Community health centers that provide medical care to low-income people are laying off staff and reducing hours to grapple with Congress’ inability to provide new federal funding for them.
The last time community health centers were funded was in 2015 as part of a larger set of health legislation that also extended the Children’s Health Insurance Program.
But like CHIP, community health center funding expired on Sept. 30. Democrats have charged Republicans of letting the funding lapse to take another stab at repealing and replacing Obamacare.
“If I had my way, we would have done it the day that we had to spend beating back the horrible Graham-Cassidy [Obamacare replacement bill],” said Sen. Ron Wyden, D-Ore.
It is not clear when exactly health center funding will be restored. A potential vehicle could be an end-of-the-year omnibus spending bill or a short-term continuing resolution, but those packages are in flux.
"I don’t think we really know how those year-end packages are going to be, whether one or more [packages]," Sen. John Cornyn, R-Texas, the second-ranking GOP senator, told the Washington Examiner. "We don’t know what is going to be in what."
In addition to health centers, Congress needs to find vehicles for CHIP, disaster relief, and a stabilization deal for Obamacare.
The federal government is expected to run out of money on Dec. 8.
The centers offer medical care to areas with few doctors, higher than average infant mortality rate or high poverty. As of 2013, 1,202 health centers received federal funding and supported more than 20 million patients, according to the National Association of Community Health Centers.
The Department of Health and Human Services has estimated that not extending the funding would cause nine million low-income Americans to not have access to healthcare.
The centers have had to deal with a pressing funding cliff since Sept. 30. It has forced some centers to lay off staff, install hiring freezes, and at least one site has closed down, the health center association said. The lack of funding has caused anxiety among health center staff, said association spokeswoman Amy Simmons Farber.
“There is a lot of anxiety among health centers about ensuring their patients — particularly patients living in rural areas — continue to get the care they need with so much financial uncertainty about the future,” she said.
Before the funding expired, 72 percent of 591 centers surveyed planned to freeze spending, and 41 percent said they would lay off staff. Another 47 percent would reduce staff hours and hours of operation.
Federal funding is given to community health centers through grants and makes up 70 percent of their funding. Other sources include private insurance, state and local funding, and Medicaid.
Health centers offer care free of charge for patients who are uninsured and can’t pay.
A fund created through Obamacare was a major catalyst for the expansion of health center sites, representing a 22 percent increase from 2010 to 2016, according to a report this year from the Community Health Foundation.
The report estimates that centers would receive $3.6 billion in funding for fiscal 2018, which started Oct. 1.
The House has gone further to restore the funding than the Senate. The House passed a bill last month that would fund the centers for two years and fund CHIP for five years.
However, that bill has been dead on arrival in the Senate because of major Democratic objections to spending mechanisms for the bill that include charging wealthy seniors higher Medicare premiums and raiding an Obamacare disease prevention fund.
But the Senate has offered no plan yet to reauthorize funding for the health centers.
The Senate Finance Committee passed a five-year reauthorization bill for CHIP in October, but it doesn’t have jurisdiction over the health centers. The CHIP bill has not made it to the Senate floor as Democrats and Republicans work on finding funding offsets.
Sen. Roy Blunt, R-Mo., introduced a bill Sept. 28 that would provide $19 billion in funding to community health centers over five years. However, that bill has gone nowhere in the Senate Health, Education, Labor and Pensions Committee, which has jurisdiction over community center funding.