The Trump administration’s decision to end one federally funded program and terminate another one early could affect the Cambridge Health Alliance and Cambridge Housing Authority, two local agencies that serve low-income people. The specific financial impacts weren’t clear.
The program that is ending, the Green and Resilient Retrofit Program, paid for upgrades to tens of thousands of affordable housing units across the country. The one that will terminate at the end of this year – a year early – called Primary Care First supported innovations by primary care doctors’ practices.
The U.S. Department of Housing and Urban Development is ending the $1 billion Green and Resilient Retrofit Program, the Associated Press reported March 12. The program not only preserved affordable housing physically but required recipients to commit to keeping their developments affordable for 25 years.
The Cambridge Housing Authority was awarded a $4.6 million grant under the program as part of its redevelopment of the Roosevelt Towers midrise on Cambridge Street, executive director Michael Johnson said. Johnston said the project is in its “planning, predevelopment stage” and is not at the point where the authority would expect or need money from the grant.
He has heard nothing from HUD about the program ending, but “industry groups” in the affordable housing community have confirmed the Associated Press report, he said. HUD’s press office said Cambridge Day’s request for information on whether the program has ended is “under review.” The federal agency’s website has a broken link to the program, although it lists previous information about funding at a different spot on the site.
Primary Care First
Primary Care First gave financial incentives to primary care practices serving Medicare patients to broaden access to doctors, help patients with complex needs, improve control of blood pressure and other health conditions, reduce hospitalizations and costs, and try other initiatives. All of Cambridge Health Alliance’s primary care clinics participated, according to information from the Centers for Medicare and Medicaid Services, which sponsored the program.
Primary Care First is ending Dec. 31, a year early, the Centers for Medicare and Medicaid Services said March 12. The reason “is to better align with the CMS Innovation Center’s statutory mandate and to protect taxpayers,” the agency said. An evaluation of the 2022 plan year, which the agency called the latest assessment, found that the program did not reduce hospitalizations and that the agency paid more for services at Primary Care First practices than Medicare would have paid.
Doctors’ practices said the program didn’t pay them enough to make necessary changes, the evaluation report said.
David Cecere, spokesperson for the Alliance, said: “We were disappointed to learn that this innovative program, which recognized the role primary care providers play in providing quality care and value to Medicare patients, is being discontinued a year early. We look forward to working with CMS as it supports beneficiaries and providers with the transition.” He said the Alliance is assessing the financial impact.
Affordable housing and hospitals
In contrast to the federal funding that is ending, affordable housing and hospitals did relatively well in the federal budget extension legislation that was approved at the end of February to prevent a government shutdown.
An increase to appropriations for Section 8 rent vouchers will cover the need, Johnston said, quoting a national group that represents housing authorities. The legislation also extended Medicare reimbursements for telehealth medical visits until Sept. 30, after telehealth approval had been set to expire at the end of this month.
In addition, the budget extension preserved extra reimbursements to safety net hospitals, said Sam Melnick, spokesperson for the Massachusetts Health and Hospital Association. The Alliance is a safety net hospital. The telehealth and safety net extensions “are both measures for which Massachusetts hospitals, like those around the country, advocated over the past several months,” Melnick said.
The city of Cambridge, which gets about $23 million a year in federal grants, expects the impact of any Trump administration cuts to arrive in the fiscal year that begins July 1, city spokesperson Jeremy Warnick has said. The city is planning its budget for that fiscal year.
City manager’s USAid connection
In other news about the local impact of Trump administration cuts and policy changes, city manager Yi-An Huang revealed a personal connection to USAid, the foreign aid agency that Trump and Elon Musk have vowed to destroy, and have mostly succeeded. Huang told city councillors Monday that “almost 15 years ago now, my wife and I spent a year living in western Kenya, working with a global health organization funded primarily by USAid.”
The work “started out focused on prevention and treatment of HIV Aids, but then expanded over time to build basic health infrastructure that addressed everything from primary care to improve distribution of medicines to subsidize pharmacies,” Huang said.
Six weeks ago, more than 2,000 USAid employees were put on unpaid leave after funding freezes, he said. He added that while “there have been some indications that HIV Aids programs will be continued,” broader programs are in doubt.
Huang denounced the administration’s actions, quoting New York Times columnist Kristof’s observation that “’we are today seeing the world’s richest men plundering critical programs that are serving the world’s poorest children.’”
“I don’t really know what else to say, except that the cruelty of unrestrained executive power is now being heaped on the most vulnerable in our world,” Huang said.
Watching other federal cuts
As for Cambridge, Huang said cuts revealed recently, such as the end of funding for a program that supported school lunch programs buying food from local farmers, have not affected the city directly. Cambridge schools don’t use that program, he said.
The future is likely to be worse, he said. “We believe there may be challenging new contract terms that will be proposed by federal agencies in order to receive future funding commitments. Those may include different kinds of requirements around cooperating with immigration authorities, or restrictions on what kind of diversity, equity, inclusion programs can be conducted,” he said.
Huang pledged “to work together to figure out how we address a collective response to those kinds of contract terms. We’ve not seen anything concrete at this point, but we’ll certainly be watching for that, and we’ll keep the council and the community updated.”
Preparing a response
Huang urged residents and organizations to gather and report information about funding freezes and other administration actions and their impacts. Evidence of “harm” would be important in any lawsuit, he said.
Nonprofits and other institutions might be able to get help, Huang said. If informed, the city “can help assess if there’s an avenue to address” the problem either through the city or the state attorney general, he said.
Huang said the city will “continue to prepare for more difficult times. We’re at the very beginning of this federal administration, and the expectation at this point is that federal funding and support is likely to decrease.”
The “broader economic outlook has also darkened,” he said.
Huang said that “the news has been distressing and depressing, [so] it’s even more important that we find ways to lift up the good work that is happening in our community. That’s an example of the values that we are standing for, and I am so proud of all of the organizations that I’ve been in conversation with over the last couple of weeks for the work they continue to do.”
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