[Congressional Record Volume 140, Number 71 (Thursday, June 9, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
        INTRODUCTION OF THE ACCESS TO COMMUNITY HEALTH CARE ACT

                                 ______


                         HON. CHARLES B. RANGEL

                              of new york

                    in the house of representatives

                         Thursday, June 9, 1994

  Mr. RANGEL. Mr. Speaker, I rise today to introduce the Access to 
Community Health Care Act, a vital component of any health care reform 
legislation the Congress enacts.
  For health care reform to succeed--particularly the goal of cost 
containment--it must provide universal access to primary and preventive 
health care services as well as universal coverage. As we know all too 
well from our experience over the years with Medicaid, the possession 
of an insurance card will not necessarily guarantee Americans access to 
health care. Nowhere is this more true than in our innercity and rural 
medically underserved communities.
  Underserved communities desperately need health reform to improve 
access to care. They must have facilities that offer high-quality care 
regardless of a person's health or social status or his or her ability 
to pay for services; and that are accessible, in terms of location or 
hours of service, for those who do not have private transportation or 
cannot take time off from the workday. They must have adequate numbers 
of highly trained, culturally competent health professionals to staff 
these facilities. They must have the assurance that the facilities will 
not be driven out of business because of excessive financial risk or 
inadequate reimbursement, simply because they care for those who are 
sickest and hardest to reach.
  Many of the proposals introduced in Congress, including the 
President's, make geat strides toward reforming and improving the 
health care delivery system in the areas that need it the most. But 
none go nearly far enough in meeting the needs of the communities many 
of us represent, be they innercity or rural. For these communities, 
universal coverage is desperately needed, but it is not enough. They 
need improved access to care, as well.
  I strongly believe that health reform should build on what works. 
Among the programs that have worked best for the underserved are the 
community, migrant and homeless health center programs. Over the past 
30 years, health centers have established an unparalleled, uniquely 
successful record of providing quality, cost-effective primary and 
preventive care to the hardest-to-reach populations across our Nation, 
recruiting and retaining health professionals where they are most 
needed, and empowering communities to develop long-range solutions to 
their health needs. Health reform should invest in such successes, by 
preserving and building upon these programs in preparation for the 
implementation of reform, so that universal coverage will truly 
guarantee access to quality care for eveyone.
  Mr. Speaker, there are 43 million medically underserved people in 
this country, people who do not have adequate access to health care 
services and have poor health status. It is critical that health reform 
include special measures to meet their needs if our goal of cost 
containment is to be realized. The underserved are exactly the ones who 
end up on emergency room doorsteps. Studies have shown that up to 80 
percent of emergency room visits in underserved areas are for nonurgent 
care. If the underserved do not have their preventive and primary 
health care needs met in health reform, our goal of cost containment 
will be unattainable. Health centers have shown that we can give top-
quality care and constrain costs for our communities:
  Inpatient hospital admission rates for health center patients have 
been up to 67 percent lower than for those served by other providers, 
including hospital outpatient departments or private physicians.
  The length of stay for hospital patients served by health centers has 
been found to be only one-third as long as that for patients who are 
seen by outpatient departments and half as long as that of patients 
served by private physicians.
  Studies have shown that regular use of a health center has produced a 
33-percent savings to Medicaid, on both a per case and per person year 
basis, this is for total costs for all services.
  And health centers are the only Federal Government program that 
empowers the communities they serve to take charge, to craft long-range 
solutions to their health problems. By law, health centers must be 
governed by a board of directors, a majority of whom must be patients 
of the facility. Only through the health center programs are consumers 
in the driver's seat of their primary care delivery site, and only 
through health centers are underserved communities assured that their 
primary care provider will respond to their specific needs.
  It is for these reasons that health centers alone have attracted such 
broad bipartisan support. Every major health reform proposal--from the 
single-payer bill to the legislation introduced by our colleague, the 
distinguished minority leader--includes funding and other provisions 
for community health centers. That means that over 200 Members of this 
body--from both sides of the aisle, innercity and rural--have stated 
that they think health centers are the best hope for addressing the 
needs of underserved populations. When it comes to access to care, 
health centers are something we can all support.

  The Access to Community Health Care Act would amend the Public Health 
Service Act and the Social Security Act in three specific ways:
  First, it calls for a significant expansion of the Community Health 
Center Program, including flexible authority to make grants to other 
community-based providers and to establish Health Empowerment Systems, 
community-owned and operated networks and plans consisting of essential 
community providers. It gives preference to community-directed 
organizations, which have typically had insufficient capital to 
effectively participate in organized health care systems. It would also 
guarantee funding equal to the President's proposed levels for these 
new activities. This is a critical feature of this legislation: only 
H.R. 1200 makes health center funding mandatory, recognizing that caps 
on discretionary spending will make spending on this essential program 
increasingly prohibitive. We will never be able to control health care 
costs unless we make the appropriate, assured investment up front in 
health reform to provide access to primary care in medically 
underserved areas. This feature is lifted from the single-payer bill, 
and I ask my colleagues on both sides of the aisle who have strongly 
supported this program over the past 30 years to join me in calling for 
guaranteed funding for it.
  Second, it calls for strengthening the current Medicaid safeguards by 
ensuring inclusion of, and a reasonable payment rate to, health centers 
under section 1115 or 1915 Medicaid waivers, modeled after methods 
already used by several states, such as Maryland, Wisconsin, and 
Minnesota, to make sure these providers are not put at undue risk. This 
will preserve the existing safety net primary care infrastructure in 
underserved areas and assure their full participation in the new health 
system.
  Third, it facilitates the inclusion of health centers in health 
professions education and training by providing direct payment to cover 
the cost of their training efforts. Current Medicare GME law only 
assures funds to those entities that operate accredited training 
programs--in effect, locking in the available funding to existing 
medical schools and teaching hospitals only. This will ensure that 
primary health care professionals are trained and practice in 
underserved areas, where they are most needed.
  This is a critical juncture for the medically underserved inner city 
and rural communities of our Nation. The economics of underserved 
communities have supported solo health practitioners. We need those who 
have been there to serve those in need to be able to serve. The history 
of the health center programs is that to get health care to the people 
who cannot afford it, the Federal Government must provide a critical 
share. It comes in the form of health center operating grants. The best 
action we can take for those health professionals who want to give 
something back to their communities is to ensure a broad base of 
federally-assisted, community-based providers in underserved areas. 
This will give these professionals a place to train and practice, with 
a quality-care environment and all the supports they will need.
  Mr. Speaker, the William Ryan Community Health Center in my district 
in Manhattan is a jewel of our community that could--and should--be 
replicated in underserved areas across the country. It's cost-
effective, responsive to the community's needs, and the patients love 
it. Whatever shape health reform takes, whether it's managed 
competition, market reforms, or single-payer, the Access to Community 
Health Care Act can be incorporated into it, and can play a crucial 
role in extending access to care for the underserved and furthering our 
collective goal of restraining health care costs. I urge my colleagues 
on both sides of the aisle to join in support of this legislation. It 
may be the best investment health reform makes.

                          ____________________