HOUGHTON LAKE, Mich. — Ruth Spalding is a social worker and therapist who spends her days trying to help poor people whose lives are often something between terrible and worse.

“I treat a lot of depression, anxiety, PTSD,” or post-traumatic stress disorder, she told me last week.

“Most of my patients are highly traumatized. I have folks on my caseload with severe and persistent mental illness, folks who experience paranoid delusions. I see a lot of survivors of domestic violence. I see folks from 18 to 89.”

However, that’s not what is now causing her stress. Ms. Spaulding, who is 30, grew up in a single-parent home in Ann Arbor, with a mom who went deeply in debt so she could live where her daughter could attend a good high school.

Today, after earning a graduate degree at the University of Michigan, she works for MidMichigan Health Services in Houghton Lake. “I love my job so much,” Ruth said, because she is helping people who otherwise would get no help at all.

But funding for the network of Federally Qualified Health Centers is now threatened, as is that for the better known Child Health Insurance Program, or CHIP, which insures 9 million poor children. Both have been automatically renewed for years.

Yet that didn’t happen last year.

Neither program was a priority for the Trump Administration. And with news erupting daily on a dozen different fronts, much of the media has paid little attention.

The two programs’ funding got bogged down in squabbles over other issues. Government authorization for both CHIP and the network that employs Ms. Spalding, the Federally Qualified Health Center Program, expired Oct. 1, the day the national news was dominated by the mass murder of 58 people in Las Vegas.

But while their struggles have been largely under the radar, if both programs were to vanish, it would have enormous and disastrous consequences for millions of Americans.

Recently, the failure to renew annual funding for the Children’s Health Program has gotten more press attention.

U.S. Rep. Dan Kildee (D., Flint) has been especially vocal about the need for the program, which covers an estimated 116,000 kids in Michigan alone, children he said “will lose access to basic health care, including doctor check-ups, immunizations, and critical preventive care,” if CHIP ends.

This is especially crucial for Flint, because of the need to monitor kids who were exposed to high levels of lead — and because authorities got special permission to use CHIP funding to remove lead from homes.

Congress did, after a blizzard of unfavorable publicity, pass a short-term bill right before the Christmas break that included $2.85 billion to fund CHIP through the end of March.

However, what’s needed is a permanent piece of legislation to do that through the end of the year. Normally, that’s something you could count on happening quickly.

But, there’s little that’s traditionally normal about Washington these days.

Funding for the sprawling network of Federally Qualified Health Centers is even more at risk — and the effect on society of their being denied funding could be even more critical. Last year, they served more than 680,000 Michigan residents in hundreds of underserved areas. 

Their plight is complicated, Ms. Spalding said, because many of the patients and even some who work in centers like hers aren’t even aware they are dependent on federal funding.

Unlike the CHIP program, Federally Qualified Health Centers have existed since 1944. “We were created at a time when America was amazing, and we created an amazing health safety net for people in rural America,” Ms. Spalding said.

If the program doesn’t get funded, “those people will still get very sick. They will go to the ER instead. They will still rack up bills and debt. People will die over this.

“People will get bankrupted and live in squalor over this” she said, pausing to note that she wasn’t speaking for the system or her employer, MidMichigan Health Services.

“I’m only speaking for myself, but I need to say it. It’s not enough to talk to our congressmen. The public needs to know. If we close, my patients will have nowhere else to go.” They will be out of luck, not just for therapy, but for health care, period.

MidMichgan Health Services is, like many community health centers, a full-service medical provider that last year served about 16,000 patients. “Most of my patients see a primary care provider in the same building as they do me,” she said.

‘The brilliant thing is that we were created to serve the poor and we can’t turn anyone away due to inability to pay,” said Ms. Spalding, who grew up anything but rich herself.

But will funding for the community health care centers be renewed? “Congress was supposed to pass long-term funding for the community health center fund at the end of September, but they haven’t yet,” an aide to Mr. Kildee told me last week.

“They continue to pass short-term [continuing resolutions],” to keep them going.

The current one expires Jan. 19, soon after Congress gets down to business after its holiday break.

Ruth Spalding is determined to stay the course. She resents any implication that the patients who need these health centers are at fault for being poor.

“We have decided as a society just to throw away large portions of our nation, to write them off and provide them substandard education, wages, housing.”

And if funding doesn’t come through for the health centers, she said, “they won’t even have that.”

Jack Lessenberry, the head of the journalism faculty at Wayne State University in Detroit and The Blade’s ombudsman, writes on issues and people in Michigan. Contact him at: omblade@aol.com.

First Published January 5, 2018, 7:08 a.m.