It takes a community: One approach to health care for the uninsured

Health centers are a big piece of the government's answer to the problem of the uninsured, but it takes more than a federal grant to keep them going.

By Joel B. Finkelstein, AMNews staff. July 4, 2005.

The promise of forgiveness of his medical education debt drew Gary Wiltz, MD, to Franklin, La., a small bayou town in rural St. Mary Parish. In exchange, the internist set up shop at the Teche Action Clinic under the auspices of a National Health Service Corps program aimed at getting doctors into physician shortage areas.

That was 20 years ago. He's still there, now CEO at the center, which serves a mix of uninsured, Medicaid and Medicare patients, as well as a small number of privately insured people.

So when Dr. Wiltz, who spends about half his time seeing patients and the other half on administrative duties, talks about what it takes to run a health center, he speaks from experience.

In sum: "Local problems deserve local solutions, by local people ... using federal money."

That federal funding has burgeoned in recent years, fueling a surge in the number of community health centers across the country. Dr. Wiltz and others are cautioning the stampede of newcomers to keep their focus local and to not underestimate the difficulties involved in establishing and maintaining a successful health center.

The growth is driven by a funding initiative President Bush launched in 2002 to double the capacity of federally qualified health centers within five years.

Every year since then the president has recommended, and Congress has approved, large annual increases in the federal grant program that helps establish and support these facilities. Bush's proposed fiscal 2006 budget includes a $304 million increase from 2005. If that passes Congress, health center funding will have grown about 50%, from $1.3 billion in 2002 to $2 billion.