For those of us privileged to represent health centers day in and day out on Capitol Hill, 2015 has been quite a year. We’ve overcome – for now – our biggest funding challenge in decades, and as a result, we have seen Congressional support translate directly into new and meaningful care in every community served by health centers. We’ve seen completely unexpected changes in Congressional leadership, which when added to the roller-coaster Presidential campaign, sets up a very dynamic political landscape for the year ahead. As we head into the end of 2015, we wanted to recap the highlights for health centers on Capitol Hill from the past year.
Amongst our staff, state associations, as well as health center leaders and advocates nationwide, the year began with a sober appreciation for the challenges we faced in 2015. Without action by Congress, all health centers would face the Primary Care Cliff – the looming cut of more than 70% to the Health Centers Program (as well as the elimination of Teaching Health Centers Graduate Medical Education and the National Health Service Corps programs entirely) caused by the scheduled expiration of mandatory funding streams on October 1st. In early January, NACHC convened a targeted “fly-in” with health center advocates from around the country, who took the time to come to town and meet with key Members of Congress to make sure that “fixing the cliff” was on everyone’s agenda.
The crescendo only built as health centers around the country localized the potential impact of the cliff and spread the call for Congress to act. In budget hearings, HHS Secretary Sylvia Burwell repeatedly testified about the devastating impact the cliff would have on access to care. With leadership from NACHC, more than 100 national organizations added their voices to the bipartisan majorities in Congress who were calling on leaders to find a fix. The stakes couldn’t have been higher, especially since Congress was only expected to pass one major piece of health-related legislation this year, the so-called “doc fix.”
In March, literally as we kicked off the Policy and Issues Forum, it became clear that our call had been heard. A two-year extension of all three programs’ funding was included in the larger package, H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 – a huge accomplishment and one of very few provisions to be secured in that “vehicle.” With nearly $8 billion at stake and with more than 2,000 advocates already here in D.C. for the P&I, the health center movement flew into action: making thousands of phone calls, delivering petitions, pressuring members and staff and eventually pushing the bill over the finish line, with a major bipartisan vote in support. NACHC Board Chair Dr. Gary Wiltz and Senior Vice President Dan Hawkins joined President Obama and Congressional leaders at the White House to celebrate in April.
We couldn’t think of a better 50th birthday present for the Health Center Movement, and a few short months after the vote, dozens of Members of Congress from around the country used National Health Center Week to visit their centers, and to celebrate this history and these more recent accomplishments. No less than the New York Times recognized the work of health centers on its editorial page.
Yet no sooner was this fix enacted, however, than we turned our attention to protecting the investment and shoring up support for the other pot that makes up total funding for Health Centers – our annual appropriation. When Congress hit a stalemate on passage of human trafficking legislation, part of the solution was to tap Health Centers’ mandatory funds to pay for the new program. When Congress released initial drafts of appropriations bills over the summer, a portion of the new Health Center funds were slated for cuts and others were redirected for another purpose.
With pressure from NACHC and a bipartisan group of Senators, HRSA continued releasing the new funds – in the form of New Access Points, Expanded Services, Health Infrastructure Awards, Base Adjustments, and other new opportunities in quality improvement, oral health and substance abuse. With virtually all of the new funding either spent or “spoken for” by the time Congress finalized the appropriations process in December, we were pleased to see full funding of NACHC’s request in the final bill which passed last week.
The Health Centers program now stands at a total annual funding level of $5.1 billion – more than a doubling in the last five years. With another deadline looming in 2017, we’re not resting on our laurels. Stay tuned for more information about this year’s agenda, but know that it will focus both on solidifying the support for health center funding that’s been built this past year, and on what other tools (a strong workforce, capital funding, reimbursement, technology, etc) are necessary for health centers to thrive in the current environment.
Beyond these monumental successes on the funding side, we were deeply engaged in many other policy conversations and debates throughout 2015. A few highlights:
- Congress increased scrutiny of the 340B Drug Discount Program this year, with a hearing in March, draft legislation (ultimately withdrawn) in May, and a Government Accountability Office Report on hospitals, 340B and Medicare released in July. While much of NACHC’s work on 340B this year was on the Regulatory side (culminating with our comments on the proposed mega-guidance this fall), we don’t think we’ve seen the end of Congressional interest in changes to the program, and we’re watching it closely.
- Like Health Centers, the Medicaid program celebrated its 50th anniversary this year too, which brought with it some Congressional attention. While major changes to the program through federal legislation are not expected in 2016, Members on both sides are ramping up activity on Medicaid in anticipation of a change in the environment in 2017. As co-chair emeritus of the Partnership for Medicaid, NACHC remains at the forefront of the Medicaid legislative conversation.
- The fight over the ACA went back to the Supreme Court this year, with the case of King v. Burwell. While the court ultimately ruled to protect the law, the whole exercise brought the health reform conversation back to Capitol Hill, with Democrats defending the ACA and Republicans talking about what their alternatives might look like. Our all-star intern Genny Olson penned a three-part blog series (part 1, part 2, part 3) on the case and its implications.
- Congressional leaders showed an increased focus on behavioral health issues as the year went on, spurred by current events, from mass shootings to the opioid epidemic. Multiple pieces of legislation have been introduced and several are working their way through the legislative process, and we expect more action – and opportunities for health centers – in the year ahead.
- After more than 50 votes by the House of Representatives to repeal the Affordable Care Act passed the House but died without the 60 votes in the Senate needed to overcome a filibuster, the Republican majorities in Congress succeeded for the first time in passing repeal legislation that’s expected to make it to the President’s desk. To do this, they used a parliamentary tool called budget reconciliation, which only requires a simple majority to pass the Senate. The bill is expected to pass the House in January, and will face a certain veto from President Obama.
- A number of other positive bills for health centers have been introduced on Capitol Hill:
- 2151, the Family Health Care Accessibility Act, would add volunteer clinical providers under health centers’ Federal Tort Claims Act Coverage – a similar provision is included within mental health legislation that seems to be moving in the House.
- S. 2261, the Rural ACO Provider Equity Act would streamline the way beneficiaries are assigned to Accountable Care Organizations (ACOs) by allowing FQHCs and rural health clinics to assign patients. That bill passed the Senate last week.
- NACHC endorsed H.R. 5481, the Flex-IT Act, which would have extended the use of a 90-day reporting period for meaningful use incentives into 2015. Ultimately, CMS changed its policy without the use of legislation.
As you can tell, it’s been a busy year. We’re tired. But, as Dr. Wiltz likes to say, we feel that “good tired” that comes from putting in hard work and long hours in support of a cause we all believe in. (Side note: he should know, as he was just named co-chair of Louisiana Governor-elect John Bel Edwards’ health care transition committee.)
Thanks for giving us the privilege in 2015 – we look forward to all that 2016 may bring.
Happy New Year from your Federal Affairs team:
John Sawyer, Abigail Pinkele, Jennifer Taylor, Michaela Keller, and Alyssa Shinto