February 9, 2004
Albany, N.Y. 

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I am delighted to be here today in balmy Albany for this important meeting with CHCANYS members.
 
I’d like to begin simply by thanking you for being so dedicated to the hard work of providing top-flight health care to New Yorkers who need it most. 
 
It would take much colder weather than this to keep me away.  Besides, I grew up outside Philly – we like to think we’re pretty tough down there. 
 
At HRSA we’re doing what you do -- working as hard as we can to increase access to health care to more of our country’s neediest people.
 
As you know, much of that work centers on implementing two Presidential initiatives that are at the core of HRSA’s efforts to expand access to health care and close the health disparities gap:
 

• First, expanding the health center system to serve 16 million patients a year by 2006, up from just over 10 million in 2001.
  
  
• Second, reforming and expanding the National Health Service Corps to provide more direct medical care to the underserved and to support the health centers’ growth.

Furthermore, in the wake of the September 11 attacks, HRSA was assigned enormous new responsibilities to help communities prepare for and deal with the consequences of a bioterror attack and to treat the victims, if need be, of such a horror.  I’ll talk more about that later.
 
As 2004 begins, HRSA is entering the middle years of our efforts to meet the goals of President Bush’s health center expansion initiative.   So far we’re ahead of schedule.  In 2002, the first year of the expansion, HRSA created 171 new center sites and expanded capacity at 131 existing centers.  In 2003, year two, we funded 100 new centers and expanded medical capacity or added oral health, mental health or pharmacy services at more than 150 existing centers.
 
Sheila (Kee, CHCANYS’ CEO) tells me that she has been fielding a lot of calls on the level of New Access Point and Expanded Medical Capacity grants that HRSA will make in 2004.  The final 2004 budget numbers just recently came in, and the result will cause us to revise our plans a bit.  But the bottom line is that there are funds available to make a good number of awards in both categories this year.
 
HRSA now supports nearly 3,600 health center sites, which we estimate served 12.5 million people in 2003.   That’s an increase of more than 2.2 million patients in just two years!  It represents a remarkable effort by you and your colleagues across America.
 
And when final health center data for 2003 are released later this year, we fully expect that our 2003 grants will continue the unprecedented gains in service delivery achieved in 2002, the first full year of the expansion:
 

• Total patient encounters in 2002 totaled 44.8 million, up from 40.3 million in 2001, and health centers treated 373,000 more uninsured patients than in the previous year.
  
  
• In 2002, you continued to serve those who most need our care: 39 percent of patients had no health insurance, and two-thirds had incomes below the federal poverty line ($18,400 for a family of four).
  
  
• You treated more Medicaid patients and more minority patients.
  
  
• You increased the number of babies delivered at health centers -- and the number of HIV tests and Pap smears.  A real tribute to health centers is in the area of HIV care.  In mid-2003 we announced a wonderfully innovative plan to “twin” a U.S.-based provider with one in the Caribbean to help them learn from us and us to learn from them.  In this arena of migration of people and disease, the competition for the grant was fierce.  It’s an honor to CHCANYS that one of your members – the Sunset Park Family Health Center Network in Brooklyn – was selected to advance this life-saving work!

All these statistics tell us how many patients are treated in a year and the life situations from which they come.  But I know from my travels throughout the country -- and you know from your own experience -- that health centers provide some of the highest-quality primary health care available anywhere.
 
Sheila also told me that that CHCANYS has initiatives to increase the number of New York health centers engaged in health disparities collaboratives (now 21 of 45) and, also, the number that have JCAHO accreditation.  I understand that a third (15 of 45) currently have JCAHO accreditation.  That is the kind of commitment to quality service that we are so proud to see throughout the system and here in New York.
 
The view all of us have of health centers’ quality also is shared at the highest levels of government.  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 10 scores in the 234 programs OMB evaluated across the federal government.  That’s a great achievement.
 
That confidence in our work is why the President last week asked Congress in his FY 2005 budget for an additional $219 million for the health center system.  If approved, it will set the FY 2005 appropriations for health centers at more than $1.8 billion, an increase of 57 percent over the last four years.
 
I’ve been in Washington many years, and this I know: When the President of the United States continues to direct more money to your budget and takes a personal interest in expanding your activities – as he has done with the health center program -- that means he’s thinks you’re doing a good job and he wants to help you do more of it.
 
The President, Secretary Thompson and many lawmakers see health centers as a key element in increasing access to health care, and in contributing to efforts to reduce shameful health disparities between minority and majority populations in our country.
           
In 2002, 64 percent of health center patients were minorities.  And that figure explains why the President’s expansion initiative will reduce persistent health disparities.  Simply put, minorities stand to gain the most from the health center expansion.  The additional access will improve their health and narrow those disparities.
 
The second presidential initiative that affects our work at HRSA involves the reform and expansion of the National Health Service Corps.  Part of the President’s and Secretary Thompson’s plan to increase direct health care for America’s medically underserved means getting more NHSC clinicians to “front-line” areas of greatest need.
 
The growth in the NHSC is vital to the health center expansion, since about half of all NHSC clinicians work in health centers. 
 
President Bush’s fiscal year 2005 budget -- announced last Monday -- asked for an additional $35 million in funds to continue the NHSC expansion.  The recent increases in NHSC funding – together with changes we’ve made internally to get more Corps members out in the field -- have sparked a dramatic rise in the number of NHSC clinicians serving America.
 
The NHSC has grown from a base of 2,364 clinicians in 2001, to 2,765 in 2002, and to an estimated 3,400 last year.  In 2004, we hope to boost the field strength of Corps clinicians to 4,000, which would represent 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 field has topped 4,000. 
 
We also have added to the NHSC duties a team of elite medical professionals we call the “Ready Responders.”  We have 55 Ready Responders on staff now and hope to have a full complement of 80 on staff by the end of the year.  The idea to create them was born in the terrible hours following the 9-11 attacks on New York and Washington.

At HRSA we hurriedly identified our Commissioned Corps personnel on staff that we could send to the World Trade Center site, to the Pentagon, and to the crash site in Pennsylvania.  All of our people responded heroically to the disasters.  And the existing National Disaster Medical System, which the Federal government had established to respond to these types of calamities, also worked well.

But in the weeks after the attacks, we knew that we wanted to improve HRSA’s contribution to the Commissioned Corps Readiness Force, which the Surgeon General directs.  We also knew that we wanted to coordinate that effort with President Bush’s ongoing push to provide more direct health care to our neediest fellow Americans.
 
However, we had to do it with only the resources we had on hand; no other funds would be made available.  So we looked closely at our budget and our employees, who came up big with support and ideas.  We reorganized here, streamlined operations there, and step by step found the money and people we needed to set up the Ready Responders.

Fortunately, with the NHSC, HRSA already had a structure in place to get health care professionals to areas of greatest need.  To that existing framework, we added a new structure -- one that enables the Surgeon General to rush primary care clinicians to any public health emergency, whether natural in source or caused by the cruel natures of those who hate freedom.
 
During most of the year, these Ready Responders dedicate their talents to delivering quality health care to underserved populations in health centers and other sites that serve low-income and uninsured populations.  But they have also made an extra commitment to undergo two weeks of training each year in emergency medicine and disaster relief and to be ready on a moment’s notice to respond to large-scale medical emergencies anywhere in the country.
 
To our mind, everyone involved with the Ready Responders benefits:
·        First -- hospitals, health centers and clinics in the most underserved parts of the country get free health care professionals on site.  The Ready Responders are Commissioned Corps personnel who are on our payroll; they cost the recipient facility nothing.
·        Second -- HRSA puts more health professionals in direct service to America’s neediest citizens without increasing our budget.
·        Third -- the Ready Responders themselves gain invaluable new training and expand their professional capabilities.
·        And finally, the nation is assured that its government can respond to the worst possible events by sending in the best-trained, most qualified health care experts available anywhere.  Already the Surgeon General has sent them to the disasters caused by Hurricane Isabel and the California wildfires.
 
Let me switch gears now and talk about something that I see all of you learned about yesterday during your the Emergency Preparedness Planning seminar.
 
In terms of funding increases during my years here at HRSA, nothing matches the infusion of funds and responsibility that occurred with the creation of the National Bioterrorism Hospital Preparedness Program.  Funded at just over half a billion – that’s billion with a “b” – the Hospital Preparedness program is the base of three HRSA programs that form a major part of the federal government’s response to the challenges posed by terrorist groups.  The President is asking for another $476 million for the program in 2005, a slight drop in funds during the two preceding years. 
 
Launched in 2002, the Hospital Preparedness program is structured to develop and sustain emergency “surge capacity” at hospitals sufficient to handle mass casualty events.  It goes without saying that 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.
 
Program funds pay for more hospital beds; the development of isolation areas; and the establishment of hospital-based pharmaceutical caches.  Funds also are used to identify health care personnel who would be called on in a surge, and to provide personal protective equipment, extra mental health services, and trauma and burn care.
 
As you probably know, these hospital preparedness funds go to states, but HRSA was careful to make sure that those resources don’t stay at the state level: 80 percent of the funds must go to local hospitals and clinics, health centers, EMS centers and the like.  We specified in the program guidance that participation in the advisory planning committee must include officials from local health departments, hospitals, health centers and clinics.
 
We have heard complaints from local officials that the money is not getting down to them fast enough or in sufficient amounts.  On the whole, we feel that state and local officials have made progress in remedying this situation.  And we recognize that that states had to gear up very quickly during 2002 and 2003 to pull together stakeholders, write plans, and establish priorities. 
 
That they did so in an environment of troubled state budgets while responding to the public health threats posed by SARS, monkeypox and the West Nile virus is remarkable.  We also think it is likely that the impressive response by state and local health officials to these new public health threats was helped along in part by the planning and coordination encouraged by the hospital preparedness grants.

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 HRSA’s counter-bioterrorism arsenal, funded at $1.5 million annually, is our poison control incentive grant program, which supports efforts to improve collaboration between poison control centers and local public health agencies.
 
That gives you a brief tour of HRSA’s major priorities for 2004 and beyond.
 
I thank all of you for listening and for your incredible efforts to expand access to health care to New York residents.
 
I’ll be happy to answer any questions you may have.