(This editorial first appeared in the Tennessean’s online edition on June 21, 2017, prior to the introduction of the Senate Better Care Reconciliation Act.)

Tennesseans have a long tradition of neighbors helping neighbors, including community members taking the initiative to increase access to health care in their communities. This proud tradition is exemplified by Tennessee’s 187 Community Health Center clinic sites -- locally governed, non-profit organizations that provide primary health care services. Located in economically distressed rural and urban communities, health centers also are economic anchors that create jobs and improve neighborhoods. Today, Tennessee’s Community Health Centers are facing a unique set of challenges that threaten their future sustainability: changes proposed by the American Health Care Act (AHCA); a reduction in funding from the state for care provided to uninsured adults; and a funding shortfall at the federal level.

The AHCA, passed by the U.S. House on May 4, will bring many detrimental changes to the health care system, including drastic cuts to Medicaid, weakened consumer protections for individuals with pre-existing conditions, and more expensive health care coverage for some low-income, elderly, and rural residents. Additionally, based on an analysis by the Congressional Budget Office (CBO), the AHCA will increase the number of uninsured individuals by 23 million by 2026. Most concerning for Community Health Centers and their patients, under the AHCA, federal Medicaid dollars to states would be capped, meaning the federal government’s contribution to care for eligible adults, disabled enrollees, enrollees age 65 or older, and most children would not keep up with needed funding. Approximately 35 percent of health center patients in Tennessee are covered by Medicaid or TennCare, so reductions to enrollment and covered benefits would limit the number of patients they are able to serve. Many individuals covered by TennCare are working Tennesseans whose jobs do not provide health insurance. It is in our state’s best interest to ensure that these Tennesseans retain access to health care and continue participating in the workforce.

Community Health Centers face another challenge at the State level. Next year, Community Health Centers and Charitable Clinics will receive $2.6 million less in state funds that support care to uninsured adults in Tennessee. The Health Care Safety Net Fund helps to ensure that safety net clinics are there for Tennesseans when they have nowhere else to turn for care. In state fiscal year 2016, Safety Net funding partially supported 236,556 instances of care to uninsured adults at Tennessee Community Health Centers.

Finally, Community Health Centers face a funding reduction in September when approximately 70 percent of the centers’ federal base funding expires. Congress must pass legislation to avoid this reduction; if it does not, the Department of Health and Human Services estimates that across the nation approximately 2,800 health center sites will close, 51,000 staff members will be laid off, and more than 9 million patients will lose access to care. 

The primary health care safety net in Tennessee is a community asset worth preserving and a proven model of a successful public-private partnership. Health centers deliver cost-effective care that provides a return on investment by keeping people out of the emergency room, treating illness early to avoid costly hospital stays, and improving the health of the community’s workforce. For 50 years, Tennessee communities have been building and strengthening a network of clinics that now serve 384,411 Tennesseans, including 98,195 children and 5,911 veterans. On behalf of these patients, please urge your U.S. Representatives and Senators Alexander and Corker to carefully consider how Community Health Center funding reductions and drastic reductions to Medicaid funding will impact your community and your neighbors.

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