While PCDC was founded in New York, our work has expanded over the past 27 years to reflect a national presence. Nationally, PCDC has assisted over 1,000 primary care practices in more than 40 states and territories. We have improved primary care access for more than 1 million patients by leveraging more than $1 billion to finance over 130 primary care projects. Our strategic community investments have built the capacity to provide 3.8 million medical visits annually, created or preserved more than 13,000 jobs in low-income communities, and transformed 1.8 million square feet of space into fully functioning primary care practices. Through our capacity building programs, PCDC has trained and coached more than 9,000 health workers to deliver superior patient-centered care. We have also supported hundreds of primary care practices – encompassing thousands of primary care providers – to achieve patient-centered medical home recognition, improving care for more than 5 million patients nationwide. All told, PCDC’s work has impacted more than 40 million patients across the United States and territories. With a mission is to create healthier, more equitable communities by building, expanding, and strengthening the national primary care infrastructure, we have strong voice in federal advocacy for primary care.
Federal Policy Issues
Protect the CDFI Fund and its grant programs in federal budget allocations.
Through various awards programs, the CDFI Fund supports financial institutions recognized by the US Treasury for their expertise in providing services and support to low-income communities. Programs funded through the CDFI Fund use a relatively small amount of federal money to leverage an enormous amount of investment into underserved communities, creating jobs, growing businesses, and promoting the revitalization of local economies.
Using our unique expertise in health care, PCDC provides meaningful lending to communities that need it most. PCDC advocates for continuously upholding The Fund and rallying the community development industry to support the shared mission of advancing equitable investment nationwide.
NEW MARKETS TAX CREDIT PROGRAM
Establish the New Markets Tax Credit (NMTC) Program as a permanent and continuous federal resource.
The NMTC Program uses tax credits to attract private investment into distressed communities, thereby spurring job creation and other economic growth by providing financing with non-traditional and more flexible terms than conventional debt. As a result, borrowers benefit from below-market interest rates, higher loan-to-value ratios, and longer loan maturities.
PCDC’s NMTC program expands primary care access across the country by meeting the capital needs of community-based health providers. Since 2008, PCDC’s NMTC Program has invested $222 million to grow and enhance primary care and other vital health services. The continued renewal and extension of this indispensable resource will help meet the demand to revitalize communities, create jobs, increase economic opportunity, and improve lives in a sustainable and forward-thinking way.
COMMUNITY REINVESTMENT ACT (CRA)
Protect the integrity of Community Reinvestment Act (CRA), which focuses on connecting low- and middle-income communities with fair, affordable, and accessible financial products and services.
CDFIs rely on the CRA to incentivize banks to make credit and capital available to underinvested communities — nearly 35 percent of PCDC’s capital available for lending is from CRA-eligible financial institutions. The CRA has been a primary factor enabling the CDFI industry to grow and deliver responsible financial services and products to low-wealth communities. Changes to the CRA regulatory framework could have a significant adverse impact on the CDFI industry’s capacity to lend and invest in low-wealth markets and contribute to economic revitalization.
Through partnerships with CDFIs such as PCDC, banks can make smarter, more impactful loans in the hardest-hit communities because of CDFIs’ lending expertise and strong industry track record. Any changes made to the CRA must support and expand CDFIs’ abilities to meet the credit needs of underserved communities and enhance the lives of those they serve. Without thoughtful regulation through a framework like the CRA, PCDC is particularly concerned that the CDFI industry may lose investment from larger financial institutions, damaging the ability to impact meaningful change in communities that need it most.
MAINTAINING THE HRSA LOAN GUARANTEE
Ensure long-term federal funding for the HRSA Loan Guarantee Program.
Many CHCs have difficulty obtaining affordable loans for their capital projects due to the variable nature of their revenue streams. The Health Resources and Services Administration (HRSA) Health Center Facility Loan Guarantee Program (LGP) enables health centers to access capital by backing the lender with an 80 percent loan guarantee, thereby unlocking previously unattainable revenue sources for CHCs.
The LGP allows CHCs to expand and modernize their facilities — ultimately providing greater community access to primary care, dental, behavioral health, vision, and pharmacy services. PCDC strongly advocates for continued and increased congressional budget allocations to bolster this critical program.
PROTECTING THE 340B DRUG DISCOUNT PROGRAM
Preserve the 340B Drug Pricing Program and protect medically underserved communities.
The 340B Program entitles qualifying entities — Health Resources and Services Administration (HRSA)-supported health centers, AIDS drug assistance programs, and safety net hospitals and providers — to receive discounts on eligible outpatient drugs. Covered entities may provide 340B drugs to all eligible patients, regardless of a patient’s payer status or how the drug is administered.
Through working in rural and urban communities across the country, PCDC intimately understands how safety net providers rely on the 340B Program to bring accessible care to underserved patients. In recent years, the program has faced several threats both nationally and at the state level, which PCDC has vehemently opposed and advocated against. Because 340B providers exclusively see the most vulnerable populations, limiting the program will disproportionally impact these already hard-hit communities. PCDC strongly supports policies that safeguard the program and its vital benefits.
PROTECTING COMMUNITY HEALTH CENTER FUNDING
Establish continuous, guaranteed federal funding for community health centers.
Years of chronic underinvestment in primary care have made providers dependent on every dollar and cost savings measure to continue their essential programs. Potentially losing federal funding poses grave implications for CHCs as it represents nearly 20% of their revenue stream, and even more in states that have not expanded Medicaid. A halt in federal funding would cause CHCs to reduce care, close service sites, and cut staff.
PCDC supports policies that ensure CHCs have a steady flow of federal grant funding, enabling them to achieve long-term success and continually support their communities.
UPHOLDING THE AFFORDABLE CARE ACT (ACA)
Ensure continued access to insurance coverage through the ACA.
To achieve healthy communities, reduce costs, and create equity, the primary care system requires universal and affordable health insurance coverage. Uninsured persons are less likely to seek care, and when they do are often sicker and require more costly or urgent care due to preventable conditions being left untreated.
As health insurance coverage increased under the ACA, more people reported having a regular place to go for medical care. A repeal of the ACA without an adequate replacement plan will lead to uncertainty for the 30 million people who are covered through state health insurance exchanges and Medicaid expansion.
PCDC believes that health insurance coverage should promote access to and utilization of primary care. Specifically, preventive services should be covered without any out-of-pocket costs to ensure ease of access. Furthermore, funding for federal health insurance programs must be — at a minimum — maintained at current levels without shifting costs to states or consumers.
PROTECTING IMMIGRANT HEALTH
Reject changes made by the U.S. Department of Homeland Security (DHS) to the “public charge” rule.
As of August 2019, the Department of Homeland Security expanded the long-standing definition of “public charge” from “primarily dependent on the government for subsistence” to anyone who uses — or is deemed likely in the future to use — any government benefits from a vastly expanded list of vital programs that address the social determinants of health.
The availability and accessibility of such programs — Medicaid and Medicare, Low-Income Subsidy, Supplemental Nutrition Assistance Program (SNAP), and federal housing and rental assistance — are central to population health by helping communities address health care coverage, food, and housing. The public charge rule not only hurts patients and their families but also the health providers who serve them.
There are also profound concerns about how the changes to income levels will distress and disrupt the health care workforce and provider pipeline. PCDC strongly supports policy initiatives that reduce the burden this new rule is placing on immigrants and their families.
ENDING THE HIV EPIDEMIC
Support the federal initiative, Ending the HIV Epidemic: A Plan for America.
As part of the national imperative to end the HIV epidemic, which aims to reduce new transmissions by 90 percent by 2030, PCDC is working closely with states, local communities, and national partners to support people living with or at risk for HIV. PCDC also collaborates with government partners to scale high-impact prevention, care, and treatment strategies — particularly for the hardest-hit communities.
The Community Reinvestment Act (CRA) was enacted in 1977 to help counter informal and institutional prejudice in mortgage and business lending, including preventing the racist practice known as redlining. It requires banks to meet the credit needs of surrounding communities, particularly low- and moderate-income neighborhoods.
In 2020 PCDC submitted comments on proposed changes to the CRA that highlighted concerns that the proposed revisions would undermine the spirit of the CRA to invest in under-resourced communities and render highly impactful activities that are complex, longer-term, or not maximally profitable – such as community-based health care projects – less attractive for CRA motivated investments.