Congress has quietly created a new health care crisis for 26 million Americans

They let funding for community health centers lapse 124 days ago.

Nationally, millions of Americans visit community health centers each year. An estimate from 2016 found the 2,000 centers provided care to 26.5 million people. They rely heavily on federal funds that have passed with bipartisan support in recent decades. George W. Bush expanded the program, and the Affordable Care Act made another big investment in them.

But this fall, the $3.6 billion budget lapsed at the same time as the Children’s Health Insurance Program. CHIP, which provides coverage to millions of poor children, just got its funding back in late January. But community health centers were not included in the deal.

Legislators from both parties have said they want to extend the health centers’ budget. But so far, they haven’t. If they don’t do it very soon, health care access will decline for potentially millions of vulnerable Americans.

George W. Bush and Barack Obama were both ardent community health center advocates

Community health centers began as a tiny experiment in Mississippi and Massachusetts in the 1960s, a small element of President Lyndon B. Johnson’s war on poverty.

An enterprising young doctor named H. Jack Geiger had done work in South Africa and saw the difference that access to primary care could make for underserved communities.

Dr. H. Jack Geiger, 87, stands next to the personal gallery of photos he made of former patients and associates at his Mississippi health center during an interview at his home on November 8, 2013, in New York. Geiger was a devoted civil rights activist and founder of the nation’s first community health centers in Boston and the Mississippi Delta. Bebeto Matthews/AP

Four decades later, it was George W. Bush who pushed for a major expansion of the program. As the New York Times reported in 2008, the president “came to admire the missionary zeal and cost-efficiency of the not-for-profit community health centers” and “proposed to open or expand 1,200 clinics over five years (mission accomplished) and to double the number of patients served (the increase has ended up closer to 60 percent).”

President Obama followed up on the Bush-era expansion with increased community health center funding through the Affordable Care Act. With the law expanding coverage to millions, the Obama administration wanted to ensure that the newly insured would have adequate access to medical services.

President Obama signed a presidential memorandum related to an announcement of $600 million in American Recovery and Reinvestment Act awards for construction and renovation projects at 85 community health centers throughout the US.

December 9, 2009. Community health centers experienced another growth spurt. The number of patient visits grew from 19.5 million in 2010 to 26.5 million in 2016. An additional 200 community health centers opened and increasingly expanded their work into dental and mental health services. When Obamacare funding lapsed in 2015, Congress passed a bill funding both community health centers and CHIP for an additional two years — until September 30, 2017, when both initiatives saw their budgets lapse.

“There was a fairly widespread assumption that this would become the norm, that these two programs would travel together,” says Sara Rosenbaum, a health policy professor at George Washington University who has written on community health centers. “One program would address coverage and the other access, but this year has upended that assumption. Now the program is standing on its own.”

Community health center advocates preferred having the two travel as a unit, a pair of programs that both make it easier for underserved communities to get health care. They worry about now having to fight the battle for funding on their own, without the CHIP program as part of the package.

“I’ve always had this philosophy that it’s better to be the ornament than the tree,” says Dan Hawkins, senior vice president at the National Association of Community Health Centers. “They [CHIP] were the tree — but I guess we’re the tree now. While I am thrilled for them that their crisis is averted, we now stand alone. We’re the biggest program out there that remains uncertain of its funding.”

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