When Washingtonians lose entry to well timed major care, dental, behavioral well being or treatment providers at group well being facilities, their wants don’t vanish. They present up later and sicker in emergency departments and hospital beds. That’s dangerous for households, dangerous for hospitals and dangerous for taxpayers.
Group Well being Facilities are the entrance door to look after about 1.2 million individuals in Washington, the place 27 Federally Certified Well being Facilities function greater than 430 websites. A majority of CHC sufferers are lined by Apple Well being, our state Medicaid program, and CHCs serve greater than one-third of Apple Well being enrollees.
These clinics ship complete major and preventive medical care, dental, behavioral well being, pharmacy, and myriad different providers, effectively and near house. Additionally they get monetary savings. Analysis reveals CHC care reduces emergency division visits and hospitalizations and saves Medicaid about $1,400 per grownup affected person annually. Nationally, CHCs account for about 10% of the inhabitants whereas representing only one% of whole well being spending.
That worth is in danger. Underneath the brand new Medicaid work necessities, the Well being Care Authority tasks that 187,000 residents are more likely to lose protection. If enhanced premium tax credit expire on the finish of 2025, one other 80,000 individuals may forgo their protection with the Washington Well being Profit Trade via Washington Healthplanfinder, and $285 million in federal premium assist would disappear. The state estimates greater than $100 million in uncompensated hospital care as a ripple impact.
That is the hidden math of cost-shifting: When outpatient prevention and early remedy are disrupted, wants re-emerge in higher-cost settings ill-equipped to offer the care that’s wanted, and the general public finally pays extra.
Contemplate grownup dental care. When adults can’t get definitive remedy in a well timed method — an extraction or restoration — they flip to emergency rooms, the place clinicians often can solely provide palliative care, resembling ache management and antibiotics. Dental issues are among the many high causes uninsured sufferers go to the ER, and these visits usually repeat as a result of ERs will not be designed for definitive dental care. That’s worse for sufferers, arduous on hospitals and costlier for the state.
That’s only one instance. Equally, when CHCs can’t present behavioral well being, power illness administration or pressing major care quickly sufficient, situations escalate till they attain the emergency division, which gives non permanent stabilization at a a lot greater price per episode. Sufferers undergo from delayed, fragmented care. Hospitals take up pressure and uncompensated prices. The state pays extra via Medicaid or supplemental funding.
My recommendation to policymakers?
● First, cut back Apple Well being churn. The state ought to fund navigator partnerships that preserve eligible sufferers lined and design work-requirement exemptions aligned with different security internet packages.
● Second, keep market affordability. If enhanced premium tax credit lapse, older and rural Washingtonians face giant premium hikes, protection losses and avoidable ER use. The Washington Well being Profit Trade ought to deploy premium help the place the shock is biggest, and navigators might help these dropped by Apple Well being land on certified well being plans.
● Third, codify telehealth parity. In 2023, CHCs facilitated about 18 million telehealth visits. Cost parity is a low-cost, high-impact step that forestalls missed care and ER fallback.
● Lastly, preserve drugs reasonably priced by stabilizing the 340B Drug Low cost Program, which permits CHCs to offer sufferers with reasonably priced drugs and reinvest financial savings into providers that preserve individuals out of the hospital. Proposals to transform upfront reductions into rebate fashions would create cash-flow and administrative burdens, making it more durable for CHCs to cross financial savings to sufferers. The Legislature ought to urge Congress to reject rebate fashions or exempt Federally Certified Well being Facilities.
Our state well being care system is dealing with massive challenges, however the options are easy.
Protect Apple Well being entry. Hold drugs reasonably priced. Pay for telehealth. When you’re at it, shield the financing instruments that stabilize safety-net care.
Let well being facilities do what we do greatest: clear up issues early, within the lowest-cost setting. Let’s cease paying extra for worse outcomes. Hold care in clinics, not the ER.
