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Community Health Center fears ?fiscal cliff'

The Sonoma Index-Tribune - 9/13/2017

The Sonoma Valley Community Health Center dodged a bullet last week, when President Trump struck a bargain with Democrats Nancy Pelosi and Chuck Schumer to temporarily raise the nation's debt ceiling, effectively avoiding a government shutdown Oct. 1.

Had the shutdown occurred, SVCHC would have been forced to navigate its October expenses with a budget 70 percent smaller than the one it had in September. Overnight, it ? and nearly 10,000 community health centers like it across the country ? would have fallen off the "health center funding cliff," and the thousands of local clients who rely on SVCHC for their primary, prenatal, dental and behavioral health services would have found restricted access to the quality care they have come to expect.

Described by CEO Cheryl Johnson as a "medical office on steroids," SVCHC treats 150 to 175 people each day. Sixty-six percent of the center's clients carry some form of insurance, much of it Obama-era Affordable Care Act (ACA) coverage; the remaining 34 percent are seen on a sliding scale if they're willing to complete required government paperwork, a prerequisite many undocumented SVCHC patrons feel newly reluctant to do. "We send the information required by the federal government to the state to process, and we don't know what they do with it. That's where the disconnect is," Johnson said of her patients' reticence.

Conceived of and originally funded as part of Lyndon John-son's War on Poverty, community health centers have been serving an underserved sector of the population for decades. But it was a Republican President who cemented the model into the healthcare landscape. "People forget, or probably didn't know, that it was George.W. Bush who really propelled community health centers forward," Johnson said.

According to Johnson, President Trump's budget calls for an $89 billion increase of community health center funds, but that budget requires that the federal debt ceiling be raised before its adoption, a legislative feat that is far from a certainty. Friday's temporary suspension of the debt ceiling expires in December, and was passed over the objections of 90 congressional Republicans. In spite of the reprieve, the "health care cliff" still looms ahead. "Most years, we would feel more confident, but this hasn't been most years. Legislation hasn't been moving well in 2017," Johnson said.

Nationwide, the Health Center network cares for 27 million patients annually. In Sonoma, some 6,900 patients make 37,000 visits to SVCHC every year. If funding does indeed drop off the fiscal cliff, SVCHC will see an immediate $1 million reduction to its budget.

"If the perfect storm happens, and the Affordable Care Act is repealed, too, we're looking at a $2 million hit," Johnson said.

Community health centers have been incubators for best practices in the medical field since their inception, according to Johnson.

"A lot of the things that are being rolled out into private practice actually originated in Community Health Centers, like chronic disease management and a focus on quality. The government kind of uses us like a testing ground," Johnson said.

"(We are) the canary in the coal mine," Johnson said. "Trends appear here before they go into the general community. Right now, for example, diabetes is predicted to affect 50 percent of the population soon. Because of Community Health Centers, we knew that in the 1990s."

This summer, SVCHC received four awards for quality. "Last year, we had 78 percent of our diabetics under control. And 68 percent of our hypertensives," Johnson said.

The Community Health Center mission has historically enjoyed bi-partisan support, and currently, Senators Debbie Stabenow (D-MI) and Roy Blunt (R-MO) are jointly sponsoring a health care bill that includes continued protection.

But Johnson believes that 2017's unique political climate requires increased citizen participation, and is asking the public to let its representatives know that democratized health care is a community value.

"We feel that people are going to have to advocate for themselves more than ever before," Johnson said. "This fiscal cliff is coming, and we're asking people to create volume in terms of the number of times people contact their representatives in D.C. It's both the message and the number of times its delivered."

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