Remarks to the National Association of Community Health Centers

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By HRSA Administrator Mary K. Wakefield

March 21, 2014
Washington, D.C.

Let me begin by sharing this with each of you:

“I don’t go anywhere without people saying to me that health centers are the best primary care resource in the country.  

“…The kind of health and support that health centers give to families, the kind of neighborhood connections you make … and cutting-edge programs you use -- your work is dazzling and important.”

Now, let me step back and say that I would be proud to have been the original speaker of those words I just shared with you, but I’m not.  Those words were spoken by my boss, Health and Human Services Secretary Kathleen Sebelius, and she said that about your work during a recent internal HRSA webcast about health centers.

I know that some of you have had the pleasure of meeting the Secretary in her many visits to health centers, as she crisscrosses the country promoting the benefits of the Affordable Care Act and the outreach and enrollment activities you’ve all been so deeply involved in.  So you know that she comes by those observations based on first-hand knowledge of your activities.

During that webcast, Secretary Sebelius went on to say that the work of health centers, quote, “is not only appreciated within HHS but makes a huge difference in communities and in this country each and every day.” End quote.

And I think we can all be confident that both President Obama – and, as his presence today illustrates, Vice President Biden – share Secretary Sebelius’ sentiments.  They, too, are deeply aware of the crucial importance of health centers, particularly now, in the expansion of access to health insurance coverage to millions more Americans.

The President made it very clear how important he considers your contributions to the health of this nation when he released his FY 2015 budget request of $4.6 billion for health centers.  Budget documents signal a President’s priorities for the future, and that $4.6 billion figure is $960 million above the enacted amount for health centers in FY 2014.

The President’s request is projected to support up to $800 million in capital development grants at health centers across the nation, an investment that allows you to expand access to comprehensive primary health care services and to enhance the quality of the care you provide.  

These investments will help health centers to expand physical capacity to address the anticipated increase in demand for services from millions of newly insured patients who recently obtained or will be obtaining health insurance coverage over the next several years thanks to the ACA.

If approved, the FY 2015 funds also will support 150 new access point grants, along with continuation activities for all existing health centers, including recognition of centers performing at exceptional levels.

The budget proposal also helps secure the future for health centers, a future in which your facilities will continue to be an essential part of the U.S. health system as insurance coverage through the ACA expands.  That’s important because your clinics and offices provide an accessible and dependable source of high-quality primary care services in underserved communities.

And, after all, you also provide many services to your patients that are not covered by insurance.  These include enabling services such as case management, health education, eligibility and enrollment assistance, transportation, and translations.  These enabling services, in particular, provide an extra level of assistance and service – beyond the comprehensive primary care that you deliver – to the low-income, vulnerable patients you serve.   

Of course these populations – and many more – will continue to seek care from you, and in growing numbers.  None of us doubts that projected trend.

For example, while health centers served a record-breaking 21 million patients in 2012, we project that the proposed FY 2015 health center budget will allow you to provide care for about 31 million patients.

That projection would be a remarkable increase of 10 million patients in just three years.  And that’s on top of the 4 million new patients that health centers across the country have treated since the beginning of 2009.

This growth in your patient base, of course, is due in part to the significant support for health centers through the Affordable Care Act, and the Recovery Act before that – which, as you recall, was championed and overseen by the Vice President -- and the growth in funding support will also come through the additional revenues generated by the expansion of health insurance under the ACA.

To support your efforts to expand preventive and primary care services in FY 2014, HRSA has already awarded $150 million for 236 New Access Points, including support for 86 new health centers.

We have awarded $58 million in 1,157 one-time Outreach and Enrollment Grants to help you help millions of people nationwide enroll into affordable health insurance coverage;

And in FY 2014 we announced the availability of $35 million to address facility modifications needed to improve or enhance a health center’s capacity to deliver care using the Patient-Centered Medical Home model.

We’ve also announced the availability of $50 million for Mental Health Service Expansion/Behavioral Health Integration – that was a very strong Vice Presidential priority.  These funds are designed to improve and expand the delivery of behavioral health services by establishing or enhancing an integrated primary care behavioral health model at existing health centers.  It is a model we at HHS are fully committed to.

And soon we’ll announce $110 million in Base Adjustments, and we’ll be announcing $300 million for Expanded Services grants to support expanded medical capacity, oral health, behavioral health, and pharmacy and vision services at existing health centers nationwide.

We recognize these are critically important investments.

This Administration – from the President, to the Vice President, to Secretary Sebelius, to Jim Macrae and to myself and every staff member at HRSA – all of us remain steadfast in our continued support of your mission, your dedication to the health of your communities, and your continued success in helping the vulnerable, isolated, and underserved of this country.

The recent health center gains, of course, are the result of a lot of concentrated and focused work by all of you.  And, from our end, by a lot of people at HRSA – mostly in Jim’s and Tanya Bowers’ leadership at the Bureau of Primary Health Care and in our Office of Financial Assistance Management as staff there really put it in overdrive to hit grant deadlines.  And in addition to their efforts, I want you to know that when we needed to, we pulled people in from across the agency to give you the resources and support you needed to make it happen.

So, years from now, when the history is written of how the United States expanded its health care system to more of its citizens, all of you will share a central role.  Because the patient increases you’ve managed since the Affordable Care Act became law – and the additional expansion we’re planning for – are, I think, just short of miraculous in terms of management skill, dedication to task, and, I think, at the heart of it all, deep caring for the patients you care for.  

At HRSA, we are immensely proud to have been your partners in the gains you have successfully implemented in recent years, and we certainly look forward to doing more great work with you in the future.

Of course, while the historic growth of health center sites and services is at the core of HRSA’s efforts to expand access to primary health care, several other HRSA programs and budget initiatives funded, created, and supported by the Affordable Care Act are designed to supplement and complement your own efforts.

For example, thanks largely to ACA investments and to the Recovery Act before that, the ranks of the National Health Service Corps have more than doubled, from about 3,600 clinicians in 2008 to nearly 8,900 primary care providers today.  These providers care for about 9.3 million people in all 50 states and, as you well know, about half of all NHSC clinicians practice in health centers.

President Obama’s FY 2015 budget asks the Congress for $810 million for the NHSC, and he proposes a sustained level of commitment to the NHSC through 2020 totaling $3.95 billion.

If approved, those funds would raise the total field strength of the Corps to 15,000 annually from 2015 through 2020 – just think of the difference this can make!  That field strength would be an increase of close to 70 percent over today’s high-water mark and would serve the primary care needs of some 16 million patients in underserved rural, urban, and frontier areas.

The ACA also established and funded HRSA’s Teaching Health Center Program, which trains primary care residents in ambulatory settings by supporting a key cohort of physicians with a real grounding in community-based care and, for many of these programs, with a notable inclusion of rural training.  To date, the program has invested $230 million in 40 residency programs that are training nearly 350 primary care residents.

And President Obama’s FY 2015 budget proposal would fund teaching health centers through a new Targeted Support for Graduate Medical Education program beginning in fiscal year 2016.

This 10-year program, which HRSA would administer, would produce 13,000 physicians over the next 10 years and advance key workforce goals, among them: training more physicians in primary care and other specialties with shortages; encouraging physicians to practice in rural and other underserved areas; and aligning training with more efficient and effective care delivery models like Patient-Centered Medical Homes and Accountable Care Organizations.

And the ACA also introduced another important program in the area of maternal and child health -- the Home Visiting program, based in HRSA in partnership with ACF, which puts more health care “boots on the ground” in at-risk communities.  Under this program, nurses and others work with pregnant women, fathers, and young children in their homes in high-risk communities, providing early counseling and evidence-based intervention services to improve health outcomes.  And through ACA investments, the program continues to expand across the country.

If your health center is collaborating with home visiting programs in your area, I commend you.  If you’re not yet doing so, I strongly urge you to make contact with them and look for ways to help each other reach even more at-risk children and families.  This program works best when we have strong partnerships, and many of you already are – or could be – essential partners in the Home Visiting effort.  

By linking Home Visiting to health centers, Early Head Start, and Head Start, along with other early childhood programs, we can continue to drive important improvements in health outcomes for mothers and children.

Well, let me turn your attention for just a second to another very important topic: care quality.  One of the most impressive aspects of health centers’ amazing growth over the last few years is that many of you expanded while improving quality at the same time by transforming into medical homes for your patients, a large number of whom are at high risk for poor health outcomes.

As of early March (2014), 44 percent of health centers had at least one site recognized by accredited bodies as Patient-Centered Medical Homes, putting us firmly on track to significantly exceed the 40 percent target recognition rate for health centers in FY 2014.

The Patient-Centered Medical Home model is designed to improve quality of care through better coordinated, team-based care; through treating multiple needs of a patient simultaneously; and through increasing access to care, and empowering patients to be partners in their own care.

In no small part, by increasingly making use of these interdisciplinary teams to care for your patients, you’ve created impressive reductions in health disparities:

• Between 2008 and 2012, for example, the percent of low birth weight babies seen in health centers decreased from 7.6 percent in 2008 to 7.1 percent in 2012 – that’s substantially lower than the most recent estimated national rate of 8.2 percent!
• Between 2008 and 2012, the rate of entry into prenatal care in the first trimester increased from 65 percent to 70 percent.
• In addition, 70 percent of health center patients demonstrated control over their diabetes with a hemoglobin A1c (HbA1c) level less than or equal to 9.
• And 64 percent of health center patients with hypertension actually have their blood pressure under control.

And that’s not all.  By tightly aligning the skills and resources of physicians, nurse practitioners, physician assistants, nurses, dental providers, midwives, behavioral health care providers, social workers, health educators, and many others, the team‐based model of delivering care is effective in overcoming geographic, cultural, linguistic and other barriers.  This results in lower overall costs to other health systems, as this model of care has been shown to reduce the use of costlier providers of care, such as emergency departments and hospitals.

And in addition to your own internal monitoring of health center performance, peer-reviewed literature and major reports continue to document that health centers successfully increase access to care; promote quality and cost-effective care; and improve patient outcomes, especially for populations that are traditionally underserved.

A recent Stanford University study, for example, demonstrated that the quality of care at health centers is comparable to that delivered at private doctors’ offices, even though your patients tend to be sicker and poorer.

And you do it all at a low average cost.  In FY 2012, the average annual cost per health center patient was $687, including Federal and non-Federal sources of funding.

So it’s no wonder that Secretary Sebelius had such high praise for health centers during our webcast at HRSA last month.  In fact, she went out of her way to praise the work that health centers have done over the past year or so to increase access to care through the new affordable insurance coverage available in 2014.

As you recall, HRSA awarded about $208 million to health centers in the second half of 2013 to reach out to patients and community residents to educate and encourage them to enroll in affordable health insurance coverage through the Health Insurance Marketplaces, Medicaid, or the Children’s Health Insurance Program.

The Secretary has seen you working on outreach and enrollment in her many visits to health centers, and in the webcast she lauded the “great job” that health centers “are doing to sign patients and others up for health insurance coverage.”

Through the end of the 2013 calendar year, health centers reported training almost 11,000 outreach and enrollment workers and assisting approximately 2.1 million people in their efforts to become insured.

Numbers like that are impressive, but so are the individual stories, stories that you see play out and then told, one person at a time.  

For example, like the woman in an Alabama health center, where an enrollment worker helped her find affordable health insurance after she lost her job and her health insurance, and after her health declined, and after a visit to the ER left her with a bill she couldn’t afford to pay.  The enrollment counselor reviewed options on healthcare.gov and found that the woman was eligible for tax credits that resulted in monthly premium payments of three dollars and twenty-three cents!  The woman’s last word as she left the enrollment counselor’s office was a shouted “Hallelujah!” That’s an investment in the health of our nation – one person at a time.

And like the man at a health center in northeast Michigan, where a physician’s assistant determined that tax credits would allow the man and his wife to sign up for coverage that they could finally afford.  Soon after, using his new insurance, the man saw a doctor who admitted him to a local hospital the same day after detecting a serious health issue.  The man’s wife was very grateful for the new coverage and wondered what the outcome would have been if they had not had health insurance.     

These are just two of the thousands of examples of the great work health centers are doing in educating and helping people enroll for affordable health insurance coverage.   By helping the uninsured enroll in affordable coverage, you’re impacting their personal health and their economic health and you’re also building a more stable financial future for your center’s operation.

Because when you help community members enroll in health insurance coverage, that increases the bond that they already have with you and the services you offer.  That’s a win across the board.

So where do we find ourselves right now?  It’s crunch time, and we have just a few days left to enroll folks in the Marketplace.  Let me close by urging you to continue to push strong on outreach and enrollment right through the end of March, when the 2014 open season will end.

And certainly when this enrollment ends, we still can’t stop, we won’t let up.  Because while the 2015 open season begins in November of this year – just seven months from now – people who are eligible for Medicaid can enroll at any time.  Every day is open season for Medicaid.

And beyond helping with Medicaid enrollments at any time, please don’t forget that others may be eligible for health insurance coverage on the Marketplace due to qualifying life events.

And I have a feeling that as word spreads more widely about people like the “Hallelujah!” woman in Alabama and the man and his wife in Michigan, and the difference that access to affordable coverage means to them, and to millions of others like them, I have a feeling that demand for counseling services will pick up, especially as time grows close to the start of the next open enrollment period in November.

Again, I want to thank each and every one of you for your historic work to expand access to health care in America.

This phrase gets tossed around a lot, but it couldn’t be more true in this case:  Literally – honestly – we wouldn’t be where we are without you.

Thank you so much for everything you do to help the underserved across our great country.  Thank you.