By Liora Engel-Smith
Across North Carolina, community health centers are contending with what has become an unpleasant tradition: planning for a potential federal funding lapse.
The nation’s safety net clinics — 250 of which are in North Carolina — serve thousands of uninsured and underinsured patients and enjoy bipartisan support. But a battle between Congress and President Donald Trump over funding a border wall at the U.S.-Mexico border has stalled the passage of a full federal budget, which includes funding for community health centers.
The federal budget nearly lapsed twice this year — in September and in November — but two stopgap bills kept the government open and guaranteed short-term funding for community health centers. Without a new budget or a resolution to extend current spending, federal funding to health centers will lapse a few days before Christmas.
Community health center advocates from across the state say that Congress’ reliance on short-term spending bills and the specter of a funding lapse has created uncertainty that could hurt services to patients, many of whom are low-income.
“A five-year plan is short-term, a two-year plan is minuscule,” said Leslie Wolcott, a spokeswoman for the North Carolina Community Health Center Association.
“It’s like nothing, and here we are with three weeks of funding at a time.”
At issue is the federal Community Health Center Fund, which provides the bulk of federal funding to almost 1,400 health centers across the U.S. In the 2019 federal fiscal year, that fund had $4 billion, according to the National Association of Community Health Centers. In North Carolina, the loss of those funds could translate to community health centers losing almost half of their patients collectively, and a loss of almost 1,500 full-time jobs, a recent state-by-state analysis by the association said.
Even without the economic impact, the continued viability of health centers is important in the Tar Heel state, where the uninsured rate is 9th highest in the nation, Wolcott noted. With community health centers serving many of these low-income people funding instability makes an already difficult job even harder.
“It always keeps us somewhat tentative about making decisions long-term about where [our] funding priorities are because you want to make sure that you have enough money to pay for staff and pay for the services that our patients need,” said Reuben C. Blackwell IV, who heads OIC of Rocky Mount, a community health center in the eastern part of the state.
Located in Edgecombe County, which according to the N.C. Department of Commerce is the most economically distressed county in the state, OIC of Rocky Mount serves people with significant unmet medical needs. A more stable funding environment would allow OIC to expand its services to other critical areas, such as pediatrics, Blackwell said.
Blackwell said he’s had to consider contingencies if funding does lapse. OIC has roughly 150 employees, and though OIC managed to avoid staffing cuts when federal funding lapsed in 2017, Blackwell said he may have to make difficult choices ahead.
“We have to have plans in the event that money doesn’t come, who won’t have a job,” he said. “Or who would have less pay or how will we absorb this impact within the organization.”
‘The system would implode’
Community Health Centers have been here before. In 2017, Congress failed to reach a budget agreement and funding lapsed for five months before it was extended for two years. Back then, health centers resorted to closing clinic sites, laying off staff and reducing services to deal with the delay. A September survey from the Kaiser Family Foundation found that health centers across the country are already considering similar measures.
“I keep saying to anyone that will listen, ‘How does that make sense in the safety net environment?’ Because the larger health systems count on us. If we weren’t there … the system would implode,” said Kim Schwartz, CEO of Roanoke Chowan Community Health Center, which serves several counties in Eastern North Carolina.
Schwartz said the funding uncertainty has slowed the growth of the health center, which already serves 25,000 patients. Stable funding could mean opening two or three new sites in underserved areas, she said.
Part of her organization’s long-term plan, she said, is to reduce its dependency on federal funding by finding additional sources of income. The federal grant, she said, makes up about 20 percent of the Roanoke Chowan’s budget.
“So that means that [if funding lapsed] we would have to reduce everything by about 20 percent, she added. “So reduce our access to care, reduce our workforce if we don’t have that 20 percent to cover [these expenses].”
A path forward?
There are signs that longer-term funding for community health centers is on the horizon. Key leaders of U.S. Senate Committee on Health, Education, Labor and Pensions, and the U.S. House Committee on Energy and Commerce have reached an agreement to extend funding for community health centers for five years as part of a larger proposal that deals with surprise medical bills, according to a statement from the National Association of Community Health Centers.
Though the proposal has bipartisan support, there is still no guarantee it’ll pass and be signed by the president before the December deadline.
Christopher Vann, spokesman from CommWell Health, a community health center with clinics in Sampson, Bladen, Brunswick, Johnston and Pender Counties, worried that the impeachment proceedings in Congress may delay the passage of the proposal.
“[E]verything hinges on the passage of the Continuing Resolution by 12/20,” he wrote in an email.