Remarks to the Georgetown University School of Nursing and Health Studies

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by HRSA Administrator Mary K. Wakefield

November 22, 2010
Washington, D.C.

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Thank you, Dr. DeLoia, for that nice introduction.  And I thank all of you for attending this lecture on a topic that – from my perspective – is one of the most important developments in my career.

Of course, I’m talking about health care reform, generally; and the Affordable Care Act specifically.

I always like to begin by taking a few minutes to make sure everyone knows what we do at the Health Resources and Services Administration.  You may be surprised by the range of our reach, and by the potential avenues for collaboration with us.

On this note, I was especially pleased to hear that there would be so many undergraduate students in the room this afternoon, because I want all of you to know that a “partnership” with HRSA early in your careers can take you a very long way in the health professions.

HRSA is part of the U.S. Department of Health and Human Services. We manage a $7.8 billion portfolio of 80 different grant programs.  Most of these programs go toward expanding primary care and extending health services to those who are poor, medically vulnerable or geographically isolated.

The scope of our activities might seem bewildering at first. But, when seen in their entirety, they come together to reveal an integrated mission plan. So let me first give you a look at some of the pieces – the principal HRSA programs:

• HRSA funds the national Community Health Center system. Our 1,100 grantees provide primary and preventive care at more than 7,900 clinical sites nationwide – which are a major part of the Primary Care Safety Net. These clinics, which receive special reimbursements and grants from HRSA, serve nearly 19 million patients at an average annual cost of about $600 per person.
   
• HRSA also administers the Ryan White HIV/AIDS Program, whose 900 grantees provide top-quality care and life-sustaining medication to more than half a million low-income and uninsured people living with HIV/AIDS. About a third of the providers in the Ryan White program also happen to work in health centers.
   
• Next, our Maternal and Child Health block grants to states pay for health care services, screening and counseling that reach six of every 10 women in the U.S. who give birth, and their infants.
   
• HRSA also manages the National Health Service Corps – a signature program of the agency – which places primary care professionals in medically underserved areas in exchange for student loan repayments and scholarships.  We currently support about 7,500 of these primary care clinicians in the field; and HHS Secretary Sebelius recently announced $290 million more to support another 3,000 applicants.
   
• Similarly, HRSA strengthens the nation’s primary care workforce by giving financial support to the nation’s teaching institutions for training and curriculum development, and for scholarship and loan repayment programs for health professions students.
   
• We also house the Department’s Office of Rural Health Policy, which bolsters rural hospitals and coordinates coalitions of rural providers. Nearly 7 out of 10 health professions shortage areas nationwide are in rural communities, and HRSA is the lead federal agency in helping them come up with solutions to health care scarcity.
   
• HRSA also promotes and supports the expanded use of telehealth to meet the needs of underserved people by connecting them to distant care providers through remote monitoring devices and teleconferencing. This is especially crucial in rural and remote parts of the country, where care providers historically have been few and far between.
  
  This is pretty exciting, because as the next generation of tech-savvy providers moves into the workforce, it’s going to coincide with the increasing use of this promising technology across the spectrum of care settings.
   
• Finally, HRSA oversees the nation’s Poison Control Centers; our federal organ procurement and allocation efforts; and the National Vaccine Injury Compensation Program.

That’s a look at what we do at HRSA; now I should mention how we do it.

The agency works with a range of partners to tackle the Nation’s public health and primary care needs.

HRSA has about 3,000 partner organizations.  They are state and local government agencies, non-profits and community-based organizations, foundations, clinical providers, universities, research centers and others.

We fund them.  We support them.  We oversee their work.  But our partners provide the hands-on care.  They do the training.  They carry out the research.  This is the principle means by which HRSA puts policy into practice, and executes the will of the Congress and the President.

Some of these programs are expected to expand sharply in the next few years.

After nearly a decade of flat funding – and budget cuts in some instances – many of HRSA’s programs have grown tremendously with the support of President Obama and Congress. And the Recovery Act and Affordable Care Act in particular have made HRSA one of the HHS agencies front and center in addressing the nation’s health care challenges.

The Affordable Care Act is a direct – and, frankly, overdue – response to a complicated, expensive, “broken” health care system that bankrupts businesses; ruins families’ finances; and leaves many millions of Americans without access to even basic care.

We couldn’t simply hold steady and watch health care costs consume a quarter of our gross domestic product within the next 15 years, while millions go sick because they can’t afford care.

Here are a few things the Affordable Care Act will fix in coming years:

• Senior citizens on Medicare will have their preventive services covered, without co-payments.  Faced with this burden in the past, many simply went without the low-cost interventions that could keep them healthy going forward.  Under the Act, preventive services will expand for all Americans without co-payments;
   
• Likewise, the Affordable Care Act ends discrimination by insurance companies against children who have pre-existing conditions.  The ACA also bans lifetime limits on health insurance benefits;
   
• Access to care will improve across the board.  For the first time, the Act lays out a comprehensive plan for closing the gaps in health insurance that up until now left 32 percent of working-age adults and their families with only sporadic coverage – and 87 million people uninsured at some point during a typical year.

This is an essential step toward equity in health care.  Right now, in one of the richest nations in the world, one in 10 children are not fully immunized; and 32 percent are unhealthy from just one cause – that is, they are overweight or obese.

The Affordable Care Act sets aside $16 million from the Prevention and Public Health Fund to fight obesity – which has risen over the past 30 years to become a leading threat to public health across half of the 10 regions served by HRSA.

Of those funds, $5 million was committed in FY 2010 to create a Prevention Center for Healthy Weight. The Center – to be located at the National Initiative for Children’s Healthcare Quality in Boston – will lead national efforts to establish community-based and clinical interventions to prevent and treat obesity among children and families.

The Center is also charged with establishing a Healthy Weight Collaborative to recruit 50 teams made up of representatives from health departments, community organizations, safety net providers, and HHS and HRSA grantees to come up with a plan to address this problem at the grassroots.

More immediately, we have launched a Healthy Weight Initiative that provides $250,000 in funding to HRSA’s Maternal and Child Health Bureau to fight obesity in child-care and early-education settings.

And the First Lady has signed on to bring visibility to this problem through her Let’s Move Campaign – in conjunction with the HHS Healthy Weight Task Force. Aiming to end childhood obesity within one generation, Mrs. Obama is encouraging healthier kids, healthier households and healthier schools.

Now, since we’re here on the lovely campus of Georgetown University, we can look here to see how you work with the federal government to transform funding and policy into practice and progress.

Under last year’s Recovery Act – sometimes called the “stimulus bill’’ – Georgetown received $32 million in grant funds from the U.S. Department of Health and Human Services. Most of these funds went toward furthering research projects into such health concerns as osteoporosis, Parkinson’s disease, colorectal and breast cancer, and racial disparities in cancer screening and treatment.

Part of that money also went to make improvements in university facilities that will reap benefits for years to come, such as replacing the 24-year-old ventilation system in the Comparative Medicine animal lab, helping to leverage funding for a new MRI suite, and developing a biomedical research data retrieval system.

Now, besides that infusion of funds from the Recovery Act, Georgetown also receives substantial annual funding from HHS and its various agencies: $242 million over the past three years alone.

Again, these funds are predominately for research under the auspices of the National Institutes of Health.

But $8.5 million came to Georgetown from HRSA.  These funds support Georgetown’s good work in training health care professionals, in developing cutting edge health professions curricula, and in research on issues that are critically important to the populations we serve.

For example, HRSA funds help pay for the training of Advanced Practice Nurses and Primary Care Physicians at Georgetown.

Our funds support disadvantaged students seeking health professions degrees here.
Georgetown also uses HRSA funds in support of the Global HIV/AIDS Initiative; the Sudden Infant Death Project; and training in Children’s Oral Health.

Now you’re beginning to see how HRSA and Georgetown work together as partners.   Similar investments are being made by the Obama Administration at hundreds of colleges and universities across the country.  

Together, funds from the Affordable Care Act and the Recovery Act will support the training and development of more than 16,000 primary care providers over the next five years – impacting students and faculty just like you.

Since August alone, the Department has awarded $558 million in health professions training and development grants to partners like Georgetown across the nation.

Now let me bring the rest of the picture into focus for you.

Clearly, the most significant investment that Congress and President Obama made in HRSA under the Affordable Care Act is $11 billion over the next 5 years for the operation, expansion, and construction of health centers throughout the nation.

Of this money, $9.5 billion is targeted to creating new health center sites in medically underserved areas, and expanding preventive and primary health care services at existing health center clinics.

An additional $1.5 billion will support major construction and renovation projects at health centers nationwide.  

This support will enable our grantees to nearly double the number of patients they serve by 2015.  19 million patients now; nearly double that in five years.  It’s an enormous challenge.

One of our major concerns, obviously, is how to staff all these new and expanded sites.

So the Affordable Care Act also dedicates $1.5 billion to the National Health Service Corps over the next 5 years.  That’s enough to fund about 3,000 new loan-repayment contracts and scholarships for primary care clinicians.

These clinicians include nurse-practitioners, nurse-midwives, physicians and physicians assistants; dentists and hygienists; and mental and behavioral health professionals.

If you’re not familiar with how the NHSC works, it boils down to this: HRSA pays down your student loans or other academic debts in exchange for your promise to practice in an underserved community for a set period.

These are well-compensated positions, with salaries negotiated by you.

Not surprisingly, more than 75 percent of health care professionals who join the program continue to practice where they are after their contracts expire – and half of them choose to make a career of it.

So, even if you’ve never considered the NHSC, I urge you to go to NHSC.HRSA.Gov and take a minute to look around. We’re also on Facebook at Facebook.com/nationalhealthservicecorps  –  one word – to take any questions or comments you might have.

This is not your mother’s NHSC, folks. In fact, most everything about the program has been re-tooled in the past couple of years to work better for our providers.

Those who join today receive up to $60,000 in academic debt servicing for a two-year commitment – and up to $170,000 for five years. Your loan-repayments are tax-free. And, in many NHSC sites (such as Health Centers), you also may be covered against medical malpractice at no charge to you.

For the first time in the 38-year history of the Corps, we’re also now accepting applications for part-time clinicians – those who might want to split time between private practice and a health center, or who want to assume a teaching position while also working in a school clinic.

From a total field compliment of 3,600 providers just two years ago, the National Health Service Corps today is on track to reach 10,500 primary care clinicians by next year. That’s more than tripling the number of clinicians through the Affordable Care Act – and it’s especially important at a time when states are cutting back on their school loan programs.

But what this is really all about is access to primary health care. This increase in providers is roughly enough primary care clinicians to take on about 6 million more patients over 2008 levels.

So the NHSC is a win-win-win for everyone involved.  New professionals get the loan repayments or scholarships they need to pay off loans quickly.  We get the providers we need in areas where their talents can do the most good.  And best of all, underserved patients get access to quality health care.

And let me just add this: about 15 percent of all clinicians in the National Health Service Corps are advanced-practice nurses.  We have standing vacancies for 1,700 more at hundreds of locations across the country. And our Health Centers employ 15,000 nurses, a third of them in advanced practice.  

In these two HRSA programs – health centers and the NHSC – there’s a lot of opportunity waiting for people with ambition and a drive to serve.

I should note here – since it was your School of Nursing that invited me here today – that an expanded role for nurses is a prominent feature of the Affordable Care Act.  The legislation invests millions of dollars in support for Nurse Faculty Loans; Advanced Education Nursing Traineeships; and Nurse Education, Practice and Retention Grants – to name just a few.

The Affordable Care Act also recognizes the importance of Nurse-Managed Health Centers by investing $15 million to support 10 of these centers; and we recently awarded $30 million to boost the number of primary care Nurse-Practitioners by 600 individuals.

But it’s not just about nurses.  The Affordable Care Act and Recovery Act commitments counter years of underinvestment in all of the health professions.

New investments in training primary care doctors, dentists, psychologists and geriatricians, among others, leave us increasingly confident that we have a plan in place to make sure the federal government does its part to ensure that the right health care providers serve in the right places to meet the growing need for quality affordable care.

Within the Affordable Care Act, we have the most comprehensive overhaul of the health care system in our lifetimes. Above all, it is a forward-leaning law that addresses current needs, while breaking ground on innovative service-delivery models for the future.  

In addition, it looks to prevent future illness as much as it looks to solve the immediate problems people face today.  While not talked about very much, prevention and health promotion are a major emphasis of the Affordable Care Act.

For example, through HRSA, the Act authorizes $200 million over the next four years for the construction, renovation and expansion of school-based health centers.  That way, even the most disadvantaged kids can get care conveniently – and get it before major health problems take root.

The Act also authorizes $1.5 billion over five years for a Maternal, Infant, and Early Childhood Home Visitation Program. Under this model, nurses, social workers and others will visit expectant mothers and their families in high-risk communities.  There, they will provide counseling and intervention services designed to improve health outcomes for mothers, infants and families.  

Common to various provisions of the ACA, states are required to deploy evidence-based home visiting models to ensure results. Again, it makes more sense in the long run to provide preventive care sooner rather than more costly clinical care later.

And the Affordable Care Act invests heavily in fighting obesity, which has risen over the past 30 years to become a leading threat to public health to children and adults everywhere.
That’s a summary of the ACA from HRSA’s vantage point.

We clearly have a lot of challenges ahead, but we also have extraordinary opportunities.

Thank you.