Public Health Centers Struggle to Keep Up

STONE MOUNTAIN, Ga., March 13, 2009 — The healthcare safety net is straining. Just look at Jeffrey Taylor's parking lot.

Taylor oversees a community health center for the poor in this suburb a dozen miles east of downtown Atlanta. The center, a modest one-story brick building on a hillside, has never been busier. People who recently lost their jobs and health insurance fill the waiting rooms, and their cars jam into the clinic's 50-space parking lot - with much of the overflow ending up at the nightclub next door.

"We need to expand this lot," said Taylor, who runs Oakhurst Medical Centers Inc., which operates two clinics.

Oakhurst is among 1,200 community health centers, 1,100 public hospitals, and nearly 3,000 local health departments that are primary strands in the nation's healthcare safety net. Most say they have become significantly busier in the last seven months, as the economy has worsened.

These last-resort centers coping with waves of new customers are looking forward to a jolt of new money from the $787 billion federal stimulus package signed into law last month.

Safety net providers struggle as a rule, but times are unusually tough. Most community health centers and public hospitals are temporarily maintaining their razor-thin operating margins, but say they can't keep it up for long. Many health departments - which play a leading role in preventive care and are heavily dependent on waning state revenues - are doing worse, eliminating thousands of jobs and shedding services.

"We've never seen it this bad," said Dr. Georges Benjamin, executive director of the American Public Health Association.

The stimulus package includes $87 billion for government health insurance for children and the poor, and another $3.5 billion to bolster public health services and safety net care. Federal officials are still deciding specifically how and where to spend that money, causing hand-wringing at these facilities.