Today two House Committees are taking the first step in the long process of considering proposed changes to our health care system. On behalf of the 25 million patients served by the nation’s more than 1,400 community health centers, we want to thank members and leadership of both Committees for their longstanding, bipartisan support for health centers and our mission and model of care, and for their ongoing willingness to work collaboratively with us on issues facing the patients of our health centers.
In that spirit, NACHC offers the following feedback on the Committees’ legislation.
More than any other public program, the Medicaid program is critical to health centers’ ability to serve the millions of Americans who depend on us – just under half of all health center patients are covered by Medicaid, and adequate Medicaid reimbursement is essential to helping health centers maintain current service levels nationally. Health centers share the Committee’s stated goal of increasing value within the Medicaid program—indeed, a host of recent independent studies have found that Medicaid patients served by health centers lower by at least 24% the total costs of care when compared to those served elsewhere. The bill makes two major changes to Medicaid that give us cause for concern. In these areas especially, we would like to work with policymakers to make improvements.
First, the bill would phase out the Medicaid expansion, which has thus far been adopted by 31 states and the District of Columbia. Between 2013 and 2015, the period during which the expansion took effect in most states, the number of health center patients covered by Medicaid increased by more than three million. If that coverage goes away, health centers will struggle mightily to continue serving these patients, but will endeavor to do so, because that is our mission. Without coverage, however, our patients will face dramatically diminished options for needed specialty care and other services. What’s more, the loss of reimbursement for services will both limit health centers’ capacity and place a greater burden on federal grants designed to support operations and care for the uninsured. That is why NACHC would like to work with policymakers to ensure that the millions of health center patients who have gained the security of health care coverage don’t lose it, and that any coverage proposal continue the cost-effective primary and preventive services that those patients have today.
Secondly, we are concerned about the implications of the bill’s provisions changing the underlying structure of Medicaid to a capped federal contribution. Our concern is that placing a cap on payments to states does not incentivize a move toward higher-value care—or higher-quality care—it incentivizes cuts. It is difficult to envision how this proposal will not result in states having to lower eligibility, restrict covered benefits, or reduce provider payments. Each of these outcomes would prove damaging to patients, the health of the entire community, and health centers—a fact we urge policymakers to consider as the process moves forward.
Today’s Committee markups represent the first steps in what should be a robust and ongoing debate—with extensive stakeholder input—over the future of health care in America. As the voice of underserved patients and communities nationwide, America’s health centers look forward to working with policymakers as these deliberations move forward.