On Romney, health clinics, and the emergency room

Most everyone interested in health policy has seen, and commented, on this zombie idea brought up my Mitt Romney in his interview on CBS’s 60 Minutes (all emphasis in bold mine):

Pelley: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?

Romney: Well, we do provide care for people who don’t have insurance, people– we– if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.

This is in stark contrast to the Mitt Romney who introduced near-universal coverage in Massachusetts. The sentiment was expressed as recently as 2010 when he was citing emergency room usage as a reason to reform health care:

“Look, it doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way,”

But I’d like to direct your attention to the back to the followup response from Romney to Pelley’s question:

Pelley: That’s the most expensive way to do it.

Romney: Well the–

Pelley: In an emergency room.

Romney: Different, again, different states have different ways of doing that. Some provide that care through clinics. Some provide the care through emergency rooms. In my state, we found a solution that worked for my state. But I wouldn’t take what we did in Massachusetts and say to Texas, “You’ve got to take the Massachusetts model.”

The ‘clinics’ portion of his response isn’t something I saw brought up in people’s reporting of the exchange. Obviously the occurrence of Romney contradicting himself is nothing new. Yet the idea that health clinics are a particularly state-centered solution to the need for uninsured citizens to access affordable health care may be just as erroneous as his emergency room comments.

That’s because many of these health centers are actually Federally Qualified Health Centers (FQHC) and so-called “look-alikes” that receive federal funding. In 2010 there were 1,124 of these organizations, and here’s a map of where they are located:

Now these are organizations that receive grants, extra reimbursements from Medicaid/Medicare, and other special benefits from the federal government in order to provide services to the underserved and uninsured. Most health center funding come from federal grants and federal reimbursements – they get 65.9 percent of their revenue from the federal government (PDF). These clinics are arguably more important in getting the uninsured access to care, and I would hazard more cost-effective, than emergency rooms.

Moreover, funding for health clinics strikes me as something that a potential Romney administration would consider unnecessary given his willingness to “move” other programs that serve the poor to the states in order to save money:

Pelley: You would move some government programs to the states. What would they be?

 Romney: Well, for instance, Medicaid is a program that’s designed to help the poor. Likewise, we have housing vouchers and food stamps, and these help the poor. I’d take the dollars for those programs, send them back to the states, and say, “You craft your programs at your state level and the way you think best to deal with those that need that kind of help in your state.”

Pelley: So how does moving those programs to the states bring relief to the taxpayer?

Romney: Because I grow them only at the rate of inflation, or in the case of Medicaid, at inflation plus one percent, that’s a lower rate of growth than we’ve seen over the past several years, a lower rate of growth than has been forecast under federal management. And I believe on that basis you’re going to see us save about $100 billion a year.

Pelley: So you’re going to cap the growth on those social welfare programs?

Romney: Exactly right.

Thus a relevant question to ask Romney might be, “Would your proposal to cap federal funding of some programs that serve low-income Americans also include health clinics?” If the answer is yes then he is just as disingenuous to suggest that the ACA isn’t needed because health care clinics serve the uninsured.

Yet the point I’m trying to get to is that while it is true that the uninsured can get access to health care services at the ER and health clinics, and irrespective of whether or not they act as true alternatives to health insurance, they are nevertheless the result of federal policy. The ER of a hospital is only required to serve the uninsured because of the Emergency Medical Treatment and Active Labor Act – a federal law. Health clinics owe much of their effectiveness to federal funding and reimbursements. Ergo, these are not as Romney characterizes them, existing “state-centered” solutions to the issue. They are instead the federal government’s seemingly meager attempts at helping the uninsured gain affordable access to health care services. That the Affordable Care Act exists seems to tell us that those previous attempts were not sufficient.

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