Health care on the chopping block

Millions of Americans will be without basic medical care if Congress fails to fund Community Health Centers, worries SUSAN FRIEDBERG

KALSON of the CHC in Squirrel Hill

As he told his story, our patient’s eyes welled with tears. A few years ago, his wife had started to have worrying symptoms, but despite having been employed throughout their adult lives, they had no health insurance. They were still too young for Medicare, and so his wife let the months pass. Finally, this couple made their way to Squirrel Hill Health Center (SHHC), a nonprofit, federally funded Community Health Center that that serves anyone, regardless of insurance status or ability to pay.

At SHHC, one of our doctors quickly determined that our new patient needed to be referred to specialists. Our care coordinators helped the couple enroll in insurance made available under the Affordable Care Act and set up appointments. Our staff then followed up with ongoing care back at the health center.

Sadly, it was too late. Just a few months after her first visit to SHHC, this patient died of lung cancer.

I met her husband at the center after she had died when he was there for a hearing exam and to schedule his next appointment with our dentist. He wanted me to know how grateful he was for the excellent care and support we continued to provide to his family. I wept with him, not only because of his grief but also in frustration at a health care system that had failed his wife and in fear that we could return to those days.

What happened to this woman beats at the heart of our health center’s desperate fight to preserve our funding so that we can survive and help our patients survive. Since last fall, we and 1,400

other Community Health Centers across the nation have faced a potential reduction of 70 percent in our direct federal funding.

We care for many children through the Children’s Health Insurance Program (CHIP), which also is in jeopardy, but direct funding is separate from CHIP. Our patients need not only insurance, but also access to care. Direct federal aid allows our centers to provide high-quality, comprehensive, cost-effective primary and preventive medical, behavioralhealth and dental care, along with crucial care coordination, access to low-cost medications and support services to 27 million patients each year. These include the most vulnerable, low-income residents of both rural and urban areas.

Community Health Centers have been around for decades, serving not only as a vital primary-care safety net, but also as the testing ground for innovative and transparent quality-improvement initiatives. Despite the upfront federal investment, we save the health system more than $24 billion a year by keeping our patients healthier and decreasing the inappropriate use of costly hospital and emergency services.

Since 1972, year after year, regardless of the political climate, Congress has understood our value and voted to renew our funding. Yet the “funding cliff” we now face poses an existential threat: Congress failed to reauthorize the majority of our base funding by the deadline of Oct 1. We have kept our doors open because we had funding through the end of the year, which now is two weeks away. If Congress does not act, come New Year’s Day, we and the other Community Health Centers across the country are looking at across-the-board cuts that would devastate our organizations and leave our communities without care.

Nationally, this could mean that 9 million patients lose access to primary care. Some 2,800 Community Health Center sites could be closed, and 50,000 employees could lose their jobs. In Pennsylvania, an estimated 400,000 patients would lose care, including more than 1,700 at our health center alone. We may be forced to close one of our sites, lay off staff and greatly decrease “supplemental” services, such as behavioral-health care, just as we are adding a program to provide critically needed medical treatment for opioid addiction.

Worst of all, it will mean that more patients will tell stories like the one I cannot get out of my mind, of loved ones lost because in this nation of such great wealth, they could not get basic health care.

Susan Friedberg Kalson is CEO of the Squirrel Hill Health Center (sfkalson@squirrelhillhealthcenter.