SALT LAKE CITY — Wayne County is so sparsely populated, Evan Christensen says, that it is considered "not only rural, but 'frontier.'"
"People really don't understand until they get out here," he says. "It's beautiful, magnificent country — but it is remote."
Christensen, CEO of Wayne Community Health Centers, is no stranger to the complex hurdles faced when trying to hire medical professionals to serve such a scattered population. That's why he's anxiously hoping that uncertainty over federal funding for community health centers will be resolved soon, allowing him to keep critical staff members on board.
"It's a little bit difficult to get providers to come to these rural areas," Christensen said. "We're fortunate — we have one physician on our full-time staff and he happened to be from Wayne County and he wanted to come home."
But the murky status of federal funding for clinics like the ones Christensen runs may have thrown a wrench in those plans. The uncertainty, Christensen said, has caused his prized physician hire to become "a little gun-shy."
"If we lose him, we're really in a fix," he said. "Other providers (too), they're a little hesitant. We've got a few new ones here and they want to put a stake in the ground. ... They want to buy a house, but they're a little uncertain about what the market's going to do."
"We're nothing without our providers," Christensen later added.
Christensen and others who run community health centers in Utah say they are finding it extremely difficult to do much long-term planning because the legislative mechanism that dispenses 70 percent of their federal funding expired at the end of September and has has not been renewed by Congress.
If that funding is not reauthorized in time to kick in by the beginning of 2018, many of those clinics, which serve much of the state's uninsured, could shutter their doors, according to the Association for Utah Community Health, a group that provides training to those organizations.
More than 30 of the state's 54 community health center locations "would really be forced to be closed down," estimated Alan Pruhs, CEO of the Association for Utah Community Health.
More than 400 jobs would likely be lost, Pruhs said, and "almost 70,000" Utahns would lose access to care. He said the health centers, run by 13 parent organizations, serve about 152,000 patients per year.
"We've been working on this ... quite heavily since January, meeting with our congressional offices," Pruhs told the Deseret News. "The impacts are pretty dramatic, as you can imagine."
The Community Health Centers Fund was established when the Affordable Care Act passed and was renewed by the Medicare Access and CHIP Reauthorization Act of 2015. As of last year, community health centers around the country received $3.6 billion from the fund.
That is in addition to roughly $1.5 billion of annual federal money under a different funding mechanism predating the ACA that did not expire, Pruhs explained.
He said he thinks he could "characterize our entire delegation ... as being supportive" of renewing community health center funding, but worries about whether Congress plans to act "quickly and hastily."
Rep. Chris Stewart, R-Utah, is the sponsor of one of a few competing bills in Congress that would reauthorize money for the centers. Stewart's bill, called the National Health Service Corps Strengthening Act of 2017, would fund the program for another five years and "increase its funding levels," according to a release late last month from his office.
“The NHSC program brings access to many Utahns who are living in rural communities and have limited access to care,” Stewart said in a Sept. 29 statement. “Communities in my district rely on this vital health care program, and I am dedicated to making sure this access continues.”
A competing bill, which Republicans passed through the House Energy and Commerce Committee last week along party lines, would reauthorize the program for two years and would not increase funding to the program.
The committee has since taken the measure up for consideration again in the interest of further bipartisan negotiations. The bill would also be the mechanism reauthorizing federal money for the Children's Health Insurance Program, which provides coverage to more than 19,000 young people in Utah and for which funding also expiredSept. 30.
Others in Utah's congressional delegation also say they are paying close attention to reauthorization of community health center funds, though they didn't go into detail about which bill they support. Rep. Mia Love, R-Utah, said in a statement to the Deseret News that reauthorization of the program "is a priority for me."
"Although I am not on the committees of jurisdiction, I have reached out to those committees to let them know about the centers’ importance to Utah," Love said. "I will support reauthorization bills that maintain funding for these important programs that are vital to Utah.“
Matt Whitlock, spokesman for Sen. Orrin Hatch, R-Utah, told the Deseret News in an email that the senator "recognizes the critical role public health centers play in our communities and is confident funding will be renewed prior to any lapses."
Sen. Mike Lee's spokesman, Conn Carroll, told the Deseret News that the Republican senator "does not prefer any one existing bill" and "is confident CHIP will be reauthorized soon before Utah runs out of money," but did not directly address funding for the community health centers.
Rep. Rob Bishop, R-Utah, could not be reached for comment.
The groups that operate Utah's community health centers received $35.6 million in federal grants last year. If funding is not renewed, they would stand to receive only about 30 percent of that figure in 2018.
Pruhs said the clinics rely significantly on federal funding because they serve underserved populations and areas, including low-income and uninsured people, at the expense of profit. In all, 52 percent of patients who use community health clinics in Utah are uninsured, he said, a higher rate than their counterpart organizations in most states.
"That grant revenue ... is the foundation that the entire practice is built upon," Pruhs said.
In a handful of remote areas in Utah, he said, community health centers serve just about everyone because they are the only medical care "for many miles in any direction." Those centers are also a major source of jobs, Pruhs said.
Christensen said the presence of his clinics in Wayne and Garfield counties is also what makes the difference between a quick trip to the doctor and a parent needing to take the day off work just to make a visit for their sick child.
Asked whether losing funding next year could cause clinic closure, Christenen replied, "It is possible."
"We've got some contingency plans in place of initially reducing staff, limiting services, but when you start doing that ... (you may learn) you've either got to be all in or all out," he said.
Pruhs said that on average, his association's member organizations receive 28 percent of their total funding from federal grants, with other sources of money being reimbursement for services through Medicaid, commercial insurance or payments made directly by patients.
At the 4th Street Clinic in Salt Lake, which serves homeless clients, federal grants make up about half of the organization's total budget.
"It's a substantial portion and it's a big piece of who we are, we're a health center," said Janida Emerson, chief operating officer of 4th Street Clinic.
Emerson said "it's hard to predict what Congress is ever going do do," but that "we remain hopeful," thanks in part to reassurances from Utah's congressional delegation. She would like any reauthorization to last long term.
"It's difficult to plan in that type of environment and it just (takes) … huge time and effort to have to be constantly addressing the issue," she said.