Health Center Federal Policy, Health Center News, Health Center State Policy

The 2014 Midterm Elections: Implications for Health Centers

by NACHC Federal Affairs and Advocacy staff

What Happened?

Tuesday’s elections saw a sweeping victory for the Republican Party in Congressional races across the country, and will return the GOP to the majority in the United States Senate. Republicans will hold at least 53 seats in the Senate (a gain of 8), with the election in Louisiana headed to a runoff that will take place in December. In the House, the GOP also gained 13 seats and now holds a 243-179 majority.

What does this mean for Health Centers?

By far the biggest challenge Health Centers face in the year ahead is the Primary Care funding cliff – the very real threat of Health Center grants being reduced by up to 70% at the end of September, along with the expiration of the National Health Service Corps and Teaching Health Centers programs. This election result doesn’t change that issue. Health Centers will need to continue advocating loudly, and demonstrating the impact of the cut to their Members, on both sides of the aisle.

Congress needs to act in order to fix this problem, which affects every single health center, and while our strategy to educate members – and substantially raise the profile of the issue – has been effective (through bipartisan Congressional sign-on letters, Health Center Week events, a national groups letter, a national email campaign, national, state and local media, op-eds, letters to the editor, etc.), so far Congress has not taken action to fix it.

The agenda for the new Congress is being set as we speak, and the opportunities to move a piece of legislation that fixes the cliff will be limited and challenging. Every health center faces this cut – and thus every health center MUST have a role in ensuring it gets addressed.

What are the Biggest Challenges and Opportunities as We Work to Fix the Cliff?

Challenge: Price Tag Fixing the health center funding cliff requires Congress to spend billions of dollars, and that’s just to keep us where we are today. NACHC and health centers across the country have been advocating for a multi-year fix in order to address the uncertainty caused by the cliff, but this makes the price tag even higher. With Republican control of House and Senate, there will be stronger pressure to balance the budget – even as we’re advocating for Congress to deliver resources to address our shortfall, they will be looking for ways to reduce and tighten spending.

Opportunity: Demonstrate our Value Health centers are better positioned today than ever to plainly demonstrate why investing in us is a net positive for the health care system. We have hard data on the cost-savings and economic impact we generate in our communities, and have shown that we lead the way on high-quality preventive care. Every member should understand clearly what their local health center means in terms of preventing chronic disease and emergency room visits, how many people we employ and the vital economic role we play in the community. Each health center must communicate what a cut would mean not just in terms of closed sites, lost jobs and patients losing access, but in terms of leading to a costlier, less efficient health care system. NACHC has an estimator tool to help you start generate these figures.

Challenge: Association with the ACA The ACA remains a divisive issue, and given the origin of the Health Center Fund, some members have come to view Health Centers as an “ACA program.” That doesn’t mean they don’t support us, but it adds another layer of complexity when talking about this specific issue. It’s important that health centers always advocate first and foremost from a place of representing our patients, communities, and organizations.

Opportunity: A 50-year history of bipartisan support Many newer members of Congress and their staffs may not be aware that health centers were around before the ACA, or that we were championed by President Bush (as well as candidates like John McCain) as a centerpiece of their health care policy. Earlier this year, with help from health center advocates across the country and Congressional Champions on both sides of the aisle, bipartisan majorities in both the House and Senate signed letters calling for action to fix the cliff, and earlier this month, more than 100 national groups joined in with the same message. With our 50th anniversary on the horizon, we have a major opportunity to educate and remind members that supporting health centers has never been a partisan issue.

Challenge: Getting on – and to the top of – a crowded agenda

Our best shot at fixing the Primary Care Cliff is if Congress and the Administration consider averting these cuts to be a “must-do” item – in other words, if the consequences of allowing it to go forward are understood to be so dire back home that Congress feels compelled to act. That said, there are a number of other “must-do” items on Congress’ plate. There will be pressure to reduce the deficit even as these items are dealt with, and a broad range of stakeholders will be going after what, in the end, is a limited pool of resources.

Opportunity: Be Louder and More Effective Advocates Than Anyone Else!

What should I do?

Ultimately we need every newly elected (and re-elected) Member of Congress to arrive in Washington a Health Center Champion – fully aware of the invaluable role Health Centers play in the community and to the health care system overall, up to speed on what is at stake relative to the Funding Cliff, and committed to take swift action to fix the cliff upon arriving in DC.

The three current action steps as part of Phase II of the Access is the Answer Campaign – (local support letter collection, local media placement, new Member education)  – are critical advocacy building blocks necessary to lay a solid foundation for Congressional action to fix the cliff. For Congress and the President to be convinced to act to fix the cliff there needs to be an outpouring of support and voices from back home demanding that the cliff be made a priority.

When it comes to Health Center advocacy and education, there is simply nothing more valuable or effective than showcasing the health center model in action, on the ground, locally. Every health center should make it a priority to host your Member of Congress for a site visit in the coming weeks and months. The goal for these visits should be three-fold:

  1. to showcase the invaluable role of Health Centers locally and nationally;
  2. to educate about the Funding Cliff, what it would mean to your organization, your patients and your community, and convey the urgent need for Congress to act to fix it now;
  3. to cultivate a relationship with new elected officials (and deepen that relationship with existing ones) wherein you serve as a resource and a trusted voice within the community.

Where do I go for more info?

NACHC has brought together a wealth of background info, resources and advocacy tools at the Campaign for America’s Health Centers website,, and has additional talking points on the cliff on the NACHC site at Our policy staff and grassroots advocacy staff are available any time to answer questions, share intelligence, give advocacy pointers, and coordinate and support your efforts. No amount of information you gather in conversations with your Members and their offices is too small to share – we are always on the lookout for new leads and potential health center champions in Congress.