With funding uncertain, community health centers watching Washington

A bill passed Tuesday by the U.S. House of Representatives and a Wednesday budget deal by Senate leaders both included funding for community health centers that have faced an uncertain future since Sept. 30.

The centers provide primary care as well as dental, mental, and addiction treatment services to 27 million patients in underserved areas nationwide. Twelve centers in Arkansas operate more than 100 delivery sites, more than 30 school-based, that serve 196,000 patients, said LaShannon Spencer, CEO of Community Health Centers.

The Community Health Centers Fund, which comprises 70% of the federal dollars funding the centers, expired Sept. 30. The centers were funded with $550 million through March 31 with a stopgap measure passed in December.

Senate Majority Leader Mitch McConnell, R-Ky., and Minority Leader Chuck Schumer, D-N.Y., announced they had reached a spending deal that would increase defense and domestic spending by $300 billion over the next two years and lock in funding for the centers over that amount of time. Congress must pass a funding bill by midnight Thursday, or the government runs out of money.

The issue remains far from settled. As Politico reported Wednesday, many conservatives in both the House and Senate are expressing concern about the $300 billion in new spending and what effect it will have on the $20.5 trillion national debt. Meanwhile, Democrats are still demanding action to protect undocumented immigrants brought to America illegally as children.

Spencer said the centers serve underserved areas. While most patients do receive Medicare and Medicaid benefits, some have insurance.

But the centers depend on the federal funding. Without it, she said, “We’ll begin to see more patients actually seeking health care primary care services in the emergency room. … The local hospitals cannot afford to see uninsured patient populations again. Those small, safety net hospitals cannot afford that.”

Funding through the Community Health Centers Fund had grown from $1 billion in 2011 to $3.6 billion in 2017, according to the Kaiser Family Foundation. With an additional annual appropriation, the centers received $5.1 billion total in fiscal year 2017. The fund was created by the Affordable Care Act, otherwise known as Obamacare.

Spencer spoke with Talk Business & Politics Wednesday after visiting Mid-Delta Health Systems in downtown Clarendon, the only primary care services provider in town. Mid-Delta Health provides primary care, pediatrics, obstetrical-gynecological, mental and behavioral health services.

Uncertainty over funding has already had an effect, according to a survey by George Washington University and the Kaiser Family Foundation. Twenty percent of those surveyed have instituted a hiring freeze, and 4% have reduced staff.

Spencer said the lack of funding has kept centers from expanding their services. One provider, 1st Choice Healthcare in Corning, has a growing, diverse patient population, but the director has been reluctant to hire anyone because of the uncertain funding. Spencer did not know of any centers that have laid off staff.

The House legislation, passed Tuesday, would fund the centers for two years as part of a deal that also would fund the Defense Department for one year but fund other non-defense agencies only through March 23. The measure passed, 245-182, with all four members of Arkansas’ congressional delegation voting yes.

The vote in the House followed a letter sent Friday to Speaker of the House Paul Ryan, R-Wisc., that was signed by 105 Republicans, including Reps. Rick Crawford and French Hill of Arkansas.

A similar letter was sent Monday to McConnell and Schumer. It was signed by 67 senators, including Sen. John Boozman, R-Ark. U.S. Sen. Tom Cotton, R-Ark., did not sign the letter, but his spokesman, Dylan Haney, said Cotton supports funding the centers.