Health Center Federal Policy

The Difference Between Discretionary Appropriations and Direct Appropriations: It’s a Big Deal

By Krystal E. Knight, MPH

Wait…health centers are getting $34 billion in health care reform?

Well, that’s what you might be asking if you were reading the news last week.

The Congressional Budget Office (CBO) released an updated analysis of the health reform law—the Patient Protection and Affordable Care Act (PPACA). The new analysis covers an additional $115 in discretionary spending not previously scored. This figure includes between $10 and $20 billion in administrative costs to federal agencies implementing PPACA, $39 billion for the Indian Health Service, and $34 billion for community health centers.

PPACA permanently authorizes the Health Centers program, which means it will never expire. When writing that new authorization, Congress also authorized specific funding levels for the program for each of fiscal years 2010-2015. Those authorized levels total $34 billion. Authorized, discretionary funding, such as the $34 billion present in the Health Centers program reauthorization, is not guaranteed money. Appropriations committees make the final decision regarding how much money an authorized program, like the Health Centers program, actually receives.

The health reform legislation also creates the Community Health Center Fund. The fund includes $9.5 billion in operations funding and $1.5 billion in capital, which is $11 billion in total direct appropriations from FY 2011 through FY 2015. This is currently the only funding directly appropriated (read: real money) to health centers in health reform. Health centers are authorized to receive $3.86 billion in FY 2011, but again, this is not real money. In reality, there will be $1 billion available to health centers in FY 2011 from the Community Health Center Fund, in addition to regular appropriated funding, which was $2.19 billion in FY 2010. Health centers are urging Congress to keep our discretionary funding at least at that FY2010 level of $2.19 billion, meaning there would be a total of $3.19 billion in total Health Centers program funding for FY2011, which is below the authorized level. In subsequent years, the gap between what health centers can reasonably expect to receive (based on the Health Center trust fund and discretionary appropriations) and the authorized levels will be even larger. For this reason, the CBO report is somewhat misleading.

As for now, NACHC will continue to work hard to ensure that the Health Centers program is funded at least at the FY 2010 level of $2.19 billion. In order to realize the full intent of the Community Health Center Fund—to reach 20 million new health center patients at the end of the next five years, doubling the program to 40 million medically underserved Americans—the program needs to stay at least at the current appropriated funding levels. Many of you have already been in contact with your Members on the various Appropriations Committees in Congress, and we thank you for your support. Stay tuned for more contacts on this front from NACHC’s grassroots advocacy team.