Box IV.1

Recovery Act Investments in Community Health Centers

The Recovery Act provided $2 billion in investments for community health centers. Community health centers offer access to primary care for medically underserved populations, including the homeless, seasonal workers, the uninsured, and others who have difficulty affording care. According to the Department of Health and Human Services (HHS), which provides grants to qualified community health centers, around 1,100 community health centers receiving federal support treated more than 16 million people in 2008, of whom nearly 40 percent were uninsured, and a third of whom were children. Treatments range from basic prenatal care, immunizations, and vaccines to cancer screenings and diagnostic laboratory and radiologic services, as well as referrals to specialists.

As the recession forced millions out of employment in 2008 and 2009 -- causing families to face the double burden of losing their employer-sponsored health coverage along with their job -- community health centers provided an essential backstop of access to primary care. By avoiding costly emergency care through catching, diagnosing, and treating diseases before they become urgent, centers reduce uncompensated care costs passed on to state and federal budgets and privately insured individuals.

The Five ARRA Community Health Center Infrastructure Programs

The $2 billion in Recovery Act funding is divided among five programs aimed at improving the infrastructure and technology of community health centers, expanding their capacity to serve more patients due to the recession, and breaking ground on new centers. The ARRA investments in community health centers described individually below and shown in Box Table 1 have bolstered infrastructure and technology, created jobs, and resulted in the treatment of millions of uninsured patients.

1. Capital Improvement ($858 million). The Capital Improvement Program provides grants between $250,000 and $2.5 million to fund infrastructure investment in health centers, including construction, repair, renovation, and equipment purchase, as well as health information technology. The program was designed to help health centers meet immediate and pressing needs. Of 2,614 projects funded through this program, around 60 percent are for construction, alteration, and repair, with the rest for health information technology and electronic medical records. More than 41 percent of capital improvement grants had already been outlayed through June 2010.
2. Facility Investment ($521 million). Like the Capital Improvement Program, the Facility Investment Program provides infrastructure grants to support construction. The Facility Investment Program is targeted toward major investments in facility modernization and improvement and has a larger grant ceiling than the Capital Improvement Program, with awards between $750,000 to $12 million and an average award of $6 million. Because these grants were announced in December 2009 and scheduled for later implementation than the other investments in community health centers, less than 3 percent of the grant funds had been outlayed through June 2010.
3. New Access Points ($157 million). Grants for New Access Points are designed to support community health centers in building new delivery sites to provide wider access to care. Nearly 60 percent of the funds for this program have been spent to date, and recipients report that these grants funded more than 1,000 jobs in the first quarter of 2010. HHS estimates that a total of more than 750,000 patients will be served by the new sites supported by this program.
4. Health Information Technology ($121 million). The ARRA offered grants specific to community health centers to invest in health information technology systems such as electronic medical records and networks to enhance coordination between centers. HHS had obligated nearly the entire appropriation by the end of the second quarter of 2010.
5. Increased Demand for Services ($343 million). In order to help health centers maintain access and quality care for an expanding uninsured population during the recession, Increased Demand for Services grants were designed to increase health center staffing, extend hours of operation, and expand existing services. More than 59 percent of these grants had been outlayed by the end of June, funding nearly 4,000 jobs in the first quarter of the year according to recipient reports. HHS estimates that more than 2 million new patients -- of which more than 1 million are uninsured -- will be served by the additional capacity supported through this program.

Taken together, nearly the full $2 billion in community health center grants has been obligated, with just over one third of that outlayed so far. ARRA funding for community health centers has broken ground on the construction of new sites, repaired infrastructure in urgent need of renovation, and will treat more than a million uninsured patients, all while supporting thousands of jobs.

Examples of Community Health Centers Supported by ARRA Infrastructure Investment

The aggregate data make clear the effect of the community health centers funding, but it is also useful to explore the impact in individual communities.

For example, Community Health Centers of Southeast Kansas received an Increased Demand for Services grant for $336,330, and a Capital Improvement Program grant for $809,020. The network of centers -- which served 16,000 patients during 59,300 visits in 2008 -- used the Increased Demand for Services grant to hire two new family physicians and retain a previously overburdened doctor on the staff. The centers used the Capital Improvement Program grant to add five exam rooms to an existing building, increasing the facility’s capacity by 6,000 patients per year. The augmented staff and new construction will help the center respond to rising demand for care, projected to increase by 13 percent to 17,700 patients in 2010.

Halfway across the country in Washington, DC, Unity Health Care—a nonprofit operator of health centers and other social services serving 81,000 individuals and families each year—received a $12 million Facility Investment Program grant in 2009. As described by Unity Health Care, “the $12 million award will pay for a portion of the cost associated with the construction and renovation of two of Unity’s busiest health care facilities; the Anacostia Health Center serving more than 7,000 patients annually and the Upper Cardozo Health Center serving more than 20,000 patients a year.” The new Anacostia facility will more than quadruple the size of the previous facility, replacing a 6,000 square foot, pre-fabricated, windowless building constructed in the 1960s.

Community Health Centers and Health Insurance Reform

Just as the Recovery Act has helped families and individuals weather unemployment and uninsurance by strengthening community health centers, the comprehensive health insurance reform legislation signed into law by the President in March continues to make investments going forward. The legislation establishes a Community Health Centers and National Health Service Corps Fund that will provide $12.3 billion in support for the infrastructure and staff of community health centers between 2010 and 2019. These investments will build on the foundation established by the Recovery Act to expand access and reduce the burden and cost of disease in a reformed health care system.

Return to IV. The Public Investment Provisions of the Recovery Act