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Boreal Community Media

Future Uncertain for Federal Health Program

Sep 08, 2017 03:48PM ● By Editor

If Congress fails to act, it will have huge impact on community health care centers, including Sawtooth Mountain Clinic in Cook County.  Write your representatives in Congress!

By Gaby Galvin - U.S. News and World Report  • Sept. 7, 2017

As Congress weighs North Korea, Hurricane Harvey and DACA this month, funding sits in limbo for thousands of community health centers that serve 27 million impoverished and uninsured Americans. 

If Congress fails to act by Sept. 30, more than 10,400 community health centers will lose 70 percent of their federal funding – about $3.6 billion – despite bipartisan support from lawmakers and President Donald Trump's administration. 

The inaction would force 2,800 of the federally funded centers to shut their doors, leaving 9 million patients without access to health care and 50,000 people out of work, according to estimates from the National Association of Community Health Centers. 

These health centers provide high-quality primary and preventive care to underserved rural and urban communities, where many people are either uninsured or insured through Medicaid, or don't qualify for Medicaid but can't afford private insurance. 

The centers save the health care system more than $24 billion annually by reducing the number of hospital visits and helping patients manage complex and chronic health conditions, according to a 2016 study published in the American Journal of Public Health. And about 500,000 babies are born in community health centers annually, says Dan Hawkins, NACHC's senior vice president for public policy and research. 

Yet amid seemingly more-pressing national concerns, there is no sense of urgency in Congress to approve the funding by Sept. 30, Hawkins says. That's because funding renewal for these health centers will begin in January 2018 , giving members of Congress the impression that this issue can wait. 

But without funding in the interim period, clinic leases and staff contracts will not be renewed, and other operational costs will become too high for many health centers to bear. Hawkins says that by the time Congress addresses the issue in December, it will be too late for many centers to recover. 

"We've gotten assurances from everybody on the Hill that they're going to take care of the problem," Hawkins says. "But what happens when they finally do – they've got a monster facing them in December. A trainwreck. And what's going to make it through? There could be a lot of debris by the tracks by the time this is over." 

That debris could include vehicles, clinicians and physical space, Hawkins says. Community health centers operate like businesses, and although they may have the resources to treat patients for now, they need money to pay for leases on clinic space, staff contracts and other overhead costs. 

"Although we are a nonprofit like all community health centers, the electricity companies don't give you free electricity," says Gary Wiltz, CEO of Teche Action Clinic in Franklin, Louisiana. "Our expenses have to be met, and we can't sustain that big of a hit, that 70 percent funding cut." 

Wiltz's health centers in "Cajun Country" serve about 26,000 people, about 16 percent of whom are uninsured, down from approximately half before Louisiana expanded Medicaid in 2016, he says. His clinics have identified more than 2,000 cases of breast cancer, colon cancer, heart disease, diabetes and hypertension. 

Still, if Congress does not approve the health center funding soon, at least three of Teche Action's 13 clinic sites will be shuttered, affecting 6,000 to 10,000 patients, Wiltz says. 
"I can't make any long term plans based on month-to-month funding," Wiltz says, citing the difficulty of hiring new doctors when he can't guarantee pay or employment beyond the next few months. "The only plan I have now is this: I have enough money to last maybe two months in reserves to keep us going from the end of September." 

If community health centers close, uninsured people in regions such as Wiltz's will likely turn to the emergency room, a costlier alternative, Wiltz and Hawkins agree. 
The potential cuts come as health centers react to recent natural disasters – Hurricane Harvey in Texas, Hurricane Irma in Florida and other storms forming off the Florida coast – after which the poor and uninsured who were unable to evacuate have overwhelming medical needs. 
In Houston, for example, where people have been wading in contaminated water, there is a great need for tetanus shots, Hawkins says. And despite flooding in their own homes, many health center staff members returned to work immediately. 

While the responsibility of handling emergency health care needs generally falls to local health authorities, Hawkins says community health centers provide additional support and will be affected by an influx of patients. 

And as Congress grapples with how best to provide emergency relief to states hit by the natural disasters, it has been difficult to “cut through the noise” to ensure immediate funding for community health care centers, Hawkins says, even though the hurricanes and the health centers’ involvement in the recovery efforts make the issue all the more urgent. 

"Policymakers don't always see the reflection of the people that the policies affect. We see it on the frontlines every day," Wiltz adds. "It's hard enough living paycheck to paycheck, but when you try to apply that to health care, that equation costs human lives. They've got to understand that we can't continue in this unstable environment. No one can."

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