When WORLD intern Kira Clark asked 37 charitably minded Americans what they thought about FQHCs, she found that not one had heard of them.
FQHCs are Federally Qualified Health Centers. They receive cash from Washington-start-up funding of up to $650,000, and millions afterward—plus free malpractice coverage under the Federal Tort Claims Act. They must be governed by a board of directors, a majority of whom must be active, registered FQHC patients.
Legislators and officials originally created FQHCs to reduce the patient load on hospital emergency rooms, but their function has expanded to serve potentially all poor or uninsured Americans and immigrants. Some 1,100 FQHCs now provide services regardless of ability to pay.
What's not to like? Just this: FQHCs may be a healthcare blessing to some poor Americans, but if historical precedent holds, they will also become a curse. The precedent: American poverty-fighting until the 1930s was Christian—and community-based. The Depression intensified the challenge, but the New Deal, instead of bulwarking private programs, marginalized them. A generation later the War on Poverty warred on the remaining Christian programs.
The result: Soulless welfare offices replaced charities that offered challenging, personal, and spiritual help. In many households, provision from the government replaced provision from a husband and father—and devalued men slunk away. Washington enabled more people to disable themselves by using drugs or alcohol. The same dollar flow went to a mother who cared for her children and one who selfishly ignored them.
American churches and charities before the 1930s, within the material opportunities of their eras, did a good but incomplete job of poverty-fighting. Today, America's charity clinics do a good but incomplete job of providing medical help to the poor and the uninsured. Sure, gaps exist and more resources would be great, but does that mean that the Affordable Care Act ("Obamacare") should wave a magic wand, with dollars stuck to it, and turn many of them into FQHCs?
A recent Kaiser Permanente Institute for Health Policy (KP) study offered an imperative for federal policymakers: "First, do no harm.?…?Policymakers should consider the impact of reform measures on the financial viability and operational stability of these programs." The KP study noted that "current financial support for charity care programs may diminish amid health reform implementation. For example, donors may perceive a reduced need for funding, given the extensive coverage expansions."