Senator HARKIN. Thank you very much. That is a great story. You say you now pay as much in taxes as you received in welfare? MS. WHITEHEAD. Per year. Senator HARKIN. That is a great success story, one that ought to be retold. You ought to be very proud of that. MS. WHITEHEAD. Thank you. Senator HARKIN. What did we have last year? We had National Center for Nursing at $43.7 million is the request. You are requesting $58.8 million for that and $66 million for the nurse training. Ms. WHITEHEAD. That is correct. It is an increase of about 10 percent. Senator HARKIN. It was $39 million last year. And the administration was asking for $43 million this year. I see. I just want to get my figures straight here. How can we encourage more nurses to practice in underserved areas? Ms. WHITEHEAD. Increase the salaries. MS. WHITEHEAD. In Pennsylvania, I work in Philadelphia and I make a very good salary. But you can go about one-half an hour away from Philadelphia and I am probably making about 25 to 30 percent more than nurses in those areas, the small rural communities. Senator HARKIN. How much do nurses learn now in their training about health prevention, disease prevention, and health promotion? Ms. WHITEHEAD. Over the years it has been increasing. When I went to school in 1979, 1980, 1981 range, that probably was the focus of maybe about 40 percent of our education. And I know over the years I know a lot of it was to help people through patient teaching and education to either minimize the problems they were experiencing or to prevent them. I work in a coronary care unit. I do a lot of preventive education while I am taking care of these people, like how to prevent further heart attacks and things like that. Senator HARKIN. Thank you very much for your testimony. It was very good. I appreciate it. MS. WHITEHEAD. Thank you. STATEMENT OF DR. CHARLES R. WALLACE, NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS Senator HARKIN. Next is Dr. Charles Wallace, Lee County Cooperative Clinic from Marianna, AR, representing the National Association of Community Health Centers. Dr. WALLACE. I am substituting for Dr. Payne who was suddenly ill. I came in his place. Senator HARKIN. Sorry to hear that. Welcome, Dr. Wallace to the subcommittee. We have your statement. Please proceed. Dr. WALLACE. Thank you, Mr. Chairman. Good morning, Mr. Chairman and members of the subcommittee. For the record, I am Dr. Charles R. Wallace. I am a clinic physician and surgeon at the Lee County Cooperative Clinic in Marianna, AR. I am here today in place of my colleague, as I just mentioned. I am also here today on behalf of the National Association of Community Health Care Centers which represents over 600 community and migrant health centers and homeless health care programs. I deeply appreciate the opportunity to present to you the problems which these health centers face and the current climate and the issues of the fiscal year 1992 funding for these programs. Mr. Chairman, these health centers are community-based systems which provide high quality prevention-oriented primary health care services to patients who are impoverished, disabled, rural, or have no other places to have health care or health education. By law, these health centers are placed in medically underserved areas, deteriorating neighborhoods of major cities, are in rural areas too isolated or too poor to attract private physicians. A written statement is submitted for the record, but I would like to touch on some of my own personal experiences at the Lee County Clinic in Marianna, AR. The clinic population is basically large, rural, mixed with many farmers and laborers. Most of the patients I see are not necessarily poor, but because of economic situations in the country today they find themselves with no place to go for health care except this clinic. I have seen in the past month alone three teenagers under 15 years pregnant because of inability of the health care system to provide outreach. I have dealt with sickness and death throughout my career and practice, but have not been so devastated until a 9-month old was brought in dead because the family was too poor to go to a doctor and waited until the last minute. By then it was too late. Yes; teenage pregnancy and infant mortality is a real problem and health centers today are really helping to curb this problem. I see many people in Marianna who are temporarily out of work and some homeless whose medical problems would become catastrophic if the health center were not there to provide services which are relatively inexpensive. In summary, there are three key points I would like to reiterate. First, is the lack of physicians. Second, the basic underfunding of these health centers. And third, the number of patients keep growing. PREPARED STATEMENT For these reasons, I ask you to support the recommended funding level submitted in the record for health, happiness, and stronger moral guide consciousness. Thank you, Mr. Chairman. [The statement follows:] 1 1 STATEMENT OF DR. CHARLES R. WALLACE Mr. Chairman and Members of the Subcommittee: My name is Earnest Payne, Jr., Medical Director of the Lee County Cooperative Clinic, based in Marianna, Arkansas. Today, I am speaking on behalf of the National Association of Community Health Centers which represents over 600 Community and Migrant Health Centers and Homeless Health Care Programs throughout our nation. As you know, these health centers provide basic comprehensive primary health care to America's poorest, most disadvantaged people from inner-city ghettos to rural migrant farmworker labor camps and isolated, resourcepoor communities. I deeply appreciate the opportunity to present to you today the problems which these health centers face in the current climate, and the issues of fiscal 1992 funding for the federal programs which support the health center activities. Overview of Health Centers Health centers are community-based systems of care which provide high quality preventionoriented, comprehensive case-managed primary health care services to patients who, because of poverty, disability, geographical, occupational and cultural barriers would otherwise have little or no health care. By law, health centers are placed in medically underserved areas, usually in the inner, deteriorating neighborhoods of major cities or in rural areas that are too isolated or too poor to attract private physicians. Twenty five years ago, prior to the advent of Medicare, Medicaid, and the federally funded health centers, low-income patients or persons living in remote areas were forced to choose between the hospital emergency room, local public health services, or the teaching clinic of medical schools, if and where they existed and if the patient were accepted. These services were and still are inadequate both in scope and size, or inappropriate for the level of care needed. Health centers' achievements over the past 25 years show how much is known about how to make a difference in the health of the poor and how far even a modest investment will go. Health centers understand their communities' most urgent needs: As the primary, if not sole, source of health care for the medically underserved, health centers respond to a host of needs. Their strong community ties have made health centers extremely sensitive to emerging community needs. Their community-based nature means that health centers tailor their services to meet those needs. Centers provide a broad array of comprehensive primary and preventive health services in settings that are appropriate for their patients and accessible. They charge for their services only in accordance with patients' ability to pay. Health centers care for those whom other providers cannot or will not serve: Perhaps the greatest testament to the unique ability of health centers to design services that are accessible to their patients is that, ironically, health centers report that for every ten currently served there are another three on waiting lists who seek care. And the individuals and families on waiting lists do not even begin to take into account the far larger number of persons who need the services of health centers but who do not have a center within reach. Health centers offer high quality medical care: Because health centers exist to provide comprehensive care they are staffed to offer ongoing medical treatment as well as preventive and diagnostic services, through a staff that includes primary care physicians plus an array of other health professionals who have been particularly recognized for the quality and impact of their work on low-income and medically underserved communities, such as nurse midwives, nurse practitioners, and physicians assistants. Health centers have had a major impact on the health of their communities and provide care in a highly cost-effective fashion: Numerous studies have shown the impact of health centers on the health status of their communities: More Effective Care: Community health center patients have been shown to have lower hospital admission rates, shorter lengths of stay and make less inappropriate use of emergency room services. Fewer Infant Deaths: Communities served by health centers have been shown to have infant mortality rates from ten to forty percent lower than communities not served by health centers. The provision of health center services also has been linked to improvements in the use of prenatal care and reductions in the incidence of low birthweight. Less Preventable Illness: Community health centers have been shown to reduce rheumatic fever and untreated middle ear infections in children and have significantly increased the proportion of children who are immunized against preventable disease. Better Use of Preventive Care: Health centers have increased the use of preventive health services such as Pap smears and family planning services. However, the need to strengthen the capacity of health centers has grown more urgent in recent years. And yet, although demand for services has increased significantly, federal funding for centers has actually decreased by up to 30 percent over the past ten years, when compared with virtually any measure of increased costs, as shown in the attached chart. What is most remarkable is that the centers have increased the number of patients served by nearly one million over that same period, despite the inadequacy of federal support. Clearly, this cannot be allowed to continue. The simple fact is that, after 25 years of experience, and despite their remarkable record of achievement, the health centers today serve only one of every five Americans who lack access to a regular source of continuous, high-quality primary health care. For 24 of the 30 million medically underserved Americans, the ability to get health care when they need it is still only a dream - and their struggle to obtain any kind of care is a regular nightmare. It is well past time that we, as a nation, made the commitment to assuring available, accessible, affordable health care for every American. Our recommendations, which are made with the full awareness of the severe economic, fiscal, and political constraints you face in crafting the fiscal 1992 appropriations, are nevertheless absolutely essential to put us on the path of realizing that commitment by the end of this decade. Recommendations I. II. Community Health Centers - $620.0 million This amount would continue current funding as well as allow health centers to serve an additional 1.2 million medically underserved individuals in the neediest unserved communities through existing health centers and by establishing another 120 health centers in the neediest communities. In addition, this amount would continue to provide and enhance health care services to high-risk pregnant women and children. Current perinatal care funding for health centers meets less than one-third of the service needs of low income pregnant women. A recent study of the perinatal program indicated that at least $100 million was needed to meet the basic maternity and infant care needs in health center communities last year compared to the $35 million currently available. We wish to note that, in 1989, health centers provided perinatal care to over 200,000 low-income, pregnant women one out of every 15 American women who gave birth that year -- including more than one of every four pregnant teenagers under the age of 15. It goes without saying then, that we care for many of the highest-risk pregnancies in this nation. Migrant Health - $80.0 million This amount would continue current services as well as provide for an additional 300,000 migrant and seasonal farmworkers and their family members still only 20% of the migrant population who need health care. Because they are located in areas with significant shortages of health care providers, health centers depend on the NHSC for manpower. However, as I have already noted, centers face a severe loss of critically-needed physicians. There is currently a vacancy of 930 physicians at health centers of which 600 are NHSC physicians who will complete their scholarship obligation at health centers this year. Approximately onehalf (300) of the NHSC physicians will leave for reasons which health centers can do little about e.g., rural isolation, lack of medical peer interaction, "burn-out" from heavy caseloads. Currently, there are 360 scholars and loan repayment assignees available for all medically underserved areas. Only about 288 of these will be available to health centers. Although scholarships will be awarded this year, these recipients will not be available for service until 1996. In order to provide for the expansion of the Community and Migrant Health Center programs, an additional 500 physicians are needed. This means that health centers face a need to recruit nearly 850 physicians in FY 1992. Furthermore, most rural health centers and those in high priority areas are IV. V. VI. VII. in great need of physicians and may even be forced to close their doors if they are unable to recruit physicians. Field - $65.0 million This amount requested would allow for a field strength of approximately 867 federal hires, in addition to increase the recruitment activities of the NHSC. NHSC Scholarship/Loan Repayment - $101.0 million This amount would provide for approximately 714 agreements in FY 1992, as well as $10 million for nurse practitioners, physician assistants and other non-physician health providers, and $10 million for state loan repayment grants. Health Care for the Homeless - $80 million This amount would provide funding for this program at its fully authorized level for both primary care and substance abuse services, and would provide services to another 240,000 homeless individuals as well as providing for expansion of the program. Black Lung Clinics - $5.0 million This amount would allow services to 50,000 persons in FY 1992. AIDS Treatment - $75 million This amount would support outreach and treatment services to approximately 19,500 persons with AIDS and up to 63,000 HIV-infected persons out of the estimated 247,000 health center patients who are currently infected with the HIV virus. Public Housing Health Services - $35.0 million This amount would provide for the full authorized level for this program. The amount requested would provide health and social services to approximately 200,000 residents of public housing. VIII. Native Hawaiian Health Care - $6.4 million IX. This amount would allow for continuation and expansion of the program in FY 1992, including development of at least two new primary health centers. Minority Health/Translation Services - $25.0 million This amount would ensure the availability of $3 million to assist providers of primary health care and preventive health services for translation services to thousands of nonEnglish speaking patients. Mr. Chairman, and members of the Committee, I deeply appreciate the opportunity to present this information to you today. I will be happy to answer any questions. |