By Rose Hoban
With Congress’ recent failure to repeal and/or replace the Affordable Care Act, many health care providers feel that they have enough certainty to plan for the coming year.
But the leaders of North Carolina’s community health centers say they’re still not able to relax because they’re staring down a budgetary hole that Congress still needs to fix.
If nothing happens before Sept. 30, community health centers will see a 70 percent cut to the federal grants that keep the clinics going.
For Carrboro-based Piedmont Health, the total that’s at risk is close to $6 million for the coming fiscal year, out of a total operating budget of about $52 million.
“For us, that would be approximately 11 percent of our operating budget,” said Brian Toomey, the CEO of Piedmont Health, which operates 10 clinics and two PACE sites that serve low-income seniors. “We have an operating margin of 1 percent that means we’re 10 percent in the hole.”
Leaders like Toomey are calling this cut to funding a “budget cliff,” and they’re pushing Congressional leaders to find the time, and the focus, to address it.
But a solution requires Congress to do one of two things: either pass a separate bill that fixes the problem or do something Congress hasn’t done in close to a decade – pass a budget.
End of the lifeline
Community health centers grew out of the social movements of the 1960s, when physicians saw a need for health care centers in poor communities that were not government-run clinics.
In North Carolina, 41 organizations with 220 clinics across the state served about a half million people last year, according to the website of the North Carolina Community Health Center Association. According to association statistics, about 43 percent of those patients were uninsured and fewer than one-in-five had private insurance.
Over the years, the centers have enjoyed bipartisan support. President George W. Bush doubled funding to community health centers during his time in office. Under the Affordable Care Act, the centers were an integral part in the plan to expand access to care.
“When the Affordable Care Act was first crafted, it was assumed that Medicaid expansion would be part of every state program,” explained Ben Money, who heads the North Carolina Community Health Center Association. “More people would be insured, less people would be uninsured, the increased access would be available to them to utilize their Medicaid at a community health center.”
Since passage of the ACA, Money said 14 more community health centers have been established in North Carolina, serving an additional 50,000 patients per year. Other, more established clinics opened new sites and extended hours.
But to Money’s frustration, the community health centers got caught up in the bitter partisan politics of the law. And over the past seven years, as Congress has withheld funding that was needed for the ACA to function, the community health centers were caught in the middle.
Hence the fiscal cliff.
To throw the centers a lifeline, Congress added community health center funding into a 2015 bill that fixed reimbursement rates for doctors who take Medicare. But that lifeline runs out at the end of this federal fiscal year on Sept. 30.
And what frustrates both Toomey and Money is that the centers are so much more efficient at seeing patients and stewarding public funds. Toomey said he’s able to treat one of Piedmont’s 42,000 patients for an annual cost per patient of about $1,250.
That’s less than the cost of one emergency room visit.
On a busy afternoon, Abigail DeVries, the medical director of Piedmont Health, has three third-year medical students from UNC’s School of Medicine helping her see patients in the Carrboro Clinic.
DeVries has spent her entire primary care career working in community health centers, first in upstate New York and then in North Carolina. Having the students around gives them a taste of this kind of medicine, and something of an inducement.
“Most of the time people apply to work here because they want to work in a place like this because of the mission,” DeVries said. “They’re usually convinced and they’re kind of deciding between a couple of the health centers, but sometimes they’re deciding between us and a position at UNC.”
One of the other inducements to work in a center is the fact that a new doctor – or nurse practitioner, physician assistant or dentist – can work off any federally guaranteed students loans. That’s what DeVries did.
But that’s part of the fiscal cliff too. Money supporting Public Health Service Corps placements to clinics treating the underserved is also slated to go away on Sept. 30, barring Congressional action.
“Which would also be devastating,” she said. Currently, Piedmont Health has 15 such providers receiving loan repayment across the organization’s 12 facilities that stretch from southeastern Chatham County to a clinic in the Caswell County community of Prospect Hill, Piedmont’s original site.
“The recruitment issue and the fiscal impact on our bottom line makes me quake a little bit,” DeVries said. “That’s money that allows us to see people who otherwise would end up in the emergency room.”