The coronavirus pandemic has again laid bare stark racial and economic inequalities in the United States. People of color and the working poor have suffered disproportionately from severe illness, death, and economic hardship wrought by the disease, due to inequalities which have long existed.
Community Health Centers, also known as Federally Qualified Health Centers, specialize in providing much-needed medical care and social services to the underserved and vulnerable communities most impacted by COVID-19. CHCs provide care on a sliding fee scale, regardless of insurance status or ability to pay.
To date, federal coronavirus relief funds allocated to CHCs fall far short of what is needed to provide testing and treatment to the high-risk communities they serve. Clinics have been plagued by short staffing and forced to close sites amid declines in non-essential visits, even as they ramp up coronavirus-related services.
“Community Health Centers are under-resourced for the job Congress has asked them to do”, said Amy Simmons-Farber, Associate Vice President of Media Relations at the National Association of Community Health Centers (NACHC).
There are about 1400 CHCs providing care to 30 million people in the United States, over half of which are people of color. Seventy percent of CHC patients earn income below the federal poverty level, and many work in retail, food service, or caregiving occupations where they face higher risk of exposure to the coronavirus. Patients are often “doubled up” in unstable housing or living in multigenerational households with other essential workers where social distancing and quarantine are impossible.
In response to the current pandemic, CHCs have added COVID-19 testing and treatment to an already vast array of services, with 96% of CHCs able to administer tests. By testing and treating patients who contract COVID-19, they offload some of the burden from overwhelmed hospitals, yet these “hotspot” CHCs have been largely left out of federal relief funds available to providers during the pandemic.
One such CHC is Morris Heights Health Center (MHHC), which operates eight clinics and several school-based health centers in the Bronx, providing care to over 80,000 patients, many of whom suffer from chronic diseases and social problems such as unstable housing, food insecurity, and fluctuating health insurance status. The Bronx, where household income is lowest of all New York City boroughs and the majority of residents are people of color, has been hardest-hit by covid-19, with the highest rate of cases, hospitalizations, and deaths in the city.
Because they employ over 500 staff, MHHC does not qualify for the largest source of federal coronavirus relief funding available to smaller CHCs: the Paycheck Protection Program. These funds provided half of total federal support for CHCs with less than 500 employees, matching funds from federal grants and the Provider Relief Fund combined. Larger clinics ineligible for the Paycheck Protection Program also care for 30% of CHC patients nationwide.
The Provider Relief Fund is likewise limited in its ability to provide relief to strapped CHCs. Clinics can get the equivalent of 2% of their revenue from this funding stream, but this doesn’t amount to much for those serving low-income, uninsured patients. CHCs are eligible for only about a third of the $175 billion Provider Relief Fund, and a portion of that is designated for rural clinics, which again leaves out large urban clinics in “hotspot” areas.
Nearly 20% of the Provider Relief Fund is earmarked for safety net hospitals that treat similarly high-risk, high-need patients, and hospitals located in “high-impact” areas. CHCs are not eligible for these funds either, despite their role in relieving some of the pressure on hospitals. MHHC, for example, has coordinated with area hospitals to treat patients who arrived in swamped emergency departments but did not require hospitalization.
Like other healthcare providers that have seen sharp decreases in patient visits due to lockdowns and fear of exposure, Morris Heights Health Center has dropped to 30% of its previous productivity levels and has taken a financial hit. Their biggest present need is increased medical staffing for “pop-up” sites they’ve established in the community for COVID-19 testing and treatment.
One of these pop-ups is located at River Park Towers, an affordable housing community in the Bronx where many residents have been sickened and some have succumbed to COVID-19. They’re also working to establish outreach sites for undocumented immigrants, in trusted locations such as churches, for immigrants who may be infected but are too fearful of law enforcement to seek care.
“We’ll do what we can for as long as we can”, says CEO Mari Millet, although “we still haven’t made a dent in what we could do with additional funding. All of what we do takes support and money and the ability to hire people to do the job.” She notes that city and state governments have been helpful in boosting supplies of PPE, however the clinic must still purchase large quantities. CHCs in locations where local and state governments are less supportive of their needs likely confront greater struggles acquiring PPE.
Complicating the ability of CHCs to provide future care — any care, let alone in a pandemic — is an ever-present “funding cliff” looming over operations and planning. The annual federal grant that helps fund CHCs expires on November 30, and has lately been renewed by Congress only in small increments of a few months at most. “It’s hard to provide healthcare for 30 million people under these circumstances”, observes NACHC’s Simmons-Farber.
NACHC estimates it will take $7.5 billion in emergency COVID-19 funding to get clinics back on their feet, offset lost revenue, and support continued testing and treatment. According to Simmons-Farber and other NACHC leaders, a portion of this should be allocated to those subgroups of CHCs — large, urban, suburban, or hotspot — that have been most shortchanged to date.
CHCs provide quality, accessible care to vulnerable patients for whom COVID-19 poses the greatest threat to health and welfare. This makes their services all the more critical amidst the COVID-19 pandemic.