Racing against the September 30 deadline for budget reconciliation, Republican leadership has thrown all its energy into passing the mind-bogglingly bad Graham-Cassidy repeal bill. However, September 30, the last day of the federal fiscal year, is a significant date for other reasons that right now are being largely neglected by that same leadership. On that day, federal funding for the Federally Qualified Health Center Program and the Children’s Health Insurance Program will expire, leaving millions of people—including millions of children—without access to health care.
Whether they are blinded by partisan politics or they feel pressured by a president obsessed with erasing every vestige of his predecessor’s administration (or a bit of both), lawmakers who insist on continuing to wage war on the ACA to the exclusion of all other concerns are abandoning their duties as representatives of the people. And as is so often the case when government acts irresponsibly, the casualties will be the most vulnerable people in our communities.
Federally qualified health centers have had bipartisan support for over 50 years. If Congress doesn’t act by September 30, the program will lose 70% of its funding.
More commonly known as community health centers, federally qualified health centers (FQHCs) deliver high quality primary care services to 27 million people nationwide. Funded by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, they are required by law to serve anyone who walks through their doors, regardless of their insurance status, ability to pay, or immigration status. In 2016, 92% of health center patients were living at or below 200% of the federal poverty level. In 2016, this was $23,760 for a single person and $48,600 for a family of four. (Source: Families USA) Only 17.7% of health center patients have private insurance. Half of all FQHC patients are covered by Medicaid and/or the Children’s Health Insurance Program, and close to a quarter are uninsured. About a quarter of all health center patients are best-served in a language other than English—health centers are known for their commitment to delivering culturally appropriate care—and 62% are members of a racial and/or ethnic minority group. (Source for FQHC Patient Demographics: Bureau of Primary Health Care, HRSA) FQHCs are often the only available source of primary and preventive care for people who are undocumented.
FQHCs receive 70% of their funding through the mandatory Health Centers Fund (the remainder comes from discretionary appropriations). In its statement on the Senate health care debate, the National Association of Community Health Centers (NACHC) says that the administration itself has estimated that without a continuation of funding, 2,800 FQHCs nationwide would be forced to close, leaving nine million patients without access to care and eliminating 51,000 jobs.
On September 19, Republican Senator Roy Blunt of Missouri and Democratic Senator Debbie Stabenow of Michigan sent a letter to the leaders of the Senate Health, Education, Labor and Pensions (HELP) committee asking them to take immediate action to ensure continued funding for the FQHC program. The letter, signed by over 70 Senators from both sides of the aisle, warned that health center operations were already being disrupted by uncertainty over whether their funding would be extended.
According to NACHC, despite this effort, as well as the introduction of a bill in the House to extend funding for the program, this issue still isn’t a priority on the congressional agenda. In a post for the NACHC blog, John Sawyer, Director of Federal Affairs, wrote, “Congress is easily distracted—and in the Senate there is significant attention being paid to three other health care stories: bipartisan efforts to stabilize the marketplaces, introduction of Senator Sanders’ Medicare-for-all legislation, and the last-ditch effort to repeal and replace the ACA in the form of the Graham-Cassidy bill.”
Sawyer undoubtedly has a kind of access to the Congressional process that puts him in a much better position than me to observe what’s holding Senators’ attention right now. But from an outsider’s perspective, it seems to me that Graham-Cassidy, and the drama surrounding it, overshadows even Bernie Sanders’ introduction of a single-payer bill (that Sanders himself has said won’t pass), and has all but destroyed any chance that a marketplace stabilization bill produced through the bipartisan efforts of the HELP committee will make it to the floor.
Nine million kids are enrolled in the Children’s Health Insurance Program. Every one of them is at risk of losing coverage.
The Children’s Health Insurance Program (CHIP) provides insurance for children whose families make too much to be eligible for Medicaid but not enough to afford private insurance. It’s an important gap filler for middle income families. Almost 85% of children covered by CHIP have at least one working parent. And, together with Medicaid, CHIP provides an important safety net of coverage for children—in fact, in many states, the benefits offered under CHIP are indistinguishable from those provided under Medicaid. Nationwide, about nine million children are covered by the program, which has enjoyed consistent bipartisan support since it was introduced in 1997.
In a May 22 piece on the uncertainty surrounding CHIP funding, NPR reported that it was “already too late for states to plan their budgets effectively.” By that time, more than half of state legislatures had adjourned for the summer, and states needed to know the status of their funding while their legislators were still in session. (Source: Shots – Health News from NPR)
Not knowing what else to do, many states planned their budgets as if CHIP funding will materialize when it is needed. Most states have enough funds to carry them through the first part of fiscal year 2018—for 30 states, those dollars will run out by March 2018 or sooner, less than halfway through the year (which starts October 1).
If federal funds aren’t available when states run out of existing money, it will be pure chaos as states scramble to move CHIP-eligible children to other coverage. Many children will fall through the cracks, administratively or because there aren’t any other options for them that their families can afford. Children with complex medical needs are at particular risk of not receiving the care they need during a transition period. What is more, the financial burden of losing CHIP will be greatest on families of these children. In some states, they could go from paying nothing for CHIP coverage to paying over $10,000 a year to purchase health insurance that covers all of the services their medically-fragile children require.
On September 19, Republican Senator Orrin Hatch of Utah and Democratic Senator Ron Wyden of Oregon filed a bill that would extend funding for CHIP for another five years.
No vote is scheduled.
Congress is failing the people. And they should be ashamed.
It feels like some kind of sinister version of Groundhog Day to once again find ourselves fighting against “repeal and replace.” And since it appears that anyone who knows anything at all about healthcare is appalled by the Graham-Cassidy bill, the fact that we’re back here is also patently absurd. Those who are so single-mindedly focused on passing a bill that no one wants have lost all sense of their responsibilities as elected representatives of the people and can no longer truthfully call themselves public servants. If Graham-Cassidy does pass, they will bear the blame for the devastating results. But even if it doesn’t, they are still accountable for the damage they have done by sacrificing FQHCs and CHIP, and the millions of people they benefit, for their own selfish political goals.
Both of these action items are applicable in red and blue states, so get that dialing finger ready wherever you are!
On September 25, the Health Center Advocacy Network is sponsoring a “Cliff Call-in Day” (advocates refer to the sudden drop-off of funding after September 30 as the Funding Cliff). Visit their page to learn more: http://www.hcadvocacy.org/makethecase
Call your Senators and House Reps and tell them to act on CHIP now. Families USA is a great resource for information on how to talk about CHIP. Start here: http://familiesusa.org/blog/2017/09/congress-must-pass-chip-funding-soon
Are there other healthcare issues you feel Congress is neglecting amidst the Graham-Cassidy firestorm?
Share them, and any other thoughts, concerns, or questions (or hints for staying positive through it all) in the comments below.