When Erica Earl gets congested and wheezy, her choices for medical care are straightforward: She can go to a community health clinic in East Baltimore that receives federal funding, or she can head to the emergency room.
Earl, a 43-year-old nursing student, prefers the clinic — and that's the choice doctors, politicians of both parties and hospital executives want patients to make.
But at the same time, the nation's 8,000 community clinics that serve millions of low-income patients are bracing for a $600 million cut in federal aid under the budget compromise approved by Congress on Thursday.
"There's not too many places I can go to where I feel like I'm going to be OK," said Earl, who has developed such a strong rapport with the staff of the Baltimore Medical System clinic that during a visit Thursday she brought a photo album from her recent wedding to show to the doctors and nurses.
"If they cut it, we're going to be in trouble."
Patients at clinics that rely on federal funding are one group likely to be affected by the highly partisan budget battle now raging in Washington. As part of the 11th-hour deal struck last week to avert a government shutdown and keep the federal agencies running through the end of September, lawmakers agreed to cut $600 million from the roughly $2 billion that the U.S. Department of Health and Human Services gives the centers annually.
The budget compromise, which makes $38 billion in trims overall, was approved Thursday by bipartisan majorities in the House and Senate.
Funding the centers has been a priority for President Barack Obama, who included a five-year, $11 billion increase in the national health care overhaul signed into law last year. That money was intended specifically to help the centers gear up for the nearly twofold increase in the number of patients expected to need their services — from about 23 million to 40 million — as the new law takes effect.
Sen. Benjamin L. Cardin, who supported the short-term spending measure Thursday — even though he said he does not approve of the health care cuts — said House Republicans went after the spending in part because of its ties with Obama's controversial health care law.
"It became a target," the Maryland Democrat said Thursday. "They went there because it was symbolic of the health care act that they wanted to repeal."
An earlier version of the bill called for $1 billion in cuts to the clinics. Cardin said he would help push to restore the money in next year's budget.
The immediate impact of the funding cuts in Maryland is not clear. That's because the Obama administration may use some of the extra money set aside in the health care law to make up for the reductions. But officials stressed that maintaining federal aid at last year's levels would amount to a cut because of the expected influx of new patients.
"It'll be very harmful," said Rep. Elijah E. Cummings. The Baltimore lawmaker was one of 108 House Democrats who voted against the budget compromise Thursday.
"We're in a time when people are relying more and more on this kind of care," Cummings said.
Sixteen nonprofit community health centers in Maryland operate 111 clinics and serve some 261,875 patients, according to the National Association of Community Health Centers. They provide primary care, mental health treatment and other services for the uninsured, seniors on Medicare, families on Medicaid and patients who have private health insurance.
Officials say the centers ultimately save money by keeping low-income patients out of emergency rooms.
The Baltimore Medical System manages six centers that handle visits from 45,000 patients a year, said Jay Wolvovsky, the group's president and CEO.
Wolvovsky said the group had hoped to offer extended weeknight and weekend hours, add pharmacies to two additional centers and offer dentistry services. But given the budget constraints, he said, some of those plans are in limbo. He said the group receives about $2.5 million of its $37 million annual budget from Washington.
On Thursday morning, patients piled into a busy waiting room of the Orleans Street clinic as nurses and doctors darted in and out of exam rooms.
Ursula McClymont, the center's medical director, said she had long teased Erica Earl about whether she would get married. Now McClymont also sees Earl's husband as a patient.
"It's unique in that we know the patients so well," said McClymont. When people miss appointments, she said, the center's staff places a phone call to make sure they are all right.
"Often these patients are choosing between their BG&E bill and their medicine."
William Wheeler Jr. also has strong feelings about the East Baltimore center.
"They saved my life," said the 63-year-old Park Heights man, who credits clinic staff with acting quickly when he arrived years ago suffering from congestive heart failure.
"The doctor said they got me to the hospital just in time."
The House of Representatives voted 260-167 on Thursday to approve the plan to keep the government funded through September. The Senate supported the measure 81-19.
With this year's budget now out of the way, Congress will turn its attention to still thornier issues, such as whether to raise the nation's $14.3 trillion debt limit.
Republicans reclaimed control of the House in last year's midterm elections in part on promises to cut federal spending. Many also ran against the nation's new health care law and promised to reverse its unpopular provisions — particularly the individual mandate, the requirement that virtually everyone in the country carry some form of health coverage or face a penalty.
Rep. Andy Harris is part of the GOP freshman class pushing for deeper cuts to address the nation's spiraling deficits. Harris was one of 59 Republicans to vote against the stop-gap spending bill Thursday.
Harris, a Baltimore County anesthesiologist, could not be reached for comment Thursday. In a statement, he argued that the spending plan "just doesn't go far enough to build an environment for long-term economic growth and job creation."
The state's other Republican, Rep. Roscoe Bartlett, also voted against the measure.
Sen. Barbara A. Mikulski has argued that the reduced spending would have a particularly deep impact on women's health. Mikulski first raised the point last week when Republicans had proposed cutting funding for Planned Parenthood. The idea was later dropped.
"This is not about responsible reduction of the deficit or the debt," Mikulski said in a statement. "We know that using health centers is much less costly than seeking care in emergency rooms."