Remarks to a meeting of
Community Access Program grantees

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Prepared Remarks of Elizabeth M. Duke, Ph.D.
Acting Administrator, Health Resources and Services Administration

CAP Grantees Meeting
Baltimore, Md.
May 2, 2001

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Thank you for asking me to come here today.  The work you’re embarking on is very important.  Your efforts are of great interest not just to us at HRSA but to communities across the nation that are searching for better ways to deliver health care to the uninsured and underserved. 

Let me begin by saying that -- as a former Chief Information Officer -- I’m impressed by your emphasis on building top-flight management information systems and your use of technology to track patients and match their needs with available services.  This innovation is a testament to your dedication to providing quality services to those Americans most in need.

Our mission at the Health Resources and Services Administration is to improve the nation's health by assuring equal access to comprehensive, culturally competent, quality health care for all.

Your work assists this mission and fits into the comprehensive strategy within the Department of Health and Human Services to improve the delivery of health care to America’s uninsured and underserved individuals and families.

It is the Administration’s goal to ensure greater access to quality health care for all Americans.  To bridge the cultural and economic chasms that have, for generations, separated this nation into factions of healthy and unhealthy citizens.

One way that President Bush is bridging the gap is by offering tax credits to encourage people to buy health insurance -- $2,000 in tax credits for families and $1,000 for individuals.

Here at HRSA, we’re working to expand health insurance coverage by continuing our outreach to low-income working families to enroll their children in the State Children’s Health Insurance Program and Medicaid.  This effort, taken in partnership with the Health Care Financing Administration, has signed up nearly 3.3 million children since S-CHIP was launched three-and-a-half years ago.

And in February, Secretary Thompson announced the second round of State Planning Grants.  Nine states received one-year grants totaling $10.2 million to develop plans for providing their uninsured citizens with affordable health insurance.  These nine grantees join 11 other states that last year shared grants totaling $13.6 million.

Under the program, grantees from state agencies first will conduct studies to identify characteristics of their uninsured citizens.   Then they will use that data to determine the most effective methods to provide their citizens with high-quality, affordable health insurance similar to plans that cover government employees.

We’re also working to help communities expand their capacity to deliver quality health care.

For FY 2002, President Bush’s budget asks for a $124 million increase for Community Health Centers.  Currently, about 3,200 health centers and affiliated clinics serve about 11 million patients.  Over the next five years, the President plans to add 1,200 sites and double the number of patients served by the clinics.  These Community Health Centers form the foundation of America’s health care safety net by providing services directly in the community with health care professionals that understand the medical needs and the cultural concerns of the diverse population.

The President and the Secretary have made it clear throughout this budget that providing care directly to Americans is the most important service that this Department can provide.

The administration already has moved to increase health center services.  In March, Secretary Thompson announced $11.3 million in grants to 25 community health centers to expand access to health care for the medically underserved. 

These funds will help grantees in 17 states create new health care sites and expand access for 200,000 individuals.  Two more funding cycles will take place this fiscal year, and those grantees will be announced in June and August. 

Increasing the capacity to deliver quality, community-based health care is where you CAP grantees come in.  You represent America’s diversity and the lessons you learn from these grants will be important to the entire country.

Of the 76 CAP communities represented in this room, 30 are from urban areas, 20 from rural areas, 25 from a combination of the two, and one tribal community.

It is critical to the success of our mission at HRSA, that the CAP program dutifully chronicles its progress.  It is our aim to provide the services that Americans need.  We need to know what works, what doesn’t work, and what needs to be improved.  Your experience in providing quality care to the uninsured will give us useful information and guidance that we can take to every corner of America.

As a group, you cover most of the circumstances that communities will confront anywhere in the United States.  People trying to expand services in San Antonio or Brownsville, for example, will be able to look at the experiences of the CAP grantee in West Texas, the El Paso Hospital District.

And communities throughout the rural South will be able to look at and apply the lessons learned by the Aaron C. Henry Community Health Center in Clarksdale, Mississippi, another of last year’s grantees. 

President Bush and Secretary Thompson are strong believers in the creativity and strength of local communities.  They know that Washington cannot design a one-size-fits-all model of delivering health care to the uninsured.  The President, the Secretary, and I will all be looking to your comments and suggestions, your thoughts, and your concerns as we continue to build on our work.

I understand that many of you may be frustrated with this year’s proposed budget.  The proposal to eliminate CAP is rooted in the Administration’s belief that we need to increase spending on direct patient care.  The President and Secretary had to make tough choices when allocating the limited public funds that are available.  This money is the people’s money and must be used to the greatest work for the people’s business.

In my many years of public service I have witnessed the tremendous complexity of the federal government.  We have a federal system that offers the best of all governments, with a key responsibility to provide good governance to the people of the country.  Our three-branch system of checks and balances delicately walks a line of competing interests.  The Executive branch competes with the legislative branch -- with general commentary from the Judiciary.  Within the Executive Branch you have competing interests, and certainly within our bicameral Congress there are hundreds of differing opinions and interests. 

In addition, we have the critical element of federalism, which offers states and local governments power and authority rarely given to lower levels of government in societies throughout the history of the world.  Indeed, our system is unique to the world.  It is a brilliant system devised by brilliant and forward-thinking men.  And, to imagine that it all began as a great political experiment more than 200 years ago.

Within our system of self-governance we have, of course, elections, which cause a natural ebb and flow: An exchange of ideas while refocusing on the priorities of our government and our nation.  This Administration, and each new administration, not only has the right to focus on their priorities, but they inherit that duty.  A duty imposed on them by the American people.

During a transition people tend to focus on the negatives.  We need to focus on the positives.  This HHS budget, and indeed the budget in its whole, is greater than the sum of its parts.  By focusing on direct services to patients, this budget uses available coordinating devices within the Rural Health Network, Maternal and Child Health, HIV/AIDS Bureau, and the Bureau of Primary Care.

There is still much good work to be done through the CAP grants already awarded, and there is still much that CAP can offer to this Administration, to the Department of Health and Human Services, and to the American people.

We need test beds for ideas -- we need your information to improve the health of this nation’s citizens.  As I mentioned earlier, the Department has just recently awarded the CAP grants -- we need you to use that money wisely, and in the best way that you can.  Your work and your evaluation components will be invaluable as this Administration and Department seeks to provide essential health care services to millions of Americans.

What you have is an opportunity to explain the breadth and depth of needs within our health care system in the United States.  As contractors, as grantees, and as leaders you have the chance to participate in the process that will permanently impact the health of our nation’s citizens.  It is a grand task, with a grand hope.  I appreciate the work that you have done, and the work that you will do over the coming months.  I know that working together we can succeed in our common mission.

Throughout the length of your grant project, you will be able to count on Eric’s office and his staff – and the rest of HRSA – to give you the support you need to do a complete job.

  I thank you for your dedication and I wish you the best of luck.

 

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