The federally qualified health center, or FQHC, is a vital component of the U.S. healthcare safety net. The FQHC model was developed, in part, here in the Mississippi Delta in the 1960’s to combat structural racism. The centers were signed into law and expanded nationally within the same decade as the Civil Rights Act, Medicare, and Medicaid. Today, this government designation enables community health centers to provide affordable, and, in many cases, free doctor’s visits to 28 million people every year. This is an invaluable service for the more than 59 million Americans who have inadequate health insurance coverage (both uninsured and underinsured).
Despite vicious federal cutbacks over the years since their inception, the FQHC has remained effective in reducing health disparities while also bringing jobs and economic opportunities to the country’s most structurally impoverished communities. These centers continue to serve as medical homes for 8.4 million children, 1.4 million homeless persons, and half of all people living in poverty in the US. (National Association of Community Health Centers Factsheet 2018)
Here in Louisiana, where undocumented refugee children and families do not qualify for Medicaid, FQHCs are the only option for healthcare for thousands of New Orleanians. These families are covered under FQHC’s federal mandate to “operate in a manner such that no patient shall be denied service due to an individual’s inability to pay” (HHS/HRSA Health Center Program handbook, p. 37).
Tragically, over recent months, several New Orleans’ clinics have implemented a minimum $40 fee for clinic visits, resulting in downstream effects such as parents canceling long-awaited pediatrician visits. No family should ever have to choose between putting food on the table or taking their child to the doctor. Physicians working in one particular clinic group have witnessed patients being turned away for not being able to provide proof of income. These practices are blatantly in violation of the FQHC mandate- services must be affordable, and no patient is to be turned away from health care services. Such attacks on the human right to health care fall squarely on vulnerable families such as those who have endured unimaginable trauma and risk to their lives to seek a safe haven here in the US.
In a country known for its shoddy safety net, the FQHC system is a legacy we can be proud of. As physicians and community members, we must fiercely guard the integrity of this vital institution. No center under the designation of the FQHC banner has the right to turn patients away based on income or any other criteria, and it is our duty to bring the illegal and cruel behavior of these corporations to light. To quote Dr. Martin Luther King, Jr., “Of all the forms of inequality, injustice in health is the most shocking and inhuman.”
– Dr. Virginia Byron