Health Center Federal Policy

Health Centers on the Hill: 2014 Year in Review

by John Sawyer, Director of Federal Affairs

It’s been quite a year on Capitol Hill and in public policy for America’s Health Centers. As the team here in DC that represents health centers, your staffs, your boards and your patients, we spend every day working to convey to policymakers the value of the work you do in your communities, and to communicate back to you the implications of what happens (or just as often, what doesn’t happen) here in DC. We try to do this while keeping our focus squarely on our shared mission – access to care for those we serve.

As the year comes to a close, we wanted to recap the major policy events of the year, and take a look at what opportunities and challenges lie in store in 2015.

It comes as no surprise to every health center advocate that the health care landscape is in a major state of flux. We began 2014 with health centers still helping to pick up the pieces from a disastrous rollout of healthcare.gov, fighting for Medicaid expansion and state direct funding, implementing new payment systems, recruiting and training a workforce, forming new partnerships, working on improving quality of care while demonstrating value. With all these pieces in flux, there were many directions our policy agenda could take. But the message from the membership and leadership of NACHC was clear – focus on funding.

With the final year’s allocation of the 5-year mandatory Health Centers Fund still to be distributed, and with the looming uncertainty created by its expiration hanging over not just the Health Centers program but also the National Health Service Corps and the Teaching Health Centers program, the priorities were clear:

  • First, secure the full amounts intended by the Fund in FY2015;
  • Second, pass a longer-term fix to what we have collectively called the primary care cliff.

Those efforts began well before 2014 started, with a major push the previous fall to get Democratic leaders in the House and Senate to urge the administration to include a cliff fix in the budget. When the President’s budget proposal was released in February, it was clear those efforts had paid off. The budget proposal was crystal clear on the need for additional mandatory funds into the future, calling for an additional three years beyond 2015. While there was plenty we took exception to in the budget (cuts on the discretionary side and no call for future growth), it was clear on the continued importance of investment in health centers. It also called for major workforce investments in recognition of the ongoing challenges faced within primary care.

But the President’s budget proposal is just that: a proposal. And with a divided Congress, nothing could be taken for granted. So when thousands of Health Center advocates descended on Washington for this year’s Policy and Issues Forum, we stayed clear on the message – fully fund Health Centers and other vital programs in FY15, and fix the cliff into the future. We heard inspirational words from Congressman Elijah Cummings and Vice President Joe Biden about the importance of health centers and the need to continue the fight. NACHC Board Chair Gary Wiltz issued a challenge to the membership – “we’ve got work to do” – and was back in DC weeks later testifying before a Senate Committee on the value of Health Centers and the threat posed by the cliff.

On FY15 appropriations, as in the past, we showed our breadth of bipartisan support for the program through sign-on letters in the House and Senate, led once again by Senators Debbie Stabenow (D-MI) and Roger Wicker (R-MS) and Representatives Gus Bilirakis (R-FL) and Frank Pallone (D-NJ). The signed letters went to the appropriations committees with 54 signatures in the Senate and 226 in the House.

As the appropriations process kicked off in the early summer, it became clear that those efforts had also paid dividends. The Senate Labor-HHS Subcommittee passed a bill that included the full increase for Health Centers in FY2015 – rejecting the administration’s proposed discretionary cut and doubling down on the need for growth in the program. However, that’s where the appropriations process would end for a matter of months – before the bill could even get to full Committee, the process stalled out over larger policy disputes, primarily to do with the Affordable Care Act. The House Appropriations Committee never released a bill.

With the appropriations process for FY15 on hold, we turned the advocacy focus to the cliff. NACHC worked with bipartisan champions in both houses to circulate a new set of sign-on letters focused on the longer-term funding challenge facing health centers. The letters, led in the Senate by Senators Debbie Stabenow (D-MI), Roy Blunt (R-MO), Tom Carper (D-DE) and John Boozman (R-AR) and in the House by Representatives Kay Granger (R-TX), Gene Green (D-TX), Leonard Lance (R-NJ), and David Price (D-NC), focused on support for the Health Centers program, concern about the funding reductions scheduled for FY2016 and beyond, and a desire to work together to address the issue. Since multiple Congressional Committees will be involved in any fix, the letters went to House and Senate leadership.

The effort to gain signatures on these letters was strategically timed to coincide with National Health Center Week, which again set records this year. Health Centers hosted more than 1,500 events nationwide, and nearly 100 Members of Congress, from both chambers and from both parties, attended events in person. This was used as an opportunity to celebrate health centers’ achievements in our local communities, and remind policymakers that it is their ongoing support that makes those achievements possible.

Building on the success of Health Center Week, a massive coordinate effort from the grassroots achieved a record result in terms of members signing on to show support. 250 House Members, including 71 Republicans, signed the House letter and 66 Senators, including 17 Republicans, signed the Senate letter. These letters were a crucial tool to both build awareness of the issue, underscore the urgency of addressing it, and demonstrate a broad bipartisan consensus that Congress must act.

Congress adjourned in the early fall to return home and campaign for the elections, which brought about a sweeping change in the Congressional landscape, giving control of both Chambers to the Republican Party. The election doesn’t change the core issues for Health Centers

Before departing Washington for the year, however, Congress had to return post-election for a so-called “lame duck” session, where major unfinished business remained – first and foremost, finishing the FY15 spending package and avoiding a government shutdown. Health Center advocates and NACHC made a final push on our two priorities – the full FY15 increase and a fix to the cliff – and were joined in the call for a cliff fix by more than 100 national organizations.

In the end, Congress did fully fund the Health Centers program for this year, spelling out in some detail how some of the new resources should be used. This was a major win for health centers, and one of the only program-level increases of any domestic program in all of government.

On our cliff issue (and on other issues facing similar deadlines, like the Children’s Health Insurance Program and Medicare Physician Payments), Congress took no action during the lame duck.

That means we will have to hit the ground running next year, with a deadline looming at the end of September, to take every opportunity to address this problem with the 114th Congress. The threat of a 70% reduction to Health Center grant funding is still very much in play – and it will take action on the part of every single health center advocate to avoid that outcome, which would turn back the clock on all the progress we’ve made for those we serve in the last decade or more.

As your federal affairs team, it’s our honor to come to work every day and fight for you, your communities, and your patients. But we can’t do this alone. All politics is local, as they say, and our influence and success on Capitol Hill comes from health center advocates – CEOs, staff members, board members, patients and partners – who speak up and get active.

Please visit www.saveourchcs.org to get involved! Happy Holidays!