1. Community Health Centers: The Foundation of Community Economic Health Healthy Communities: The Intersection of Community Development and Health Sept. 28, 2011 Federal Reserve Bank of Dallas

2. What Are Community Health Centers? Primary care medical clinic Located in low income areas – urban and rural Small federal operating grant Delivers care regardless of patient’s ability to pay. High number of uninsured and Medicaid. It’s a doctor’s office! But more.

3. Services Provided by CHCs Individual and family medical care OB/GYN services Pre-natal care Dental Services Behavioral Health Optometry

4. Outcomes and Costs? Patient mix much higher for at-risk individuals Yet, health outcomes are significantly better than private providers. And, cost of services significantly lower than private providers. ER diversion is critical in some communities. Moreover…a whopping 22% better outcomes on prevention!

5. © HealthChange, LLC 2004-2005

6. Economic Impact

7. National Impact of Healthcare 7

8. Community Impact Tend to be the largest employer in the urban community. Create the foundation for a healthy workforce Are community activists for safe environment (traffic and general safety) Often, especially in urban areas, their building projects provide the largest economic impact in the community’s history.

9. Examples from Massachusetts Lowell CHC - $40 million expansion Fenway CHC - $65 million new facility Mattapan CHC- $32 million new facility Whittier Street CHC - $37 million new facility 350 – 450 staff members

10. Texas Association of Community Health Centers Worked with many CHCs individually in Texas on capital projects – two currently TACHC (Daniel Diaz) have provided educational seminars on business planning and grant applications Did a financial trends analysis for TACHC and 50 CHCs

11. Banks and CHC’s Community Reinvestment Act – perfect Use of New Market Tax Credits – perfect Market analysis Economic impact analysis Financial trends analysis Loans typically only 30% of total project costs! Typical debt service coverage ratio: above 2.0

12. Health Care in the U.S. CHCs are on the front line of health care 49.9 million American’s are uninsured 44% of all Americans are under-insured (still can’t pay for health care) What’s to come?

13. Social Security, Medicare & Medicaid Outlays as a Percentage of GDP 1990-2075 13 Source: C. Eugene Steurle and Adam Carasso, (Budget Crisis at the Door), The Urban Institute, 2003. Based on data from the Congressional Budget Office, “A 125-Year Picture of the Federal Government’s Share of the Economy, 1950- 2075,” July 3, 2002, table 2.

14. Federal Receipts vs. Entitlement Spending 14 Source: C. Eugene Steurle and Adam Carasso, (Budget Crisis at the Door), The Urban Institute, 2003 Based on data from Budget of the U.S. Government, FY 2004 and CBO’s “Analysis of the President’s Budget, FY 2004.” (As percent of GDP)

15. International Monetary Fund Determined that the U.S. must increase taxes by 60% or Reduce Medicare, Medicaid and Social Security Benefits by 50%

16. CHCs on The Front Line The most cost effective source of health care in the U.S. The most “health effective” The most effective source of preventative care. And yet, they are on the front line against highest risk and lowest economic cohort of Americans. The future capability of America’s health care system may largely depend on its CHCs As well may the economic sustainability of thousands of urban and rural communities.

17. Terry Glasscock Capital Link, Inc tglasscock@caplink.org 781-789-6847 tglasscock@caplink.org