When you walk into the Squirrel Hill Health Center, you hear something you don’t hear very often in Pittsburgh: the sounds of people talking in seemingly every language but English.
The patients at this federally qualified health center, or FQHC, are mostly seniors, immigrants and refugees and speak Spanish, Nepali, Russian, Arabic and a few dozen other languages. It’s a community not easily serviced everywhere. It's also one that's grown to depend on FQHCs.
The centers, which provide health care to millions across the country, were looking at losing some of the funding when the threat of automatic, across-the-board federal budget cuts — known as the sequester — loomed large.
FQHCs were spared those cuts, but there's worry about what comes next.
Plans Were Made
Under the Affordable Care Act, FQHCs stood to be winners. A trust was established for the centers that would have funneled money that would lead to increased access to health care for millions through additional sites and services.
"One of the few areas that had bipartisan agreement was the health center program," said Cheri Rinehart, president and CEO of the Pennsylvania Association of Community Health Centers, which oversees 250 sites in the state. "And the vision was that the health center program would double by 2014 — double the number of sites and double the number of people served."
Rinehart has doubts that will happen now.
Sequestration went into effect in March. The cuts were put in place in 2011 as part of a deal to raise the country’s debt ceiling and were intended to push lawmakers toward making a long-term deal to address the budget deficit. That never happened.
Now, those cuts are affecting a range of federal programs such as Head Start and Meals on Wheels. Rinehart said community health centers were originally on that list. Money from the health center trust was tapped.
"Some of that funding was used by this budget so that the health centers would not be impacted as greatly by sequester," she said.
Centers had planned for those sequester cuts, which would have varied from location to location. Susan Kalson, the Squirrel Hill Health Center's CEO, said they were looking at a 9 percent cut.
"For us it was a full staff position, and we were trying to figure out who we were going to let go," she said. "We are a very small HQFC. There are much larger ones that were looking at laying off lots of people or closing smaller sites," she said.
Because of the funding they received, they ended up not cutting anyone.
Federally qualified health centers were started in the 1960s as part of President Lyndon Johnson's "War on Poverty." The majority of their funding comes from the federal Department of Health and Human Services. Medical professionals at the centers treat the uninsured and underinsured and bill them on a sliding scale. They also treat those on Medicare and Medicaid.
In Pennsylvania alone, the centers serve about 700,000 people.
Kalson said across the state they were gearing up to serve twice as many people. As it is, she said they are already seeing more people come in for medical, behavioral and dentist services.
"I have a lot of concern about our ability to continue to expand at Squirrel Hill," she said. "We’ve been expanding our patient base year after year. We see that continuing ... the need isn’t going away, the need, if anything, is growing."
According to a spokesperson for the Department of Health and Human Services, the community health centers got $11 billion in the Affordable Care Act.
Some of that went toward building new health centers or establishing centers in already existing infrastructure. A chunk of it went toward outreach and enrollment of patients in the new health insurance exchanges, and a portion went toward quality improvements. The remainder went to support ongoing services.
The spokesperson said he could not speculate about future spending or budgets.
Kalson said while they are OK this year, looking ahead, she has concerns.
"I’m very concerned that if funds aren’t used the ways they were originally envisioned then we will be scrambling," she said. "It is essential to us to continue to have this federal support."