As every health center director, staff member, board member and advocate knows well, the Community Health Centers Fund (CHCF), which accounts for more than 70% of all federal grant funding to America’s 1,400+ health center organizations, expired on October 1st. While each health center has until the beginning of their next budget period before the direct impact on grant funding is felt, we know that the uncertainty surrounding future funding is already causing major disruptions in health center operations and care.
With the October 1 deadline having passed, last week we saw Congress take a step forward toward an eventual cliff fix. On Wednesday in the House, the Energy and Commerce Committee, which has jurisdiction over the Health Centers program, held a markup (basically a hearing on a specific bill, with debate, amendments, etc.) on legislation that would extend the CHCF and other important programs. Advocates interested in seeing the legislative process in action can watch the full markup (over 10 hours long) on the Energy and Commerce Committee website.
The Committee considered one bill with extensions of Children’s Health Insurance Program (CHIP) funding (the HEALTHY KIDS Act) and one (the CHAMPION Act) focused on health centers, the National Health Service Corps (NHSC), Teaching Health Centers Graduate Medical Education (THCGME) and other related programs.
The CHAMPION Act contains:
- a two-year extension for health center funding, at current funding levels ($3.6 billion annually);
- a two-year extension for NHSC funding, at current levels ($310 million annually);
- a two-year extension for THCGME, with upward adjustments in THCGME funding to ensure adequate program support ($126.5 million annually);
- and policy-related tweaks to Section 330, the governing statute for the Health Centers Program, related to clarifying HRSA authority around certain types of grants. NACHC worked collaboratively with Committee staff around drafting of this language, and we support its inclusion.
The provisions listed above are all uncontroversial – however, the markup was divided along partisan lines, with Committee Democrats ultimately voting no on both measures, because of disagreement over how the extensions are paid for.
The CHAMPION Act is “offset” (or paid for) with reductions in future funding for the Prevention and Public Health Fund, which currently comprises about 12% of the budget of the Centers for Disease Control and Prevention, as well as with a change to the “grace period” during which Qualified Health Plan enrollees can stay enrolled without paying premiums.
The CHIP extension is paid for with tweaks to Medicaid third-party liability, a long-sought Republican bill around Medicaid payments to lottery winners, and by increasing Medicare cost-sharing (to 100% of premium costs) for the wealthiest Medicare beneficiaries – those with incomes above $500,000/year.
While the bill that passed out of Committee brought a partisan vote, our understanding is that bipartisan negotiations are continuing over the offset provisions, with the goal of achieving a consensus result. Both Committee Chairman Greg Walden (R-OR) and Ranking Democratic Member Frank Pallone (D-NJ) have issued statements calling for – and expressing openness to – ongoing bipartisan negotiations.
The best possible outcome in the House is a bipartisan package that reflects the longstanding bipartisan support for the program. This is especially true because of the fact that any package that passes into law will require 60 votes – and thus bipartisan support – in the Senate.
The Senate is out this week, and the House next week, so the earliest date at which we can expect a vote on a cliff fix is by the end of the month.
Even amidst these negotiations, we continue to focus our advocacy requests of individual member offices on the CHIME Act (S.1899/H.R. 3770), which is bipartisan legislation that sends an important message about our ideal result: a long-term fix with increases in funding.
While the CHIME Act is not the specific proposal that was considered in Committee, it remains our best way to demonstrate strong bipartisan support for a long-term fix in both chambers. If you have members who have not co-sponsored CHIME, please continue to request that they do so.
Without question, each of the steps that Congress has taken toward a meaningful cliff fix is a direct result of the persistent work done by Health Center Advocates. The massive outpouring of advocacy throughout the month of September is what led to 70 co-signers on the Blunt-Stabenow Health Center Cliff letter in the Senate, the introduction of the CHIME Act in both the House and Senate, and the growing list of co-sponsors on respective bills. These steps, along with the committee markup and continued effort on the part of Congress to work toward a cliff, demonstrates the power, effectiveness, and importance of advocacy.
As Congress continues to weigh options for the size and scope of a cliff fix, the need for continued advocacy in volume and intensity is critical. Advocates can and should be in ongoing contact with their Members of Congress to request that they co-sign the CHIME Act and to continue to push for immediate action to fix the cliff. Part of the advocacy message must also be to share the very real and immediate impact of the cliff today – having passed the October 1st deadline. Advocates interested in contacting their Members of Congress via the Health Center Advocacy Network can do so quickly and easily by visiting www.hcadvocacy.org/takeaction. A number of resources to assist with advocacy efforts and to demonstrate today’s immediate cliff impact are also available at www.hcadvocacy.org/makethecase.