Community Health Centers and the Affordable Care Act: Increasing Access to Affordable, Cost Effective, High Quality Care

For more than 40 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay.  During that time, community health centers have become the essential primary care medical home for millions of Americans including some of the nation’s most vulnerable populations.  With a proven track record of success, community health centers have played an essential role in national recovery and reinvestment efforts and will play a key role in implementation of the Affordable Care Act.

The Affordable Care Act: The Essential Role of Community Health Centers

The Affordable Care Act provides $11 billion to bolster and expand community health centers over the next 5 years.

  • $1.5 billion will support major construction and renovation projects at community health centers nationwide.
  • $9.5 billion will:
    • Create new community health center sites in medically underserved areas; and
    • Expand preventive and primary health care services, including oral health, behavioral health, pharmacy, and/or enabling services, at existing community health center sites.

Next week, $250 million is being made available to support the establishment of approximately 350 new community health center sites in fiscal year 2011.  The expansion of community health center sites and services will make affordable, cost-effective, high quality preventive and primary care services available to nearly twice as many people regardless of their insurance status or ability to pay; and will create thousands of direct employment opportunities in many of the  country’s most economically distressed, low income communities.

Community health centers are poised to play an essential role in the implementation of the Affordable Care Act.  In particular, community health centers emphasize coordinated primary and preventive services or a “medical home” that promotes reductions in health disparities for low-income individuals, racial and ethnic minorities, rural communities and other underserved populations.  Community health centers place emphasis on the coordination and comprehensiveness of care, the ability to manage patients with multiple health care needs, and the use of key quality improvement practices, including health information technology. The community health center model also overcomes geographic, cultural, linguistic and other barriers through a team-based approach to care that includes physicians, nurse practitioners, physician assistants, nurses, dentists, dental hygienists, behavioral health care providers, case managers and health educators.

Community Health Centers Served All Ages in 2009. 12% of patients were under 5 years old. 13% of patients were between 5 and 12 years old. 8% of patients were between 13 and 17 years old. 11% of patients were between 18 and 24 years old. 49% of patients were between 25 and 64 years old. 7% of patients were 65 years old or older.
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, Uniform Data System, 2009.

Delivery of Care:  Increased Access to Health Services

Rooted in a commitment to community-based, patient-centered care, community health centers continue to focus on comprehensive services that meet the varying needs of their patient populations including:  chronic disease management, prevention and patient education activities, and outreach.  Today, a network of more than 1,100 community health centers operate 8,100 service delivery sites that provide care to nearly 19.5 million patients in every State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin.  About half of all community health center grantees serve a critical need in rural America; the remainder are found in urban areas.

This network of community health centers has created one of the largest safety net systems of primary and preventive care in the country with a true national impact.

  • Community health centers, supported by the Health Resources and Services Administration (HRSA), treated 19.5 million people in 2010, more than half of whom were members of racial and ethnic minority groups. Nearly forty percent had no health insurance; a third were children
  • In 2009, one out of every 17 people living in the U.S. now relies on a HRSA-funded clinic for primary care..
  • Community health centers are an integral source of local employment and economic growth in many underserved and low-income communities. Since the beginning of 2009, health centers have added more than 18,600 new full time positions in many of the nation’s most economically distressed communities.
  • In 2010, they employed more than 131,000 staff including 9,600 physicians, 6,400 nurse practitioners, physicians’ assistants, and certified nurse midwives, 11,400 nurses, 9,500 dental staff, 4,200 behavioral health staff, and more than 12,000 case managers, health education, outreach, and transportation staff.

Community health center quality of care equals and often surpasses that provided by other primary care providers. A programmatic emphasis on quality improvement as well as community-responsive and culturally appropriate care has also translated into impressive reductions in health disparities for community health center patients. Calendar Year 2009 Health Center Program data demonstrate that centers continue to provide high quality care and improve patient outcomes, while reducing disparities, despite serving a population that is often sicker and more at risk than seen nationally:

Community Health Centers Served a High Proportion of Minority, Uninsured and Low-Income Patients in 2009. 34.9%% of Community Health Center patients were Hispanic, whereas 15.4% of the U.S. population was Hispanic. 38% of Community Health Center patients were racial minorities, whereas 20.2% of the U.S. population were racial minorities. 38.2% of Community Health Center patients were uninsured, whereas 20.2% of the U.S. population were uninsured. 92.5% of Community Health Center patients were at or below 200% of poverty, whereas 31.9% of the U.S. population were at or below 200% of poverty.
Source: Health Center Data: U.S. Department of Health and Human Services, Health Resources and Services Administration, Uniform Data System, 2009. National Data: U.S. Census Bureau, 2008 Current Population Reports.

  • Between 2008 and 2009, the percent of low birthweight babies decreased yet again, from 7.6 percent to 7.3 percent, which is lower than the most recent estimated national rate of 8.2 percent.   In addition, the rate of entry into prenatal care in the first trimester increased from 65 percent to 67 percent.
  • 71 percent of community health center patients demonstrated control over their diabetes with a hemoglobin A1c (HbA1c) level less than or equal to 9.
  • 63 percent of hypertensive community health center patients have their blood pressure under control; an increase from 2008.

Community health centers also reduce costs to health systems; the community health center model of care has been shown to reduce the use of costlier providers of care, such as emergency departments (EDs) and hospitals. Community health centers continue to deliver high quality care efficiently and effectively at a total annual cost of $600 per patient in 2009.

Recovery and Reinvestment: Demonstrated Community Health Center Impact

Enacted in 2009, the American Recovery and Reinvestment Act (ARRA) provided $2 billion for community-based grants to community health centers over a 2-year period; an unprecedented opportunity to serve more patients, retain existing and support new jobs, meet the significant increase in demand for primary health care services among the nation's uninsured and underserved populations and address essential construction, renovation, equipment and health information technology systems needs in community health centers. To date, this $2 billion investment in community health centers has resulted in major increases in access to care while supporting the long term capacity of community health centers to serve even more patients through facility and technology expansions and upgrades, including:

  • The establishment of 127 new community health center sites.
  • Preventive and primary health care services for more than 4.3 million additional patients, about 50% who are uninsured;
  • In 2009, community health centers hired 10,000 additional staff, and overall provided employment opportunities for more than 123,000 people in many of the nation’s most economically distressed communities; and

Community Health Center Recovery Act Investments: $2 Billion over 2 Years. $155,938,944 funded opening new Community Health Centers. $341,738,453 funded increases in services. $853,419,154 funded expansion of facilities and upgrades of equipment. $520,434,263 funded major construction and renovations. $120,046,636 funded expansions in health information technology.

The construction, repair and renovation of more than 1,600 community health center sites nationwide, including the addition of electronic health records systems in more than 350 community health centers.  Find a community health center near you.

Date Last Reviewed:  March 2017