Remarks to the Health Foundation of South Florida

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by HRSA Administrator Mary K. Wakefield

Washington, D.C.
October 1, 2010

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Thank you for the gracious introduction…It is my pleasure to be here to address your annual Board of Directors retreat.

I always begin by taking a few minutes to make sure everyone knows about what we do at HRSA.  You may be surprised about the range of HRSA’s reach, and hopefully you’ll see potential avenues for collaboration with us, our programs and our staff.

HRSA is a $7.8 billion agency that proudly wears the mantle of being the ‘primary Federal agency charged with improving access to health care services for people who are uninsured, isolated or medically vulnerable.’

• Our network of 1,100 community health center grantees across the nation provides primary health care at more than 7,900 sites, where they serve nearly 19 million patients, about 40 percent of whom have no health insurance.
• We administer the Ryan White HIV/AIDS Program, whose 900 grantees provide top-quality care to more than a half-million low-income and uninsured people living with HIV/AIDS.  That’s about half of all people in the United States living with this disease.
• We help ensure the adequacy of the health care workforce – nurses, physicians, dentists and more – by supporting curriculum development and through scholarship and loan repayment programs offered by our Bureau of Health Professions.
• Through our National Health Service Corps, we place primary care professionals in medically underserved areas, where they're needed most. The Corps provides scholarships and student loan repayments worth up to $50,000 in exchange for two or more years of service in shortage areas, both urban and rural.
• We also house the Office of Rural Health Policy, which funds efforts to bolster rural hospitals and coordinate health care among coalitions of rural providers and linkages between rural and urban providers.
• We work to increase and improve the use of telehealth to meet the needs of underserved people, especially those living in rural and remote areas. 
• We also oversee the nation’s Poison Control Centers; federal Organ Procurement and Donation efforts; and the National Vaccine Injury Compensation Program, among many other programs.

Today at HRSA we’ve acquired a new important focus, and that’s the implementation of provisions of the Affordable Care Act, the historic health care reform legislation President Obama signed in March.  HRSA is the lead agency overseeing more than 50 different authorizations under the Act, and the co-lead agency on 16 others.

A number of ACA provisions took effect last week on its six-month anniversary.  Together, they have begun to change the culture of American health. Much of the new law bears directly upon HRSA’s strategic goals, your Foundation’s priority interests, or both.  Consider some of what the ACA requires:

• Added protection from rate increases: Insurance companies will need to publicly disclose rate increases and provide justification before raising monthly premiums.
• Added protection from having insurance canceled:  An insurance company cannot cancel your policy except in cases of intentional misrepresentation or fraud.
• Certain preventive benefits, immunizations, and screenings will be covered with no cost-sharing requirement.
• No lifetime maximums on health coverage or essential health benefits.  More than 20,000 people who typically hit their lifetime limits will benefit from this provision alone – along with nearly 102 million consumers who will no longer have a lifetime limit on their insurance policy.
• No pre-existing condition exclusions for children: If you have children under the age of 19 with pre-existing medical conditions, you can add them to your family health insurance plan and their application for coverage cannot be denied due to a pre-existing condition.
• Extension of coverage for young people up to their 26th birthday through parents’ insurance.

Most significantly to HRSA and the populations we serve, the Affordable Care Act provides $11 billion in funding over the next 5 years for the operation, expansion, and construction of health centers throughout the nation.  This support will enable us to nearly double the number of health center patients by 2015.

Another $1.5 billion is dedicated to the National Health Service Corps through 2015.  More than 2,800 new Loan Repayment awards and over 200 scholarships are expected in FY 2011.  

These investments will help ensure we have the providers we need, serving where they are needed most.  HRSA’s Affordable Care Act dollars build upon the $2.5 billion HRSA received last year under the Recovery Act: $2 billion to expand health centers (more than $1.9 million which has been awarded in grants to communities); $300 million for the NHSC; $200 million for workforce training.

Strengthening the health care workforce is a key element of HRSA’s strategic plan. We want to make sure that the health workforce is capable and diverse, and that it is trained to provide high quality, culturally and linguistically appropriate care.

Together, the Recovery Act and Affordable Care Act will support the training and development of more than 16,000 new primary care providers over the next five years.

Since August alone, the Department has awarded $558 million in workforce training and development dollars from the ACA and Recovery Acts combined.

In the latest awards, released Tuesday, we announced $253 million in training funds from the Affordable Care Act’s Public Health and Prevention Fund for primary care medical residents, physician assistants, advanced practice nurses, and personal and home care aides.  More than $9 million of that amount went to Florida-based grantees, meaning nearly $28 million in workforce training dollars have been awarded to institutions in your state during the past two months.

In addition, part of the funds announced Tuesday – almost $6 million – go to 26 states to begin comprehensive health care workforce planning or implementation.
To further improve workforce development, the ACA also establishes:

• A National Health Care Workforce Commission, an independent entity to develop a national strategic plan for the health care workforce; and
• The National Center for Health Care Workforce and Analysis, a national center to provide analysis, modeling, and data collection to project current and future workforce demands.

These ACA and Recovery Act investments counter years of underinvestment in health professions, and leave us increasing increasingly confident that we have a plan in place to make sure the right health care providers serve in the right places to meet the growing need for quality affordable care.

I want to turn for a moment to another of your Foundation’s priorities: oral health. Through HRSA’s health centers, we provide direct oral health services to almost 3.5 million people each year.  Nearly all health centers provide dental exams and care, and people can find the nearest health center to them by going to the HRSA web site at www.hrsa.gov and clicking on “Get Health Care” on the top banner, then “Find a Health Center.”

And though the NHSC has nearly 700 dentists and hygienists working in needy communities, the fact remains that 49 million people in the U.S. now live in oral health shortage areas. We are nearly 7,000 practitioners short of the number necessary to extend services to those underserved communities, and the dentistry workforce is among the most rapidly aging in the health professions.

Encouragingly, the ACA addresses and will improve oral health care quality in a number of ways. It provides for:

• Establishment of an oral health care prevention education campaign at CDC focusing on preventive measures and targeted towards key populations including children and pregnant women;
• Creation of demonstration programs on oral health delivery and strengthened surveillance capacity;
• Insurance plans to include pediatric oral health services for children up to 21 years of age; and
• Increased eligibility for new grant programs in the Title VII Health Professions Programs to train dental and allied dental health professionals.

These elements of the legislation give us reason for optimism about the future of oral health care and the prospect of broad-based improvements in the availability and quality of care.

In addition, I co-chair -- along with the Assistant Secretary for Health -- the HHS Oral Health Initiative 2010 Initiative, a Department-wide effort that emphasizes: 

• oral health promotion/disease prevention;
• access to care;
• an enhanced oral health workforce; and the
• elimination of oral health disparities.

To those ends, HRSA has commissioned the Institute of Medicine to do two studies for us – the Oral Health Initiative Study and the Study on Oral Health Access to Services.

The Oral Health Initiative Study will have a broad focus across all HHS programs. It will examine the current system, including private practice, and will explore ways to improve our oral health literacy.  Most importantly, it will examine new and innovative ways to engage the public with key messages about prevention.

Why focus on oral health literacy?  Because all providers, not just those in the dental care field, should be up to speed on the importance of oral health care -- physicians, nurses, physical therapists, and physician assistants, and the wide range of health care professionals as well.

To learn more about what HRSA is doing in oral health, go to: http://www.hrsa.gov/publichealth/clinical/oralhealth.

In oral health and in overall health, prevention is an integral part of the Affordable Care Act.
I mentioned earlier that the Affordable Care Act mandates that certain preventive benefits, immunizations, and screenings will be covered with no cost-sharing requirement.  These preventive services include such things as annual mammograms for women over 40, regular Pap smears to screen for cervical cancer, and pre-natal care.  Also covered will be tests to screen for:

• high blood pressure;
• cholesterol and diabetes; and
• colon cancer for adults over 50.

Counseling on ways to stop smoking, lose weight, and work exercise into daily activities is covered, too.

Health plans will cover a set of standard vaccines recommended by the Advisory Committee on Immunization Practices.  These range from routine childhood immunizations to periodic tetanus shots for adults.

And by eliminating the cost-sharing provision, the new law also helps make it affordable for seniors on Medicare and Americans enrolled in Medicaid to access critical preventive screenings and services. This is consistent with your Foundation’s “Healthy Aging” initiative.

For children, health plans will cover preventive care for children recommended under the Bright Futures guidelines, developed by HRSA with the American Academy of Pediatrics.  This includes regular visits to a pediatrician, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.

Tackling obesity is a theme you’ll find throughout the Obama administration’s health activities.  In fact, preventing health problems associated with being overweight or obese in our Nation is a Presidential priority.

The First Lady’s “Let’s Move Campaign” wants to end childhood obesity within one generation by promoting healthy eating and an active lifestyle. Mrs. Obama is encouraging healthier kids, healthier households and healthier schools by emphasizing:

• Portion control;
• Reducing fat, sugar and salt content in restaurant and take-out food; and
• Providing healthy menu choices, prominently displayed, so “parents don’t have to hunt around and read the small print” on the menu to find them.

Just a week ago, HRSA awarded $5 million from the Public Health and Prevention Fund to the National Initiative for Children’s Healthcare Quality in Boston to create and manage a new Prevention Center for Healthy Weight to address obesity in children and families.

The Center will launch the Healthy Weight Collaborative to share evidence-based and promising community-based and clinical interventions in preventing and treating obesity. Collaborative teams will be recruited to help states and local communities develop practical approaches that link public health and primary care.  The Center will oversee and provide technical assistance to the team which, at a minimum, will represent health departments, community-based organizations, HHS and HRSA grantees, and others.

The Obama Administration is laying the foundation to help transform the health care system from a system that focuses on treating the sick to a system that focuses on keeping every American healthy.  We want to create a culture of wellness.

Having shared my ‘snapshot’ of some of ACA-driven activities, I want to take a moment to share with you my thoughts about how your Foundation and other grant-makers ‘fit’ within this era of thoughtful systemic change.  There can be no question that transitions are dynamic…that change can be difficult.

We are already sometimes known as “Safety Net Agency,” but we might just as well be called “The Health Care Partnership Agency.”  We certainly expect a spike in our cross-agency collaborations within and outside the federal government, and an increase in consultations with state and community health constituencies as we implement provisions of the Affordable Care Act.

Let me be clear: We need you.  I have asked my senior staff to fashion a comprehensive strategy for engaging with Foundations, grant-makers and public health funders like the Health Foundation of South Florida.   Despite the funds to expand primary care I’ve just discussed, much more is needed to reach everyone who requires our help.

Remember, of course, most of the funds appropriated through the Affordable Care Act are dedicated to very specific programs and activities.  So, I encourage Regional Foundations like yours to consider the specific needs of the region or community you serve and position yourselves to leverage Affordable Care Act dollars.

In any event, as implementation of the ACA proceeds, you belong at the table.  Foundations seek and cultivate the expertise we need to tackle some of our nation’s toughest challenges. You engage thinkers and doers to fashion and test prospective solutions across disciplines of public health. You are able to bridge numerous divides that government finds hard to traverse.

In short: without your Foundation and organizations like it, HHS and HRSA cannot be as successful as we will otherwise be in getting health care and services to the people who need them most.

We have an enormous task before us.  To keep up with the pace of reform, and to learn more about how the Affordable Care Act helps you, your family, and your community, I encourage everyone to go to www.healthcare.gov.  That’s a government Web site that allows users to compare the value of insurance plans available in your state, compare the performance of nearby hospitals, and learn about ways to stay healthy.

The site is totally geared to the needs of consumers, and it’s remarkably easy to navigate.  In addition, it has been structured to evolve and expand as consumers use it and comment to Website administrators on ways to improve it.  Remember: www.healthcare.gov.

Thank you.