Editor’s note: This is the first installment of an ongoing, periodic series by the Missoulian State Bureau examining the federal health reform bills. The series will focus on the more immediate impacts and how they might affect Montana. Today’s stories look at the bills’ huge investment in expanding community health clinics and the number of primary care doctors.
HELENA – If federal health reform legislation leads to millions more Americans with health insurance, they’ll need somewhere to go for primary care – and that place may be a community health clinic.
With that goal in mind, the reform bills contain $11 billion of increased funding for these centers, to expand existing ones or start new ones, across Montana and the country.
“We care for 20 million people (nationwide),” says Mary Beth Frideres, associate director of the Montana Primary Care Association. “They’re asking us to double that number in five years.”
Some of the health reform package’s main elements don’t take effect until 2014, such as its requirement that everyone buy health insurance and subsidies to help some purchase that insurance.
But many other parts of the reform package start within the year, and the community health center funding is one of them.
Across Montana, existing centers and communities that want a center are planning to apply for the funds later this year, as part of a grant process that’s expected to be highly competitive. There is no guaranteed amount for any state. Money may be awarded as soon as December.
Montana already has 14 federally funded community health centers, one state-funded center and 11 satellite offices, which offer basic medical, mental health and dental health care to those earning up to 200 percent of the federal poverty level ($44,000 for a family of four).
In 2008, the centers served 85,000 Montanans, many of whom had no health insurance. Customers are charged on a sliding scale, based on what people can afford.
Frideres says Congress realized that as the reforms extend health insurance to millions of people by 2014, the newly insured will need access to primary care, which is having a family doctor, internist or other medical professional one can see for routine care and management of chronic health conditions. Doubling the money for the centers is a major effort to provide that access, she says.
Expanding the centers also is considered a way to save on health care costs, because if more people can see a primary care physician, they’re less likely to use expensive emergency room or hospital care.
“(Congress) knows that the centers can save money for the entire system, so it’s a good investment on their part,” Frideres says.
One of the first Montana projects expected to apply for funding is Sapphire Community Health Center in Hamilton, which opened its doors in February.
Sapphire used state and local funds to finance its opening, but federal funding can give it ongoing money and perhaps allow it to increase its medical personnel, says executive director Jim Morton.
“The effort here (to start a center) has been continuous for almost 10 years,” he says. “That’s why we think we have a reasonable chance to be successful.”
Morton says other communities hoping to land a center with new federal funding include Superior, Sidney, Malta and Ronan, which would partner with the Confederated Salish and Kootenai Tribes.
Centers that already have federal funding also plan to apply for money to expand.
Kate McIvor, executive director of the Cooperative Health Center in Helena, says if the center is going to double the number of people it sees in five years, it will need to expand its building and hire more medical professionals.
McIvor rates as “average” the chances that her center can win part of the money in the grant process.
“They will be looking for need in the community,” she says. “It’s hard for a nice town like Helena to compete with inner-city Chicago or Detroit. … (But) sometimes they want to balance rural and urban, which would be a nice advantage for us.”
Coming next: A look at the new “high risk pool” created by the federal bill, for people who can’t afford health coverage now because of pre-existing health conditions.
Missoulian State Bureau reporter Mike Dennison can be reached at 1-800-525-4920 or at firstname.lastname@example.org.