UPDATE: The House Energy and Commerce Committee said Thursday that it will consider legislation to extend community health center funding next week. Advocates are encouraged, but still on edge. This is an early step in the legislative process and will occur after the September 30 funding deadline, so uncertainty over when the funding might come through remains a challenge for the health centers.
Safety net health centers in Texas have been scrambling for attention from Congress as they face a funding cliff Saturday that could leave hundreds of thousands of poor Texans without care. But lawmakers in Washington have been distracted by Republicans’ latest Obamacare repeal bill, which would cut billions in federal funds to states and leave millions more Americans uninsured.
On Tuesday, the GOP repeal bill was declared dead (for now), but the heated, weeks-long debate sucked time and energy from lawmakers and advocates. Now, three days ahead of the funding deadline, lawmakers are preparing to leave for the week without any action on bipartisan legislation to continue a federal grant for community health centers, leaving them in what they say is a dangerous limbo.
Without congressional intervention, safety net providers will face a 70 percent cut to their federal funding beginning October 1 — an estimated $150 million reduction in Texas, according to the Texas Association of Community Health Centers (TACHC). The centers provide primary care to underserved communities and have stepped in to offer care in areas devastated by Hurricane Harvey. More than 1.3 million people — most at or below the poverty level — receive care annually at about 460 sites around Texas, which has the highest uninsured rate in the country. Of those, about 200,000 Texans could lose care if the funding in question is not continued.
The federal grant at issue, established under the Affordable Care Act, primarily funds care for uninsured patients. According to national estimates, allowing the federal grant to expire could lead to a $3.6 billion decrease in funding for centers in fiscal year 2018, the departure of 51,000 doctors and other staff and loss of access to care for 9 million patients.
Action this week is unlikely, but Congress can elect to bring back the funding grant after the September 30 deadline. That would need to happen quickly, though. Centers in Texas have enough funding to continue full operations for an average of about 44 days, according to TACHC. Well ahead of those funds running out, they would need to start preparing for reductions. The longer Congress waits, the greater the uncertainty for the centers, and the more services will be cut, advocates say.
Lawmakers’ procrastination has already taken a toll. Community health centers in Texas have reported that some doctors have elected not to take jobs there because they didn’t know if services would continue, according to TACHC. The organization worries about banks declining loans, staff leaving, infrastructure projects coming to a halt and patients being turned away because of uncertainty, even if the grant is later approved.
“The greatest threat we face is instability … most health centers don’t have enough cash reserve to deal with it,” said José Camacho, executive director of TACHC, adding that it costs health centers about $40,000 to recruit a new doctor, a particular challenge in rural areas. “It’s taken us over 50 years to build the network of services for patients that we have right now. If that’s interrupted or destroyed, it will take years to rebuild. We’ve seen it happen with family planning clinics, and we’ll see it happen as a result of Harvey. It’s not easy to rebuild.”
As the state has cut funding to family planning clinics and kicked Planned Parenthood out of the low-income women’s health program, the centers have seen demand for care increase. Texas’ decision not to expand Medicaid means centers are not getting that revenue from many uninsured patients who otherwise would have been eligible for the coverage, so they rely more on the federal grant. Proposed GOP cuts to Medicaid, and the failure of Congress to reauthorize the Children’s Health Insurance Program (CHIP) by September 30, could add further instability, advocates say.
Ten Texas representatives — seven Democrats and three Republicans — are signed on as co-sponsors of the bill introduced earlier this month to extend health center funding. It was referred to the House Energy and Commerce Committee, but no hearing has been scheduled, and there’s nothing on the House or Senate calendar to address the issue. Texas Republican Joe Barton, of Ennis, is vice chair of the committee, while Lewisville Republican Michael Burgess chairs the health subcommittee and Gene Green, D-Houston, is its ranking member. Of the three, only Green has signed on to the legislation.