Remarks to the National Association of Community Health Centers

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by HRSA Administrator Mary K. Wakefield

March 27, 2009
Washington, DC

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Obviously, it's an exciting time for me to take the reins at HRSA, and a privilege to be here today with all of you. It's also a privilege to be in our business – with this once-in-a-lifetime chance to make a permanent mark in one of the most important arenas in American public life: health care.

The election of President Barack Obama has returned comprehensive health care reform to the front burner for the first time in 15 years. For those of us who have been around longer in the Community Health Movement, we're now hearing language from a sitting President that we haven't heard since Lyndon Johnson first gave us this national trust back in 1966.

President Obama's signing of the American Recovery and Reinvestment Act on February 17 put health centers and HRSA's workforce programs squarely in the middle of the effort to re-imagine, re-invent and re-build the health care system.

I've been on the ground - and I've seen CHCs in action - in places as different as Northwood, ND and Denver, CO. And I don't mind saying that I think the HRSA-supported network of 7,000 health center clinics represents one of the best reform models in existence – tried, true and time-tested.

That's just a fact.

The President's Recovery Act has invested $2.5 billion in HRSA, with $2 billion of these funds targeted for health centers. We're already underway with those investments, and their sheer size should be evidence that this President means business. He intends to make an immediate difference in the lives of our nearly 17 million patients – one-third of whom are children – and to greatly increase our current reach.

They are the reason we are here, most especially those 5.2 million kids.

Nine out of 10 of our patients are living in poverty, and four out of 10 are uninsured, and there's going to be a lot more of them before this economic crisis is behind us. According to the U.S. Department of Labor, 4.4 million Americans have lost their jobs in the past 18 months – and with those jobs went their health insurance.

All of you know that on March 2 the President led off his news conference to introduce Kansas Governor Kathleen Sebelius as his nominee for HHS Secretary by announcing grants worth $155 million to establish 126 new health centers. Those grants mean another 750,000 people in 39 states and two territories will have access to quality health care.

Today, I'm privileged to announce on behalf of the Administration, the release of $338 million in Increased Demand for Services grants to extend your hours and current services, to add staff – and to prevent the lay-offs of existing staff as you struggle with the economic downturn.

We know you're facing a crushing influx of patients: 900,000 since the economy first went south in 2007. We know there's tremendous need. We heard you, and that's why we pushed to get these grants done in this short timeframe.

This week, we heard from Dr. Margaret Gray, CEO of the Family Health Care Clinic in Pearl, Mississippi. Dr. Gray tells us that the health centers she oversees in 11 counties “are busting at the seams” with increased demand. With $1.3 million in new Access Point funds being rushed her way, Dr. Gray will be able to open three more clinics, hire 70 new staffers, and take in another 9,000 patients on top of the 31,000 she's already serving.

We're also sending $442,000 in IDS funding, which will enable Family Health to hire five new clinicians and four support staffers, which translates into 22,000 patient visits over the next two years.

Expand care. Help families in need. Create jobs. That's what this is about.

For helping achieve these aims, I thank all of you for preparing and sending your IDS applications so quickly.

I also want to thank Jim Macrae and his staff - and Becky Spitzgo and her people in our Office of Federal Assistance Management - for the long hours they put in to turn around these grants and the earlier ones on March 2. Members of the HRSA Team did about three weeks of work in three days to move those New Access Point funds I mentioned earlier.

Like you, they proved, as President Obama said so often on the campaign trail, that ordinary people, committed to a cause, can accomplish extraordinary things.

I've barely managed to unpack my luggage in my new job as Administrator, and we're already moving with lightning speed, thanks to these folks.

Looking forward to the Recovery Act construction, renovation and equipment funds for health centers, we are working on a process for how best to administer those investments.

Remember, we haven't awarded construction grants in more than a decade and we want to make sure we get everything right, so these will take a little longer. After all, we're talking about significant sums: taken together, the capital grants – and the money to support health information technology investments – total $1.5 billion in Recovery Act funds.

President Obama has made it perfectly clear that he does not intend for that money to be wasted or frittered away on “dream” projects. Every nickel will be accounted for. Every grant and contract will be transparent. And I have no intention of allowing HRSA's reputation to be tarnished for inadequate oversight.

As President Obama told all of his senior managers in a memo just a few days ago…and I quote: These dollars are “ not intended to fund projects for special interests…there will be no aquariums, zoos, golf courses or swimming pools…no project(s) that (do) not further the job creation, economic recovery, and other purposes” of the stimulus plan.

Period. Close quote.

That strikes me as a pretty good standard for every penny we spend at HRSA.

And let's not forget, we also have a $125 million increase coming in the FY 2009 appropriation for health centers…

And $500 million in health care workforce support funds, which I'll be talking more about in a moment…

Taken together, these and other investments in the Community Health Center system represent the single largest infusion of capital in the 43-year history of the program. The stewardship of so many of you in this room is what brought us here, to this moment.

We must not – we will not – fail in this historic mission.

All of us have heard President Obama consistently repeat two words throughout his first two months on the job: transparency and accountability. And those words will guide Federal oversight of these grants.

All grantees receiving Recovery Act funds will be responsible for reporting anticipated outcomes through www.Recovery.gov, including how quickly the funds awarded will be obligated; how many new jobs were created or retained; and the overall status of your projects. From that Web site, the American People will be able to track progress toward your goals in real-time.

It's their money you'll be spending. It's their future, and the future of their children, that you'll be holding in your hands. We all would be wise to never forget that, not even for a moment.

For our part, HRSA will use our current monitoring and oversight procedures to assess the success of the Recovery Act-funded projects. For the new health centers, we'll provide technical assistance to make sure they're in compliance with program rules and that you're all achieving expected outcomes.

But the message I have received from the highest levels of this Administration could not be more clear: We will be judged on results. We will be held to the strictest letter of accountability. And if we flub any part of it, we will find ourselves sitting in an uncomfortable chair in a small, hot room with Vice-President Joe Biden.

If you've ever seen the Gentleman from Delaware run a Senate hearing on C-SPAN, it's not a place any of us ever wants to be.

It's no accident that health centers took center stage at one of President Obama's very first Recovery Act events. He knows from his days as a community organizer on Chicago's South Side how important your work is to people in underserved communities.

And it's no accident that First Lady Michelle Obama made a visit to a District health center on one of her first solo trips outside the White House. Just a few years ago, she ran a program in Chicago that encouraged emergency room patients to go to health centers and other community clinics to get regular, ongoing health care.

The President's statement announcing the New Access Point grants stressed our role in “relieving the burden on emergency rooms across the country, which,” he said, “have become primary care clinics for too many who lack coverage -- often at taxpayer expense.”

He knows health centers can help the nation cut overall costs. He knows that for every dollar you get from HRSA, you find four operating dollars from other sources. He knows – we all know – that the average annual cost per patient receiving regular primary care at a health center is $562, or one-tenth the per capita national average.

We also know our patients on Medicaid are less likely to use emergency rooms, less likely to become ill enough to require hospitalization, less likely to require referrals to specialists…

That's why the President expects our health centers to play an important role in overall health care reform. And he has faith that you in this room – working together with us at HRSA – together, we can help the nation find a path out of the health care mess we're in.

One of every 19 people living in the U.S. now relies on a HRSA-funded clinic for primary care, including nearly a quarter of the nation's homeless and migrant and seasonal farm workers. In health care, people vote with their feet. And their feet are bringing them here.

For this President and this First Lady, it was no fluke that health centers came first out of the chute. They get it. Access to quality health care is the key to everything else: a productive workforce, high-achieving schools, a fit military, thriving communities.

All of you have witnessed the sustained expansion of the health center network over the past eight years. Now, the Recovery Act funds will provide the trigger for more growth - growth that can change the health care landscape across the United States. Over the next two years, these dollars will help you serve nearly 2 million more patients and add thousands of new jobs.

Here's how on the ground:

The Stewart County Community Medical Center in Tennessee has two enormous and very different problems: the state ranks 5th in the Nation for deaths due to untreated diabetic complications, and they're running out of dentists. For a comparatively small investment of $147,000 in IDS funds, the Stewart County health center will be able to provide free retinal eye screens for hundreds of their residents; a full-time dental assistant, a part-time dentist to help their full-time staff clinician, and a bus service to get local kids to and from the dental clinic.

As we all know, parents can't get much work done when their child misses school days because he's in pain from otherwise treatable dental problems. We're going to do something about those problems.

And, friends, we're going to do it… fast!

This explosive growth raises a crucial question: how will you find the staff needed to support it?

Part of the answer is in the $300 million investment HRSA received for the National Health Service Corps. By adding 4,100 doctors, dentists, nurses, nurse practitioners and other professionals, that expansion will effectively double the number of NHSC clinicians in the field today.

Another part of the answer will come from the $200 million in the Recovery Act for HRSA's health professions programs.

But even these historic investments will only get us so far. They will not, in and of themselves, solve the dilemmas we face:

• Doctors and dentists are coming out of school with crushing debt – well in excess of $100,000 on average. How will we, together, persuade them to work at health centers?
• There's a serious shortage of nurses. How will we recruit the few available to work with us when competing opportunities exist?
• More than a third of doctors and dentists currently in practice are 55 or older and likely to retire in the next 10 to 15 years. And the average age of a nurse in practice today is the highest it has been since HRSA first started tracking the profession in 1980. We need new blood – new personnel strategies -- and we need them fast.
• And it's hardly a secret that shortages of nurses, doctors, dentists and other care providers land hardest in rural communities. Already, 20 mostly rural states are reporting workforce shortages.
• Health centers have 8,000 physicians on staff, but we are well aware that you have thousands of clinical vacancies that are proving very hard to fill.

So no matter which side of the problem you look at, the healthcare workforce crisis looms larger and larger before us as a limiting factor – and not just in the growth of health centers but in health care reform writ large. We have deferred these challenges for too long. We simply can't wait any longer. When it comes to the health care workforce, we're out of time.

The $500 million investment Congress and the President have made gives us some time to figure out a broader, more inclusive strategy to develop a sufficient, sustainable health care workforce. But no one should be under the false impression that it solves our long-term workforce issues.

The Recovery Act alone won't cure the recruitment conundrum. We must do a better job of retaining the workforce we have, and we must consider innovative ways to bring in community-based providers. Here are two examples:

• At HRSA, we're developing a demonstration project to allow clinicians to work part-time for the National Health Service Corps. Up to now, our loan repayor programs have locked out mid-career professionals who might be willing to split time between private practice and a health center position. We're convinced that a part-time option will bring in seasoned practitioners with much to offer patients and young clinicians alike.
• We talk a lot at HRSA about innovative programs that work, and one of them is A.T. Still University in Mesa, AZ – which has received about $30 million in grants from the agency since 1985. The A.T. Still School of Dentistry and Oral Health has expanded its community-based dental program to a second location off-campus in nearby Glendale. From 2,500 patients a year ago, ATSU is now poised to reach thousands more. This is a two-fer.

A.T. Still is both vastly expanding oral health services and producing the next generation of oral health professionals – in a state in which almost half-a-million kids are without adequate access. I can assure you that when this President talks about “rebuilding America,” and the importance of “national service,” this is the kind of program he has in mind.

These are just two models. The list of programs and people and organizations taking positive steps is long, but it needs to be longer, much longer.

As you can tell, HRSA has a lot of work in front of it. We have to continue the day-to-day work of the agency. We are implementing the President's Recovery Act. And we will have a contribution to make in health care reform. We await and look forward to your wise counsel and positive contributions across all of that.

Health reform cannot be resolved by HRSA alone, by Recovery money alone, or by health centers alone. We are a piece of the puzzle. We're certainly not the whole puzzle, but we are an important piece of the puzzle.

When President Obama addressed his health care reform summit on March 5, he said: “Every voice has to be heard. Every idea must be considered…there should be no sacred cows. Each of us must accept that none of us will get everything that we want, and that no proposal for reform will be perfect.”

He was equally clear when he said, there is only one option that is not on the table: the status quo.

In closing, I've always operated as someone who brings everyone to the table. I want to work together with you in real partnerships. I've found that when that happens, key leaders emerge who push forward viable solutions.

I'll learn from the many organizations, like NACHC, that represent the interests of key actors in HRSA programs.

I'll learn from folks on the front lines: psychologists, pharmacists, physicians and nurses in health centers; caregivers in HIV/AIDS clinics; persons awaiting organ transplants.

I'm also hearing more from HRSA's employees about how well we're doing – and I'm inviting them and frankly expecting them to tell me how we could do things better. Like you, their expertise is terrific. It spans the decades.

President Obama captured the spirit of these times during his campaign last year, when he said: “This is our moment.”

These are the times for which many of us have been preparing all our lives. We are on the precipice of wide-ranging and critically needed health care reform, and health centers and HRSA and organizations like NACHC are key players. It's our time.

We have the responsibility. We're ready to use it wisely on behalf of our 16.1 million patients – soon to be 17 million – in what is already the largest primary care network in the United States of America.

The President was right: “We are the people we've been waiting for. We are the change we seek.”

Thank you for listening.