Gazette opinion: Unhealthy stopgaps from Congress

by Billings Gazette

Congressional dysfunction is hazardous to Montanans’ health.

The four stopgap spending bills that have dribbled out of Capitol Hill since the last fiscal year ended on Sept. 30 have left 100,000 Montanans and millions of other Americans behind. These are citizens who rely on the high-quality, low-cost primary care provided at Federally Qualified Community Health Centers. A law that provides 70 percent of funding for these clinics expired last September and Congress has not reauthorized it.

One in every 10 Montanans uses a community health center for care at one of 57 sites from Hardin, Billings and Miles City to Libby and Kalispell. These centers are open to all, but primarily serve low-income, under-insured and uninsured people whose care is subsidized according to their ability to pay.

In early December, leaders of Montana community health centers wrote to Sens. Jon Tester and Steve Daines, asking them to support the “multi-year funding extension needed to bring stability for the patients we serve.”

The health center chiefs, their staffs and patients are still waiting.

Also threatening the availability of health care in Montana is Congress’ failure to reauthorize the National Health Service Corps, which reimburses educational loans for doctors, dentists, nurse practitioners, counselors and other health care professionals who work in rural and under-served communities. Without the NHSC loan repayment program, clinics in rural Montana and those caring for low-income populations would not be able to hire the people they need. Small, rural clinics don’t have the money to compete for staff on salary alone.

Across Montana, 76 health care professionals working in community health centers are covered by the NHSC loan repayment program, said Cindy Stergar, chief executive officer for the Montana Primary Care Association. That’s more than 25 percent of the clinical workforce. “To stop that will be devastating,” she told The Gazette in a telephone interview last week.

Some health centers have frozen hiring because of month-to-month funding uncertainty, Stergar said.

Congressional inaction has put medical education in limbo, too. The program that funds primary care doctor training at community clinics – including three slots at RiverStone Health in Billings – expired last September. This program is vital to Montana; it is training doctors for the highest-demand jobs: primary care in rural communities.

During last weekend’s debate during the three-day government shutdown, Sen. Jon Tester told his fellow senators that the latest three-week spending bill “fails to fund our community health centers, putting them on the brink of closure. These are clinics like RiverStone Health in Billings, Flathead Community Health Center in Kalispell and Bullhook in Havre.”

Tester voted against the legislation that reopened government offices through Feb. 9. Sen. Steve Daines and Rep. Greg Gianforte voted for the short-term bill, which President Trump signed.

All three members of Montana’s congressional delegation have said they support community health centers, National Health Service Corps and health center teaching. Tester is a cosponsor of bills that would provide the multi-year reauthorizations needed for the health centers and the rural loan repayment. S.1899 would extend funding for health centers and the NHSC for five years. The chief sponsor is Sen. Roy blunt, R-Mo., and Tester is one of 19 co-sponsors.

Both Tester and Daines signed onto S.1754, which proposes to extend the clinic doctor training for five years.

These vital legislative proposals have languished for months. Members of Congress know what they must do. Public health has bipartisan support, yet there has been no action.

For the sake of the Montanans who get their care from community health centers and all of us who want to be sure there are enough doctors in Montana to take care of us when we get sick, Tester, Daines and Gianforte should demand that their party leaders insist on five-year renewals of funding for community health centers, health center doctor training and the NHSC. Those health care needs must be priorities in the February spending bill. That bill should fund health care and the rest of our national government through September. Anything shorter term will be another abdication of congressional duty. The stopgaps must stop.