We turn the page on 2019 and plunge ahead to 2020 with a lot of unfinished work. A key task left unfinished as we approach a new decade is long-term and stable funding for Community Health Centers, now operating under a temporary measure through May 22nd. Even so, health centers are no less supported; indeed, there remains a growing enthusiasm for a long-term fix among decision-makers. Health centers certainly used every available day on the calendar to make the case for their value with visits to Capitol Hill, writing op-eds, letters or even just demonstrating it as they responded to public health challenges of our day without much fuss or fanfare. As usual, 2019 brought disasters, new problems to fix and opportunities to break out into the limelight. Here are a few highlights:
Congress and Health Center Funding
The Year 2019 started out encouragingly enough for health centers. January launched the Senate Health, Education, Labor, and Pensions (HELP) Committee’s first hearing of the 116th Congress — and the focus was health center funding and the demand for primary care. Health center leaders from around the country were invited to testify, a positive sign that bipartisan leaders were ready to listen and act on a long-awaited stable funding measure. Senate leaders on the panel also seemed to understand the value of the health center mission and the importance of sustaining public investment.
“Community Health Centers are one way American families can have access to affordable health care close to home,” said HELP Committee Chairman Lamar Alexander (R-TN). “This includes a wide range of health care, including preventive care that helps manage chronic conditions like asthma, or high blood pressure, vaccines and prenatal care.”
“This time last year, Community Health Centers across the country were forced to cut back hours, staff, and services, and halt planned expansions. Like in Spokane, Washington—where new opioid-addiction treatment services, initiated to combat the opioid epidemic, were jeopardized by the funding freeze,” said HELP Committee Ranking Member Patty Murray in her opening remarks.
Even beyond Capitol Hill, there seemed a growing recognition of the critical role health centers play in addressing every major public health problem – substance use disorders, natural disasters, caring for veterans. Health centers were tapped to play leading roles in the national response to ending the HIV AIDS epidemic and the Department of Health and Human Services unveiled $200 million in grants to help health centers continue their ground war against opioid use disorder with mental and substance abuse services.
“Health centers and behavioral health providers are on the front lines of the fight against the opioid crisis and substance abuse, especially in rural communities,” said HHS Secretary Alex Azar.” (August 2019).
Not only were health centers responding to more challenges, a National Health Center Week 2019 press release announced that they are serving more patients in greater numbers than ever before at 29 million.
For this year’s funding push, NACHC held two fly-ins in July and September. In July, the Congressional Leadership fly-in hosted 47 participants from 22 different states, and the September National Fly-in hosted 219 participants from 32 states and Washington, D.C. Both events provided an opportunity for advocates to meet with Congressional members and staff to advocate for long-term health center funding — and the message of value is getting through:
“Community Health Centers are the embodiment of health care as a human right. They provide a wide-range of services to some of our most vulnerable populations and help ensure our communities have access to quality health care,” wrote U.S. Senator Kirsten Gillibrand in a December 26th Post Journal op-ed.
“I am a big advocate, and I think most of the health care community over the past couple of decades has also become a big advocate for the role these centers play and the ability of everyone who comes through the door to find a way they can get treated,” said U.S. Senator Roy Blunt in an editorial published on August 1 in the Joplin Globe.
Health Center Advocacy in 2019
National Health Center Week (NHCW) 2019 was also an opportunity to make the case for health centers. The theme of this year’s week was “Celebrating America’s Health Centers: Rooted in Communities.” On social media our #ValueCHCs had over 6 million impressions and the #NHCW19 hashtag experienced over 15 million impressions.
Seismic policy changes certainly had a ripple effect on health centers — to the point that it played out like a nerve-wracking game of “whack-a-mole.” Once again, Section 1115 Medicaid waivers stole the show. While Utah pushed the envelope on state flexibility by seeking permission (and receiving a quasi-denial) from CMS to implement per capita caps, other states, like Georgia, sought to strike deals on long-delayed expansion efforts by agreeing to seek ubiquitous waivers to implement work requirements. Meanwhile, Kentucky, Arkansas, and New Hampshire all had their CMS-approved state waivers to implement work requirements blocked by the courts, and the states of Alaska and Tennessee seemed to be in a race towards a block grant. It is indeed evident that a state’s decision on Medicaid can weigh heavily on voters’ minds. In one of his first acts after being sworn into office, Kentucky Governor Andy Beshear dismantled the waiver. Maine’s new Governor also revoked a waiver that implemented work requirements. In 2020, there is no doubt that Medicaid waivers will, in three-peat fashion, continue to be a testing ground for both politics and policy alike. Tennessee’s block grant waiver amendment remains under review at the Centers for Medicare and Medicaid Services.
Public Charge continues to loom over the health center community. The regulation would make it very unlikely that legal immigrants could get a Green Card if they have used Medicaid, SNAP, and/or other Federal benefits. The rule was scheduled to go into effect on October 15, 2019, but shortly before that date, three courts issued national injunctions blocking it from being implemented. While the rule was scheduled to go into effect on Oct. 15, three District Courts issued national injunctions blocking it from being implemented. Over the last several days, two of these injunctions have been lifted by Circuit Courts. While the rule remains blocked nationwide due to the remaining injunction issued by the District Court in New York, the Administration has asked the 2nd Circuit Court to overturn it.
The Trump administration also finalized a rule that is expected to remove nearly 700,000 people from the federal food-stamp program, known as the federal Supplemental Nutrition and Assistance Program or “SNAP,” by enforcing federal work requirements. Meanwhile, an effort by the Trump Administration to deny visas to potential immigrants unless they can prove they will have health insurance soon after arriving in the U.S. has been blocked by a federal judge. And speaking of insurance, 2019 saw the first increase in the ranks of uninsured in 10 years. The number has grown to 27.5 million, up from 25.6 million in 2017. The Affordable Care Act remains in effect despite a pummeling of legal challenges (see NACHC Blog post).
In addition to challenges in the policy environment, Mother Nature also got in some blows in the form of tornadoes, fires, and massive storms. Natural disasters are affecting more communities and health centers are joining in the response, as this post from Direct Relief describes
Making the Case with Data
Data continues to help make the case about the value of health centers. The January 2019 release of the NACHC Chartbook provided valuable insights and information about the growth of health center services and patients. There were also new studies to cite: for instance, a study in the Journal of General Internal Medicine which found that health centers perform better than private practices on a number of measures for providing high-value care and avoiding low-value care at primary care visits. Specifically, health centers performed better on three measures of high-value care (ordering beta-blockers for congestive heart failure, prescribing statins in diabetes, and providing treatment for osteoporosis).
NACHC continued to work with the Association of Asian Pacific Community Health Organizations and the Oregon Primary Care Association to help health centers identify and respond to social determinants of health needs using the national standardized social determinants assessment known as PRAPARE. A majority of PCAs and HCCNs are supporting PRAPARE. It is now the most dominant social risk screening tool used by health centers. PRAPARE is also increasingly popular among hospitals, health systems, and payers—it is even the most dominant social risk screening tool used by Medicaid managed care organizations, as reported in U.S. News & World Report. This past year, in addition to continuing to build health center capacity for PRAPARE, the PRAPARE team has focused on incorporating PRAPARE social risk data into a national, standardized risk stratification model. As we move into the new year, NACHC will build on this important work and strengthen health center and social sector alignment in order to address community social risk.
“Refresh and Reboot” for 2020
To close, 2019 was a very busy year for the health center community. As a network, we produced over 73,000 advocacy activities in support of health centers. Our voice as a movement remains strong. The outlook for 2020 may look uncertain, but after more than 50 years of fighting, history shows that health centers know how to survive uncertainty.