August 31, 2006

Published February 8, 2006

Don’t Close the Clinics
Cuts in community health clinic funding mean higher costs— for everyone

By LINDA McVEIGH
Guest Writer

Each day in our community, thousands of people seek health care for themselves and for their families. But an enormous number of people delay or avoid care when they need it: they are the uninsured. Since 2002 there has been an increase in the number of people without insurance in King County, for a total that now surpasses 150,000.

Thankfully, there are places for them to turn. Anyone in Seattle who is uninsured has likely heard of Country Doctor or the 45th Street Clinic or the Pike Market Medical Clinic. In fact, a lot of Seattleites who do have insurance know of these stellar health clinics that provide high quality health care regardless of patients’ ability to pay.

There are community health clinics such as these around the city — from West Seattle to Holly Park, from Georgetown to Greenwood. In fact, there are more than 130 community health clinics around the state, providing health care for people living in rural and urban communities. Community health clinics have a unique model. They provide multiple services — medical, dental, mental health, pharmacy — in one location and help ensure that patients have transportation, translation, disease management, and other critical services they need to be healthy.

This approach has proven to successfully reduce or eliminate persistent health disparities. For example, in states with higher numbers of low-income patients treated by community clinics, health disparities between whites, Blacks, and Hispanics are narrower, and newborns are healthier. This success is due, in part, to removing the barriers that cause patients to miss out on the single most important element of health care: the primary care visit. Prioritizing accessible primary and preventive care pays off, both in terms of patient health outcomes and cost efficiency. This investment also yields substantial returns to the entire health care system.

Country Doctor Community Clinic has served the Capitol Hill community for 35 years. Over the past four years, the number of uninsured people we serve has grown by 50 percent — those without insurance now account for nearly two-thirds of our patients and represent a broad range of people struggling to get the care they need. It doesn’t take a Harvard MBA to understand the difficulty of sustaining a business where so many customers cannot afford to pay the full cost of the services they receive.

In part, the growing uninsured problem in our state is due to decisions made over the past few years by our state legislature to slash health care funding. Since 2002, thousands of children have lost their state insurance coverage as the result of new administrative barriers, and the Basic Health Program was cut by 30,000 slots. The state’s Community Health Services grants have provided funding to community clinics to help care for the growing number of uninsured — helping cover the cost of more than 140,000 uninsured clinic visits in 2004. But last year, the clinics took a big hit as legislators decided to cut these grants by $5 million (22 percent of the program).

It’s hard to make sense of a poor decision. With the number of uninsured patients at an all-time high, these funding cuts result in decreased access, increased wait times, reduced staffing levels, and an increase in uninsured people using the least cost-effective care setting: hospital emergency rooms.

At a community clinic, the average cost per medical encounter — such as a preventative diabetes visit — is $127. A diabetes-related hospitalization costs nearly $3,500.

Who pays when the uninsured can’t afford their hospital bills? We all do. The uncompensated costs to treat the uninsured at emergency rooms are passed on to people with insurance and taxpayers. In turn, health care costs are driven up even further for both the insured and uninsured. As a result, more people lose coverage, and the whole vicious cycle begins again.

We can do something to help slow this cycle and spend limited dollars more wisely. Until we can find a universal coverage solution, let’s make sure that uninsured people can access care in the most appropriate and lowest-cost setting. The shortsighted decision to cut the grants that help support primary care at community health clinics can be corrected this legislative session. With the first budget surplus in five years, our state can afford to restore $5 million to the program. It’s a minimal cost with huge returns.

[Take Action]

To raise your voice on the issue, call 1-800-562-6000 and leave a message for Rep. Eileen Cody, chair of the House Health Care Committee, and Rep. Frank Chopp, Speaker of the House. Urge them to protect access to medical and dental care for the uninsured by restoring $5 million in funding for the Community Health Services program.

Linda McVeigh is the executive director of Country Doctor Community Health Center (cdchc.org), which provides high-quality, caring, culturally appropriate primary health care regardless of people’s ability to pay.