lynn_121109_10

lynn_121109_10 by Martha Coakley

I thought the President was pretty clear yesterday – he thinks we’ve cut the domestic and defense budgets to the bone, and any future savings must come out of a combination of tax revenues and so-called “modest adjustments” to health care programs. So you can forget about that defense-heavy trigger being fired, and even if it is, the defense lobby will have all of 2012 to come up with a substitute for the cuts. And some of the potential areas for cuts in that trigger include some of the best spending in the Affordable Care Act, for community health centers.

Health care experts Monday warned that the nation’s debt crisis could lead to budget cuts that could cripple the nation’s $11 billion plan to expand primary health care [...]

Maddux-Gonzalez, who is now chief medical officer for the Redwood Community Health Coalition, said that earlier this year Congress reduced funding to health centers by $600 million.

The association, in a report issued Monday, found that for every $1 million in federal funding cuts, health centers lose the capacity to serve 8,297 patients. The group also found that the number of uninsured patients at health centers grew by 36 percent between 2004 and 2009, even as state funding to health centers decreased by 42 percent in the past two years.

With this and with the potential for cuts to expanded Medicaid, you’re seeing the seed corn of the Affordable Care Act, the very elements that made some liberals in Congress believe it was worth supporting, possibly bargained away. This is a dynamic we’ve already seen with the exchange subsidies, already reduced once to pay for the cancellation of enhanced 1099 reporting, a pay-for in the ACA. Exchange subsidies could be reduced as part of a trigger, and so could funding for community health centers. On the opposite side of the ledger, while Medicaid is protected from trigger cuts, it could wind up being reduced through the Catfood Commission II if they actually make a deal.

These community health centers are really transformative for low-income Americans. Health and Human Services just awarded 67 community health centers with additional funds, part of the ACA grants. $11 billion is slated to pour into community health centers over the next five years. This does not just move the country toward universal health access, but toward something akin to the NHS in Britain – with funded health centers providing whole-of-care service to all residents. With the cost-saving potential of early prevention and things like accountable care organizations, community health centers fit perfectly into a model of spending less on health care with better quality.

So to take any of this funding away would be a tragic rollback of the very priorities the Administration claims to support.