Ravenswood Family Health Center in East Palo Alto could lose its providers and staff after Congress failed to renew a fund that supports community health centers.
By Saturday, Congress had to vote to re-appropriate the Community Health Center Fund, which keeps community health centers across the country providing services for millions of people, but it did not get to that legislation in time, instead focusing on an attempt to repeal the Affordable Care Act, or "ObamaCare."
Some local clinics providing essential and comprehensive services for very-low-income patients and those with complex needs would lose up to 70 percent of their funding as of Saturday, when 2017 fiscal year funding ended. Among them is Ravenswood Family Health Center, also known as South County Community Health Center, in East Palo Alto that provides services to 16,000 low- and very low-income patients.
Since Congress's "funding cliff" deadline has passed, health centers such as Ravenswood will now be operating on thin margins. Ravenswood has only 15 days of cash to keep its center fully operational after funding ends. It faces a $2.7 million loss in federal funding, which could affect 1,600 patients, forcing more patients to be diverted to expensive hospitals and the emergency room.
The clinic could also lose many providers and their support staff, said Pancho Chang, Ravenswood's business strategy adviser and staff representative to the advocacy committee, which reports to the board of directors.
Chang said the center needs to expand its dental services. Other programs, such as medical services, would also be cut. Additional programs include substance-abuse assessment, hearing, vision, dental and women's health services, including breast cancer screenings.
"If we lose that funding, we will have to cut many of those services. It will be devastating for our community," Annie Wu, grant writer and program planner, said.
Other clinics have long wait lists, but Ravenswood provides high-quality services where patients don't have to wait. Women can get same-day screening for mammograms to detect breast cancer, which helps them detect the disease early, Wu said.
Nationally, an estimated 9 million patients would lose access to health care, 50,000 providers and staff would lose their jobs and 2,800 health center sites would close, the U.S. Health and Human Services Department estimates.
There's no decision yet on what percentage of Ravenswood staff would be cut.
The loss in funding would also have a trickle-down effect. Stanford Health Care sees patients that Ravenswood cannot see "and at a significant financial loss to themselves," Chang said. San Mateo County also faces pressures to absorb costs related to children who will lose funding through the Children's Health Insurance Program (CHIP). Nationwide, an estimated 9 million children could lose coverage through that program, and its funding also ends Saturday unless reauthorized, Chang said.
Ravenswood staff and patients have been advocating for Congress to quickly approve the funding. The center has created a phone script and phone contacts for congressional representatives that staff and patients can call if they choose. Each Wednesday, the center distributes flyers at the city's farmers market and to local organizations, said Katie Bick and Virginia Wang, who are working on the advocacy project, said.
The Health Center Program is currently authorized in Section 330 of the Public Health Service Act. The program is financed through a combination of discretionary funding passed by Congress through regular appropriations for each fiscal year and mandatory funding under the 2010 Community Health Center Fund (CHC). Congress initially approved $11 billion through five years for health centers. It extended the Community Health Center Fund in 2015 for two more years through fiscal year 2017.
According to the nonprofit Kaiser Health News, the Republican Party's focus on repealing the Affordable Care Act before end of September caused a stalemate on other health legislation, including the Health Center Program and the Children's Health Insurance Program. Legislators are not expected to clear the backlog quickly.
U.S. Rep. Anna Eshoo, D-Palo Alto, a member of the Energy and Commerce Committee, which will discuss legislation this week, said in an email statement: "I will be actively participating in the markup of CHIP and CHC legislation, which are currently scheduled to be taken up by my committee on Wednesday, Oct. 4.
"CHIP and CHC funding are critically important to reauthorize. This funding goes to the healthcare of millions of children in our country, and provides resources to Community Health Centers, such as Ravenswood. Congress should not allow any lapse of funding and I will continue to do everything I can to see that we keep our commitment to those who need it."
In addition, bipartisan legislation, the Community Health Investment, Modernization and Excellence (CHIME) Act of 2017, would extend the Community Health Center Fund for an additional five years.
Eshoo said that currently, the Energy and Commerce Committee's leadership is negotiating with House leadership on what the final package will be. The CHIME Act, however, is not expected to be the final language.
For Ravenswood and other clinics, the timing could be critical. Even if Congress passes legislation in time for the Jan. 1 funding cycle, there's still a gap to fill in the meantime, and it's going to bleed into health centers.
"As of Saturday, we are unfunded," Chang said, referring to the federal program, but not other funding. "We are looking to get the five-year re-authorization done. If there is a God, we hope that she/he will help to get Congress to retroactively fund this gap," he said.
Not all health centers will lose federal funding.
Mayview Community Health Center, which has a clinic on Grant Avenue in Palo Alto and additional locations in Mountain View and Sunnyvale, is not affected by the health center funding because it does not receive any monies through that program, CEO Kelvin Quan said. But it does receive some funding through the CHIP program.
Quan said he has not yet analyzed how the loss of CHIP would impact the clinic or its clients at this point. The bigger focus for Mayview has been the Affordable Care Act, which would affect many of the center's patients, he said.