The Brass Tacks of Budget Cuts: The Precarious Future of Community Health Centers

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August, 2011; Source: Governing Magazine | We’re no longer talking about “marginal” cuts to health and human services programs, are we? With federal and state budget cuts cascading down to nonprofits, some parts of the sector are now asking questions about basic survival.

In its August 2011 issue, Governing Magazine inquires as to the future of community health centers. If the Affordable Care Act (ACA) does in fact go fully operational—by no means a certainty given the recent spate of conflicting court decisions and a bevy of budget-related attacks in Congress—the whole issue might be moot. But the ACA isn’t supposed to get totally underway until 2014. And even then, many people might be left without health coverage, which means they may have to turn to nonprofit community health centers for primary-care services.

Governingnotes that more than half of the 50 million Americans who it says lack health insurance are African Americans. Without access to community health centers, un- and underinsured people turn to hospital emergency rooms for primary health care, a very expensive alternative. (To get an idea of the cost difference: Governing reports on a recent demonstration project in Detroit that diverted thousands of patients from the ER—where they would have cost $1,000 per visit—to community health clinics, which cost just $30 per visit.)

The ACA initially appropriated $9.5 billion for the construction or expansion of community health care centers and services in medically underserved areas and another $1.5 billion for major construction and renovation projects at existing centers. NPQ readers can guess what comes next: Budget problems have already led to a cut of $600 million in the program, and future deficit-reduction strategies will cut more. And don’t forget that in fiscal year 2011, 23 states cut their funding for health centers and another four eliminated all of their health-center funding dollars. 

Defenders say that community health clinics aren’t going to disappear, that the model has been proven to be of value, and that they are resourceful institutions that will figure out how to navigate and outlive the budget storm. Our questions: How long will that take? At what cost to the clinics? And at what cost to the millions of low-income people who currently and may well in the future lack health insurance? It’s brass-tacks time in terms of the impact of budget cuts on safety net programs.—Rick Cohen