The major budget-slashing measure Congressional Republicans passed last week contained a funding cut that could force the two-year-old public health clinic in Kalispell to close its doors.
“The cuts in the continuing resolution will defund 127 new access programs,” Wendy Doely, executive director of the Flathead Community Health Center, said, “which essentially means that we would close.”
“The only one in Montana that will disappear if this goes through is us,” she added.
The Flathead Community Health Center is approaching the end of a two-year operating grant provided through the American Recovery and Reinvestment Act, also known as the stimulus. The House voted Saturday to slash more than $60 billion from the federal government in the Continuing Resolution, which funds its operations for the next seven months. The reduced budget sets up a showdown with the Senate’s Democratic majority and the White House.
Doely said if the funds aren’t restored at some point in the budget process, she is unsure how long the health center can remain open. The grant currently funding its operation expires at the end of February, and both the House and Senate must reach a budget compromise before the measure currently funding the government expires March 4.
House Republicans also eliminated Title X funding, which pays for family planning services. The Flathead health center relies on Title X for contraception and cancer screening services, among other uses. Though the Title X cut was aimed at abortion providers like Planned Parenthood, Doely was clear that those funds are not used for abortions at the Flathead Community Health Center.
“We absolutely are prohibited from doing that,” she said.
The Flathead Community Health Center first opened on a limited basis in 2007, but received a federal grant under the stimulus in March 2009. Located on the third floor of the Earl Bennett building, the center had 13,000 visits, serving 5,500 patients last year, Doely said. It employs three physicians, five nurse practitioners, three dentists and a dental hygienist.
Of the patients receiving care there, 61 percent have no health insurance, Doely said, and most of the rest have Medicare or Medicaid. Because care is provided on a sliding-fee scale, no one is turned away due to inability to pay.
Doely acknowledged that, because the health center was expanded with stimulus funding, it operated in a financially tenuous environment, but over the last two years she hoped that the deep need for low-cost health care in the Flathead would increase the likelihood of receiving ongoing operating funds.
“To just remove the money – what about the two-year investment?” she said. “That doesn’t seem to be a very cost-effective way to do business.”
Doely also noted that many patients served by the health center receive preventive care for chronic conditions like diabetes or hypertension. If the health center closes, those patients could cost the health care system more because they won’t seek treatment until their conditions worsen and require hospitalization.
“They end up on the doorstep of the emergency room when they’re sick,” Doely said. “You can think of the impact that this is going to have.”
Also on the chopping block in the Continuing Resolution is the Community Health Center program, which could lose $1.3 billion in funds. According to the National Association of Community Health Centers, funding cuts to the program will result in a loss of more than $2 million to Montana, and the elimination of 54 jobs.
Reached last week while the House debated the Continuing Resolution, Montana Rep. Denny Rehberg, chairman of the Appropriations Labor and Health and Human Services subcommittee, said the current position of the Kalispell clinic underscores why he so strenuously opposed the stimulus in the first place.
“The stimulus bill was not intended for ongoing expenses,” Rehberg said. “If it was an expense that was then going to be incurred year after year after year, then that was not stimulative.”
“This is a perfect example of why we said the stimulus plan wasn’t going to work,” he added. “If their doors are open because of a stimulus grant, that seems intended to be a one-time grant.”
Rehberg went on to emphasize that his committee adjusted funding based on regulations in the new health care law, where roughly half the funding for health programs that was previously discretionary is now mandatory. So to fund the Community Health Center Program an additional billion dollars when expanded funding was already contained within what Rehberg derisively calls, “Obamacare,” would have increased funding at a time when the federal government faces trillion-dollar deficits.
“There is no cut in community health center funding,” Rehberg said.
“The Obama Administration is turning their back on the Flathead Health Center, not Congress, because we’re giving them the same $2 billion that we always did,” he added. “They ought to be mad at the Administration, not Congress.”
Expansions in Medicaid, he added, should be sufficient to compensate for the end of Title X funds.
“The majority of the money for the low-income care actually comes from Medicaid, so it’s a duplication,” Rehberg said. “The community health center in Kalispell has access to Medicaid,” along with state and local funds.
But Doely noted that Republican lawmakers at the state level are moving to reject federal funds dedicated to a mandatory increase in Medicaid, with some talk of withdrawing Montana from Medicaid entirely. In that case, no health clinic in the state would be able to apply for the funds.
Doely is monitoring the budget debate in Congress, and hoping something emerges that will allow the Flathead Community Health Center to continue operating.
“I’m very hopeful that because we do good work, at some point in this process that things will get turned around,” Doely said. “We need to be here next year at this time.”
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