September 18, 2004
San Francisco, Calif.

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I’d like to begin by thanking NACHC for the invitation to speak with all of you.  It’s always a delight to be with and talk with so many friends from health centers and primary care associations and offices.

We meet at a time of some uncertainty, with national elections coming six weeks from Tuesday.  But I think we can be confident because of bipartisan support from the President and Congress.
 
That support is deserved:
 

• The Office of Management and Budget, in its continuing assessment of all federal programs, has affirmed health centers’ value to the nation.
  
  
• UDS data from our Bureau of Primary Health Care tracks the success of the President’s health center growth initiative in expanding services to more and more people.
  
  
• The President is asking for still more money for health centers in his FY 2005 budget, and wants to make sure all poor communities in America have access to health center services in the future.
  
  
• A recent independent study shows that access to needed health care is improving, especially among low-income children.
  
  
• I know, from repeatedly visiting health centers and other HRSA-supported delivery sites across America, that your services are top-notch and your dedication to your patients is unmatched.

And I let everyone I meet know it – Secretary Thompson chief among them.  In fact, the Secretary is scheduled to visit a health center in Indianapolis tomorrow.
 
Today I’d like to share with you a broad range of efforts and initiatives we’re working on at HRSA.  But let me begin with the state of President Bush’s five-year health center expansion initiative. 
 
We’re now winding down on the third year of implementing the President’s initiative.  So far we’re ahead of schedule.  Since 2002, the first year of the expansion, HRSA has awarded about 650 grants to create new health centers or expand capacity at existing centers.
 
That figure includes Service Expansion awards totaling nearly $11 million to 91 health centers.   Secretary Thompson has asked me to announce today the award of these funds.  The press release is available on our HRSA Web site (http://www.hhs.gov/news/press/2004pres/20040919.html).  About $8.5 million of it went to 79 health centers to expand mental health, substance abuse and oral health services and to enroll centers in health disparities collaboratives.  The additional 12 grants, totaling $2.25 million, will build integrated operations and pharmacy services networks among multiple health centers.
 
By the end of this year, HRSA will support about 3,650 health center sites across the country, serving an estimated 13.2 million people.
 
According to the latest UDS statistics, health centers served 12.4 million people in 2003, an increase of more than 2 million patients in just two years.  Patient encounters totaled more than 49 million, up from about 40 million in 2001.  Those are remarkable achievements!
 
Dental encounters were up 40 percent from 2001 to 2003, reaching a total of almost 4.5 million dental treatments last year.  That reflects a determined effort by all of us to increase the number of health centers that offer dental care and to improve care at the majority of health centers that already have oral health services – but we have much more to do.
 
In his FY 2005 budget, President Bush asked Congress for an additional $219 million for the health center system. If approved, it will set FY 2005 appropriations for health centers at more than $1.8 billion, an increase of 57 percent over the last four years.
 
These budget increases for health centers are a key part of why access to needed medical care has increased – modestly, but unmistakably -- since 2001.  A national study by the Center for Studying Health System Change indicates that the proportion of Americans reporting an unmet medical need between 2001 and 2003 declined by half (0.5) a percentage point to 5.2 percent.  That doesn’t sound big, but it is the equivalent of about 1 million fewer people going without needed care – a great success!
 
For children, the statistics are even more favorable.  Between 1997 and 2003, according to the study, the percentage of low-income children with unmet medical needs declined by more than half, from 4.6 percent in 1997 to 2.2 percent in 2003.
 
Now, all of us would agree that any person going without needed medical care due to poverty or a lack of health insurance is one person too many.  But this study shows that safety net providers are moving America in the right direction – thanks in large part to greater coverage for children under S-CHIP, the reach of state waivers approved by Secretary Thompson for S-CHIP and Medicaid, and thanks, too, to the continuing investment President Bush and the Congress have made in your network of health centers in every corner of the country.
 
And we are trying to be innovative to support you in meeting the needs of our constituents.  This year we announced three awards in a program to fund linkages of health centers and other providers in service augments.  It is sort of like HCAP but it allows 100% service augments, whereas HCAP limits actual service to only 15% of funds.  Also this year, we are getting close to putting out an announcement in the Federal Register for our 2-for-1 program or “grow your own.”
 
I am proud to say that with all of the challenges that come with an expansion of this size and scope, we have continued our focus at health centers on quality and prevention.
 
Last week my senior advisor, Steve Smith, and I were in Nashville at the Collaborative Congress.  Great work.  There the group of over 800 agreed to continue current collaboratives, begin new ones in prevention and perinatal care and move toward a full-person model.
 
Of course, the main reason that our collaboratives are being so strongly embraced is that they work.
 
Our cardiovascular collaborative model has demonstrated remarkable achievements at a time when the disease is on the rise nationally, especially in the African American and Hispanic communities.
 
And with asthma—a condition that so negatively impacts millions of American children—our collaboratives are dramatically increasing the number of patients who maintain symptom-free days. 
 
In the cancer collaborative we have mobilized grass-roots leaders to target those people who are hard to reach and who experience the greatest disparities in access to needed preventive and primary care services.  Then we get them into care. 
 
On another front, I met recently with the folks from an expert panel working on the launch of our first Perinatal Care and Patient Safety pilot collaborative.   This pilot involves HRSA bureaus other than BPHC in a collaborative.  The Perinatal/Patient Safety Collaborative will involve staff in the Maternal and Child Health Bureau, the Bureau of Health Professions, the HIV/AIDS Bureau and the Office of Rural Health Policy.   The real energy in the expert panel was encouraging.   Our effort is being led by Suzanne Feetham and Ahmed Calvo of Primary Care with the full support of top management throughout HRSA – Sam Shekar from BPHC, Kerry Nesseler of BHPr, Marcia Brand of Rural Health, Peter van Dyck of MCHB and Deborah Parham of HAB.
 
Finally, let me highlight just one more example of how well the collaborative model works.  I am delighted to report that the concept is sparking significant gains in increasing organ donations under the excellent leadership of Michelle Snyder of our Healthcare Systems Bureau and her team of Jim Burdick and Dennis Wagner.  Before the collaborative began, we averaged 500 donations per month or less.  Now after only 10 months of the collaborative, we are averaging over 600 per month and, for the first time ever, we hit a high of 650 on the most recent month for which we have data.
 
Our goal in the months ahead is to see that the benefits of collaboratives touch every health center, every site, every provider, and every patient.  We’ll do this with input from all of you over a long period of time, with substantial IT support.  One of the short-term constraints in the future is somehow getting computers into every health center and helping centers get into networks to support their IT needs as they deem appropriate.
 
We recognize that we must do more to overcome the barriers to access to mental health and behavioral health care faced by many special populations in the United States, including people living with HIV/AIDS, people living in rural areas, migrant workers and their families, homeless people and people living in public housing.  We met with representatives of the latter recently in an effort to better serve the unique needs of these special populations.  It was a superb meeting ably led by Jean Hochron.
 
We need to see patients in their entirety, because that is how they come to us.  The brain and the mouth are inseparable from the body.  They are component parts of a single entity, and we must treat them that way.  We must treat the whole person.
 
I have designated Steve Smith to lead a work group of HRSA staff from across all of our programs to plan and coordinate HRSA’s program activities for mental health, behavioral health and substance abuse treatment.  Steve is also the HRSA representative on the Federal Executive Steering Committee that will be coordinating activities across the involved Federal agencies and reaching out to the private and non-profit sectors to strengthen and expand partnership efforts. 
 
And all of you who know me know how deeply I am committed to expanding and improving the oral health services our grantees offer.   Lack of access to dental care is a scandalous, but often overlooked, shortcoming in our nation’s health care system.
 
Shortly we will be announcing the dates and place for the National Primary Oral Health Care Meeting for dentists working in your health centers.
 
This is a professional forum to support them in the very special kind of oral health programs that exist in health centers across the country. 
 
Steve Smith continues to lead HRSA’s Oral Health Work Group, a group from all of our Bureaus and Offices.   They have done a marvelous job of re-thinking our oral health goals and objectives, which set the stage for engaging other organizations and oral health care providers to improve the public-private partnerships we need to accomplish our mission.
 
Finally, I want to assure you that we will continue to emphasize access to oral health services as part of every new access point we fund.  The new HRSA Preview for 2005 includes $30 million in new opportunities for both Oral Health and Mental Health Service Expansions. 
 
The Preview also contains a new opportunity I want to tell you about.  We created a small demonstration opportunity for three or four awards totaling about $4 million.  We are opening this opportunity only to consortia of existing health centers already receiving Section 330 funding.  We believe this opportunity will allow multiple health centers to join forces with other health care providers in their community to solve community-wide health care problems.  The grant application guidance will be available by October 1 and the application deadline will be November 1.  You may think of this program as being similar to HCAP, but this program will permit spending on direct patient care as part of an effort to expand capacity and better integrate and coordinate services for an entire community.
 
We’re also working very strongly through our Office of Rural Health Policy and the health center network to improve access to health care in rural areas.
 
In fact, Secretary Thompson will soon announce $37 million in grants through two HRSA programs to boost the operations of small rural hospitals.
 
Under our Small Hospital Improvement Program, awards of almost $15 million will go to state offices of rural health in 46 states.  Rural hospitals are defined as small if they have 49 or fewer beds.  States will take these funds and share them among 1,520 rural hospitals, with three awards made directly to hospitals in Puerto Rico. 
 
And under the Rural Hospital Flexibility Program, awards of $22.4 million will be distributed to health departments in 45 states to help small hospitals improve their financial and clinical operations.
 
Last year, the Office of Rural Health Policy and BPHC worked together on a small project to identify and promote models to improve collaboration between Critical Access Hospitals and FQHCs.  Safety-net providers can dramatically improve access to primary care services for people in underserved rural communities if they work together.  That four-state project was a success, so we are expanding it to work with an additional 12 states over the next year.  The power of working together is so clear at both the Federal level and on the ground.
 
All of you know that HIV/AIDS care is one of HRSA’s main responsibilities, and we are currently deeply involved in implementing President Bush’s pledge to help people who are waiting for life-saving medications through HRSA’s AIDS Drug Assistance Program, or ADAP.
 
This is a very important effort.  The president took a look at the 10 states that reported having waiting lists to enroll in ADAP and was concerned.  He asked us what we could do to get people off the lists and into treatment.   Our answer was to put together a program, which the President announced earlier this summer, to deliver $20 million to patients in those states.  We’re in the process of sorting out the actual mechanisms to get the medicines to those patients and, once that mechanism is in place, we hope we’ll be able to target a $35 million increase in ADAP in the proposed budget for FY 2005 to areas that report having a waiting list.
 
The ADAP program has increased tremendously.   It is now at $784 million, and that will purchase drugs for over 100,000 patients a month.  That’s up from 94,000 just this year.
 
The President and Congress have given HRSA authority to operate internationally and to bring the benefits of our expertise, housed in HRSA’s HIV/AIDS Bureau, to others in the world who can benefit.  That’s happening through President Bush’s Emergency Plan for AIDS Relief.  I always have to stop on that one, because it’s got a title so long, and we just call it PEPFAR.  But this is an important fight.   This is a five-year commitment of $15 billion, billion with a B.
 
Through PEPFAR, the U.S. will devote $5 billion to ongoing bilateral programs with over a hundred countries.  We’ll increase our pledge to the Global Fund, chaired by Secretary Thompson, to fight AIDS, tuberculosis and malaria by over a billion dollars.  And in 15 of the most impacted countries, 12 of them in Africa, America will commit $9 billion to provide treatment, prevention and social services to millions of people who would not have those services without our help. 
 
We know, of course, that the high cost of pharmaceuticals is a challenge faced by health centers as well.  If any health centers are not yet registered with HRSA’s 340B Drug Pricing program, I encourage you to do so immediately, because participation in the program can save safety-net providers up to 30 percent or more on their wholesale drug costs.   The savings are possible because the sheer number of all of the program’s participating entities allows us to negotiate lower prices with manufacturers and build more efficient distribution services. 
 
If you’re not involved, we have folks here who would be happy to tell you about the benefits of the program.  You can register by yourself by going to the Web site of our Office of Pharmacy Affairs.  It’s a great program.   It’s one of the little-known wonders of what we’ve been able to do.  And I always have to tell people this story, because everyone assumes that a program as big as the 340B program must include many federal staff, you know, bureaucrats running around.  If I told you that that program is staffed by six people, it would tell you about the real dedication of those six people to their mission.  Please get to know them – the office is headed by Jimmy Mitchell.  He and his staff are good people, and they can be very, very helpful to you – and they’ll be getting four new people soon to help them with the mountains of work there.
 
Now I’d like to tell you about our ongoing work with other HHS agencies and how it affects health centers.
 
As many of you know, Regan Crump, formerly of BPHC, earlier this year succeeded Rhoda Abrams as head of our Center for Health Services Financing and Managed Care.  Regan’s extensive background with health centers is a great asset for us in this position, since one of his main tasks is to lead HRSA’s interactions with our sister HHS agency, the Centers for Medicare and Medicaid Services.
 
Regan and his staff review all Medicaid waivers that states submit to CMS.  They provide comments on HRSA’s behalf to both CMS and the state, suggesting ways to maintain or expand access to care and improve the effectiveness of services provided through America’s safety net.  With Medicaid dollars providing about a third of total revenue for health centers, these waivers can have a direct impact on your bottom line.
 
We are working with CMS to reassess the Medicare Payment Limit for FQHCs, as requested by Secretary Thompson.  With so many baby boomers becoming eligible for Medicare, we want to maximize your ability to take care of Medicare beneficiaries using the new Medicare Drug Discount Cards and get a fair FQHC reimbursement rate.
 
HRSA recently teamed up with CMS and NACHC to send an email out to providers regarding the benefits available to eligible low-income seniors who take advantage of the new Medicare Drug Card and Transitional Assistance funds.
 
We value our working relationship with CMS and will continue to work with them as closely as we can.
 
HRSA also is stepping up our working relationship with the Indian Health Service, another HHS sister agency.
 
Last April, IHS Director Dr. Charles Grim and I directed our staffs to work together to develop a plan of action to upgrade interagency collaboration and improve access to health care for American Indian and Alaska Native people.  HRSA’s Deputy Administrator, Dennis Williams, is leading this effort on my behalf.
 
Before I close, let me take a few moments to update you on an exciting initiative that HRSA is taking the lead in organizing next month – Binational Border Health Week.  The growing Hispanic population is not unique to the U.S.-Mexico border – as we see from Massachusetts to South Dakota to California to Kentucky.
 
But when you look at that 2,200-mile border, you find that if the border area were a state, across the board, it would have the worst health statistics in the nation.  And that is a disgrace.  So now we are very engaged in targeting substantial HRSA resources on Binational Border Health Week, which we’ll celebrate with events in more than a dozen sister cities along the border in both countries from October 11 to 17.

HRSA and several other Federal agencies are working with the U.S.-Mexico Border Health Commission and the Mexico Secretariat of Health to promote lasting improvements in health care and disease prevention education on both sides of the border.
 
One of the ways we’re pushing this initiative forward is by promoting immunizations.   We’re also going to be doing health education, testing and screening, and meeting with the people who need us most in that area.  This is not a one-time effort.  We see it as an opportunity to rev up the engines of care and take off to provide much better care in that area of our country.  I plan to convene another meeting of the HRSA grantees providing services in the border region in early December.  Marcia Brand, the Director of the Office of Rural Health Policy, is now coordinating HRSA’s border initiative for me.
 
If you are not yet involved in Border Week activities, I urge you to jump in.  We would be so pleased to have you involved and we can all learn from these activities and employ some of the learning from this initiative all across the country.
 
Let me conclude by thanking all of you for your dedication to the cause of improving the health of the American people.
 
Please accept from me, as a representative of the federal government, the nation’s gratitude for the hard, long hours you work to make our country stronger.  Because of you, people live better lives. 
 
So thank you.  Thank you from the bottom of my heart from this agency and this government for everything that you do.
 
Thank you.