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Lame-duck Congress should fix the ‘primary care cliff’

REUTERS/Jim Young
Unless Congress fixes the cliff by reauthorizing the Community Health Centers Fund, thousands of low-income Minnesotans will lose access to their primary care.

With the 2014 elections behind us, political pundits have launched into an optimistic refrain that Washington will transform into a political environment with compromises and deal-making between the president and the new Congress.

But before we reach 2015, the current Congress is in a lame-duck session. Expectations are low, given the fact that the 113th Congress is one of the least productive of all time — enacting only 185 bills into law. (For perspective, the “Do Nothing” Congress of 1947-48 enacted 906 laws.)

Jonathan Watson

Election 2014 polling suggests that one of the public’s main priorities is for the upcoming 114th Congress to work together and get something done. Why should we have to wait? Why shouldn’t the lame duck session provide the next Congress with a bipartisan head start?

It could do so by fixing the “primary care cliff.” Unless Congress fixes the cliff by reauthorizing the Community Health Centers Fund, thousands of low-income Minnesotans will lose access to their primary care – specifically the medical, dental and mental health services provided at one of Minnesota’s 17 Community Health Centers operating at 72 sites throughout the state. Congress’ failure to deal with the cliff will lead to higher health-care costs, difficult access to cost-effective preventive services and jobs lost in neighborhoods and small towns that can least afford it.

Serving urban and rural areas

Community Health Centers have been around for almost 50 years throughout the United States and in Minnesota. These patient-directed, nonprofit organizations serve neighborhoods and towns ranging from Minneapolis’ Phillips and Near North neighborhoods to rural areas such as Cook and Northome on the Iron Range and Worthington and Marshall in the southwestern portion of our state. Health centers are not only in the communities they serve but are a part of the communities in which they thrive.

The common thread running through these urban neighborhoods and rural towns is the fact that without a Health Center, access to primary health-care services would not exist.

So what happens if Minnesota’s Health Centers go over the “primary care cliff” due to congressional inaction? Or, put a better way, how do Health Centers improve the health of communities and control health-care spending? A few examples answer this question and demonstrate the impact of Health Centers for Minnesota’s low-income populations:

  • In Minnesota, Health Centers serve 9 percent of the Medical Assistance population and spend only 0.6 percent of the MA budget.
  • Health Center mothers give birth to fewer low-birthweight babies in every race/ethnicity when compared to the state’s general population.
  • Community Health Centers participating in a payment reform demonstration project reduced their patients’ emergency department visits by 10 percent in only one year.
  • Health Centers generate roughly $215 million in annual economic activity – in some of Minnesota’s poorest neighborhoods and small towns.

These measures are impressive — especially since Health Centers serve a population living in poverty.

For five decades, bipartisan support

Equally significant is the political support for Community Health Centers over the last five decades. Few national programs received such extensive bipartisan support as Health Centers. Both the late Massachusetts Sen. Ted Kennedy and former President George W. Bush gave extensive support to Health Centers.

Both of these leaders, and many more between them on the political spectrum, understood that Health Centers provide access to primary care services, reduce health disparities, control health-care costs and serve as economic engines in blighted urban and rural areas.

In addition to keeping Health Centers open, fixing the primary care cliff will also safeguard America’s future primary care work force. By maintaining the National Health Service Corps and the Teaching Health Centers program, Congress can ensure that Minnesota has an adequate and diverse medical, dental and mental health work force.

Everyone has heard the term “too big to fail,” a reference from the global financial crisis of 2007-2010 to elements of our banking/finance industry. Community Health Centers are, in contrast, “too effective to fail.” Fixing the primary care cliff during the lame duck session would prove the pundits right (for once): Congress can indeed work together and avert a health-care crisis of primary care in our state.

Jonathan Watson is the director of public policy at the Minnesota Association of Community Health Centers, Minneapolis.

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