Avoiding a Shutdown, Resurrecting AHCA, and Closing Out the Wicker-Stabenow Health Center Funding Letter

By: Oliver Spurgeon, Deputy Director, NACHC Federal Affairs

The halls of Capitol Hill are buzzing this week as Congress returns from the two week Easter Recess, President Trump and Congressional Democrats continue negotiations to keep the federal government open beyond Friday, April 28, the Wicker-Stabenow Health Center funding letter closes, and House Republicans consider bringing the American Health Care Act back from the dead.

We here at Health Centers on the Hill want advocates to be up to date on all the latest developments. To that end, you can get a more in-depth look at these and other policy issues impacting health centers by joining our April Policy and Advocacy Webinar, this Wednesday at 3:30 PM eastern. Click here to register.

Shutdown Fight

With just three days left to negotiate a deal before the federal government shuts its doors and temporarily suspends nonessential services on Friday at midnight, Democrats on Capitol Hill and the Trump administration have yet to find agreement on the remainder of the FY17 spending package. At issue for the Trump administration and Congressional Democrats, respectively, are a $1.5 billion down payment to begin construction of the southern border wall, and $7 billion to fund cost sharing reduction (CSR) payments for participants in the federal healthcare exchanges with incomes below 250% of the poverty level. For more on CSR payments and their role in marketplace coverage, see a recent post here on our sister blog, The Policy Shop.

Until the inclusion of recent demands to fund the border wall and continue CSR subsidies for health exchange enrollees, Congressional leaders were able to iron out roughly 200 controversial provisions in the FY17 continuing resolution. Congressional leaders in both parties were able to put partisan affiliations aside to avoid the traditional political stumbling blocks of Planned Parenthood funding and budget cuts at various federal agencies, including the Environmental Protection Agency and State Department, which have held up previous negotiations. However, the recent addition of border wall funding and CSR payments have left Congressional Democrats and the Trump administration at loggerheads.

Most recently, Mick Mulvaney, the Director of the Office of Management and Budget OMB and President Trump’s chief negotiator on the FY17 spending package, proposed a dollar-for-dollar exchange to fund both the border wall and CSR subsidies; however, that offer has drawn sharp rebuke from Congressional Democrats who support a permanent extension of the CSR payments. We’ll continue to send out updates this week negotiations between the Trump administration and Congressional Democrats progress. Please keep an eye on NACHC’s social media accounts and blog for up-to-the-minute news about the FY17 spending package.

****Editor’s Note****


Negotiations between the Trump administration and Congressional Democrats are still ongoing, showing glimmers of a possible breakthrough to avert a government shutdown before Friday’s midnight deadline. President Trump’s $1.5 billion request for border wall funding has been rescinded ‒ removing one of the largest obstacles leaders in Washington faced to strike an agreement that keeps the federal government open.

However, a deal isn’t guaranteed. As of Wednesday afternoon, Republicans and Democrats are still wrestling with several issues including $7 billion for CSR subsidies, at least a $15 billion increase in defense funding, $500 million to alleviate Puerto Rico’s looming Medicaid crisis, and $1.3 billion for coal miners’ health benefits. At Wednesday’s morning press briefing, Speaker of the House Paul Ryan suggested that the $7 billion for CSR subsidies have no place in Congress’ annual spending bills ‒ implying that the Trump administration, and not Congress, is responsible for funding them. As we move closer to Friday’s midnight deadline, it looks increasingly likely that Congress will pass a week-long extension in order to reach a deal next week.


****End Note****

Wicker-Stabenow Health Center Funding Letter

If Friday’s shutdown drama doesn’t provide enough excitement for you, there’s also another deadline on the horizon: the Wicker-Stabenow Health Center Funding Letter closes out Thursday, April 27. Currently, 46 Senators have signed on board to support health center funding in FY18; but that’s still well short of the 62 who joined last year. (Click here to see if your Senator has signed, or if he/she signed last year but not yet this year) We need your help to make sure Congress knows the importance of ending the health center funding cliff well before September 30, and why providing robust funding for health centers in FY18 is important. Click here to send a note to your U.S. Senators and ask them to add their names to the Wicker-Stabenow Health Center Funding Letter.

Reviving the American Health Care Act

House Republicans spent much of the Easter Recess discussing potential changes to their Affordable Care Act repeal bill, the American Health Care Act, which failed to receive a vote on the House several weeks ago. In a concerted effort to bring additional members of the House Freedom Caucus on board the American Health Care Act, Rep. Tom MacArthur (R- NJ) proposed an amendment to relax many of the ACA’s current consumer protections. Specifically, it would allow states to opt out of certain ACA requirements that everyone be charged the same amount for health care coverage, regardless of their health status. In exchange for waivers, states would be required to establish a new risk-sharing program to help cover the sickest and most costly patients, who could be denied coverage by insurers due to the waiver.

Lastly, a change made to the bill before Congress departed for the Easter Recess provided $15 billion for states to establish their risk-sharing programs; however, a recent analysis of Rep. MacArthur’s proposal suggests states will need between $3.3 billion and $17 billion each year in order to make the proposal viable. Long story short, Rep. MacArthur’s amendment is expensive!

House Republicans have yet to decide whether to move forward with Rep. MacArthur’s amendment, and several moderate Republican members of the House of Representatives have already expressed concerns about the potential impact, and cost, of removing health care protections for vulnerable Americans.

Wrapping Up

Although progress on the House ACA repeal effort is expected to grind to a halt this week due to Congress’ focus on the looming government shutdown, the Federal Affairs team here at NACHC will continue to publicly express the importance of immediately fixing the health center funding cliff, preserving the structure and integrity of Medicaid, and providing predictability for health centers. Click here to read NACHC’s statement on the American Health Care Act, and please continue to follow our activities on Twitter and Facebook for the latest updates on the House’s ACA repeal effort.

Congress Comes Home Part III- To Utah, North Carolina, and Texas

Over the past six months, we’ve heard from you about thirteen Members of Congress visiting health centers in about ten different states! BIG thank you to those who’ve shared their stories. As mentioned in previous posts, inviting a Member of Congress for an in-person visit is a vital advocacy tool and a great way to strengthen a relationship that could potentially last for decades. Keep in mind, the House and Senate will be on recess from now until September 6th. So, for the next seven weeks, Members will back home in their districts, making this a great time to reach out. Here are a few short notes from the field about recent health center visits:

During the Memorial Day recess, Senator Orrin Hatch (R-UT) visited Wayne Community Health Center’s (WCHC) KAZAN Memorial Clinic in Escalante, UT. The Association for Utah Community Health (AUCH) says, “Besides our ongoing relationship with the Senator, one of our hospital partners, Intermountain Healthcare, reached out earlier to the Senator to facilitate visits to Health Centers and Rural Hospitals in Southern Utah. By cooperating with community partners, the visit transformed from something that might happen into a set date and time. The bulk of the work for the health center visit fell on Wayne Community Health Center in inviting patients, the media, and local elected officials.” A few tips they offered were to have a plan, document the visit, and cultivate a relationship with their staff. AUCH also worked diligently to promote the visit on social media. In a video posted on Senator Hatch’s Twitter and Facebook pages, he describes WCHC as, “a fantastic rural health center.”

Senator Hatch at KAZAN Memorial Clinic. Photo courtesy of AUCH

Senator Hatch at KAZAN Memorial Clinic. Photo courtesy of AUCH.

Tip #1 and #2: For more on AUCH’s perspective of Senator’s Hatch’s visit as well as their tips for planning a tour, read President Pro Tempore Orrin Hatch Blog. Also, be sure to let NACHC and your state’s PCA know about any upcoming Congressional visit so you’re armed with the latest information regarding your Member. Don’t forget 2016 health center visits by your Rep., Senator, and/or delegate are one criteria used to determine 2017 NACHC Congressional Awards.

On June 1st, Senator John Cornyn (R-TX) convened a roundtable discussion at Community Health Center of Lubbock (CHCL) to discuss local partnerships that support Lubbock’s mentally ill and homeless individuals. He also highlighted components of his proposed bill, Mental Health and Safe Communities Act of 2015, which is designed to strengthen the mental health system and improve public safety. Following the discussion, Senator Cornyn toured the newly opened health center and held a joint press conference. Senator Cornyn also included CHCL’s CEO in a short video on his Facebook page.

Senator John Cornyn at Community Health Center of Lubbock. Photo courtesy of Facebook.

Senator John Cornyn at Community Health Center of Lubbock. Photo courtesy of Facebook.

Tip #3 and #4: If your Member’s office reaches out to you for some feedback on an issue or bill(s), feel free to reach out to us (federalaffairs@nachc.org). We are happy to provide you with requested information, background information on the Member, and some up-to-the-minute insight on what is currently percolating on Capitol Hill. Do your best with posting on social media as your Member may include you in their social media outlets as well. If possible, coordinate coverage with member’s communications staff so they can simultaneously promote.

Also on June 1st, Congressman G.K. Butterfield (D-NC) attended the ribbon cutting ceremony of Roanoke Chowan Community Health Center’s (RCCHC) newest site, Creswell Primary Care Clinic in eastern North Carolina. RCCHC did an all-around great job with publicizing the event by posting on their website’s RCCHS News, tweeting, posting photos on Facebook, and inviting the local news. Rep. Butterfield’s office made sure to tweet about it too.


Rep. G.K. Butterfield at Roanoke Chowan Community Health Center. Photo courtesy of Twitter.

Tip #5 and #6: Invite your Member to attend an event at your health center such as a ribbon cutting or ground breaking. In addition, alert local news sources of the event as they might feature the segment in the nightly news, similar to what WITN did with this event.

On June 3rd, Senator Richard Burr (R-NC) visited Piedmont Health’s PACE site in Pittsboro, North Carolina. Piedmont Health detailed the event on their Facebook page, “He (Senator Burr) talked with many participants while they were playing Bingo, saw the beautiful gardens and facilities and talked about this managed care model of providing service for seniors as a solid business model. He also saw the satisfaction of many happy participants and the depth of care that they received.” In addition, Carl Taylor, Director of the Pharmacy and Dr. Abby DeVries, Piedmont Health’s Medical Director spoke to Senator Burr about the benefits of the 340 B Program to community health center patients and the future of this program.  Both Piedmont Health and Senator Burr posted the experience on their respective social media sites.

Senator Richard Burr speaking with Carl Taylor, Dr. Abby Vries and Pharmacy intern, Felicia Charles from Piedmont Health. Photo courtesy of Piedmont Health.

Senator Richard Burr speaking with Carl Taylor, Dr. Abby Vries, Mike Fenley, and Pharmacy intern, Felicia Charles from Piedmont Health. Photo courtesy of Piedmont Health.

Tip #7 and #8: Show off your health center’s unique program(s) or service(s). Tell your story of how it came about and demonstrate your health center’s innovation to address the needs of your community. Make the most of this year’s National Health Center Week (NHCW) theme, “Celebrating America’s Health Centers: Innovators in Community Health.” Also, try to coincide the visit with one of NHCW’s focus days. For more information on this, please refer here.

For more how-to’s on inviting your Member and meeting tips, visit our Grassroots Advocacy website or read previous Congress Comes Home blogs (Part I and Part II). Refer to the NACHC 2016 Congressional Calendar to plan a congressional visit or tour. Don’t forget, August 7th through 13th is National Health Center Week (NHCW) and another opportune time to invite your member to tour your health center.

Do you also have a story to share? What tips and tricks have you learned in the process of scheduling and organizing Congressional visits? Do you alert the local press or utilize social media? Let us know by emailing your story, photos if available, and tips for fellow health centers to federalaffairs@nachc.org.

Congress Adjourns for the Summer – So Where Do We Stand?

By: NACHC Federal Affairs Team

With Members of Congress scheduled to attend the party conventions this week and next, and then to head back to their districts for the August recess, Congress will be out of Washington for the next seven weeks. With National Health Center Week looming, the recess is a great opportunity to get Members to come visit your health center. While Congress is scheduled to return to DC after Labor Day, reports indicate that depending on a number of factors, that session could be very short. So that all advocates are up to speed, we wanted to share some updates on key legislative issues as Congress heads home.


Last week, the House Appropriations Committee approved the Fiscal Year (FY) 2017 Labor, Health, and Human Services (LHHS) Appropriations bill. The bill was considered over two days and 30 amendments were considered. The legislation was ultimately passed by a vote of 31-19, with nearly all of the Democrats on the committee opposing the legislation. The timing of potential consideration and a final vote on the FY17 LHHS bill in the House is unclear.

The legislation contained the full health center funding request for fiscal year 2017 (FY17) of $5.1 billion in funding for health centers. This is level funding compared with FY16 and composed of $1.5 billion in discretionary funding from the Appropriations Committee and $3.6 billion in funding from the mandatory Health Centers Fund, which was extended last year by H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015.

As you will recall, the Senate proposed FY17 LHHS bill allocated $100 million out of the $5.1 billion in available health center funding to be evenly split between mental health ($50 million) and opioid abuse ($50 million) expansion efforts. The House FY17 health center funding levels funding levels matched the Senate, but the bill did not specify $100 million the funds should be used for mental health and opioid abuse treatment. However, the House LHHS Committee report clearly indicates support for expansions in health centers in those two areas.

That is just one issue that will have to be resolved when the House and Senate begin negotiations over the summer and into the fall. It is widely expected Congress will move to pass a continuing resolution (CR) to extend funding at current levels before the end of the current fiscal year on September 30th. Reports from the Hill indicate Republican leadership is debating the length of time of the potential CR. It is unclear as to whether the CR will run until just after the election or into January – or even March – of next year. Either way, Congress does not appear to be ready to pass an omnibus bill (wrapping up all of the 12 appropriations into a single yearlong funding bill) at the moment. An omnibus will almost certainly not come up as an option until the elections are settled.


Opioid legislation was one of the only bills actually passed into law before Congress adjourned. On an overwhelmingly bipartisan basis, both chambers passed the conference report on S. 524, the Comprehensive Addiction and Recovery Act (CARA), legislation that would seek to address the current opioid epidemic through a variety of grants and programs related to prevention, treatment, and recovery. NACHC previously sent a letter to House and Senate Conferees urging them to remove the federal restriction preventing both physician assistants (PAs) and nurse practitioners (NPs) from prescribing buprenorphine for the purposes of Medication-Assisted Treatment (MAT), and the final bill authorized NPs and PAs who meet certain criteria to prescribe buprenorphine for a period of five years – an important step forward. The bill briefly hit a snag when Democrats and the President voiced serious concerns about the lack of new funding provided for these programs, but ultimately the bill garnered nearly unanimous support in both the House and Senate and was signed into law with the hopes that further funding would be included as part of the appropriations process later this year.

Mental Health

In addition to passing opioid legislation, the House moved forward with a broader mental health bill, voting 422-2 to pass H.R. 2646, the Helping Families in Mental Health Crisis Act, a bill to strengthen federal infrastructure for mental health, improve Medicaid coverage for adults and children receiving treatment in an institution for mental disease (IMD), clarify HIPAA regulations, and bolster federal, state, and local grants and programs to address mental illness. Of particular importance to health centers is a provision to extend FTCA liability protections to health professional volunteers serving at community health centers. NACHC is working with Senate health center champions to ensure this language, introduced in the Senate as S. 2151 , the Family Health Care Accessibility Act, is included in their version of mental health legislation which may be considered when Congress reconvenes in the fall. NACHC also advocated for provisions to require that states allow same-day billing by Medicaid for behavioral health and physical health services (some states currently allow this, some don’t), but those provisions were watered down due to cost concerns. The future of mental health legislation depends on whether Congress is able to overcome legislative and political hurdles related to potential gun amendments, cost concerns, and a dwindling number of days in the legislative session.

ACO Parity for FQHCs

In a bit of good news from Congress, Congresswoman Jenkins (R-KS) and Congresswoman Linda Sanchez (D-CA) recently introduced H.R. 5667, the Rural ACO Provider Equity Act, a bill to allow FQHCs and rural health clinics to assign their patients to ACOs under the Medicare Shared Savings Program. The Senate version of the legislation, S. 2261, was introduced by Senators Thune, Cantwell, and Murray and passed the Senate unanimously on December 17, 2015. If this is an issue that is important to your health center we encourage you to ask your Representative to cosponsor the bill. To help you with those discussions, NACHC put together a one-page overview that you can use to explain the issue.


After nearly five months of on and off negotiations, Congress was unable to come to an agreement to fund the Zika response before adjourning for the summer. As expected, the last week of legislative business before recess resulted in a second failed vote in the Senate on the conference report passed by the House – the measure failed 52-44, short of the 60 votes needed for the bill to advance toward a final passage vote. Again this vote broke down largely along party lines, with Democrats pointing to several issues of concern within the Republican-led conference report, as detailed in this post, and Republicans blaming Democrats for voting down a bill that would have addressed the current crisis before the seven-week recess.

Also right before the summer recess, a bipartisan group of senators introduced legislation to create a permanent fund to address public health emergencies, The Public Health Emergency Response and Accountability Act, S.3280. Recognizing that public health emergencies like Zika are inevitable and Congress is not necessarily inclined to act quickly in the face such emergencies, the legislation would allow for Congress to provide immediate resources where they are needed most. Similarly, the House included in its draft of the FY2017 Labor, Health and Human Services (LHHS) Appropriations bill a provision to create the “Infectious Diseases Rapid Response Reserve Fund” to make funds available through the annual appropriations process, which could be tapped into quickly to respond to future infectious disease emergencies. While these can be viewed as positive developments, as with the original funding request to address the Zika virus, we will be waiting until after Labor Day to see where Congress will go from here.

Zika Funding: One Step Forward, Two Steps Back

By: Michaela Keller

In the early morning hours on Thursday, amidst a Democrat led sit-in to protest the House Republicans resistance to vote on gun safety measures, a conference report bill to address the Zika virus was introduced in the House, voted on favorably and sent to the Senate.  The report came after negotiations within a bipartisan conference committee in both the House and Senate, which sought to reconcile the various funding measures proposed to fight Zika, broke down. The conference report package that House members ultimately voted on did not have bipartisan support and the vote, 239-171, was largely along party lines.

In the hours and day that followed, details of the bill emerged, including rhetoric from both parties as to how the bill should proceed. The major pieces of the bill include a top line funding level of $1.1 billion, which is equal to the Senate agreed upon number and higher that the House passed number of $622 million, yet lower than the Administration’s request for $1.9 billion. The package includes $476 million to the CDC for mosquito control, $230 million to NIH for vaccines, $227 for the Public Health Social Services Emergency Fund and $165 million to the State Department and USAID to respond to outbreaks overseas.

While many agreed that the House’s willingness to accept the Senate passed number of $1.1 billion was a step in the right direction, the details of how that money is allocated, and under what provisions, caused immediate backlash from most Democrats. One of the first points of contention is that $750 million of the funding is offset by redirecting funding from unspent Ebola and Affordable Care Act funds as well as about $100 million from HHS’s administration fund. As you may recall from this post, the funding that both the Administration and Senate proposed did not include any offsets. Second, there is concern that the funding provided through Social Service Block Grants for primary care services in areas most affected by Zika is prohibited from being used for contraception and other reproductive health services. Lastly, policy riders related to pesticide use were also raised as red flags for Democrats.

Despite the aforementioned areas of disagreement, NACHC was pleased to see that the bill included $40 million to expand primary care services for health centers in Puerto Rico and other territories as well as $6 million to assign National Health Service Corps members to Puerto Rico and other territories.

By the end of the day on Thursday, Senate leadership proceeded to call for a vote on the conference package, which is scheduled for next week. The Senate will need 60 votes in order to pass the conference report; however, given that Democrats have harshly criticized the funding measure, it is unlikely that the conference report will pass. Additionally, President Obama announced that he would veto the funding measure if it came to his desk in its current form.

When all is said and done next week, Congress will likely be back where it started more than four months ago, without an agreed upon funding mechanism to prevent and respond to the Zika virus.  With the House currently on recess until after the 4th of July and only a few days of regular business scheduled for both chambers before the summer recess period begins on July 15th, there is great uncertainty as to what the path forward is from here. Many speculate that a deal will not be reached in the coming weeks, meaning that the summer will pass before Congress passes a funding bill to address the Zika virus. For additional updates, stay tuned to the Health Centers on the Hill blog.

Zika Funding Negotiations Set to Begin

By: Michaela Keller

This past week, the Senate named its conferees on the Zika spending package to join the already-named House conferees, signaling a formal start to negotiations on the differing measures put forth by the House and Senate to combat the Zika virus. Chief among those differences is the funding level that both chambers agree is appropriate to address the virus. As detailed in this post, last month the Senate approved $1.1 billion, while the House approved $622 million to fight Zika, both levels below the Administration’s original request of $1.9 billion.

Apart from the funding levels, another significant difference between the House and Senate passed measures is whether or not the funding is offset. In the Senate passed bill, the funding is considered an emergency appropriation, meaning that it is not tied to any offset, or cuts to other programs. In contrast, the House offsets the full $622 million by repurposing emergency Ebola funding as well administrative funds within HHS.  Whether or not to offset any agreed upon funding will certainly be one of the key decisions of the conference committee.

Among other things, the conference committee will also be tasked with determining whether to provide funding until the end of September 2017, as agreed upon in the Senate, or to provide funding until the end of September of this year, as agreed upon in the House. House conferees have stated that they plan to include Zika funding in the yet-to-be-unveiled Labor-Health and Human Services funding bill, which is expected later this month.  However, whether that funding will get approved through the regular appropriations process and under what time frame, remains a question that conferees will need to consider.