For the patients and the employees of Mary's Center, a community health center that serves Washington, D.C., and its Maryland suburbs, the 2010 health law had a big impact on business. The facility has always promised care to anyone who walks through its doors. But since Obamacare's implementation, the patient population and the quality of care they receive has changed.
"The first set of patients we saw -- it was like, 'Wow, I can see a doctor for the first time. I can afford to go to the doctor,'" recalled Maria Gomez, the center's president. "There were patients that knew they had tumors, or knew they hadn't had a pap smear in a long, long time."
But it wasn't just access to care, Gomez added. The law, which extended health insurance to more than 20 million people, also provided new streams of revenue. Since Mary's Center was handling fewer uninsured patients, that financial security let it hire more specialists and operate more health education programs.
Similar stories played out at many of the nation's more than 1,400 federally backed community health centers, according to two studies published Monday in the journal Health Affairs. The research offers evidence that in states that embraced the health law, community health centers -- which play a key role in providing health care to low-income people, often in medically underserved areas -- further extended their reach. It also quantified the types of clinic visits and health services provided that resulted from the expansion.
These findings, though, also highlight the uncertainties some of these clinics face as the incoming Trump administration and the GOP Congress advance plans to repeal and replace Obamacare.
"I'd love to think we can think of policies that will reduce harm, and make things better," said Leighton Ku, director of the Center for Health Policy Research at George Washington University and an author on one of the studies. "But my crystal ball isn't that clear."
The two studies use data from the federal Health Resources and Service Administration to examine Medicaid, the federal-state insurance plan for low-income people. Under the law, states could opt into an expanded version of the program that covered more people. GOP plans to undo the 2010 law would likely include erasing that option. Many Republicans also want to change Medicaid from its current open-ended, entitlement status into a block grant, which would send a set, lump sum of funding to states and allow them more flexibility to tailor the program to address local health needs, potentially spurring innovation and more efficiency.
"There may be things that can be done in the delivery of care for community health centers, which ultimately is more valuable and effective than the traditional Medicaid program," said Tom Miller, a resident fellow at the American Enterprise Institute, a conservative think tank.
It's too soon to say, Miller argued, how health care funding will play out, how money could be used and who will benefit. But other advocates of the law -- including many leaders of community health centers -- say that current discussions leave strong potential for funding cuts that would limit their ability to provide care. The Health Affairs findings play into that concern.
Ku's paper, which used data from 2012 to 2015 to track visits to community health centers, compared how many patients visited the centers, their insurance, and whether they sought medical, dental or mental health care. In states that opted into the expansion, health centers saw more patient visits, lower rates of uninsured patients -- a financial boon for clinics that typically operate on thin margins -- and an increase in patients specifically seeking mental health care.