Program Highlights: Surviving and Thriving through the Decades
Providing a forum and "branding" a movement
Six years after the founding of Columbia Point, health centers joined with public agencies and other
community-based health organizations in a conference held at Northeastern University to address the coordination
of public health planning for the city’s neighborhoods. As a major outcome, the Massachusetts League of
Community Health Centers (the League) was formed in 1972 to help define health centers as a network of
community-focused providers and to establish a forum for addressing their common needs and concerns. Subsequently,
the League and similar state associations helped found the National Association of Community Health Centers
(NACHC), established to provide technical assistance and advocacy for the centers at the national level.
Threat of program elimination and later, block grants
However, support for the community health center movement was not always unanimous. As health centers across
the country became an increasingly cohesive national movement, they faced several challenges to their federally
funded grant program. In 1975 the League worked with Senator Kennedy and NACHC to beat back the first threat to
health center funding when President Gerald Ford's Administration proposed eliminating the program altogether.
In the end, the health centers not only had their funding restored -- they secured enough broad-based support to
obtain their first congressional authorization. Later in 1981 and again in 1995, Congress considered the block
granting of health center funding. In both cases, passage of grants failed as national grassroots efforts to
ensure that the health center program remained a direct federal-local partnership prevailed.
1980s bring managed care, a new health plan and recognition of the plight of the uninsured
It was in the early 1980s
that managed care began to take hold in Massachusetts. In an effort to remain competitive and to ensure health
access for the most vulnerable, the League joined with Boston business leaders in 1986 to help found the community
health center-based HMO, Neighborhood Health Plan. Around the same time, health centers were treating an
increasing number of uninsured patients, then Governor Michael Dukakis was running for President and the state
legislature was crafting a universal health care plan for Massachusetts. Making the case that health centers could
expand care to the growing uninsured and steer people away from costly hospital emergency rooms, health centers
gained the support of business leaders and policymakers. As a major result, by 1991 health centers became eligible
providers of care through a new state uncompensated care pool designed to pay for the medical costs of uninsured
Massachusetts.
Health centers come full circle as they emerge once again as a solution for expanding health access
In the early 1990s, there was considerable consensus among public health advocates to promote the idea that a tax on cigarettes was a necessary and just approach to funding public health programs. In 1992, Massachusetts' voters overwhelming approved a ballot initiative to place a 25-cent per pack tax on cigarettes programs focusing on smoking prevention and cessation.
In 1996, another 25-cent per pack increase was supported by a broad-based coalition, including the League. The intent was to use cigarette tax revenues to expand eligibility for the state?s Medicaid program, and for creation of a second plan to cover children whose families' incomes were too high to qualify for Medicaid. The culmination of these efforts resulted in passage of M.G.L. Chapter 203, the 1996 landmark legislation that extended Medicaid coverage to more low-income Massachusetts residents. In order to find and enroll the newly eligible residents, state officials turned to community health centers. By 2002, health centers had helped to enroll 300,000 new people into the Massachusetts' Medicaid program and had gained recognition as a solution for expanding care to low-income patients as a result of their accessible, quality and cost-effective care.
