Funding Needed Now Congress!!

If Congress doesn’t fund community health centers, thousands are expected to close

Rosenbaum recently led an analysis of what would happen if Congress let funding lapse.

Community health centers would still have other income streams, including other grants, as well as reimbursements from the insurance plans (often Medicaid) that cover 77 percent of their patients. But the loss of the federal dollars currently at stake — $3.6 billion in annual funding — would be a significant hit.


Some places, like North Carolina, would be hit harder than others. North Carolina, for example, is among the 18 states that have not expanded Medicaid. This means that it still has high uninsured rates among its patients and is relies more on federal funding.

Wagenaar estimates that losing federal funding would reduce their budget by 52 percent — and that would force the clinic to make some tough decisions.

Alma Delia Torres, 8, has her ears checked by Reyna Martinez, a certified nursing assistant, during her annual physical at the Holton Wellness Center in Durham, North Carolina, on October 26, 2010. The clinic is part of Duke University’s plan to improve community-based health care by serving the uninsured. Jason Arthurs/For The Washington Post via Getty Images

“I’ve had these contingency plans in place and ready since October [when funding lapsed],” she says. “We’re working with our lawyer to start crafting a reduction in workforce plan so that I can make sure employees get an appropriate amount of notice.”

She’s applying for other grants too, as a safeguard, but that wouldn’t be enough to keep the clinic afloat.

“We’ll probably at minimum have to close two sites, one in each county we serve,” she says. “We’re still waiting on other grants we applied for. Worst case, we’d close three of our four sites and leave Rowan County entirely.”

Congress is dallying: ”It’s all about the pay-fors”

Congressional aides on both sides of the aisle say they expect community health center funding to be attached to the next must-pass piece of legislation. That is likely a bill to fund the government that’ll need to pass when the current short-term patch runs out on February 8.

“It is my belief that providing this critical, long-term funding needs to be a top priority when the House returns next week,” Rep. Greg Walden (R-OR), who chairs the Energy and Commerce Committee, wrote in an op-ed last Friday.

Energy and Commerce Committee chair Rep. Greg Walden (R-OR) on October 25, 2017. Drew Angerer/Getty Images

But so far, there is no firm proposal. The biggest obstacle is figuring out how to pay for it, according to Hawkins. Congress use the euphemism “pay-for” when describing the process of cutting one program to fund another.

“It’s all about the pay-fors,” Hawkins says of his conversations with congressional staff. “It wasn’t in the tax bill, it wasn’t in the continuing resolution a few weeks ago, and it’s all about where are you going to get the money? They’re working through that. We hear they’re closer than ever.”

Community health centers are asking for Congress to keep their funding relatively stable, at $3.6 billion each year, which would work out to $36 billion over a decade (although it’s not clear whether Congress would extend its budget for that long — its last extension, for example, was only for two years).

This is a tiny amount of money compared to the $1.5 trillion price tag of the recent Republican tax cuts. Funding it for two years, as Congress did in 2015, would work out to $7.4 billion — less than half the estimated $18 billion cost of the first phase of the border wall that President Trump has proposed.

And that frustrates the supporters of these centers, who point to how effective they are given their relatively small costs.

Wagenaar hopes the funding will come through but also emphasizes that some damage has already been done. She has frozen hiring on seven positions at her clinics. That includes an open position for a doctor, who could be seeing patients and expanding the clinics’ capacity if it weren’t for the lapsed budget.

“Our staff have had to cover for the providers [who] were missing, so they are not only seeing their patients but seeing some additional patients,” she says. “In the last three years we’ve seen 30 percent growth in our patients, so I really need more space. But I can’t open another site if I don’t know I have the funding to keep it open.”

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