By Craig A. Kennedy & Kaitlin McColgan
Sitting down to write our annual NACHC review of legislative activity, it is hard to believe all that has happened in one calendar year. One thing is already certain: this is a year that will go down as one of the most active in the health center movement’s already distinguished history. What has brought us to this point is not luck or simple fortune as some might like to think. Instead, it is because we have the most hardworking group of grassroots advocates in the country. Many of you have worked for decades, and all of us have worked for years to plan for this type of year, to be ready and organized when the time came — and ready we have been. While writing this now seems premature since we are truly in the midst of battle, it is still amazing to look back on the year that has been 2009.
The year started out with a bang as Congress passed the CHIP reauthorization package in January, the American Recovery and Reinvestment Act (better known as the “Stimulus”) in February, followed by the FY09 spending bill for HHS in March.
The CHIP Reauthorization bill, called CHIPRA, expanded the current program to cover 4 million new children and also established in law a mandatory payment mechanism for all Health Centers. The bill was signed into law by new President Barack Obama after several vetoes from former President George Bush. Starting October 1, states with separate CHIP programs will have to pay health centers based on their Medicaid PPS rate. The bill also contained $100 million for outreach, and several health centers and PCAs received a portion of these funds earlier this year! All in all, CHIPRA was a tremendous victory and one that started the year off on a very good foot.
From there, it was right into ARRA, which NACHC had been working to lay the groundwork for since the Obama Administration transition, The Stimulus package provided a record investment in Health Centers by adding $2 billion in direct funding through HRSA, and another $1 billion in HIT incentive payments through the Medicaid program. The first $500 million of operations funding enabled HRSA to fund 126 new access points and temporarily increase grants to every health center in the country in recognition of the increased demand for services health centers were facing as a result of the economic downturn. The remaining $1.5 billion in capital funding enabled HRSA to award grants to every health center for capital improvement projects and start a competition for larger facility investments, which were awarded in December. In effect, the $2 billion nearly doubled the funding available for the Health Centers program. The Health IT payments are scheduled to become available as part of the federal government’s larger HIT funding roll out, but they will be based on a formula that recognizes how many providers each health practice employs, with particularly strong payments for health centers. This could mean up to $1 billion in total for health centers in the very near future.
After battling for a regular funding increase throughout the previous year, and even in light of the passage of the Stimulus package, health centers were able to secure another $125 million funding increase in the FY09 Omnibus Appropriations package. Although it seemed like a small increase compared to the Stimulus, unlike that funding this was permanently made a part of our program’s base funding. The Omnibus Appropriations bill enabled HRSA to award permanent base grant adjustments to every health center to the tune of $56 million….the largest base grant adjustment ever. It also set a new record for annual funding for the Health Centers program at $2.19 billion.
Throughout the year, we were also working on our FY2010 annual appropriations request. This year, we’d asked for $2.602 billion, a significant increase, but one called for by our reauthorization. While we had the support of almost 200 Members of the House and 60 Senators on that request, both the House and Senate decided ultimately to follow the President’s request and level fund our program at approximately $2.2 billion, based largely on the stimulus investment. We voiced our concerns over this level funding, but made clear that we understand this is in the context of both stimulus and the health reform provisions related to growth (see below) .
Before the dust had even settled on the Stimulus and FY09 Appropriations, Congress marched right into Health Care Reform. Fortunately, we laid out our priorities early: participation and payment; growth (funding), capital and workforce. As a result of a strong plan, multiple grassroots pushes-both widespread and targeted, tremendous Hill champions, and lots of hard work, we were able to secure some key provisions related to each of our priorities in the House and Senate packages., The House and Senate had very different health center provisions, however, so the upcoming Conference will determine how successful we will be. The House established a Trust Fund that would provide $12 billion over 5 years for health center growth, and also $2 billion for the National Health Service Corps. The Senate included a mandatory reimbursement provision for health centers in the new exchanges and also a new payment mechanism for Medicare.
However, the landscape around health care reform changes very quickly. In the final move to pass the bill through the Senate, Senator Bernie Sanders convinced Majority Leader Reid to add $10 billion in direct funding for Health Centers and the NHSC. The manager’s amendment was accepted and the bill passed December 24th. The process is far from over, with the House and Senate needing to resolve their differences and pass a final agreement before anything can be signed into law by the President.
As health care reform progresses we will know how 2010 and maybe even beyond will fare for Health Centers. We are on the cusp of some historic developments, but success will require a true team effort. Hopefully 2009 was just a glimpse of what the future holds! Stay tuned.