COOK— Fresh off more than a week in Washington, D.C., Scenic Rivers Health Services CEO Mike Holmes said the uncertainty of the current political moment is palpable throughout the nation’s capital.

After an effort to repeal and replace the Affordable Care Act fell short in the Republican-led House of Representatives in March, and a brief effort to revive a repeal measure fizzled last week, Holmes said it remains unclear what, if anything, will happen on the health care front this year.

It’s a major concern for Holmes, both as head of Scenic Rivers and as an executive board member of the National Association of Community Health Centers.

Passage of the Affordable Care Act in 2010 was a boon to community health centers, like Cook-based Scenic Rivers. The funding provided by the ACA enabled the more than 10,000 such health centers nationwide to receive more funding, since many of the patients they once served for free or minimal payment were able to obtain insurance, either through generous subsidies to purchase private insurance or through expanded Medicaid eligibility. That meant greater reimbursement for the care that such centers provide.

The ACA also helped such facilities expand their operations, open additional satellite clinics—such as the Scenic Rivers clinic in Tower— and serve more patients. Such centers served 24.3 million people in 2015, up from 19.5 million in 2010.

While it appears that the ACA may be safe from legislative changes, at least for now, Holmes said the law may still be subject to regulatory changes implemented by the Trump administration. “The ACA vests a lot of authority in the HHS secretary, and it’s possible the administration may try to unwind the law from a regulatory standpoint, and give the states more freedom to rewrite their Medicaid programs.”

“If they start granting waiver requests, we will see more work requirements, co-pays, and other limitations on Medicaid coverage,” Holmes predicts. Minnesotans probably don’t have to worry about such changes, he said, at least for now.

Holmes is more concerned about the future of a federal trust fund created under the ACA that provides most operating dollars to facilities like Scenic Rivers. “About 70 percent of our funding comes through the Community Health Centers Trust Fund,” said Holmes.

The fund expires Sept. 30, and as of now there is no legislation currently in place that would reauthorize the program. Without renewal, as many as 3,000 community health centers across the country could be forced to close, reducing services to about nine million patients annually, according to Holmes. “It would create a huge access problem,” he said.

Holmes remains cautiously optimistic that the trust fund will be replenished in the end. “Community health centers have really good bipartisan support, all the way up through the leadership, and we had some good conversations in Congress on both the House and Senate side. Their intent is to fix it in time, but right now there is no legislative vehicle.”

Holmes said good intentions aren’t always enough, particularly given the hurdles that a divided Congress and country can put in the way of any legislation. And the next several months look particularly fraught with potential distractions and crises that could put the health center trust fund well down on the list of priorities in Washington.

Lawmakers are currently on Easter recess and won’t be back until the end the month, when they face the sunset of the current continuing resolution to fund the government. Approval of a new funding resolution is no guarantee, given the current chaotic situation in Washington, and that would force a shutdown of the federal government.

If they can avoid that landmine, congressional leaders and the Trump administration have indicated they’ll seek to tackle tax reform, which is all but certain to be a long and controversial measure. Later this summer, a looming requirement to raise the debt ceiling is likely to provide another distraction and potential point of conflict in Washington.

In the meantime, folks like Holmes hope the clock doesn’t run out without reauthorization of funding for community health centers. “We think we will be able to resolve the issue. But Congress will have to do something,” he said. “And right now there’s a certain level of uncertainty.”