As Congress returns from the Thanksgiving holiday, they confront a list of complicated, controversial, and interconnected “must-pass” items that rival any legislative pileup seen in modern times. And squarely in the middle of that pileup sits the now long-overdue extension of funding for Community Health Centers and other key health priorities. While many of the details of the path forward remain unresolved, here’s what we know:

Without some action by December 8, the government will shut down.

The first date of major significance is December 8, when the current Continuing Resolution (CR) which has been funding the government on auto-pilot since the end of the fiscal year (back on October 1), is set to expire. Conventional wisdom has been that to buy more time to work out the details of a year-long spending package, Congress will likely pass a short-term CR on December 8th, which would kick the can for an additional two, possibly three, weeks. However, today the negotiations over a path forward to avert a shutdown got off to an inauspicious beginning, with confrontational tweets from President Trump followed by Democratic leaders pulling out of a long-scheduled meeting with the President in the afternoon.

A fix to the Health Center funding cliff is tied to passage of an extension of CHIP and other “health extenders.”

Just one of the many issues facing Congress in December is the need to extend funding (or, in certain cases, prevent scheduled cuts) to a number of popular, important health programs. Among these is the extension of the Children’s Health Insurance Program, or CHIP, which covers nearly 9 million children. Of most interest to health center advocates is the extension of the Community Health Centers Fund (CHCF), which accounts for more than 70% of federal grant funding for health centers, and which, like CHIP, expired on October 1. Without action to extend the fund this month, health centers will begin seeing restricted funds as soon as January 1st.

CHIP and the CHCF are the two biggest items (in dollar terms) on a much longer list of these so-called “health extenders.” That list includes other Health Resources and Services Administration (HRSA) programs like the National Health Service Corps and the Teaching Health Centers Graduate Medical Education program, extension of Medicaid Disproportionate Share Hospital funding for hospitals, funding for home-visiting programs and a slew of Medicare related items.  The House passed an extension of most of these items as part of H.R. 3922, the CHAMPIONING HEALTHY KIDS Act last montnh, though that vote broke down largely along party lines due to disagreement over how to pay for the extensions. That disagreement has led to inaction in the Senate, where 60 votes – and thus a more bipartisan consensus – are needed for passage.

The good news is that there’s progress in the overall negotiation over these health extenders. The Hill  reported on Monday that bipartisan, bicameral negotiations over the health extenders were making headway, and that it remains possible the package of multi-year extensions could ride along with the short-term CR on December 8. What is clear in either case is that the plan on both sides is for all of the health-related provisions to move together. The biggest question is when?

No one knows what the endgame looks like.

Beyond the primary issue of keeping the government open, beyond the more than a dozen “health extenders” mentioned above, Congress faces a raft of difficult questions and issues that must be resolved this month. All eyes this week are on the Senate debate over tax reform, which – while it does not face a hard deadline – conventional wisdom suggests will be much harder to pass next year as the midterm elections approach. Non-health, non-tax issues, from immigration to flood insurance to surveillance authority to disaster relief, all are yet to be debated or decided. The federal debt ceiling must be raised.

The lack of clarity surrounding how all of these issues will be resolved only leads to one conclusion when it comes to health center funding: the earlier we can get this resolved, the better. That means, for starters, pushing for consideration alongside a short-term CR next week. Most importantly, health centers should stay engaged with their congressional offices, letting them know of the specific negative effects that the uncertainty is causing — and to push for the swiftest resolution possible in the coming days.