Prepared Remarks of Elizabeth M. Duke, Ph.D.
Acting Administrator, Health Resources and Services Administration
House Appropriations Subcommittee on Labor, Health and Human Services,
and Education
Washington, D.C.
May 8, 2001
Mr. Chairman and Members of the Committee:
I am pleased to appear before you today to discuss the Fiscal Year
2002 Budget request for the Health Resources and Services Administration
(HRSA).
HRSA’s programs reach into every corner of America, providing the
foundation for the safety net of health care services relied on by
millions of our fellow citizens. HRSA grantees deliver preventive
and primary health care to needy, unemployed and underserved individuals
and families. We administer programs like the Ryan White Care
Act, that give low-income people with HIV/AIDS the medication and
care they need to get better or stay well. We work with States
to ensure that babies are born healthy and that pregnant women and
children have access to health care. We help train physicians,
nurses and other health care providers and place them in communities
where their services are desperately needed. And we oversee
the Nation’s organ transplantation system.
While the U.S. Census Bureau reported recently that the number of
Americans without health insurance coverage declined to 42.6 million
in 1999, down 1.7 million from the previous year, there are still
some families and individuals -- especially those who use HRSA-funded
services in large numbers -- who continue to fare poorly, especially
Hispanics, African Americans and Asian/Pacific Islanders, whose communities
lag behind coverage rates when compared to white non-Hispanics.
Cost is not the only barrier to health care. For 62 million
people in rural areas, the obstacles are distance and isolation; their
communities often have too few people to support critical services
typically provided by health care systems in urban and metropolitan
areas.
For the 78 million Americans who are racial and ethnic minorities,
obstacles to greater access to health care also may include culture
and language. Some individuals avoid health care because they
are unable to find health care providers who speak their language.
Others decline care because they do not feel welcome at sites that
are insensitive to their cultural norms and habits. This combination
of obstacles -- cost, culture and language -- leaves U.S. minorities
more vulnerable to certain diseases and less likely to receive services
to prevent or treat them.
For all Americans who are -- for whatever reason -- medically underserved,
HRSA programs represent the ultimate safety net, a net whose strength
depends on collaboration among partners in each community and at all
levels of government. HRSA programs draw on the full range of local
assets -- schools, churches and other faith-based organizations, and
community and neighborhood groups.
In FY 2002, HRSA intends to weave together an ever-tighter health
care safety net, providing more and better preventive and primary
care services to reduce unnecessary hospitalizations and prevent chronic
disease and disability. To meet these goals, HRSA requests a
total appropriation of $5 billion. At this time, please allow me to
address some of the major initiatives described in the President’s
Budget.
Health Centers Presidential Initiative
For more than 35 years, HRSA's primary health care programs have helped
build cost-effective, high-quality primary care delivery systems serving
low-income residents in inner cities and in rural and isolated areas.
Several programs housed in HRSA’s Bureau of Primary Health Care --
the Community and Migrant Health Centers, Health Care for Residents
of Public Housing, and Health Care for the Homeless and school health
programs -- are the foundation of the U.S. health care safety net.
Each year, these programs provide case-managed, family-oriented preventive
and primary health care services to over 10.5 million people at more
than 3,200 access points Nationwide.
One in six low-income children, one in seven low-income uninsured
individuals, one in 10 Medicaid recipients, and one in five homeless
people benefit from BPHC’s programs. Among patients served at
HRSA-supported Health Centers, about 41 percent are uninsured and
34 percent are Medicaid recipients. Almost two-thirds are members
of minority groups: 35 percent of all clients are Hispanics, 25 percent
are African Americans, and 4 percent are Asian/Pacific Islanders and
members of other groups.
Many Health Centers are involved in special initiatives to monitor
and control community-specific health problems, such as diabetes management,
boosting infant immunization rates, keeping patients’ blood pressure
under control, and reducing the number of low birth-weight babies.
By tailoring services to deal with pressing local health problems,
by coordinating programs and making sure services are accessible to
all who need them, Health Centers help communities lower hospital
admission rates, shorten hospital stays, reduce Medicaid costs and
lower infant mortality rates. According to a Health Center effectiveness
study, Health Center Medicaid patients are 22% less likely to be inappropriately
hospitalized than Medicaid beneficiaries who obtain care elsewhere.
The resulting reductions in Medicaid costs range from 30 to 34%.
The President’s FY 2002 Budget for HRSA includes the Health Centers
Presidential Initiative, which requests $1.3 billion for Health Centers,
an increase of $124 million above the FY 2001 appropriation.
These additional funds will allow Health Centers to create 200 new
and expanded access points and serve up to 1 million additional patients,
almost half of them uninsured.
The added funds represent the first installment of the Administration’s
multi-year initiative, which will eventually increase or expand health
center access points by 1,200 over five years and eventually double
the number of people served.
Presidential Initiative on National Health Service Corps Reform
Health care at many health center sites is provided by clinicians
recruited through HRSA’s National Health Service Corps, a critical
element in local safety nets for over 25 years. Since 1972,
the NHSC, through its scholarship and loan repayment programs, has
placed over 22,000 health care professionals in areas with a health
professions shortage.
Today, approximately 2,400 NHSC clinicians serve in border towns,
rural areas and inner cities, in every State, the District of Columbia,
Puerto Rico and the Pacific Basin. In FY 2000, 46 percent of the NHSC
health care providers cared for patients in HRSA-supported Health
Centers; the remaining 54 percent worked at similar free-standing,
community-based sites. Working in partnership with State and
community organizations, HRSA’s Health Center and NHSC programs provide
high-quality primary care and improve the social and economic environment
in more than 4,000 U.S. communities.
The NHSC Presidential Management Reform Initiative will improve the
NHSC’s service to America’s neediest communities. The initiative
will examine several issues, including the ratio of scholarships to
loan repayments and other set-asides, and will consider amending the
Health Professional Shortage Area definition to include non-physician
providers and J-1 and H-1C visa providers practicing in communities.
These efforts will enable the NHSC to more accurately define shortage
areas and target placements to areas of greatest need.
Healthy Communities Innovation Presidential Initiative
The President’s FY 2002 Budget also includes a Healthy Communities
Innovation (HCI) Initiative, a partnership among Department of Health
and Human Services (DHHS) agencies to target existing resources to
areas where health needs are greatest. In FY 2002, approximately $400
million may be available through existing DHHS grant programs to fund
innovative health care solutions at the State and local levels.
DHHS will coordinate the efforts of its agencies to ensure that the
best and broadest range of innovative solutions across the country
are funded.
Approximately $220 million is available in HRSA for this initiative
through its existing grant activities. Funding will also be
available for the HCI Initiative in the Centers for Disease Control
and Prevention and the Health Care Financing Administration.
HRSA programs involved in this initiative contribute to the goal of
encouraging local community innovation by increasing access, funding
demonstration/pilot projects targeted at specific health risks, and
improving the quality of health care. HRSA activities that may
contribute to the initiative’s goals are the Maternal and Child Health
Block Grant (including Special Projects of Regional and National Significance),
Community and Integrated Service Systems and Healthy Start.
Ryan White CARE Act
The FY 2002 Budget includes $1.8 billion for the Ryan White HIV/AIDS
program, the same as the FY 2001 level and $214 million over FY 2000.
The Budget will support services to 500,000 persons and provide pharmaceuticals
to 72,000 persons with HIV/AIDS. These funds are used for grants
to: Eligible Metropolitan Areas for outpatient and ambulatory care;
States and territories for the provision of medical and other health
and social services (including pharmaceuticals); Early Intervention
Services for comprehensive primary health care; Programs for Youth,
Women and Families for comprehensive family-centered care; AIDS Education
and Training Centers to conduct targeted education and training programs
for health care providers; and Dental Schools and other eligible institutions
to ensure oral health care for patients with HIV disease.
Organ Procurement and Transplantation Program
Each day in America, an average of 62 people receive an organ transplant,
but another 17 on the waiting list die -- 5,500 people annually --
because too few organs are available. Currently, about 75,000
Americans are on National waiting lists for organ transplants, thousands
more wait for tissue transplants, and more than 30,000 people each
year are diagnosed with diseases that a bone marrow transplant could
cure. In 2000, organs were removed for transplant from about
6,000 cadaveric donors. Total U.S. transplants in 2000 reached
almost 23,000.
The President’s Budget includes nearly $20 million, an increase of
$5 million, for the Organ Procurement and Transplantation program.
The requested level is targeted to a new effort to encourage increased
organ donation and education. In the coming year, HRSA will
establish a program to give every adolescent an hour of education
on organ/tissue donation prior to receiving a driver’s license.
DHHS also will promote donor awareness by conducting National and
regional ceremonies to honor donor families and living donors.
Current efforts to promote donor awareness include education partnership
grants with the transplant, business, education and religious communities.
Projects include identifying and implementing physician education
strategies, working with attorneys to ensure that donation discussions
occur during estate planning, and conducting awareness campaigns with
clergy to promote donation within their congregations.
Nurse Education
A projected shortage of nurses threatens the quality of health care
in communities across America. As the Nation grows older --
and the Census Bureau estimates that 40 million Americans will be
over age 65 in 2010, 5 million more than currently -- so, too, does
the nursing workforce. Nurses are growing older and leaving
the profession, but today’s entrants are too few to replace them and
meet growing demand for their services. Over the past four years
the growth in the registered nurse workforce has not kept pace with
population growth.
The President’s Budget will enhance the educational mix and utilization
of the nursing workforce by adding $1.5 million for Nursing Workforce
Diversity and $3.5 million for the Basic Nurse Education and Practice
program.
Program Management
To make these programs work efficiently, HRSA has implemented an aggressive
and successful effort to reduce operating costs and increase productivity.
In order to support the DHHS’ Information Technology Security and
Innovation efforts, an increase of $5 million has been included to
improve HRSA’s ability to reach Department-wide information technology
compatibility targets and to decrease HRSA and the Department’s vulnerability
to technological security breaches.
Targeted Program Reductions
To moderate the large discretionary health funding increases of recent
years, and to build a budget sustainable over time, the President’s
Budget includes targeted reductions in several HRSA programs.
Health Professions Education. The President’s Budget
recommends a reduction in funding for categorical Health Professions
activities, which have traditionally provided training grants to institutions.
These training grants were created almost 40 years ago in response
to a looming physician shortage; currently, however, a widespread
physician shortage is not evident. To reflect changing priorities,
the budget recommends focusing resources on Health Professions grants
that address current health workforce supply challenges and the impending
nursing shortage discussed previously.
Community Access Program. The President’s Budget recommends
eliminating the $125 million categorical Community Access Program.
The administration supports policies to integrate health care services
and give States greater flexibility to merge and align health care
delivery through existing channels such as Medicaid waivers, the State
Children’s Health Insurance Program, and the Health Centers Integrated
Services Delivery Initiative. Furthermore, Health Centers are
an effective and proven mechanism for improving direct access to primary
care for the uninsured.
Small Categorical Programs. The Budget includes a total
of $41 million, a reduction of $9 million below the FY 2001 level,
for four small categorical programs, including Universal Newborn Hearing
Screening, Emergency Medical Services for Children, Poison Control
Centers, and Trauma/Emergency Medical Services. These programs
had received substantial funding increases in the past two years.
While there are decreases in the FY 2002 Budget, the programs will
be able to maintain support to help States improve care.
Annual Performance Plan
Our FY 2002 Budget request also presents the annual performance information
required by the Government Performance and Results Act (GPRA) of 1993.
This includes the FY 2000 GPRA performance report for HRSA, which
compares FY 2000 results to the goals in our FY 2000 performance plan.
HRSA has made a strong effort to build performance management into
the way it conducts its business. The agency has gone through
an internal strategic planning process and has used a set of four
long-term strategies to guide the development of its Annual Performance
Plans. Each individual performance goal is supportive of one
of the four HRSA strategies:
- Eliminate Barriers to Care
- Eliminate Health Disparities
- Assure Quality of Care
- Improve Public Health and Health Care Systems.
This year’s performance plan includes targets and/or results for three
years:
- the Final FY 2002 Annual Performance Plan, based on the President’s
Budget;
- the Revised Final FY 2001 Annual Performance Plan, based on the
appropriation; and
- the FY 2000 Annual Performance Report.
As our performance measures continue to mature and performance trends
emerge, the GPRA data will serve as important program indicators to
identify strategies and objectives that will continuously improve
programs across DHHS.
Conclusion
U.S. health care is among the finest in the world, but many Americans
have limited access to it. Because these individuals lack access
to high-quality, community-based health services such as those provided
at HRSA-supported Health Centers, illnesses that could have been treated
successfully with early interventions become medical emergencies requiring
more intensive, more expensive hospitalizations.
Through this budget request, HRSA will remain the anchor for the Nation’s
health care safety net, investing more than $5 billion in community-based
primary health care, services for low-income individuals and people
with HIV/AIDS, health systems for mothers and children, and targeted
health professions training. HRSA works in partnership with
State and local governments and private organizations to expand access
to care and thus improve the health and the lives of millions of Americans.
Mr. Chairman and members of the Committee, I will be pleased to address
any questions or comments you may have on the specifics of this budget
request. I will be assisted today in answering questions by
the Associate Administrators and Program Directors I previously introduced.
