Sonoma County health centers could lose millions without action by Congress

The largest health centers in Sonoma and Marin counties stand to lose more than $15.3 million in federal funds by the end of the month, a financial blow that has nothing to do with latest effort to repeal former President Barack Obama’s signature health care law.

Even as Republican lawmakers in Washington, D.C. wage a last-ditch effort to repeal the Affordable Care Act, a major funding deadline for health centers is looming - and getting little attention. The funding consists of billions of dollars in federal grants that help health centers pay for general operations aimed at low-income and uninsured patients.

If Congress fails to reauthorize the funding by Sept. 30, local health centers could see a 70 percent reduction in their federal grant funding, said Suzie Shupe, chief executive officer of the Redwood Community Health Coalition, a consortium of 17 community health clinics in Sonoma, Napa, Marin and Yolo counties.

“There’s a strong possibility that this could happen, given what’s happening in Congress at this moment,” said Shupe. “The effort to repeal ... the Affordable Care Act is sucking up all the time. There is legislation in Congress on an extension of health center funding; the question is whether it will get voted on in time.”

The money helps health centers cover the cost of providing care for uninsured patients and low-income patients who pay for services on a sliding scale. It funds preventative measures such as diabetes control and hypertension-reduction strategies, as well as case management and patient navigation services.

Medi-Cal, the state’s Medicaid program and the largest funding source for health centers, does not pay for these services.

“These are not billable but they are actually what improve the health of the patients in our community rather than just treating their illness,” said Naomi Fuchs, CEO of Santa Rosa Community Health, the North Bay’s largest network of health centers.

Failure to reauthorize the funding could cost Fuchs’ nonprofit $3.5 million in federal grant funding, she said. The entire state stands to lose $300 million dollars if Congress does not extend the funding.

“You have to take it seriously every time it comes up,” she said.

Shupe said Congress could re-authorize the funding at a later date, after the fiscal year begins Oct. 1, but that leaves local health officials in limbo and forces them to plan for the worst, which is the loss of those funds.

The loss of more than $15.3 million would mean 11,000 local residents would lose access to care, the coalition said. Its nearly one dozen health center organizations in Sonoma and Marin counties serve about 25 percent of the two counties’ residents.

Even if Congress does decide to reauthorize the funding in the future, it’s unclear what level those payments would be.

The uncertainty over the funding comes at a time when Republican members of Congress are aggressively waging yet another campaign to repeal the Affordable Care Act. Health center officials said this week that passage of the repeal bill, authored by Sens. Lindsey Graham, R-South Carolina, and Bill Cassidy, R-Louisiana, would also be a devastating blow to health centers.

The bill would convert federal health insurance funding to state block grants, eliminate a dramatic expansion of Medicaid coverage and do away with Obamacare mandates that require all Americans to enroll in health insurance. The Redwood Community Health Coalition said local health centers rely heavily on Medi-Cal funding and collectively treat about 54 percent of the people who received coverage by expanding Medicaid.

Hospitals would also be impacted by the Graham-Cassidy bill. In a statement released Wednesday, Kaiser Permanente chairman and CEO Bernard Tyson said block grant funding “would erode coverage of needed medical services and pose major issues for state budgets. Repealing the individual mandate without alternative incentives for enrollment will lead to fewer people enrolled and higher premiums.”

Tyson decried the inability of Congress to stabilize premiums for 2018.

“Only a few changes are needed to stabilize the Affordable Care Act for the millions who are dependent upon the law for their care and coverage,” Tyson said. “It is an urgent matter for policymakers to address right now, with big implications for families even in the next few months.”

Kelly Mather, CEO of Sonoma Valley Hospital, said that the hospital would have to figure out how to “live without” payments for patients currently covered through the Medicaid expansion. Those patients would become charity care, a cost the hospital would have to absorb. That could mean a loss of $1.1 million.

Prior to Obamacare, Medi-Cal payments comprised 9 percent of the hospital’s business, or about $5 million. Now it’s $10 million, Mather said.

“Honestly, I don’t know what’s going to happen to those patients who were covered,” Mather said. “Most likely they’ll become charity care.”

Rep. Jared Huffman, D-San Rafael, said it’s critical that Congress act now to reauthorize the health center funding. Failure to do so would likely result in the closure of some health centers, he said.