In this issue, we continue our exploration of the increasingly important role of community health workers as critical members of the health care team. Professors James Macinko and Lee Rosenthal, on our editorial board, summarize the articles, which come from both the United States and beyond. We look forward to additional submissions as I feel that the community health workers are key to success of national health reform, whether it is the United States or elsewhere.

At the end of the day, we who believe in health care access for all confront diminishing resources. We also face increasing difficulty with apportioning these diminishing resources to health care professionals/organizations that provide high value (outcomes quality divided by payment). I believe that community health workers are an important part of high-value services but we can not just say it; these 2 issues of the Journal guided by the professionalism and generosity of Professors James Makincko and Lee Rosenthal will help tell this story in ways that are useful from a policy point of view.

I also believe that Community Health Centers are key to success. Gurewitch and coworkers and also a commentary by Prosser and coworkers highlight the benefits and challenges that Community Health Centers face in an era of diminishing resources. This type of research is important for policymakers to be aware of as they struggle to make cuts in the federal budget. By the time Journal readers see this issue in print/online, we hopefully will have raised the debt ceiling. I only hope that we do not raise the debt ceiling on the backs of the most vulnerable members of our society by cutting Medicaid. If we do cut Medicaid now, there is simply no chance for the dramatic expansion in coverage of the uninsured using Medicaid that is to occur in 2014 can succeed. I am hopeful that proposals that make cuts in Medicare and Medicaid by improving value instead of across the board cuts can be heard at the debt ceiling talks.

We close our issue with our management column from Dr Ron Goodspeed and a report from the Republic of Texas. As a side note, the State (not the republic) of Texas recently passed landmark legislation that represents a significant step forward in looking at the efficiency of health services for those Texas citizens who have health insurance. Hopefully, improved efficiency will lead to increased coverage.

-Norbert I. Goldfield, MD

Editor