Health Center Funding Cliff Update

Despite Momentum, Cliff Fix Not Yet Atop Congressional Agenda

  September 17, 2017  | 

Thanks to the advocacy of thousands of health center leaders and supporters across the country, the last two weeks have shown a marked uptick in Congressional awareness of the need to fix the  Health Center Funding Cliff, which, if left unaddressed, would have devastating consequences for the nation's health centers and the people they serve. Yet, with only a handful of legislative days left before the mandatory funding for health centers and other critical programs expires, the path toward a fix that can be signed by the President before October 1st is far from clear.

Several important developments have occurred that boosted bipartisan urgency around the funding cliff:

  • A bipartisan group of House Members led by  Representative Elise Stefanik (R-NY), introduced legislation,  H.R. 3770, the Community Health Investment, Modernization and Excellence (CHIME) Act of 2017, which would extend health centers' mandatory funding for 5 years, with increased funding in each of years two through five. The bill is a critically important tool that demonstrates the public commitment of a bipartisan swath of House members - a key step toward getting any fix. A list of cosponsors can be found  here. Note that with the House in recess this week, House offices CAN add themselves as cosponsors - but that list will not appear publicly until lawmakers return September 25th.
  • In the Senate, bipartisan health center champions also began organizing their colleagues to call for a fix. Senator Roy Blunt (R-MO) and Senator Debbie Stabenow (D-MI), who've teamed up before to fight for health center funding, circulated  a letter to the Senate Health, Education, Labor and Pensions (HELP) Committee and Senate leadership, calling for a cliff fix before September 30. As of this writing, more than 40 Senators-Republicans, Democrats and Independents-have signed onto the letter, which closes on Monday the 18th. A current list of signers can be found on the Make the Case page on the Health Center Advocacy Network site.
  • The House Energy and Commerce Committee's Subcommittee on Health last week held a  hearing focused on the importance of workforce programs, including two programs with funding is set to expire alongside health centers: the National Health Service Corps and the Teaching Health Centers Graduate Medical Education Program. Taken together, NACHC refers to these three program expirations as the "Primary Care Cliff." Alongside partner organizations, we'll be co-hosting a  Capitol Hill briefing on the issue this coming Wednesday to further draw attention to the issue.
  • Capitol Hill wasn't the only place where health centers made headlines last week. Health and Human Services  Secretary Dr. Tom Price traveled to New Hampshire to announce the release of more than $200 million in funding to health centers to increase capacity around mental health and substance use disorder treatment services ( NACHC press release). The Secretary tweeted  multiple times from the event, and Health Resources and Services Administration  (HRSA) Administrator Dr. George Sigounas touted the value of health centers as part of the fight against the opioid epidemic in a  blog post on the HHS website. Not lost on legislators was the fact that if the funding cliff is not addressed, these very services will be at risk in a matter of weeks.
  • NACHC made several new resources available for policymakers and advocates, including a revamped  Funding Cliff Estimator tool and a  document sharing examples of the kinds of disruption that could occur without a cliff fix by October 1. These and many other resources can be found on the Make the Case  page.

So with all this activity, and with the cost of inaction being so high, why aren't we on the brink of action in Congress? Why hasn't this issue broken through into the "must-do" category? And what can be done to get us there?

First, Congress is accustomed to waiting until the eleventh hour (or the twelfth, or thirteenth…) to act on even high-priority issues. Second, while there may be general consensus on the importance and value of health centers, agreeing on the length and size of a funding extension (and how that is paid for, and what it gets packaged with) is a difficult and multi-dimensional negotiation. Third, 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. In the House, there are fewer health care distractions - but they also aren't even in Washington this week.

All of this adds up to a very difficult environment for getting Congress to act. But it can be done. The key is to raise the volume. 

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