Jack Lessenberry for Tuesday, January. 2, 2018

For the last year, there has been a lot of news about Republican efforts to kill the Affordable Care Act, or failing, that, to try and strangle its funding.

In recent weeks, we’ve also become increasingly aware of the crisis facing the federally funded Children’s Health Insurance Program, known as CHIP, which provides health insurance for more than nine million kids nationwide, more than 100,000 of them in Michigan.

For the first time since it was created 20 years ago, Congress did not reauthorize CHIP’s funding. Shortly before the holiday break, they did pass short-term funding through the end of March. But a long-term solution has been stalled in part, Congressman Sandy Levin told me yesterday, by a battle over whether to use some Medicaid funds set aside for research to fund the program, something Democrats like Levin strongly oppose.

But there’s another program that reaches even more people that is in even more jeopardy. That’s funding for the nation’s network of Federally Qualified Health Care Centers, mostly in rural areas. They have nothing to do with Obamacare -- they were first authorized by the Public Health Service Act of 1944, created to serve poor rural areas where there are few doctors.

There are also some in underserved urban areas. Nearly 700,000 Michiganders visited one last year. But their funding also hasn’t been reauthorized. They’ve been continuing to function, Congressman Dan Kildee’s office told me, with funding kept alive by a series of even shorter-term continuing resolutions. The current one expires January 19.

Ruth Spalding is a 30-year-old social worker and therapist who works for one of the 45 such health care centers in Michigan; she’s at MidMichigan Community Health Services in Houghton Lake. She contacted me to say while she didn’t speak for the program or her employer, she was desperately worried about the fate of her patients -- and concerned that the public has very little idea what is happening.

“Here’s the thing,” she said.

“Most people don’t know that the clinic they go to is a Federally Qualified Health Center that receives funding through the federal government. They don’t know we’re in danger of closing at some point. They just know they see their favorite doctor here and they see their favorite therapist here.” Nor is she allowed to talk to her patients about these issues.

MidMichigan Community Health Services does have an affiliation with the University of Michigan’s medical center, but isn’t supported by them. Spalding, who has a masters’ in social work from the U of M, has what you might think a stressful job. “I have folks on my caseload with severe and persistent mental illness, folks who experience paranoid delusions on a regular basis. I treat a lot of depression, anxiety, PTSD," she told me.

But, “all that I can handle. I cannot handle my patients losing their doctor and their therapist,” she said. Last year Mid-Michigan treated about 16,000 patients.

“We’re in a rural area. If we close, my patients will have nowhere else to go." Many of them are “one car repair away from total devastation,” she said.

She told me her superiors weren’t keen on her going to the press, but that she thought it essential that someone tell people about this.

So that’s what I’ve just tried to do.

Jack Lessenberry is Michigan Radio’s Senior Political Analyst. Views expressed in his essays are his own and do not necessarily reflect those of Michigan Radio, its management or the station licensee, The University of Michigan.