Lawmakers face a September deadline for the community health centers, after which their funding would begin to expire, likely leading to steep cuts.

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Pallone said the plan would provide the security of the longest guaranteed funding commitment ever secured by the clinics, averting the September cliff. But flat funding would not keep pace with medical inflation, likely forcing the community health centers to serve about 4 million fewer people annually by 2023 than they do now, said Leighton Ku, professor of health policy at George Washington University’s Milken Institute School of Public Health.

That prospect has alarmed liberal lawmakers including Sen. Bernie Sanders (I-Vt.), Rep. Ro Khanna (D-Calif.), Rep. Alexandria Ocasio-Cortez (D-N.Y.), and Rep. Pramila Jayapal (D-Wash.), co-chair of the congressional Progressive Caucus. They argue Democrats should use their control of the House to approve increases in funding for the centers, and then hammer out an agreement with Senate Republicans.

“I was, quite honestly, stunned. It’s just absolutely disastrous, and moving in the wrong direction,” said Sanders, a 2020 presidential candidate, in an interview. “We should be substantially increasing funding. I was very, very disappointed by Democratic leadership … We will do everything we can to rectify this.”

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Pallone dismissed Sanders’ objections and said Democrats need to secure the support of Republican lawmakers to prevent funding for the clinics from expiring this fall. Sanders and Pallone had a contentious conversation about the issue in a phone call on Friday, according to congressional aides who spoke on the condition of anonymity because they were not authorized to speak publicly about the matter.

“My goal is to always actually do things that will be signed into law. I’m not looking for a message bill,” Pallone said. “Remember: I have to get the Republicans, because this has to be done by the September deadline.”

Spokespeople for House Speaker Nancy Pelosi (D-Calif.) didn’t respond to requests for comment.

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The debate could have significant consequences for the nearly 30 million people nationwide who rely on the community health clinics, which serve poor people and those without sufficient access to medical care, including in rural areas.

The plan backed by Pallone, while better than letting the funding expire altogether, would amount to a nearly 20 percent funding reduction over four years for the clinics, almost certainly cutting the amount of medical, vision, dental, and mental health care they can provide primarily low-income Americans, said Sara Rosenbaum, a health expert at George Washington University who studies community health clinics.

“For the Democrats in the House to propose flat funding, as opposed to an adjustment over time, I was really worried and taken aback,” Rosenbaum said. “You’d have to scale back your hours, scale back your sites.”

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In an interview, Pallone rejected the charge altogether that his proposal amounted to a funding reduction. “It’s not a cut,” he said.

The package was also approved without controversy by a House subcommittee earlier this month, and was praised in remarks by Rep. Greg Walden (R-Ore.), the committee’s top Republican, as well as other Democrats on the committee. The Senate’s health and education committee also overwhelmingly advanced its similar measure.

“I know the community health centers are very happy about it, and all the people who support them are very happy about it,” Pallone added. “They’re getting $16 billion. There was a time they were going month-to-month, and now they’re talking about four years.”

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A spokesman for Pallone did not provide the names of community health centers who supported the legislation. The National Association of Community Health Centers did not return a request for comment. Angelica Journagin, a spokeswoman for the Unity Health Care in Washington, D.C., said the clinic was grateful for the prospect of a long-term funding commitment, but added that “we strongly hope” members of Congress will provide funding to accommodate inflation.

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In a June news release, Tom Van Coverden, CEO of the National Association of Community Health Centers, praised Murray and Sen. Lamar Alexander (R-Tenn.) for advancing a similar measure to the one in the House.

Recent increases in health center funding also may lessen the blow of flat federal funding. Congress has increased spending on the health centers from $3.6 billion in 2017 to $4 billion in 2019, or by about $200 million annually.

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But liberal lawmakers believe the Democratically-controlled House should pass legislation with funding that at a minimum keeps pace with inflation, then compromise with the Senate after that chamber passes funding for the health centers, using leverage created by the House vehicle. They believe doing so would give Democrats greater leverage in negotiations with conservative lawmakers, although other Democrats doubt that premise.

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In the Senate, Murray has continued to try pushing Republican lawmakers to increase the community health centers’ funding in the final package, according to a Senate aide who spoke on the condition of anonymity to discuss private negotiations. The Senate bill would provide five years of flat funding, rather than the four provided for by the House.

Sanders and Rep. James E. Clyburn (D-S.C.), the House whip, have introduced legislation to fund the health centers for five years with increases greater than inflation.

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The lawmakers’ disagreement comes at a particularly contentious moment for the Democratic Party, which has recent seen unusually public feuds between its leadership and liberal members over a number of issues.

The fight over the community health centers reflects the broader dispute over how aggressively the Democratically-controlled House of Representatives should push the party’s agenda, a fight that sparked a battle over emergency funding for the border.

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Ocasio-Cortez, who led the liberal opposition to the border measure, said in a statement: “I want us to use our majority to fight for these families — not allow a 20 percent cut.” Khanna also said: “Why would we vote to cut community health centers and push more than 3 million low-income Americans off their care?”

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But the most significant criticism of Pallone’s legislation may be Jayapal, who as co-chair of the progressive caucus can influence the voting of other members.