Hanging with the Secretary
By Krystal E. Knight
This Monday, I headed over the Department of Health and Human Services (HHS) to watch Secretary Sebelius’ remarks on the FY 2011 Budget. I’m glad I braved the Washington, D.C. weather and made it out because Secretary Sebelius said some PHENOMENAL things about Health Centers!
- She deemed Community Health Centers the “backbone of the American health care system,” and said the $290 million increase the program received in the President’s Budget would “provide high-quality primary care” for 3 million patients.
- Secretary Sebelius said Community Health Centers will use the increase to provide additional health care access to those Americans who are without it, but she was careful to point out that the budget, including the Heath Center increase, is not a substitute for health reform.
- Secretary Sebelius called Health Centers a “platform” for health care reform, an example of what reform should look like in this country.
Those who heard Secretary Sebelius speak at last year’s CHI in Chicago already knew she was a true health center fan, but this briefing certainly confirmed it!
Health Centers Get Big Boost in President’s Budget
By Kaitlin McColgan
Today, the President released his FY2011 Budget. After all the talk of the discretionary spending freeze, health center advocates like many others were understandably 
wondering (and nervous about) what the budget would hold.
The answer?
The budget contained a significant increase for the Health Centers program: $290 million. Even more, though, it demonstrated an advanced understanding of the situation on the ground for health centers and medically underserved communities. For years, through our ACCESS for All America plan, NACHC and health centers have urged that increases to the Health Centers program preserve, strengthen and expand, and this budget does just that.
For starters, the budget appears to propose making the Increased Demand for Services or “IDS” funding to every health center in the country permanent. Making this funding permanent would essentially provide a $175 million base grant adjustment. This, combined with making the ARRA New Access Points permanent (at a cost of around $78 million), would provide funding for continued care to almost 3 million patients.
In addition, the budget calls for $40 million in growth funding above that, meaning possible service expansions, expanded medical capacity, and New Access Points (NAPs) for areas without a health center. We would have liked, of course, to see that growth funding significantly higher. As many know, there has not been an opportunity to apply to become a health center since 2007, and there is huge pent-up demand across the country for these grants. Our service and expanded medical capacity grants have also been incredibly competitive, with demand far, far outstripping need. This is one reason why NACHC’s requested increase may exceed even the President’s request.
However, on a day when so many programs are facing flat funding or minimal increases, health centers are at least in a better position than most heading into the long appropriations season. And, while this is without a doubt a positive first step in the process, there’s a long road ahead. In a year like this, we’ll need plenty of advocacy from the grassroots in the coming months to make this funding increase a reality.
Finally, if you are wondering how this funding interacts with the trust fund spending proposed in health reform, stay tuned for a future blog post on that very subject!
An Annual Ritual: Washington Waits for the Release of the President’s Budget
by Krystal E. Knight
It’s seems like only yesterday Congress passed the FY 2010 Omnibus Appropriations Act, which unfortunately level-funded the Health Centers program at $2.2 billion. Well, another appropriations season is upon us and it all starts Monday when the President releases his FY2011 Budget. The Department of Health and Human Services (HHS) has announced that Secretary Kathleen Sebelius will present the HHS portion of President Obama’s budget on Monday, February 1st. NACHC will have representatives at the presentation, but most of us will be anxiously monitoring the unveiling and analyzing the numbers from our desks the minute the budget is posted (most likely around 12:30EST on this web page for those who can’t just wait for the Washington Update) .
In his State of the Union address Wednesday night, the President confirmed media reports that he will request a 3-year freeze on discretionary spending. However, this freeze will not be across the board, rather some programs will be cut and others increased.
With the President’s budget unveiled, NACHC will be moving forward to implement our annual appropriations strategy, this year doing so in parallel to our continuing efforts to secure mandatory health center funding in health reform.
We’ll be back on Monday with an update on what the President’s Budget says about the Health Centers program, the National Health Service Corps, and other key programs.
Stay tuned!
Majority Leader Hoyer Says Jobs, Deficit, Health Reform On Democrats’ 2010 Agenda
By Ielnaz Kashefipour, NACHC Public Policy Intern
House Majority Leader Steny Hoyer (D-MD) delivered a speech at the National Press Club this morning on the Democrats’ 2010 legislative agenda. According to the Majority Leader, Dems will focus on job creation and deficit reduction – one and the same goal, as unemployment and a down economy drive the deficit up. Majority Leader Hoyer framed health reform as a powerful response to economic insecurity, as comprehensive reform would create millions of jobs and ensure middle-class Americans have stable health insurance coverage and lower health care costs. Read more
Practicing the Art of the Possible
By Alexandra Sange
Last week was a challenging one and it left people around the country, including some Members of Congress, unsure about the future of national health reform. It’s understandable – with the media interpreting Tuesday’s election as a referendum on health care and the loss of the Democrats’ filibuster-proof majority in the Senate. It’s understandable, but it is not final. Although no one is sure exactly what shape and size reform will take in the days and weeks ahead, the administration and Republicans and Democrats in Congress have indicated that they still strongly support reform. We can agree we need improvements to the insurance market, making coverage more affordable, and that we need improvements to the delivery system, making care more accessible. We can agree, but we will need to make tough choices about the path forward to meaningful reform, and we will all need to practice the art of the possible.
So what can you do from your health center, your desk, your laptop, your home phone or your classroom to move Congress toward passing meaningful health reform legislation? You can advocate!
In the face of this uncertainty, Congress needs to hear from their base, from families, communities, and businesses they represent, to know there is still strong support for reform back home. Now, as much as any time over this past year, is the time for health center advocates to have a real impact on national health reform. It’s a time to thank your Member of Congress for supporting Community Health Centers, and to encourage them to work with their colleagues to expand coverage and access to quality health care for all. Community Health Centers stand, as ever, at the ready to provide comprehensive primary care to all those in need. We support Congress moving forward to pass national health reform to help pave the way to affordable, accessible health center homes for millions of Americans.
The future of health care reform just got cloudier, but we have a clear message. The art of the possible can include Community Health Centers if we get our message out.
So go out and advocate. We know you can!
Fishing for a Deal
By Craig A. Kennedy, MPH
The time is fast approaching to fish or cut bait on health care reform….and it looks like the President and Congress are opting to try their hand at catching some fish. Despite some apparent large-scale differences between the House and Senate-passed versions of the legislation, Congressional leaders from both sides of the Capitol and even the President himself have been cranking through negotiations day and night that appear to be coming to a close. Read more
A Year in Review – 2009
By Craig A. Kennedy & Kaitlin McColgan
Sitting down to write our annual NACHC review of legislative activity, it is hard to believe all that has happened in one calendar year. One thing is already certain: this is a year that will go down as one of the most active in the health center movement’s already distinguished history. What has brought us to this point is not luck or simple fortune as some might like to think. Instead, it is because we have the most hardworking group of grassroots advocates in the country. Many of you have worked for decades, and all of us have worked for years to plan for this type of year, to be ready and organized when the time came — and ready we have been. While writing this now seems premature since we are truly in the midst of battle, it is still amazing to look back on the year that has been 2009.
The year started out with a bang as Congress passed the CHIP reauthorization package in January, the American Recovery and Reinvestment Act (better known as the “Stimulus”) in February, followed by the FY09 spending bill for HHS in March.
CHIP
The CHIP Reauthorization bill, called CHIPRA, expanded the current program to cover 4 million new children and also established in law a mandatory payment mechanism for all Health Centers. The bill was signed into law by new President Barack Obama after several vetoes from former President George Bush. Starting October 1, states with separate CHIP programs will have to pay health centers based on their Medicaid PPS rate. The bill also contained $100 million for outreach, and several health centers and PCAs received a portion of these funds earlier this year! All in all, CHIPRA was a tremendous victory and one that started the year off on a very good foot.
Stimulus
From there, it was right into ARRA, which NACHC had been working to lay the groundwork for since the Obama Administration transition, The Stimulus package provided a record investment in Health Centers by adding $2 billion in direct funding through HRSA, and another $1 billion in HIT incentive payments through the Medicaid program. The first $500 million of operations funding enabled HRSA to fund 126 new access points and temporarily increase grants to every health center in the country in recognition of the increased demand for services health centers were facing as a result of the economic downturn. The remaining $1.5 billion in capital funding enabled HRSA to award grants to every health center for capital improvement projects and start a competition for larger facility investments, which were awarded in December. In effect, the $2 billion nearly doubled the funding available for the Health Centers program. The Health IT payments are scheduled to become available as part of the federal government’s larger HIT funding roll out, but they will be based on a formula that recognizes how many providers each health practice employs, with particularly strong payments for health centers. This could mean up to $1 billion in total for health centers in the very near future.
Appropriations
After battling for a regular funding increase throughout the previous year, and even in light of the passage of the Stimulus package, health centers were able to secure another $125 million funding increase in the FY09 Omnibus Appropriations package. Although it seemed like a small increase compared to the Stimulus, unlike that funding this was permanently made a part of our program’s base funding. The Omnibus Appropriations bill enabled HRSA to award permanent base grant adjustments to every health center to the tune of $56 million….the largest base grant adjustment ever. It also set a new record for annual funding for the Health Centers program at $2.19 billion.
Throughout the year, we were also working on our FY2010 annual appropriations request. This year, we’d asked for $2.602 billion, a significant increase, but one called for by our reauthorization. While we had the support of almost 200 Members of the House and 60 Senators on that request, both the House and Senate decided ultimately to follow the President’s request and level fund our program at approximately $2.2 billion, based largely on the stimulus investment. We voiced our concerns over this level funding, but made clear that we understand this is in the context of both stimulus and the health reform provisions related to growth (see below) .
Health Reform
Before the dust had even settled on the Stimulus and FY09 Appropriations, Congress marched right into Health Care Reform. Fortunately, we laid out our priorities early: participation and payment; growth (funding), capital and workforce. As a result of a strong plan, multiple grassroots pushes-both widespread and targeted, tremendous Hill champions, and lots of hard work, we were able to secure some key provisions related to each of our priorities in the House and Senate packages., The House and Senate had very different health center provisions, however, so the upcoming Conference will determine how successful we will be. The House established a Trust Fund that would provide $12 billion over 5 years for health center growth, and also $2 billion for the National Health Service Corps. The Senate included a mandatory reimbursement provision for health centers in the new exchanges and also a new payment mechanism for Medicare.
However, the landscape around health care reform changes very quickly. In the final move to pass the bill through the Senate, Senator Bernie Sanders convinced Majority Leader Reid to add $10 billion in direct funding for Health Centers and the NHSC. The manager’s amendment was accepted and the bill passed December 24th. The process is far from over, with the House and Senate needing to resolve their differences and pass a final agreement before anything can be signed into law by the President.
As health care reform progresses we will know how 2010 and maybe even beyond will fare for Health Centers. We are on the cusp of some historic developments, but success will require a true team effort. Hopefully 2009 was just a glimpse of what the future holds! Stay tuned.
Senate Makes Big Health Reform Investments in Community Health Centers
by Craig Kennedy
Late last week Senate Majority Leader Harry Reid (D-NV) released his “manager’s amendment” to the Senate’s health care reform package. The Senate has been considering the base reform bill, called the Patient Protection and Affordable Health Care Act, for several weeks but everyone has been waiting for the final agreements to be struck and offered as an amendment by Reid (the manager’s amendment). Turns out there was a lot more than just health center issues in the amendment, but I’ll keep this post to those that directly impacted health centers (the actual amendment is nearly 400 pages long). Read more
Snow Can’t Stop Senators from Passing Holiday Health Reform
by Alex Sange
This morning, in the middle of an historic snowstorm, the Senate took an equally epic vote to move health care reform forward toward a final bill on the President’s desk. At 1am Monday morning, all 100 Senators cast a vote on party lines (58 Democrats and 2 Independents supporting, 40 Republicans opposing) to move the health care reform debate forward. Technically, this was a vote to ‘invoke cloture’ on Majority Leader Reid’s Manager’s Amendment improving and adding to their reform bill, the Patient Protection and Affordable Care Act. NACHC supports the underlying bill, and especially appreciates the improvements made for health centers in the Manager’s Amendment. Essentially, this was the symbolic first vote, which needed all 60 votes, to pass a health care reform bill out of the Senate. Up through Christmas Eve we’ll see a series of procedural votes – and all of them will take all 60 in support – to finally approve the bill by the Christmas Eve. Here’s a holiday week-ahead Senate timeline for what we can expect: Read more
The Jobs Bill and FIP
by Kaitlin McColgan
So, as if there isn’t enough going on in Congress with health reform to keep health center advocates busy, along comes the “Jobs Bill!”
As many of you have heard by now, Congress is currently drafting legislation to further stimulate the economy and produce jobs quickly. The House of Representatives passed their version of the bill before leaving town for the holidays; it included approximately $49 billion in infrastructure projects, $27 billion for public service jobs (including $200 million for Americorps), and other emergency relief such as an extension of enhanced FMAP through June 2011.
The Senate, however, is still putting together their Jobs Bill, and health centers have an opportu
nity to advocate for an additional $2 billion in Facility Investment Program or FIP funding. This funding could allow HRSA to go back the pile of high-scoring, but unfunded, FIP projects already submitted and instantly make new awards. These awards would create short-term construction jobs as well as permanent health center jobs and improved health access.
While health reform continues to be NACHC’s and health center advocates’ top priority in the days and weeks ahead, this rare opportunity to secure additional capital funding for health centers is something that many advocates will want to speak to their Senators about. For this reason, NACHC has created a grassroots alert on FIP and the Jobs bill that you can access by clicking here.
Our best information is that the Jobs Bill will not be taken up in the Senate until January. However, Senator Byron Dorgan (D-ND) and Senator Dick Durbin (D-IL) are working on putting together the legislation right now. If your health center has an application in the FIP pile, and you would like it to have a chance to get funded, you should use our alert to make a call to your senator, and let them know you’d like them to communicate their support to these lead senators for health centers’ construction funding in the Jobs bill.
As always, stay tuned to the Hotline and other NACHC communications for the latest info in the weeks to come!
