Emergency aid is needed for rural, urban community health centers

Funding legislative operations will be the first order of business for Minnesota lawmakers returning to the State Capitol on Feb. 20. But if they can quickly accomplish that self-interested goal — and they will — they should also have the decency to provide temporary funding to keep the doors open at the state's vital community health center network.

The monthslong federal failure to fund these safety net clinics, which are often the only place to get care for miles around in rural Minnesota, is a stunning act of congressional negligence. Community health centers (CHCs) also operate in medically underserved areas in the Twin Cities.

Minnesota has 17 CHCs operating in 70 locations. Nationally, CHCs provide care to 27 million people in 9,800 communities. Their decadeslong work on public health's front lines has long won them broad bipartisan support, with Republican President George W. Bush making a CHC service expansion a signature health care policy.

So the shameful treatment at the hands of Congress this year comes as a shock. The deadline for reauthorizing CHC grant dollars was the end of September, when funding for the Children's Health Insurance Program (CHIP) also expired. Congress finally reached a deal on CHIP funding late this month, but CHCs grants weren't included.

CHCs nationally stand to lose about $3.6 billion a year in federal grant dollars if Congress doesn't act, with Minnesota clinics seeing a loss of $26.5 million. CHCs don't rely entirely on these federal grants, but they do make up a substantial part of their budgets. "One health center is looking at laying off 45 staff, shutting down their mobile unit and ending the on-site ultrasound for pregnant mothers,'' said Jonathan Watson of the Minnesota Association of Community Health Centers. "Another ... would lay off one-third of their staff. And another health center would be closing six sites. Another would shut down their enrollment."

In many locations, patients can't easily find alternative care. Sawtooth Mountain Clinic, based in Grand Marais, is the only clinic serving all of Cook County and the Grand Portage Indian Reservation. Duluth, as clinic CEO Rita Plourde notes, is two hours away. "We've got to be here because there's no one else,'' Plourde said Friday.

Because of the rolling distribution of federal grant dollars, Plourde's clinic won't lose federal funding — which provides a sixth of the clinic's $6 million budget — until June. But even now, she said the uncertainty is not helpful in recruiting staff. Her worries are mounting as she watches service disruptions at other state CHCs. Her message to Minnesota lawmakers: "We definitely have to have a backup plan.''

State lawmakers should respond. There are some indications that Congress could fund CHCs this spring, but there are no guarantees. Temporary state support would help CHCs already suffering cuts get back on their feet and provide certainty to others. A state aid measure could also have a sunset clause if a federal deal happens.

There is broad bipartisan support for CHCs in Minnesota. But the aid discussion is tempered with concerns about the February budget forecast. Gov. Mark Dayton is writing a letter to pressure the state's congressional delegation. And he said he is open to talking with state lawmakers about assisting CHCs.

State Sen. Tony Lourey, DFL-Kerrick, said he will push to begin legislative conversations about temporary state help, calling it the right thing to do. State Sen. Jim Abeler, R-Anoka, said he's also open to discussions.

Lawmakers are expected to move swiftly to fund the Legislature. They ought to pass temporary funding for CHCs at the same speed to ensure that patients will be able to see their doctors and get the care they need.