Expand Community Health Centers to Heal The Nation
by Sanjay Kishore and Micah Johnson
A nursing home worker with diabetes. An Amazon delivery driver with high blood pressure. A hospital cafeteria worker with blood clots. These folks have two things in common: they come from the groups hit hardest by COVID, and they are patients at the community health centers where we practice primary care. These facts are not unrelated. For decades, community health centers have served the Americans who have suffered most in the pandemic—people of color, low-income families, people with chronic illness, immigrants, and frontline workers. To respond to the pandemic effectively and equitably, Congress should make a massive investment in the community health center program.
The need for action could not be greater: in the midst of the pandemic, over 80 million Americans live in areas with too few primary care providers, and tens of millions of Americans lack a usual source of medical care.
Here’s where community health centers come in. Officially known as federally-qualified health centers (FQHCs), these clinics were born during the civil rights era and now serve 30 million Americans who are mostly poor and disproportionately Black and brown. They often tailor their care towards those neglected by the rest of the health system, including those who are homeless, recently incarcerated, or who are migrant workers. They provide comparable quality of care for less cost than other clinics, and importantly, they are governed by those who they serve.
These health centers have been on the frontlines of the COVID pandemic. They have already conducted over 10 million tests for the coronavirus. And, they are now a centerpiece of the Biden-Harris Administration’s effort to ensure vaccine equity: in early data, nearly 60% of patients who have received a COVID vaccination at FQHCs are racial or ethnic minorities.
But to meet the scale of the challenges we face, FQHCs need much more support. Largely financed by federal funds and Medicaid reimbursements, clinics saw their revenue plummet when patient visits dropped early in the pandemic. Thousands of sites shut down when they were needed most. Even before the pandemic, roughly 50% of health centers reported vacancies for nurse practitioners, and over two-thirds have openings for MDs. The number one reported barrier to recruitment and retention? Lack of competitive salaries.
When it comes to rolling out the COVID vaccine, the linked problems of money and staffing have reared their head again: aside from having an adequate supply of vaccine doses, the top challenges reported by FQHCs in deploying the COVID vaccine are financial constraints and inadequate staffing to give the shots.
Congress can fix these immediate problems while laying the groundwork for a health system that guarantees primary care to all. First, Congress should immediately double the funding provided to community health centers so they can keep their doors open for the duration of the pandemic, fill staffing vacancies, and launch effective vaccine campaigns. Second, Congress should expand the community health center program both to grow existing clinics and to bring a new clinic to every primary care shortage area. Third, Congress should enact a slate of policies to strengthen the primary care workforce, including a major expansion of the National Health Service Corps program that brings newly-minted doctors to underserved areas.
In a proposal we released this week with Data for Progress called “Primary Care for All”, we call for a $150 billion investment over five years allowing health centers to support an additional 50,000 clinicians across the country to care for 50 million Americans who currently lack reliable access to primary care. For comparison, the federal government is currently projected to spend $1.6 trillion over the next five years on tax breaks for job-based private insurance. For less than a tenth of that cost, we can endow a publicly-sponsored network of primary care, attuned to the holistic needs of its community that would meet American citizens where they are and focus on walking the path to health alongside them.
The politics are also promising. Perhaps because they serve rural and low-income urban areas alike, FQHCs have enjoyed bipartisan support for decades. In the Democratic Party, President Biden campaigned on a promise to double funding for FQHCs, and the recent American Rescue Plan has already invested $6 billion to expand vaccine rollout in underserved areas; likewise, Senator Bernie Sanders has been a long-time champion of FQHCs.
The need is dire. The political opportunity is at hand. Our patients need action now.
Sanjay Kishore (@sanjaykishore31) and Micah Johnson (@MicahJohnsonMD) are resident physicians who practice primary care at federally-qualified health centers in Boston.