The community health centers where more than 106,000 Montanans get care are worried they could lose 70 percent of their federal support if Congress allows funding to lapse at the end of the month.
About one in 10 of the state’s residents see a primary care doctor, get help with chronic conditions, have their teeth cleaned or see a mental health professional at one of Montana’s 17 community health care centers.
The Community Health Centers Fund was first approved by Congress in 2010 as part of the Affordable Care Act and extended for two more years in 2015. But without action in Washington by Sept. 30, it will expire.
Nationally, it’s estimated that more than 2,800 community health centers will close, more than 50,000 will lose jobs and 9 million patients will lose access to care if funding expires. Sixty-one senators, including Montana’s Steve Daines, a Republican, and Jon Tester, a Democrat, have signed on to a letter supporting the funding.
In Montana, 17 community health centers account for 407,084 patient visits a year. About 20,574 patients are children and adolescents and 85,768 are adults, according to information from the Montana Primary Care Association. The association estimates the centers lower medical costs for patients by about 24 percent and have saved the state's overall health system $134 million.
Many of Montana's centers say they would have to drastically reduce services if funding expires.
Cindy Smith, the CEO of Bullhook Community Health Center in Havre, said her facility sees about 5,000 people a year, about 15 percent to 20 percent of whom are uninsured. About 70 people work there.
If Bullhook loses 70 percent of its federal funding, it would end up with just a little over $500,000 in federal funding. That loss of money would make it nearly impossible to offer things like a sliding scale for fees that make care possible for many.
“I might be able to keep providers in place because you still need those providers, but we’d be running at minimal staffing levels,” Smith said. “We need to try to keep providers in place to meet some patient needs. It would be really difficult to do the sliding fee scale as much as we do. It could be a devastating impact.”
Katherine Shrauger, the outreach and enrollment coordinator for Bullhook, said the health center provides huge savings to individuals, the community and the state.
A study done by the National Association of Community Health Centers shows community health care centers provide $24 billion in health care cost savings by keeping people from seeking more expensive care in emergency rooms and by treating conditions before they become severe or chronic.
“It empowers them,” Shrauger said about patients. “I can think of patients that seem more confident because they know they can come in here and get to see a provider and know they’re going to get better. There are people out there who haven’t been to the doctor in 20 to 25 years. And they’re the lucky ones who don’t have anything wrong.”
PureView Health Center, another community health center, has locations in Helena and Lincoln and provides medical, dental and mental health care. Chief Executive Officer Jill Steeley said the center sees about 7,840 people a year, including 805 in the small town of Lincoln. About 400 people experiencing homelessness use the center each year.
That equates to more than 25,045 visits. Most are for medical care and about 15 percent are dental visits. Between July 2015 and December 2015, the center had 1,951 mental health visits. The center also serves about 400 veterans a year.
Of the center's patients, about 30 percent receive Medicaid, 20 percent are uninsured, 20 percent get Medicare and the rest are otherwise insured. Even more important, Steeley said, about 36 percent of patients are at 100 percent or below the federal poverty line.
At PureView, the reduction in funding “would be a drastic cutback of services and a drastic decrease in the amount of patients we’re able to serve each year,” Steeley said. "The number of uninsured or under-insured people we would be able to see would be reduced greatly."
Patients at community health centers get care from a whole team: doctors, nurses, therapists, case managers, diabetes educator and clinical pharmacists who help them understand how medications interact. Most of those positions are not billable and depend on the federal dollars, Steeley said.
Shrauger, at Bullhook, works to enroll people into health care under the Affordable Care Act and Medicaid. She is worried about the possible double hit from the federal cut and the state of Montana’s move to lower the rates it reimburses for Medicaid services.
If both were to happen, “we wouldn’t be able to keep our doors open very long,” she said.
Anyone can use community health centers, rich or poor, insured or not, Shrauger said. A lot of people who end up with chronic illnesses, like hypertension, diabetes, chronic obstructive pulmonary disease or other heart conditions rely on providers at Bullhook.
Bullhook’s sliding fee scale, which is based on income and household size, would be at risk if federal funding were lost. It’s a critical tool for people to access care, Shrauger said.
“Even if people have insurance, say they don’t make very much money, they can still qualify for our slide,” she said. “If they qualify for the slide, they're going to be able to use that for health care before their deductible kicks in.”
Bullhook also provides treatment for addiction and behavioral health issues. The center wouldn’t be able to provide as much of that type of care if federal funding were lost, Shrauger said.
“I can’t even imagine what would happen to them,” she said. “It’s scary right now.”
Bullhook is essential for patients like one man Shrauger said hit a bad string of luck and would have been without care if not for the center.
She signed the man up for an insurance plan offered under the marketplace established through the Affordable Care Act. Shortly after, he had a stroke. When he was recovering from the stroke, he fell and ended up needing to have his little finger amputated. Then he fell on the ice and broke his hip.
Within 17 months he lost his job, his income and his insurance. Then he got a toothache.
“He knew he could come into Bullhook and not have to pay up front,” Shrauger said. What he didn’t know was that she could also sign him up for coverage under Medicaid expansion, which she did.
“It actually saved his life because from my office I went and got one of the mental health counselors, who helped him with his depression and so on… He was in debt up to his eyeballs, but at least he has coverage if something happens again.”
Shrauger said she sees people who are incarcerated worry about how to get medical care when they’re not in county custody.
When people are in jail, “they know they’re going to get their medication, they know they’re going to get their diabetes or high blood pressure medication, or whatever they take. When they get out, they get in trouble and go back in because they know they’re going to get their medicine.”
At Bullhook, Shrauger can often sign them up for Medicaid coverage.
“It’s until they can get on their feet and get a job,” she said. “Once they know they can feel good because they’re going to have their medication, it’s much easier to get a job.”
It's unclear when the Senate will pick up the funding issue, but with 60 senators in support, some see reason to hope. Still, Montana's delegation is raising concerns as the deadline looms.
“Without extension of the CHCF, community health centers will lose 70 percent of their funding,” Daines said. “ … We are already hearing of the disruptive effects of the uncertainty created by the impending funding cliff on health center operations. This disruption will increase significantly without an extension of funding by Sept. 30.”
Tester also called for quick action.
“Instead of working together to support community health centers, lower costs, and increase access to health care, some folks in Congress are pushing a dangerous bill that will devastate rural America. Washington politicians must start listening to Montana families and stop trying to dismantle health care.”
Although House approval is not needed to keep funding for the health centers in place, Gianforte said he supports keeping it at current levels.
“I appreciate the critical role community health centers play in ensuring the health and well-being of Montanans. They provide access to quality health care for those who would otherwise not have it, including Montanans in our rural communities,'' Gianforte said. "Extending funding for our community health centers remains one of my top priorities.”