Special report: Workplace clinics grow in number, sophistication
Community health centers work to block cuts
After taking a funding hit in the latest round of federal budget skirmishes for fiscal 2011, officials for community health centers are gearing up to try to prevent future potential cuts to their federal and state revenue.
Community health centers, also known by their government designation of federally qualified health centers, are facing potential funding losses as a result of cuts to direct federal grants and reduced Medicaid revenue.
Health centers for the balance of fiscal 2011 ending Sept. 30 already are facing a shift in their federal dollar allotment as a result of the April budget agreement. While the centers aren’t receiving less money than they did in fiscal 2010, representatives of the industry view it as a cut because a healthcare reform-related expansion may now be threatened as a result of the congressional maneuvering.
A reform-linked statutory payment of $1 billion into a trust fund toward the expansion of community health centers now appears more likely to be used to mostly cover a drop in Congress’ regular grant allocation for the centers. The budget agreement for fiscal 2011 included a $660 million cut to health center primary-care funding, which fell to $1.5 billion from $2.1 billion in fiscal 2010. The general idea behind the cut is that the $1 billion trust fund money under the Patient Protection and Affordable Care Act can cover the lost funds while still providing extra money to health centers.
Now, advocates for community health centers are working to prevent more cutting. “They are exceedingly determined not to lose any more money,” says Sara Rosenbaum, law professor at the George Washington University School of Public Health and Health Services, Washington.
An August report Rosenbaum coauthored from the Kaiser Commission on Medicaid and the Uninsured notes that most of the trust fund expansion money—$9.5 billion out of $11 billion total over five years—was expected to add new health center grantees and services
“They are exceedingly determined not to lose any more money.” —Sara Rosenbaum, law professor, George Washington University
sites, and enhance service capacity of new and existing sites. The balance was to go toward capital needs for renovation and information technology, in preparation for the added patients coming through reform expansions, according to the Kaiser report. Rosenbaum estimates 5 million patients who could have been served at the clinics under the ACA will not be as a result of the funding changes.
“They cut the discretionary program and argued that it wasn’t a cut because the trust fund was there,” says Jose Camacho, executive director and general counsel for the Texas Association of Community Health Centers, Austin. That creates a problem, he says, because the trust fund money is for only five years, while the expansion of the health centers is expected to help meet the increased demand when the major elements of healthcare reform kick in Jan. 1, 2014.
“If you continue to cut that discretionary funding program, what happens? No. 1, you can’t build the capacity to serve extra people,” Camacho says. “No. 2, when the trust fund goes away,” you’ve crippled the community health center program.
Community health centers were backed by former President George W. Bush and are considered a major component of the Affordable Care Act. During Bush’s first term, HHS’ Health Resources and Services Administration launched the President’s Health Center Initiative in 2002, which achieved its goal of establishing new or expanded health-center sites in 1,200 communities. Funding also grew significantly under Bush to its roughly $2 billion funding levels, but the latest move by Congress is a step backward, industry officials say.
Daniel Hawkins, senior vice president with the National Association of Community Health Centers, Bethesda, Md., says the roughly 800 applications filed by community health centers for expansion won’t be funded, putting the expansion on ice, and it’s an open question as to what will happen in the next fiscal year.
To raise awareness of the situation among congressional leaders, the NACHC led an effort to garner signatures for a letter of support for community health centers. The letter received signatures of 110 House members from both parties and was sent to two key members of the House Appropriations Committee, Rep. Denny Rehberg (R-Mont.), chairman of the subcommittee on Labor, HHS, Education and Related Agencies, and Rep. Rosa DeLauro (D-Conn.), the panel’s ranking member.
Donna Thompson, CEO of the Access Community Health Network, Chicago, which operates 58 health facilities in the metropolitan area, says her network had applied for expansion funds and has not given up hope on receiving some. “We’re hoping that in the new fiscal year
Rod Manifold, center, executive director of Central Virginia Health Services, addresses a March briefing in Washington for congressional staff touting the costeffectiveness of community health centers.