Stopgap funding endangers key federal program for health care shortage areas

 Stopgap funding endangers key federal program for health care shortage areas
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As congress debates funding to prevent the government from shutting down it must also fund expired federal programs like the National Health Service Corps (NHSC) that ensure health access to children and families.

According to data just published, there are more than 82 million people living in more than seven thousand primary care Health Professional Shortage Areas (HPSAs) in the United States — and it is estimated that of the tens of millions of families living in HPSAs, almost 20 million are children. A primary care HPSA is a designation of an area and its population that has officially been defined as having a significant shortage of primary care health professionals.

Established in 1972, the NHSC is a federal program designed to provide scholarships and loan repayments to healthcare providers in exchange for practicing in a designated HPSA. Since its inception, the program has helped place more than 50,000 health professionals in medically underserved areas. Today some 10,200 members care for more than 10.7 million of the nation’s most medically underserved.


It is unconscionable therefore that it has been over 100 days since funding expired for this program, which incentivizes newly trained primary care providers to practice in medically unserved areas. This lack of action is threatening the ability of medical programs to recruit and retain much needed help.

The NHSC is a lifeline to rural clinics in our network; in fact a substantial majority of Children’s Health Fund programs are located in HPSAs. In the 16 states and District of Columbia where Children’s Health Fund provides services, there are about 49 million people living in HPSAs and more than 8,500 new primary care practitioners would be needed to end the shortages. 

Programs like the ones NHSC serve help to sustain health care services for rural and underserved communities — providing incentives for health care providers to live and work in areas where there is no other doctor. But many of our programs — some as remote as southeastern Arizona to urban centers in the South Bronx — still struggle with retention and recruitment in the face of such stark shortages.

Children’s Health Fund has long recognized that the key to progress in addressing the goal of connecting every child to a medical home is eliminating both fiscal and non-fiscal barriers to care. Absent a comprehensive effort to ensure a robust health workforce pipeline, the health and wellbeing of the nation’s most medically underserved children and families will continue to be out of reach.

While Congress passed a short term funding patch to carry the program over till March, the patch misses the reality of many medical students who are making one of the most significant decisions of their young careers. Creating uncertainty in funding for such programs undercuts all the hard work put in by these programs trying to attract young talented medical professionals to medically underserved areas.

“As rural healthcare providers, recruitment and retention are one of our biggest struggles. Without a stable provider workforce, we simply cannot provide the high quality medical services that the children in this region deserve” said Dr. Darlene Melk the Medical Director of the Southern Arizona Children’s Health Project, a program that provides medical health in one of the most remote areas of the country.

Melk should know. Not only does she direct medical services in this remote area of Arizona, but her husband, Dr. Jonathan Melk, was an NHSC provider himself and is now the CEO of a Federally Qualified Health Center network where Children’s Health Fund operates.

Neither those hiring nor those making major career decisions can afford to make workforce decisions based on month-to-month funding. There is fear that uncertainty will have a chilling effect on current students who may have been considering the program. 

“Often times, young health professionals we seek to recruit are torn between their desire to work in rural communities where their skills are badly needed and fulfilling financial obligations to cover heavy student debt. In the face of such heavy loan payments, many opt instead to work for corporate practices in big cities leaving unfilled positions in rural programs like ours,” said Adam Hodges the Medical Director of the Idaho Children’s Health Project. 

As many child health care safety net programs continue to struggle to recruit primary care providers to medically underserved areas, parents and their children will be left with few options. The unfortunate truth is that even when programs like the NHSC are fully funded our nation still has massive health workforce challenges.

Playing politics with funding is complicating recruitment and potentially exacerbating the problem. Congress must act immediately — rural and urban communities alike are caught in the trap of indecision.

Dennis Walto is the CEO of Children’s Health Fund, a nonprofit organization that provides health care to America's most vulnerable children.