Health Center Walks Trump Tightrope

Fair Haven Community Health Care is looking to open a separate private practice — with no federal funding — so that it can continue to treat all of its patients without violating any of President Donald Trump’s executive orders. 

The neighborhood-anchoring community health center’s CEO, Suzanne Lagarde, detailed that plan Friday morning during a meetup with U.S. Sen. Chris Murphy, city Health Department Director Maritza Bond, Alders Sarah Miller and Caroline Tanbee Smith, and a small group of Fair Haven Health staffers.

She said that Fair Haven Health is working with the Elicker administration to open a new location, potentially at the Health Department’s current clinic and office building at 424 Chapel St.

The new site would allow for a private-practice affiliate of Fair Haven Health to treat all different types of patients — including those who receive gender-affirming care and who are undocumented immigrants. Lagarde said that a handful of Trump’s already-signed executive orders could imperil Fair Haven Health’s ability to continue treating those latter groups at its existing Grand Avenue clinic. 

“We’re not gonna break any laws,” Lagarde made clear. And ​“we’re not gonna abandon any patients.” 

Creating a new private practice that is operated without any federal funds, and that is not under the auspices of Fair Haven’s federally qualified health center (FQHC) status, would allow the agency to achieve both of those goals.

This new site would serve a general population of patients, Lagarde stressed, and not just the undocumented and those seeking gender-affirming care. But the impetus for creating such a private practice would be to ensure that the health center does not leave any of its community behind amid a rapidly changing regulatory environment.

The reason for Murphy’s last-minute visit to 374 Grand Ave. Friday was for Connecticut’s junior U.S. senator to hear directly from local healthcare providers and advocates about just how harmful $880 billion in cuts to Medicaid could be. Sizable cuts to Medicaid, a federal health insurance program for the poor, are looking increasingly likely, thanks to budget resolutions recently approved by the Republican-controlled U.S. Senate and House of Representatives.

Lagarde spent the first 15 minutes of Friday’s meetup, however, focused on a different area of concern emanating from Washington, D.C.: Trump’s executive orders. 

There are ​“three buckets” of executive orders that she and Fair Haven Health find ​“very scary.”

The first target diversity, equity, and inclusion (DEI), and include Executive Order 14151: Ending Radical and Wasteful Government DEI Programs and Preferencing and Executive Order 14148: Initial Rescissions of Harmful Executive Orders and Actions.

The second bucket of executive orders singled out by Lagarde for concern affect gender-affirming care. Those include Executive Order 14168: Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government and Executive Order 14187: Protecting Children From Chemical and Surgical Mutilation. Lagarde said that these executive orders are currently the subject of a court-ordered injunction. However, if the courts do allow them to go into effect, they could impact the gender-affirming care that Fair Haven Health currently provides to around 120 patients, all of whom are over the age of 19.

The third bucket of executive orders Lagarde is worried about involve immigration, and include Executive Order 14218: Ending Taxpayer Subsidization of Open Borders. This is ​“the scariest one,” she said. Depending on guidance issued by the federal Department of Health and Human Services, Fair Haven Health could be required to verify a patient’s immigration status before providing care.

Lagarde said that the community health center does not currently ask any patients about their immigration status. However, based on the number of uninsured patients Fair Haven Health treats, Lagarde estimates that around 5,500 of the 36,000 patients the center saw last year are undocumented immigrants.

Lagarde told Murphy that her clinic is considering pursuing a method called Other Line of Business (OLB) in order to ensure that it can continue to treat patients who are undocumented and who receive gender-affirming care without running afoul of federal law.

That would involve setting up a separate site as a private practice, and not as a FQCHC. The private practice would have to get its own malpractice insurance coverage; it would have to have separate billing and payments systems; it would have to have different staff; and it couldn’t operate with any federal grants or program income generated from Fair Haven Health’s existing work. But, ​“it is definitely doable,” Lagarde said.

She stressed that this off-site clinic would very much be open to a ​“general population” of patients, and not just the populations Fair Haven Health is most concerned about being impacted by these executive orders.

But just to be clear, Murphy said, this new site would have to be run with no federal dollars?

“Correct,” Lagarde said. It would be funded through Fair Haven Health’s ​“reserves,” and philanthropy. ​“I am confident we can do this.” She said it should cost $1.5 million a year to run.

Lagarde and city Health Director Maritza Bond said that Fair Haven Health and the city are currently working on a memorandum of understanding (MOU) as to where exactly such a new clinic site would be located. (“We are in this together,” Mayor Justin Elicker told the Independent in a statement, ​“and jumped to collaborate with Fair Haven Health in this effort to support the health and wellbeing of all members in our community.”)

Fair Haven Health has also engaged a law firm, Feldesman Leifer, to help with this planning, and it’s conducted a ​“stress test” to evaluate the costs, in terms of expenses and lost revenue.

A slide presented by Lagarde during Friday’s meetup identified ​“key elements” of this plan as ensuring that the site is set up at a separate location; that it’s open to all Fair Haven Health patients, and not solely the undocumented; and that its operations involve separate employees, accounting, phone numbers, and financing.