His back hurts when he walks because of damaged disks. He has arthritis and takes medication daily for high blood pressure.
"My health is bad," said Joseph Tippings, a homeless Philadelphian who is grateful for respites from the street.
"I'm 62 years old, and I don't want to die out here," he said, nursing a coffee and reading a newspaper at Project HOME's new Hub of Hope daytime service center in Suburban Station. "I'm just trying to make it until the weather breaks."
The walk-in center, which has basic amenities such as bathrooms, showers, and laundry machines, has space set aside for a small clinic equipped to provide medical, dental, and behavioral health care five days a week. Those plans could be disrupted if Congress doesn't act to fund community health centers nationwide.
This situation looked more positive after a Senate vote Wednesday to provide $7 billion over two years for community health centers. A House bill passed Tuesday also included funding. The health care centers aren't fully protected yet, though. The House must approve the Senate's changes, and the President must sign the legislation. Without a vote to reapprove funding, the federal Community Health Care Fund, which pays for as much as 70 percent of free medical care at community health centers around the country, will be emptied of funds by March 31, according to a recent report from the Kaiser Family Foundation.
If the money doesn't get approved this week, community health centers around the country will begin preparing for the worst. It could mean layoffs, service cuts, and even closure for some centers.
"They're just not prioritizing it or just not realizing what a painful impact this is having on health centers," said Monica Medina McCurdy, vice president of health care services for Project HOME.
There is bipartisan agreement that community health centers serve a valuable purpose, but each party is pointing at the other for threatening the fund.
"While I have consistently voted to fund community health centers in the House, Senate Democrats continue to derail the process," Rep. Lou Barletta (R., Hazelton) said in a statement this week.
"I hope they will finally listen to the pleas for help from people across the country on community health centers," Sen. Bob Casey (D., Pa.) said in a recent conference call.
Republicans offered to fund the health centers in a package proposed in November, but Democrats balked at the deal because it pulled funding from other health-care infrastructure, including the Centers for Disease Control and Prevention, said Jim Willshier, director of policy for the Pennsylvania Association of Community Health Centers.
The fund was supposed to have been replenished by September, but since then, the U.S. Health Resources and Services Administration has found ways to stretch available money to keep the centers running. The fund is due to run out of cash by March 31.
"The deadline is much more real than it has been in the past," Willshier said.
There are 71 community health care service sites in Philadelphia, and 264 statewide, serving 774,921 people annually. New Jersey has 144 sites serving more than 511,000 people. About 25 million people nationwide rely on these health centers, largely in underserved rural and urban areas, according to the report from the Kaiser Family Foundation.
They act as a safety net for uninsured or under-insured people, filling the gaps for care Medicaid and Medicare don't cover, and providing some primary care services that give people an alternative to far more costly emergency rooms. Those services include dental care, addiction treatment, and maintaining prescriptions.
People living on the streets tend to be more vulnerable to illness, said Medina McCurdy of Project Home.
"People will be sicker and die quicker when they're homeless," she said.
Among the problems people without a home contend with are bed bugs, lice, scabies, and the consequences of exhaustion and exposure to the elements. One man who came to Hub of Hope to get clean clothes recently discovered he had parasites.
Community health centers rely on differing funding formulas, so some will be harder hit than others if Congress doesn't authorize additional dollars. A dozen centers run by the city, for example, will be able to weather the loss, city officials say. Project HOME, though, would lose up to $1 million, a fifth of its total health care budget. That organization's health centers have served about 3,600 people in the last three years.
"Other, smaller health centers cannot absorb that, and this, in some cases, threatens their existence," said James Garrow, a spokesman for Philadelphia's Department of Health.
In Reading, three community health centers run by Berks Community Health Center attract 11,000 patients a year from the county and neighboring Schuylkill County, said Mary Kargbo, the organization's chief executive. Her program relies on $2.8 million a year in federal funds, she said, about 20 percent of its total budget.
Her program has been growing by about 250 new patients every month, Kargbo said, and with the growth, has added services such as substance abuse and behavioral health care. Both drug abuse and mental illness are particular plagues among homeless populations and addressing those can be a big step in helping people regain stability. A $2.8 million cut, Kargbo said, could force her to weigh the value of addiction treatment and dental care.
"I would have to look at that to see what can we get out of the center, unfortunately," she said. "It may mean less staffing as well."
If Congress doesn't approve funding Thursday, Project HOME would likely scale back plans for expansion to another location in the city and may have to consider reducing its overall health staff of 45, including doctors, nurses, and social workers.