June 25, 2018
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Facing the primary care fiscal cliff

George Danby | BDN
George Danby | BDN
By Vanessa Santarelli, Special to the BDN

What do lobstermen on Vinalhaven, ski patrol workers in Bethel, farmers and migrant workers in Northern Aroostook County, snowmobile repair technicians in Jackman, and restaurant owners in Eastport have in common? They represent some of the approximately 200,000 hard-working Mainers who are patients of their local community health center.

Community health centers work to provide high-quality, low-cost health care in some of the most rural and medically underserved areas in Maine. For this reason, every year a week in the month of August is set aside for National Community Health Center Week. From August 11, community health centers in dozens of towns from north to south and east to west host events such as health fairs, health center tours, and fun runs/walk — events that work to present opportunities for new patients to enroll who have not yet found a medical home.

Community health centers are local providers of choice for anyone, those with private health insurance, Medicare, MaineCare and the uninsured. Anyone can sign up to be a patient at one of over 65 community health center primary medical care offices at any time. Many of these sites also offer integrated behavioral health and oral health services for children and adults.

However, as we stop and take time to celebrate the important and impressive contributions community health centers make to the state’s economy (in 2012 alone, Maine’s community health centers had a direct economic impact of over $134 million), we are faced with a looming issue in Congress that could greatly reduce their ability to provide health care to anyone who seeks it.

This issue is the primary care fiscal cliff, and unless the mandatory Community Health Centers Fund is reauthorized by October 2015, every one of the nation’s 1,189 community health centers (at a total of 8,912 sites) are expected to have a 60-70 percent cut to their federal funding, making a majority of non-profit community health centers financially unsustainable.

Maine is in an even more vulnerable situation, being the only state in the Northeast that has neither accepted federal Medicaid expansion funds nor offers state support help to offset the cost of care for the uninsured.

What would change if the community health centers were forced to close their doors? Local access to high quality and comprehensive primary care services would be dramatically reduced, or even eliminated, in some of our most rural towns and high-need urban areas.

For example, residents of Vinalhaven would have to travel an hour and a half by boat or ferry to the mainland if they became ill. In communities across Maine, local centers may be the only primary care provider for up to 25 to 30 miles. Transportation can often be a barrier for many patients; one can imagine how much harder seeking care could be if these centers shut their doors.

The impact would not remain local, though. If community health centers lose federal money, health systems will likely see an increase in costly emergency department visits for non- emergent conditions, inpatient hospitalizations for complications stemming from chronic diseases like diabetes and COPD, and economic losses of their own. Beyond even those issues, a higher level of uncompensated care will drive up private insurance premiums.

Fortunately, community health centers have broad tripartisan support in Congress, and we remain hopeful that they will work swiftly to reauthorize the mandatory Health Centers Program to ensure that the 21.7 million patients nationally who rely on the centers for their health care needs don’t lose access.

Maine’s delegation has remained steadfast in their strong support, and we are grateful for their leadership in supporting one in every seven Mainers who seek health care at their local community health center.

If you would like to learn more about Maine’s community health centers, now is the week to do it. With nature walks, barbeques and free health screenings, National Health Center Week is the time to get to know what your local community health center can do for your health needs.

Vanessa Santarelli is CEO of the Maine Primary Care Association, an organization that works to strengthen and sustain Maine’s Community Health Centers and its primary care system, particularly in rural and underserved areas.


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