The Affordable Care Act (ACA), which marks its tenth anniversary this year, has facilitated the rapid growth of community health centers, allowing them to reach millions of new patients nationwide. This expansion of accessible, community-based health care represents one of the law’s greatest achievements, concludes a new report produced by researchers at the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, based at the George Washington University Milken Institute School of Public Health.
By expanding Medicaid, and establishing subsidized Marketplace plans, the ACA insured many of the poorest Americans, especially in those communities most likely to be served by health centers. The ACA also created a Community Health Center Fund to directly support new health center grantees, the addition of health center sites and the expansion of necessary health care services. Together, these policy reforms, and the additional resources for clinical staffing made available through the National Health Services Corps and Teaching Health Centers Graduate Medical Education (THCGME) program, have allowed the number of patients served by health centers to increase by nearly 46 percent over the last decade, from 19.5 million in 2010 to 28.4 million in 2018. Community health centers located in Medicaid expansion states have experienced the most robust growth, and health centers in non-expansion states remain somewhat smaller and more dependent on grant funds overall. Still, the authors find that health centers in all states have added new locations and expanded capacity. In addition, health centers have added new services, and now treat more many patients with complex medical and behavioral health conditions.
“The Affordable Care Act ensured that the most vulnerable patients and communities would realize its benefits,” says Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH, and one of the authors of the report. “At a time when the future of the ACA itself is on the line in the courts, and the nation is confronting a major public health crisis, community health centers have never been more important.”
With gains in staffing and capacity, health centers now serve one in twelve Americans, nearly one in five Medicaid /CHIP enrollees and one in five uninsured people. To sustain these remarkable achievements and meet future challenges, it is essential to address key coverage, funding and workforce factors. These include stabilizing Medicaid and marketplace availability, extending the ACA Medicaid expansion in all states, extending and stabilizing the Community Health Center Fund, and providing support for workforce recruitment and training that will be necessary to meet the needs of health center patients.
The brief, “Community Health Centers Ten Years After the Affordable Care Act: A Decade of Progress and the Challenges Ahead” was authored by Sara Rosenbaum, JD, Jessica Sharac, MSc, MPH, Peter Shin, PhD, MPH, and Maria Velasquez, MPH and is now available on our website.