As lawmakers face another deadline this week for passing legislation to keep the federal government open, one of the outstanding issues is long-term funding for a key health care safety-net program.
The Community Health Center program serves 27 million people at almost 10,000 nonprofit clinics nationwide, almost all of which are in low-income rural and urban areas.
Congress has allocated $3.6 billion annually to the health centers in recent years. That represents about 20 percent of the centers' budgets -- much of the rest comes in reimbursements for services. The money, say health center advocates and directors, is critical to providing services not always covered by Medicare, Medicaid and private insurance, including mental health and substance abuse care, transportation and in-home visits.
Congress was expected to renew long-term funding for the centers on Jan. 22 when lawmakers funded, for six years, the Children's Health Insurance Program. One in 10 kids covered under CHIP gets most of their care at a community health center.
But that agreement didn't deal with the centers. Although federal money for the centers ran out on Oct. 1, a previous budget patch provided temporary funds through March 31.
"We are caught up in Washington's political dysfunction," said Carmela Castellano-Garcia, CEO of the California Primary Care Association. "These centers are a lifeline for millions of people, especially in rural areas where they may be the only health care provider for miles around."
She said the budget impasse has already forced many centers in the state to freeze hiring, put off service expansions and tap financial reserves.
Nationwide, 20 percent of health centers have instituted a hiring freeze already, and 4 percent have laid off staff. Another 53 percent said they might lay off staff if federal funding is not forthcoming, according to a survey of community health centers by George Washington University and Kaiser Family Foundation researchers released last week. (Kaiser Health News is an editorially independent program of the foundation.)
The reasons for Congress' delayed action on funding are not altogether clear.
"We don't really know why," said Dan Hawkins, senior vice president of the National Association of Community Health Centers in Bethesda, Md. "But this has gone on long enough. Centers nationwide are feeling the pain. They need stable funding to plan and operate effectively."