A LIVING HISTORY OF AMERICA’S COMMUNITY HEALTH CENTER
By Tom Van Coverden and Dan Hawkins
In this modern era, staying in one place seems a lost art. Most Americans today live and work
somewhere far from where they were born and raised. With free agency, it is rare to see an athlete
remain with a single team throughout his or her full career. And the proverbial “company man”
remains an artifact of the past century. Everyone is perpetually on the move, it seems.
In that context, we are a bit the odd couple — having now devoted more than 30 and 35 years,
respectively, to the same pursuit, most of them with the same employer, the National Association of
Community Health Centers (NACHC), our journey consistently focused in trying, in the immortal
words of an exceptional child who was daughter to one of us and goddaughter to the other — and
who left us all too soon — to “help poor people get health care.” Thus has the health center
movement become our permanent home, and its growth the pathway for our lives and our careers.
And we are hardly alone here. Along the way, we have been the most fortunate recipients of the
welcoming and wise counsel of the movement’s pioneering founder, Dr. Jack Geiger, who conceived
of the community health centers system based on a model he had seen as a medical student
visiting South Africa’s apartheid homelands, and who directed one of the first health centers of the
modern era, in a small Mississippi delta town called Mound Bayou. We have marveled at the
bravery and fortitude of individuals such as Dr. Aaron Shirley, who risked not only his livelihood
but his life as well, as he developed and then ran a health center in Jackson, Mississippi, the “heart
of Dixie,” at the very time when civil rights workers were being harassed, beaten, and killed. We
have valued the friendship and rhetorical gifts of Congressman Danny Davis, and the organizational
skills of Danny Cantrell, who early in their careers led the Mile Square Health Center in Chicago, and
then served as national board chairs of our organization, before Mr. Davis was elected to the U.S.
Congress, where today — with Mr. Cantrell as his Chief of Staff — he co-chairs the 100-member
Congressional Community Health Center Caucus, which serves to advance the cause of “health care
for the poor” in that august chamber. And we have been inspired by the political leadership of
Senator Ted Kennedy, the “Godfather” of the health centers movement, whose home town of
Boston is the birthplace of America’s very first community health center, who as a first-term Senator
in 1966 fought for the very first federal funding directed to these health centers, and who nearly a
decade later authored the federal law that defines and sustains them to this day.
There are so many others across the country — and across the past four decades — who played
significant roles in the efforts that have led the health centers movement to the proud plateau it
occupies today, as family doctor and health care home for more than 18 million Americans —
mostly poor, mostly uninsured or publicly insured, mostly people of color, all living in rural and
urban communities designated as underserved. They include people such as Jim Hunt, who joined
the Massachusetts League of Community Health Centers before our national association was even
formed; Jack Cradock and Dan Driscoll, who headed — and still head — the nation’s earliest health
centers in Boston; Roland Gardner, who came to one of those early health centers in South
Carolina’s “Low Country” (among the poorest communities in America) more than 35 years ago, and
still heads that center today; Olly Neal and John Eason, who developed a rural health center and
co-op in Arkansas; “Dr. Sam” Rogers, who converted his Kansas City private practice into a health
center that bears his name today; Curtis Cooper, the always affable head of a health center in
Savannah; Jessie Trice, a nurse and health center director from Miami who constantly reminded us
that quality is “job one;” “Miss Eloise” Westbrook, a consumer advocate from San Francisco, who
fought for community ownership and control of all health centers; Vic Huerta, a nurse who has
worked in literally dozens of health centers, especially those serving America’s migrant
farmworkers; and Jerry Brasher, who took a small farmworker health center in Colorado and built it
into a huge multi-site network serving a large swath of northeastern Colorado. They also include Dr.
John (Mike) Holloman, Jr., a physician leader (with Jack Geiger) in the civil rights movement, who
went on to lead the William F. Ryan Community Health Center in northern Manhattan, along with
Jan Robinson, a nurse who later served as CEO of NACHC, and Julio Bellber, who today heads the
Ryan Community Health Foundation, which provides philanthropic support for efforts to document
the achievements of health centers and the need for their continued growth. There are too many
others to mention in this short space; suffice it to say that America’s health center story is a
quintessential example of the success that “has a thousand parents,” in the words of that ancient
proverb.
We first came together in 1975, when Tom — as the newly-hired head of NACHC’s policy advocacy
unit — rallied Dan and a few dozen other health center advocates to help secure the two-thirds
vote in Congress needed to override a veto by then-President Gerald Ford of a bill that established
the Community Health Centers program in law for the first time. Until that moment, the
“Neighborhood Health Centers” program had operated only as a limited demonstration within
President Lyndon Johnson’s “War on Poverty” initiative for 10 years, while the Migrant Health
program had been signed into law by President John F. Kennedy 13 years earlier.
The newly-enacted program was barely school-aged, in human terms, when it faced the closest
equivalent to a “near death” experience in 1981, as the new administration of
President Ronald Reagan attempted to combine it — and dozens of other federal health
programs — into three broad “block grants” to the states. With Dan now a member of NACHC’s
policy team, we both understood clearly that if the program were to lose its strong community base
it would surely face a slow and agonizing death. Thanks to a substantial expansion under former
President Jimmy Carter’s leadership, the almost 900 health centers across the country — and the
five million people they served — gave us a somewhat stronger advocacy base to work with; even
so, we were a poor David facing the new administration’s Goliath, together with its congressional
supporters. But, thanks to the heroic efforts of people like Cornell Scott of Connecticut and David
Reynolds of Vermont, we were able to prevail and keep the program intact, in what one of our
more thoughtful health center directors called “the triumph of as well-managed a grassroots
campaign as Washington has ever seen.”
Having barely survived that brush with death, the program generally languished over the following
decade, highlighted only by the creation of the Health Care for the Homeless program in 1987. But
the next decade was marked by a string of huge advances — beginning with the establishment of
Medicare and Medicaid cost-based reimbursement to health centers (called Federally Qualified
Health Centers, or FQHCs). With that step, Medicaid quickly became their largest revenue source,
and health centers began a slow but sure pattern of growth over the following decade, reaching 10
million patients by the turn of the new century.
That growth was further accelerated by the extension of federal “malpractice” coverage under the
Federal Tort Claims Act, or FTCA, for the work of health center clinicians; by the creation of the socalled “340B” program, which provides deeply discounted prices on pharmaceutical purchases by
health centers and other safety net providers; and by the Vaccines for Children (VFC) program,
which provides free childhood vaccines to health centers for children who are covered by Medicaid,
or who are uninsured or underinsured. Each of these legislative advances helped to save health
centers hundreds of millions of dollars, and thus to spur further growth, even though federal
funding for the Health Centers program remained essentially flat — and therefore declined in real
terms — during the so-called “Clinton years.”
But the most rapid growth in the program’s history has occurred during the current decade, as both
President Bush and bipartisan majorities in Congress collaborated to literally double federal funding
for the program, enabling it to grow by more than 1,200 new and expanded health center sites and
by more than 8 million patients. Health centers are now the nation’s largest ambulatory care
network, providing services to more than 18 million people.
So what does the future hold? No one can say with certainty, but we clearly ascribe to the holding
of that great pop philosopher, Yogi Berra, who once said, “If you don’t know where you’re going,
you might not get there.” Not content to wait for history to unfold, we have worked with health
center leaders from across the nation to develop an initiative called the ACCESS for All America plan
— a strategy for growth that has health centers reaching 30 million patients by the year 2015. We
have done so because we see our health care system crumbling all around us, with stark
consequences for everyone — and most especially for those who live at health care’s outer
margins. But we have done so also because it is our destiny and the trajectory we must follow to
fulfill the dreams and vision of Jack Geiger and the other founders of our health center movement
— and the promise we owe to the millions who still need us today.
After all these years, we both still firmly believe that health centers hold a key to solving many of
today’s most pressing health care problems and to the success of any future health care reforms.
As Senator Ted Kennedy noted recently, reflecting on the marvelous history of this unique
movement, “If you didn’t exist, we would have to invent you.”
Tom Van Coverden is president and chief executive officer of the National Association of Community Health
Centers (NACHC). Dan Hawkins is senior vice president, policy and programs, at the National Association of
Community Health Centers (NACHC).