Nov. 10, 2011
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With health reform expected to extend coverage to 32 million Americans by 2019, primarily through Medicaid expansions and access to subsidized private insurance, FQHCs in many communities are poised to play key roles by serving newly covered people, contributing to primary care workforce development, and taking part in new models of health care delivery and payment, according to the study.
The scope and reach of FQHCs has grown significantly in the last 15 years, but FQHC development varies considerably across communities because of several important factors, including local health system characteristics and financial and political support at federal, state and local levels, according to the study.
“Two key factors appear to affect development of FQHCs at the community level—the demand for safety net services and the level of state and local assistance,” said Laurie E. Felland, M.S., HSC director of qualitative research, and coauthor of the study with HSC Consulting Researcher Aaron B. Katz, C.P.H., of the University of Washington; HSC Consulting Researcher Ian Hill, M.P.A., M.S.W., of the Urban Institute; and Lucy B. Stark, an HSC research assistant.
The study’s findings are detailed in a new HSC Research Brief—A Long and Winding Road: Federally Qualified Health Centers, Community Variation and Prospects Under Reform—available online at www.hschange.org/CONTENT/1257/. The study, funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform, is based on HSC’s 2010 site visits to 12 nationally representative metropolitan communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets since 1996.
FQHCs mainly serve low-income patients—those with incomes under 200 percent of federal poverty, or $44,700 for a family of four in 2011—who are uninsured or covered by Medicaid and other public programs. Taking into account the size of their uninsured and Medicaid populations, some communities now have extensive FQHC capacity—for example, Boston, Seattle, Syracuse and Miami—while others have lagged, including Phoenix, Little Rock, Cleveland and Orange County.
Other key findings include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.