| Speaker | Time | Text |
|---|---|---|
|
unidentified
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| Joining us now to discuss how the One Big Beautiful Bill Act could impact community health centers is National Association of Community Health Centers Chief Policy Officer Joe Dunn. | ||
| Joe, welcome to the program. | ||
|
unidentified
|
Thank you so much for having me. | |
| Thank you for coming back on. | ||
| We'll start with just an overview of your organization. | ||
| Remind our audience your mission and who you work with. | ||
|
unidentified
|
Yeah, so the National Association of Community Health Centers was founded in the 1970s after the community health center movement was started. | |
| We serve in a way to really focus around primary care. | ||
| Our members focus around comprehensive primary care. | ||
| There's 1,500 of them across the country. | ||
| We're coming up on our 60th anniversary of the Community Health Center program and 55 years of the association. | ||
| So we're here in Washington, D.C., lobbying on their behalf. | ||
| You mentioned that your organization is getting ready to celebrate or is celebrating 60 years of community health centers. | ||
| Explain what they are and who uses them, the kind of services that are provided. | ||
|
unidentified
|
Yeah, so community health centers are an incredible organization. | |
| There's, like I said, 1,500 across the country. | ||
| They provide comprehensive primary care services. | ||
| So that's obviously the medical side, but then also oftentimes dental, oral health, transportation, other services like that. | ||
| They're locally governed. | ||
| So they have a patient community board that really dictates the services that they provide. | ||
| And then also they see everybody regardless of their ability to pay. | ||
| We make sure that everybody who comes in gets care. | ||
| There is a sliding fee scale, so people pay what they can based on their income. | ||
| But really, we provide that service and that basic primary care that's so important, that saves lives and saves money to the long-term system to anybody in the community. | ||
| And it was on the 4th of July that President Trump signed the One Big Beautiful Bill Act into law. | ||
| Your reaction to the passage of that piece of legislation. | ||
|
unidentified
|
Yeah, so we were disappointed that the bill was signed into law. | |
| You know, it's something where 50% of our patients are on Medicaid. | ||
| Medicaid is a critical payer, so it's 40% of the revenue, 50% of the patients. | ||
| It's going to have significant changes around Medicaid right now. | ||
| We know that it could lead to up to 4 million community health center patients being uninsured. | ||
| The focus around uncompensated care. | ||
| So health centers operate on razor-thin margins already. | ||
| And so when you think of potentially upwards of $7 billion of newly uncompensated care costs that they're going to have along with uninsured patients, it's very concerning. | ||
| Our guest for the next 35 minutes or so is Joe Dunn. | ||
| He is the Chief Policy Officer for the National Association of Community Health Centers. | ||
| He's joining us for our discussion on how the One Big Beautiful Bill Act could impact community health centers. | ||
| If you have a question or comment for Joe, you can start calling in now the lines Democrats 202-748-8000. | ||
| Republicans 202-748-8001. | ||
| Independents 202-748-8002. | ||
| And I also want to let you know that we have a special line for healthcare workers. | ||
| That line is 202-748-8003. | ||
| Joy, I wanted to point out some statistics about community health centers. | ||
| You have on your website, it says that they serve 32.5 million patients annually. | ||
| That's one in 10 Americans, represents only 1% of the total annual health care spending in the U.S. | ||
| That is, of course, before the legislation we just mentioned. | ||
| It says providing care to approximately one in five uninsured individuals serves one in three people living in poverty, serves one in five in rural America. | ||
| It also supports over 6.4 million patients residing in or near public housing, care for more than 1.4 million individuals experiencing homelessness, also delivers mental health services to nearly 2.8 million patients annually, and says screening over 72% of adolescents and adult patients for depression. | ||
| When we hear those numbers and we hear the cuts that you just mentioned to Medicaid and how they could impact, what impact is it going to have on the people in those statistics I just mentioned who rely on community health centers? | ||
|
unidentified
|
Yeah, so our mission and the community health center's mission is to really take care of those patients as best they can. | |
| But when you think of the uncompensated care costs that could come through this bill and the uninsured care, it's going to make life much more difficult. | ||
| Our patients, 90% of our patients are 200% or below of the federal poverty level. | ||
| So as you mentioned, low-income individuals who often have multiple jobs. | ||
| It's not that they're not working. | ||
| They actually probably work two or three jobs to make ends meet. | ||
| That's where we want to make sure that we have the resources that we can care for them in a comprehensive way. | ||
| You mentioned behavioral health, mental health. | ||
| We know that we're not meeting the need that's out there right now for those issues. | ||
| And we also know that there are many communities where we could serve more people. | ||
| We did a study a couple years ago. | ||
| We believe that there's 100 million Americans that lack access to basic primary care, and they need that because not only is it going to make them healthier over the long term, but it's also going to save the health care system significant funding over the long term, right? | ||
| We know that we avoid inpatient hospitalizations, right? | ||
| People who go to the hospital unnecessarily, or an emergency department. | ||
| We don't want to have people going there at a very high-cost setting where a lot of these issues and chronic disease could be dealt with at a primary care setting like a community health center. | ||
| And you mentioned that it is primarily primary care. | ||
| How could the impact on community health centers then impact ongoing care or even emergency care? | ||
| You just mentioned that as well. | ||
|
unidentified
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Yeah, so what we believe is that it could lead to higher cost settings, right? | |
| So if individuals can't get into their primary care setting for their diabetes, they may have more complications and that may require them to go to an emergency department or to eventually have a higher cost complication like an amputation. | ||
| That's, you know, as we think of we spend $4.9 trillion on the health care system and less than 5% on primary care right now. | ||
| That is much lower than the rest of the world. | ||
| And I think that's why, you know, our system often feels fragmented for the patient and leads to higher-cost settings that right now are not delivering the best outcomes for the patients. | ||
| We have callers waiting to talk with you. | ||
| We'll start with Jason in Maryland, Lion for Independence. | ||
| Good morning, Jason. | ||
|
unidentified
|
Good morning. | |
| Go ahead, Jason. | ||
|
unidentified
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You're on. | |
| Thanks. | ||
| I think when I'm hearing everyone talking about the impacts to, say, the health care industry and those patients that are on Medicaid and the implications, I think one thing that's been overlooked in this discussion is what are the impacts that are going to be from those illegal immigrants? | ||
| Oh, I'm sorry, we lost him. | ||
| He was asking about illegal immigrants. | ||
|
unidentified
|
Yeah, so thanks so much for the call, Jason. | |
| Community health centers are required by federal law to serve all residents in their communities right now. | ||
| We don't ask for immigration status, and it's our mission to serve everybody. | ||
| We also, just yesterday or a couple days ago, there was a new announcement by the Trump administration on immigration, and we're certainly assessing those new details, waiting for some additional guidance from the federal government through the Department of HHS. | ||
| And we want to make sure that health centers continue to stay compliant with federal and state laws because that's exactly what they have always done, where we want to make sure that that continues. | ||
| You mentioned that announcement, the Trump administration halting access by undocumented immigrants to several services, including community health care centers. | ||
| Where you mentioned they can currently get coverage. | ||
| What are the alternatives for people who may be turned away in the future? | ||
|
unidentified
|
Yeah, so right now, like I said, we don't ask for immigration status. | |
| That is not something that we're required to do, but we are required to serve everybody. | ||
| And so that's the real mission that they want to focus on providing the best quality care for all the individuals in their community. | ||
| Certainly if there are changes, you know, that may lead to additional outbreaks of disease and then again, possibly going to emergency departments because hospitals have other rules around immigration. | ||
| But right now we are fully compliant with the law across the country with health centers and we're going to continue to do that. | ||
| Let's hear from Sarah in Columbia, South Carolina, Line for Independence. | ||
| Hi Sarah. | ||
| Sarah, we're having a hard time hearing and you're breaking up. | ||
|
unidentified
|
Sorry. | |
| Sorry, you're still breaking up, Sarah. | ||
| Go ahead and try to give us a call back and see if we can get a better connection. | ||
| We'll go to Nick in Charlestown, West Virginia, Line for Democrats. | ||
| Good morning, Nick. | ||
|
unidentified
|
Oh, thank you so much for taking my call. | |
| It's great to be here with you this morning. | ||
| So my question is, I'm from West Virginia. | ||
| We are a very, very rural state. | ||
| And, you know, frankly, there is a lot of chronic disease in West Virginia. | ||
| And what I wanted to ask your speaker is what kind of impact do these community health centers have on a state like West Virginia? | ||
| And what would be the impact of this one big, beautiful bill on my state? | ||
| Thank you so much. | ||
| Well, thanks so much for the question, Nick. | ||
| West Virginia is a state where community health centers are integral to their health care system. | ||
| They serve one in three West Virginians right now. | ||
| And, you know, it's just central to the future of the state that they have a vibrant community health center network of organizations that can continue to provide that high quality care. | ||
| I would say, you know, we are very concerned with the focus around these cuts, and we want to make sure that health centers have the funding and resources they need because they are so good at managing and preventing chronic disease. | ||
| Health center patients are 35% more likely to have chronic disease and chronic disease is a major epidemic in the country that Secretary Kennedy has identified. | ||
| But they've also said that health centers are at the forefront of addressing these chronic disease issues. | ||
| And so we want to make sure that they have the resources they need to move forward and continue to provide high quality care. | ||
| So thanks so much for the question. | ||
| And wanted to point out that your organization has maps on the website, Breaking Down Each Congressional District. | ||
| If anyone is interested in knowing, learning more about how many organizations, community health centers operate in your state or the funding that has been going to them as well as patients served, you can find that on the website nachc.org. | ||
| Let's hear from Alex in Bayer, Delaware, line for Republicans. | ||
| Hi, Alex. | ||
|
unidentified
|
Hi, how are you doing? | |
| I think I got the answer back to immigrants getting care, health care, and all. | ||
| When they go to get their health care and they take care of them and get them going again, just take them out and deport them back to their country so they can get their health care in their own country. | ||
| And that's all I got to say. | ||
| Thank you. | ||
| Okay. | ||
| Thanks, Alex, for that statement. | ||
| You know, like I said, health centers are not required and they don't ask for immigration status. | ||
| We provide care for everybody, but appreciate your perspective on the issue. | ||
| The community health centers themselves are going to obviously be impacted by the legislation. | ||
| How are they preparing for what could come? | ||
|
unidentified
|
Yeah, so we do have an example of in recent memory during the COVID-19 pandemic, there was a significant change to Medicaid where there wasn't an ability to redetermine eligibility for Medicaid. | |
| So eventually when that happened, health centers did see a $600,000 loss through the loss of coverage for people as they shifted from one coverage source to the other. | ||
| What they try to do is connect people with the most relevant coverage and whatever they're eligible for for social services or other kind of health care needs. | ||
| So I think what we're going to see, and obviously it's only been a week, but we are going to prepare health centers to ensure that they have the ability to take care of their patients, screen for different coverage options, hopefully try to help them maintain that coverage through Medicaid and go from there. | ||
| But it's one of these things that they operate on razor-thin margins, like I mentioned. | ||
| About 40% of them have less than 90 days cash on hand, and that's why the issue is so critical. | ||
| We have a funding deadline at the end of the year of the fiscal year, and that's why we're going to be pushing for bipartisan support for increased funding to help address these additional cuts. | ||
| Let's hear from Glenn in Pompano Beach, Florida, on the line for health care workers. | ||
| Good morning, Glenn. | ||
|
unidentified
|
Good morning. | |
| I don't know if your panel could speak to what would happen if an illegal alien who works in the hospital industry has tuberculosis and is denied care and continued to work. | ||
| What type of impact would that have on that business and the wider community? | ||
| Could he speak to that? | ||
| So thanks so much for the question, Glenn. | ||
| It sounds like you're asking if there's an untreated patient with tuberculosis, what could happen? | ||
| I'm not a healthcare professional, so I couldn't speak to the exact spread of a disease, but certainly any kind of disease outbreak would be concerning. | ||
| So it's an interesting question, but again, I'm not a healthcare professional to give you kind of a blow-by-blow of what would potentially happen if somebody's untreated. | ||
| Larry in Southport, North Carolina, line for Democrats. | ||
| Go ahead, Larry. | ||
|
unidentified
|
Yes, sir. | |
| The lady there mentioned immigrants as illegal aliens. | ||
| And I don't watch the woke news because when they say something, the sky's falling. | ||
| But here's my thing. | ||
| All they're doing is weeding out people that doesn't need vegetarian medicare that's just laying on the bucks and able-bodied people to work. | ||
| But they all, thank you. | ||
| Well, thanks so much, Larry, for the comments. | ||
| You know, I would say that what we've seen in other states that have implemented a work requirement in Georgia and then Arkansas is actually a lot of people are working. | ||
| And like I mentioned, health center patients are typically working multiple jobs. | ||
| But it's typically the administrative barriers to prove your coverage or exemption that has led to coverage losses in those states. | ||
| So that's one of the things we're concerned about. | ||
| But, you know, that's why we want to provide those resources, ensure that we're meeting the needs of patients, connecting them with the care that they need so they can be healthy and continue to work in the community and be productive citizens. | ||
| Em in Dayton, Ohio, line for Democrats. | ||
| Good morning, Em. | ||
|
unidentified
|
Yeah, my mother is 86 years old. | |
| She worked all of her life. | ||
| She raised all six of her children. | ||
| She's helped with raising her grandchildren. | ||
| And now that she's elderly and she's on Medicaid and another form of insurance to supplementize that, what's going to happen to her? | ||
| Will she be kicked off of her Medicaid? | ||
| Would she not be able to go into a nursing home if she needed like follow-up care after she was released from the hospital? | ||
| I mean, are they just going to boot her out after working all her life and paying into the system? | ||
| Well, thanks so much, Em. | ||
| And it sounds like your mom was or is a pretty amazing person raising six kids. | ||
| I have two kids myself, so I can imagine having six. | ||
| You know, that would be a real journey to be on. | ||
| But I would say that, you know, many of the provisions of this law would not affect your mother. | ||
| The work requirements, for example, is for individuals from 19 to 64. | ||
| So somebody in their mid-80s would not be included in that. | ||
| So I wouldn't anticipate that there would be much change, but certainly each state is going to implement the law differently. | ||
| And so, you know, I would keep tabs on it moving forward. | ||
| The Senate Republicans, as they worked on the reconciliation bill, they added $50 billion or I'm sorry, $50 million to the rural, $50 billion to the rural hospital fund. | ||
| But rural hospitals are still expecting to get hit by cuts. | ||
| Explain the connection between community health centers and rural hospitals. | ||
|
unidentified
|
Yeah, so thanks so much because we had worked on this. | |
| We believe that community health centers should be a big part of this new fund. | ||
| Like I mentioned, we believe that the focus around primary care is going to be a great way for the federal government to have a significant bang for your buck by investing in primary care. | ||
| But around the connection, health centers and rural hospitals often work very closely in rural communities. | ||
| But we've also seen, because of a number of factors, rural hospitals have closed at an alarming rate over the last decade. | ||
| Oftentimes, then that leaves the community health center in the rural area as the only primary care provider. | ||
| And one of the things that we've often said is: you know, you can't attract a business, a processing plant, a factory, if you don't have a primary care network for your workers to go to, that you don't have labor and delivery for families and young families who want to start or have children. | ||
| So as we think of this new law and the new fund, we believe that there's a role for rural hospitals, but also that the focus needs to also be on community health centers to have that real primary care investment to help attract that economic development, maintain those vibrant rural communities. | ||
| We do serve about one in five individuals in rural America, so it's a significant portion of our patient population. | ||
| We want to make sure that that is maintained and continued and progresses into the future. | ||
| Mary in Bethesda, Maryland, line for healthcare workers. | ||
| Hi, Mary. | ||
|
unidentified
|
Hi. | |
| Go ahead, Mary, Your Honor. | ||
|
unidentified
|
Yes, my question is: I currently work for a health center and we already deal with so much stress and we are already taking care of so many patients as best we can. | |
| What is this act going to do to us? | ||
| And what can we do to stop the impact? | ||
| Well, thanks so much for your service, Mary. | ||
| That's great. | ||
| I would love to connect with you at some point and know which health center you're working in in Maryland. | ||
| I would say that, you know, it's going to take some time to be implemented, but when it is fully implemented, one of the things that we believe is going to be an important element for health centers to screen their patients and make sure that they are connected to coverage, make sure they know if they have coverage or not. | ||
| One of the things, as I mentioned a couple years ago, you probably saw a lot of patients who come in and they thought they had Medicaid, but they actually didn't because maybe they missed a notification in the mail because they moved or they missed a phone call because their number changed. | ||
| So that is a real-life example that we believe is going to happen where health centers like yours, I'm sure, will go out of their way to do everything they can to take care of those patients. | ||
| But, you know, it's going to be an added burden at a time when resources are tight. | ||
| And, you know, right now, health centers, about 40% of them, have less than 90 days cash on hand. | ||
| And so what we're going to try to do is through Washington and our bipartisan champions in Congress is push for increased funding to address some of these challenges and give you the resources you need to have the patient care that the patients deserve. | ||
| You mentioned that some community health centers only have a 90-day cash supply. | ||
| When could they start seeing the effect of the One Big Beautiful Bill Act? | ||
| When could they start feeling the, I guess, the worst impact? | ||
|
unidentified
|
Yeah, so it will really go in stages, but it could be as early as this year as people start to think about and start to plan for what the next steps are. | |
| Health centers have already made really difficult changes and choices. | ||
| We've had a number of health centers that have had to close sites or lay off staff. | ||
| And so that's what we've tried to articulate to the members of Congress and their staff of, you know, there's not slack in the system. | ||
| They don't have the resources to fall back on or the cushion. | ||
| The average margin is about negative 2%. | ||
| And so they need to have the funding to take care of constituents in places like West Virginia or Texas or Maryland, right? | ||
| And so, but, you know, some of the biggest provisions will start to kick in next year and then beyond into the future. | ||
| Nancy in Austin, Texas, line for independence. | ||
| Hi, Nancy. | ||
|
unidentified
|
Hi. | |
| The one thing I probably needed to explain because it seems like it's been lost on Mr. Dunn, is our country is 36 trillion plus in debt. | ||
| Now, the government's overspending, it's been for quite a long time, and they don't have the money to pay for what they're spending. | ||
| They can either borrow the money from another country, in which case they want interest, or the Federal Reserve creates it out of thin air, increases the money supply, and that's what causes the prices to go up. | ||
| That's where the price increase goes up because there's more money chasing the same goods. | ||
| So you probably know that our debt has been recently downgraded. | ||
| And so that makes them have to pay more interest on the debt. | ||
| So that makes our debt even go higher because, you know, of course, other countries who buy our debt, if our debt is not worth as much as far as its grading, they want more interest on it. | ||
| So you see this tumbling kind of thing. | ||
| So we want to make sure we have enough money to pay for the health care, the Medicaid, Medicare, everything else for American citizens. | ||
| We have an excess of 40 million illegal aliens. | ||
| 20 of those came from under the Biden administration when the borders were wide open. | ||
| I live in Texas, so I saw it. | ||
| So we have got to get that under control so we can take care of Americans. | ||
| So when you talk about constituents, it's this generic term. | ||
| I guess that includes both illegal aliens and American citizens. | ||
| I'm caring about American citizens. | ||
| The illegals need to go home and have their own country take care of them or whatever they have to be. | ||
| I feel sorry for them. | ||
| But we've got to take care of our own citizens. | ||
| I know immigration is something you've addressed with previous callers. | ||
| Any responses? | ||
|
unidentified
|
I would just say, you know, Nancy, I appreciate the comments on the debt. | |
| Like I mentioned, I have two kids, two teenagers, and, you know, their future is very important to me. | ||
| And the fact that we are $36 trillion in debt is a concern. | ||
| What I would say, like I mentioned, is we spend almost $5 trillion on health care in the country. | ||
| And it's not that we're not spending enough money on health care. | ||
| We're not deploying that in the most strategic way. | ||
| And so what we've found, this is research from academics and then also from the government, that shows that community health centers actually save money to Medicaid. | ||
| They save about $1,400 for every adult and about $800 for kids compared to the other care that is often at a higher cost setting like a hospital. | ||
| And so that's where I think we can all agree that we want to be more efficient with our dollars and utilize health care dollars in a way that are going to make people more, that provide higher quality, to make them able to work and be productive citizens across the country. | ||
| Barb in Long Grove, Illinois text in this question. | ||
| Does Mr. Denn ever collaborate with hospital systems or pharmaceutical corporations like Walgreens or CVS to provide more comprehensive care? | ||
|
unidentified
|
Yeah, so our members have many partnerships with hospitals across the country. | |
| You know, oftentimes it'll be where physicians, community health centers will deliver babies or provide access to specialty care. | ||
| So that is a really important collaboration and partnership. | ||
| And hospitals have an incredible role in maintaining the nation's health as well. | ||
| So I don't want to make it out that health centers are the only way. | ||
| But I would also say, you know, about 20% of our healthcare spending is around pharmaceutical drugs. | ||
| And so those could be anything from the ear infection, you know, amoxicillin to, you know, higher cost medications. | ||
| And so we work with the pharmaceutical companies, the CVSs, and the pharmacies like Walgreens, you know, within this broader ecosystem. | ||
| So yes, very much so. | ||
| We work together in partnership in a lot of different ways. | ||
| Diana, and it's St. Paul, Minnesota, on the line for healthcare workers. | ||
| Hi, Diana. | ||
|
unidentified
|
Hi, so I am actually a provider at a community health center right now, and I just want to say that this bill is extremely dangerous. | |
| So, not only to the population who relies on health centers, but to many Americans. | ||
| So, I hope there is some pushback on this bill. | ||
| This is very, very dangerous. | ||
| There is clearly enough money to fund the military in ICE, but not health care. | ||
| I feel like a lot of callers who've been calling and been concerned about that need to use their common sense. | ||
| I serve my community in Minnesota, and in going into benefit, we don't deny care to patients. | ||
| So, to deny care to patients is to indirectly cause harm, and we take an oath not to cause any harm. | ||
| Yeah, so thanks so much, Diana, for your service in the community of Minnesota. | ||
| You know, what I would say is we are concerned, like you, about the law. | ||
| We believe that it could lead to 6,000 preventable deaths every year, closures at health centers, and loss of staff. | ||
| And so, that's what we're very concerned about. | ||
| And you're exactly right, that health centers do everything in their power to not turn anybody away. | ||
| They serve everybody regardless of their ability to pay. | ||
| But, like I said, they also set people up on sliding fee scales so they can pay what they can based on their income. | ||
| So, that's where the beauty of the health center movement and where we are providing that care across the country. | ||
| And Pep Posted this on X to your guest. |