When Congress finally passed a continuing resolution last month allowing the government to re-open, there was much rejoicing. In addition to agreeing that continuing basic government services is a good thing, lawmakers reauthorized the Children’s Health Insurance Program, or CHIP, which provides critical funding for more than 10 million children nationwide. Unfortunately, CHIP was but one in a long list of “must do” items that, for one reason or another, was left undone.
Another possible government shutdown looms this week, and a number of outstanding health care items still requiring action include funding for Community Health Clinics, or CHC’s, and for the so-called Medicare “extenders.”
CHC’s are nonprofit health care practices that provide comprehensive, patient-centered primary care to those who otherwise cannot afford or access care. In North Carolina alone, CHC’s served more than half a million patients in 2016. The most outrageous part of the failure to fund them is that both Democrats and Republicans support CHC’s, and no one has given a reason why their funding has been allowed to expire. Failure to renew CHC mandatory funding will mean a loss of $83 million to the state’s economy, thousands of jobs, and even more lives.
Also left out of the continuing resolution are the Medicare extenders. These are a package of programs added over the years to help Medicare function properly by addressing specific shortcomings or performance deficiencies in the original law. These extenders are routinely authorized by Congress because, if they are not, the Medicare system begins to destabilize.
Programs such as the Medicare Dependent Hospital Program and Low-Volume Adjustment Program, the geographic payment cost index for physicians, or the Extension of State Health Insurance Assistance Programs don’t sound sexy or garner headlines, but without them, the problems with Medicare, and those who are dependent on it, begin to mount.
During his State of the Union address, President Trump talked a lot, but he didn’t say that his tax giveaway to millionaires and Wall Street is largely paid for with healthcare cuts. To pay for the permanent corporate tax cut which lowers taxes for big corporations like Apple, Pfizer, Wells Fargo and many others from 35 percent down to 21 percent, the tax plan repeals the individual responsibility provision of the Affordable Care Act. This change in the ACA will destabilize markets, strip 13 million Americans of health insurance, and raise premiums 10%.
One direct impact of these ACA and Medicaid cuts is making the opioid crisis even worse by denying treatment to people who could recover if they had coverage and care. At the same time, rewarding prescription drug companies with big tax breaks under the new law won’t do anything to stop the over-prescription of drugs or hold them accountable for their role in the crisis.
An added threat is the reduction of substance abuse services that CHC’s normally offer. Three cities in North Carolina fall in the top 25 in rates of opioid addiction nationwide, and there are CHC centers currently serving all of these areas. If they disappear, who will step in to get these people the care they need? It’s a recipe for disaster brewing in our state.
Republicans in Congress spent nearly all of 2017 trying to take health care away from millions of people in order to keep their campaign promises and please their corporate donors. But for families, seniors, people with addiction or disabilities, and many others in North Carolina, our health care isn’t about partisan politics. Health care is personal, and is fundamental to our well-being and to providing for our families.
Other large, and more widely-reported threats to quality, affordable health care access loom in 2018. Will the GOP resume its “repeal and replace” holy war against the ACA? Will Congress make the substantial changes and cuts to Medicaid that Speaker Ryan and many other Republicans endorse? Will Medicaid expansion happen in our state and others in exchange for work requirements? What will be the fate of the cost-sharing subsidies that have made expanded coverage under the ACA possible? Will “Medicare for All” gain greater political support in this election year?
Coverage and cost concerns abound in a health care delivery and insurance system that represents more than one of every six dollars spent in the U.S.. It’s hard for all of us to comprehend what reforms make sense. But let’s keep our eyes on the CHC’s and Medicare extenders this week. These funding decisions should be no-brainers. Whether Congress has the brains to make them is less certain.
Kevin J. Rogers, JD, is the director of policy and public affairs for Action NC and a lecturer of government and political science at William Peace University in Raleigh.