The grants will come in the form of $10 million per year, over the next six years, accounting for approximately 10 percent of the governor's proposed fiscal year 2008 budget.
FQHCs provide medical care with an emphasis in primary care in medically underserved urban and rural communities. Statewide, 19 FQHCs provide care to nearly 300,000 low-income and uninsured Missourians per year. Combined with satellite offices, they offer 90 sites of service.
Columbia's FQHC is Family Health Center, located at the intersection of Worley St. and West Boulevard. It has satellite offices on Providence Road and in Salisbury as well as Family Dental Service on Business Loop 70 W.
The three centers serve a 10-county area comprised of Boone, Audrain, Chariton, Callaway, Cole, Linn, Moniteau, Cooper, Howard, and Randolph counties. Together, the three centers served 12,100 patients in 2006.
The bill passed the House with a vote of 153-4. Rep. Robert Schaaf, R-St. Joseph, a family physician, was among the four who voted against the bill. He said that he voted against the bill because directing $60 million to FQHC's is unjust, misdirected and unwise.
Unjust because, "what we are doing there, is we're funding a provider that is fully reimbursed under Medicaid when all the private physicians in Missouri lose money every single time we send a Medicaid patient there," he said. He said that by giving the money to FQHCs, the state is helping the competitors of physicians.
Kay Strom, chief operating officer of Family Health Center said that doctors are selective in the patients that they will accept.
"And there are a number of docs who do take Medicaid -- and a number of good docs who take Medicaid -- it's just, there a fewer docs who will and so it limits the access," she said.
Schaaf said, "the reason for that is the reimbursement is so low that it actually costs doctors money in order to see Medicaid patients," adding that "there is only a certain percentage of Medicaid patients that you can see before you go bankrupt." He said the reimbursement rate for doctors is somewhere between 25 and 40 percent of Medicaid rates.
Schaaf said it is unwise because Missouri taxpayers would be subsidizing the uninsured.
"Funding of federally qualified health centers represents a gigantic expansion of the role of government in providing health care to people," he said. "It's a giant leap toward socialized Medicine." Shaaf also said that it was unwise because federally qualified health centers would not be necessary if the state would adequately reimburse doctors.
Democratic House leader, Jeff Harris, D-Columbia voted in favor of the bill, but his support could change. He said he supports FQHCs because they are a good way to provide health care to an underserved population, but he does not support the governor's Louis and Clark Initiative.
"This bill at this time does not contain the governor's Louis and Clark Initiative, although we are told that it may be added in the Senate," he said. "If the governor's Louis and Clark Initiative, which includes the sale of MOHELA assets, is going to be a part of any bill then I am going to vote against that bill."
Harris said in order for that to happen they would have to have the votes in the Senate to add it with a gubernatorial amendment.
"Right now I'm skeptical that they have enough votes," he said. "But, I'm not in the Senate."