Health Center Federal Policy

Four Questions For Every Health Center Advocate

NACHC’s Federal Affairs team has been pounding the pavement (really, the marble floors) of the House and Senate office buildings since Congress reconvened in January, conveying the impact and urgency of the Primary Care Funding Cliff to Members of Congress and their staff. With a 70% cut to Health Centers looming this fall (not to mention elimination of the National Health Service Corps and Teaching Health Centers), the issue has been and will be priority one until it’s fixed.

But in an environment like this – with tight budgets, political polarization, a very crowded agenda and limited legislative vehicles to carry any solution to final passage – our advocacy needs to be clear, direct, and overwhelmingly loud and persistent if we have any hope of breaking through. As Health Center advocates, we’ve all done a lot so far to raise the profile of this issue and push for a solution. I’m sorry to say, it isn’t nearly enough.

The reaction from many Congressional staff to our direct appeals for a path forward on fixing the cliff is troubling. We are seeing a lack of urgency, despite the deadline being just seven months away. We are seeing other issues much higher on the priority list. Most worryingly, we hear from many – even most – Members and staff that they just aren’t hearing from back home about this. In every meeting, they hear from us what the national impact of the cliff would be. But what they really want to know is what does this mean for my district.

In just over two weeks, nearly 2,500 health center advocates will descend on Washington for the 2015 Policy and Issues Forum and will head to Capitol Hill to speak with one voice about the need to sustain what has been gained over 50 years and fix the funding cliff. Between now and then, every health center advocate should ask himself or herself 4 questions. When every advocate in the country can answer YES to all four of these questions, fixing the cliff will be a priority for Congress. If you’re coming to the P&I, taking action on these items now will make your meeting far more productive. Even if you’re not coming, this is the time for action. Here they are:

1. Have I calculated the impact of the Primary Care Funding Cliff on my Health Center in specific terms?
In other words, what would a 70% cut to grant funding mean in terms of: patients who would lose access, sites (which sites) you would have to close, layoff decisions you would have to make, programs you would have to cancel, dollars lost from your budget. We have a useful tool, the Funding Cliff Estimator, that can be found on the NACHC Primary Care Cliff Resource Library. This gives a good start. But every advocate needs a specific, detailed description of what this level of cut would mean for your Health Center.

2. Have I conveyed that specific information to each of my Members of Congress and their staff?
You may have spoken with a Member of Congress or their staff about the cliff, even told them it would be devastating, or that you need their support. This is important, but it’s not enough. They need to hear from you, from your perspective as either a CEO, board member, clinician, staff member, or patient, what the specific figures from Question #1 are and what specific impact that level of cut would have. We’ve watched Members from across the political spectrum come to understand the seriousness of this issue in the last few months, but it almost never happens until it’s been conveyed directly from a constituent in specific, local terms.

3. Do I know where my member stands?
Health Centers enjoy a general, broad support in Congress, the direct result of both hard work on the ground and strong advocacy for many years. But again – this year, general support won’t be good enough. Once you’ve articulated the information (#1 above) and conveyed it directly to your Members and their staff (#2 above), you need to ask where they stand on fixing the cliff. We’ll have ways for them to show that support publicly, which will be rolled out for the P&I. But make sure you don’t to all the work of gathering the information and educating your Member, only to hold back on pressing them for a strong, specific commitment of support.

4. Does my member (and his/her staff) know who stands with me?
The Access is the Answer Campaign, now in its third phase, has had one goal since the beginning: rally a chorus of support to convey to Members of Congress the need to fix the funding cliff. Health Centers are strong advocates – when we walk into a meeting, we are listened to and respected. But, when our message is amplified by Mayors, City Council Members, Governors, State legislators, hospital presidents, foundation partners, financial institutions, not to mention our own boards, staff, and patients, it becomes much harder for any Member of Congress to say no.

Last week, Secretary of Health and Human Services Sylvia Mathews Burwell testified before Congress that the funding cliff would mean a loss of access for 7 million patients, cost 40,000 jobs and mean closure of some 2,000 Health Center sites. The national numbers are out there now, and they are staggering. But take our word for it – it’s the local numbers that count.

There’s no reason to go into these conversations unprepared. Many, many resources, including new Congressional District Fact Sheets and maps, the Funding Cliff Estimator, recent news articles on the cliff, one-pagers, talking points, FAQs and charts are available at to help advocates make the case. The time is now. Start with the questions above, and don’t ever hesitate to contact us for advice or with questions or ideas. We hope to see you in a few short weeks. Let’s make it count.