Federally Qualified Health Centers and Related Primary Care Workforce Issues

Abstract

Since the Affordable Care Act (ACA) was enacted in 2010, provisions that increase access to insurance coverage have generated widespread policy attention and contentious public debate. By contrast, other important provisions of the ACA, such as the expansion of the National Health Service Corps and federally qualified health centers (hereafter referred to as health centers), generated almost no conflict. Federally qualified health centers are community-based health care organizations that, with federal funding, provide primary care in underserved areas. Through these programs, ACA funding increased the number of primary care locations, services, and clinicians available to medically underserved rural and urban communities. This expansion was particularly important given research linking primary care to improved health outcomes and increased health equity. 1 Federally Qualified Health Centers: Background While significant funding increases are a recent phenomenon, health centers have a long history of federal support dating back to the first $51 million appropriation from Congress in 1967. In 1990, federal legislation augmented health center reimbursement from Medicare and Medicaid. Following a $2 billion investment in health centers through the American Recovery and Reinvestment Act of 2009 (ARRA), the ACA infused an additional $11 billion over 5 years (2011-2015). By2020,1400federallyqualifiedhealthcenterswere operating 14 500 health care sites, with locations in every state, US territory, and the District of Columbia, 2 with an enacted federal appropriation of approximately $5.6 billion. Today, approximately 16% of health center revenue comes from competitive federal grants awarded by the Health Resources and Services Administration (HRSA). This funding largely benefits individuals insured through Medicaid and Medicaid expansion, as well as individuals whoareuninsured.Anadditional43%ofhealthcenterrevenue is derived from Medicaid reimbursement and 8% from Medicare. 3 Foundation and state funds, as well as private insurance, supply most of the other revenue. Prior to enactment of ARRA and the ACA, federally qualified health centers were providing care for an estimated 18.8 million patients. By 2020, an estimated 30 million people received primary care services in these centers, including 9 million children. 2 Overall, health centers have more than tripled the number of patients served since 2000. At federally qualified health centers, primary care is defined broadly. An array of services, often available onsite, includes behavioral health and medical and dental care. Transportation to and from the health center is often available, reducing missed appointments. Some centers also include food banks, em-VIEWPOINT

Characteristics of family nurse practitioners and their preparation for practice in rural vs urban employment settings

“…This lack of racial diversity is also observed in the recently published National Academy of Medicine report The Future of Nursing 2020À2030: Charting a Path to Achieve Health Equity (2021). To continue to provide services specific to underserved populations, a stable workforce made up of culturally sensitive and diverse primary care providers is needed (Wakefield, 2021).…”

“…To meet capacity expansion in federally funded health care centers, it is necessary to increase numbers of primary care providers prepared for practice. Rural health care center and academic institution partnerships could assist in the creation of safety net settings to provide immersive experiential learning as well as a better appreciation of health inequities and population specific health needs (Wakefield, 2021). Health care providers typically receive education and training in more metropolitan areas thus exposing them disproportionately to practice in urban settings.…”

“…Exposure to rural practice through partnerships can provide opportunities for health care providers to experience practice in these areas where they are desperately needed. Additionally, rural health care centers may provide a mechanism to identify and encourage community members to pursue careers in health care and help increase the numbers of health professions representative of the populations they serve (Wakefield, 2021).…”

Primary Care Physician Supply by County-Level Characteristics, 2010-2019

“…In the US, many communities face systemic barriers accessing health care in part due to primary care physician (PCP) shortages . Recent federal investments such as the 2011 Community Health Center Fund, which was established through the Affordable Care Act and provided more than $11 billion in funding, aimed to expand the primary care workforce in underserved communities . Changes in PCP supply since the implementation of these initiatives remain unclear.…”

Community Health Centers Caring for Adults With Hypertension and Diabetes

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Federally qualified health centers (FQHCs) play a special role in caring for 30 million adults and children in low-income urban and rural communities in the US. 1 These communities often have high rates of chronic health conditions, such as hypertension and diabetes. Without high-quality primary care that includes regular screening and monitoring, guidance on lifestyle modifications, and use of effective medications to control blood pressure, glucose, and cholesterol levels, hypertension and diabetes can often lead to myriad complications, including coronary artery disease, congestive heart failure, cerebrovascular disease, chronic kidney disease, peripheral arterial disease, dementia, retinopathy, and neuropathy.Author affiliations and article information are listed at the end of this article.

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