January 20, 2004
Washington, D.C. 

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Good afternoon.   It’s again my pleasure to be with so many of HRSA’s partners in our continuing struggle to make more quality health care available to those who need it most.
 
First of all, let me congratulate all the HCAP grantees on the wonderful work you’ve been doing to expand access to health care for uninsured and underinsured Americans.
 
At HRSA, we, too, are working as hard as we can to provide more direct health care to more of our neediest fellow citizens.
 
As you probably know, much of that work centers on our role in implementing the two high-profile initiatives President Bush assigned to HRSA:   expanding the health center system to serve 6 million more patients by 2006 and reforming and expanding the National Health Service Corps to support that expansion.  I’ll tell you more about our achievements in meeting the President’s goals in a few minutes.
 
Furthermore, in the wake of the September 11 assaults, HRSA has been 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 tell you more about these efforts, too.
 
To make sure HRSA meets these challenges, we knew we had to operate more efficiently.  To that end, we have taken several internal reforms to cut waste and duplication: 
 

• We have centralized grants management and financial oversight responsibilities so that now all of HRSA’s bureaus and offices follow the same policies and procedures in these areas.
  
  
• We have centralized offices of communications and legislation which were once split into tiny offices that reported to each bureau and office.
  
  
• And we have reorganized the Bureau of Primary Health Care so that staff there is better able to carry out the tasks needed to meet the expansion goals the President has set.

I tell you this because I want you to understand how seriously my staff and I take our responsibilities to make sure the federal dollars we oversee are well-spent.
 
I am a career senior executive in the federal government who spent most of my career before coming to HRSA dealing with thorny administrative, budget and personnel issues.  I have a lifetime of experience in trying to make federal programs work to the greatest benefit of the people who are to be served by them.
 
And I want to assure you that when HRSA is given the responsibility to award grants and oversee the operations of a program, it does not matter who pushed to fund the program or how oversight happened to be placed in our care.  It matters only that we provide top-flight service to each program and to each grantee in that program.
 
I know the staff at the Bureau of Primary Health Care and I am confident that they give HCAP grantees the same professional, responsive and efficient service that they give to grantees from the other programs they administer. 
 
And with that in mind, I say to the 193 HCAP grantees, again, thank you for your dedication to the low-income and uninsured people we all serve. 
 
There are several ways to expand access to health care.  One is by funding more direct services, as the President is doing with the health center and NHSC initiatives.
 
Another way is to encourage greater flexibility in existing programs:
 

• Waivers and state plan amendments approved by my boss, HHS Secretary Tommy Thompson, have expanded eligibility for Medicaid and the S-CHIP program to more than 2.2 million people and improved benefits for more than 7 million people since 2001.
  
  
• At the Food and Drug Administration, new regulatory processes are dramatically reducing the time and cost of generic drug approvals.  By getting low-cost generic alternatives to consumers more quickly, FDA could save Americans as much as $35 billion over the next 10 years.

A third way to expand access to health care is to integrate into workable networks the disparate and sometimes disjointed system of programs and clinics that serve low-income and uninsured Americans.  That’s what you HCAP grantees have done.
 
Already HCAP grantees have reached some remarkable milestones:
 

• You have created medical homes for over 500,000 uninsured persons.
  
  
• You have enrolled almost 250,000 patients into Medicaid and over 90,000 into
  S-CHIP.
  
  
• Your systems have referred over 260,000 patients for specialty care.

This impressive work is starting to get noticed.
 
Project Access
A December 2002 article in the Wall Street Journal highlighted Project Access of Danville, Virginia, for coordinating a volunteer physician network to serve uninsured local residents.  162 of 175 doctors in the Danville area agreed to participate. 
 
Project Access has more than 450 active clients at any one time; to date, they’ve done health screenings for about 2,000 people.  During the past year, Danville physicians contributed medical care estimated at $762,000.
 
And those contributions are in addition to the free diagnostic testing and in-patient services provided by Danville Regional Medical Center, the local HCAP grantee.  That care totaled $986,000 last year.
 
SKYCAP
Last November, as part of President Bush’s HealthierUS initiative, Secretary Thompson honored eight businesses and organizations that do a great job of promoting healthier lifestyles in their communities.  Among the honorees was SKYCAP, an HCAP grantee from Kentucky.

SKYCAP hires and trains "patient navigators" who know where to go to get help for rural family members who suffer from chronic diseases like asthma, diabetes, heart disease, and hypertension.  In the first three years of the program, the navigators helped more than 9,000 patients get access to over 87,000 service encounters.  These include primary care and dental visits with health care professionals; access to pharmaceuticals, housing and transportation; and education classes on disease prevention and management. Since SKYCAP was launched, area hospitals have registered a 95 percent reduction in heart disease-related emergency room visits.
 
Access Health
Earlier this month, another Wall Street Journal article, this one on state and local efforts to provide health coverage to the uninsured, focused on the efforts of HCAP grantee Access Health in Muskegon, Michigan.  Under the “three-share” approach designed by Access Health, employees, employers and the county share the cost of health plan premiums.  Access Health then contracts directly with doctors and hospitals to provide employees with basic and specialty care.
 
I congratulate these three grantees and thank them for their service to their local communities.  Their efforts are representative of the work you all do.
 
Now let me update you on where we are in administering the President’s Health Center Expansion Initiative.  You probably know a lot about this, since 73 percent of HCAP grantees include a health center in the local partnership.  I’ll be brief.
 
So far we’re ahead of schedule on the plan – which foresees 1,200 new and expanded health centers serving an additional 6 million patients annually by 2006.  In 2003, HRSA created 100 new centers and expanded capacity at more than 150 existing centers. We now support nearly 3,600 health center sites, which we estimate served 12.5 million patients in 2003.
 
When the Uniform Data System figures 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:
 

• In 2002, health centers served a million more patients than in 2001.  Total patient encounters grew from 40.3 million in 2001 to just under 44.8 million in 2002, and health centers treated 373,000 more uninsured patients than in the previous year.
  
  
• Health centers continued to serve their traditional patient base during the expansion.  In 2002, 39 percent of patients had no health insurance; two-thirds had incomes below the federal poverty line ($18,400 for a family of four); and 64 percent of health center patients were minorities.
  
  
• Health centers also continued in 2002 the trend of expanding the range of services they offer – 68 percent offered mental health services, 69 percent had pharmacy services, and 72 percent offered preventive dental care.

All of these achievements verify what the President’s Office of Management and Budget discovered during a recent evaluation of health centers.  The health center program managed a grade of 85 from OMB – a score that not only tied the best score of all HHS programs, it was among the top 10 scores in the 234 programs OMB evaluated across government.
 
The reform and expansion of the National Health Service Corps – the second of the Presidential initiatives HRSA is responsible for -- plays a fundamental role in the health center expansion, since many NHSC clinicians are assigned to health centers.
 
The NHSC’s 2003 budget of $171 million was an increase of about $26 million over 2002, and the President’s 2004 budget contains another increase, this time of $42 million.
 
These additional funds have sparked a dramatic increase in the number of NHSC clinicians serving America.  From a base of 2,364 clinicians in 2001, the number grew to 2,765 in 2002 and to an estimated 3,400 last year.  The President’s 2004 budget request would boost that total to 4,000 NHSC clinicians this year, an increase of almost 70 percent in just three years.
 
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.
 
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 our 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 will pay for more hospital beds; the development of isolation areas; and the establishment of hospital-based pharmaceutical caches.  Funds also will be 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.
 
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 efforts to expand access to health care for our uninsured and low-income neighbors.
 
I’ll now answer any questions you may have.