to Utah’s economy.

In order to understand our position, it may be helpful to understand our structure and the role we play. Utah’s 13 Health Center organizations operate 40 clinics across the state. They are the medical home for approximately 128,000 Utahns, providing more than 415,000 medical, dental and behavioral health visits annually. They are a part of a 45-year-old national grant program administered by the Federal Bureau of Primary Health Care — The Health Center Program — that currently serves more than 21 million Americans at over 8,000 clinic locations across the country. While the federal Health Center Program provides a base grant to the centers, we are not federally owned nor operated. Health Centers are community owned, not-for-profit entities governed by patient majority boards – allowing centers to remain responsive to community needs. Health Centers are not free clinics. They accept most forms of insurance and offer discounted fees to low-income, uninsured patients. Uninsured patients below poverty level pay a nominal fee and are not turned away based on an inability to pay.

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Utah’s Health Centers struggle financially to meet the needs of our uninsured patients. In 2013, Utah’s Health Centers provided over $44 million in care to uninsured patients — $22 million of which was not covered by federal grants or discounted patient fees. Health Centers operate best when they serve a balanced mix of insured and uninsured patients. Utah’s Centers provide care to nearly twice the percentage of uninsured patients than the national average, yet we receive similar base grant funding as our national colleagues. This funding shortfall causes extreme fiscal fragility and limited access to care. A new study from the Milken Institute at George Washington University estimates that because Utah has refused to expand Medicaid, Utah Health Centers will lose out on approximately $16 million in increased revenue in 2014 alone - revenue that would translate directly into additional health care jobs, tax revenue and expanded services such as dental benefits that are not currently covered.

Of utmost importance is the impact expansion would have on health and well-being of our patients. While we were able to provide a medical home for 70,000 low-income uninsured Utahns, most of Utah’s Health Centers are full. We do not have the financial means to expand access to additional patients. Further, our existing uninsured patients struggle to make nominal payments and often place their immediate family needs in front of their own health. As a result, they do not come in for needed preventive care and many end up with worsening conditions or costly hospitalizations that could have been prevented. Lastly, the scope of services provided by Health Centers is limited to primary and preventive care. Only Medicaid expansion can provide the specialty and hospital care that our patients need.

While we are flattered by the notion that Health Centers can meet the health care needs of Utah’s low-income uninsured, the simple fact of the matter is that we cannot. We lack the fiscal and physical capacity to do so and the scope of our services is limited to primary and preventive care. Medicaid expansion would provide funding necessary to build our infrastructure to serve more patients and would cover the full spectrum of health care needs for our patients. Simply stated, Medicaid expansion will lead to healthier communities and a healthier economy. It’s time to recover a portion of the federal taxes we already pay and expand Medicaid now.

Alan Pruhs is executive director of the Association for Utah Community Health.




Copyright 2014 The Salt Lake Tribune. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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