The Importance of Community Health Centers

8/7/2019 The Importance of Community Health Centers

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1 Center or American Progress |The Importance o Community Health Centers

The Importance of Community Health CentersEngines of economic activity and job creation

By Ellen-Marie Whelan August 9, 2010

Introduction and summary

Communiy healh ceners across our counry have a 45-year hisory o providing

care in underserved communiies or everyone, regardless o heir abiliy o pay.

By design, hese healh ceners are run by a board o direcors comprised mosly ohealh cener paiens, ensuring he care delivered is ailored or he needs o he com-

muniies hey serve.

Communiy healh ceners enjoy srong biparisan suppor. Presiden George W.

Bush commiting o double he number o paiens seen by hese ceners during his

presidency and succeeded, and Presiden Barack Obama commiting an addiional $2

billion in he American Recovery and Reinvesmen Ac o 2009 o help hese impor-

an communiy healh ceners expand heir operaions and build new ceners.

Communiy healh ceners quickly demonsraed hey could pu addiional ederal

invesmens o work, ramping up o provide care or an increased numbers o paiens

and expand heir services. Wih he $2 billion Recovery Ac invesmen, hese ceners

were projeced o provide care o an addiional 2.9 million paiens over he simulus

acs wo-year unding period, bu in ac regisered seeing over 2 million addiional

paiens in he rs year o undingindicaive o he demand or communiy healh

services in our counry.1

Now, because o he passage o comprehensive healh care reorm earlier his year, an

addiional 32 million Americans will have healh insurance coverage wih abou halo hese individuals o be covered hrough an expansion o he Medicaid program.

Once again, policy makers idenied communiy healh ceners as ideal locaions o

provide his addiional care. Trough he Aordable Care Ac, hese healh ceners

will receive an addiional unding over he nex ve years o expand services and pre-

pare o help mee he needs o hese newly covered Americans. Te new law provides


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an addiional $9.5 billion in operaing coss and $1.5 billion or new consrucion.

Wih his addiional unding, communiy healh ceners will be able o double he

number o paiens hey serve o up o 40 million annually by 2015.2

Along wih providing qualiy healh care a hese sies, hese invesmens in commu-

niy healh ceners will help neighborhoods where hey are locaed. Sudies demon-srae ha increased unding o healh ceners creaes addiional economic simulus

boh wihin he cener and beyond. Te nearly $2 billion invesmen rom he

simulus ac, or example, generaed $3.2 billion o economic aciviy, and in 2009,

healh ceners generaed approximaely $20 billion in economic aciviy or heir local

communiies.3 By inen, hese healh ceners are locaed in lower income medically

underserved communiies mosly in rural and inner-ciy neighborhoods. In addiion,

sudies nd hese are he same areas wih he highes raes o unemploymen and he

highes raes o uninsurance.

Tis memo examines he imporan role communiy healh ceners play in bohhealh care delivery and improved neighborhood economic aciviy, describes how

simulus ac unding quickly ranslaed ino expanded healh care and improved scal

healh, and esimaes he economic impac he addiional ACA unding will have on

economic aciviy and he creaion o more jobs. In he pages ha ollow, we also will

demonsrae ha all o his new unding will generae $53.7 billion in economic aciv-

iy or some o he mos disadvanaged neighborhoods in he counry over he nex

ve years, wih $33.5 billion o his oal atribuable o he increased invesmens via

he Aordable Care Ac. Over his same period, hese ceners will suppor 457,289

jobs in hese same communiies (over 284,000 as a resul o ACA unding).

Community health centers deliver

Te passage o comprehensive healh care reorm was ruly hisoric, seting he

sage o achieve he dual goals se ou a he beginning o he healh care debae

expand coverage or nearly all Americans and rein in ou o conrol healh care coss.

Communiy healh ceners are well placed o help he naion achieve boh hese goals.

By design, hese ceners are locaed in medically underserved areas in lower income

rural and inner-ciy communiies and are prepared o ramp up quickly o providehealh services o our needies Americans. Tese ceners boas srong primary care

capabiliies ha decrease healh care coss overall. 4


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Wha is less oued is he economic aciviy ha communiy healh ceners generae

in heir communiies. Case in poin: he $1.8 billion invesmen ha he American

Reinvesmen and Recovery Ac made in hese ceners in 2009 yielded $3.2 billion in

oal economic aciviy in hose areas o he naion ha needed i mos. New jobs and

in some cases brand new businesses ha did no previously exis were creaed.5

Why are communiy healh ceners so capable o puting hese unds o work quickly

and eecively? Because hese neighborhood-based and paien-direced ceners are

so inerwined wih heir neighborhoods hey can oen ideniy he healh needs ear-

lier and design eecive communiy-based soluions beore ohers even undersand

he underlying dynamics. Tese criical providers developed hese skills since heir

launch in he 1960s. oday, hese healh ceners serve over 20 million paiens a over

8,000 sies, including 941,000 migran/seasonal arm worker paiens and 1 million

homeless paiens. Te saue ha creaed hese ceners requires hem o mee our

basic sandards:

They must be located in or serve a high-needs community.Tese medically under-

served areas are dened as having a high percenages o people living in povery,

areas wih ew primary care physicians, higher han average inan moraliy raes

and high percenages o he elderly.6

They must provide health care to all, regardless of ability to pay. All communiy

healh ceners mus commi o providing services or everyone, wih ees based on a

sandard a sliding ee schedule ha adjuss charges or care according o income.

They must provide comprehensive health care services. All communiy healh

ceners also mus oer a broad range o enabling services o suppor he delivery

o consisen, aordable healh care.

They must be governed by a community board. All communiy healh cener

boards mus be comprised o a majoriy (a leas 51 percen) o healh cener

paiens who have he auhoriy o oversee he operaions o he cener. Tese

powers include approving budges, hiring and ring chie execuives, and esablish-

ing general policies.

Tese mandaed links o he communiies in which hese healh ceners are locaed

ensures hey serve heir neighborhoods ecienly and eecively. Les look in a bi

more deail a who hey serve, where hey are, and wha services hey provide.


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Who community health centers serve

Because o heir mission and mandaed locaions, he

paiens hese healh ceners ypically serve are wihou

access o oher healh care setings. Tese include low-

income people, he uninsured, hose wih limied Englishprociency, migran and seasonal arm workers, individuals

and amilies experiencing homelessness, and hose living

in public housing. In ac, over wo-hirds o he paiens

who receive care a communiy healh ceners are members

o racial and ehnic minoriies, which is one o he reasons

hese ceners are so successul a reducing racial and ehnic

healh dispariies in our counry.7 (See gure one)

Because o he commimen o provide care or all,

communiy healh ceners also serve a disproporionallyhigh percenage o poor and uninsured paiens. Seveny

percen o paiens seen have incomes below he ederal

povery level (jus over $22,00 or a amily o our) and

over 90 percen are under wo imes he ederal povery

level (abou $44,000 or a amily o our). Tese ceners

also serve a much higher percenage o individuals wih

Medicaid. Tis is imporan since abou hal o he 32

million Americans who will be newly insured by he

ACA will be eligible or Medicaid. Tese people will need

access o care. (See gure wo)

Where community health centers are located

Tese healh ceners are locaed in all 50 saes, he

Disric o Columbia and in he naions erriories and

commonwealhs, bu wihin hese poliical boundaries

hey are locaed in he mos underserved areas. Te law

requires hem o be in areas wih higher povery raeswihin hese saes. Tese end o be areas such as inner-

ciy neighborhoods or isolaed rural areas paricularly

hard hi wih he recen economic recession. One sudy

nds ha saes wih higher levels o unemploymen have

70

92

38 36

17

32

15 14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percent ator below100% ofpoverty

Percentunder

200% ofpoverty

PercentUninsured

PercenMedica

CHC population

U.S. population

CHC populationU.S. population

35

21

41

16 15

51

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Hispanic/Latino AfricanAmerican Asian/Pacific

Islander

AmericanIndian/

Alaska Native

Figure 1

Community health centers serve large

minority groups

Race/Ethnicity o CHC patients compared to U.S.

population, 2009

Figure 2

Community health centers serve mostly

lower-income people

Comparison o CHC patients to U.S. population, 20

Note: Race/ethnicity may not sum to 100 percent due to rounding and noninclusimore races.

Source: CHC: Bureau o Primary Health Care, HRSA, DHHS, 2009 Uniorm Data Syste

U.S. Census Bureau, Table 4: Estimates o the Population by Race and Hispanic OrigUnited States and States (2009).

Source: National Assocation o Community Health Centers, United States: At A Gla

Compares health center UDS data to state population data, respectively. State popdata come rom Kaiser Family Foundation, State Health Facts Online, available at hstatehealthacts.k.org.
http://www.statehealthfacts.kff.org/http://www.statehealthfacts.kff.org/http://www.statehealthfacts.kff.org/http://www.statehealthfacts.kff.org/


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higher numbers o communiy healh ceners and aer analyzing couny level

daa nds ha hese ceners were locaed in counies wih even higher raes o

unemploymen.8

Alhough here are over 8,000 communiy healh cener, he unme need is

sill enormous. Las year, he invesigaive arm o Congress, he GovernmenAccounabiliy Oce, repored ha 43 percen o ederally designaed under-

served areas sill do no have a communiy healh cener.9

What community health centers provide

Tese healh ceners are required o provide a ull range o healh-relaed services,

ypically beyond wha oher healh care providers such as hospials or ou-paien

clinics provide. Tis means in addiion o providing comprehensive primary

healh care services hey also oer specialy care (such as orhopedic, cardiac, orpodiaric care), denal and menal healh services, as well as supporive services

ha can include nuriion educaion, ranslaion services, care coordinaion and

case managemen, ransporaion o and rom healh care sies, and oureach aciv-

iies o help nd eligible paiens. Tis also means he care delivered is culurally

appropriae and in languages ha many in hese communiies speak.

Because o he infuence o he communiy board and heir commimen o com-

prehensive healh care, communiy healh ceners ailor he services hey provide

o mee he specic needs o heir communiies. Tas why 89 percen o healh

ceners provide inerpreaion/ranslaional services on sie, 79 percen provide

weigh reducion programs, 91 percen provide case managemen services, and

89 percen have services on sie o help paiens ideniy addiional programs or

which hey migh be eligible.10

Sudies consisenly show ha communiy healh ceners provide care ha

improves healh oucomes o heir paiens.11 Te paiens o hese ceners are also

more likely o ideniy a usual source o care, and repor having beter relaion-

ships wih heir healh care providers.12 Tis ocus on primary care and he provi-

sion o addiional supporive services are among he reasons ha care deliveredby communiy healh ceners is less expensive and ulimaely saves money o he

broader healh care sysem.13 Sudies esimae ha he provision o care in com-

muniy healh ceners ulimaely saves he U.S. healh care sysem beween $9.9

billion and $24 billion annually by eliminaing unnecessary emergency room

visis and oher hospial-based care.14


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Recent expansion of community health centers

Communiy healh ceners expanded rapidly in he 21s cenury o mee he

growing needs o medically underserved, lower income neighborhoods. Te new

unding necessary o grow ound suppor rom he Bush adminisraion and he

Obama adminisraion, receiving he mos recen boos in invesmen unds romhe American Recovery and Invesmen Ac o 2009 and he Aordable Care Ac

o 2010. Bu he expansion began almos a decade ago.

Bush administration investments

In scal year 2002, which began in Ocober 2001, Presiden Bush launched

he Presidens Healh Ceners Iniiaive wih he goal o adding 1,200 new and

expanded healh cener sies over ve years o ulimaely double he number

o paiens reaed a communiy healh ceners.15 Tis was he hallmark o hissraegy o address he naions uninsured.16 Due o subsequen budge consrains,

however, as he ederal budge surplus o he 1990s under Presiden Bill Clinon

urned o decis under Presiden Bush, his goal shied o expanding he number

o paiens seen rom 10 million in 2001 o 16 million in 2006.17 Sill, his paien-

driven goal helped grow he unding levels o communiy healh ceners rom

$1.34 billion or FY 2002 o $2.1 billion in FY 2008.

Recovery Act investments

Te Recovery Ac graned addiional unding o abou $2 billion o communiy

healh ceners or operaing coss and new consrucion dollars. Tis one-ime

unding nearly doubled heir annual unding o $2.1 billion in FY 2008. Wih his

addiional unding i was projeced ha healh ceners could provide care or an

addiional 2.9 million paiens. In ac hey served an addiional 2.1 aer only he

rs year o unding.

Te imporan role ha communiy healh ceners play in heir neighborhoods

proved o be especially eviden as he Obama adminisraion and Congress revvedup o comba he economic consequences o he Grea Recession o 2007-2009.

One analysis ound ha counies receiving simulus ac unding or communiy

healh ceners had an average unemploymen rae (or January hrough November

2009) almos a ull percenage poin higher han average rae or nonrecipien


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counies. Whas more, hese counies unemploymen raes were growing aser

ha han nonrecipien counies because o he Grea Recession, wih he raes

increasing by 4.4 percen in counies ha already had communiy healh ceners

compared o an unemploymen growh rae o 4 percen in oher counies.18

Providing addiional simulus unding o communiy healh ceners in 2009mean ha economic benes and job creaion wen hand in hand wih expanded

primary care accessargeed o he communiies ha need he mos help.19 As a

resul o Recovery Ac unding, communiy healh ceners generaed an addiional

$3.2 billion in economic aciviy or he communiies hey served.20 Much o his

is a resul o he new jobs creaed. In he hree-monh period beween January and

March 2010, or example, i is esimaed ha his invesmen creaed or main-

ained over 7,000 jobsover hal o which were healh proessionals. Tese jobs

also include ancillary sa direcly employed in he communiy healh ceners and

oher jobs indirecly creaed by indusries supporing he services hese com-

muniy healh ceners provide. Te unding also creaed an addiional 1,500 jobsrelaed o consrucion.

We don ye know how many addiional jobs were creaed as a resul o simulus

ac spending on communiy healh ceners because more research will be neces-

sary o learn how his job creaion infuenced he unemploymen rae a boh

couny and sae levels. Bu he pas rack record o invesing in communiy healh

ceners and broader economic daa indicae he gains will be imporan.

Affordable Care Act investments

Te hisoric passage o he new healh care law earlier his year now poses a

number o implemenaion-relaed challenges, including how o deliver care o he

addiional 32 million Americans who will have healh coverage. Because here are

sill huge pockes o America wihou accessible healh care services, communiy

healh ceners are well posiioned o ramp up and be ready o provide care o hese

newly covered healh care recipiens. Te Aordable Care Ac commis $11 bil-

lion o hese ceners over he nex ve years o expand services.

Communiy healh ceners are long recognized or heir abiliy o eecively

uilize ederal grans o improve and expand paien access o medical, denal, and

menal healh services.21 Te seady increase in ederal unding has enabled hese

ceners o provide high qualiy, accessible care o he naions mos vulnerable

populaions. Tas why any discussion o how o expand access o healh services


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while rying o slow he rising coss o healh care mus include maximum uiliza-

ion o our naions exising communiy healh ceners and he new ones needed

o mee uure needs.

Te new $11 billion in unding via he Aordable Care Ac will help bring new

healh ceners o communiies in need and enhance capaciy a exising ceners.Mos o he unding ($9.5 billion) will be used o provide or expansion and

increased operaing expenses a he exising ceners, wih he res desined or new

consrucion ($1.5 billion).

Wha does his increased invesmen really buy? Wih addiional unding or opera-

ions, communiy healh ceners will add sa o accommodae more paiens,

and add addiional services a he ceners o improve care delivery and lessen he

chances o paiens needing o ge care will go o more expensive locaions. One

sudy nds ha increased unding rom 1996-2006 resuled in increases in he

provision o on-sie menal healh services, 24-hour crisis inervenion, aer-hoursurgen medical care, and subsance use counseling.22 Bu he increased unding also

has enormous benes ouside he doors o he healh cener. o his we now urn.

Economic activity and jobs

An imporan bu less widely discussed byproduc o he increased unding o

communiy healh ceners is he enormous economic aciviy in he broader

communiy generaed by his infux o dollars. Sudies demonsrae ha increased

unding o healh ceners creaes addiional economic simulus boh wihin he

cener and beyond. Weve seen his rom he simulus ac unding, which creaed

new jobs in areas mos in need o his invesmen. Tis is especially imporan dur-

ing imes o economic insecuriy.

How does expanded economic aciviy occur? Firs, and mos obviously, healh

ceners direcly employ people in heir communiies, including key enry-level

jobs, raining, and oher communiy-based opporuniies. Te healh ceners hen

purchase goods and services rom local businesses and expand and build new

locaions. Tese new healh ceners and he businesses ha have ramped up oserve he ceners also mus hire new employees. Every dollar spen and every job

creaed by healh ceners has a direc impac on heir local economies.


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Previous sudies analyzed he economic aciviy generaed in communiies rom

having a communiy healh cener.23 Case in poin: Using modeling developed

by he U.S. Deparmen o Agriculure and he Minnesoa IMPLAN Group, an

economic modeling rm, researchers deermined how much economic aciviy a

paricular communiy healh cener will bring o a communiy, wih deails spe-

cic o each couny and indusrial secor. Using his modeling, we are able in hismemo o esimae he economic impac and eec on job creaion ha he unding

provided in he Aordable Care Ac will have on communiies in 2015 naionally

and on a sae-by-sae basis.

Te Aordable Care Ac allocaes ha he addiional $9.5 billion unding or

operaing coss be disribued by a ormula over he nex 5 years and indicaes ha

he unding should be in addiion o (no a replacemen or) curren, appropri-

aed unding which was $2.2 billion in FY 2010.24 We esimae ha oal spending

by communiy healh ceners (including base appropriaed unding and he new

healh reorm unding) will generae $54 billion in economic aciviy in 2015,wih $33 billion o his a direc resul o he addiional invesmen in he new law.

Tese dollars also ranslae ino job reenion and creaion. We ound ha in 2015,

communiy healh ceners will generae over 457,000 jobs, (284,000 as a direc

resul o he new ACA dollars).

o ge he ull picure o how his aecs he neighborhoods served by he healh

ceners, his economic aciviy can be broken down by wha happens inside he

healh cener and ouside o hem in he communiy a large. Because o a ripple

eec, healh ceners oen serve as an engine or simulaing exising and new busi-

nesses. So besides he directeconomic eecs wihin a healh cener, communiy

healh ceners also provide indirecteconomic eecs hrough heir purchases o

goods and services rom oher local business, as well as induced economic eecs,

which represen he response by all local indusries caused by he expendiures o

new household income generaed by he direc and indirec eecs. Te ollowing

example romAccess Granted: Te Primary Care Payo25 illusraes he how healh

ceners have direc, indirec, and induced economic infuences on is neighborhood.

Imagine a health center that purchases waiting room chairs om a local

urniture store (direct eect). Te urniture store in turn purchases paper oman ofce supplies store to print receipts and a truck om a car dealer to make

deliveries (indirect eect). Te urniture store, the ofce supplies store, and

the car dealership all hire sta and pay them salaries to help run the various

businesses. Tese employees spend their income on everyday purchases such as

groceries, clothing, cars, and Vs (induced eect).


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As his demonsraes, economic aciviy expands well beyond he walls o he

communiy healh cener. Tese dollars can be broken down by direc inves-

men in he healh cener and he addiional indirec eecs his unding creaes

in local communiies. As seen in able 1, alhough he majoriy o he economic

aciviy ($31 billion) will be generaed wihin he healh cener sysem, businesses

in surrounding communiies will enjoy a large percenage ($22.8 billion) o heeconomic growh.

Similarly, here will be abou 285,800 ull-ime-equivalen

employees (an economic erm ha basically means ull-ime

employees) direcly in communiy healh ceners as boh healh

care providers and ancillary sa. Tere will also be an addiional

171,500 jobs outside he healh cener, indirecly creaed as a

resul o he business generaed by he delivery o care in he cen-

er and hrough addiional local indusries which are expanded

as a resul o he household income newly generaed.

Alhough acual economic aciviy will occur predominanly a

very local levelsin areas near he healh cenershe naional

economic impac was broken down by sae in able 2. Tis able

shows he oal economic aciviy by sae in 2015 generaed

by invesmens in communiy healh ceners and also esi-

maes wha proporion o his is a direc resul o he addiional

Aordable Care Ac unding. Te same esimaes were made or

employmen predicions.

I should be noed ha we canno know wih absolue accuracy he precise

amoun each sae will receive in 2015 because o he process o disribuing hese

unds. We esimae he breakdown by sae by examining he disribuion o unds

over he pas ve years and prediced similar growh paterns. Predominaely rural

saes see subsanial economic bene driven by healh ceners. Tis is imporan

because healh ceners locaed in rural areas are oen among he larges employers

in heir communiies.26

Table 1

The impact of community health cen

Economic activity stimulated by community

health centers operations, projected - 2015

Economic

impact

Jobs (full

equivale

Direct $31.0 billion 285,800

Indirect/induced $22.8 billion 171,500

Total $53.8 billion 457,300

Note: Direct Economic Impact is the total operating exp

or each CHC. Each ull time equivalent FTE, denotes otime employee. Total FTEs denote total workorce gene

by health centers. For the denition o FTE and addition

explanation, see appendix.

Source: Based on revenue trends rom the 2009 Unior

System, Bureau o Primary Health Care, HRSA, DHHS an

health center unding as described in the Afordable Ca

analysis by the National Association o Community H

Centers and Capital Link. Prepared by Capital Link with

Inc. IMPLAN Sotware Version 3.0, 2008 structural matri

and 2008 state-specic multipliers.


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Table 2

Projected economic activity and jobs created by community health centers by state, 2015

Total and additional amount as a result o ACA unding

StateTotal economic

activity, 2015

Economic activity

as a result of ACA

Total jobs

(FTEs) 2015

Additional jobs (FT

as a result of AC

Alabama 525,140,846 326,511,203 4,922 3,060

Alaska 565,400,596 351,543,076 3,991 2,482

Arizona 1,177,582,231 732,172,698 10,281 6,393

Arkansas 290,436,518 180,581,605 2,950 1,834

Caliornia 9,268,202,610 5,762,591,126 71,649 44,549

Colorado 1,563,498,701 972,119,851 12,464 7,750Connecticut 1,040,247,806 646,783,743 7,500 4,663

DC 378,000,893 235,025,569 3,254 2,023

Delaware 100,769,746 62,654,527 885 551

Florida 2,368,173,260 1,472,433,738 21,404 13,308

Georgia 662,684,627 412,030,327 5,696 3,541

Hawaii 485,958,030 302,148,922 4,553 2,831

Iowa 357,974,622 222,574,049 3,466 2,155

Idaho 263,134,089 163,606,066 2,626 1,633

Illinois 2,921,685,608 1,816,585,185 22,831 14,196

Indiana 626,708,583 389,661,887 5,750 3,575

Kansas 235,992,444 146,730,495 2,386 1,484

Kentucky 615,869,620 382,922,661 5,409 3,363

Louisiana 456,728,176 283,974,989 4,226 2,627

Massachusetts 2,957,813,401 1,839,047,977 22,290 13,859Maryland 931,548,123 579,198,705 7,422 4,615

Maine 466,592,396 290,108,159 4,314 2,683

Michigan 1,529,779,477 951,154,610 12,618 7,846

Minnesota 579,675,024 360,418,335 4,479 2,785

Missouri 1,140,107,396 708,872,371 9,834 6,114

Mississippi 533,803,518 331,897,300 5,299 3,295

Montana 197,374,950 122,719,710 1,937 1,204

North Carolina 895,456,835 556,758,611 8,013 4,982

North Dakota 59,158,632 36,782,429 608 378

Nebraska 157,346,108 97,831,405 1,574 979

New Hampshire 208,537,242 129,659,969 1,930 1,200

New Jersey 1,031,970,932 641,637,520 7,862 4,889

New Mexico 797,381,695 495,779,481 7,599 4,725

Nevada 159,878,479 99,405,931 1,472 915

New York 3,425,649,264 2,129,929,273 34,369 21,369

Ohio 936,582,530 582,328,894 8,343 5,187

Oklahoma 303,187,627 188,509,725 2,713 1,687

Oregon 1,269,370,452 789,242,878 10,646 6,619

Pennsylvania 1,468,532,996 913,074,041 12,061 7,499

Puerto Rico 657,674,023 408,914,937 6,969 4,333

Rhode Island 351,675,201 218,657,325 2,965 1,843

South Carolina 735,455,291 457,276,163 6,764 4,206

South Dakota 125,611,953 78,100,399 1,156 719

Tennessee 751,148,283 467,033,427 6,700 4,166

Texas 2,562,060,697 1,592,985,054 22,707 14,119

Utah 287,356,648 178,666,667 2,452 1,524

Virginia 594,748,754 369,790,567 5,407 3,362Vermont 280,661,900 174,504,145 2,457 1,528

Washington 2,522,244,589 1,568,229,019 20,563 12,785

Wisconsin 1,024,177,362 636,791,795 8,200 5,098

West Virginia 831,707,873 517,122,101 7,613 4,733

Wyoming 57,423,706 35,703,723 567 353

Other 58,018,693 36,073,662 1,139 708

TOTAL 53,793,901,051 33,446,858,023 457,289 284,323

Notes: All numbers represent direct, indirect, and induced economic impacts. Total economic impact includes the value-added impact. Each ull time equivalent, FTE, denotes one ull-time employee. Total FTtotal workorce generated by health centers. For the defnition o FTE and additional explanation, see appendix. Category Other includes American territories: American Samoa, Federal States o Micronesia, G

Marshall Islands, Palau, and Virgin Islands.

Source: Based on revenue trends rom the 2009 Uniorm Data System, Bureau o Primary Health Care, HRSA, DHHS and new health center unding as described in the Aordable Care Actanalysis by NationaAssociation o Community Health Centers and Capital Link. Nevada health center data provided directly rom Nevada health centers. Prepared by Capital Link with MIG, Inc. IMPLAN Sotware Version 3.0, 2008 matrices and 2008 state-specifc multipliers.


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Conclusion

Te dual inen o passage o he Aordable Care Ac was o increase coverage or

nearly all Americans while atemping o rein in healh care coss. Communiy

healh ceners already are key players in providing qualiy healh care or millions

o Americans. Teir role in helping o care or he 32 million Americans whowill be newly covered by he new comprehensive healh reorm law was rein-

orced when hey were acknowledged in he new law and se o receive signican

increases in unding over he nex ve years. Alhough he exra unding was allo-

caed o improve and expand paien care, he secondary economic eecs o his

invesmen on he communiies hey serve canno be ignored.

Hisorically, unding communiy healh ceners proved o be a smar invesmen in

exacly he communiies ha need i mos. Healh ceners ime and ime again dem-

onsrae hey are able o ramp up quickly and provide qualiy healh care services or

communiies mos in need. In addiion o healh services, his assisance comes inhe orm o new economic growh and new jobs. Much o he unding or commu-

niy healh ceners in he simulus ac wen o saes wih he highes unemploymen

raes, and wihin hose saes i wen o he counies experiencing higher han aver-

age unemploymen growh. We have every reason o expec increased unding or

hese ceners via he Aordable Care Ac will ollow hese same paterns.

Minoriy communiies were among he hardes hi during he Grea Recession,

and are among hose recovering he slowes rom ha deep economic downurn.

Te combinaion o high unemploymen and rising home oreclosures is espe-

cially el in communiies o color. Communiy healh ceners serve much higher

proporions o minoriies and are locaed in areas ha are heavily minoriy domi-

naed. Te increased unding or hese healh ceners hrough he Aordable

Care Ac will be unneled o ceners serving hese communiies where he exra

economic benes will be especially valuable.

Te key premise o he Accounable Care Ac was o expand coverage o nearly

all Americans. Communiy healh ceners have a key and obvious role in helping

he naion mee his charge. Te addiional economic bene his has on commu-

niy developmen is an imporan byproduc ha mus also be acknowledged as

we emerge rom he Grea Recession. Tis new unding will enable communiyhealh ceners o provide he righ healh care, o he righ individuals, righ in

he nick o ime.

Ellen-Marie Whelan is Associate Director o Health Policy and Senior Health Policy

Analyst at the Center or American Progress


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Appendix

Economic impact analysis definition of terms(Previously printed in Access Granted: The Primary Care Payo.27Available at http://www.nachc.com/access-reports.cm)

Te directeconomic impac is dened as he oal operaing expendiures o hehealh ceners. Indusries producing goods and services or consumpion, in his

case he healh ceners, purchase goods and services rom oher producers. Tese

oher producers, in urn, purchase goods and services and so on, hereby gener-

aing an indirecteconomic impac. Eecs o increased household spending are

called induced economic impac.

Tis analysis uses he muliplier eecand more specically a complee

inegraed economic planning ool called IMPLAN (Impac analysis or

PLANning)o capure he indirec business eecs o a healh ceners busi-

ness operaions. IMPLAN was developed by he U.S. Deparmen o Agriculureand he Minnesoa IMPLAN Group, an economic modeling rm, and employs

mulipliers, specic o each couny and each indusrial secor, o deermine oal

oupu, employmen, and earnings. Tose mulipliers are:

Output multiplier. Tis measures he increase in oal oupu generaed in a

dened regional economy or each dollar spen by a given indusry. I he muli-

plier or healh care services is 3.0, or example, hen every dollar spen by a healh

care cener would creae $3.00 in economic aciviy in he local communiy.

Value-added (earnings) multiplier. Tis measures he earnings (purchasing

power) ha an indusry generaes, hrough payroll and he muliplier eec, or

households employed by all indusries wihin a dened area. Consequenly, he

value-added impac represens he amoun o dollars ha aggregae households in

a given area will gain in household income based on he dollars pu ou ino ha

communiy by a Communiy Healh Cener hrough operaing expendiures.

Employment multiplier. Tis measures he number o jobs generaed across all

indusries by he aciviy wihin a given indusry needed o deliver $1 million o

producs or services o a dened geographic area. Tis muliplier produces anesimae o he oal number o new jobs ha a local economy can suppor in all

indusries due o he dollars being injeced ino he communiy by he healh

cener. In oher words, he economic aciviy o he healh cener simulaes job

growh because o he snowballing o he dollars expended.


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Full time equivalent employee. Te FE employee erm means ha he person

is equivalen o a ull-ime worker. In an organizaion ha has a 40-hour work-

week, a person who works 20 hours per week (50 percen ime) is repored as 0.5

FE. An FE employee also is calculaed based on he number o monhs he

employee works. An employee who works ull ime or 4 monhs ou o he year

would be repored as 0.33 FE (4 monhs/12 monhs).

IMPLANs oupu, earnings, and employmen gures are aggregaed based on

direc, indirec, and induced economic eecs. Tese are dened as ollows:

Direct effects. Tis represens he response or a given indusry (in his case,

oal Operaing Expendiures o Communiy Healh Ceners wih he excepion

o Nevada).

Indirect effects. Tis represens he response by all local indusries caused by he

ieraion o indusries purchasing.

Induced effects. Tis represens he response by all local indusries o he expen-

diures o new household income generaed by he direc and indirec eecs.

Wihin he eld o economics, he muliplier eec is used o deermine he

impac o each dollar enering, impacing and evenually leaving a dened econ-

omy, which is someimes dened as he dollar urnover. Tis resuls in increased

producion and expendiures, employmen creaion and atracion, and reenion

o new residens, businesses and invesmens. Sae mulipliers are acored in

o esimae he spin-o aciviy rom he expendiures o he communiy healh

cener in providing healh care services.


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Endnotes

1 National Association o Community Health Centers, Turning visioninto reality: More Patients Gain Access to Health Center Care thanksto Stimulus Funds (2010).

2 National Association o Community Health Centers, June Fact Sheet(2010) expanding under HCR.

3 National Association o Community Health Centers, Turning visioninto reality. ; National Association o Community Health Centers,Community Health Centers Lead the Primary Care Revolution (2010).

4 Sonya Streeter and others, The Eect o Community Health Centerson Healthcare Spending & Utilization, (Washington: Avalere Health,2010); Leighton Ku and others, Strengthening Primary Care toBend the Cost Curve: The Expansion o Community Health Centers

Through Health R eorm, (Washington: Geiger Gibson/ RCHN Com-munity Health Foundation Research Collaborative, 2010).

5 National Association o Community Health Centers Turning visioninto reality.

6 Health Resources and Service Administration, Shortage Designation:HPSAs, MUAs, and MUPs (2010), available at http://bhpr.hrsa.gov/shortage/.

7 P Shin, K Jones and S Rosenbaum ,Reducing Racial and Ethnic Health

Disparities, Estimating the Impact o Hig h Health Center Penetrationin Low-Income Communities, (Washington: George WashingtonUniversity Center or Health Services and Research Policy, 2003).

8 Peter Shin and others, The Economic Stimulus: Gauging the Earlyeects o ARRA Funding on Health Centers and Medically UnderservedPopulations and Communities, (Washington: George WashingtonUniversity Center or Health Services and Research Policy, 2010).

9 Cynthia A. Bascetta, Testimony beore the Committee on Health, Edu-cation, Labor and Pensions, Many Underserved Areas Lack a HealthCenter Site, and Data Are Still Needed on Service Provision Sites,Government Accountability Oce (2009).

10 National Association o Community Health Centers, United States:At A Glance, 2009.

11 Epstein AJ. The role o public clinics in preventable hospitalizationsamong vulnerable populations. Health Services Res. 2001;36(2); Falik

M, Needleman J, Wells BL, and Korb J. Ambulatory care sensitive hospi-talizations and emergency visits: experiences o Medicaid patients us-ing ederally qualifed health centers. Med Care. 2001;39(6); LeightonKu and others, Strengthening Primary Care to Bend the Cost Curve.

12 Hadley J, and Cunningham P. Availability o saety net providers andaccess to care o uninsured persons. Health Services Res. 2004;39(5);Shi L, Stevens GD, and Politzer RM. Access to care or U.S. healthcenter patients and patients nationally: how do the most vulnerablepopulations are? Med Care. 2007;45(3); Forrest CB, and Whelan E. Pri-

mary care saety-net delivery sites in the United States: a comparisono community health centers, hospital outpatient departments, andphysicians oces. JAMA. 2000;284(16) .

13 Sonya Streeter and others, The Eect o Community Health Centerson Healthcare Spending & Utilization.

14 Leighton Ku and others, Strengthening Primary Care to Bend theCost Curve.

15 Health Resources and Service Administration, The Health CenterProgram: The Presidents Health Center Initiative, available at http://bphc.hrsa.gov/presidentsinitiative/.

16 National Health Policy Forum, The Fundamentals o CommunityHealth Centers (2004).

17 Sara Rosenbaum and Peter Shin, Health Centers Reauthorization:An overview o Achievements and Challenges,: (Washington: KaiserCommission on Medicaid and the Uninsured, 2006).

18 Peter Shin and others, The Economic Stimulus: Gauging the Early e-ects o ARRA Funding on Health Centers and Medically UnderservedPopulations and Communities.

19 Ibid.

20 National Association o Community Health Centers Turning visioninto reality.

21 Lo Sasso AT and Byck GR, Funding Growth Drives Community HealthCenter Services.HealthAfairs 29 (2) (2010): 289-296.

22 Lo Sasso AT and Byck GR, Funding Growth Drives Community HealthCenter Services.

23 National Association o Community Health Centers, the RobertGraham Center, and Capital Link, Access Granted: The PrimaryCare Payo (2008), available at http://www.nachc.com/client/documents/issues-advocacy/policy-library/research-data/research-reports/Access_Granted_FULL_REPORT.pdand National Associa-tion o Community Health Centers, Community Health Centers Leadthe Primary Care Revolution (2010). Available at http://www.nachc.com/client/Primary_Care_Revolution_Final.docx

24 Aordable Care Act H.R. 3950, Sec. 10503, 111 Cong. 2 Sess. Govern-ment Printing Oce, 2009.

25 National Association o Community Health Centers, the RobertGraham Center, and Capital Link, Access Granted: The Primary CarePayo.

26 Ibid.

27 Ibid.
http://bhpr.hrsa.gov/shortage/http://bhpr.hrsa.gov/shortage/http://bphc.hrsa.gov/presidentsinitiative/http://bphc.hrsa.gov/presidentsinitiative/http://www.nachc.com/client/documents/issues-advocacy/policy-library/research-data/research-reports/Access_Granted_FULL_REPORT.pdfhttp://www.nachc.com/client/documents/issues-advocacy/policy-library/research-data/research-reports/Access_Granted_FULL_REPORT.pdfhttp://www.nachc.com/client/documents/issues-advocacy/policy-library/research-data/research-reports/Access_Granted_FULL_REPORT.pdfhttp://www.nachc.com/client/Primary_Care_Revolution_Final.docxhttp://www.nachc.com/client/Primary_Care_Revolution_Final.docxhttp://www.nachc.com/client/Primary_Care_Revolution_Final.docxhttp://www.nachc.com/client/Primary_Care_Revolution_Final.docxhttp://www.nachc.com/client/documents/issues-advocacy/policy-library/research-data/research-reports/Access_Granted_FULL_REPORT.pdfhttp://www.nachc.com/client/documents/issues-advocacy/policy-library/research-data/research-reports/Access_Granted_FULL_REPORT.pdfhttp://www.nachc.com/client/documents/issues-advocacy/policy-library/research-data/research-reports/Access_Granted_FULL_REPORT.pdfhttp://bphc.hrsa.gov/presidentsinitiative/http://bphc.hrsa.gov/presidentsinitiative/http://bhpr.hrsa.gov/shortage/http://bhpr.hrsa.gov/shortage/

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