• The state's entire federal delegation supported the $248 million in health center appropriations for federal fiscal year 2009. Oregon was one of only 11 states to gain full delegation support.
  
• OPCA facilitated legislative visits for OPCA members with Oregon's federal delegation during the National Association of Community Health Centers' Policy & Issues Forum, held in the spring of 2009 in Washington D.C. We shared the national community health center policy agenda with legislators (or their staff members) from all of Oregon's Congressional districts.

Health care reform is moving forward in Washington D.C. Committees of both the House and Senate have released bills that move us toward accessible, affordable, high-quality health care for every American.

Overview of current bills

U.S. Senate

• The Senate Health, Education, Labor & Pension (HELP) Committee has passed its Reform Bill, The Affordable Health Choices Act. Senator Kennedy's landmark bill aims to address choice, cost reduction, prevention, health system modernization and long-term care and services.
• The Senate Finance Committee, chaired by Senator Max Baucus, also is expected to produce a health care reform bill.

U.S. House of Representatives

• A Health Reform Bill, America's Affordable Health Choices Act (AAHCA) of 2009 (HR3200), represents the collective work of the three House committees with jurisdiction over health reform - Ways and Means, Energy and Commerce, and Education and Labor. The bill seeks to provide quality affordable health care for all Americans while controlling health care cost growth.

While not perfect, these bills do meet three important principles for successful health reform:

• An expansion of coverage that is available and affordable for everyone, and especially to low-income individuals and families.
• Coverage that is comprehensive, with emphasis on prevention and primary care.
• Guaranteed access to a medical or health care home, where anyone can receive high quality, cost effective care for their health needs.

What's Missing from the Senate & House Bills

Not included in the proposed legislation are three important items:

• Appropriate and stable payment for community health centers.
  • Community health centers have advocated for the inclusion of a requirement that any insurance plan, operating either through an insurance exchange or with a federal subsidy, be required to reimburse health centers at an appropriate and stable rate. This provision will ensure that health centers do not lose money serving newly insured patients. The current legislation does not address this issue.
• A new Medicare payment level at least equal to Medicaid for community health centers.
  • The House bill would reportedly update the list of preventive services included as part of the Medicare rate paid to community health centers. The bill also should restructure the payment system for health centers, aligning the Medicare reimbursement system with that currently in place under Medicaid.
• Improvements in health centers' access to low-cost funding to help clinics grow and add services.
  • Health centers have proposed a series of legislative improvements designed to promote better access to low-cost capital resources in the long term. These provisions are not included in the draft legislation.

To improve the chances that these issues will be addressed in the final House and Senate bills, community health centers have introduced Concurrent Resolutions. These are House Concurrent Resolution 144 (HCR144) and Senate Concurrent Resolution 25 (SCR25). Oregon's legislators are encouraged to sign on to these important resolutions.

Members of the House and Senate are expected to continue working on these bills during the fall. Our hope is that votes will be taken in both houses in time for the president to sign a final piece of legislation by the end of the year.

• In the Spring of 2009, the U.S. Department of Health and Human Services (HHS) released a one-time grant of nearly $6 million to expand services at 25 of Oregon's community health centers. The money was made available by the American Recovery and Reinvestment Act (ARRA, the federal economic stimulus package) and came as more Oregonians joined the ranks of the uninsured.
  
• The grants -- titled Increased Demand for Services grants -- will be used over the next two years to hire additional health care professional, increase hours of operation or expand health center services. HHS reports that the funds will allow centers to create or retain an estimate 120 jobs throughout Oregon and to serve an estimated additional 32,500 patients.
  
• In June 2009, the White House announced the next round of ARRA funding for Oregon CHCs. Under the Recovery Act Capital Improvement Program, the federal government will release $14.6 million to address immediate and pressing health center facility and equipment needs and increase access to health care for Oregonians.
• In December 2009, HHS awarded the final grants to community health centers under ARRA.  One Oregon CHC, Central City Concern, received a $9 million Facility Improvement Grant for construction and renovation projects. 

• The grants will help OPCA's health centers continue to serve our most vulnerable residents. But they should not be viewed as a solution to our centers' ongoing financial challenges.
  
• Navigating the ARRA funding process for community health centers: Visit the HHS website for comprehensive information at www.hhs.gov/recovery.
• These grants will support the construction, repair and renovation of health center sites. Oregon’s CHCs will use the funds to purchase new equipment, invest in health information technology systems, and adopt and expand the use of electronic health records.