- The Washington Times - Sunday, December 7, 2014

Republicans won’t need to lift a finger to make a dent in at least three Obamacare programs.

The trio of primary care programs, which serves poor Americans, is due to expire at the end of this fiscal year unless Congress finds more funding. But keeping the programs alive could be a tough sell amid a political climate still sour on President Obama’s signature health law.

Obamacare supporters have labeled it the “primary care cliff,” and say it would be a disaster for the health of 22 million poor Americans if the country goes over the Sept. 30 deadline without finding more money for the programs.

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“It will precipitate a huge crisis in primary care,” said Sen. Bernard Sanders, Vermont independent.

Community health centers operating more than 9,000 locations across the country would forfeit at least 60 percent of their federal funding, while a program that offers scholarships and loan repayment to health professionals who work in underserved areas would lose all of its support, because federal lawmakers eliminated its discretionary funding years ago, the Congressional Research Service said in a recent report on the looming cuts.

Making matters worse, about $230 million for teaching health centers that train medical and dental residents in primary care also will run out in 2015.

Mr. Sanders has written legislation to keep the funding going, but said no Republicans have signed onto his bill and that “money” is the main sticking point. His bill would direct nearly $30 billion to the programs over the next five years.

“It’s an expensive proposition,” he said.

Sen. Lamar Alexander, the top Republican on the Senate’s health committee, said in a brief hallway interview this week that he would have to research the “cliff” further before commenting on it.

But any vote to prop up part of the unpopular law could be dangerous for Republicans, most of whom are still vowing a full or partial Obamacare repeal rather than looking for ways to maintain it.

The Affordable Care Act created the Community Health Center Fund and set aside $11 billion from 2011 to 2015 to support the Federal Health Centers program and the National Health Service Corps, the program that offers scholarships and school loan assistance.

The fund accounted for 60 percent of health centers’ spending in fiscal year 2014 and provided all of the National Health Service Corps’ money for the last few years.

Part of the problem is that the expiring fund had “partially replaced” the primary care programs’ annual discretionary funding, according to congressional researchers.

The health center program’s discretionary appropriation declined from about $2.1 billion in 2010 to $1.4 billion in 2014 as Obamacare phased in, while the health corps program has not received any discretionary funds since 2012.

Advocates say another major snag is that many health officials had expected all of the states to expand Medicaid, which would have provided a funding stream to cover many of the poor, who now end up using community health centers.

Gary Wiltz, CEO of the Teche Action Clinic in rural Louisiana, said about a quarter of the people he serves would have been covered by Medicaid had his Republican-led state opted to expand.

Instead of a $130 reimbursement from the government program, his patients — Cajun country sugar cane farmers and fishermen among them — are paying about $20 or $30 for a visit, leaving the center to absorb the rest.

Funding cutbacks and the lack of Medicaid dollars have forged a “double whammy” that’s causing him sleepless nights.

“I’m Catholic, so I’ve been praying and doing the rosary,” he said.

Health centers tend to operate on a five-year plan, and Dr. Wiltz said he is borrowing against the center’s property just to make payroll.

He said the sooner Congress acts, the sooner his facility and ones like it can rest easy and plan for the future.

Dan Hawkins, health policy director for the National Association of Community Health Centers, said Congress isn’t likely to act before the new year, but said lawmakers don’t have to fund the centers as part of Obamacare.

“We’re not stuck on one solution to the problem,” said Mr. Hawkins. “There are many, many roads to Rome.”

Congress could switch funding back to the normal annual discretionary spending process, thus keeping the programs alive without making it into an Obamacare fight. But budget caps would be a sticking point in that scenario, he noted, and any new investment would have to account for an “unprecedented” demand for care.

“We believe the intent of Congress was to take five years to invest in primary care — in creating more options for care among working people, whether they have an insurance card or not, and figure out the next path forward,” he said.

He said Mr. Sanders‘ $30 billion request may be a “bridge too far” to gain support from other lawmakers.

“I think it was a message bill,” Mr. Hawkins said. “He’s saying, ‘This is my North Star; this is my ideal. If anybody wants to introduce a bill, we’ll measure it against mine.’”

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