Mr. Chairman and members of the Committee:
I am pleased to present the fiscal year 1997 budget for the Health Resources
and Services Administration (HRSA).
HRSA provides quality health care and services to our Nation's underserved
and vulnerable populations. Those we serve are the uninsured, the working poor,
the geographically isolated, mothers and children, HIV-infected persons; in a
word, those who have significant barriers to, or special needs in, health care
and often have no other alternative. HRSA is, in effect, the provider of last
resort.
This Agency is critical to the basic health of millions of Americans. Often
we hear that Federal agencies have constituencies -- groups of people who
benefit in some way from the work of the agencies. Our constituency is composed
mostly of those who have no other hope, no other source of basic health care or
have special needs that are otherwise difficult to meet. Many of these are
individuals not covered by private health insurance, Medicare or Medicaid.
Unfortunately, our constituency is increasing. Analysis by Brookings
Institute and Harvard University economists indicate that the number of
uninsured may rise from 40 million today to possibly 65 million in five years.
In 1980, about 11 million children under 18 years of age lived in poverty; by
1994, this number increased to almost 15 million. Exacerbating the problem is
the fact that even if some of these people are covered by Medicaid, many
providers do not accept them as patients -- creating an increasing burden on the
HRSA safety net.
In addition to facing the needs of a growing constituency, we face the
challenge of a health care system undergoing rapid change. There is an increase
in the number and type of managed care arrangements serving a larger proportion
of our insured populations, and we see more responsibility for allocating and
managing resources being moved to State and local levels. With all this change,
sometimes health care services lose in the transfer, particularly those for the
uninsured and higher risk populations. We are concerned about the future health
care issues faced by American's growing number of underserved people.
I want to discuss the measures HRSA is taking to meet these challenges. We
are making a concerted effort to provide the leadership that is crucial to
providing high quality care in this changing environment. Now, more than ever,
it is incumbent upon us to assure that the results of our efforts fulfill the
expectations for the scarce resources we invest.
We have developed a broad strategic plan which we believe will keep HRSA on
the leading edge of health care delivery and services into the 21st century.
This is not simply a statement of good intention but a viable strategy
reinforced by my Agency's rigorous program priorities, ranging from a new
emphasis on managed care to developing academic and community partnerships which
provide real world education to health care professionals and genuine service to
communities. We are seeking a range of partnerships, particularly with State
and local governments, to take advantage of broader knowledge of issues and
needs in the community and to combine resources so that we provide the maximum
impact for Federal, State, and local dollars.
Doing more with less has become a cliche in government and industry. Not
only is HRSA doing more with less, but we are stretching the impact of every
dollar so that the taxpayers, dollars we invest in the Nation's health care
system have an impact that brings value far in excess of the funds spent. For
example, we are proposing to consolidate 47 categorical programs into 7 clusters
to provide more flexibility in awarding funds and a simpler process for the
grantees.
A clear example of the effectiveness of our efforts in stretching dollars
and delivering quality care and service is our proposed Consolidated Health
Centers Cluster. First, let me cite some demographics. Our centers care for
about eight million people. Sixty-six percent are below the poverty level; 44
percent are children; 61 percent are minorities -- 28 percent African-American;
27 percent Hispanic, and 6 percent Asian.
I am proud to point out that in serving these individuals, each Federal
grant dollar we invest helps to leverage nearly two and a-half additional
dollars. Patients who regularly use our health centers require 20-30 percent
fewer dollars to cover their total health care costs per year than those using
other providers. Compared to similar patients, those who use our centers have
lower hospital admission rates, shorter hospital stays, and lower infant
mortality rates.
We will continue to stress value for every dollar we invest in our centers.
Furthermore, we are about to launch a major effort to accelerate the improvement
in quality of care and services we provide in these centers, in light of new
developments in our knowledge of health care delivery and generally recognized
standards.
While HRSA programs improve the life and health of underserved communities,
these programs also contribute to the overall economic health and development of
impoverished, underserved communities and residents. The current health
investment generates over $2.5 billion in revenues, supports over 50,000 jobs,
and creates numerous economic opportunities for residents of impoverished,
underserved communities across the country.
Another example of successful service impact and sound investment is our
Maternal and Child Health Block Grant program. Our annual investment of
nearly 700 million dollars combines with an additional one billion dollars in
State and local funds and another one billion in other Federal funds --
principally Medicaid. Thus, every Maternal and Child Health dollar invested
facilitates almost four dollars in health care. Of course, the most important
aspect of the Maternal and Child Health program is the people served. The block
grant touches the lives of over 15 million Americans including 1.5 million
pregnant women, two million infants, and about nine million children. Through
the block grant, HRSA provides leadership in strengthening core public health
functions for mothers and children, in building the infrastructure of public
health programs at State and community levels, and in ensuring the provision of
critical services to mothers and children. Our objectives are always the same
-- provide the best care possible, stretch every dollar, and combine skills of
people and funds to increase value and impact so that the whole is greater than
the sum of its parts.
HRSA remains a major part of the national offense against the AIDS epidemic.
Our Ryan White Title I and II monies combine with city and State funds to help
State and local governments in this battle to deal with the continuing increase
in AIDS patients. Our Title III funds enable about 150 grantees to provide
comprehensive services including HIV testing, medical evaluation, and clinical
care to thousands. Finally, our Title IV supports programs in 20 States and
territories to about 20 thousand individuals, a third of whom are children ages
2-12 and 25 percent of whom are women over 21. The Ryan White programs are
working together as well as collaborating with other HRSA programs such as
Maternal and Child Health to create a more comprehensive coordinated approach
against AIDS.
Our efforts with regard to academic and community partnerships are designed
to provide Federal leadership in training the next generation of health
professionals through academic linkages with communities, moving clinical
education beyond the teaching hospital setting and into community-based sites.
We believe that the dollars we invest in the development and training of health
care practitioners need to be oriented so that the individuals we train can
provide necessary care and services in the community and that the community
becomes a pivotal part of the education process. We carry this philosophy of
academic and community partnerships into the rural health setting as well. Our
telemedicine and long- distance education projects, for example, allow
hard-pressed physicians practicing in rural settings the benefits of
consultation with experts in academic health centers and permit the training of
future health professionals in rural and small community clinics.
Besides stretching every dollar and making continual efforts to increase and
improve care and services to our growing constituency, we are moving to deal
with changes in the health care system.
Managed care is clearly having a profound effect on health care delivery.
During 1995, the number of Medicaid beneficiaries enrolled in managed care
reached 11.6 million or approximately 30 percent of the Medicaid population
compared with just 3 percent in 1983. 700,000 individuals served by our
community health centers are enrolled in managed care organizations, and the
number is increasing rapidly. As States move increasingly to use managed care
systems, HRSA is working to assure that its program components and the
underserved, vulnerable populations they serve are active and knowledgeable
participants in these managed care systems. we also will address the concerns of
rural communities that managed care delivery systems may not adequately serve
their special needs. Furthermore, long-standing, skilled providers of care to
these vulnerable populations often are at a competitive disadvantage with
aggressive, well capitalized, managed care organizations sweeping across
communities.
We want to make sure that managed care plans and providers are aware of
about 200 positions over the past two years. More importantly, we are and
supported in meeting the needs of these underserved populations, and that an
appropriately trained primary care workforce exists to provide services in
managed care settings. I have recently established within HRSA a Center for
Managed Care to help coordinate these efforts. We will work to improve training
and technical assistance, particularly for programs such as the community health
centers, MCH clinics and programs, and Ryan White CARE Act sites, so that they
can enter into supportive contractual arrangements with managed care
organizations. We are also providing technical assistance to rural areas which
have special issues to consider as we move to greater public/private
partnerships.
HRSA has established priorities to improve our relationships with State
health departments to help integrate our programs with the service delivery
systems that communities around the country are developing. We also will
provide leadership in the training of the next generation's health
professionals, emphasizing the prime need to meet community needs in terms of
access, distribution, and diversity of our health care workforce -- features
that are not well addressed by the marketplace.
Finally Mr. Chairman, I want to mention some of our internal management
improvement activities. Not only are we attempting to stretch and maximize our
program resources, but we are restructuring and reorienting our own organization
to move into the 21st century.
We have reduced our administrative overhead through the reduction of about
200 positions over the past two years. More importantly, we are moving to
retrain and reorient our workforce. we have reorganized and streamlined our
management of human resources, begun a major improvement in our technological
capabilities, and are beginning a major employee training and career development
effort.
In concert with these efforts, we are working with the National Academy of
Public Administration (NAPA) to examine our organizational structure. This
study will be completed in July, and I fully expect to further streamline HRSA
to make it even more effective within the existing resources to meet the
challenges we face.
In summary, Mr. Chairman, I would say that we in HRSA pledge to continue our
efforts to effectively and efficiently serve the underserved and those with
special needs. We will complement the marketplace by addressing
gaps/deficiencies and assuring quality and access. We will partner where
possible with the private sector and other parts of the public sector to
leverage additional fiscal and human resources. Our FY 1997 request of
$3,113,483,000 ($33,099,000 above the FY 1996 policy level) is, I assure you,
invested with care and concern and will enable us to continue our critical role.
I am pleased to present the fiscal year 1997 budget for the Health Resources
and Services Administration (HRSA).
HRSA provides quality health care and services to our Nation's underserved
and vulnerable populations. Those we serve are the uninsured, the working poor,
the geographically isolated, mothers and children, HIV-infected persons; in a
word, those who have significant barriers to, or special needs in, health care
and often have no other alternative. HRSA is, in effect, the provider of last
resort.
This Agency is critical to the basic health of millions of Americans. Often
we hear that Federal agencies have constituencies -- groups of people who
benefit in some way from the work of the agencies. Our constituency is composed
mostly of those who have no other hope, no other source of basic health care or
have special needs that are otherwise difficult to meet. Many of these are
individuals not covered by private health insurance, Medicare or Medicaid.
Unfortunately, our constituency is increasing. Analysis by Brookings
Institute and Harvard University economists indicate that the number of
uninsured may rise from 40 million today to possibly 65 million in five years.
In 1980, about 11 million children under 18 years of age lived in poverty; by
1994, this number increased to almost 15 million. Exacerbating the problem is
the fact that even if some of these people are covered by Medicaid, many
providers do not accept them as patients -- creating an increasing burden on the
HRSA safety net.
In addition to facing the needs of a growing constituency, we face the
challenge of a health care system undergoing rapid change. There is an increase
in the number and type of managed care arrangements serving a larger proportion
of our insured populations, and we see more responsibility for allocating and
managing resources being moved to State and local levels. With all this change,
sometimes health care services lose in the transfer, particularly those for the
uninsured and higher risk populations. We are concerned about the future health
care issues faced by American's growing number of underserved people.
I want to discuss the measures HRSA is taking to meet these challenges. We
are making a concerted effort to provide the leadership that is crucial to
providing high quality care in this changing environment. Now, more than ever,
it is incumbent upon us to assure that the results of our efforts fulfill the
expectations for the scarce resources we invest.
We have developed a broad strategic plan which we believe will keep HRSA on
the leading edge of health care delivery and services into the 21st century.
This is not simply a statement of good intention but a viable strategy
reinforced by my Agency's rigorous program priorities, ranging from a new
emphasis on managed care to developing academic and community partnerships which
provide real world education to health care professionals and genuine service to
communities. We are seeking a range of partnerships, particularly with State
and local governments, to take advantage of broader knowledge of issues and
needs in the community and to combine resources so that we provide the maximum
impact for Federal, State, and local dollars.
Doing more with less has become a cliche in government and industry. Not
only is HRSA doing more with less, but we are stretching the impact of every
dollar so that the taxpayers, dollars we invest in the Nation's health care
system have an impact that brings value far in excess of the funds spent. For
example, we are proposing to consolidate 47 categorical programs into 7 clusters
to provide more flexibility in awarding funds and a simpler process for the
grantees.
A clear example of the effectiveness of our efforts in stretching dollars
and delivering quality care and service is our proposed Consolidated Health
Centers Cluster. First, let me cite some demographics. Our centers care for
about eight million people. Sixty-six percent are below the poverty level; 44
percent are children; 61 percent are minorities -- 28 percent African-American;
27 percent Hispanic, and 6 percent Asian.
I am proud to point out that in serving these individuals, each Federal
grant dollar we invest helps to leverage nearly two and a-half additional
dollars. Patients who regularly use our health centers require 20-30 percent
fewer dollars to cover their total health care costs per year than those using
other providers. Compared to similar patients, those who use our centers have
lower hospital admission rates, shorter hospital stays, and lower infant
mortality rates.
We will continue to stress value for every dollar we invest in our centers.
Furthermore, we are about to launch a major effort to accelerate the improvement
in quality of care and services we provide in these centers, in light of new
developments in our knowledge of health care delivery and generally recognized
standards.
While HRSA programs improve the life and health of underserved communities,
these programs also contribute to the overall economic health and development of
impoverished, underserved communities and residents. The current health
investment generates over $2.5 billion in revenues, supports over 50,000 jobs,
and creates numerous economic opportunities for residents of impoverished,
underserved communities across the country.
Another example of successful service impact and sound investment is our
Maternal and Child Health Block Grant program. Our annual investment of
nearly 700 million dollars combines with an additional one billion dollars in
State and local funds and another one billion in other Federal funds --
principally Medicaid. Thus, every Maternal and Child Health dollar invested
facilitates almost four dollars in health care. Of course, the most important
aspect of the Maternal and Child Health program is the people served. The block
grant touches the lives of over 15 million Americans including 1.5 million
pregnant women, two million infants, and about nine million children. Through
the block grant, HRSA provides leadership in strengthening core public health
functions for mothers and children, in building the infrastructure of public
health programs at State and community levels, and in ensuring the provision of
critical services to mothers and children. Our objectives are always the same
-- provide the best care possible, stretch every dollar, and combine skills of
people and funds to increase value and impact so that the whole is greater than
the sum of its parts.
HRSA remains a major part of the national offense against the AIDS epidemic.
Our Ryan White Title I and II monies combine with city and State funds to help
State and local governments in this battle to deal with the continuing increase
in AIDS patients. Our Title III funds enable about 150 grantees to provide
comprehensive services including HIV testing, medical evaluation, and clinical
care to thousands. Finally, our Title IV supports programs in 20 States and
territories to about 20 thousand individuals, a third of whom are children ages
2-12 and 25 percent of whom are women over 21. The Ryan White programs are
working together as well as collaborating with other HRSA programs such as
Maternal and Child Health to create a more comprehensive coordinated approach
against AIDS.
Our efforts with regard to academic and community partnerships are designed
to provide Federal leadership in training the next generation of health
professionals through academic linkages with communities, moving clinical
education beyond the teaching hospital setting and into community-based sites.
We believe that the dollars we invest in the development and training of health
care practitioners need to be oriented so that the individuals we train can
provide necessary care and services in the community and that the community
becomes a pivotal part of the education process. We carry this philosophy of
academic and community partnerships into the rural health setting as well. Our
telemedicine and long- distance education projects, for example, allow
hard-pressed physicians practicing in rural settings the benefits of
consultation with experts in academic health centers and permit the training of
future health professionals in rural and small community clinics.
Besides stretching every dollar and making continual efforts to increase and
improve care and services to our growing constituency, we are moving to deal
with changes in the health care system.
Managed care is clearly having a profound effect on health care delivery.
During 1995, the number of Medicaid beneficiaries enrolled in managed care
reached 11.6 million or approximately 30 percent of the Medicaid population
compared with just 3 percent in 1983. 700,000 individuals served by our
community health centers are enrolled in managed care organizations, and the
number is increasing rapidly. As States move increasingly to use managed care
systems, HRSA is working to assure that its program components and the
underserved, vulnerable populations they serve are active and knowledgeable
participants in these managed care systems. we also will address the concerns of
rural communities that managed care delivery systems may not adequately serve
their special needs. Furthermore, long-standing, skilled providers of care to
these vulnerable populations often are at a competitive disadvantage with
aggressive, well capitalized, managed care organizations sweeping across
communities.
We want to make sure that managed care plans and providers are aware of
about 200 positions over the past two years. More importantly, we are and
supported in meeting the needs of these underserved populations, and that an
appropriately trained primary care workforce exists to provide services in
managed care settings. I have recently established within HRSA a Center for
Managed Care to help coordinate these efforts. We will work to improve training
and technical assistance, particularly for programs such as the community health
centers, MCH clinics and programs, and Ryan White CARE Act sites, so that they
can enter into supportive contractual arrangements with managed care
organizations. We are also providing technical assistance to rural areas which
have special issues to consider as we move to greater public/private
partnerships.
HRSA has established priorities to improve our relationships with State
health departments to help integrate our programs with the service delivery
systems that communities around the country are developing. We also will
provide leadership in the training of the next generation's health
professionals, emphasizing the prime need to meet community needs in terms of
access, distribution, and diversity of our health care workforce -- features
that are not well addressed by the marketplace.
Finally Mr. Chairman, I want to mention some of our internal management
improvement activities. Not only are we attempting to stretch and maximize our
program resources, but we are restructuring and reorienting our own organization
to move into the 21st century.
We have reduced our administrative overhead through the reduction of about
200 positions over the past two years. More importantly, we are moving to
retrain and reorient our workforce. we have reorganized and streamlined our
management of human resources, begun a major improvement in our technological
capabilities, and are beginning a major employee training and career development
effort.
In concert with these efforts, we are working with the National Academy of
Public Administration (NAPA) to examine our organizational structure. This
study will be completed in July, and I fully expect to further streamline HRSA
to make it even more effective within the existing resources to meet the
challenges we face.
In summary, Mr. Chairman, I would say that we in HRSA pledge to continue our
efforts to effectively and efficiently serve the underserved and those with
special needs. We will complement the marketplace by addressing
gaps/deficiencies and assuring quality and access. We will partner where
possible with the private sector and other parts of the public sector to
leverage additional fiscal and human resources. Our FY 1997 request of
$3,113,483,000 ($33,099,000 above the FY 1996 policy level) is, I assure you,
invested with care and concern and will enable us to continue our critical role.
