As the Gov. Paul LePage administration has repeatedly emphasized, primary care is an integral part of helping Mainers improve their health. The state should make an investment in its primary care centers, which fill gaps — both geographic and financial — in the state’s health care system.
One in seven Maine residents receives care from one of the state’s 20 community health centers and their affiliated services. These Federally Qualified Health Centers are open to everyone, meaning they do not turn patients away for lack of insurance or ability to pay. Patients are charged based on their ability to pay.
Many of the centers, which are spread from Fort Kent to Springvale, are in underserved areas. The centers in Washington County, for example, serve a third of that county’s population. The centers are often the only medical facility within 30 miles of where people live.
The clinics are built on the model of coordinating multiple health needs, physical, dental and behavioral, for example, through one provider, a health home. The centers increased access to dental care in underserved area more than four-fold in five years.
Patients are urged to take charge of their health, rather than being passive recipients of treatment. As a result, the centers are efficient. They serve 20 percent of the state’s MaineCare population but account for just 1.6 percent of MaineCare spending.
The nonprofit clinics are run by a board, the majority of which are clients, and they often have a significant economic effect in the small communities where they are located.
The clinics are funded through federal grants and payments from private insurers and the government, through Medicare and Medicaid. Their services are needed now more than ever after the state rejected an expansion of Medicaid coverage that would have extended health insurance to about 65,000 Mainers.
Last year, the state’s centers provided $2.7 million in care that was not paid for. As a result, some clinics tapped their reserves to balance budgets. Others reduced staffing and services. Most have only two to three days of operating money in reserves.
Department of Health and Human Services Commissioner Mary Mayhew has touted the value of primary care, especially when explaining why LePage proposes to cut funding for some health services and public health initiatives. For example, Mayhew has said that Suboxone treatment for opioid addicts is much better than methadone because it is administered by primary care providers. In his two-year budget, LePage would eliminate state funding for methadone treatment for MaineCare clients. The budget also would divert $10 million from Healthy Maine Partnerships earmarked for smoking cessation and other public health needs. The $10 million, from the state’s tobacco settlement money wouldn’t expand access to primary care; it would merely retain increased Medicaid reimbursement rates for primary care providers that were in effect for the past two years under the federal Affordable Care Act and expired Dec. 31, 2014. The Appropriations Committee rejected the governor’s proposal.
Maine is the only state in the Northeast that does not invest state funds in these health centers. Last year, Massachusetts allocated $74 million to its 37 federally qualified health clinics. New Hampshire allocated $3.3 million to its 11 clinics. Thirty-two states provide direct state funding to these clinics to help support the care that is provided to those without insurance. It is time for Maine to do so as well, especially in the absence of Medicaid expansion.
LD 969, which is sponsored by Sen. Roger Katz, R-Augusta, and co-sponsored by both Senate President Mike Thibodeau, R-Winterport, and House Speaker Mark Eves, D-North Berwick, seeks $1.5 million per year for the health centers. The money is for patient services and to recruit and retain needed providers.
This is a small and needed investment in a health care model that has proven its worth.
