The United States has the most expensive healthcare system across the globe, yet 40 percent of American adults have reported foregoing healthcare due to high cost. In Arizona, 11.7% of residents reported cost as the reason they didn’t seek care in 2020. This growing issue was taken up by Arizona health leaders to dedicate a panel on healthcare affordability in the state at the 2023 Arizona State of Reform Health Policy Conference.
Jonathan Melk, MD, chief executive officer of Chiricahua Community Health Centers, spoke on the importance of federally qualified health centers (FQHCs). Arizona is home to 25 FQHCs and look-alikes, which directly stemmed from the Civil Rights Movement, and were directly tied to the defined rights of human beings, Melk said.
“One of those rights is access to primary care,” Melk said, adding how it was a concept that most agreed with at that time.
FQHCs grew out of the Black Civil Rights Movement and the desire to expand healthcare access. During the 1960s, many Black individuals received healthcare from clinics and public hospitals that lacked adequate funding—even after the passage of the 1965 Medicare and Medicaid Act which made it illegal to provide federal dollars to hospitals discriminating against patients, although this was not strictly enforced.
The Black Panther Party, a Black power political organization, opened 13 free health clinics across the United States, with the Carolyn Downs Family Medical Center in Seattle—formerly known as Sidney Miller Free Medical Clinic—being the only one still in operation.
“The first money that came out of the 1964 Civil Rights Act, among that money, was money to fund the very first FQHC.”
— Melk
In 1964, numerous doctors traveled to Mississippi to aid Freedom Summer volunteers, who were working to register Black individuals to vote in Mississippi during a period of extreme racism and rising instances of violence. Volunteers set up an array of community resources for Black individuals, including community centers, health centers, and schools. That group of volunteers named themselves the Medical Committee for Human Rights, which continued to aid Black communities who were under threat of violence.
By 1965, neighborhood health centers were launched and funded under demonstration authority by the United States Office of Economic Opportunity, or the lead agency overseeing President Lyndon B. Johnson’s “War on Poverty.”
Chiricahua Community Health Centers, which include mobile health clinics units, are the only FQHCs in the rural parts of Cochise County, Melk said. He identified a primary issue for the health centers: there’s currently not enough providers to meet the daily demand, and it’s an area where providers don’t necessarily want to relocate to.
Saudamini Wadwekar, MD, chief medical director of Equality Health, hopes to see a shift away from fee-for-service models of care and towards fee-for-value models of care, while optimizing practice performance and increasing compliance. She also acknowledged how the continued support from policymakers and lawmakers is crucial in addressing high healthcare costs.
Access and affordability boils down to health equity, Wadwekar said, mentioning that one of the things that Equality Health does differently is to meet members where they are while enabling primary care physicians to do the same. Wadwekar said that members receive better care quality and providers have options to increase their own revenue with value-based care contracts.
Dustin Taylor, west region president of UnitedHealth Group, explained how he works with numerous FQHCs in Arizona, and there’s an opportunity in front of them—what he sees as a missing component: consultants sitting down with employers to discuss costs, and potentially negotiating contracts between providers and hospitals. Taylor believes it’s important that employers are supported in negotiating contracts that provide their employees with care that’s affordable.
Taylor also said the cost of pharmaceuticals is catastrophic to the entire healthcare system, particularly the commercial space. He said he’s concerned about states requiring health plans to cover the cost of certain medications, only to have those medication costs skyrocket. Taylor applauded the Arizona Health Care Cost Containment System’s (AHCCCS) increase in reimbursement rate to Medicaid providers.
Piggybacking off of Taylor’s comments, Melk voiced concern about the government taking on increasing premium costs related to prescription drugs.
“It’s getting too expensive. There’s going to be a magnifying glass on companies like United that are spitting out profit that started out as tax money,” Melk said. “The Arizona Health Care Cost Containment System model that we have here puts a cap on how much money you can make.”
Melk explained how Arizona caps a profit of investments, so if an AHCCCS plan makes over three percent, it must reinvest money back into the community. While these profit caps are not yet in place for Medicare advantage or commercial health insurance, Melk thinks that pressure is being felt.