**The Communities Building Access Act**

**Common Questions**

**How much will this cost?**

The bill is requesting \$45 million spread out over seven years.

\$36 million for the multi-share grants (Title I)

\$9 million for the Voluntary Specialty Network Programs (Title II)

**How many individuals will be covered?**

Given that each community has some discretion in how their grant is
used, and the Secretary has some discretion in the amount of each grant
depending on the application, it is very difficult to make such
estimates. There are other variables. For the multi-share grants, the
amount the employer, employee and community contribute must be at least
70 percent. For the Voluntary Specialty Network Programs the amount the
community matches must be 33 percent (1/3).

Title III of the bill requires community grantees to account for and
report annually various data including how many individuals and
businesses are receiving coverage or care under the grant that
previously did not have regular access to care.

Ultimately, the federal government is virtually guaranteed a measurable
return on these grants because every federal grant dollar under these
programs will be matched two or three times by the community.

**Will grants for employer coverage drive employers to drop current
private coverage?**

The bill includes requirements that a community plan must include
mechanisms that will prevent displacement of private coverage in
exchange for public coverage. The default mechanism, which is commonly
used in similar existing community programs, requires that an eligible
employer must not have offered coverage to employees in the last 12
months.

**How is this going to solve the national crisis of the uninsured?**

The legislation in not a silver bullet for the uninsured, but an interim
solution that will aid communities to creatively develop solutions for
their uninsured populations.

Local health care access programs can be laboratories for learning about
national solutions for the uninsured. They have yielded important
findings such as the level of subsidy necessary to get small employers
to purchase coverage for their employees**,** how to effectively market
access programs to the uninsured, and how to effectively manage chronic
care among lower-income populations.

**Does the bill duplicate other federal spending or initiatives for the
uninsured?**

The bill was carefully designed *not* to duplicate other federal
spending or popular initiatives for the uninsured such as Association
Health Plans and Health Savings Accounts. The targeted populations for
these grant programs are (1) those working in businesses who have not
offered coverage in the last year, and (2) those below a certain poverty
level without access to employer coverage, spousal coverage and those
ineligible for Medicaid or Medicare.

Title II, Voluntary Specialty Network Programs, was designed to narrowly
focus on the lack of specialty health care availably to the uninsured,
and is careful not to duplicate current primary care clinics (community
health centers) that receive funding for the uninsured from the federal
government.

**Why ruin a proven success with Government intervention?**

While these models have been tested and proven successful, many are
financially unstable and are in need of at least a small, dependable
source of funding. In addition, many communities have examined the
possibility of establishing similar programs for their uninsured
populations, but have postponed initiatives due to lack of funding. The
legislation as drafted is careful to allow the flexibility for
communities to tailor the program to meet their needs, and not to
over-regulate or interfere with successful plans.

**Will these programs eventually become independent?** It is possible
that many of the programs, once a stable, integral part of the
community, could be fully funded by those in the community. It is
important to note that many of the employers that have utilized the
multi-share employer program have moved on to commercial coverage.

**Does the bill promote individual responsibility?**

The Multi-Share employer programs (Title I in the bill) require
employees to pay a monthly share of the coverage, similar to commercial
insurance. Many of these individuals have never had health insurance,
and this is therefore an important first step of personal health care
responsibility.

Additionally, the bill requires community plans to include chronic care
management programs and other cost control mechanisms. Several community
programs, such as the one in Muskegon, Michigan, motivate individuals to
take responsibility for their chronic conditions by offering lower
cost-sharing for those who maintain their care.

**What about chronic care management?**

As mentioned above, in order to be qualified for an employer multi-share
grant (Title I), a community must have a plan for coordinating chronic
conditions across provider settings. The Voluntary Specialty Network
Programs (Title II) allow grants to be used for medical training
specifically for managing chronic conditions.

**Can the grants be used for health information technology?**

Yes. The development of Electronic Medical Records (EMR) for groups of
uninsured individuals in a community have proven to be very beneficial
for continuity of care, reducing duplicative care and inducing providers
to volunteer medical care. Therefore, the bill specifies that grants for
Specialty Care Access Networks (Title II) can be used for the purchase
of information technology systems used for developing electronic medical
records for uninsured individuals enrolled in the network.

**How is this legislation different from other federal health programs
that have recently been defunded?**

According to the President's budget for 2007, the Congress terminated or
reduced spending in a number of HHS programs that were "either
duplicative, inefficient, or not producing results."

These concerns were seriously considered during the drafting of the
legislation. The legislation includes several accountability provisions
for grantees, and it is careful to target specific populations who do
not qualify for other federally funded programs. In addition, to ensure
the greatest return on investment, the legislation was modeled after two
proven community models that have accumulated an impressive amount of
expertise that can be disseminated to grantees creating similar models.