A new government report finds that one in five safety-net health centers — federally funded clinics that serve low-income Americans — aren’t routinely testing patients for HIV, even though the Centers for Disease Control began encouraging regular HIV tests back in 2005.

As the global community has continued to make strides to combat the HIV/AIDS epidemic over the past several years, health experts have gradually expanded their guidelines on HIV testing, pointing out that the best defense against the spread of the virus is educating all Americans about their HIV status. The U.S. Preventative Task Force, a government-backed panel that determines what preventative health care will be covered under Obamacare, updated their recommendations last year to make HIV testing as routine as regular blood pressure screenings in annual check-ups.

Nevertheless, the health centers that provide care for the country’s poorest residents don’t have enough funding to make sure they can screen everyone for the virus:

The health centers, all of which received money from the federal Health Resources and Services Administration (HRSA), reported a lack of financial resources from patients and sites as one factor that limited their HIV testing.

“Respondents from one health center site reported that patients who were not eligible for free HIV tests were unlikely to pay for tests, and respondents from another health center site reported that patients had difficulty paying even the small office visit fee, let alone an additional testing fee,” the report said. [...]

HRSA funds grantees that administer clinics for community health, migrant health, homeless health, and public housing primary care. In 2011, such sites provided care to more than 17 million patients, and, with the CDC estimating one in five people in the U.S. living with HIV doesn’t know his status, HRSA centers can play a critical role in reducing the transmission of the virus, the [Department of Health and Human Services Office of Inspector General] said.

The health clinics that are currently forced to prioritize their resources for HIV testing often can’t focus on regular screenings because they only test patients who categorized at “high-risk” for contracting the virus. But it’s important to do regular screening even for patients who don’t exhibit symptoms, or don’t appear to be at a high risk for contracting HIV, since an estimated 220,000 HIV-positive Americans don’t know their HIV status. In fact, half of the HIV-positive individuals between those ages of 13 and 24 aren’t aware they have the virus because they don’t get tested regularly — which is partly why that age group contributes to more than a quarter of the country’s new HIV infections each year.

Fortunately, Obamacare prioritizes funding for the community health centers that are often on the front lines of providing care for the nation’s most vulnerable populations. Under the health reform law, more than $125 million in grant money will be awarded to about 200 safety-net clinics across the country. If fully implemented, that increased funding will allow community clinics to serve more than twice as many people by 2019 — and potentially better adhere to the CDC’s guidelines on HIV testing.

HHS Secretary Kathleen Sebelius endorsed President Obama’s jobs bill in today’s Huffington Post, writing that the plan would “provide an immediate boost to America’s economy.” She argued that the Affordable Care Act will also improve job growth and touted a new round of community health care grants: “the availability of $700 million in new funding to support the renovation and construction of community health centers — an investment that will create thousands of good jobs in construction and health care while enabling more Americans to get the kind of affordable primary care that can keep them healthy and out of the hospital.”

Indeed, investing in CHCs — one area of health reform both Democrats and Republicans can agree on — totals $11 billion over 5 years and could “generate $54 billion in economic activity in 2015, with $33 billion of this a direct result of the additional investment in the new law” — that’s 457,300 jobs by 2015. The additional dollars will set off a job spiral: 1) health centers directly employ people in their communities, including key entry-level jobs, training, and other community-based opportunities and 2) health centers then purchase goods and services from local businesses and expand and build new locations. Thus, every dollar spent and every job created by health centers has a direct impact on local economies.

Republicans have long supported CHCs as a means of expanding health care coverage — despite proposing massive cuts to centers in the last year. Former President George W. Bush doubled U.S. financing for community health centers and Appropriations Committee Chairman Hal Rogers (R-KY) has described CHCs as “essential,” regularly touting new federal funds for CHCs in his district.

Last week, the Department of Health and Human Services announced that the federal government would be awarding $28.8 million to 67 community health center programs across the country as a result of funding made available through the Affordable Care Act. “Community health centers work to improve the health of the nation’s underserved communities and vulnerable populations by ensuring access to comprehensive, culturally competent, quality primary health care services,” the agency said in its release, noting that the new grants will help deliver care “for an additional 286,000 patients.”

But Rep. Joe “You lie” Wilson (R-SC) has seized on the announcement as a fundraising opportunity, arguing that since the funds are distributed to health clinics in farm communities that don’t check the legal status of their patients, the health law will, in fact, subsidize care for undocumented immigrants. Wilson, in other words, is taking a victory lap and claiming that President Obama did lie about the provision:

Nearly two years ago I made national news when I voiced your outrage at the misrepresentations being perpetuated by the Obama administration. The media and Obama’s liberal allies attacked me for only pointing out the truth that ObamaCare would cover illegal immigrants.

Yesterday, my point was vindicated when the Department of Health and Human Services announced its newest ObamaCare grant. CNS News reported:

“Because the health care centers receiving $8.5 million in ObamaCare money ‘to target services to migrant and seasonal farm workers’ will not check the immigration status of the migrant workers who seek their services it is inevitable that they will serve illegal aliens.”

The president specifically promised the American people that ObamaCare would not cover those who are here illegally. He misled all of us.

Wilson’s self-congratulatory re-election gimmick is not only callous in its tone, but also highly dismissive of the health care needs of migrant workers — many of whom are actually legally working in the United States. According to data from the U.S. Department of Labor, since 2001, the share of crop workers who are citizens “has increased from about 21 percent to about 33 percent, while the share who hold green cards or other forms of work authorization has fallen from about 25 percent to about 19 percent.” The Department estimates that approximately half of all migrant are citizens or have another legal status.

In fact, most still have a hard time obtaining steady insurance through Medicaid and have to rely on community health centers for their primary care needs. “Different state eligibility requirements and the lack of portability or reciprocity in Medicaid and SCHIP, create administrative barriers to coverage for mobile populations,” the National Center for Farm Workers Health concludes. “Therefore, when farmworker families move from state to state seeking employment, Medicaid and SCHIP benefits stop at the state border, making Medicaid and SCHIP unobtainable for most farmworkers and their families.”

As HHS spokesperson Chris Stenrud told Fox News, “By statute, health centers are required to provide primary health care to all residents of the health center’s service area without regard for ability to pay. However, health centers do not provide free care. All health center patients are expected to contribute to the cost of their care.”

Community health centers offer primary care to underserved populations — both legal and undocumented. And if Wilson doesn’t buy the moral argument of ensuring that everyone should have access to medical treatment, he could at least take solace in the fact that these centers create jobs, lower health care costs by treating conditions before they grow chronic and keep people out of the emergency rooms. But even all that won’t shake his deep resistance to treating all people as human beings.

House Speaker John Boehner (R-OH) is claiming that he doesn’t “want anyone to lose their job.” My colleague Ellen-Marie Whelan has produced this interactive estimating how many jobs would be lost under the GOP’s continuing resolution to slash community health centers (CHC). Republicans are proposing to cut $1 billion from the FY 2010 baseline funding, which would translate into a loss of more than 178,000 jobs. Boehner’s home state of Ohio would lose 3,125 jobs:

What kind of jobs? First, and most obviously, these health centers directly employ people in their communities, including doctors, nurses, other health professionals, and key entry-level jobs. The centers provide training on-site and other community-based opportunities. And they purchase goods and services from local businesses and expand and build new locations. All of these activities create additional jobs.

Look (and click here for the interactive):

Whelan estimates that defunding Affordable Care Act (and its $11 billion for community health centers) — the GOP’s other priority — would mean a loss of even more economic activity and eliminate nearly 300,000 jobs in 2015. (See that map here.)

Ironically, Republicans have long supported CHCs as a means of expanding coverage. Former President George W. Bush doubled U.S. financing for community health centers and Appropriations Committee Chairman Hal Rogers (R-KY) — who put together the Republican CR — has described CHCs as “essential,” regularly touting new federal funds for CHCs in his district.

Yesterday, in an effort to make good on their election promise to significantly reduce federal spending, Republicans on the House Appropriations Committee released a preliminary plan of specific cuts that would result in a “9% reduction in nondefense, discretionary spending from 2010.” The proposal makes significant reductions to health care programs, including $1 billion from the national institutes of health, $327 million from Title X, and $210 million from Maternal and Child Health Block Grants.

Surprisingly, Republicans would also eliminate $1.3 billion from community health centers — which provide much needed care to rural and undeserved communities. The programs were expanded by former President George W. Bush (and Obama) and have previously been described as “essential” by Appropriations Committee Chairman Hal Rogers (R-KY). In fact, his website is littered with press releases touting new federal funds for CHCs in his district:

– U.S. Congressman Hal Rogers (KY-05) announced today that the U.S. Department of Health and Human Services (HHS) has awarded $100,000 to Grace Community Health Center….”"Grace Community Health Center serves those who are most in need and will use this funding to help improve the quality of life for those with little to no access to health care. This investment in Clay and Knox counties improves the well-being and health of the local community.” [State News Service, 9/17/2010]

– U.S. Congressman Harold “Hal” Rogers (KY-05) announced today that the Department of Health and Human Services (HHS) has awarded Morehead State University (MSU) with a $235,620 Rural Health Care Grant…“This is great news for the people of Martin County,” said Rogers. “By providing new resources to focus on preventative health care, the community will now be better equipped to address the health care problems that have plagued our region for far too long.” [Press Release, 10/17/2009]

– U.S. Congressman Harold “Hal” Rogers announced today that the Department of Health and Human Services (HHS) has awarded Health Help, Inc. with a $1,433,244 Rural Health Care Grant…”This Rural Health Care Grant program ensures medical care is available to seniors, children, and low-income families,” said Rogers. “In these challenging economic times, rural health care clinics are now more than ever an essential part of the health care safety net in our region and this investment in Jackson County will aid in continuing these important services.” [Press Release, 5/18/2009]

“If this cut were to be approved, it would mean that America’s health centers will lose the capacity to serve 11 million patients over the next year, with well over 3.3 million current patients losing their care within the next few months,” Tom Van Coverden, president and CEO of the National Association of Community Health Centers, said in a statement.“That is equivalent to terminating all healthcare to the entire population of Chicago, or to everyone living in the states of Wyoming, Vermont, North and South Dakota, and Alaska combined,” Van Coverden said.

Indeed, this kind of disinvestment could also translate to serious job losses on the local level. Economists estimated that the additional $2 billion investment in CHCs from the stimulus package generated $3.2 billion of economic activity in 2009, with health centers creating approximately $20 billion in economic activity for the communities where they are located.” Health centers directly employ people in their communities, including key entry-level jobs, training, and other community-based opportunities. The clinics also purchase goods and services from local businesses and expand and build new locations. That’s why members of both parties embrace these centers and will have a hard time in actually voting for their elimination.

Sen. Ben Nelson (D-NE), a last minute hold out on the Affordable Care Act, is potentially facing a tough re-election bid in 2012 and may be having second thoughts about his vote in favor of reform. While he has yet to endorse the Republican effort to repeal the measure — he recently told a local radio station that he would “make some changes” but not “throw it all out just because there are some pieces of it, or parts of it, that aren’t working as good as some others are working” — he has tasked the Government Accountability Office (GAO) with exploring alternatives to reforms most unpopular provision: the individual mandate.

Political pressures and the Senator’s reputation for acting as a thorn in the Democrats’ back could soon push him to take a stronger stance on repeal. Therefore, in an effort to prevent Nelson’s 2012 grandstanding against the law, it’s worth highlighting that Nebraska is already benefiting from reform — and Nelson is taking full credit for delivering the benefits. Yesterday, a local ABC station in Omaha, Nebraska reported that “the One World Community Health Center in south Omaha is planning a major expansion thanks to an $8.9 million grant from the Affordable Care Act.” Fortunately, Nelson was on hand to offer some supportive quotes:

Officials said the money will go toward the $15.3 million project to be built on the former Omaha Stockyards property. [...]

The expansion was made possible by the president’s health care reform and by a deciding vote from Nebraska Sen. Ben Nelson. “Whether you’re rich or poor, when people need health care, they need to receive it,” Nelson said.

The senator said he hopes critics will understand his vote when they see results like this in the metro.

“It makes me feel real proud to know people who are going to get care here are going to get quality care in quality facilities,” Nelson said.

The existing space for One World inside the Livestock Exchange Building will also be renovated with the funds.

According to HealthCare.gov, since the enactment of the Affordable Care Act, the Department of Health and Human Services “has made $14.6 million in new grant funding available in Nebraska,” and enrolled 26 employers in the early-retiree program.

It’s worth noting that Sen. John Ensign (R-NV), who supports full repeal, actually sent a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius requesting grant money authorized by the law for the University of Nevada School of Medicine for “Primary Care Residency Expansion.” Nelson, I hope, avoids similar hypocrisy.

On Friday, The Department of Health and Human Services announced “awards of $727 million to 143 community health centers (CHC) across the country to address pressing construction and renovation needs and expand access to quality health care.” “The funds are the first in a series of awards that will be made available to community health centers under the Affordable Care Act,” the agency said in a press release, noting that CHCs “serve nearly 19 million patients” and “deliver preventive and primary care services at more than 7,900 service delivery sites around the country to patients regardless of their ability to pay.”

CHCs enjoy strong bipartisan support. President George W. Bush committed to double the number of patients seen by these centers during his presidency and succeeded, and President Barack Obama included an additional $2 billion in the American Recovery and Reinvestment Act of 2009 and $9.5 billion in operating costs and $1.5 billion for new construction in the Affordable Care Act. With this additional funding, community health centers will be able to double the number of patients they serve to up to 40 million annually by 2015.

But if Republicans follow through on their promise to completely defund or repeal the health law, they would undermine the planned expansion, drastically reducing the services of institutions that their constituents have come to depend on. A Wonk Room analysis of the 143 community health centers that have received the first series of grants finds that 36 are located in Republican district and have already benefited from the extra ACA funding. Below is a sampling:

- Open Door/BMH Health Center, Inc: $6,078,544.00 — Mike Pence (R- IN)

- Perry County Medical Center, Inc: $1,455,603.00 — Marsha Blackburn (R-TN)

- Kenosha Community Health Center, Inc: $2,851,204.00 — Paul Ryan (R-WI)

An Energy and Commerce Committee report found that there are 14 community health centers in Pence’s district and estimated that the law, once fully implemented, would provide them with approximately “$18.2 million in new assistance.” Blackburn’s 12 CHCs would receive “$15.6 million in new assistance” and Ryan’s 4 would get $5.2 million.

The full list of community health centers in GOP districts that received the first series of CHC grants (Riley Waggaman assisted in researching this report): Read more