Right before their August recess, Congress and the President reached a budget agreement that automatically raises the debt ceiling until 2021 and sets budget caps for federal fiscal years 2020 and 2021. This agreement will allow Congress to negotiate annual discretionary appropriations for the next 2 years without too much argument over funding levels.
Some of the health related priorities for Congress and the President include addressing medical billing and the high cost of prescription drugs. The window for achieving any agreement on those issues is small, because the focus will turn to campaigning for the 2020 election early next year.
Over the past few months, CaliforniaHealth+ Advocates has been closely monitoring issues at the federal level that impact community health centers and patients. Unfortunately, there have been some significant attacks on access to care through changes to Title X and public charge. Additionally, the mandatory health center fund is set to expire at the end of September, unless Congress takes action to reauthorize funding. CaliforniaHealth+ Advocates will continue to be heavily invested in all of these issues, working with both local and federal partners to advocate on behalf of community health centers and patients.
Health Center Fund Reauthorization
In early 2018, CaliforniaHealth+ Advocates, along with health centers, consortia and other partners, successfully advocated for reauthorization of the mandatory portion of the health center fund, National Health Service Corps, and Teaching Health Center GME. That win, however, was short-lived as the extension expires at the end of September 2019. Congress has once again committed to extending the authorization and funding for community health centers and thankfully, bills have been introduced that aim to extend funding. Earlier in the summer, the House Energy and Commerce Committee approved a package of bills that includes four years of level funding for health centers, the National Health Service Corps, and Teaching Health Center GME programs, while the Senate HELP Committee approved a bill that includes five years of level funding. Neither the full House nor the full Senate have yet to take action on these bills.
Unfortunately, because there are disagreements about other parts of those pieces of legislation, it is not guaranteed that Congress will take action after the August recess. Considerable advocacy will be needed by health centers to ensure the reauthorization happens before the end of September with possible increases over the current levels. In early September a contingency of California health center leaders joined their colleagues throughout the country in a critical NACHC fly-in to urge congressional action and those who were unable to join the fly-in participated in the national call-in day. Thank you to everyone for your amazing advocacy work!
Advocates will continue to work with consortia, the National Association of Community Health Centers (NACHC) and other partners to demonstrate to our elected officials the importance of community health centers and the need for more permanent funding.
Among Advocates’ top issues this year was supporting our partners at Essential Access Health and Planned Parenthood Affiliates of California to help protect Title X. The final rule imposing a gag rule on Title X providers was issued in March 2019 and, unfortunately, it’s been an up-hill battle ever since. Multiple lawsuits were filed from around the country, including one by Essential Access Health and California’s Attorney General, Xavier Becerra, and preliminary injunctions were initially granted. However, the 9th Circuit Court of Appeals lifted the injunction pending a decision on the merits of the case. Ultimately, the U.S. Department of Health and Human Services announced that Title X grantees need to submit an action plan detailing how they will comply with the gag rule portion of the final regulations by August 19, 2019. In August 2019, Planned Parenthood clinics across the country officially withdrew from the Title X program, saying they would dip into emergency reserves before complying with the changes to Title X.
The final rule creates more barriers to access to care for California’s most vulnerable populations, especially women. The majority of people who benefit from Title X are the uninsured, those with low income, and people of color. Moreover, the rule seriously infringes on the doctor-patient relationship. Physicians should be able to provide comprehensive health care, which includes information about all medical options. To read more about the changes to Title X, please click here. For a copy of this HHS’s guidance about complying with the rule and other information around the new Title X rules, see the NACHC webpage on Women's Health Services.
Advocates will continue to work closely with NACHC, Essential Access Health, and other partners to navigate changes to Title X and fight back against this attack on our ability to provide comprehensive reproductive care to everyone.
Protecting Immigrant Rights
For the last few years, the President and his Administration have introduced policies and procedures that unjustly target immigrant communities and their families, such as attempting to add an immigration question to the 2020 Census, the new deportability rules and the changes to public charge. The anti-immigrant rhetoric pushed by this Administration has created an increased atmosphere of fear in our immigrant communities. This fear is referred to as the ‘chilling effect’ and it has discouraged many immigrants and their family members from enrolling into lifesaving programs, such as Medi-Cal, out of fear that their immigration status, or that of a family member, will be affected.
Advocates remains committed to protecting the rights of its immigrant patients and will continue to lead both within California and nationally on immigration issues on behalf of health centers.
Public Charge Final Rule
On August 14, 2019, the Administration released the final public charge rule that would expand the list of public benefit programs currently considered in a public charge assessment when an individual applies to enter or reenter the country or applies for legal permanent residency (i.e. green card). While the public charge rule does not impact those seeking to become citizens and is likely to impact a small portion of our immigrant communities, uncertainty and misconceptions about the final rule are leading many immigrants to cease accessing public benefit programs.
Community health centers, along with other safety-net providers, will likely experience an increase in uninsured patients. Since health centers and safety-net providers may no longer be able to enroll all of their immigrant patients into public benefit programs, it could raise the cost of providing services to patients. This is of great concern for health centers in states with significant immigrant populations.
Currently, Advocates is supporting federal legislation, H.R. 3222, the No Federal Funds for Public Charge Act. Advocates will continue to keep you apprised of this legislation and future legislation that aims to protect immigrants against this harmful policy.
Additionally, in response to the final public charge rule, lawsuits were filed across the country to stop the implementation, which is currently scheduled for October 15, 2019. Our partners at the California Primary Care Association were one of the many immigrant advocates to file a lawsuit. We will continue to stand with our immigrant partners as they fight this unjust and harmful rule.
If we want our communities to thrive, all of the families in those communities must be able to receive the care and services they need. At this time of rising national division, Advocates and health centers are proud to stand with our immigrant communities and re-affirm our commitment to valuing and protecting the health care rights of our immigrant patients.
Health Centers Prepare for the 2020 Census
The U.S. Census provides critical data to inform how the federal government and the states match funding for programs to the needs of the people in different states and communities, as well as to determine equitable political representation. These high-stakes decisions must be based on complete and accurate data. For every Census, there is always the risk of an undercount, but for Census 2020, the chances of an undercount are more likely due to the anti-immigrant overtures from the federal government including the public charge rule. The threat of being identified will undoubtedly deter low-income immigrant and minority-headed households from participating in the Census. As such, with the largest immigrant population in the country, California faces the greatest barriers in the nation to ensure an accurate count and thus receive a fair share of federal funding and Congressional representation.
The state must reach more than 13.5 million households in order to raise awareness of the 2020 Census and motivate the hardest to count Californians to respond. The results from the Census guide the allocation of more than $800 billion in federal funding to programs that are crucial to the well-being of families and communities, such as the Child Care and Development Block Grant, Substance Abuse Block Grant and the Social Services Block Grant.
The state recognizes that partnering with health centers is particularly important because they are a trusted community voice. California’s community health centers are well positioned to reach nearly 7 million people – a good percentage of which may be deterred from participating in Census 2020 because of their immigration status or the immigration status of family members. Health centers have an opportunity to influence the engagement of a critical block of Californians, thereby helping to secure much needed resources to the state and local communities, as well as advance the Newsom Administration’s priorities, and further prove the power of the health center network.
Over the past few months, Advocates has been working closely with the state Census, CPCA, and the regional health center consortia to develop a comprehensive education and outreach plan to encourage all community health center patients to participate in the 2020 Census and have already started to push messaging through a social media campaign gearing up for the 2020 census. Advocates and our partners at CPCA will be developing more materials for health centers to use for the official 2020 Census kick-off in January 2020.