August 2, 2004
Washington, D.C.

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Welcome.   I am delighted to be here today for this Rural Health Outreach Grantees meeting.   I applaud you all for the work you do to expand health care access to the millions of people who call rural America home.
 
During my tenure as Administrator for the Health Resources and Services Administration, I have had the opportunity to visit many rural communities from Alaska to New Hampshire.  And I am always impressed by those I meet who work on the frontlines to address the many health care challenges that exist in rural America.
 
Since 1991, we have funded more than 630 rural outreach grants totaling more than $300 million.  As you know, these funds stimulate innovation in rural health care delivery by encouraging greater coordination of services and fostering more and stronger partnerships that help us all do a better job for the people we serve.  For your outstanding effort, I commend each and everyone of you. At HRSA, we are so proud to call you partners. 
 
I am also proud to work for a President and Secretary who are adamant that rural Americans have access to quality health care when they need it and where they live.
 
When Secretary Thompson took office, his mandate to us was clear: make sure our policies don’t get in the way of meeting the needs of the 65 million people who live in the nation’s rural and frontier communities.
 
His leadership in this area is probably best exemplified by his creation in 2001 of a department-wide task force to improve our Department’s response to many of the health and social challenges you face everyday.
 
Last July, the task force report –– “One Department: Serving Rural America” -- was presented to the public.   And since then we at HHS and HRSA have been moving swiftly to put many of the report’s recommendations into action. As a result of this unprecedented effort, we are changing the way we do business within all HHS agencies when it comes to rural concerns. 
 
For example, the Center for Medicare and Medicaid Services holds monthly rural health open door calls where participants can raise issues for resolution with senior CMS officials. The Substance Abuse and Mental Health Services Administration has identified rural health as one of its cross-cutting principles impacting all SAMHSA programs and priorities. 
 
And the National Institutes of Health has a number of ongoing research activities designed to develop new strategies to reduce the burden of disease and disability for residents of rural and other disadvantaged communities. 
 
The Secretary’s Rural Health and Human Services Advisory Committee is also working diligently to meet the needs of rural communities.  Its annual report was released just a few weeks ago and included recommendations to the Secretary along with examples of model rural programs.  The report urged the Secretary to:
 

• support efforts to cover mental health services equally with primary care services under Medicaid and Medicare;
• authorize an oral health bonus within Medicaid to encourage greater participation by dentists in rural areas and increase funding for HHS programs that train and place dentists; and
• support transportation projects to help the rural elderly access health care.

And we’re pleased with the work of the Rural Assistance Center, which serves as single point of entry for anyone seeking information about health policy and social services for rural communities. To date, the RAC website has been visited more than 50,000 times by users seeking a broad range of information on rural health and social service issues.
 
The importance of our work in rural America is heightened, of course, by HRSA’s responsibility for administering the President’s Health Center Expansion Initiative.  By now all of you know its outline.
 
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. 
 
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 capacity at more than 88 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.
 
Health centers did even better than before serving low-income patients and those who prefer to speak in a language other than English.  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 64 percent and the uninsured 39 percent of health centers patients in 2003, percentages that haven’t changed over the past two years.  But the overall growth in services means that health centers served nearly 4.9 million uninsured patients in 2003, almost 900,000 more than in 2001.
 
Dental encounters were up 40 percent from 2001 to 2003, reaching a total of almost 4.5 million dental treatments last year. 
 
I think we can agree that all of these numbers look pretty good -- good from HRSA headquarters and good from your vantage point on the front lines.
 
To make sure we have enough health care professionals to work in these health centers, the President gave us a second, related initiative to reorganize and substantially boost the ranks of the National Health Service Corps.  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. 
 
Related to the NHSC is our National Rural Recruitment and Retention Network -- 3RNet. It links organizations in 46 states to share information on communities looking for health care professionals and health care professionals looking for practice locations.  More than 2,000 physicians and over 300 other health professionals have registered with 3RNet during the last year.
 
Our health centers are also seeing more patients with costly chronic diseases like diabetes, asthma, obesity, heart disease, depression and cancer, even as the system expands.  Here we have a proven strategy that reduces the harm done by chronic diseases  -- that strategy would be our health disparities collaboratives that promote early intervention and improved patient management.
 
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 myth Americans have about cancer’s eventuality – it is not – 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 strategy to expand collaboratives to all health centers dovetails exactly with the emphasis by President Bush and Secretary Thompson on fighting chronic illness. 
 
On September 21 the Secretary will sponsor the annual “Take a Loved One to the Doctor Day.” Radio personality Tom Joyner will again join him in encouraging Americans – especially those from minority communities – to take charge of their health by encouraging family members and friends to get a checkup from a health professional.  We want all of our grantees to get involved in this activity. 
 
Another initiative HRSA is spearheading in the Department of Health and Human Services is “Border Binational 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.
 
There are many ways for you to participate in Border Binational Health Week.  I urge you to get involved.  For more information, go to www.borderhealth.org or call HRSA’s Office of International Health Affairs.

These are just a few examples of what we at HHS and HRSA are doing overall to improve health and human services all across America.  It’s important that you have a sense of the “big picture” so you can see more clearly how your work at the local level complements what we are doing here in Washington.
 
In the weeks and months ahead, Secretary Thompson and the entire HRSA family will continue to improve outreach to rural America, but we need your help.
 
We are excited about hearing from you and sharing information about the broad range of programs that we administer. 
 
During the next few days, you will   have the opportunity to hear from several rural health experts who will talk with you about some innovative approaches to problem-solving that they have developed in communities just like yours all across the country.
 
You will also hear from several HRSA staff who will give you the latest information on topics such as grants management, mental health, telehealth and telemedicine, and the 340B pharmacy program.   Jim Macrae from our Office of Performance Review is also going to conduct an important session on grantee reviews.  You won’t want to miss this presentation.
 
Another highlight is the session on the new Medicare law and its impact on rural providers.  Amy Elizondo from the Centers for Medicare and Medicaid will give this very important update.   
 
I challenge all of you to make the most of your time with us the next few days – to learn from one another, to meet with our HRSA staff, and to explore new ways we can work together to make the most of our shared mission.
 
In closing, I want to thank each and every one of you for your commitment to rural America.  With your help, I believe we can create better systems of care and reach more and more people.    Together, we can do this.
 
Again, enjoy your time with us.  Thank you for listening.