By Craig A. Kennedy, MPH

 We are definitely entering the stretch run for health care reform for this year (really we are this time!) and, perhaps, for many years to come.  As someone who sits in the middle of the arena, my read is that reform is either going to pass in the next month or two (probably shortly after the Easter break), or it will not pass this year.  With that in mind, there are a lot of groups working harder than ever to keep the momentum moving forward and to get reform passed (see the FamiliesUSA letters, among others).  NACHC has signed onto a variety of letters supporting reform, and we have endorsed both the House and Senate bills because they meet our principles for reform.  However, new legislation is being written right now that may have a tremendous impact on the health center-specific provisions we have worked so hard to get included.  We are working with leaders in Congress and the Administration to preserve the health center priorities in the Senate-passed legislation (see my previous post), while also understanding that the big test will be navigating the process and winning votes in the House.

All indications are that the path forward is for the House to pass the Senate-passed health care reform bill as is, followed by a “fix” bill using the budget reconciliation process. This process limits the ability to “fix” some provisions, but perhaps the trickiest step is that the House would have to send the Senate bill to the President before the “fix” bill is completed by the Senate.  Many House Members see this process as a huge risk since they may have to agree to move forward a Senate bill they are not enthusiastic about while waiting for the “fixes” to that bill to come later via the reconciliation process.

From the health center perspective, regular readers will remember that both the House and Senate bills had different strengths for health centers.  The House bill contained higher guaranteed funding for health centers in its trust fund as well as higher Medicaid eligibility thresholds, and more generous subsidies for low income families looking to buy private insurance.  The Senate also had strengths in addition to its own Health Center Trust Fund, including the “Menendez” PPS amendment which would guarantee health centers their Medicaid PPS rate under the new private health insurance exchanges.  However, it has become clear that in the view of Congressional leaders, the only way to enact comprehensive health reform this year is to move forward with the process above: passing the Senate bill and then a reconciliation bill “fix”.

NACHC remains optimistic that leaders will find a way to pass the Senate bill, which we will continue to support because it is a good bill for health centers, and a “fix” bill that improves the legislation and doesn’t undermine key health center provisions.  In fact, the President himself indicated that he would use a “fix bill” to improve the Senate bill for health centers by expanding the Health Center Trust Fund even beyond the Senate’s proposal. 

As Congress works behind closed doors to fashion a reconciliation “fix” bill, NACHC is continuing to advocate for our provisions. Once we see the “fix” bill and ensure that it, in fact, does make improvements to the Senate bill for health centers and for low-income communities, or at the very least doesn’t undermine the provisions we have worked for, you can be sure that we will undertake a full-scale grassroots efforts to push in every way we can to get House and Senate members to support it.  That’s where health center advocates come in because it will be your pushing that will actually win the support we need.

There is still a lot happening on health reform, and there is still a lot of work ahead of us all to make it a reality.  We at NACHC are working to promote health reform legislation, and you can be sure we will be asking every health center advocate to help as much as possible when the time comes.  So, stay up to date by reading the Washington Update and our blogs, and be ready to act soon.