Thursday, January 17, 2002

Community health centers
need federal and state help

The number of people without
medical insurance is soaring

By Helen Altonn

Hawaii's community health centers need state and federal help to care for soaring numbers of medically uninsured residents, officials of the safety-net health system emphasize.

"The state needs to get involved and work in partnership with the centers," John Mengenhausen, president of the National Association of Community Health Centers, said at a forum on the issues at the Capitol.

House Health Committee Chairman Dennis Arakaki, who sponsored the event, said bills will be introduced this session to carry out the Hawaii Primary Care Association's 2002-2003 "Agenda for Health."

But he said "it's going to be very difficult" to address the growing uninsured plight with the state in an economic crisis.

About 11 percent of Hawaii's population -- 135,000 people -- have no insurance now, and the situation is worsening, says Beth Giesting, executive director of the Primary Care Association.

She said the centers had a 60 percent increase in uninsured patients from 1997 to 2000, caring for 72,000 people last year. They have a sliding fee scale but take everyone regardless of ability to pay. The centers receive about $2 million annually from the state for uninsured patients. About 26 percent of their money is from federal grants, and the Bush administration has pledged to double community center health funding over five years.

The Hawaii centers want to expand services by 2006 to care for more than 120,000 uninsured people -- an 85 percent increase, Giesting said.

The association's legislative package includes proposals to increase state funding for health care for the uninsured, remove the limit on the number of people who can enroll in the state's QUEST program, provide Medicaid coverage for pregnant immigrants, change QUEST eligibility requirements from 200 percent to 300 percent of poverty so the working poor -- the largest category of uninsured -- can get health coverage.

The association also is seeking restoration of dental coverage for adults in QUEST and Medicaid. Arakaki said a measure will be introduced for special licensing to encourage dentists to serve the uninsured and underserved.

Mengenhausen said the federal government is requiring community centers to include mental health and dental services if they expand existing centers or establish new ones. This is a good mandate, he said, but staffing must be there. Most of Hawaii's centers provide mental health services, but few offer dental care, Giesting said.

Mengenhausen said the growth of the uninsured population -- a national dilemma -- is compounded by cutbacks in charity care by private doctors, reduced Medicaid payments and eligibility restrictions for government insurance programs.

The Hawaii centers operate in 34 locations. They provide an array of services, from language translation and homeless outreach to school-based health and specialized chronic disease management.

The average cost according to a 1998 study was $677 per patient per year, Giesting said, compared with $7 million for hospital care for 700 uninsured patients who could have been in outpatient care.

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