Most of the uproar around Capitol Hill gridlock is aimed at the Children’s Health Insurance Program (CHIP). It has historically had bipartisan support and covers 9 million children and pregnant women who don’t have employer-based insurance but make too much money to qualify for Medicaid.
In the meantime, the federal government has repeatedly released unspent funds to help states keep CHIP running. The most recent money is supposed to keep the programs afloat through March, but federal health officials warned last week that some states could run out this month.
Congress has til Jan. 19 to pass another spending bill. House leaders predict it will be another short-term one that continues to punt on many issues.
CHIP, however, isn't the only health program with an uncertain future. Here are others that Congress also let expire on Sept. 30 but get far less coverage. All of the programs have some degree of bipartisan support, but like CHIP, Congress just can't seem to find a bipartisan way to fund them.
The Community Health Center Fund was created by the Affordable Care Act (ACA), which set aside an additional $11 billion dollars to create more community health centers and expand capacity at existing ones. Roughly 70 percent of their funding comes from the feds, according to the National Association of Community Health Centers.
These clinics serve 27 million people, most of them low-income, and about half of them are in rural areas, where options for care are limited.
Congress released enough money to keep the fund going through the end of March, but advocates say that isn’t enough.
“Health centers can’t operate week to week or month to month,” says Dan Hawkins, senior vice president for public policy and research at the National Association of Community Health Centers. “They have staff to retain and leases to hold.”
One community health center was already forced to close in Delaware, according to Hawkins, who says "now you have people who have to drive more than 30 miles. You get out in these more rural states, places like North or South Dakota where traveling this time of year is a real struggle, it becomes even more difficult."
The expiration of the Community Health Center Fund could also hurt employment. It’s estimated that up to 160,000 jobs could be lost if the fund doesn’t get renewed.
“I’m getting emails everyday asking if there will be some stability," says Hawkins. "But I fear this saga will continue."
Compounding the struggles in community health centers is the expiration of the National Health Service Corp (NHSC) and the Teaching Health Centers.
The corp sends doctors to medically underserved areas and in exchange, pays off their medical school debt. There are about 10,200 corp members scattered around the U.S., and about half of them practice at community health centers.
The American Academy of Family Physicians (AAFP) says the NHSC is vital to keeping top-notch doctors in communities that need them the most.
"Teaching health centers and the NHSC scholarship and medical school loan repayment programs build the primary care physician workforce and bring medical care to Americans living in rural and underserved areas," said AAFP president Michael Munger in a statement.
Teaching Health Centers place medical residents in medically underserved areas with the agreement that they’ll become a primary care physician in that community once their residency is complete.
Both the corp and the health centers received money to keep going through the first few months of the year, but those on the frontlines don't feel especially comforted.
“We’ve got a triple threat happening to community health centers,” Mitzi Moran, CEO of Sunrise Community Health in Colorado, told Stateline.
Compared to CHIP, the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) is small -- serving around 160,000 families -- but advocates say it’s become a critical part of the social safety net for the most vulnerable new moms and children.
It helps at-risk parents, like teens or those with a history of substance abuse, care for themselves and their children during their first years of life. Nurses and social workers provide them with pre- and post-natal care, parenting skills and counseling on education and job opportunities.
Unlike all the other programs, it has not received any stopgap funding. A bill to revive the program through 2022 passed the House in September, but there’s been no action since then.
State health officials, however, have concerns with the House bill as it is. It would require states to match 50 percent of federal funding by 2022.
“This would result in 1,116 fewer families being served through home visiting as well as a loss of 51 home visitor full-time employees,” John Dreyzehner, Tennessee's health commissioner, wrote in a letter to Tennessee Rep. Martha Black in November.
The Congressional inaction is already being felt in the states.
Iowa and Rhode Island pledged to freeze enrollment if Congress didn’t act by Jan. 1, Illinois ended two home visiting services, and Colorado had to cut off service to 100 families because it couldn't rehire a handful of home-visiting staffers.
“When we talk to folks on Capitol Hill, there’s policy agreement. There’s consensus that it’s needed, valuable and cost-effective. All of the normal barriers to passing legislation have been addressed. And yet it’s still not moving forward,” says Cat Macdonald, executive director of the Association of State and Tribal Home Visiting Initiatives.
This is the country’s first fund dedicated to public health programs and efforts to prevent epidemics. Since it was created by the Affordable Care Act (ACA), $2.3 billion has gone to state and local governments. By 2016, it accounted for 12 percent of the Centers for Disease Control and Prevention’s budget.
It hasn't actually expired, but since Sept. 30, Congress has taken money from it to keep CHIP and the Community Health Center Fund afloat. In December, it redistributed $750 million, a significant chunk considered its 2016 budget was around $900 million.
Without that money, the U.S. can’t stem the tide of the opioid epidemic, says Chrissie Juliano, director of the Big Cities Health Coalition, because it is used for programs designed to prevent opioid addiction, such as prescription drug monitoring. (The Trump administration says it has made combating the opioid epidemic a priority, but it has taken little action toward that goal.)
The fund also provides support for immunization programs, infectious disease tracking and lead poisoning prevention.
“Public health is used to doing more with less, but you can only cut so much before you damage people’s health and wellness,” Juliano says. “While health is bipartisan, sometimes funding isn’t.”
Indeed, the fund could become a partisan target in future negotiations. One of the bills to repeal the ACA last year in fact proposed phasing out the fund by October 2018.