Cheryl Champion of Solon Springs describes herself as a member of “the working-class poor” and said that if not for the Lake Superior Community Health Care Center, her struggles with diabetes and heart disease likely would have landed her in the hospital.

“There are many people in our community who work at that just-below-getting-insurance level like me. We’re sort of stuck, and that’s why people stop going to the doctor. Or they start taking their meds every other day,” she said.

Looming ‘cliff’

The Lake Superior Community Health Care Center, with clinics in Duluth and Superior, is part of a federal network of centers that provide sliding-fee medical and dental care to many of the nation’s most vulnerable residents, including the poor and uninsured.

But much of the funding for these centers could dry up this year unless Congress takes action before Sept. 30 - what’s been called a “funding cliff.” If Congress doesn’t replenish the federal Health Centers Fund, the center and other facilities like it will see their federal funding slashed by 70 percent.

That would translate into a blow of more than $902,000 for the center’s two Twin Ports clinics.

In the face that kind of funding reduction, the center’s management team anticipates its clinics would be able serve 1,241 fewer patients - 11 percent less than the 10,994 people it treated last year.

The clinics, which now employ 83 people, would likely need to consider staffing cuts, as well.

Dr. Emily Anderson, the center’s medical director, said that if patients are deprived of care, it could wind up costing society more. She explained that preventative care typically is more cost-effective than expensive emergency care.

“From a provider perspective, we have a lot of insecurities right now and concerns that at some point we won’t be able to provide the breadth and type of care that we want to provide,” she said.

“That makes us sad,” Anderson said. “We like being able to care for everyone and truly provide quality health care to everyone, regardless of their ability to pay.”

The center’s resources already are stretched, particularly when it comes to providing dental care, with new patients encountering a two-year wait for an appointment involving anything short of an emergency.

Julie DeMarte has worked as a dental hygienist at the health care center for the past 12 years and said she considers her job demanding but rewarding.

“I wanted to work in a place where I knew my skills would be most needed. And they certainly are needed,” she said. “It’s amazing, the need for dental care in this community.”

Medicaid doesn’t cover dental care, so many people on it can’t afford to see a private-practice dentist. If not for the services the Lake Superior Community Health Center provides, DeMarte said many people would need to travel to facilities in Cook, Deerwood or Minneapolis for dental care.

More uncertainty

Other potential threats also lie ahead if the Affordable Care Act is dismantled, said Dayle Patterson, the center’s CEO.

“There are three big uncertainties,” she said. “One, of course, is the federal funding cliff, and another is if the ACA is repealed, we could see the retraction of Medicaid expansion and also, there’s language in the American Health Care Act proposed by the Republicans that would change Medicaid funding to a block grant or a per-capita model.

“Of course the prediction is that over the next 10 years there will be billions of dollars lost out of Medicaid because of that, which will likely cause a variety things: fewer recipients so the eligibility criteria would likely have to change; the amount of reimbursement to providers would likely have to change; and the schedule of benefits for recipients would likely have to change. So it could be one or any of those things. We just don’t know,” Patterson said.

With so much in flux, Patterson said contingency planning has been a challenge.

While there was insufficient support to pass the American Health Care Act as a replacement for the Affordable Care Act, Patterson said it remains unclear what could be proposed next.

Anderson described the ACA as a game changer for many patients, who now have access to coverage.

“It has made a huge difference in preventative health,” she said.

“When I started here, our uninsured rate was 33 to 35 percent. Now, four years later, we’re down to 17 percent. That’s amazing,” Anderson said.

While that’s a big improvement, community health clinics continue to see a greater share of uninsured patients than most other facilities because of the clientele they serve. Anderson noted that about 4 percent of Minnesotans currently lack health insurance coverage.

Anderson fears the progress that’s been made could prove short-lived.

“We’re really nervous that we’re going to start heading backwards, where fewer people have insurance, which means they have less access, which means they put off the things that keep them well and they wait until a major crisis happens. That’s exactly what we want to keep from happening,” she said.

Champion’s part-time job as a therapist doesn’t offer medical benefits, so she enrolled in a health insurance exchange plan with help from the care center’s Navigator program last summer. And when she recently turned 65, staff helped her shift to Medicare Part B.

Champion said the community health center has helped her manage her health every step of the way, providing medical care, dental care, a nutritionist, as well as access to vision care.

“It just feels like a family here,” said Champion, who recently agreed to serve as a patient representative on the center’s board of directors.