Friday Memo- September 13, 2019

Dear Team:

           There is a famous non-denominational prayer that you may know. Sometimes it is called the Serenity Prayer, sometimes the Prayer of St. Francis, and often a part of Alcoholics Anonymous meetings. When reading about health policy these days, it is a good thought to keep in mind.

                                      Grant me the serenity to accept the things I cannot change,
                                     The courage to change the things I can,
                                    And the wisdom to know the difference.”     

           With that in mind, here is an update on a few of the policy issues the Community Healthcare Network is working on.  Think serenity. And courage.

           We begin with the United States Congress. (Quick, pray!) Our representatives in Washington are once again driving into a financial car crash at the end of this month. The September 30th budget deadline for keeping the federal government open may, once again, be missed.

           These government shutdowns, now almost routine, hurt millions and community health centers are at major risk. Across the nation, community health centers depend on these federal grants to keep their lights on.  Authorization for those grants also expires on September 30th.

           The federal government has been providing funds – about $4 billion annually – to health centers since 2010 following passage of the Affordable Care Act, also known as Obamacare. Earlier this week CHN joined forces with health centers across the country in Washington D.C. to urge legislative action. Maybe there will be a short term extension. Maybe not.

           This uncertainty is infuriating. Running a business, which is part of what we are, is undermined by chronic uncertainty.  Health center funding is not even a controversial issue. Republicans and Democrats alike support it overwhelmingly.

           Little wonder: health centers deliver high quality care while spending 24 percent less than non-community-based care. The problem is that Congress, twisted into partisan knots, cannot deliver federal budgets or even garden variety legislation, on time.

           There will be news coverage as the month winds down as to whether the governmental stalemate will lead to yet another shutdown. Somewhere lost in the political maneuvering will be the financial stability of the nation’s community health care.  CHN, because of the timing of its federal contracts, has breathing room should the September 30th deadline be missed. Still, for CHN and for community health across the country, Congress and the White House need to do their jobs.


           We are engaged in several other areas of advocacy, as you may know. On the state level, we have been prodding the Cuomo Administration to allow New York Medicaid to pay for both a medical visit and a behavioral health visit when a patient receives both services on a single day. Currently, only one of those two bills will be paid.

           This issue has the nickname “same day billing.” It is important when delivering integrated health care – as CHN does. Treating a patient’s medical care only, while ignoring behavioral needs, will likely result in bad outcomes —  on both the medical and behavioral fronts.

           Over two years ago the State promised to end this restriction on same day billing and join the 37 other states throughout the country which allow same day billing. In many cases, a same day handoff of a patient from one provider to another is in the patient’s best interest. CHN has been pushing the state’s Health Commissioner to get this done.

           There is more. We continue to wrestle, friendly style, with City officials as to how they will support the relocation of CHN’s Lower East Side Health Center, come 2021-22. We are looking for the City’s financial support, and have brought the Deputy Mayor for Housing and Economic Development for a tour of our existing center. All local elected officials, along with City Council Speaker Cory Johnson, have called on City Hall to help CHN, and we expect that to happen. But push we must.

           Lastly, the federal Public Charge Rule, one of the Trump Administration’s many efforts to persecute immigrants,  is due to kick in next month. There are multiple court challenges to stop the Rule, which will penalize documented immigrants who accept benefits like Medicaid and food stamps (to which they are legally entitled) when they seek entry into the United States through certain visas or when they apply for permanent resident status – or citizenship.

           For our part, we are doing what CHN can do to reassure and support patients who could be impacted. We have information available at all of our health centers, and this afternoon CHN social workers will be trained by experts from the New York Immigration Coalition on how best to counsel patients.

          The battles continue.