This analysis was prepared by Venable, LLP, on behalf of AACOM.

Witnesses:

Amanda Pears Kelly, Chief Executive Officer, Advocates for Community Health, and Executive Director, The Association of Clinicians for the Underserved

Ben Harvey, Chief Executive Officer, Indiana Primary Health Care Association

Robert S. Nocon, Assistant Professor, Kaiser Permanente Bernard J. Tyson School of Medicine

Sue Veer, President and Chief Executive Officer, Carolina Health Centers

Jessica Farb, Managing Director, Government Accountability Office

Summary Notes:

• The Government Accountability Office (GAO) recently released a report illustrating how community health center (CHC) revenue sources and amounts have changed from 2010 to 2017. Overall, revenue for health centers more than doubled, moving from $12.7 billion to $26.3 billion Furthermore, the GAO report shows that health centers have become less dependent on grants as revenue from Medicare, Medicaid, and private payers has increased. Ranking Member Bill Cassidy (R-LA) requested that the GAO update its report to reflect more recent data.
• CHCs provide high-quality, cost-effective care, saving the Medicare and Medicaid programs an estimated $25.3 billion in 2021. For every dollar invested in CHCs, three dollars are returned. CHC patients have lower rates of multi-day hospitals, hospitalizations, hospital admissions, lower rates of specialty care visits, and lower numbers of occupied inpatient beds. Research has shown that CHC patients have about 24% lower overall costs than patients receiving primary care in other medical settings.
• CHCs are a crucial tool in addressing the rural healthcare shortages the U.S. is facing. Between 2010 and 2021, 136 rural hospitals closed. Research has shown that in areas previously served by a rural hospital, there is a higher probability of community healthcare delivery sites post closure. CHCs are filling in the gaps left by rural hospital closures. Moreover, the witnesses testified to the fact that CHCs usually deliver healthcare to patients regardless of their ability to pay or insurance status. This is particularly vital for rural populations who tend to be poorer, more medically complex, and un- or underinsured.
• CHCs’ rapid growth has greatly outpaced funding. From FY2015 to FY2021, total CHC funding increased by 11% while the number of patients served increased by 24%. Similarly, in 2021, community health centers reached a record 124 million. Without more economic support, CHCs will be unable to maintain the quality of care they currently provide. Medicaid unwinding is expected to lead to a $2.5 billion funding loss for CHCs and the expiration of the American Rescue Plan funds will lead to a 7% decrease in CHCs’ bottom lines. 92% of CHCs surveyed said that they would have experienced additional staff turnover without the funding included in the American Rescue Plan.
• The foundation of CHCs’ quality care is their integrated, interdisciplinary workforce, and that CHCs proudly serve as the training ground for the country’s primary care workforce. To recruit, train, and retain workers, CHCs leverage HRSA healthcare workforce scholarships and education loan programs which help train a diverse workforce, including the National Health Service Corps, and the Teaching Graduate Medical Education Program. Many CHCs serve as rotation sites for physicians and nurses to train and administer care in rural areas. Ms. Veer found success providing living stipends to second year residents in exchange for a commitment to a four-year service agreement. Mr. Harvey suggested that increased federal funding would allow CHCs, especially those located in rural communities, to hire more staff by allowing CHCs to provide lucrative wages and employment benefits. Witnesses testified to the fact that it was important to expand training opportunities in rural areas, and that this is the best method to get young physicians to stick around in these communities.
• Overall, CHCs received bipartisan support from virtually every member of the Senate Committee on Health, Education, Labor, and Pensions. Republican Senators, however, were skeptical that simply increasing funding for CHCs would be an effective solution to increase access to care. Republicans also voiced concerns around the ability to pay for increased funding to CHCs.