Remarks to the National Black Nurses Association

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by HRSA Administrator Mary K. Wakefield

February 3, 2011
Washington, D.C.

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Thank you for taking the time to be here to talk about what I consider to be one of the most important developments in our careers.

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

As most of you know, I’m a nurse. And I’m not the only one in the Obama Administration that you’ll be hearing from. There are more nurses in senior positions in the federal government right now than at any other time in my memory – and I have a fairly long memory.

Interestingly, there are also more nurses today than at any time in more than 30 years – 3.1 million strong; 85 percent of whom are in active practice; that’s the highest rate of nursing employment since HRSA first started tracking our profession in 1977.

Before I get to my main topic, let me take a minute 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.

HRSA manages 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 principal HRSA programs include:

• 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. These clinics serve nearly 19 million patients, about 40 percent of whom are uninsured. That’s more than any other health system, public or private. And 6 out of 10 are minorities.

• HRSA also administers the Ryan White HIV/AIDS Program. We have 900 grantees that provide top-quality care and life-sustaining medication to more than a half-million low-income and uninsured people living with the virus.

Across these and other HRSA programs, equity in health and health care is a goal not only of HRSA, but across the entire Administration.

In a tribute message to HHS staff on Martin Luther King Day, Secretary Sebelius said: “When the average African-American child born today will live five fewer years than the average white child -- with a greater likelihood of illness -- we are still falling far short of Dr. King’s vision.”

Secretary Sebelius is committed to addressing health disparities and she has requested the development of a health disparities strategic plan – identifying this are as one of her highest priorities.

Various HHS components, including HRSA, are commenting on and contributing substantially to her plan and this aim – aligning with your association’s missions to build a nation free of disparities in health and health care, because, as we know: African-Americans are still twice as likely as their white counterparts to have a stroke; African-American men are 30 percent more likely to die from heart disease; and while African American women are less likely to be diagnosed with breast cancer, they are 40% more likely than white women to die of it.

These numbers tell us that African-Americans have far less access to routine primary, preventive health care. So illnesses that could be caught early and treated are allowed to become chronic, disabling and eventually deadly in many cases.

We also know we have significant challenges in our shortage of racial and ethnic minority health professionals. While we have seen some encouraging trends, minority health professionals don’t come close to meeting their percentage of the population.

As I’m sure we all are aware, this includes a shortage of black nurses.

Greater equity in representation isn’t just a good idea for the sake of equity, it’s also a good idea for the delivery of health care and the improvement of health outcomes among minority populations. We know this is true, and several studies have confirmed it.

HRSA’s latest nursing survey shows that RNs from minority groups increased from 330,000 in the year 2000 to 515,000 in 2008 – a 56 percent rise in less than a decade -- with the growth occurring mostly among recent graduates.

During this same period, African-Americans rose from 4.9 percent of graduating RNs to 7.3 percent.

Trending in the right direction in terms of graduating nurses, we still have much to do. Black nurses still are underrepresented in our profession. Yes, we have made recent gains. But African-American nurses represent just 5.4 percent of the nursing workforce.

Those of us who are over 50 – and I’m one of those nurses -- comprised 44.7 percent of the total RN population in 2008. So it is incumbent on all of us to work even harder at mentoring this new generation of young, idealistic nurses that is now pouring into our ranks, and to attract more.

This is against a backdrop of sustained projections of current and future demand exceeding supply for all:  shortages fueled by the retirement of nurses; an expanding and aging U.S. population; and the expansion of insurance coverage under the ACA.

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

Here are a few things the Affordable Care Act is designed to 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.  Under the Act, preventive services will expand for all Americans without co-payments;
• Likewise, the Affordable Care Act ENDS discrimination by insurance companies, first against children who have pre-existing conditions. It is now illegal to deny coverage for kids based on their health status.  And, starting in 2014, discrimination for pre-existing conditions will be gone for all Americans – gone for good. This is critical, particularly for African-Americans, given both their high rates of under-insurance and their higher rates of certain chronic diseases, which often puts them just one big hospital bill away from personal financial disaster.
• The ACA also bans lifetime limits on health insurance benefits.

This is an essential step toward equity in health care.  Right now, for example, in one of the richest nations in the world, one in 10 of our 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. As we all know, obesity has hit particularly hard in the black community.

And obesity is just one of many chronic conditions targeted under the Act.

These are just some of the reasons that Secretary Sebelius has called the ACA the most important legislation to reduce health disparities since Medicare.

Clearly, the most significant HRSA-specific 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.

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.  If we use the current baseline patient population as our guide, almost 8 million African Americans will be receiving care at health centers by then.

Now, obviously, such a big expansion is going to require special attention to the workforce that staffs these patient-centered health centers.

As part of this expansion, the Health Centers now employ 4,000 advanced-practice nurses and almost 11,000 RNs – a two-year staffing increase of nearly 20 percent. And more will be coming, adding to what is already the single largest professional class in the CHC workforce: our 15,000 nurses.

Together, funds from the Affordable Care Act and the Recovery Act will support the training and development of thousands more primary care providers (including nurses) over the next five years.  Since last August alone, the Department has awarded $558 million to colleges, universities and other institutions across the nation toward this end.

Sustaining the growth of the health center system is an immediate priority for HRSA.

Fortunately, the Affordable Care Act 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.

Of the 7,500 providers currently serving in the Corps, more than 3,100 are self-reported minorities, including 900 African-Americans.

These clinicians include nurse-practitioners, nurse-midwives, physicians and physicians assistants; dentists and hygienists; and mental and behavioral health professionals. In all, there currently are almost 1,400 advanced-practice nurses in the Corps.

That’s about 16 percent of all Corps clinicians in the field.  And we have standing vacancies for 1,500 more at hundreds of locations across the country. So there’s a lot of opportunity waiting for nurses with ambition and a drive to serve.

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.

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.

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 a health center position and family commitments; or assume a teaching job 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 the end of this year.

We also are boosting our support of clinicians in the field through a $1.5 million cooperative agreement with the Morehouse School of Medicine.

As we speak, Morehouse is putting the finishing touches on a new web-based clearinghouse service for NHSC clinicians that we expect to have fully operational by next summer. In the meantime, you can preview the site at www.PrimaryCareForAll.org. It will have special networking, instructional and resource features, tailored to the specific needs of our Service Corps providers.

For many, an NHSC position is more than just a job. It’s a calling.  And through our partnership with Morehouse, it’s about to become a community.   

I should also note here that an expanded role for nurses is a prominent feature of the Affordable Care Act.  The legislation authorizes 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 Nursing Education Loan Repayment Program – which is accepting new applicants for another week – has seen its budget more than double (from $37 million in 2009 to almost $94 million). In exchange for a two-year commitment to serve in a health care facility with a critical nursing shortage, RNs in financial need get 60 percent of their education debt paid off by HRSA; and another 25 percent if they remain in service for an additional year.

The Nursing Workforce Diversity Program – which formerly supported only undergraduates –received a $3 million boost in 2009 from the Recovery Act and was later extended to graduate-level candidates to promote the entry of minorities into advanced nursing positions and leadership roles.

This program provides funds to 45 teaching institutions nationwide for academic enrichment, scholarships and stipends that help students in financial need enroll and advance to graduation. Four out of 10 of these students are African-American.

Similarly, the Administration invested $5 million under the Recovery Act in the Centers of Excellence program – and doubled the budget from $12 million in 2008, to $24 million today.

And since 2009, $40 million in Recovery Act funds have been committed to Scholarships for Disadvantaged Students – and annual funding for the program was increased by some $4 million. More than 21,000 students training in the health professions have received scholarship support as a result.

Six out of 10 of these students (many of them nurses) are minorities – whom we know are 4 times more likely to choose careers in primary care; to practice in underserved areas; and to make careers working in disadvantaged communities.

Picking up where the Recovery Act left off, the Affordable Care Act also recognizes the importance of Nurse-Managed Health Centers by investing $15 million to support 10 of these centers over three years.

HRSA also recently awarded $30 million to boost the number of primary care Nurse-Practitioners by 600 individuals over five years.

You may also be familiar with the Act’s Home Visitation Program, which calls for a $1.5 billion investment over 5 years to fund state and local programs that send nurses, social workers and others into high-risk communities to counsel and guide expectant mothers into care.

The Act also authorizes $200 million over the next four years – half of which already has been awarded -- 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.

I don’t need to tell anyone in this audience that nurses have been the backbone of school-based care for years.

In conclusion, I share all of this to make a point: President Obama isn’t just talking about health disparities; and he’s not just hoping for a more diverse health care workforce. He’s already addressing them.

The Affordable Care Act represents the most substantial federal effort to eliminate health inequalities in recent memory.

To that end, HRSA has committed two of our most senior and most knowledgeable people to the priority of Secretary Sebelius and of HRSA. They both just happen to be African-American nurses – and I doubt they need any introductions:

• Dr. Regan Crump, our Associate Administrator for Regional Operations, not only practiced in a health center prior to joining HRSA, he was an NHSC clinician. And he’s now HRSA’s representative to the HHS Office of Minority Health; and…

• Michele Richardson is the former Director of HRSA’s Division of Nursing, and also the former Chief of the Diversity and Basic Nurse Education Branch in HRSA’s Bureau of Health Professions. Recently, she was named Senior Advisor for National Workforce Diversity – charged with overseeing our strategic plan for diversity in the health professions.

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.

The ACA looks to prevent future illness as much as it looks to solve the immediate problems people face today.

And it addresses the critically important but far too long deferred problem of health disparities.

Thank you.