Supporters rally for health center funding

Backers of Havre's Bullhook Community Health Center and health care advocates throughout the country Tuesday rallied in support of community health centers and a legislative fix to keep them from losing 70 percent of their federal grant funding.

The effort was part of a Day of Demonstration: #RedAlert4CHCs, an effort by community health centers and their supporters to raise awareness about the work the health centers do and the need to get Congress to restore a crucial stream of funding that expired in September.

Bullhook CEO Cindy Smith said as part of the Day of Demonstration, people were encouraged to wear red, use the hashtag #RedAlert4CHCs on social media, and have their picture taken at Bullhook to post on the Center's Facebook page. People were also offered informational flyers and urged to contact their congressional representatives and urge them to restore their funding.

"Right now, keeping our doors open is our number one priority," Smith said. "We think it's pretty important to keep going what we have going, especially for the 5,000 patients we serve and the 70 people we have employed."

All three members of Montana's congressional delegation have called for a long-term renewal of funding.

Sens. Jon Tester, a Democrat and Steve Daines, a Republican and Rep. Greg Gianforte, R-Mont., have voted to fund centers in the past, and have all recently signed letters to leadership in the House and Senate calling for a long-term renewal of funding.

The three spoke along with a bi-partisan group of other lawmakers and health advocates at a press conference Tuesday in Washington, D.C.

"With 17 community health centers in Montana, they are vital to providing health care to thousands of Montanans," Daines said in a press release after the press conference. "Health care is a priority for Montanans, and Washington, D.C., needs to get this done."

"Community health centers provide health care that is effective and affordable," Tester said at the press conference. "It has been 130 days since Congress failed to fund community health centers and put them in a world of hurt. Without long-term funding, these health care facilities could close down and lay off staff. It is time for Congress to quit kicking the can down the road and provide community health centers with long-term certainty."

Gianforte, who like Tester and Daines was at the press conference Tuesday, voted later in the day for a stop-gap bill to keep the government funded and expand funding for the program for two years.

"I've been a strong advocate for community health centers, which about 1 in 10 Montanans rely on for their health care needs," Gianforte said Tuesday in a press release. "Three months ago, I voted to extend this vital program, and I voted again today to provide continued, predictable funding for our community health centers. I hope the Senate will act to protect Montanans' access to care."

Tester has co-sponsored a bill that would extend funding for another five years for the fund. The bill has not yet been taken up by the Senate Committee on Health Education Labor and Pensions has not yet taken up the bill, Tester Communications Director Marnee Banks said last week.

Community health centers provide a range of services to patients including primary health care, dental care, behavior health services and substance abuse services all in one location.

Susie Schmele, chief financial officer of the Sweet Medical Center, which has offices in Chinook and Harlem, said the centers play an important role.

Sweet Medical, she said, served 1,921 patients last year in Blaine County and surrounding communities, including 9 percent who lacked health insurance.

"Community health centers in the United States, we provide a lot of care to a lot of people, where they would otherwise go to other facilities where they couldn't pay for the care," she said.

The centers in 2016 served 27 million people throughout the nation in about 100,000 communities, a fact sheet from the National Association of Community Health Centers says. Patients included 330,000 veterans and 1.3 million homeless people.

In Montana, health centers provided care to 106,342 patients, with 58 percent at or below 100 percent of the poverty level, the fact sheet says.

Health centers, Schmele said, focus on preventive care and early diagnoses that make care more cost effective.

The Association website says centers receive a large portion of their funding from the Community Health Center Fund. When it was established in 2010 the fund paid out $11.5 billion over five years to establish, expand and operate the centers. Funding ran out in 2015 but was extended for two years.

The fund had $3.6 billion in fiscal year 2017 before funding expired in Sept., 30, creating a "CHC funding cliff," a December report from the Gieger Gibson/RCHN Community Health Foundation says.

A bill was signed into law in December that provides $550 million to the fund through March.

For Bullhook, money from the fund makes up about 20 percent of their overall $7 million budget, Smith said. Other money comes from smaller grants and revenue generated from billing patients and insurance providers, she said.

Smith said money from the fund allows Bullhook to pay employees and offer medical care to patients on a sliding fee scale based on income.

Schmele said that money from the Community Health Center Fund also allows Sweet Medical Center to provide patients with vouchers to obtain treatment from other health care facilities.

Smith said Bullhook has enough money from its current revenue stream to continue operating as is for about five months. Smith said if Congress does not renew the fund they could still operate for about five months and the center does have reserves, but those can only last so long.

Plans have been crafted in the event the fund is either partly replenished or not funded, she said.

Bullhook would have to consider instituting a hiring freeze, putting on leave or laying off nonessential employees or not offering the sliding scale at its current levels, Smith said.

"We hope it doesn't come to that," she said.

Schmele said that Sweet Medical Center would likely reduce the number of appointment slots available to patients, but added that the center would still be able to provide basic health care, even without money from the fund.

"We absolutely would still be able to do primary care," she said.

The uncertainty that has come from the lack of a long-term budget is already being felt, a report from the Kaiser Family Foundation says.

Because of the uncertainty about funding, the report says 39 percent of centers have either closed offices or are considering doing so. Another twenty percent have instituted hiring freezes and another 4 percent have already laid off staff.

Though health centers enjoy bi-partisan support, Smith said bills that fund them are often folded into larger bills where more divisive issues are included. Funding is then either voted down or not voted on at all.

Smith said that the loss of money to the fund comes as lawmakers are asking centers to take a larger role in several health care issues such as the opioid crisis and mental health issues.

"So they keep asking us to help, yet they are not saying what they are going to give us," she said.