It’s been 110 days since Congress failed to refinance the Children’s Health Insurance Program (CHIP) that insures nine million kids nationwide. And the same is true for community health centers, which provide health care services to 27 million patients nationwide.
As members of Congress continue to wrangle over legislative details ahead of the potential government shutdown, federally-qualified health clinics, CHIP kids, and Dreamers are all caught in the middle; although, clinics haven’t all reaped the same rallying cry.
The clinics’ funding cliff hasn’t gone unnoticed by those in the health sector because the centers, often unsung heroes, are an integral part of the safety-net system. Jonathan Watson, of the Minnesota Association of Community Health Centers, told ThinkProgress that a state house hospital lobbyist recently spoke with him about the funding cliff and asked him, “how can we advocate on your behalf?”
The lobbyist and countless others in the industry understand that without federal money, clinics will close and more patients will depend on the emergency room for untreated care. Currently, 10 Minnesota health centers are participating in a Medicaid accountable care program, and ER use has dropped by nearly 18 percent, said Watson. This saved tax payers $17.3 million over three years.
While centers, like CHIP, enjoy bipartisan support, Congress hasn’t been able to allocate long-term funding.
“They don’t question what we do and the savings [clinics] provide. This is an easy one,” said Watson, the director of public policy.
The inaction has affected day-to-day operations. One of the six federally-funded clinics in Delaware closed last year. Westside Family Healthcare Spokesperson Maggie Norris-Bent told ThinkProgress then that its patients will now need to travel an extra 15 to 25 miles for care. Watson was just notified by one Minnesota clinic CEO that layoff notices will go out as earlier as Monday; the clinic can still technically operate until March, but union contract requires employees be notified with ample notice. And already, many centers across the country have issued hiring freezes with funding in limbo. Continued inaction will result in loss of care to nine million patients, closure of over 2,500 sites, and a loss of over 50,000 jobs.
Several Minnesota sites have issued hiring freezes on administrative staff, dentists, doctors, and behavioral health specialists. A business can’t operate this way, said Watson.
Despite the Trump administration’s frequently hyped emphasis on job creation, the centers’ hiring problems have received little attention from the president.
“This is a time when centers would be recruiting at residency programs,” said Benjamin Money, of the North Carolina Community Health Center Association. Instead, recruitment is on pause because it’s impossible to attract potential doctors and nurse practitioners when their paychecks are in abeyance.
“I feel the impact right now — I have had one person within my organization leave,” said Money. “They felt a great sense of insecurity about the funding cliff. When another opportunity came along, it’s not a matter of not being loyal … [they] can’t run the risk of being eventually laid off.”
The most recent — but seemingly dead — continuing resolution to keep the government running does not include a long-term solution for community health centers, despite attempts by Democrats to add provisions to that end. The exclusion came as a surprise to several state clinic officials that spoke to ThinkProgress on Thursday.
“We are extremely disappointed that this funding was not included in the Continuing Resolution,” said the National Association of Community Health Centers Communications Director Amy Simmons in an email. “There are 27 million patients who depend on Community Health Centers right now. With such a high demand in communities it is unsustainable to run health care on a month to month basis.”
Congress provided $550 million dollars in stopgap funding last year, but it will only keep the centers going until March. While clinics are used to operating with tight-budgets, this period of uncertainty is unprecedented.
Most assume that clinics only provide care to the uninsured — keeping them healthy and saving government dollars. While this is true, individuals with insurance utilize the services as well, particularly in rural areas. More than half of the centers are in rural communities, serving 13 million patients in total.
The majority of patients in California’s centers, for instance, are on Medicaid. North Carolina has an active number of Medicaid and CHIP payers who rely on the centers. Northern Minnesota centers also see many private payers due to the area’s sparse population.
Health insurance is an empty card without a doctor’s office to turn to.