Community health clinics face funding cliff as Congress fails to act

From the Tennessean
By Holly Fletcher

Community health centers are girding to keep the fight for Congress to reauthorize funding going deeper into autumn as the funding cliff approaches on Saturday — with no legislation teed up.

Clinics, which serve the working poor, uninsured and homeless around the state, are set to lose 70 percent of 2018 funding if Congress doesn't pass legislation to help them.

Funds are allocated on a rolling cycle starting Jan. 1. For the cycle starting Feb. 1, Congress would have to act by early December.

The House and Senate will be in session for 24 days between October and mid-November, and Mary Bufwack, CEO of Neighborhood Health, said "the focus will likely become getting a bill through Congress by Thanksgiving."

It will be tough for the U.S. Health Resources and Services Administration to get money to clinics on the Jan. 1 cycle if legislation isn't passed by mid-November, Bufwack said.

 

A continuing resolution signed by President Donald Trump extended 30 percent of the funding temporarily. The HRSA could help with discretionary funds through March if another continuing resolution is passed.

There's a bill in the House — H.R. 3770, the Community Health Investment, Modernization, and Excellence Act of 2017 — that could be discussed in the House Committee on Energy and Commerce next week.

By the numbers

In 2015, community health centers and clinics part of the Tennessee Primary Care Association:

  • $440 million economic impact around the state

  • 3,990 total jobs

  • 369,265 patients served

  • 1.3 million patient visits

  • 95 percent of patients are low income and below 200 percent of the federal poverty line, or $49,200 for a family of four.

  • 44,129 patients were diagnosed with diabetes

Federal funding is on average half of the clinics' budget, andthat money has had bipartisan support for years. Bufwack, who will retire Oct. 1 after decades with Neighborhood Health, said before this year it was unthinkable that community health centers would go over a funding cliff. 

"At the national level there seems to be an underlying assumption that something will come through and everything will be OK, but no one is willing to go on the record and say they support it or tie it to a legislative vehicle," said Suzanne Hurley, co-CEO of Connectus Health. "There’s nothing real, concrete. There seems to be an overarching misconception that it will work out in the end, but no one can really describe what that looks like.”

Connectus Health would see its funding cut from $1.89 million to $554,434. If its funding falls, it will immediately be unable to serve 53 percent of its current patient load, which increasingly includes people who can't pay high deductibles.

The company served 9,243 patients in 2015.

Connectus staff members are beginning to talk to patients about what happens if funding gets cut. Patients aren't interested in the politics in the exam rooms, said Caroline Portis-Jenkins, co-CEO of Connectus Health. 

“That’s where people end up. They can go fuss about politics at a coffee shop. They don’t do it here,” Portis-Jenkins said.

Here's what Tennessee's elected federal lawmakers had to say:

Sen. Lamar Alexander, R-Tenn.

"Chairman Alexander is working with his colleagues and the administration to extend funding for community health centers this year," a spokeswoman said.

Sen. Bob Corker, R-Tenn.

“Community health centers are a vitally important part of Tennessee’s health safety net, and our staff is in close contact with the Tennessee Primary Care Association about funding concerns and a range of other issues,” Corker said. “We are working in coordination with Senator Alexander and the Senate Committee on Health, Education, Labor and Pensions to ensure our federally qualified health centers get the support they need.”

Rep. Diane Black, R-Tenn.

Did not respond to an inquiry by press time.

Rep. Marsha Blackburn, R-Tenn.

“We are in regular contact with and visit these centers regularly and are deeply appreciative of the valuable service they provide many communities. Our goal is to reauthorize funding for these centers as quickly as possible, and we are working to make sure that happens.”

Rep. Steve Cohen, D-Tenn.

Cohen acknowledged the deadline in a Facebook post on Sept. 22, in which he listed several programs facing a funding cliff. Cohen wrote: "Please be assured that I will join my Democratic colleagues in Congress to ensure that all of these vital programs are renewed in an appropriate manner for Fiscal Year 2018."

Rep. Jim Cooper, D-Tenn.

“Just this week I met with community health center leaders in Nashville. They are doing terrific work but can’t keep it up if funding runs out. Once again, Congress is playing chicken with a deadline on a bipartisan program that 375,000 Tennesseans need. I hope Republican leaders come to their senses before it’s too late.”

Rep. Scott DesJarlais, R-Tenn.

"More funding for community health centers has been a centerpiece of Republican efforts to improve health care, included in the American Health Care Act, which repealed federal regulations raising health insurance and other costs, returning more control to states and localities. The opposition's intransigence has prevented necessary changes that would improve Tennesseans' expanded access to community health clinics, private insurance and more. The Congressman will continue his hard work fixing the broken health care system."

Rep. John Duncan Jr., R-Tenn.

Duncan is aware of the House legislation and its impact on Tennessee. No further comment was immediately available.

Rep. Chuck Fleischmann, R-Tenn.

“Congressman Fleischmann recognizes the critical role of community health centers in providing care for millions of Americans and has voiced his support for tackling the reauthorization as soon as possible," a spokeswoman said.

Rep. David Kustoff, R-Tenn.

Did not respond to an inquiry by press time.

Rep. Phil Roe, R-Tenn.

“As an OBGYN, I know how important it is for everyone to have access to health care, especially those in vulnerable populations. Just last week, I visited Camp Creek Medical Center in Greeneville where they shared their concerns about losing federal funding. I share their support for ensuring these centers continue to receive robust funding as the House continues to work toward finding a funding solution. Folks most in need of health services use community health centers every day, and I will continue to support community health centers so Tennesseans that receive their care there continue to have access.”

Jay Sheridan