August 6, 2004
Little Rock, Ark.

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Let me begin by saying thank you to members of the Arkansas Primary Care Association for inviting me to speak with you.   Sen. (Blanche) Lincoln, we are honored to have you join us today.
 
Today I want to give you an update on where we are with President Bush’s health center expansion initiative, which is succeeding in spreading the benefits of health center care to more and more medically underserved communities across America.   I also want to tell you about several other exciting new HRSA initiatives.
 
Before I start with that, however, I’d like to share with you a summary of HRSA’s impact in Arkansas.
 
HRSA may not be as well-known as our sister HHS agencies like CDC or FDA, but our grant programs have a surprising impact on communities large and small. In federal fiscal year 2003, for example, HRSA invested some $54 million in Arkansas.
 
Let’s look at some of the major programs that are included in that $54 million.   First there’s the $18.3 million in health center grants and the $814,000 in Healthy Communities Access Program grants that some of you administer.   In addition, HRSA grants to public and private organizations in Arkansas include:
 

• Almost $10 million for maternal and child health programs and another $3 million to promote abstinence education;
• Nearly $7 million in Ryan White grants to fight HIV and AIDS; and
• More than $6.7 million to prepare local hospitals and local health care professionals to treat victims of a bioterror attack or other mass casualty event.

We also distributed six nursing education and training grants worth about $680,000 to Arkansas State University, the University of Central Arkansas, and the University of Arkansas.
 
HRSA is now in the third year of implementing President Bush’s five-year health center expansion initiative.  So far we’re ahead of schedule.  Since 2002, the first year of the expansion, HRSA has awarded about 560 grants to create new health centers or expand capacity at existing centers.  By the end of 2004, HRSA will support about 3,650 health center sites across the country, serving an estimated 13.2 million people.
 
According to just-released statistics, health centers served 12.4 million people in 2003, an increase of more than 2 million patients in just two years.  Patient encounters totaled more than 49 million, up from about 40 million in 2001.  Those are remarkable achievements!
 
In 2003, 90 percent of patients had incomes below 200 percent of the poverty line, up from 88 percent in 2001.  And 30 percent were best served in a language other than English, up from 28 percent in 2001.
 
Minorities continued to make up two-thirds of health center patients in 2003; and the uninsured are 39 percent of all patients, percentages that haven’t changed over the past two years.
 
Dental encounters were up 40 percent from 2001 to 2003, reaching a total of almost 4.5 million dental treatments last year.  That reflects a determined effort to make sure health centers that offer dental care improve it, and those that don’t, better start.
 
Without a doubt, you have earned bragging rights about the health center program. An evaluation of health centers completed last year by the President’s Office of Management and Budget gave the program a grade of 85, which tied for the best mark given to any HHS program. Furthermore, the health center score was among the top scores in the 234 programs OMB evaluated across the federal government.
 
This favorable impression of our work is also why the President asked Congress in his FY 2005 budget for an additional $219 million for the health center system. If approved, it will set FY 2005 appropriations for health centers at more than $1.8 billion, an increase of 57 percent over the last four years.
 
With the health center expansion come other challenges. One of the biggest is finding the right people to fill the many new positions that are being created.  We estimate that the health center system will add 36,000 new health center staff positions through 2006, including more than 11,000 clinicians.
 
This is a difficult task, no doubt about it.   After two years, we’re pretty close or ahead on most of our goals. 
 
We’ve added almost 1,200 physicians during 2002 and 2003; our goal for those years was 1,236.  We wanted to recruit 252 dentists; we’ve added 365.  For nurse practitioners and physician assistants, we’re only about a dozen short of our goal of 666 new recruits.  And we’re way ahead of our targets on x-ray and lab technicians.  Recruiting nurses has been a problem, just as it is across the country.  Our two-year target was about 1,600; we’ve recruited 1,000.
 
The National Health Service Corps plays a fundamental role in the staffing strategy. As  part of his plan to expand health centers, President Bush also directed us to reform and expand the Corps. That makes sense, of course, because about half of the current number of NHSC scholars and loan repayors work in health centers.
 
With support from both sides of the aisle in Congress, we’ve been given the funds to make dramatic increases. The NHSC has grown from a base of almost 2,400 clinicians in 2001 to an estimated 3,400 last year. In 2004, we hope to boost the number of Corps clinicians to 4,000, an increase of about 70 percent in just three years. 
 
When that occurs, it will be the first time in history that the number of NHSC clinicians in the filed has topped 4,000.  HRSA has helped boost that number through an internal policy shift that emphasizes loan repayments over scholarships. That way we sign up more and more physicians and other health care professionals who are ready to work, rather than waiting years for them to finish their studies. 
 
But here’s the problem: even this impressive expansion in the NHSC’s ranks will not provide enough people to cover the positions we need to fill at health centers.
 
How will we do it?   We’ll all need to do the hard work of developing new recruitment and retention strategies.  We’ll need to improve existing strategies by working closely with residency and educational training programs.  The situation will mean expanded opportunities for health care professionals who want to serve America and who may end up in the very health centers where you work.  We welcome your advice as health center administrators in bringing more capable men and women into public health service.
 
As we move forward with the health center expansion, I think it’s critical that health centers retain their reputation as a front door to our nation’s vast prevention, surveillance, and treatment systems.
 
Arkansas has already taken steps to ensure that some of their residents have greater access to care and access to information that will help them lead healthier lives. 
 
In June, Arkansas took advantage of an HHS rule that allows states to extend prenatal care to low-income pregnant women and their unborn children through ARKids First, the state version of the S-CHIP program.  Nationally, S-CHIP programs extended health insurance coverage to almost 6 million children in 2003.
 
Arkansas’ decision is a smart way to make sure children of low-income mothers get off to a healthy start.  Without it, these children would only be eligible for federal health care assistance through Medicaid or SCHIP after they are born.
 
And I understand that in May Gov. Huckabee launched a “Healthy Arkansas” initiative, which aims to persuade Arkansas residents to give up unhealthy habits and take more responsibility for improving their own health.  With its emphasis on increasing physical activity, reducing obesity and cutting the number of people who smoke, the Healthy Arkansas initiative will do a lot to limit the impact of chronic diseases like diabetes and cardiovascular disease, cut medical costs and avoid unnecessary hospital visits.  More importantly, it will help people live longer, healthier lives and get more enjoyment out of living in this beautiful state. 
 
Health promotion and disease prevention has been a central focus of Secretary Thompson’s term at HHS and of President Bush’s Healthier US Initiative.  Healthy Arkansas and the Healthier US initiative have many of the same goals.  The President’s initiative urges Americans to improve their personal health and fitness by:

• being physically active every day;
• eating a nutritious diet;
• getting preventive screenings;
• and making healthy choices.

At HRSA, we, too, place a great deal of emphasis on trying to prevent chronic illness before it begins.  Our efforts are perhaps most evident in our determination to spread the obvious value of health disparities collaborative throughout the health center system.
 
You know better than anyone that health centers are seeing more patients with costly chronic diseases like diabetes, asthma, obesity, heart disease and cancer.
 
By promoting greater teamwork among health professionals, by improving procedures to track treatments and reach out to community residents, and by encouraging patients to take greater responsibility for monitoring their illnesses, collaboratives reduce the harm done by chronic diseases.
 
We have seen that participation in collaboratives can transform the performance of many health organizations.   And we need this kind of effort because our health centers are seeing more patients with costly chronic illnesses. 

In the past year I have visited a dozen health centers that are participating in pilot cancer collaboratives.  In the past six weeks, I’ve visited sites in South Dakota and Georgia to further our big push for outreach to overcome the many myths Americans have about cancer and about why early detection is not a death sentence.
 
Soon HRSA will launch its first Perinatal Care and Patient Safety pilot collaborative.  There is much to be done in this area, and we are making progress. We can make a difference.

The emphasis on fighting chronic disease through collaboratives is part of a determined effort by President Bush to reduce health care expenditures.  We all save money if chronic diseases are controlled before they reach the point where the patients end up going to emergency rooms for much more expensive, and often lengthy, treatments.
 
Already collaboratives have spread to more than two-thirds of the nation’s health centers.  Our goal is to implement the collaborative care model in all health centers by the end of 2005.
 
I congratulate the Arkansas PCA for your efforts in getting nine of the state’s 10 health centers participating in collaboratives on diabetes, cardiovascular disease, and depression.  And I understand that you have been helping the new Healthy Connections health center in Mena apply to join the diabetes collaborative early next year.  I was delighted to visit Mena to help folks there launch the new health center.   That’s great work and I thank you very much for all that you’re doing!
 
One certain area of growth at HRSA and in 21st century America is in the field of disaster preparedness.  HRSA has three programs that form a major part of the federal government’s response to the challenges posed by terrorist groups.     

And in terms of agency funding, nothing matches the infusion of funds and responsibility that marked the creation in 2002 of the National Bioterrorism Hospital Preparedness Program, coming in this year at just over half a billion dollars.  The President is asking for another $476 million for the program in 2005. 

The Hospital Preparedness program increases emergency “surge capacity” at hospitals sufficient to handle mass casualty events. Hospitals – along with health centers and other first-responders -- will play a critical role in identifying and responding to terrorist attacks or outbreaks of infectious disease. Funds cover more hospital beds, the development of isolation areas and hospital-based pharmaceutical caches, and are used for on-call health care personnel, to provide personal protective equipment, mental health services, trauma and burn care. 
 
Those of you who work in health centers simply must have a place at the table in our efforts at hospital improvement.
 
The second counter-bioterror program HRSA administers is a new “Bioterrorism Training and Curriculum Development Program,” which provides $26.5 million in grants for continuing education and training for health care professionals and to add bioterrorism-related curricula in medical education.

The third element in the arsenal is the $21 million in annual appropriations for poison control operations.  We also fund $1.5 million annually to support efforts to improve collaboration between poison control centers and local public health agencies.
 
Before I close, I’d like to take a few moments to update you on some exciting new initiatives at HRSA.
 
Earlier this year, Surgeon General Rich Carmona and I announced a new campaign to educate Americans on ways to prevent bullying and youth violence.  HRSA’s Maternal and Child Health Bureau is leading our efforts in the campaign, which is called -- "Take a Stand.   Lend a Hand.  Stop Bullying Now!"

We have a Web site at www.stopbullyingnow.hrsa.gov that contains resources you can use at the school or community level to counter bullies and create bullying prevention programs.  We’ve had a tremendous response thus far, and we think this campaign will help reverse this surprisingly severe problem among our youth.

Another initiative HRSA is spearheading in the Department of Health and Human Services is “Binational Border Health Week,” which will occur during the week of Oct. 11-17 along the U.S.-Mexico border.
 
In partnership with the U.S.-Mexico Border Health Commission and the Mexico Secretariat of Health, HRSA and several other Federal agencies will use the week to promote lasting improvements in health care and disease prevention education on both sides of the border.  We will sponsor events in at least 13 sister cities along the border in both countries to share easy-to-understand information on immunization, on health problems such as diabetes, on services and programs that can help, and on how residents can access those services. 
 
We also plan to mobilize existing community-based organizations to build networks of care that make better use of their individual contributions, to immunize children and screen for diabetes, and more.
 
Finally, HRSA is stepping up international efforts in HIV/AIDS prevention and treatment.  Earlier this year Secretary Thompson gave HRSA direct authority to work internationally, and since then we’ve engaged our HIV/AIDS Bureau in several activities in support of the President’s Emergency Plan for AIDS Relief.  The President’s plan will provide substantial new aid to 12 African countries, two Caribbean nations and Vietnam – all deeply impacted by HIV/AIDS.
 
In closing, I’d like to tell you how much we appreciate the collegial relationship we have with all of you here at the Arkansas Primary Care Association.  It’s because of the efforts of fine people like you that our nation is a healthier and safer place to live for many Americans and their families.
 
Thank you for giving me the opportunity to speak to you today.