Dan Hawkins, policy director for the National Association of Community Health Centers, said they want to be in position to push for an extension of the funding during a lame-duck session after Election Day. Other healthcare related items that could also be on the agenda at that time: a permanent fix of Medicare's sustainable growth-rate formula for paying doctors and an extension of funding for the Children's Health Insurance Program, which also expires at the end of this fiscal year next September.
“These are all great big dreams and plans,” Hawkins acknowledged. “They can all fall apart pretty quickly.”
Hawkins points to several factors that justify extending the life of the fund. Roughly half the states have failed to expand Medicaid to individuals with incomes up to 138% of the federal poverty threshold, as provided for under the ACA. That means community health centers in those states aren't seeing a significant reduction in charity care for poor households.
In addition, community health centers are encountering many individuals who purchased bronze plans through the exchanges because they were cheaper. But they therefore don't have access to cost-sharing subsidies and often have very high deductibles. That means health centers still aren't receiving adequate payments for treating those individuals, he said.
Further stressing budgets is the fact that the standard annual appropriation for community health centers has been reduced by $700 million, or roughly a third, since 2010.
“There's not a health center I've talked to that doesn't say they're struggling to handle the patient volume that's coming in their doors,” Hawkins said.
Community health centers fear that it will become harder to secure loans or hire staff if the funding uncertainty lingers. Federal funds make up roughly 20% of the typical budget for the not-for-profit groups.
Opinions differ on how much appetite for tackling difficult healthcare issues Congress will have in a lame-duck session. Most political observers believe there might be more of a chance for movement on those issues if Democrats retain control of the Senate. Otherwise, the thinking goes, Republicans will be preoccupied with preparing to take power and organizing their agenda for 2015.
But Hawkins doesn't think that's necessarily true. “I think they'll want to clear out a whole lot of stuff so they can focus on their priorities come January,” he said.
Follow Paul Demko on Twitter: @MHpdemko