Congress' indecision leaves Minnesota safety net clinics paralyzed

Nearly 70 of Minnesota's safety net medical clinics, with thousands of patients, face an uncertain future because Congress has failed to reauthorize their federal funding, leaving them unable to fill doctor vacancies or plan out services for the year.

The program brought $27 million to Minnesota, supporting free or affordable care for more than 50,000 patients who lack health insurance. Before Congress left for the holiday break, and three months after the program's funding expired, lawmakers did authorize a 90-day extension, but they were unable to reach a permanent fix even though the program enjoys bipartisan support.

Clinics say the temporary extension prevents them from making big decisions at a time when demand for their services could increase because of recent changes to the Affordable Care Act and proposed cutbacks to the Medicaid program for the poor.

"It hasn't changed my long-term anxieties any," said Kristi Halvarson, executive director of Community Health Service, based in Moorhead.

The clinic would take a 60 percent funding hit if its $2.5 million grant is not renewed, endangering care for the 85 percent of its patients who are uninsured. Most are migrant or seasonal farmworkers who get care at four clinics, a seasonal site and two mobile clinics. They are often the only sliding-fee scale option in a service area that encompasses southeastern, west-central and northwest Minnesota.

"It buys us a little bit of breathing room, but it still makes me hesitant to hire staff or plan expansion projects because we don't have that full-time guarantee," Halvarson said.

Before Congress passed the temporary extension, Halvarson anticipated that she would have to announce layoffs or service cuts last week, a move that would be difficult to undo once taken.

"Once we lay off staff and not renew leases it is hard to go back," she said.

The clinic, founded in 1973, has seen its patient base gradually evolve. There are fewer migrant workers than before, partly because weed-resistant seeds and mechanization have reduced agriculture's demand for hand labor and weeding.

Still, 70 percent of its patients are farmworkers, mostly local residents who have seasonal jobs.

The clinic was taking steps to expand beyond agricultural workers.

"We recognize that there are other underserved folks and we can fill that need," said Halvarson.

Like many other safety net clinics, Community Health Service sees a lot of patients with chronic conditions, including diabetes, obesity, heart disease and mental health problems. The clinic also runs a battered women's program in concert with other agencies.

Although Congress provided funding for safety net clinics through March, the issue of permanent funding will be taken up again in January, when the lawmakers will face another deadline on a government spending bill, something they were unable to pass before the holiday break.

Minnesota's congressional delegation has gone on record in support of continued funding for the safety net clinics.

"Both Democrats and Republicans alike kept reiterating to us that they are going to fix it, but they just ran out of time," said Jonathan Watson, executive director of the Minnesota Association of Community Health Centers, which represents the 16 nonprofit clinic groups that receive the federal funding.

Disagreements over how to pay for federal safety net clinic funding, however, could further delay a permanent fix, creating more uncertainty.

"It is impossible to run a business and not know what is going to happen three months from now," said Ann Cazaban, executive director at Southside Community Health Services in Minneapolis.

The clinic gets 30 percent of its budget from the $2.55 million the federal funding provides.

"We anticipate that we will not survive" without the funding, Cazaban said. "Right now we are just living day by day."

Founded in 1971, the clinic provides care to many in the Hispanic community, including undocumented workers who do not qualify for government health programs such as Medicaid and MinnesotaCare.

About 30 percent of its 9,000 patients are uninsured.

Southside needs to hire a doctor and a dentist, but Cazaban said she can't make job offers given the financial uncertainty.

"I don't want them to come to us and then [have to] say. 'Sorry, you are going to have to find another job,' " she said.

Like other safety net clinics, Southside hires doctors, nurses and other professionals through the National Health Service Corps program, which offers student loan repayments and scholarships to those who agree to take jobs in underserved communities. The program, too, just got temporary funding.

"That is our No. 1 recruiting tool," said Cazaban. "That is a huge benefit to people."

Cazaban said that without safety net clinics, more people will have to use hospital emergency departments, where care tends to be much more costly.

"They are forgetting that this affects real people," she said. "It is not like these uninsured people will go away."