The following manuscript was published as part of the February 2018 Social Medicine theme issue.
Just like many Americans, Teresa is a busy mother-of-two with a lot on her plate. Enrolled in nursing school by night after her shifts working full-time as a medical assistant, she barely has enough energy to help her children with their homework before starting on her own.
When her four-year-old daughter fell ill with the flu, she was grateful that the Child Health Insurance Coverage (CHIP) their family relies on was recently reauthorized in January after four months of funding limbo.
With her tightly-bundled and still-sniffling daughter in tow, Teresa arrives to her local community health center for a same-day appointment with her primary care physician. A fixture of her low-income neighborhood, this worried mother and many of her neighbors trust the health center to provide affordable patient-centered primary care, behavioral health, dental care, pharmacy, and health education resources when they need it most.
But today is very different. On arrival to the clinic, she finds the lights off and the doors closed permanently. Due to months of inaction by Congress since failing to meet its September 30 reauthorization deadline, this scene is not just hypothetical. It a nightmare of a reality that is playing out across the nation.
While Congress delays, a bipartisan-supported backbone of the American health care system is running on life support.
Serving as the primary medical home for 1 in 13 Americans in over 1,200 urban and rural clinics in every state and US territory, community health centers (CHCs) are at risk of losing $3.6 billion dollars or approximately 70% of their yearly funding sources.
While there are many priorities vying for attention of budgeting decisions in Washington, it is shocking to allow the death of a program proven to provide better care at lower cost.
Due to this unprecedented level of financial uncertainty, up to 1 in 4 community health centers across the country could have their doors shut for good. Forced to turn patients away, patients like Teresa and her daughter, whether they live in Massachusetts, Nebraska, Colorado or Arizona, will soon find that they have nowhere else to turn.
According to the National Association of Community Health Centers, clinics nationwide are already making painful cuts. A reported 72% of CHCs have instituted a hiring freeze, 41% will lay off staff, and 47% will reduce staff hours or hours of operation.
Not only vital to the physical health of their communities, CHCs are economic engines as well. A Recent study by the George Washington University’s Milken Institute School of Public Health estimates that without long-term funding, as many as 161,000 jobs would be eliminated and state economies could lose upwards of $15 billion dollars in revenue.
Community health centers provide crucial access to primary care for millions of Americans, promote health prevention that keeps people out of emergency rooms and prevent hospitalizations, and have been unequivocally shown to improve the health and economic vitality of their communities.
The medical community and lawmakers on both sides of the aisle support funding community health centers. There have been repeated efforts urging Congress to fix the funding cliff without success originating from America’s Essential Hospitals, the American Academy of Family Physicians, American College of Physicians, American Nurses Association, and the March of Dimes.
Even pleas from over 150 Republican and Democratic members of the House of Representatives as well as the National Governors Association have not resulted in restored funding to prevent “jeopardizing health access and jobs in struggling communities” in all 50 states and US territories.
On February 8, temporary funding for community health centers, the Teaching Health Center Graduate Medical Education Program, National Health Service Corps, and many other vital programs will once again run out for the third time in six months.
Uncertainty of sustainable funding has already caused closures of primary care training sites at community health centers in Detroit, MI, Tulsa, OK, and Memphis, TN, effectively cutting off communities from their future doctors for generations to come.
The health of America is on red alert, and may soon become a code blue due to the very real danger of loss of long-term funding for community health centers.
Show your support, and implore your elected officials to #FixTheCliff and #ValueCHCs today by supporting community health center funding. The health of the nation depends on it.
Resident Physician Contributing Writer
Melissa Palma is an Iowa-raised daughter of Filipino immigrants and aesculapian advocate. She trained in family medicine at safety-net community health centers and is a board-certified Preventive Medicine and Public Health physician in Chicago, IL. Her writing reflects on the privileges and responsibilities we have as physicians to advance health equity for our patients and our communities. When not in clinic, you can find her reading non-fiction while nursing a taro boba tea.