Running head: COMMUNITY HEALTH CENTERS 1

Community Health Centers:

Expanding Healthcare Access

Susan Hensler

Delaware Technical Community College

NUR 420 Nursing Policy

October 5, 2018
COMMUNITY HEALTH CENTERS 2

Community Health Centers: Expanding Healthcare Access

It is easy to sit idly and hope others will enact the change we would like to see in this

world and then complain when things don’t go our way. It is much more exciting, albeit

demanding, to choose to be the change agent on an issue that concerns us. The American Nurses

Association encourages all nurses to take an active stand for their patients on all levels, whether

it is advocating for a sick patient at their bedside, caring for individuals in their homes, or

lobbing for improved healthcare policy. According to the National Association for Community

Health Centers, for over sixty years, Community Health Centers (CHS) have remained an

affordable option for low income individuals seeking healthcare. These federally funded centers

are an option that over 27 million Americans choose for their healthcare needs. With timely

access to primary care and specialty medical services, Community Health Centers reduce

mortality and health disparities within the communities they serve in a cost-effective manner

(National Association of Community Health Centers, 2018). While the Affordable Care Act

(ACA) granted increased funding for low income individuals through increased Medicaid and

Community Health Center (CHC) funding, current legislature seeks to repeal the ACA and slash

federal funding for CHCs. As nurses, we must advocate for our patients on all levels, including

the formation and support of healthcare policy.

Current Bills and Laws

Comprehensive and affordable healthcare services should be a right of all Americans, yet

the current administration in tandem with multiple states are pushing to decrease funding and

services that meet basic healthcare needs for Americans (Craig, 2018). Concerns about

affordable, easily accessed healthcare continue to make the headlines, while the Affordable Care

Act is slowly being eroded. In an article in the American Nurses Association Capitol Beat, Craig
COMMUNITY HEALTH CENTERS 3

(2018) reported that due to funding cuts and tumultuous policy decisions, ACA enrollment is in

decline: 8.7 million Americans are currently enrolled in the ACA marketplace, down from 9.2

million in 2017.

Section 330 of the Public Health Service Act authorizes the Health Center Program

which is administered by the Health Resources and Services Administration under the

jurisdiction of the Department of Health and Human Services. Congress funds these health

centers through a combination of discretionary funding and regular appropriations each fiscal

year under the Community Health Center Fund Act of 2010 (National Association of

Community Health Centers, 2018). The Senate has passed fiscal year 2019’s budget for health

care discretionary spending and the bill now awaits its fate with our Congressional lawmakers,

who have historically supported the funding of Community Health Care Centers. The current

2018 budget of $1.63 billion in discretionary 330 grant funds together with the anticipated FY19

allocations are slated to top $5.6 billion for health care centers (National Association of

Community Health Centers, 2018).

The American Health Care Act of 2017

House Resolution 1628, sponsored by Republican Representative Diane Black, was

introduced on March 20, 2017. The bill was read twice and returned to the calendar while it

awaits deliberation in the Senate. HR 1628, also known as the American Health Care Act of

2017, seeks to repeal parts of the Affordable Care Act. Although supporters of House

Resolution 1628 maintain their goal is to reduce the federal budget deficit, HR 1628 would in

turn decrease the number of insured Americans by 22 million through the elimination of $772

billion in Medicaid funding for low income Americans. In addition to the direct cuts in

Medicaid funding, $1 billion per year in prevention funding for tobacco cessation, vaccinations,
COMMUNITY HEALTH CENTERS 4

well checks, etc. would be eliminated through the passage of HR 1628. This loss of funding for

Community Health Centers would increase costly emergency room visits as well as result in the

loss of over 1 million healthcare jobs by 2023 (American Nurses Association, 2018).

Pending Legislature

House Resolution 3417, a bill introduced by Democratic Representative Janice

Schakowsky into the 115th Congress on July 26, 2017, aims to increase funding for Community

Health Centers. HR 3417 would authorize the Secretary of Health and Human Services to carry

out a pilot program aimed at appropriating $100 million in funding for community-based care

infrastructure improvements. The bill was referred to the Subcommittee on Health on July 28,

2017 where it sits awaiting deliberation (Congress.gov, 2018). Unfortunately, this bill to

promote Community Center Spending does not seem to hold the same urgency of bills opposing

the Affordable Care Act in this currently Republican led Congress.

A Call for Action

Provision 9.4 of the ANA Nurses Code of Ethics states that “The profession of nursing

collectively through its professional organizations, must articulate nursing value, maintain the

integrity of the profession, and integrate principles of social justice into nursing and health

policy” (American Nurses Association, 2018). As nurses, it behooves us to become involved in

our patient’s welfare beyond the bedside. We must ensure that through public policy and

legislature our patient’s basic needs are met.

We can become advocates for our patients by lobbing for healthcare reform. As a

member of the American Nurses Association, our voices can be heard through the ANA Political

Action Committee. The ANA-PAC finds candidates, regardless of their party affiliation, to

endorse for federal office through careful vetting. Information on candidates is gathered by ANA
COMMUNITY HEALTH CENTERS 5

Government Affairs Department staff in an effort to identify potential candidates to support.

Candidates must complete a questionnaire and consent to an interview with ANA staff members

to determine their position on nursing and healthcare issues. Once a candidate has demonstrated

their support for healthcare, the ANA grants their endorsement (American Nurses Association,

2018).

Key Stakeholders for Change

Contacting legislators to urge healthcare funding that finances Community Health

Centers is another way to express support. On the local level in Delaware are State Senator

Gerald Hocker and State Representative Richard Collins. These legislators have a vested interest

in the needs and desires of their local constituents and tend to be more approachable than federal

lawmakers. Letters or email correspondence can open the dialog for determining the position of

an issue like funding for Community Health Centers. Local town hall meetings are a great start

for communicating an exchange of ideas, however, scheduling may be sporadic, so requesting a

face to face interview may be more successful. While contacting these legislators may be easy,

looking at their track record is not encouraging. Both Hocker and Collins are conservative

Republicans who historically have voted socially conservative.

A much better avenue for seeking support would be United States Senators Thomas

Carper and Chris Coons. Delaware Democrats Senator Carper and Senator Coons have

demonstrated their support for the Affordable Care Act. Both Senators have voted against

President Trump and the conservative legislature in their attempts to repeal the ACA and restrict

health care spending for low income Americans (Vote Smart, 2018). Another ally is United

States Congresswoman Lisa Blunt Rochester from Delaware, who has also come out in favor of
COMMUNITY HEALTH CENTERS 6

federal healthcare spending and voted against the repeal of the Affordable Care Act (Vote Smart,

2018).

Another major supporter of health care spending is United States House Representative

Janice Shakowsky (D-IL), who introduced House Resolution 3417, the bill discussed above

requesting the earmarking $100 million for Community Health Centers.

My Strategies for Implementing Change

Expediting the passage of HR 3417, ensuring that the Affordable Care Act is not

repealed, and the continued funding for Community Health Centers are my primary goals when

meeting the legislators and lobbyists.

Change begins one step at a time. I would begin by sending emails within the next week

or two to the legislators as an introduction to dialog and to determine their current plans for

supporting healthcare funding for Community Health Centers. After email contact has been

established, I would request a face to face meeting with these Legislators within the next month

or two to lobby their ongoing support of this important issue.

There are several legislators it would be relevant to convene with. I would request to

meet with Democratic Representative Janice Schakowsky, who introduced HR 3417 and ask

about her intentions for that bill and whether she plans to continue to push for its passing. I

would ask the Congresswoman for an estimated timeline for the bill to pass through committee

and would ask from where the funding would be allocated so that I could lobby the individuals

on the various budget committees. I would plead the timely passing of HR 3417 with concrete

facts citing the urgent need this country has for Community Health Centers and the financial

savings preventative care elicits. Continuing to enlist individual nurses and groups such as the

Community Health Center staff to lobby our legislators for the passing of HR 3417 can be a
COMMUNITY HEALTH CENTERS 7

powerful force on the federal, state and local levels and demonstrate our determination for

healthcare reform.

Since Senator Carper and Senator Coons have established their support for healthcare

spending, I would contact each of them to determine their awareness of and ask their support of

HR 3417 introduced by Representative Janice Schakowski. I would like to find out if they can

improve momentum of the bill through committee. I would like to ask what steps can be taken

by my fellow nurses on the grassroots level to ensure Community Health Center funding and

would remind them that nurses are the largest sector of the healthcare workforce and that we

carry a strong vote (American Nurses Association, 2018).

Conclusion

With over 27 million Americans relying on Community Health Centers for their primary

healthcare (National Association of Community Health Centers, 2018) and the current

administration working diligently to slash healthcare funding, we as nurses, cannot sit idly by

and hope others will take a stand. It is our duty to advocate for our patients by ensuring that they

receive the healthcare they need and deserve. Taking a stance is easy. Creating a healthcare

reform plan and seeing it through is challenging, and often disheartening. But we, as nurses, are

fortunate to be in a position to be heard and to have the ability to make positive changes for those

entrusted into our care.

References

American Nurses Association. (2018). ANA-PAC FREQUENTLY ASKED QUESTIONS (FAQs).

Retrieved from ANA: https://ana.aristotle.com/SitePages/anapac.aspx

American Nurses Association. (2018). Code of Ethics for Nurses With Interpretive Statements

(View Only for Members and Non-Members). Retrieved from ANA American Nurses

Association : https://www.nursingworld.org/coe-view-only

American Nurses Association. (2018). What's at Stake for Nurses and Patients without the

Affordable Care Act. Retrieved from ANA American Nurses Association:

https://www.nursingworld.org/~4af2b8/globalassets/docs/ana/ana-health-care-

infographic-nurses-patients-no-aca_2017july13.pdf

Congress.gov. (2018). H.R. 3417. Retrieved from Congress.gov:

https://www.congress.gov/bill/115th-congress/house-

bill/3417/text?q=%7B%22search%22%3A%5B%22community+health+care%22%5D%

7D&r=7

Craig, G. (2018, August 29). States and Trump Administration Push to Roll Back Health Care

Gains. Retrieved from Capitol Beat From the American Nurses Association:

https://anacapitolbeat.org/

National Association of Community Health Centers. (2018). National Association of Community

Health Centers. Retrieved from Appropriations: http://www.nachc.org/policy-

matters/federal-issues/appropriations/

Vote Smart. (2018). I Spy. Retrieved from Vote Smart Facts Matter:

https://votesmart.org/candidate/political-courage-test/22421/tom-carper/#.W7eu3S_MzIE