San Diego Business Journal

President's Initiative Strives to Aid the Uninsured
Clinics, Centers Work to Provide Health 'Safety Net'

BY JOSHUA LAZERSON
Special to the Business Journal

Today, an estimated 660,000 county residents under the age of 65 live without health insurance, and approximately 140,000 of the county's children are counted in that number. The great majority of uninsured San Diegans either are working people or dependents of a working parent or guardian.

San Diego county's "uninsurance" rate stands among the highest in the nation, a result in part of the prominence of the small-business sector within the county's economy and the high (and rising) costs associated with offering health benefits to small-business employees.

The costs associated with being uninsured, on both a personal and societal level, are equally significant. Uninsured infants and children are much less likely to receive needed preventive care such as immunizations, developmental screenings, and dental, vision and behavioral health services.

Uninsured adults at risk for serious chronic illnesses often do not seek medical care until symptoms arise that announce the presence of serious damage to vital systems. The uninsured regularly seek care in hospital emergency departments, at great cost and in a manner that places tremendous burdens on those resources.

At a time when a constellation of local, state and national factors, including rising health care costs, state budget deficits and new regulatory requirements are conspiring to exacerbate the crisis in health care, the uninsured bear the greatest burden in this regard.

- Five-Year Health Center Initiative

San Diego is an unusual county in the context of health care service delivery, given its reliance upon the private sector to provide most services to the county's uninsured and other low-income and medically underserved residents. The county's primary care "safety net" is composed almost wholly of private, not-for-profit community health centers and clinics, some of which receive federal funding as a portion of their overall budget.

These health centers and clinics serve the majority of San Diegans who either are uninsured or insured through public programs such as Medi-Cal and the Healthy Families program. Health centers and clinics, challenged in recent years by the transition of public insurance programs into a managed care model, now find that they also are challenged to survive in a context of greater numbers of uninsured persons.

Given the harsh reality of the health care terrain as described, President George W. Bush's decision to look to safety-net providers in San Diego and throughout the United States to improve access to health care among the nation's most medically vulnerable residents came as welcome news in the community health sector. In 2000, Bush initiated his five-year, $500 million Health Center Initiative, an ambitious plan to fund the development of 1,200 new community health center sites across the country, and to expand medical, dental, behavioral health and pharmacy capacity at a number of existing sites.

The ultimate goal of the president's initiative is to increase the nation's primary care safety-net capacity by 6 million new patients. In accepting federal funds, community health centers and clinics must adopt and adhere to clinical, administrative and fiscal requirements that ensure high standards of care and administration.

In its first year, the initiative has been responsible for the development of 158 new health care sites and the substantial expansion of medical capacity at an additional 131 sites. Add to that the promotion of new or expanded oral health, mental health/substance abuse, or pharmacy services at a further 202 sites across the United States. Low-income and/or uninsured residents of San Diego county are already witnessing the benefits of the initiative, as health centers in San Diego received grants in the Initiative's first year that will add capacity to serve thousands of new patients in a number of county regions.

On a national level, the awards made in the first year of the president's five-year effort should translate to the capacity to serve approximately 1 million new safety-net users. With the initiative's awards almost evenly divided between rural and urban areas, access to health care services will improve for many families in both urban and rural areas.

- Bolstering Infrastructure

What, then, is the relationship of the Health Center Initiative to the problem of the uninsured, in San Diego County and throughout the United States? One might suggest that the initiative is a silver lining attached to the cloud of 42 million Americans currently living without insurance.

The Health Center Initiative expands substantially the capacity available to meet the health care needs of uninsured and underserved persons. However, it does not cover the actual and full costs of providing this population with comprehensive and ongoing care.

Nor does it, alone, address the problem of those uninsured individuals and families who tend to delay or deny their own care or ultimately seek it in emergency rooms, based upon their belief that they simply cannot afford to meet these needs or their aversion to what they perceive as "handouts."

The residents of San Diego, California, and the United States generally are likely to benefit tremendously in the decades to come from the leadership shown by Bush in bolstering the nation's health care safety-net.

This safety net of community health centers will be a necessary element of America's health care infrastructure whether the problem of uninsured persons in the United States persists or is resolved. If the problem of the uninsured persists, these associated and expanding costs will debilitate a health care system already in crisis.

Lazerson is the director of program development for Family Health Centers of San Diego.