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The health care crisis you don’t know about 

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Ruth Spalding loves her job — not that it isn't stressful. She is a social worker and therapist who sees poor people with a whole lot of problems.

"I treat a lot of depression and anxiety, PTSD," she says. "I have folks on my caseload with severe and persistent mental illness, folks who experience paranoid delusions on a regular basis."

She says she treats folks from 18 to 89. "I see a lot of survivors of intimate partner violence and domestic violence," she says. "I see a lot of people who live with family members who otherwise wouldn't due to poverty. All these folks work; they do not need more jobs, they need a decent wage."

"I see a lot of people one car repair away from total devastation," she says.

Heavy-duty stuff. But Ruth, who is 30 and calls herself, perhaps wrongly, a "typical millennial," loves her job because she knows she is really making a difference. She works for a community health center called MidMichigan Community Health Services in Houghton Lake.

What's special about it is that it is one of about 40 Federally Qualified Health Centers in Michigan, and gets federal aid to treat a largely rural population who have little money and live in an area drastically underserved by doctors. Community health centers like hers served nearly 700,000 Michigan residents last year.

Most are rural; a few inner-city. But all are in danger of being closed down. They, like CHIP, the Children's Health Insurance Program that serves 9 million or so poor kids, aren't important to Donald Trump. Nor are they something the ruling Republicans in Congress care much about. Funding authorization for both ran out on Oct. 1, the same day the maniac shooting from his hotel window murdered 58 people at a country music concert in Las Vegas.

The news media took little notice of the programs' peril. Since then, both have been kept running temporarily. Of the two, CHIP probably has a better chance for long-term survival.

It's hard for even hard-right Republicans in Congress to deny doctor visits to little children. They did pass short-term legislation last month including money to fund CHIP through the end of March.

Nobody knows anything for certain in the nut world of today's Washington, but it is likely full funding for the children's health insurance program will be passed to cover the rest of the year.

But funding for community health care centers like the one in Houghton Lake is more at risk. Not only do the adult rural poor not look as good on posters, many of Spalding's clients don't even know they are being assisted through federal funding.

"Some of the staff don't realize it either," she told me.

But government money does keep the place afloat. In fact, you could argue it would be hard to find a better use for our tax dollars.

Ruth Spalding, by the way, doesn't speak for the program, or for her employer, or anyone except herself. Herself, that is, and millions of Americans whose health care future is, she felt, too important to leave to the not-so-tender mercies of a bunch of GOP congressmen.

She wasn't exactly encouraged to talk about it, but came to me because she felt "keeping this alive in the press is the only way that this (saving the program's funding) will get done."

For now, funding for the FQHCs has been maintained by a series of short-term continuing resolutions, the latest of which expires next week, Jan. 19.

That has left providers like hers more or less living day to day.

Neither of these, by the way, are part of "Obamacare," or the Affordable Care Act, which Republicans are now strangling.

The CHIP program has been around since 1997, and was supported even by George W. Bush. Until now, its funding, currently about $14 billion, has been renewed almost automatically every year.

The FQHC program is even older — it was created by the Public Health Service Act of 1944. They were started because rural areas lacked doctors and medical facilities.

"But the federal government doesn't create them — communities create them and then apply for the designation," Spalding says. Hers, in Houghton, was created in the 1970s.

"The community health center I worked for last year served about 16,000 patients," she says. "We're in a rural area. If we close, my patients will have nowhere else to go. Most of my patients see a primary care [practitioner] provided in the same building as they do me."

Three days after Christmas, Spalding told me, "Just today I had a patient tell me how thankful she was that I could talk to her doctor down the hall so easily and how she felt she got such good care as a result of the coordination." Best of all, "since we were created to serve the poor we can't turn anyone away due to inability to pay."

That may all be threatened, however.

Spalding does have a minor personal stake in the survival of the FQHCs. While she isn't exactly getting rich working at MidMichigan, she got out of graduate school in 2011 owing about $39,000 in student loans.

But by taking this job, she qualified for a student loan repayment program sponsored by the National Health Service Corps. Her loan balance vanishes if she stays at an approved site like MidMichigan for two years. She's due to reach that milestone in June.

However, if her center closes down before that, she's still stuck with owning the whole $39,000, plus interest. Her center does get some other funding; a few patients do have private insurance.

"I may just barely complete my contract, but many will not if the funds are not renewed," Spalding says, adding that if the entire system implodes, many of her co-workers will be out of a job with no place to transfer to — meaning they'll once again be stuck with no job and crippling student loan balances, plus interest.

For many boomers and Gen Xers, millennials are a bunch of spoiled brats who want to start their careers with cool jobs, high salaries, and generous vacation plans. That's not Spalding, whose single mom went deeply in debt to move to a neighborhood in Ann Arbor where her daughter could attend a good high school.

She had an inspirational teacher who helped her first get into psychology at Albion and then graduate school at the University of Michigan. She already knew the world was a little different from that which her classmates, largely professors' kids, grew up in.

"We have decided as a society to just throw away large portions of our nation, to write them off and provide them with substandard education, wages, housing," she says. "It is the insanity I am tasked with helping my patients cope with, every day."

When she graduated, she says, "I had to work a million jobs because, well, that's just how it is. I graduated into a Great Recession economy and all my jobs until now have been contractual, temporary, and usually the working conditions were horrendously abusive."

She worked in prisons. She saw grim stuff. Much grimmer than written here. She sees more, almost every day.

But she tells me: "All that, I can handle. I cannot handle my patients losing their doctors and their therapist."

Memo to Congress: America can't handle this either.

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