The Unkindest Cut?

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JONATHAN COHN FEBRUARY 17, 2011

The Unkindest Cut?

Republican promises to defund the Affordable Care Act and, perhaps, turn Medicare into a voucher scheme are getting a lot of attention right now. And rightly so. But the Republicans are also proposing a more immediate cut in health care spending--one that could impose real hardship on a population that can ill afford to bear it.

Specifically, the House Republicans propose to reduce federal funding for the health clinics known as "federally qualified community health centers." The change would take effect in the very near future, since it's part of the House Republican proposal for financing government operations through the end of this fiscal year. (Remember, last year's Congress passed only temporary spending bills, which are set to expire in March.) 

How big is the cut? On paper, House Republicans propose to reduce clinic funding from current levels by $1 billion, or roughly a third of their total federal funding. Calculating the precise impact of those cuts is tricky, because the clinics are presently drawing money from different federal sources and funding has increased in the last few years. But, based on estimates from the Senate Appropriations Committee and the National Association of Community Health Centers, it sounds like more than 100 clinics could close and more than 1000 clinics could reduce services, leaving around 3 million people without a regular source of affordable health care.

Although I can't vouch for the precision of these figures, I have no doubt the cuts would have a significant impact, particularly at a time when high unemployment means even more people than usual lack health insurance. Worse still, the Republican spending bill would effectively eliminate new money, allocated by the Affordable Care Act, that was supposed to finance the building of new clinics and the further expansion of existing ones. The hope was that these new clinics would enlarge the country's primary care workforce, reducing the strain on existing professionals and easing the transition to nearly universal coverage.

Well, but maybe this program has a lot of waste in it? I don't think so. Having visited literally dozens of these clinics around the country, I can tell you that the people who run these clinics not only do the lord's work. They also do it efficiently. Precisely because the need for their services always exceeds the resources at their disposals, they know how to squeeze the most health care value out of every dollar, all while providing the kind of support services that their low-income communities need. 

If you want to get a sense of what I'm talking about, take a look at the St. John's Well Child and Family Center in South Central Los Angeles. Services there include dental care, parent workshops, literacy programs for children entering school, and so on. On one of my visits to St. John's a few years ago, a staffer told me that clinic workers were visiting patient homes to inspect for environmental hazards. Cockroaches nestling inside children's ears had apparently become a major problem, to say nothing of asthma and lead poisoning that are bona fide epidemics in that community.

If the case for funding these clinics seems a bit too bleeding heart for your sensibilities, consider that uninsured people who don't get primary care tend to end up in the emergency room, contributing to overcrowding and generating bills that hospitals eventually pass onto everybody else. That's one reason community clinics have traditionally enjoyed bipartisan support. In fact, it was the one health care program for low-income Americans that the Bush Administration endorsed consistently and enthusiastically, with dollars as well as words:  "This is a really good use of taxpayers' money," Bush said at one point. "It makes a lot of sense to have Community Health Centers so that we can cut down on unnecessary visits to the emergency rooms. Health centers help lower the cost of health care for everyone.”

Update: I forgot to mention something. Downsizing or shuttering clinics also means laying off some of the people who work there. How many jobs are we talking? The Center on American Progress pegs the loss at 178,000 in the next year. I can't speak to that figure's veracity, but I am confident that the job loss, like the effect on available medical care, would be real.

Update 2: Not surprisingly, DailyKos blogger DrSteveB was all over this story a few days ago. I say "not surprisingly" because DrSteveB is a New York pediatrician and epidemiologist who has worked closely with federal health clinics for many years. Also, he's a very smart guy who usually has important things to say about health care policy. His item in worth reading in full, as it provides a history of the clinic program and an explanation of how it works.

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posted in: jonathan cohn, politics, bush, congress, medicare

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