The following article by Jonathan Cohn was posted on the Huffington Post website February 4, 2018:
This time the issue is funding for community clinics — which, in theory, everybody supports.
LOS ANGELES ― Jim Mangia, CEO of the St. John’s Well Child and Family Center, spent much of the last year wondering how many of his facilities he would have to shutter. St. John’s is a network of health clinics serving roughly 100,000 of the poorest people in Los Angeles. If Republicans had succeeded in repealing the Affordable Care Act, St. John’s revenue would have dropped as more of its patients became uninsured, making layoffs and closings all but inevitable.
The threat of repeal seems to have subsided, at least for the moment. But these days Mangia has a new worry. A federal program called the Community Health Center Fund, which subsidizes federal clinics through direct grants, officially expired in the fall. Congress has since made a pair of short-term appropriations, in order to keep the grant money flowing, and leaders in both parties talked about coming together on a deal that would finance the clinics for a longer period of time.
But multiple opportunities to do that have now come and gone, the most recent being the legislation Congress passed last month to keep the government funded through early February.
“We’re really very worried,” Mangia said on Wednesday, during an interview at the organization’s main facility about 4 miles south of downtown. “We can’t keep going like this.”
The stakes here are substantial. If the funding were to stop completely, as many as 9 million low-income people would lose their source of care, according to federal estimates. They’d have a hard time finding alternatives, even if they managed to hold onto their insurance, because they live in places that don’t have a lot of doctors and facilities with capacity ― or a willingness ― to see them.
That’s certainly true in Los Angeles, where, Mangia says, St. John’s is the largest primary care provider in what is the nation’s largest contiguous area of poverty. Without the federal grants, he says he’d have to close six facilities and lay off 150 staff members, leaving something like 10,000 to 15,000 of his patients with no source of care. The effects would ripple throughout the community, adding yet more strain to local emergency rooms, among other effects.
In theory, nobody in Congress wants this kind of thing to happen ― in Los Angeles or anywhere else. The clinics have a long history of bipartisan support, and serious negotiations over how to extend funding are underway. On Friday, a key House Republican told The Hill that clinic funding could be part of the bill Congress is now crafting to keep the government open through the end of February.
But the Republican leaders who control Congress insist the new spending must have offsetting cuts ― a condition, notably, they didn’t place on their $1.5 trillion tax cut. Democrats seem willing to go along with that, but the parties haven’t yet reached agreement on what those cuts should be. And the temporary funding Congress supplied is about to run out again
It’s entirely possible that, in order to get a deal done, Republicans will insist Democrats give up some other item on their agenda, which is precisely what happened with reauthorization of the Children’s Health Insurance Program last month. It’s also possible that funding will last for only a year or two, which means the clinics woul be right back in the same situation come early 2020.
There are roughly 10,000 federally qualified health centers around the country. They must abide by certain rules, like operating on a nonprofit basis and setting up boards with community representatives to oversee their operations. The clinics also must take all patients, whether they have private insurance, Medicaid or no insurance at all. These requirements, which entitle the clinics to grants from the Community Health Care Fund, are what distinguish them from other clinics serving low-income populations.
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The clinics trace their history to President Lyndon Johnson’s War on Poverty and, unlike some other programs of that era, they have generally enjoyed enthusiastic support from both parties. Presidents George W. Bush and Barack Obama each made the clinics a priority, pouring billions upon billions of dollars into them. That money has allowed clinics to build new facilities and hire new staff, making it possible not just to see more people (patient volume nearly tripled between 2001 and 2017) but also to offer more services.
The growth at St. John’s is as good an illustration as any of how important the money has been. When Mangia took over in 1995, it had just one facility. Today it has 15, including two school-based clinics ― that is, clinics on or adjacent to school grounds that can handle both kids and their families.
St. John’s has also upgraded its onsite medication dispensary, which relied heavily on inconsistent donations, to a full-fledged pharmacy. It has introduced dental and behavioral health services. And it has brought on full-time nutritionists who, among other things, offer classes on how to cook ethnic food with healthier, but still cheap, ingredients.