It's a long drive from Dr. Van Breeding's hometown of Whitesburg, Ky., to Lexington. As a child, his family frequently made the trip to take his octogenarian grandmother to the nearest cardiology clinic. “I remember you had to get up at 3 o'clock in the morning in order to drive down for her to make her 9 o'clock appointment,” Breeding said.
Today, Breeding serves as director of clinical affairs for Mountain Comprehensive Health Corp., a community health center network based in Whitesburg that serves 30,000 patients a year across six counties in eastern Kentucky. One-third of residents in the Whitesburg region are poor and many are addicted to heroin. Nearly a quarter of the residents of Whitesburg's Letcher County have diabetes, and adults have higher rates of colorectal cancer, hypertension, asthma, stroke and heart disease than others in the state.
“My heart is in these hills and with these people,” Breeding said. And he's been able to help them in ways he never imagined. In the past seven years, Breeding has seen his practice grow from five clinicians at two sites to 300 employees at seven clinics. Mountain also has a dental clinic and an optometry clinic. And in 2015, it opened its Farmacy program, which gives low-income people vouchers to buy fresh produce from local farmers.
Much of Mountain's growth occurred through the Affordable Care Act, which funneled grants aimed solely at helping community health centers provide services not traditionally covered by third-party payers. Between 2011 and 2015, local clinics across the country received $11 billion in Section 330 grants through an ACA provision called the Community Health Center Fund. Congress extended the program in 2015, providing $7.2 billion over the next two years.
But the fund is set to expire in September, and its future is in doubt. Community health center operators are fairly confident lawmakers will re-authorize the fund because their work has consistently received bipartisan support. Plus, Congress has already extended the fund twice.
The difference this time around is how it can continue without the ACA, which has been its funding mechanism over the past several years. It's unclear where the money will come from if the health law is repealed. Also uncertain is whether funding would continue to be a part of mandatory federal spending or become discretionary and subject to the annual congressional budget appropriation process.