Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.
A real-world cost of spending stalemate
Critical funding for community health centers, which provide primary care to underserved rural and urban locations, is caught up in the congressional standoff that could cause a government shutdown.
September 20, 2023 at 10:45PM
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Northeast Minnesota's Scenic Rivers Health Services is a close-to-home example of the type of community asset that's at risk because of congressional gridlock and a potential government shutdown.
Its 11 medical and dental clinics provide care for 14,000 patients across more than 8,500 square miles. Locations include Cook, Tower, Northome, Eveleth, Floodwood, Big Fork and Big Falls.
Federal dollars provide about 25% of Scenic Rivers' budget. The health care system is part of the nation's network of 1,400 community health centers, which provide affordable care to patients in locations often unserved by traditional clinics.
The current three-year funding authorization for these critical centers expires at the month's end. Legislation to extend it, as well as a sensible bipartisan deal to increase it, is bogged down in the standoff in Washington, D.C., over next year's appropriations. While Scenic Rivers has reserves to keep its doors open should a shutdown happen, a prolonged one would significantly stress its resources, particularly with rising patient care demand and the need to compete for staff in a historic labor force shortage.
The uncertainty created by Congress means "You can't make any long-term plans," said Scenic Rivers' CEO Keith Harvey. "How can you run a business doing that?"
Community health centers in Minnesota and elsewhere are grappling with the same worries, with some not as well-positioned as Scenic Rivers to withstand the impact. This is alarming because this health care network is among the nation's largest primary care providers, serving 31 million patients nationwide. That's 1 in 11 Americans, a sobering reality adding to the many reasons a congressional spending agreement best serves the public.
Unfortunately, there's a tendency to dismiss a shutdown's real-world impact. On a Sunday appearance on ABC's "This Week" news show, U.S. Rep. Nancy Mace, R-S.C., downplayed the ripple effects, essentially boiling it down as vacation for federal employees.
On Monday, the National Association of Community Health Centers (NACHC) offered a more troubling view. In a news conference, the organization's leaders sounded the alarm about the funding extension's lack of progress. Without congressional action, the federal Community Health Center Fund will expire on Sept. 30. The fund provides about 70% of federal assistance to health centers.
Mike Taylor, CEO of Cornell Scott-Hill Health Center in New Haven, Conn., noted that community health centers already operate on slim margins. Even a brief interruption in federal aid could result in staff departures, shorter hours and reduced services — with the impact not easily reversible.
Taylor said he was "begging Congress on behalf of our patients" to do everything possible to reauthorize community health center funding. "Literally lives depend on this specific funding," he said.
In Minnesota, community health centers are also vital providers of primary care in the Twin Cities. Dr. Roli Dwivedi, CEO of the University of Minnesota Community-University Health Care Center in south Minneapolis, joined the plea to extend funding expeditiously. The center has more than 10,000 patients, many of them immigrants.
Federal dollars provide about 10% of the south Minneapolis center's budget. Patients' medical needs won't stop and start while Congress deliberates, Dwivedi told an editorial writer. "We have to be there for them ... every single day," she said.
The alternative to the low-cost care provided at Dwivedi's center? More expensive care at emergency rooms, for example.
Total federal appropriations for community health centers in 2023 came to $5.75 billion. That's up from $3 billion a decade ago, a healthy trend but one that hasn't kept pace with the increased patient demand and staffing costs, according to the NACHC.
Earlier this month, Sen. Bernie Sanders, I-Vt., and Sen. Roger Marshall, R-Kan., announced a deal to increase health center funding as part of an initiative to address primary care shortages. One laudable component: providing "$3 billion in capital funding primarily to enable community health centers to expand dental care and mental health care in their facilities."
The fate of this worthy measure is uncertain as political theater continues to take precedence over serious efforts to reach a spending agreement. Community health centers have long enjoyed bipartisan support because they're a health care safety net in rural and urban areas. That's a patch of common ground for lawmakers, one that perhaps could lead to a broader deal averting a shutdown.
Now that Gov. Tim Walz’s vice presidential bid has ended, there’s important work to do at home. Reinvigorating that “One Minnesota” campaign is a must.
