Shark Snider cut out of preschool early for an appointment with his pediatrician, Dr. Jonathan Weinkle of Squirrel Hill Health Center. The 3-year-old’s snoring had gotten worse, and his parents were worried it could be a symptom of something bigger.
“Open up your mouth really big and stick your tongue out,” said Weinkle. “Stick your tongue all the way out, say ‘aah.’”
Shark has been a patient of Dr. Weinkle’s at Squirrel Hill Health Center since he was a newborn, a community health center which operates two clinics and a mobile health care unit in Pittsburgh. Like all federally qualified health centers, this community clinic charges patients on a sliding scale and won’t turn away anyone who can’t pay.
People go to community health centers if they don’t have a lot of money or live in areas that don’t have a lot of medical services. But due to Congressional gridlock, CHCs don’t know if the majority of their federal funding will continue after March.
The majority of this clinic's patients have Medicaid, Medicare or coverage through the Children’s Health Insurance Program, or CHIP. This includes Shark, who despite the loud sleeping, seemed to be fine.
“Right now, it’s not worth working up. Just let him be,” Weinkle said to Shark’s parents.
Federal funding for Squirrel Hill and every community health center in the country is in jeopardy. According to the Pennsylvania Association of Community Health Centers, there are 50 CHCs that operate almost 300 sites around the state; there are more than 10,000 CHCs nationwide.
These clinics say if they have to reduce services or close, people who already have a hard time paying for health care will have even fewer options. That includes Shark's mom Shyloh Hadley, who lives in Friendship and turned to Squirrel Hill in 2013 when she was pregnant and uninsured.
“I would have a small co-payment, but it wasn’t nearly as expensive as any other doctor’s office,” said Hadley. “Unfortunately, most doctors’ offices just won’t see you if you don’t have insurance. So this (was) pretty much my only option.”
Funding for CHCs expired last September. Then right before Christmas, Congress passed additional funding for CHCs and several other health safety net programs, like CHIP. But that money runs out at the end of March.
This puts Squirrel Hill in limbo. CEO Susan Kalson, who has headed the organization since it opened in 2006, said the federal support she’s waiting for Congress to renew comprises about $1.5 million of the organization's roughly $7 million annual budget.
Like many CHCs, Kalson said she’s struggling to plan for the future and doesn’t know how she’ll make payroll in a few months. If Congress doesn’t reauthorize the funding, Squirrel Hill might have to close one of its clinic sites, lay off staff and turn away 1,500 patients.
“We have done everything in our power to protect ourselves financially, to have a little bit of a buffer, a little bit of a nest egg,” said Kalson. “We have great relationships with area foundations and funders, but that can’t make up the difference.”
While there is bipartisan support in Congress for CHCs, the issue is how to pay for them.
"I don’t think any of us want to kick this can down the road any further than we already have," said Rep. Mike Doyle, a Democrat from Pittsburgh who sits on the House Energy and Commerce Committee, which oversees CHCs.
What Congress can't agree on is how to pay for CHC grants. Democrats say the GOP’s proposals take money from other health care initiatives and that CHCs need their own, dedicated funding stream.
Republican Rep. Ryan Costello of Chester County sits on the same committee as Doyle. Costello declined an interview, but in an emailed statement his office said that he voted for CHC legislation that’s currently stalled in the Senate. Republican Sen. Pat Toomey said he anticipates that funding will continue beyond March, but didn’t provide specifics.
In another Squirrel Hill exam room, 90-year-old Don Bell waited patiently. The retired boat builder has been coming the CHC for two years, and right now he has shingles.
"It's especially uncomfortable to try to lay down and sleep," Bell said.
Bell is on Medicaid and said he probably wouldn't find another primary care doctor if Squirrel Hill closed its doors.
“I’d probably end up going to… different kinds of urgent care offices,” he said.
If Congress doesn’t act, urgent care and emergency rooms are probably going to be seeing a lot more people. Some researchers say that means patients are going to get sicker and their health care more expensive.
