Community health centers are a critical piece of the state’s safety net. They provide medical care to more than 60,000 uninsured and underinsured residents.But a recent report found that they live on a financial edge. And our worsening economy is threatening their viability.
NHPR’s health reporter Elaine Grant has the story.
OPEN: Baby cries, little kid: I want to go home. Fade under:
EG1: We’re in the waiting room of the Manchester Community Health Center, and clearly this little boy would rather be somewhere else.
But the roomful of adults waiting to see doctors and nurses are, presumably, pretty happy to be here.
This clinic, like the other 8 federally qualified community health centers in New Hampshire, provides care to anyone who walks in the door, whether they’re insured or not.
DOCSOUND.WAV: Doc checks patient.
EG2: This health center seems no different than any big medical practice – it’s bright and airy and provides high quality health care.
It’s doing well.
But most community health centers are in trouble.
Their margins – how much cash they have left over after paying expenses – are at or near zero.
Some are so financially unstable that if they were to receive no revenues for 10 days, they’d run out of money.
That’s not news to the health center community.
For the last five years, they’ve been struggling to make ends meet as rising health care costs and shrinking revenues chip away at their funds.
In fact, state Medicaid director Katie Dunn was quoted in Foster’s Daily Democrat as saying that one or two centers may have to close in five or ten years.
She was unavailable for this story, but Ann Peters say Dunn’s prediction is optimistic.
Peters runs Lamprey Health Care, a system of three clinics in Nashua, Newmarket and Raymond.
APSHUTDOWN.WAV: [It’s gonna happen a lot quicker than that. It’s not going to take 5 or 10 years. There are many community health centers that are on the edge, have approximately 20 days cash on hand. Some of them are down to less than 10. That’s a very very difficult place to be.] 17 seconds
EG: Community health centers no longer fit that old image of care provided by volunteer doctors in the church basement.
Today, they are so-called medical homes for patients who get not only their primary care here, but all sorts of other care as well – from ob-gyn to substance abuse treatment to dentistry.
SOUND: LAMPREYDOCSOUND.WAV [Ambient…”Your 3:20 is here, etc. etc.” Bring up EG.]
EG: MariEllen Durso is the site director at Lamprey’s Nashua health center.
During a recent tour, she tells me how their care for pregnant women goes far beyond scheduling ob gyn appointments.
LAMPREY.TOURSOUND.WAV [FADE IN UNDER EG ABOVE]: They see the midwife, they see the doctor, and BRING UP she sees them and does what’s called a psychosocial assessment. How are things in your life? Helps them get on WIC. Maybe finds out there was violence in the home, connects them with Bridges, maybe finds out that there was some other stressors that they needed support with, or they just needed somebody to talk to. 29 seconds
But it’s getting harder and harder for Lamprey and other community health centers to keep up with the need.
In New Hampshire, the number of uninsured patients flocking to community health centers has increased 5 % every year for the last five years.
In Nashua, 64% of the center’s patients have no insurance.
And while state by state data doesn’t exist, the Commonwealth Fund says that the number of underinsured adults nationwide has jumped 60% since 2003.
The Nashua health center’s Mariellen Durso:
NEWLYPOOR.WAV: [The other thing you see in times like this is you see people that are newly poor.]
TWISTANKLE.WAV: [I’ll not forget there was a woman who recently came to our front window and we have a nurse there and she had twisted her ankle on Saturday night and this woman was insured her whole life but because of her personal economic situation had to let the insurance go and she was petrified, she was so distressed! …Maybe if the economic times were different, she wouldn’t have been in that circumstance. ] 30 seconds
Today, the Nashua center serves 4,500 patients, and is adding 100 new ones each month.
Many of those patients are delaying health care as long as possible – and so they’re coming in sicker.
And, says Durso, a severe shortage of doctors and nurses is making matters worse.
MEcompetitive.wav: [It’s just incredibly competitive. I’ve been doing this for a lot of years now and I would think back in the early 90s it maybe 6 months to nine months and it’s at least double that now to hire a primary care physician.] 16 seconds
EG: As a result, wait times for new patients are getting longer – at a time when there are more new patients than ever.
At Lamprey, a new patient will wait close to four months to see a provider.
In a way, community health centers are victims of their own success.
Lamprey’s director Ann Peters says every time they see a new uninsured or Medicaid patient, they lose money.
Ann Peters:
APEXIST.WAV: [That’s why we exist, so we can’t look at that as a problem. That’s why we exist. We’re a safety net. We’re here for that. So the problem has to be, how do we get the revenues to support it?]
Dr. James Squires is the president of the Endowment for Health.
He agrees that one or more health centers will fail unless the state comes up with a new way to generate revenue.
And, he says, if a center should close, insurance premiums for people in that region will likely rise.
SQUIRES.UNINSURED.WAV: [Those uninsured patients will now be going to the local hospital, and the local hospital will turn around, with some justification, in a year or two and say look, our uninsured rate has increased, we need more premium dollars from those that are paying, to cover this burden of the uninsured.] 20 seconds
Community health care centers are a link – a weak one -- in the complex machinery of the entire health care system.
James Squires likens them to a gear in a watch.
SQUIRES.WATCHGEAR.WAV [It may be a little gear, but if it collapses, the whole system collapses.]4 seconds
But community health centers have been threatened before and survived.
Advocates for community health centers are looking for relief on federal and state levels.
They’re hopeful that an expansion of the Children’s Health Insurance Program, or S-CHIP, will help.
And they’re pushing to protect existing state grants.
In the meantime, they’re holding their breath that state budget cuts expected on Friday won’t do any more harm.
For NHPR News, I’m Elaine Grant.
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