Public Health Law Watch
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Why is Congress not prioritizing health care for children and other vulnerable populations?

By Jennifer Lea Huer

Back in September of this year, Congress was faced with the decision of whether or not to renew funding for both the Children’s Health Insurance Program (CHIP) and the Community Health Center Fund. Both sources of funding expired on October 1, 2017. As of the date of this post, 68 days have passed since Congress failed to renew funding for these crucial programs. Much has been written about the imminent need to reauthorize CHIP funding; states are already warning their residents that funding is running low and decisions about cutting coverage may soon follow. In addition to the estimated 9 million children in danger of losing coverage if CHIP funding is not renewed, recent studies estimate that millions more people could lose access to care if Congress does not take concrete steps to reauthorize funding for community health centers.

The federal government formalized its commitment to community health centers (CHCs) back in 1965, when it established the Health Center Program – a program that champions the development and capacity of CHCs, especially in the provision of care for millions of our country’s most vulnerable patients. The Patient Protection and Affordable Care Act (ACA) reiterated the US commitment to CHC growth and funding by establishing the Community Health Center Fund. The ACA authorized five years of funding, a total of about $7 billion, for CHCs. This funding meant that every state in the United States, including the District of Columbia, could have at least one CHC.  Federal funding also led to implementation of primary care programs, as well as behavioral health programs, and specific programs focused on special populations (e.g., veterans, children, chronically ill, homeless). Upon its expiration in 2015, Congress extended community health center funding for an additional two years, which, as mentioned, expired on October 1st.

Congress’ inaction is of the utmost concern, because community health centers are essential components of the American health care system, providing primary care services to more than 27 million people each year. One in 12 patients are served by a federally-funded CHC. Twenty-five percent of rural Americans receive their primary care from a CHC. An overwhelming percentage of CHC patients represent racial and ethnic minority groups. As other settings within the health care system continue to grow and cost more money, CHCs find themselves struggling to provide care to increasingly larger volume of patients, particularly for patients who would otherwise not have access to appropriate and cost-effective primary and ambulatory care services.

CHCs are known to provide high quality care and have a low per patient cost, but because the majority of their patients are under- or uninsured, CHCs heavily rely on federal support to maintain financial stability. Federal support for CHCs comes in the form of grants – which account for 70% of CHC funding. And end to the health center program means that CHCs will lose 70% of their funding, which will result in what experts have termed a “funding cliff.” This situation is especially dire for states that chose not to expand Medicaid; CHCs have even higher numbers of uninsured patients in these states (when CHCs cannot rely on Medicaid payments for otherwise reimbursable services, they must utilize more of their federal grant dollars to provide direct care, rather than using that grant funding to expand capacity for care delivery and specialized programs).  Experts are also forecasting that beyond stress to the health care system, this significant loss of funding will have detrimental effects in other sectors of our economy, including employment and state tax revenue.

Interestingly, both the House and the Senate have introduced bills that would extend funding for CHCs. But while both chambers have referred the Community Health Investment, Modernization, and Excellence Act of 2017 to sub-committees for review, the bills have stalled, with no further action occurring since September.

Here in Massachusetts, CHCs are trying not to panic, but many are worried that they will need to cut staff, clinic hours, and in the worst cases, shut down their facilities. The CHC funding cliff would result in Massachusetts CHCs losing $196 million in funding, which would impact hiring of new staff, continuation of much needed expansions (facility and programmatic), and, most importantly, it would mean that more than 141,000 residents could go without health care.

As the Trump Administration continues to aggressively degrade the integrity of the ACA and health care in the United States, CHCs will find themselves pressured to rise to the challenge of filling gaps in care delivery and cost containment. The CHIME Act indicates bipartisan recognition and support for solving the impending funding crisis, but Congress has not stopped internal squabbling long enough to focus on acting in the best interest of its constituents. It’s time members of Congress prioritize serving those who need them most and move to immediately reauthorize funding for the Community Health Center Fund.