The following hasn't gotten much attention, but it could have major consequences. According to news reports, millions of low-income consumers could lose access to primary care if a funding provision within the ACA scheduled to expire next year is allowed to do so. But letting the only safety net many of the poor have be diminished could have devastating consequences.
First, the scope of the problem. A study conducted by researchers at the George Washington University Center of Health Policy Research predicts that if the ACA funding doesn't continue to flow, some community health centers will shut down. Others will have to cut back on services or raise fees. All told, the number of Americans served by the nation's network of community health centers could fall from about 25.6 million in 2014 to 18.8 million by 2020 if ACA funding isn't extended when it expires in September 2015.
Despite the success of the health insurance marketplace, it isn't a cure-all by any means. It only covers 8 million enrollees, many of whom still have trouble paying for healthcare due to high deductibles and coinsurance requirements. And given that several states have refused to expand Medicaid, another large group of patients make "too much" to qualify for traditional Medicaid and are left without good options. (Those who don't income-qualify for Medicaid typically don't qualify for large ACA subsidies either.)
To date, an ACA provision has provided $11 billion in mandatory funding for community health centers each year. The loss of those funds would be devastating for these centers, and particularly for the population of chronically ill poor suffering with cancer, stroke, heart disease, diabetes and hypertension.
And of course, loss of access to community health centers will mean that more patients will end up visiting the ED for treatment they can't afford, worsening hospitals' financial position, as well as more—and possibly avoidable—hospital stays by medically indigent patients. This is neither a cost-efficient nor strategically wise way to manage the health of this population.
Unfortunately, since the funds come through the door of the ACA, the extension could turn out to be a political football in Congress. While Republicans may have toned down their rhetoric somewhat, most have never dropped their opposition to Obamacare and would be happy to defund it if they had the chance. Some may see a cutback such as this as a way of proving their continued opposition.
However, the needs being served by the 1,300 community health centers in the U.S. will remain critical regardless of what party to which a member of Congress belongs. And the millions of low-income patients will be a financial burden on the healthcare system regardless of whether private healthcare businesses or the federal government helps carry the cost.
The ACA, while innovative and relatively far-reaching, has not by any means eliminated the need for free or low-cost primary care in the U.S.—at least not yet. Until it gets within striking distance of that goal, it would be folly to undermine the highly effective work being done the community health centers over a funding squabble.