The American fiscal cliff is making us sick

Being sick of partisanship is one matter. Getting sick from it is another.

Yet that’s exactly the scenario as of October 1. Consumed by its failed repeal of the Affordable Care Act, Congress missed the deadline to vote to reauthorize the Community Health Centers Fund, a vital source of funding for local health centers. Now at risk are the 27 million Americans — children, veterans, farmworkers, and others — who rely on federally qualified health centers (FQHCs) for primary care.

{mosads}This fiscal cliff marks an extraordinary moment in U.S. history. Few institutions have remained as truly bipartisan as health centers, a product of Lyndon Johnson’s Great Society program to eliminate poverty and racial injustice. Since then, community health centers have had universal support across both sides of the aisle. George W. Bush doubled them in number. The Affordable Care Act doubled them again.

Congressional inaction has upended it all, jeopardizing providers and patients alike. Without a fix, the country’s 10,000 health centers face a 70 percent cut in federal funding — which some lawmakers mistakenly assume will not take effect until January. In fact disruption has already started, with three serious consequences looming.

The first is increased illness among the most vulnerable Americans. Slashing funds cuts deep into both rural and urban communities.  A halt to federal funding will force 2,800 centers to close and 9 million patients to lose access to care. In these communities, which the federal government has designated as having insufficient primary care providers, the results would be devastating.  

The paradox is that what FQHCs offer — cost-effectiveness, accessibility, affordability, efficiency, cultural competence, and strong outcomes for patients — are not easily found in totality elsewhere. They provide a spectrum of care, from medical and dental to behavioral and pharmacy needs, to all ages and all comers — insured or not.  Congress’s failure to address the cliff casts doubt on their future. 

The second is an economic backslide. Jobs are suddenly in doubt for the 200,000 people working at FQHCs; more than 50,000 of them, providers and staff alike, will be laid off if funding goes unrestored. There will be no new jobs — neither permanent nor temporary, following planned cancellations or delays in construction work at 52 percent of health centers. None of the 98 percent of Congressional districts that have at least one FQHC are immune from the repercussions. 

The third is higher costs for all, from patient to taxpayer. With regular access to quality primary care, common conditions that are costly — such as diabetes, asthma, and heart disease — can be prevented or managed before they become more difficult — and more expensive — to treat. Without it, millions risk serious complications from illnesses that diminish financial security, threaten long-term well-being, and worsen other social and economic inequities.

Above all, by delaying reauthorization we cheat ourselves of a successful and longstanding investment. Health centers yield an estimated $29 billion in annual health system savings, one reason why bipartisan support has rightly endured. To withdraw resources now, from a time-tested solution that ultimately saves so many lives and so much money, undercuts all parties. Patches that would allow temporary funding instead of a long-term solution only postpone the dilemma.

But Congress can still avert a crisis. Yesterday’s House vote turned the debate toward restoring funding. The final solutions are straightforward: Reauthorize the funding necessary for maintaining and sustaining FQHCs for a minimum of two years; shield health centers from threat by eliminating expiration dates on FQHC funding; and expand the pool of dollars so that new health centers can open in every community that needs one. 

Across decades and administrations, health centers have eluded politicization to the benefit of all constituents, from every county, across every state. The current turmoil around health care need not and should not interfere; rather, it reinforces the urgency to safeguard health centers. 

No one wants to get sick. But when we do, politics is the last distraction we need — especially when it threatens lives and livelihoods. Health centers help keep the country moving, working, and thriving, regardless of political leanings. We owe it to ourselves and each other to protect them. Congress must act on our behalf to do just that.

Louise Cohen is the CEO of the Primary Care Development Corporation, a nationally recognized nonprofit organization and a U.S. Treasury-certified community development financial institution (CDFI) dedicated to health equity. You can follow her on Twitter @LouiseCohen.