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Delivery System Day: Sara Rosenbaum

Rosenbaum.jpgSara Rosenbaum is chairman of the Department of Health Policy at George Washington University. She also led the team that drafted Bill Clinton's 1993 Health Security Act. And she brings up a piece of this that's not betting much attention, but should: community health centers.

Both the House Tri-Committee bill and the Senate Finance Committee proposal assume modest efficiency reforms. The House bill also assumes an investment in community health centers, which furnish comprehensive primary health care access to millions of residents of medically underserved communities. This investment turns out to have an important impact on costs, even as it expands access. A recently completed GW study that considered the economic effects of this investment found that the $38.8 billion expenditure assumed in the House bill would result in overall health care savings of $212 billion over the 2010 to 2019 time period, including federal Medicaid savings of $59 billion.

The dollar value of these expected savings would significantly exceed the cost of the investment. Savings are the result of the highly efficient way in which health centers operate, as well as their documented impact on reducing avoidable hospital and emergency department use. Were the reach of health centers to be further extended by assuring that exchange health plans pay health centers at the special Medicaid rate, Medicaid savings would climb to $70 billion as health centers' reach grows. This is a case in which doing good for medically underserved communities also turns out to be the smart investment.

You can download the full report here. (pdf)

By Ezra Klein  |  September 22, 2009; 1:10 PM ET
Categories:  Health Reform  
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This is definitely the kind of thing that I can 100% get behind. Hopefully they will make great use of Nurse Practitioners as part of these community health centers.

Posted by: spotatl | September 22, 2009 1:16 PM | Report abuse

Nice. I've advocated this same idea, but less completely. I think this is one of the best ideas around. In the end, you need efficient providers and it is better to have several avenues to get there.

I think a "basic" plan (perhaps the "bronze" plan) should even mention including such centers in their benefits, and allowing "bronze" benefit packages to be set up that even rely primarily on such centers as the primary care provider for youthful policy holders. I think good health insurance for 25 yr olds could reasonably cost as little as $200-$250/month when efficient centers are available for the bronze plans to use.

Such plans would then require less subsidies to low-income policy buyers, reducing the total federal costs.

Posted by: HalHorvath | September 22, 2009 1:22 PM | Report abuse

BTW- the only problem with this is going to come from the fact that any mistakes from a government funded community health center will be wildly trumpeted by the Right. It will be disingenuous because mistakes happen everywhere but its still something to be aware of. Wait lists would also be discussed the same way without regard to showing that this is a low cost alternative to doing nothing.

Posted by: spotatl | September 22, 2009 1:36 PM | Report abuse

President Obama in the beginnings of this round of reform just after his election spoke about expanding community health centers and then like now I agree 100% with them. They can be a great resource for those that will stay uninsured. Not only giving them options but hopefully lower cost options that cost us all less than what we pay for the uninsured.


in NJ where i live that cost for insurance for the younger are already lower than that and we are one state that has many mandates that increase the cost. So your figure of $200-$250 is already much lower than that. see the link I provide:

rates for these plans are as low as $128 a month for young single individuals. There is no excuse not to have some kind of coverage like this and even moreso when and if these policies become subsidized for those at or near the poverty levels as mentioned in all the bills.

Posted by: visionbrkr | September 22, 2009 1:46 PM | Report abuse

Ezra - great post but I think your link is to the wrong report (it links to one about CHCs in Indiana) - this appears to be the right one:

Posted by: JS330 | September 22, 2009 1:52 PM | Report abuse

visionbrkr, the table of rates you link is interesting in that the variation is so large. This is because of out-of-pocket levels?

Posted by: HalHorvath | September 22, 2009 2:11 PM | Report abuse

"But here’s a quick snapshot of federal employee health benefits:

"Two of the most popular options are national, fee-for-service Blue Cross plans. There is a “basic” option that requires the use of in-network doctors, hospitals and other providers, and a more expensive “standard” option that covers some out-of-network charges.

"The basic plan costs employees $92.44,per month or $1,109.28 per year for individuals, and $216.48 per month or $2,597.76 per year for families. The government pays $277.32 per month or $3,327.84 per year for individuals, for total annual individual premiums of $4,437.12, and $649.45 per month or $7,793.40 per year for families, for total annual family premiums of $10,391.16. The out-of-pocket maximum is $5,000. "

Posted by: HalHorvath | September 22, 2009 2:38 PM | Report abuse


It varies based upon age, gender, geographic location. THe only factors it doesn't account for in cost is health status or tobacco use.

The reason for the majority of the variation is age. Note that single males cost is less than single females until they reach age 45-49 where it is almost the same (reason is child bearing years) and then men are more expensive.

The out of pocket levels for these plans are all the same as mandated by NJ law.

Posted by: visionbrkr | September 22, 2009 2:55 PM | Report abuse

A local CHC (Yuba County, CA) may have saved my life. I had high blood pressure and did not know it. I have no healthcare and I was seen on a sliding scale based on income. My blood pressure medicine was also highly discounted. I have since reduced food intake, stopped drinking, lost weight and exercise more. My family has a history of heart disease. Imagine if I would have had a heart attack? The proactive approach of providing affordable access to healthcare may have saved alot of money. see my complete blogpost at: and scroll to my post on Community Healthcare Clinics

Posted by: daveduggan | September 25, 2009 9:19 AM | Report abuse

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