CITIZEN JOURNALISM: Health centers perform key services

On 15th Street Northwest between Harvard and Girard streets stands La Clinica del Pueblo, which serves the types of clients who stand at the heart of the national dialogue about health care reform.

La Clinica is a federally qualified health center that targets a special population — in this case, uninsured and underinsured immigrants.

The stimulus package that Congress passed and President Obama signed into law earlier this year boosted funding for clinics such as La Clinica. Also, a Senate measure and a House bill support increased funding for these community-based clinics.

The stimulus money and the House and Senate bills are intended to bolster preventive and primary care for uninsured and underserved populations. That was President Johnson’s intent as well when he first established federal funding for community health care centers as part of his war on poverty.

La Clinica was founded in 1983 by U.S. and Salvadoran activists. It initially was a one-room clinic that opened one night per week to address the needs of Central American refugees. Under the leadership of Dr. Juan Romagoza, who returned to El Salvador in April 2008 after serving as executive director for 20 years, La Clinica expanded the scope of its services. The clinic now has a staff of 80 and has evolved into a health care center that offers clinical, substance abuse and mental health services as well as services for HIV/AIDS patients. It also offers social services for such basic needs as housing, clothing and food.

At La Clinica, primary care and mental health services are provided using a sliding fee scale. Other services, such as support groups and HIV testing, are provided free of charge. No patient is denied services because of inability to pay.

In 2008, La Clinica provided more than 7,500 men, women and children with more than 55,000 culturally appropriate health services. More than 90 percent have incomes below the poverty level. Twenty-five percent of the clinic’s patients have no insurance, and 75 percent receive some form of public assistance. About 77 percent of the clinic’s clients live in the District, 19 percent live in Maryland and 4 percent live in Northern Virginia.

“The majority of our patients are excluded from the [health care reform] conversation, and anything that will include them is welcomed,” said Alicia Wilson, the clinic’s executive director.

Ms. Wilson said she wants the focus of the dialogue to shift from profits and government control to granting more people access to basic health care.

“Investing in health care is an investment in the nations potential. The alternative of not investing is squandering our capacity for enhanced productivity,” she said.

“A man or woman who is diabetic comes to La Clinica for routine maintenance four times a year. These costs to La Clinica are from $1,000 to $2,000. If this man or woman did not receive this routine care, the eventuality could be an emergency-room visit with the costs of up to $10,000, then ultimately being passed on to us by the hospital,” she said.

The D.C. government agrees.

“The District continues to exhibit alarming rates of chronic disease, such as heart disease, asthma, diabetes and HIV infection. District agencies responsible for public health, including the Department of Health (DOH) and the Department of Mental Health (DMH), will collaborate across the government as well as with the community to target the most pressing health issues confronting District residents,” the Fenty administration’s 2008 Vision and Initiatives said.

La Clinica is one of several federally qualified health centers in the city and one of 1,200 across the country. The stimulus package signed into law in February provides $2 billion to help build up to 126 more clinics and hire medical personnel. The bill passed this summer by the House proposes a dedicated funding source called the Public Health Investment Fund. A version approved by the Senate Health, Education, Labor and Pensions Committee does not propose such a permanent fund, but calls for increasing funding from $2.2. billion this year to $8.3 billion by 2015.

The discussions about reform must continue to include community-based health care services, Ms. Wilson said.

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