While Congress has been immersed in contentious health policy debates, the legislative clock is still ticking on some essential health care programs that will expire unless action is taken by the end of the week.
Minnesota health advocates are closely watching for signs of progress in Washington on programs that underwrite care for the uninsured and for low-income children. Unless reauthorized and funded, both are set to end on Saturday when the federal fiscal year ends.
Although the Senate decided Tuesday not to vote on the Cassidy-Graham proposals that would have removed some consumer protections in the Affordable Care Act and cut back on the Medicaid program, congressional observers don’t expect these other health care programs to get legislative attention until October, creating uncertainty among health care providers as well leaving a hole in Minnesota’s state budget.
One of the programs on the block is CHIP, or the Children’s Health Insurance Program, which in Minnesota helps pay for the care of 125,000 children. Minnesota is projected to be the first state to run out of CHIP money — perhaps by the end of this week.
Minnesota children on the program will keep insurance coverage through Medicaid, but the state will lose $94 million in federal funds annually until the program is reauthorized.
“It is unfortunate that we are so down to the wire as this has been on folk’s radar for a significant time,” said Bharti Wahi, executive director of Children’s Defense Fund-Minnesota. “Congress frankly has been distracted by efforts to repeal the ACA and they leave the CHIP language until the last possible moment.”
Safety net clinics are also facing a loss of funds through a program that funnels $27 million to Minnesota for care for the uninsured.
Minnesota’s congressional delegation has signed a letter of support for the safety net clinic renewal, and although a bill has been introduced in the House it has not left committee. CHIP has also enjoyed support from both parties. A bill in the Senate is still in committee, but its path to the floor is unclear.
Since most safety net clinics operate on tight budgets, they are making contingency plans in case the funding stream runs dry. In most cases it would mean cutting back services, workers and entire clinic locations.
“I still think we are confident that this is going to be solved, if for no other reason than this care is not going to go away,” said Steve Knutson, chief executive of Neighborhood HealthSource, which has three Minneapolis locations. “Most of this care will have to be provided and it will end up in the emergency room at three times the cost.”
Safety net clinics, which have more than 70 locations scattered throughout the state, are also looking at another federal program that needs reauthorization this week. The National Health Service Corps program offers student loan repayments to new clinicians who agree to practice in underserved or rural locations. Many safety nets rely on the program to recruit and hire new staff.
“We could not match the offers that are being made by the bigger health systems,” said Knutson. “The only thing I can counter with is loan repayments and that has been a pretty successful recruiting tool here.”
Knutson is looking at a loss of $2 million without the funds. Although he has some time before the current grant expires, a permanent cut would result in cutbacks and even pulling back on a planned expansion of much needed dental care.
Sawtooth Mountain Clinic, with three locations in Cook County, would lose up to $1 million for care for the uninsured, but it would result in service and staff cutbacks that will affect the entire community.
“We are the only clinic that provides primary care,” said Rita Plourde, chief executive of the Grand Marais-based clinic. “There clearly is going to be a major impact going forward if Congress does not do its work.”
Though no cuts have yet hit the safety net clinics, patients already say they’re concerned, especially given the wider debates about the future of health care.
“There is a high degree of anxiety for staff and for some of our patients,” said Stella Whitney-West, CEO at NorthPoint Health & Wellness. “I think Congress understands that we are vital to the safety net and they have to continue to support the community health centers.”
Community-University Health Care Center in Minneapolis is looking at potential a loss of about $700,000, which represents the amount it takes to serve 1,000 of the 11,000 patient visits it has each year.
“We run on a shoestring budget, there’s not a lot of fat to cut,” said chief executive Colleen McDonald Diouf. “It feels like right now we are getting stuck in the chaos of all of the things that are happening.”
Nate Beske, one of the clinic’s board members and patients, said he worries that the service cutbacks would touch someone like him, who came to the clinic 10 years ago after he completed treatment and sought mental health care.
“It is very concerning. Traditionally, this has been a bipartisan issue,” Beske said. “I continue to go here because I not only believe in the mission but the quality of care I get here is second to none,” he said. “It breaks my heart that folks won’t get the same opportunity to bounce back like I did.”