If Obamacare proves to be a success, it will be due in large part to people like Lee Francis.
Francis is president and CEO of Erie Family Health Center, a network of 12 neighborhood clinics in and around Chicago. He's also a practicing physician at one of those clinics, where he sees firsthand the benefits, both financial and health-related, that having health insurance and a regular provider has on his patients.
So Francis has concentrated a great deal of effort in enrolling eligible patients in health plans created or enabled by Obamacare (officially, the Patient Protection and Affordable Care Act, or ACA). Francis and his staff have helped 2,600 patients enroll in Cook County's ACA-fueled Medicaid expansion program since January, and they're now helping patients enroll in private health plans under Illinois' health insurance exchange, which went live Oct. 1.
"When we enroll patients in Obamacare, when they get health insurance, all of a sudden they feel proud," Francis says. "Insurance is a worry that people carry around with them. It's a terrible burden. And when you lift that burden, you see people really feel respected. It's a remarkable change."
Erie Family Health Center is one of thousands of clinics—legally known as community health centers, and sometimes called Federally Qualified Health Centers, or FQHCs—that provide community-based care to millions of Americans. These clinics are often considered "safety net providers" because they serve inner-city and rural areas that typically don't have access to large hospitals or doctors' offices, and because they treat all patients, regardless of their ability to pay.
In many ways, FQHCs are on the front lines of Obamacare implementation. More than a third of their patients lack insurance, and they've been at the forefront of enrolling these patients in ACA-enabled health plans. And, as millions of Americans become newly covered under the ACA, they'll need someplace to get care. FQHCs are filling that void.
"Community health centers are central players" in ACA implementation, says Sara Rosenbaum, professor of health policy at George Washington University School of Public Health and Health Services. "They do enrollment in the toughest communities, where the people are poorest and least able to navigate the enrollment system on their own." They also have extensive experience in treating people in those communities, so they are a natural source of care for the newly insured, Rosenbaum says.
Community health centers aren't new. They're little known, but they enjoy bipartisan support. The program was created by Civil Rights legislation in the 1960s and expanded in the early 1990s (when they became eligible to accept Medicare and Medicaid). The program doubled in size in the early 2000s under President George W. Bush, who openly promoted their use.
Community health centers are sustained by nearly $3 billion a year in federal funding -- a drop in the bucket compared with the $2.7 trillion total annual spending on health care in the United States. What do we get for that money? Today, approximately 1,200 health centers deliver care through more than 9,000 service delivery sites nationwide, treating more than 21 million Americans a year.
The ACA contains a major boost for health centers. It created a five-year, $11 billion trust fund called the Community Health Center Fund for the operation, expansion, and construction of health centers. The fund will allow centers to hire approximately 3,000 application counselors, the so-called "navigators" who are tasked with helping patients enroll in health plans under ACA, nationwide. It will also help establish more than 300 new health center sites and support the construction and renovation of nearly 600 clinics, according to Jim Macrae, associate administrator for primary health care at the Health Resources and Services Administration, the federal agency that oversees the program.
The chief reason for the expansion: If millions of Americans join the health insurance rolls, they'll need somewhere to go to get care. "As people become insured, we have to make sure they have a place to access health services," Macrae says.