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George Washington University, School of Public Health and Health Services, Department of Health Policy


Geiger Gibson/RCHN Community Health Foundation Research Collaborative Policy Research Brief No. 17


Medicaid & SCHIP; Safety Net; Community Health Centers


During times of economic crisis, community health centers and other health care safety net providers become even more vital to the communities they serve. The current downturn, with its high levels of unemployment and enormous impact on family incomes, carries major implications for health insurance coverage. The American Recovery and Reinvestment Act (ARRA), signed into law on February 17, 2009, provided slightly more than two billion dollars to community health centers for capital improvements, expansion (or retention) of personnel and services, and adoption of health information technology. All of these uses not only support health centers' mission to serve populations with limited access to health care, such as the uninsured, low-income populations, minorities, and the homeless, but also generate new economic activities in communities hit hardest by the recession:

  • More than 1,100 health centers throughout the United States have received ARRA funding to date. These centers are projected to serve 21 million persons in 2011, including nearly three million new patients as a direct result of ARRA funding. By targeting health centers, ARRA effectively provides needed health resources to populations at higher risk of poor health.
  • Community health centers receiving ARRA funding tend to be located in areas with higher rates of unemployment and recent job losses. The average unemployment rate among counties with health center ARRA grantees was 9.6 percent compared to an average rate of 9.0 percent in all other counties; the average unemployment rate grew by 4.4 percent in counties with health centers compared to 4.0 percent in all other counties.
  • The $1.85 billion invested to date in health centers under ARRA translates into $3.2 billion in new economic activity in these communities, suggesting that health centers are able to rapidly transform an infusion of funding into new services and expanded jobs.

These findings indicate that ARRA has achieved its goal of directing resources into those communities that tend to bear the heaviest burden of an economic downturn, and have low community incomes, a disproportionate percentage of low wage workers, inadequate primary care access, and elevated health risks. However, the challenge lies in sustaining this expansion and assuring that the ability of health centers to respond to community needs is maintained even as overall economic circumstances begin to improve. Reforms contained in both the House and Senate bills, such as expanded Medicaid coverage for low income patients and direct investment in health center expansions, hold the greatest promise for operational sustainability and growth.


Funder: Geiger Gibson/RCHN Community Health Foundation and United Health Foundation.

Open Access