NEWSBYDAN PETERSON

It seems like a good idea. Invest in the expansion of our nation's community health centers (CHCs) so that low income workers without adequate health insurance would have a regular doctor to visit, instead of the only other alternative, high-cost hospital emergency rooms. Keeping this workforce healthy and on the job would also maintain productivity in our recovering economy.

Unfortunately, the federal funding to grow health center capacity is in doubt right now as Congress debates a new budget. House Republicans have proposed cutting $1.3 billion from health center funding.

This week, new research, from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, pinpoints just how much we stand to lose in health care efficiency savings if the funding is cut as proposed; $15 billion. Put another way, for every $1 invested in CHC expansion, there is a potential savings in health care costs of $11.50.

It seems like a logical win-win plan to fight cancer. The California Cancer Research Act is advocating to raise the excise tax on a pack of cigarettes by $1 in a voter referendum scheduled for the next statewide ballot.

If approved, the initiative could raise between $600-$750 million per year for cancer research, education and smoking cessation programs for California residents. The vote could be as soon as June if there is a special election, otherwise it would appear on the February 2012 ballot. So, smokers paying for research and education that may save them in the long run seems to make sense, except to one group: cigarette makers.

Seven-time Tour de France winner and cancer survivor, Lance Armstrong, joined the cause last month. "Well, I continue to be a person, as a cancer survivor, who hates this disease," said Armstrong. "I hate cancer. It's real simple. And no matter what we have to do in any state, in any country, to help fight the disease, then we'll do it."

Sometimes it is difficult for those of us separated from an injustice thousands of miles away to get a real sense of the struggle and passion of those affected. For those HIV/AIDS patients living in developing countries in Africa, Asia and Latin America, the possibility of losing access to their low-cost, generic medicines is not only very real but also very scary.

That's the message that a new advocacy video from MSF Access Campaign is delivering, in the wake of news that the European Union and India are working on an international trade agreement that could threaten the availability of generic HIV/AIDS medicines around the globe.

Please watch this video below, which is direct from the protest in India. And if you haven't already, add your name to our petition to the EU and India trade ministers asking them to not disrupt access to generic medicines in the new free trade agreement they are currently negotiating.

Access to life-saving, low-cost generic medicines is critical to HIV/AIDS patients everywhere, but especially in developing countries. Over five million people battling the disease, across Asia, Africa and Latin America, rely on generic drug manufacturers, primarily in India. Indian pharma producers supply 50 percent of the world's AIDS medicines and an amazing 90 percent of the developing world's needs.

That supply chain is now threatened by a new free trade agreement (FTA) being negotiated between the European Union (EU) and India. Changes to intellectual property rules in the agreement, pushed by the EU, may severely limit or delay these Indian companies from continuing their public health mission.

Last week, representatives of Médecins Sans Frontières (Doctors Without Borders), the international medical humanitarian organization, protested along with thousands of people in New Delhi, urging the Indian government to resist pressure from the European Union to accept the new provisions.

Just as our Community Health Centers were fending off state budget cuts of over $90 million, they are under attack again from an approved U.S. House budget bill that has approved cuts of $1.3 billion. While the Senate considers the bill, we all need to understand the full impact of these cuts on health care's best kept secret.

These reductions will have profound effects on the mission and capacity of your local community health centers including:

- eliminating capacity of health centers to serve 11 million patients over the next year;
- ending funding for 127 new health centers in under served districts across the country whose residents have long waited for access to doctors and health care services;
- forcing health centers to lay off 10,000 employees in rural and urban communities nationwide.

Last week, the Wisconsin Department of Health Services received a performance bonus of $23 million from the Centers for Medicare and Medicaid Services to help support the addition of over 85,000 children to the state's Medicaid program, known as BadgerCare. Because of a more efficient process for signing up children and an online renewal option, the agency boosted enrollment by 23 percent in 2010.

The irony of that effort begins this week as the new Republican administration of Scott Walker takes over the governor's office. Vowing on the campaign trail to cut the popular public health assistance program, Walker begins to look for ways to bring the state's serious deficit under control.

Wisconsin's situation is just one example of a struggle that is beginning in many states no longer controlled by Democrats.

With major expansions under outgoing Democratic Gov. Jim Doyle, BadgerCare has grown to include 767,000 state residents, including 455,000 children. Coverage had been expanded under Doyle and, interestingly, under BadgerCare founder, former Republican Gov. Tommy Thompson. But the program has seen rising costs over the last ten years, and for the 2011-2013 budget, there is a funding shortfall of $300 million.

Proponents of BadgerCare are concerned about the rhetoric they hear from the Walker camp.  

Community Health Centers (CHCs) have the distinction of being one of the few components of the health care delivery system that have consistently impressed both Republicans and Democrats. For over 45 years, CHCs have delivered primary care to a patient population that may not otherwise be able to afford it. Their crucial role was elevated even more in the Patient Protection and Affordable Care Act, with much needed funding to provide the capacity to double the number of patients they serve from 20 million to 40 million by 2015.

However, each state also contributes to the CHC payment formula by providing operational funding and managing Medicaid reimbursement plans. Since 2007, state funding for CHCs has dropped by 42 percent. It now has fallen below 2006 funding levels, which could threaten the ability to serve the expected spike of new patients that health care reform will bring, according to the National Association of Community Health Centers (NACHC).

"The federal government has invested additional resources in health centers, and at the same time, states have been significantly cutting back," said Dawn McKinney, director of state affairs for the NACHC. "It is incongruent with the goals of expansion and serving additional people."

According to a recent NACHC report, 23 states have cut funding to CHCs for the current fiscal year, including 8 states that have slashed their budget by 20 percent or more. Four states (Arizona, California, Montana and South Carolina) eliminated health center funding altogether.

Cutting funding for CHCs may be penny-wise, but it is clearly pound-foolish. Even though health centers now treat more chronically ill and uninsured patients than at any other time in their history, they are still able to reduce the use of costly emergency departments, hospitals and specialty care. In fact, health centers save between $9.9 and $17.6 billion a year – a figure that will continue to grow as health centers do.

With the mid-term elections just over four weeks away, political ads are heating up, especially among Republican candidates vowing to change or even repeal the health reform bill passed just six short months ago. They hope to benefit from the confusion many Americans have regarding the reform and how it will actually impact them. The Obama Administration was able to overcome the enormous challenge of the getting reform passed, but a recent poll indicates they now face their toughest sell yet -- the American public.

The latest Kaiser Family Foundation tracking poll reflects the lack of understanding on key features of the legislation and the need to ramp up easy to understand public education on the topic. In the September poll of 1,200 adults, including 1,081 "likely" voters, 53 percent said that they are "confused" by the health reform bill, the highest level since April.  Overall, 49 percent said they have a favorable opinion of reform versus 40 percent who do not, but the split is much closer among likely voters -- 46 percent like it and 45 percent don't.

As expected, there is still a clear partisan divide with 75 percent of Democrats favoring the bill and 73 percent of Republicans opposing it. Those that identify themselves as Independents have maintained a steady opinion with a favorable rating in the low 40 percent range.  Consistent among all groups is the specific populations thought to benefit from health reform -- low-income families, the uninsured and those with pre-existing conditions. Respondents were unclear if the bill would help either small businesses or "you and your family." One group that is thought to benefit the least was big business, with only 24 percent saying health reform is good for large organizations.

Last week, HHS Secretary Kathleen Sebelius announced $130.8 million in grants to grow the health care workforce. The bulk of the money is going toward increasing the supply of primary care providers, including family medicine, general internal medicine and general pediatrics programs. With tens of millions of Americans entering the health care market thanks to health reform, studies project a shortage of 44,000 to 46,000 primary-care doctors by 2025 unless action is taken to lure more medical students into the field and retain experienced primary-care doctors. However, a new report from the Dartmouth Atlas Project reveals that while increased access to primary care is needed, it might not be enough.

By studying the fee-for-service Medicare population from 2003 to 2007, researchers found that where you live matters more than the ratio of physicians to patients. The first step to better health is getting in to see a doctor at least once per year. However, the relationship between the supply of primary care physicians and the percent of Medicare beneficiaries who had at least one annual visit with them during 2003-07 suggests that there is no correlation between the supply of docs and access to primary care.

You're in Chicago and wondering which deep-dish pizza is really the best ... there's a website for that.  Shopping for a car, TV, hot tub, vacation or pedicure ... there's a website for any of that. About to choose a surgeon for one of the most complex and scary medical procedures you will ever face ... now, thankfully, there is finally a website for that. This week, Consumer Reports, the venerable watchdog publisher, launched an addition to their health-related site that provides a ranking of 221 surgery groups from around the country who perform heart bypass surgery. Patient advocates are thrilled with this breakthrough transparency of clinical outcomes. Critics, including some physicians, caution that there is still much work to be done before this data can be accurate and useful.

The online accessibility of data has been heralded as the consumer revolution in health care. Second opinions have been around for years, but that only helps confirm the diagnosis. Usually, when a treatment or procedure is needed, patients just stay with their current physician or rely on a specialist referral.  But what if that physician is not the best possible choice? Now, with specialists agreeing to share performance and care data, patients can decide for themselves.