This article first appeared in the St. Louis Beacon, March 5, 2010 - A budget appropriations committee in the Missouri House of Representatives has voted to eliminate funding for community health centers at a time when more Missourians are finding themselves unemployed, uninsured and in need of health-care providers.
The centers, known as Federally Qualified Health Centers (FQHC) rely on state funding for 5 to 15 percent of their total budgets. Advocates for the centers say the cuts could lead to layoffs of doctors, nurses and other staff at the centers, which provide care to thousands of residents living at or under the poverty line. The fear is that an increasing number of impoverished Missourians will seek treatment at emergency rooms where the cost of care is much higher.
Many steps remain before Missouri's 2011 budget reaches the governor's desk. Supporters of community health centers hold out hope that at least some of the funding will be restored as the process moves along. But Joseph Pierle, director of the Missouri Primary Care Association, said starting from zero makes the effort more difficult.
"Now we have to find money elsewhere and get it added back," he said. "We can understand some reduction because we understand the state fiscal situation," Pierle said, "But to take a 100 percent reduction -- we were shocked by that."
Legislators who voted for the cuts have not returned phone calls to the Beacon. But Missouri has suffered a 15 percent decline in revenue from a year ago. By cutting funding for the community health centers, the state would save $9.25 million.
Bipartisan Support
Supporters of Federally Qualified Health Centers say those savings are illusory. The cuts will hurt a program that has mitigated health care costs and in doing so has attracted support from both Democrats and Republicans.
Rep. Tishaura Jones, D-St. Louis, who is on the budget appropriations subcommittee and who voted against the cuts, said reductions in funding will affect thousands of people and not necessarily save money. "It pushes the people that could get primary care or preventive care back to the emergency rooms, which pushes that money back on the state of Missouri. We'll end up paying more in the end from this one cut," she said.
Federally Qualified Health Centers have served as broad "safety net" health providers for about two decades. President George W. Bush made community health centers a priority of his administration, doubling federal financing, which led to either creating or expanding 1,297 clinics in underserved areas, according to a New York Times article in December of 2008.
To be designated a Federally Qualified Health Center, the facility must provide comprehensive care to a medically underserved population on a sliding fee scale. The fee scale is based on the federal poverty guidelines and takes into consideration the size of the family and income. FQHCs must be public or private nonprofit organizations and, like emergency rooms, they are not permitted to turn anyone away.
Most of their funds come from the federal government, local governments, private foundations and donors. But state money is important, Pierle said, especially when "the anecdotal evidence is that our health centers are bursting at the seams."
Along with layoffs, Pierle predicts some clinics may be forced to close.
Consequences
Grace Hill Neighborhood Health Centers in the city of St. Louis are among the facilities that would be affected. "This funding has supported ongoing operations and its loss would directly affect the amount of services we could supply," Alan O. Freeman, president and CEO of Grace Hill Neighborhood Health Centers, said in a statement.
According to Grace Hill's website, its health centers alone "served more than 41,000 unique patients in 2008." More than half of these patients were uninsured and nearly all - 95 percent - were below 100 percent of the federal poverty line.
Like all FQHCs, Grace Hill's clinics provide basic medical and dental care including such specialties as OB/GYN, pediatrics, podiatry and internal medicine. They have programs supporting mental health, immunizations, nutrition for children, pregnant women and nursing mothers, and their pharmacies provide medicines at lower cost. Grace Hill's uninsured patients pay fees on a sliding scale with some as low as $10. Community health centers "do not get fully reimbursed for the care we provide to the uninsured," said Pierle. "That was another usage of this funding."
Another FQHC that would see funding cuts is Crider Health Center in St. Charles. "I don't understand why FQHCs were singled out for 100 percent cuts. Other types of services got significant cuts, but none of them more than 50 percent," said Karl Wilson, CEO of Crider, which also serves Lincoln, Warren and Franklin counties.
"As the health care debate rages in this country, about one out of six people don't have insurance of any kind. And we pay for that in many ways," Wilson said. "People think it's expensive to cover them. But it's very expensive not to cover them because we all pay for it when they end up in emergency rooms," he said. "We're taking care of it when it finally gets to an emergency situation, but prevention would have been a much wiser choice and a much more conservative choice. We have a safety net that has gaping holes in it and those are going to get bigger."
Budget Not Set
But given the early stage of the budget, Rep. Jones remains optimistic. "This is only the first step of the budget process. I am hopeful that the entire budget committee can find a way to restore the money," she said.
Wilson expressed similar hope about the remainder of the budget process, but he does not foresee a return to full funding. "I don't think zero is likely, but I don't think complete restoration is likely," he said.
Julia Evangelou Strait is a freelance science writer based in St. Louis. She is a 2009 Missouri Health Journalism Fellow.