Policy Volatility in the Healthcare Safety Net

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 17. The State, Legal System, and Healthcare Policy

Abstract

Federally Qualified Health Centers (FQHCs)--the national network of federally funded primary care providers that serve patients regardless of their ability to pay–provide services to 1 in 12 Americans and are responsible for significant healthcare savings. And yet, in spite of their demonstrated value, health center funding has long been characterized by significant volatility. We draw on interviews with 60 stakeholders at 6 FQHCs in New York City, examining the impact of changes in three policy streams on FQHCs in New York City: (1) COVID-19-related funding, (2) the state 1115 Medicaid waiver, and (3) the 340B prescription drug program. We demonstrate how FQHC operations are fundamentally shaped by short-term infusions of funds. Reliance on these infusions leads FQHCs to make unsustainable investments in staffing and programming. Notably, many of these unsustainable investments are in innovations that are meant to impact health equity by addressing the social determinants of health. This makes it difficult to assess the efficacy of interventions around the social drivers of inequality and may diminish support for such investments. Finally, we characterize health center funding in terms of a policy patchwork, which undermines the long-term project of community health. Although this work focuses on three specific policy streams, the analysis has broader implications, as our findings align with a long history of health care safety net reliance on short-term, unpredictable policies.

Author

• Sorcha A. Brophy, Columbia University