Who Relies on Community Health Clinics in the Post-Reform World?

Federally Qualified Health Centers (FQHCs) have long been at the center of the nation’s safety net providing care to the nation’s most vulnerable populations. including the poor, the uninsured and individuals covered by Medicaid. The Affordable Care Act (ACA) introduces both challenges and opportunities for FQHCs.  Many FQHC patients will gain insurance coverage under ACA, either through Medicaid or the Marketplace, requiring the centers to compete with other providers to attract and to retain newly insured patients who now have a choice of providers.  For FQHCs to be successful they have to deliver high quality health care services efficiently while balancing their mission of serving the residual uninsured population.   

We rely on December 2014 data from the Health Reform Monitoring Survey (HRMS), an internet-based survey fielding with a nationally-representative sample of non-elderly adults, to examine users of FQHCs in the post-ACA world and compare them to individuals who did not rely on a FQHC.  Then using follow-up interview information from selected HRMS respondents we explore reasons FQHC users rely on CHCs and their perceptions about the health care choices that are now available to them.

We find a high level of consistency in the FQHC user population post reform. Among the 16.6 percent reporting ever using a FQHC, 55.5 percent are current users and 46.3 report the FQHC as their current usual source of care. Data also show that FQHCs have maintained their mission of caring for at-risk populations:  Compared to those who did not use a FQHC in 2014, users were more likely to be poorer, a non-citizen, speak Spanish as their primary language, uninsured and have a lower health status. We find no difference in FQHC users by geographic region or whether they live in a state expanded Medicaid under ACA.  While more than half of current FQHC users report liking the staff and clinic environment, users cite several areas where health care center improvements could be made.