[Congressional Record Volume 153, Number 49 (Wednesday, March 21, 2007)]
[Senate]
[Pages S3512-S3513]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                COMMUNITY HEALTH CENTERS INVESTMENT ACT

  Mr. SANDERS. Mr. President, today in the United States of America 
there are 47 million people who are without health insurance and 35 
million Americans who are completely without access to the most basic 
health care services. As a result, in the richest country in the world, 
18,000 Americans die each year because their basic health care needs 
are not met. Despite the fact that we spend twice as much per person on 
health care than any other industrialized nation, Americans have a 
lower life expectancy and a higher infant mortality rate than Canada, 
Japan, and most of Europe.
  We are also faced with an alarming dental care crisis in this 
country. The Surgeon General has reported that tooth decay has become 
the single most common chronic childhood disease in this country--five 
times more common than asthma and seven times

[[Page S3513]]

more common than hay fever. Surveys have also shown that dental 
problems cause children to miss more than 51 million hours of school 
and adults to miss more than 164 million hours of work each year.
  This health care and dental care crisis bears down particularly hard 
on those who live in rural communities where there are few local health 
care centers and patients must travel many miles to seek the care that 
they need. Those living in inner-city neighborhoods also often have 
difficulty receiving the care they need because they lack health 
insurance and have no means to pay for regular doctors visits. As a 
result, far too many Americans do not have a primary care doctor or 
dentist and do not seek preventative care.
  This means the only time they see a doctor is when their situation 
has become so advanced and so dire that they must seek treatment at a 
hospital emergency room. This is a result that is bad for patients, bad 
for doctors, and bad for American taxpayers.
  Providing underserved patients with better access to primary care 
will allow doctors to catch problems before they become advanced and 
require invasive and expensive procedures. It will also, of course, 
benefit the patient--in many cases saving their lives. Studies have 
shown that patients with a primary care provider are far more likely to 
receive appropriate preventative care, need fewer prescription drugs, 
and spend less time in hospitals and emergency rooms.
  The good news is that we have a program in this country that provides 
primary health care services to those who need it most. Forty years 
ago, Senator Kennedy had the foresight to author legislation creating 
community-based health care centers that treat underserved patients. 
These centers, now called Federally Qualified Health Centers or FQHCs, 
provide high-quality primary health care for millions of Americans, 
regardless of their income.
  In addition to treating those who have Medicare, Medicaid, and 
private insurance, FQHCs primarily serve those who have no health 
insurance and charge fees on a sliding scale basis. That means that 
whether you make $50,000 per year or $15,000 per year, you will be able 
to afford treatment. No one who walks into one of these centers is 
turned away because he or she lacks payment.
  In addition to providing the quality care that patients expect to 
receive when they visit their local doctor's office, these centers also 
make sure that patients are able to afford the drugs they need by 
providing them with significant discounts on their prescriptions. The 
centers also provide critical dental and mental health care--often 
offering the only available services for those in need.
  FQHCs provide primary, dental, and mental health care that is not 
only high quality but also tailored to meet the needs of the local 
community. In order to create an FQHC, Federal law requires not only 
that there be substantial community input in the development of the 
center, but also that a majority of the members on the governing board 
of directors are actual users of the facility.
  In other words, those who know the most about the needs of their 
local community are responsible for overseeing the centers. It is a 
model that has been highly successful throughout the country, including 
my own State of Vermont, which has five of these health center 
organizations serving more than 10 percent of Vermont's population at 
18 different locations.
  These community health care centers serve as the family doctor for 16 
million Americans in more than 5,000 communities across the country. 
Their success has been well documented with studies repeatedly showing 
that these centers are a highly cost-effective method for ensuring that 
underserved patients receive quality health care. In fact the Office of 
Management and Budget has reported that FQHCs use Federal taxpayer 
dollars more efficiently than any other federally funded health care 
program. In addition, studies have found that FQHCs save the Medicaid 
Program 30 percent or more in annual spending by providing preventative 
treatment that reduces the need for specialty care referrals and 
hospital admissions.
  There are not many issues on which President Bush and I agree, but 
the importance of community health care centers is one area where we 
have found some common ground. The success of this program has earned 
support and praise from the White House, as well as members of this 
body on both sides of the aisle. With congressional support, over the 
past 5 years, nearly 900 underserved communities were able to establish 
or expand a health center, bringing the number of Americans served by 
these centers to more than 5 million patients.
  Unfortunately, during that same period more than 800 centers were 
denied FQHC status, and the Federal funds that go with it, not because 
they were not qualified but simply because there was not sufficient 
funding to incorporate them. That is 800 communities throughout this 
country that are left desperately in need of the quality, low-cost 
preventative care that these centers provide.
  Existing centers throughout this country are also in jeopardy. Over 
the past 2 years, Federal grant support for these centers has been 
reduced, threatening their ability to serve all of those in need.
  It is for that reason that I introduced a bill yesterday, along with 
Senator Lisa Murkowski of Alaska, to increase Federal support for 
community health centers over the next 8 years and ensure that millions 
of Americans living in medically underserved areas receive the care 
they need. This legislation would start by authorizing a funding level 
commensurate with our current need--an increase of $575 million for the 
upcoming year and increases between $400 and $600 million for the 
following 7 years. That will provide enough resources to fund not only 
the backlog of the 800 approved but unfunded health centers, but also 
future applicants who meet the criteria for FQHC status. It would also 
make sure that existing centers are able to grow with the communities 
that they serve by giving them annual funding increases that are 
commensurate with the number of patients they serve and the increased 
costs they incur.
  This legislation would also correct the unfair and outdated system 
these centers are forced to contend with for Medicare reimbursements. 
While health centers provide care to more than 1 million medically 
underserved Medicare beneficiaries, their Medicare payments are subject 
to an arbitrary payment cap that was established in 1991 and adjusted 
only marginally since. The result is more than $50 million in lost 
Medicare reimbursement funds that health centers now are forced to find 
a way to subsidize. This legislation would eliminate the inaccurate 
payment cap and ensure that these centers are reimbursed fairly for the 
care they provide to seniors and disabled patients.
  Finally, this important legislation would also ensure that our 
Nation's community health centers have the workforce they need by 
expanding the National Health Service Corps. Currently, health centers 
rely on the National Health Service Corps for more than 20 percent of 
their physician workforce. Unfortunately, last year, health centers 
experienced a 15 percent physician vacancy rate and a 19 percent 
dentist vacancy rate nationally. This legislation would more than 
double funding for the National Health Service Corps over the next 8 
years in order to train and send more primary care doctors and dentists 
into rural and inner-city communities.
  In the richest country in the world, no American should have to go 
without basic primary health care. Federally Qualified Health Centers 
serve as a lifeline for millions of low-income Americans, and we should 
build on their success by expanding this program for all those in need.

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