Health Centers Renewal Act of 2006

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise in support of the bill before us today, which will reauthorize the community health center program through 2011. Over the years, the health center program has gained tremendous support from Democrats and Republicans, the Congress, and the President, a claim that can be made by very few Federal programs.

This support is due to the overwhelming impact that health centers have made on the health and well-being of our country's most vulnerable populations. In 2005, health centers provided care to 6 million uninsured individuals who represented 40 percent of the patient population at health centers. Ninety-one percent of health center patients are low income, and 36 percent are Medicaid.

Without a doubt, health centers are meeting their mission for providing much-needed health care to the medically underserved in this country. Much of this success can be attributed to the core elements of section 330 of the statute we seek to reauthorize today. To be eligible for Federal funding, health centers must be located in medically underserved communities; they must have independent boards, a majority of which must be governed by members of the community who utilize the center for health care; and they must also provide compulsory, primary, and preventive health care with services available to all community residents regardless of the patient's ability to pay.

This focus on primary and preventive care has yielded tremendous savings for our health care system, as health centers provide the uninsured and underinsured with access to care that they would otherwise seek in our hospital emergency rooms.

A study in Harris County, Houston, Texas, where my district lies, found that 57 percent of the emergency room visits could be handled at a primary care clinic. This is a perfect example of the type of health care problem that health centers help solve.

Access to affordable primary care at health centers has also reduced the need for inpatient and specialty care. Because of medical problems in health centers, patients are treated earlier before they require in- hospital treatment. In fact, a study suggests that health centers saved Medicaid approximately 30 percent in annual spending on beneficiaries receiving care at our Nation's health centers.

This successful result is that health centers have become the medical home for more than 15 million Americans. Health centers also represent the Nation's largest primary care system, with one in nine Medicaid beneficiaries and one in five low-income individuals receiving care at health centers.

I have a personal interest in this issue because we have been working for years in the Houston area to establish additional community health centers to serve our growing uninsured and underinsured population. My State of Texas, unfortunately, ranks number one in the number of uninsured and with 25 percent of Texans living without insurance.

The statistics for the Houston area are just as troubling. More than 30 percent of Harris County residents are living without health insurance. Despite the obvious need for additional health centers in the Houston area, we have been playing catch-up for quite a while. Last year our area was awarded five additional FQHCs, federally qualified health centers, bringing our total to nine sites, including look-alike centers.

With more than 1 million uninsured, however, the Houston area will still have fewer than 10 FQHCs, while other large cities, like Chicago, have more than 70 sites. In the Houston area we know our work is not done. As a Nation we have a long way to go before we meet the President's goal of locating health centers in every low-income county in this country.

In fact, studies suggest there are still more than 900 poor counties in the U.S. in need of a health center. To ensure that these goals are met, it is crucial that we pass this bill to reauthorize the health center program, whose current authorization expires this year.

Mr. Deal, Mr. Bilirakis and I have put together a compromise bill that will reauthorize the program to 2011, keeping intact the core elements of the program that have been critical to its success, and I want to thank all my colleagues on the Energy and Commerce Committee who supported this bill.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to our colleague on the Committee on Energy and Commerce, Congressman Engel of New York.

Mr. Speaker, I yield 3 minutes to the gentlewoman from California (Mrs. Capps), an active member of the committee.

Mr. Speaker, I yield 3 minutes to the gentlewoman from California (Ms. Solis), our colleague on the Energy and Commerce Committee.

Mr. Speaker, I yield 3 minutes to the gentleman from Illinois (Mr. Davis).

Mr. Speaker, I yield 3 minutes to another member of the Energy and Commerce Committee, a good member, Congresswoman Schakowsky.

Mr. Speaker, I yield 1 minute to my colleague and our ranking member on the health subcommittee, Congressman Brown.

Mr. Speaker, I yield myself the balance of the time.

Mr. Speaker, I would like to close by thanking both our chairman and ranking member of the Energy and Commerce Committee, Mr. Barton and Mr. Dingell, as well as the chair and ranking member of our health subcommittee, Chairman Deal and Ranking Member Mr. Brown, who we just heard from, the committee staff and their hard work on the bill.

There are many of us on the committee with strongly held views about health centers. Some want higher authorization levels, while others sought certain changes in the statute. In the end we came together in a bipartisan fashion to ensure that our differences didn't overshadow our shared support for this important program. And that it has made a tremendous difference in many lives of our constituents.

The bill before us today is truly an example of compromise within our committee, and I would like to thank my colleagues for putting together the good of the health center program above all else when it comes to this bill.

Mr. Speaker, I yield back my time.

Mr. Speaker, I thank Chairman Deal, and I do rise in support of this bill which I have cosponsored with Chairman Deal and with our colleague from Texas (Mr. Gene Green).

I have long championed community health centers, Mr. Speaker, because they have been a model for delivering primary and preventive care efficiently and effectively for more than four decades. They serve more than 16 million Americans, many of whom are underinsured or uninsured, in areas where people need most services. They make their services available to all residents of the communities in which they are located without regard to their ability to pay.

One of the reasons community health centers have successfully provided care to so many through the years is that the individual centers are governed by a community board, a majority of whose members are patients of the health center itself. I think this feature makes health centers more responsive to the needs of the communities they serve than they otherwise might be.

Health centers have proven that health care need not be complicated or expensive to work well. The health centers program started more than 40 years ago with the idea that patients should run the show, a remarkably simple formula for success. This patient democracy, if you will, shapes the delivery of health care to the community and determines the range of affordable services the health center will provide.

And those services are certainly needed. Despite our best efforts, there are still far too many Americans who lack health insurance and for whom community health centers are their only source of care. These vulnerable individuals need the Community Health Centers program to remain strong and vibrant as they work toward greater health security for themselves and their families.

The authorization for this valuable program expires this year; however, I have introduced legislation with our colleague from Texas (Mr. Gene Green) to reauthorize the Federal health center program through 2011. Our bill would authorize $1.93 billion in funding in fiscal year 2007, thereby increasing funding next year to the level the President has requested, or approximately $181 million more than last year.

Although we introduced the bill only a few weeks ago, I am pleased that it already has 233 bipartisan cosponsors, more than half the House, including almost every member of the Energy and Commerce Committee. I believe these numbers are a testament to the broad and bipartisan support for reauthorizing the Federal health center program this year while preserving the key elements of its authorizing statute.

The bill we are considering today is identical to the Bilirakis-Green bill, except it includes specific authorization levels for fiscal years 2008 through 2011, which would bring health center funding to $2.04 billion by fiscal year 2011 and allow for the continued expansion of health centers in needed areas around the country.

I certainly want to thank our full committee chairman, Mr. Barton, and our subcommittee chairman, Mr. Deal, for acting expeditiously on reauthorizing this important program.

Although I am pleased the bill before us today maintains the fundamental structure of the Federal health center program, I do support making what I believe are commonsense legislative changes to enhance the ability of community health centers to provide care to those who need it, and, hopefully in the coming weeks, to examining the merits of several of the proposals which my committee colleagues have put forth that I believe would do just that.

I am especially supportive of H.R. 1313, legislation our colleague from Pennsylvania (Mr. Murphy) has introduced, which would extend liability protection to volunteer physicians at community health centers. I believe that this change, which the National Association of Community Health Centers fully supports, will encourage doctors and other medical professionals to volunteer their time and talent at health centers in underserved areas which are facing workforce shortages.

I believe that it is imperative we move forward on Mr. Murphy's legislation as soon as possible. There currently, as we know, is a serious shortage of health care providers in areas where community health centers are located. In addition, there will be an increasing demand for physicians to serve the millions of new patients that will be seeking care as centers come on line as part of President Bush's initiative to put new community health centers in medically underserved areas around the country.

As many of us know, the high cost of medical liability insurance can be prohibitive, especially for physicians who are going above and beyond, so to speak, by volunteering at community health centers. The bill that Mr. Murphy has introduced, which I have cosponsored, would do that by extending the medical liability protections under the Federal Tort Claims Act to volunteer physicians at community health centers.

I believe this commonsense proposal would encourage more qualified health care providers to volunteer their much-needed services at health centers that desperately need their expertise. Although I would have preferred, Mr. Speaker, to also be considering this legislation here today, I am nonetheless, of course, fully supportive of the bill and urge its passage.

Mr. Speaker, community health centers have deservedly earned bipartisan support in Congress because of their long and well- documented record of success. This bill will help them continue their mission well into the future, especially in the most needed areas around the country. I urge all our colleagues to both support and invest in proven health care solutions by voting for H.R. 5573. The health and well-being of our constituents depends on it.

Mr. Speaker, I thank the distinguished gentleman and chairman, Mr. Deal. I am pleased to be a cosponsor of this legislation and to have worked closely with him on this vitally important bill that saves money and lives, and I am pleased to represent Cornerstone Community Center, one of the centers in my district.

Mr. Speaker, H.R. 5573 is a great step toward meeting our Nation's health care needs. Community health centers are a critically important solution to providing affordable and accessible quality care to millions of Americans who are uninsured or underinsured.

Medical care at community health centers is approximately $250 less than the average annual expenditure for office-based doctor visits. And keep in mind that over 30 percent of patients seeking care at a health center are uninsured. That is some 15 million people a year that seek care.

Moreover, health center services save money and lives by treating diseases before they become chronic conditions, require hospital care or require a trip to the emergency room.

I have with me here a list of the typical procedures that are offered at community health centers: Prenatal care, dental care, mental health care, substance abuse counseling, hearing and vision screening. They also offer discount prescription drugs. They provide vital case management for those with chronic illness, and keep in mind that 80 percent of health care costs go to those with chronic illness. Oftentimes, those complex cases require that sort of case management to help them meet the needs of their cases. They provide smoking cessation classes, blood pressure monitoring, weight reduction programs, and a host of other programs so vital to saving money in health care.

It also provides a health care home for many folks, many clinics giving patients a card so they recognize this is a place where they know their doctor and their doctor knows them.

By expanding community health centers, Americans could save as much as 30 percent for Medicaid patients, or $17 billion annually, due to reduced specialty care referrals and fewer hospital admissions.

However, our Nation's community health centers are experiencing a staffing crisis. A March 2006 publication in the Journal of the American Medical Association reported that community health centers have a 13 percent vacancy rate for family physicians, a 9 percent vacancy rate for interns, 20 percent vacancy for OB-GYNs, and an 8 percent vacancy rate for podiatrists, 22 percent for psychiatrists, and 18 percent for dentists. In other words, although we are trying to meet the needs of the 15 million who use the community health centers, the problem is growing in that not enough doctors are available to provide that care.

Vacancies of needed medical personnel at community health centers jeopardizes access to care to the Nation's uninsured and underinsured. Plus, the President has called for more centers around the Nation to fill our needs, and 11,000 more doctors are needed to fill those needs.

I have a letter from the National Association of Community Health Centers that says there is a dire shortage of health care providers in underserved communities where health centers are located. Congress and the President have worked to double the capacity of the Federal health centers programs, but in order to ensure that millions of additional patients can be served through this initiative, health centers must also double their workforce by adding 12,000 clinicians and 48,000 administrative staff soon.

Many skilled health care providers are willing to volunteer their time and

expertise. Volunteer doctors acting as Good Samaritans have proved invaluable to clinics across the Nation. However, many skilled medical volunteers are turned away because community health centers cannot afford to cover their additional medical liability insurance.

Over the past year, I have been pleased to work with Chairman Deal, Mr. Bilirakis, and also Chairman Barton to make volunteering at community health centers more practical to doctors in order to meet the needs of families. Community health centers play a key role in any reform-minded approach to improving our health care delivery system.

Mr. Speaker, there is a desperate need for doctors and medical personnel of all sorts at community health centers, and I pledge I will continue to work with Chairman Barton and Chairman Deal and other members of the Energy and Commerce Committee and every Member of this body to explore every solution possible to meet our Nation's community health center staffing crisis.

We owe this to the patients, to the taxpayers of America who recognize this is a cost-saving, viable measure where we can provide care to millions of Americans who otherwise do not have it. This is the way we should be doing this, through community health centers, centers where the doctors know the patients and the patients know the doctors.

Please let us continue to work together to make this care affordable and accessible for patients all around the Nation so they do not have to see dire consequences that come when their conditions get worse because they couldn't receive the care they needed.

I thank the chairman for yielding me this time and for our collaboration together.

I thank the gentleman from Texas for yielding to me, and I rise in strong support of the Health Centers Renewal Act of 2006.

Community health centers ensure that over 15 million low-income Americans, including 1 million New Yorkers, get access to affordable primary care and preventive services regardless of insurance status or ability to pay. In my own district, I am very proud of the good work that the Mount Vernon Neighborhood Health Center, Refuah Health Center, the Community Medical and Dental Care Center in Monsey, and the Bronx Community Health Network do. I am proud of them.

Patients who use community health centers are some of our Nation's most vulnerable, with unique and complex health care needs. It has been estimated that nearly 70 percent of community health center patients have family incomes at or below the Federal poverty level. These patients, therefore, benefit from the special services that community health centers provide, such as transportation and translation assistance, which truly opens access to health care.

Community health centers improve health outcomes through their cost- effective, high-quality care. It is estimated that the health centers save the Federal Medicaid 30 percent in annual spending through innovative care. Both the Institute of Medicine and General Accountability Office have praised health centers for their effective management of chronic illnesses and have said they are a model in screening and diagnosing conditions like asthma, cardiovascular disease, depression, cancer, and HIV/AIDS. In addition, community health centers are estimated to be responsible for cutting infant mortality rates in the communities they serve by as much as 10 percent.

Considering these facts, we should support the community health centers with additional funding. Less than 25 percent of applications for new health center sites were funded last year, despite being qualified. It is also worth noting that when we do consider health information technology on the floor, we must ensure appropriate Federal investment in grants and loans to ensure community health centers get access to the technology.

While the unanimously passed Senate bill included Federal funding for low-income providers, the Energy and Commerce bill, unfortunately, did not. Health IT has the potential to even further improve the quality of care at the community health centers, but the centers simply cannot afford the technology without extra help.

I should note that New York City appropriated $27 million to help provide

1,000 New York City doctors treating underserved patients with electronic health record systems by 2008. The city's contribution is being matched by an additional $13 million contributed by the community health centers participating in the program. The end result is that 30 community health centers, which include 150 sites, will be linked throughout New York City. This worthy initiative would certainly benefit from Federal assistance as well.

Mr. Chairman, thank you again for calling for the reauthorization of the health centers program. Millions of people will be better for it.

Mr. Speaker, I rise today in strong support of H.R. 5573, the Health Centers Renewal Act of 2006. Community Health Centers are important resources for our country's healthcare system and vital sources of healthcare for many Americans. Their work, the services and care they provide, and the impacts on the lives of the over fifteen million Americans they serve are commendable. Community Health Centers are important to providing quality healthcare and services to our country's underinsured, uninsured, and underserved communities.

The Northern and Southern Community Health Centers on Guam are two of the more than one thousand such health centers that serve Americans across the country. The Northern and Southern Community Health Centers on Guam are valued and trusted healthcare delivery sites for residents of Guam.

That these community health centers are flexible in their response to the particular needs of the communities they serve is of particular value. This flexibility and ability to adapt to local needs helps ensure that local communities continue to benefit from the high- quality, focused care provided by Community Health Centers such as the Northern and Southern Community Health Centers on Guam. Key among these flexible and locally tailored services is the aggressive outreach, education, and preventative medicine programs these Community Health Centers offer.

But flexible care and services tailored to local needs alone will not ensure that Community Health Centers continue to offer and provide local communities with high-quality, cost-effective healthcare. Community Health Centers, like the Northern and Southern Community Health Centers on Guam, are small and lack significant organic capabilities to earn capital. Continued access to capital to grow these centers and improve their services is vital to their continued success. I strongly support programs that provide Community Health Centers across America access to additional capital resources.

It is only as a result of the efforts of the many professionals within the greater Community Health Center community that its innovative healthcare programs and services can be provided and adequate financial resources can be best utilized for the benefit of the Center and the community it serves. The Northern and Southern Community Health Centers on Guam are staffed by dedicated professional healthcare providers and support personnel who are committed to delivering the best care possible to their patients. Their efforts to provide high-quality care to residents on Guam are representative of their commitment to our island's unique community. The compassion and level of service they display in carrying out their duties is representative of the highest qualities of professionalism demanded by the medical profession. Lastly, the level of respect they have earned among the medical community on Guam and from the patients they serve on-island is notable.

I support H.R. 5573 and the additional authorization of appropriations for the health centers program established under the Public Health Service Act.