August 13, 2007
By CYRUS LEVESQUE
BRISTOL — A local group seeking volunteers to help start a federally funded community health center in the Bristol area, gathered to talk strategy with Sen. Bernie Sanders, I-Vt., last Wednesday evening. They hope to get such a center up and running in two years.
Sanders said that a federally qualified health center would make medical services available to all area residents, not just a segment of the population.
“This is not poor people’s health care, this is community health care,” he said. “It doesn’t solve everything, but it helps.”
The Five-Town Health Alliance, which was organized over the last few years as concern about the lack of dental care in the five-town area grew, has been working with the Bi-State Primary Care Association, a group devoted to improving access to medical care in Vermont and New Hampshire, for more than a year.
Roger Barkin, a former dentist and a member of the group, said that the effort began with a concern about a lack of dental care in the five-town area, but expanded to all medical coverage as the group looked more closely at the area’s needs.
“It developed very quickly beyond supplying a dentist for the Bristol area,” Barkin said.
Last year, the Five-Town Health Alliance received two grants to research options, and settled on a Federally Qualified Health Center (FQHC) as the most feasible way to provide better medical and dental care to the Bristol area.
A FQHC receives federal support in grants of about $600,000 per year to provide health care in underserved areas, assuming it meets certain conditions. Part of the mandate of an FQHC is that anyone in the area can get good medical and dental care regardless of ability to pay, Sanders said. People without insurance are charged on a sliding income scale. In addition, it must be democratically run: the majority of members of an FCHC’s board of directors have to be users of the facility.
Whether an area qualifies as “underserved” by health care providers depends both on physical distance of residents to a medical care provider and the affordability of it. Many Bristol area residents work at small businesses that can’t afford to provide health insurance for employees, according to Elissa Close of the Five-Town Health Alliance.
“In our society, not having insurance is a barrier to health care,” said Close, a Starksboro resident and a nurse practitioner at Fletcher Allen Health Care.
David Reynolds, Sanders’ health policy advisor, said that FQHCs have been widely used in other New England states, but did not become common in Vermont until five or six years ago. There are now several such sites around the state, including one in Burlington and another in Brandon.
The Wednesday meeting was partly held for informational purposes, so that area residents would know what they were getting into. Dan Noel, the principal of Robinson Elementary School in Starksboro and a Bristol resident, asked about how reliable the federal funding for this program actually was.
According to Sanders, the FQHC program has existed since the 1960s and has been well-supported by the U.S. Department of Health.
“One can’t guarantee it in stone, but… even Bush has recognized the importance of this program,” Sanders said. “Based on the track record of the past, I would assume that the funds would continue.”
Kate Simmons, community development coordinator for the Bi-State Primary Care Association, which is based in New Hampshire, said a number of details have yet to be worked out. The location of the FQHC, for example, would be in the Bristol area, but might or might not be in Bristol itself. Under the current rules, the grant funding cannot be used to get a facility itself, although Simmons said a rule change now under consideration may change that.
“We have a few different leads, but nothing is quite fit perfectly,” Simmons said. The group may also start in a temporary site to avoid the pressure of finding a suitable permanent site in time.
An area resident at the meeting suggested forming a partnership with Burlington’s FQHC instead of creating a new one for the five-town area. Simmons said the Burlington center has been working with the Five-Town Health Alliance in an advisory role, and the possibility of a permanent relationship is still open.
“They would be interested in a partnership in the future, if that’s something the area wants,” Simmons said.
One main goal of Wednesday’s meeting was to seek more community involvement in and help with the Five-Town Health Alliance. Simmons, Barkin, and Close are the only members of the steering committee, and they hope to get more people involved in finding a site and the other aspects of the process.
Simmons said that the biggest obstacle remaining is the planning and application process. She said that the application would probably not be ready to be submitted this fall but would be ready by next fall, and estimated that a FQHC could be up and running in about two years.
The group is relatively confident that the application would be approved once a final plan is ready and the 200-page application is submitted.
“It’s going to take good, strong community support to do this,” Barkin said. “It’s almost not a matter of, ‘Can we do this?’ It’s a matter of ‘How can we do this?’”