Community Health in the '90s
By the 1990s, community health centers (CHCs) were providing quality health care to a growing number of low-income patients. In an effort to improve access to medical care and further strengthen the infrastructure of CHCs, several federal programs were introduced throughout the decade.
These programs included:
- The 340B Drug Pricing Program, which provided health centers access to certain pharmaceuticals at reduced prices.
- The Federal Tort Claims Act, which extended medical liability coverage to health centers, freeing up more resources for patient care.
- The state Children’s Health Insurance Program (CHIP), which provided federal matching funds to states that provided health coverage to children in families with incomes too high to qualify for Medicaid, but who could not afford private coverage.
- And finally, community health center services were guaranteed benefit status under Medicare and Medicaid, ensuring that low-income patients would always have access to CHCs.
The addition of community health centers as a Medicare and Medicaid benefit was an important advancement for CHCs. They were now defined more precisely as safety net providers, similar to public housing centers and programs serving the homeless. The purpose of community health centers was also more narrowly defined as a means to improve the provision of primary care services in underserved rural and urban communities.
In 1996, another important bill was passed by Congress – the Health Center Consolidation Act. The bill consolidated funding for four federal primary care and prevention programs: community health centers, migrant health centers, health care for the homeless, and health care for residents of public housing programs. This legislation was intended to empower communities to develop their own solutions to local health care access problems. At the time, the nation's health centers were comprised of over 700 organizations at 2,100 service delivery sites, providing health care services to almost 8 million people annually.
Neighborcare Health in the '90s
In 1990, state officials formed the Washington State Health Care Commission to propose health care reforms aimed at providing universal insurance coverage for all residents. The results from the commission became the foundation of the 1993 Health Services Act, which was intended to be implemented gradually over the span of six years. The law had three goals: to insure all Washington state residents; to reduce the rate of health-care cost growth by managing competition more effectively; and to improve health care outcomes. Under the Health Services Act, health insurance companies would be required to accept all state residents who applied for coverage, and barred health plans from charging subscribers with preexisting conditions additional fees.
The Health Care Act was repealed two years later, causing insurance premiums to soar as high as 78 percent. By the late ‘90s, people could not afford to buy an individual health plan in Washington and insurers stopped offering individual coverage.
In the midst of these changes, the number of people experiencing homelessness continued to increase. By 1990, 170,000 people in Washington State were seeking emergency shelter, and an estimated 115,000-- including 37,000 children-- were turned away due to lack of space. In 1993, Neighborcare Health at 45th Street added the Homeless Youth Clinic to help meet the needs to Seattle’s growing homeless population. The Homeless Youth Clinic was the first free integrated drop-in clinic of its kind in the country.
Throughout the ‘90s, Neighborcare Health continued to grow. South Seattle’s Holly Park Medical Clinic and Rainier Vista Medical Clinic consolidated to become Neighborcare Health at Rainier Beach. In 1992, Neighborcare Health at Central District was founded to care for the dental care needs of the neighborhood.
Meanwhile, newly-appointed Mayor Norm Rice organized the Seattle Education Summit in 1990 to address the growing achievement gap in Seattle Public Schools. The summit drew more than 2,500 people to a series of gatherings throughout the city. At the summit, the community developed the idea for a levy that would fund a number of innovative programs focused on creating an environment that would ensure that children were safe, healthy and ready to learn. The levy, which would become the groundbreaking Family and Education Levy, included the Early Learning Academy, Seattle Early Education Cooperative, Step Ahead, and school-based health centers.
Seattle residents approved the Family and Education Levy in 1993, and voted to continue the work funded by the levy in 1997. Voters have continued to support students at Seattle Public Schools by renewing the Family and Education Levy every seven years since then. By 1998, Neighborcare Health was running its first two school-based health centers at Chief Sealth High school and Denny International Middle School.