It won't take a Supreme Court ruling for Congress to act on refunding. For all their collective faults, the people elected to Congress keenly understand their districts, and all of their districts have community health centers.
When someone says, "our tax dollars at work," the reference is almost always sarcastic.
You would be hard pressed, however, to find a more cost-effective use of federal tax dollars—or any dollars for that matter—than the $11 billion that Congress and the Obama administration earmarked for community health centers back in 2010.
Subsequent cuts have chipped about $3 billion from the fund since 2011. Still, by the end of this year, it's projected that the funding will have allowed 1,300 community health centers to provide access to care for about 28 million people in more than 9,000 community sites across the nation.
That five-year funding window ends on Sept. 30. And unless Congress acts before then to provide an additional $5.1 billion, these community health centers will lose about 70% of their funding, says Dan Hawkins, senior vice president for public policy and research at the National Association of Community Health Centers.
The Department of Health and Human Services estimates that more than 2,000 clinic sites could close if the funding drops over the cliff.
Unfortunately, like so many programs that rely on federal tax dollars, community health centers are now playing a wait-and-see game. NACHC wants Congress to include the funding in the larger, $175 billion-to-$200 billion healthcare compromise package designed to permanently fix the discredited Sustainable Growth Rate formula.
The SGR situation is fluid right now, and it's expected that something will surface this week, maybe today. No bill has been made public, but the permanent fix has been the subject of widespread speculation in the past few days. That makes Hawkins anxious.
"Nobody knows exactly what is going to be in there. We have been told it looks good, but that and a quarter gets you a cup of coffee. I'll believe it when I see it," he says. "It's more worrisome as time goes on that they haven't unveiled the package."
The SGR goes into effect on March 31, which leaves doctors facing a 21% reduction in Medicare payments if Congress can't reach a compromise. The situation is not so dire for community health centers, which have a few more months before the funding drops. Still, Hawkins says, it's easier to attach the funding to the larger spending bill.
"It's always better to be the ornament than the tree," he says. "It's a lot easier if you've got a big freight train pulling this thing along. It may be one of the last, if not the last big health bill to move through. There is lots of talk about the Children's Health Insurance Program extension being included, and I am sure there are extenders and other things being considered. We want to be near the front of the line on this train before they stop taking tickets."
The sooner that Congress provides the funding, the earlier that community health centers can craft budgets for the coming year.
"These are small businesses that have budgets, staff to recruit, clinicians need some security. They have facilities to rent," he says. "It is tough to plan when you don't know beyond six months from now."
The uncertain future for community health centers comes as advocates gather this week in Washington, DC to mark the 50th anniversary of the legislation that created community health centers during the Johnson administration. Hawkins says many of the out-of-town advocates are spending the week visiting their representatives in Congress to make the case for additional funding.
Fortunately for these advocates, community health centers are one of the few interest groups in Congress that can claim bipartisan support. Their mission resonates.
"Each member has their own reason for supporting health centers, especially when they visit the centers in their district and see what is going on," Hawkins says. "We have dozens of peer review studies over the years that show that health centers deliver on the Triple Aim; better health and better access to care at a lower cost. They save money. It's the whole shooting match."
In an unforeseen twist, community health center funding could be buoyed if the latest legal challenge to Obamacare is successful. Lawmakers would be reluctant to cut community health center funding while the U.S. Supreme Court considers King vs. Burwell. If the federal subsidies for health insurance in 34 states are voided by the court, an estimated nine million people could lose coverage, leaving the Republican-controlled Congress scrambling to provide healthcare access alternatives.
"Nobody wants to see nine million people lose their subsidies and most of them would have to lose their coverage, but we have been told by some folks on that side of the aisle that health centers have to be part of it," Hawkins says. "I do think that depending upon where this thing goes, I suspect you'll hear health centers mentioned in any replacement package."
When it comes to federal funding, nothing should ever be taken for granted. That said, community health centers have a long history of demonstrating care delivery and value to vulnerable people.
It won't take a Supreme Court ruling for Congress to act on refunding. For all their collective faults, the people elected to Congress keenly understand their districts, and all of their districts have community health centers.
John Commins is the news editor for HealthLeaders.