Community health centers weigh closures nationwide

Unless Congress provides funding before the end of the year, many of the nation's 9,800 community health clinics will face service cuts or closure - potentially crippling a vital part of the health system that provides care in poor and underserved communities across every state.

And the fallout could mean the loss of more than 160,000 jobs and a hit to state economies of more than $15 billion as staff cutbacks and layoffs ripple through the country. California alone could lose up to 15,841 jobs and nearly $1.7 billion next year.

Iowa, which has 14 federally funded health centers, would experience a $28 million loss in funding, according to the National Association of Community Health Centers.

Congress' inaction on funding community health centers comes just as its Republican leadership and the Trump administration continue their attacks on the Affordable Care Act, which are expected to result in higher health care costs for states, fewer people insured and rising premiums for many of those who are.

'It's pretty rough out there right now,” said Jana Eubank, associate vice president of public policy and research for the National Association of Community Health Centers.

Across the country, the clinics serve 27 million people and, without the funding, as many as 2,800 clinics could close next year, leaving as many as nine million patients without access to regular health care, according to the U.S. Department of Health and Human Services.

In Iowa, about 184,500 patients - 45 percent who rely on Medicaid - are served across 14 health care organizations. In addition, 93 percent of these organizations' patients live 200 percent or below the federal poverty level.

The Eastern Iowa Health Center in Cedar Rapids receives $1.4 million from this fund - 11.6 percent of its overall budget for this fiscal year, Joe Lock, its president and chief executive officer, wrote in an email. It is used to help pay for patients that cannot afford care, and is a vital part of the safety net, he added.

The problem for health centers nationwide extends beyond the funding they are waiting for Congress to provide, though.

Congress also failed to reauthorize two related programs, the National Health Service Corps, which provides scholarships and loan repayment funds for medical providers who agree to practice in medically underserved areas, and Teaching Health Centers, which train medical residents to work as primary care physicians in those same areas.

The total for those programs amounts to about $370 million a year.

Half the 10,200 National Health Service Corps providers serve in community health clinics, according to the federal Health Resources and Services Administration, as do many graduates from teaching health centers. The losses would deprive community health clinics of providers in areas where it is already difficult to attract medical professionals.

Congress's failure to reauthorize the $14 billion-a-year Children's Health Insurance Program, known as CHIP and which finances medical care for nearly nine million poor children, threatens to punch another hole in the budgets of community health centers, where many of those children receive care.

According to the National Health Service Corps, patients in CHIP and Medicaid, the companion health care program for the poor, represent half the patients seen at community health centers. (CHIP provides coverage for children whose families earn a bit too much to qualify for Medicaid.)

According to projections from the Kaiser Family Foundation, Iowa is expected to exhaust its federal CHIP funds in March 2018.

'We need swift, firm, united action to prevent a children's health care crisis in Iowa,” State Sen. Boulton, D-Des Moines, a gubernatorial candidate and a board member of Healthy and Well Kids in Iowa (hawk-i), the children's health insurance program, said in an email Monday.

'It's this simple: If CHIP isn't reauthorized, 44,000 fewer children in our state will lose access to the high quality health care hawk-I provides.”