Republicans Cut Funds For School-Based Health Centers

May 10, 2011 12:33 pm ET

Last week, the GOP continued its quest to dismantle parts of the Patient Protection and Affordable Care Act, with 232 House Republicans voting to cut funding for School-Based Health Centers (SBHCs) — medical facilities that provide children with access to primary care at school. In a report, House Energy and Commerce Committee Chairman Fred Upton (R-MI) rationalized defunding the SBHCs with claims that the "incoherent" authorization will pay for clinic construction but not for staffing and that it duplicates funding for community health centers — neither of which is true. Rather than eliminating wasteful spending, House Republicans have moved to take away valuable resources from effective primary care facilities for children.

School-Based Health Centers Have A Long Record Of Success In Improving Children's Access To Health Care

NASHBC: "SBHCs Are The Primary — And Occasionally Only — Available Health Care For Many Children And Adolescents Who Otherwise Would Have No Access." According to the National Assembly on School-Based Health Care: "As early as 1995 the Government Accountability Office (GAO) said: 'Communities are using school-based health centers to fill a niche in the national's health care delivery system' (GAO/HEHS-95-35). SBHCs are the primary — and occasionally only — available health care for many children and adolescents who otherwise would have no access." [, 3/8/11]

NASBHC: School-Based Health Centers "Provide Access For Nearly Two Million Students." According to the National Assembly on School-Based Health Care: "More than 1,900 SBHCs across the country provide access for nearly two million students, and a range of primary, mental, and oral health care services. These services are provided regardless of students' ability to pay in a location that meets children and adolescents where they are: at school. SBHCs are often the only source of health care for many children and adolescents who would otherwise go without needed services." [, 3/30/11]

2010 Study: "SBHCs Could Have Saved Medicaid About $35 Per Student Per Year." According to the American Journal of Public Health: "With SBHCs, the gap of lower health care cost for African Americans was closed. The net social benefits of the SBHC program in 4 school districts were estimated as $1352087 over 3 years. We estimated that the SBHCs could have saved Medicaid about $35 per student per year." [American Journal of Public Health, Vol. 100, No.9, September 2010]

1996 Study: SBHCs "Enhance Adolescents' Access To Care." From Pediatrics, the official journal of the American Academy of Pediatrics: "In summary, adolescent users of SBHCs seemed to have higher use of medical, mental health, and probably substance abuse counseling services than did adolescents in the general population. These findings are consistent with the interpretation that SBHCs do enhance adolescents' access to care for medical, mental health, and substance abuse problems." [Pediatrics, Vol. 97 No. 3, March 1996]

1996 Study: Access To School-Based Health Care Correlated With "Reduced Use Of Emergency Rooms" And "Fewer Hospitalizations." According to the Journal of Adolescent Health, the official publication of the Society for Adolescent Health and Medicine: "Access to school-based, primary health care for adolescents was associated with increased use of primary care, reduced use of emergency rooms, and fewer hospitalizations. These findings have implications for both access to primary care and funding of school-based primary care." [Journal of Adolescent Health, Vol. 19, Iss. 4, October 1996]

1994 GAO Report: "SBHCs Improve Children's Access To Health Care By Removing Financial And Other Barriers." According to the Government Accountability Office: "Health and education officials believe that SBHCs improve children's access to health care by removing financial and other barriers in the existing health care delivery system. Providing health services to children in school-based settings enables children to get both periodic preventive care and treatment for chronic and acute medical conditions. SBHCs provide services either free of charge or at minimal cost to students, which can particularly help children who lack health insurance and those whose insurance may not cover all the services they need. Locating services where the children are increases convenience for students and parents. Additionally, SBHCs provide adolescents with an environment of greater trust and confidentiality than that of other health care settings." [Government Accountability Office, "School-Based Health Centers Can Expand Access for Children," December 1994, via]

House GOP Defunded Grants To School-Based Health Centers

On May 4, The House Voted For H.R. 1214, Which Defunds Grants To School-Based Health Centers. According to the National Assembly on School-Based Health Care: "This afternoon, the House of Representatives voted 235 to 191 to pass H.R. 1214, which would defund grants for school-based health centers (SBHCs). The Patient Protection and Affordable Care Act appropriated $50 million a year for 4 years in funding for renovation, construction and equipment grants to SBHCs." [, 5/4/11]

  • Republicans Justify Defunding With Claim That SBHCs Qualify For Community Health Center Grants. According to a report submitted by Rep. Fred Upton (R-MI) to accompany H.R. 1214: "Additionally, the stimulus and the health care law each provided $1.5 billion for the construction of community health centers. Many school based health centers qualified to receive grants from this funding." [, 4/6/11]
  • Republicans Justify SBHC Defunding With Claim That Clinics Would Be Built But Not Staffed. According to a report submitted by Rep. Fred Upton (R-MI) to accompany H.R. 1214: "Section 4101(a) of PPACA provides $50 million a year through 2014 for construction, land acquisition and other capital costs for School-Based Health Centers (SBHCs). However, there is an express prohibition in the law on using these funds for personnel or providing health care services. Section 4101(b) of PPACA authorized a separate discretionary grant program to provide care at these clinics. This program was not provided mandatory funding and the President's budget did not request any money for the grant program that actually provides care. H.R. 1214 does not repeal section 4101(b) of PPACA. Providing funds for construction without funds to staff these clinics and provide health services is an incoherent policy." [, 4/6/11]

School-Based Health Centers Did Not Receive Stimulus Funds And Are Largely Ineligible For Community Health Center Funds

SBHCs Did Not Receive Recovery Act Funds, And Most Are Ineligible For Funds Made Available To Community Health Centers. According to the National Assembly on School-Based Health Care:

  • The vast majority of SBHCs do not receive funding through section 330 of the Public Health Service Act; they are ineligible for those funds.
  • SBHCs did not receive funding from the American Recovery and Reinvestment Act (ARRA).
  • The vast majority of SBHCs are not eligible for funding provided by section 10503 of the Affordable Care Act, which limited appropriations to 330-funded programs. [, 3/8/11]
  • Section 330 of Public Health Service Act Refers to Community, Migrant, Homeless And Public Housing Health Centers. From the National Health Policy Forum: "In 1975, Congress authorized neighborhood health centers as 'community and migrant health centers'; subsequent authorizations added primary health care programs for residents of public housing and the homeless. The Health Centers Consolidation Act of 1996 combined these separate authorities (community, migrant, homeless, and public housing) under §330 of the Public Health Service Act (PHSA) to create the consolidated health centers program. Health center grantees are often called 330 grantees because of this statutory authorization." [National Health Policy Forum, "The Fundamentals of Community Health Centers," 8/31/04, internal citations removed for clarity]

Only 28 Percent Of SBHCs Have Community Health Center Backing. According to a SEEN (SouthEast Education Network) magazine article: "Sponsors (organizations that serve as the primary administrative home) of SBHCs are most typically a local health care organization, such as a community health center (28 percent), a hospital (25 percent), or a local health department (15 percent). Other community sponsors include nonprofit organizations, universities, and mental health agencies. Twelve percent of SBHCs are sponsored by a school system. SBHCs often receive additional support from schools and others through in-kind donations of space and services." [SEEN, 8/23/10, emphasis added]

  • Only 23 Percent Actually Receive Funding Because Of Their Affiliation With Community Health Centers: According to a SEEN Magazine Article: "Almost a quarter (23 percent) of SBHCs receive section 330 monies through the Public Health Service Act for community, migrant, and rural health centers; these SBHCS are mainly sponsored by Community Health Centers. State Departments of Public Health are the most common source of state funds — almost half of SBHCs report receiving funds from these state entities — while the departments of human or social services and education fund about 11 percent of programs. In twenty-one states, the state funds or sponsors a grant program specifically dedicated to SBHCs." [SEEN, 8/23/10, emphasis added]

No Empty Clinics: To Receive PPACA Grants, Projects Must Be Operational Within Two Years

SBHCC Grants Are Authorized Under Health Care Reform Law. According to the U.S. Department of Health and Human Services' Health Resources and Services Administration: "SBHCC grants will address significant and pressing capital needs to improve delivery and support expansion of services at school-based health centers. [...] The program is authorized by the Patient Protection and Affordable Care Act (Affordable Care Act) ((P.L. 111-148), Title IV, Section 4101(a))." [, accessed 5/9/11]

  • To Receive A Grant, "Applicants Must Be A School-Based Health Center Or A Sponsoring Facility Of A School-Based Health Center." According to the U.S. Department of Health and Human Services' Health Resources and Services Administration:

5. What are the eligibility criteria for SBHCC funds?

For this funding opportunity, eligible applicants must be a school-based health center or a sponsoring facility of a school-based health center as defined in section 2110(c)(9) of the Social Security Act. [, 12/20/10, emphasis original]

Grant Recipients Must Be Operational Within Two Years. According to the U.S. Department of Health and Human Services' Health Resources and Services Administration:

10. We are starting a new school-based health center; does it need to be already operational in order to apply for a SBHCC grant?

To be eligible, the applicant must be a school-based health center or a sponsoring facility of a school-based health center as defined in section 2110(c) (9) of the Social Security Act. The applicant may propose any type of project for a school-based health center that is not yet operational, but will be operational within the two year project period. [, 12/20/10]