As president and CEO of Amoskeag Health, a not-for-profit Federally Qualified Health Center (FQHC) that has been serving Manchester since 1993, I write to urgently address the collective financial crisis facing New Hampshire’s community health centers.
With compounding financial pressures, including declining support from some sources and reimbursement rates that are not commensurate with the rising costs of providing care in a “post-emergency” world, New Hampshire’s FQHCs badly need a strategic investment of emergency stabilization funds to ensure access to care for the 1 in 14 New Hampshire residents we serve.
There’s an expression that goes, “If you’ve been to an FQHC once, you’ve been to an FQHC once,” because our services and programs are unique and tailored to the needs of our community.
New Hampshire’s FQHC program goes beyond providing primary care to meet basic human needs such as access to healthy food, transportation, housing and child care that have an immeasurable impact on a patient’s overall health and wellness. Outside of clinics, our centers provide health and social services in dental offices, pediatric centers, schools, recovery community organizations, community mental health centers, child care centers, soup kitchens, churches and mobile unit locations across the state. We care for approximately 20,000 children, 16,000 adults age 65 and older, 5,500 homeless people and 2,600 veterans.
FQHCs are required to serve medically underserved areas where primary care services are scarce. In some rural communities in the Granite State, where patients have to drive hours to see a doctor, FQHCs only Source of primary care.
Health centers not only save lives, they also save the health care system money, which has a ripple effect throughout the state. New Hampshire health centers generated $336 million in economic activity and created more than 2,000 quality jobs in 2021. According to Capital Link research, every dollar of federal funding invested in health centers generates $11 in economic activity through associated increased spending on health services costs, food services, transportation, construction and more. Health centers currently employ more than 1,070 New Hampshire residents.
FQHCs have enjoyed bipartisan support and success for more than 50 years, but in the last few years, and especially since the pandemic, our health centers have faced extremely challenging new circumstances that have forced us to confront our future vulnerabilities.
There are several reasons for this unprecedented financial crisis.
Labor shortage
The foundation of quality care in community health centers is a dedicated workforce. In fact, community health centers serve as the training ground for much of the nation’s primary care workforce.
However, competition for nurses, medical assistants, paramedics and other medical staff in a highly competitive market puts our nonprofits at an incredible disadvantage.
FQHC employees work for wages that are not competitive with for-profit hospitals or private practices, leaving many unable to earn a living wage or forced to choose between leaving their nonprofit jobs to support themselves and their families.
Medicaid cuts
Thousands of Granite Staters who were covered by Medicaid during the public health emergency now lose that coverage, including approximately 3,000 FQHC patients (Compare 2022 and 2023 FQHC payer mix).
Visits for these patients who have lost Medicaid coverage have mostly been shifted to “self-pay” and “sliding fee discounts” instead of being reimbursed at the state’s newly increased Medicaid rates, driving up the cost of unpaid care paid for by federal grants and other revenues.
Our mission is to continue to care for those in need, whether insured or uninsured, and to help patients maintain or find coverage.
$340 billion savings decline
Making the situation even more difficult, the 340B program, which has provided a steady source of revenue for FQHCs since 1992, is under intense attack. Although the program is not taxpayer funded and accounts for less than 3 percent of all drug purchases in the United States, it receives discounts from the pharmaceutical industry, allowing vulnerable and underserved patients to purchase drugs at lower costs.
Amoskeag Health serves many patients who are employed but have low incomes and no health insurance. Through the 340B program, they can purchase medications to treat chronic conditions such as HIV, diabetes, heart disease and thyroid disease at a nominal cost.
Unfortunately, this program is in jeopardy for several reasons, including the refusal of some pharmaceutical companies to honor the 340B discount, which has significantly reduced 340B savings, and sadly, the loss of 340B savings puts many patients at risk of losing access to the affordable medications they need.
Responding to the pandemic
Pandemic-related increased expenses (e.g., personnel, medications, supplies) have put FQHCs in an unsustainable position. Further compounding the financial difficulties is the expiration of federal pandemic supplemental funding, which accounted for 7% of community health center revenues in 2021. We once again find ourselves facing flat budgets against this new backdrop of relentlessly increasing inflation and operational challenges.
After experiencing multimillion-dollar operating losses this fiscal year, New Hampshire community health centers have been working tirelessly to spearhead advocacy efforts and consultations with state and federal agencies, build partnerships to address systemic workforce and unpaid care challenges, and develop operational strategies to reduce expenses and increase efficiencies.
But we need support to keep our facilities open and our programs running. The financial strain on FQHCs threatens to reduce communities across the state’s access to preventive and primary care services, including maternal and child health, dental and pharmacy services, pediatrics, behavioral health, drug treatment and substance use disorder treatment.
Despite the challenging circumstances, we remain vigilant and hopeful that there is a tremendous opportunity before us to strengthen the Granite State’s primary care infrastructure and develop a plan for long-term sustainability.
