Continued Funding a Must to Avoid 'Primary Care Cliff,' Say AAFP, Other Groups

November 10, 2014 04:54 pm News Staff

Federal funding for three programs that enhance access to care in underserved areas while bolstering primary care is set to expire in 2015. That prospect has dozens of medical and other groups urging lawmakers to extend the funding.

[Health care worker holding infant]

The AAFP, along with more than 100 medical and social service organizations, sent a letter to Senate and House leaders(7 page PDF) asking them to continue funding for teaching health centers, community health centers and the National Health Service Corps, all three of which received dedicated funding through fiscal year 2015 as part of the Patient Protection and Affordable Care Act (ACA).

Because these programs play a key role in providing essential medical care for underserved patients and/or training for the primary care physicians and other health care professionals who deliver that care, the looming expiration deadline of Sept. 30 is being dubbed the "primary care cliff."

"The collective impact of the primary care cliff, if not addressed, would be devastating not only to the provider organizations and health professionals directly impacted, but to the patients and communities served by those providers, and to the health care system as a whole," the letter reads.

Community health centers will retain some federal funding even if no congressional action is taken on the primary care cliff, but they stand to lose about $3.6 billion. That scenario would force many of the nation's 1,300 centers to lay off staff or even close their doors. Given that these centers now serve an estimated 22 million patients, including 7 million children and 268,000 veterans, that would mean millions of patients would lose access to their "integrated health care homes," says the letter.

The Teaching Health Center Graduate Medical Education program established by the ACA provides funding to train primary care residents in community settings such as rural health clinics, urban clinics and tribal reservations, with the goal of expanding the number of primary care residents who train -- and, hopefully, work -- in these settings. In three years, 100 primary care residents have graduated from these community-based residencies.

The program is funded at $230 million for fiscal years 2011 to 2015. Thus, residents who began their training as part of the program in July 2014 do not have guaranteed funding beyond 2015. "Because of this funding uncertainty, the completion of training for many current residents and the admission of new residents are in serious jeopardy," says the letter.

Offering loan repayment assistance to primary care physicians and other health care professionals who agree to work in health professional shortage areas for a designated period, the National Health Service Corps (NHSC) has permanent authorization but no funding beyond the Sept. 30 cutoff.

"NHSC providers are a critical element of the primary care workforce, not just in health centers, but in a variety of other care settings in underserved urban and rural communities," the letter reads.

"Taken together, these critical programs generate thousands of jobs, create much needed economic impact in urban and rural communities, and serve as the foundation of access to a health care system moving toward prevention, wellness, quality and cost-savings," say the groups in their letter.

"We strongly urge Congress to act during the upcoming lame duck (session) to address the looming shortfall in each of these programs, which work both independently and synergistically to undergird our nation's health care system, in order to ensure the stability and viability of that system moving forward."