[Congressional Record Volume 165, Number 63 (Thursday, April 11, 2019)]
[Senate]
[Pages S2429-S2430]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ACCESS TO CARE: HEALTH CENTERS AND PROVIDERS IN UNDERSERVED COMMUNITIES
Mr. ALEXANDER. Mr. President, I ask unanimous consent that a copy of
my opening statement at the Senate Health, Education, Labor, and
Pensions Committee be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Access to Care: Health Centers and Providers in Underserved Communities
Mr. ALEXANDER. This is the first hearing of the new
Congress so let me take a few minutes to talk about what we
hope to accomplishment these next two years.
Number one, reducing health care costs. And number two,
making sure a college degree is worth students' time and
money.
On health care costs, this Committee has held five hearings
on reducing the cost of health care. Testimony from Dr. Brent
James, a member of the National Academy of Medicine, said
that up to half of health care spending is unnecessary.
That startled me and it should startle the American people.
That is a massive burden on American families, businesses,
and state and federal budgets.
I sent a letter to health experts, including the witnesses
at our five hearings, asking for specific recommendations to
reduce health care costs. I'd like to encourage anyone with a
specific recommendation to submit your comment by March 1 to
[email protected].
A second priority is updating the Higher Education Act to
ensure that the expense of a college education is worth it
for students. The last time we seriously addressed higher
education was in 2007. A lot has happened since then.
In 2007, there was no iPhone. A micro-blogging company
named Twitter had just gained its own separate platform and
started to scale globally. And Amazon released something
called Kindle. In a new book, New York Times columnist Tom
Friedman puts his finger on the year 2007 as ``the
technological inflection point.'' So we need to take a look
at this federal support for higher education that affects 20
million students and 6000 universities, colleges, and
technical institutions. And our goal includes simplifying the
federal aid application; a fairer way for students to repay
their loans; and a new system of accountability for colleges.
I will be working on these priorities with Ranking Member
Patty Murray, with members of the HELP Committee, and other
Senators interested reaching a result on lowering health care
costs and updating the Higher Education Act.
We hope to complete our work on both of these things in the
first six months of this year.
And in addition, in these next few months, we need to
reauthorize the Older Americans Act, which supports the
organization and delivery of social and nutrition services to
older adults and their caregivers and reauthorize the Child
Abuse Prevention and Treatment Act, important legislation
that funds major grant programs that provide a social
services response to issues of child abuse and neglect.
And today's topic--extending federal funding for community
health centers, as well as four other federal health
programs, which are all set to expire at the end of this
fiscal year.
Community health centers actually fit into a larger topic
of great interest to this Committee, which is primary care.
There are more than 300,000 primary care doctors in the
United States, according to the American Medical Association.
This is the doctor that most of us go to see for day-to-day
medical care--an annual physical, flu vaccine, or help
managing a chronic condition like diabetes. It is our access
point to additional medical care, and can refer us to
specialists, if, for example, we need to get our hip replaced
or a MRI.
Adam Boehler, who leads the Center for Medicare and
Medicaid Innovation, estimated that primary care is only 2-7
percent of health care spending but could help to impact as
much as half of all health care spending.
We will be having a hearing next week on how primary care
can help control health care costs. Today, we are talking
about a prime example of primary care: 27 million Americans
receive their primary care and other services at community
health centers.
For example, in Tennessee, after Lewis County's only
hospital closed, the closest emergency room for its 12,000
residents was 30 minutes away. The old hospital building was
turned into the Lewis Health Center, a community health
center which operates as something between a clinic and full
hospital.
Lewis Health Center estimates they can deal with about 90
percent of patients that walk in the door. The center has a
full laboratory to run tests, can perform X-rays or give IVs,
and keeps an ambulance ready to take patients to a partnering
hospital if they need more care. Because the Lewis Health
Center is a community health center, they charge patients
based on a sliding scale which means more people have access
to and can afford health care.
Community health centers like Lewis Health Center are one
way American families can have access to affordable health
care close to home. This includes a wide range of health
care, including preventive care, help managing chronic
conditions like asthma or high blood pressure, vaccines, and
prenatal care. There are about 1,400 federally-funded health
centers that provide outpatient care to approximately 27
million people, including 400,000 Tennesseans, at about
12,000 sites across the United States. These other locations
could be a mobile clinic or at a homeless shelter or school.
Community health centers have also been an important part
of combating the opioid crisis that has impacted virtually
every community across the country.
Last year, the Department of Health and Human Services
provided over $350 million in funding specifically to support
community health centers providing care for Americans in need
of substance use disorder or mental health services.
And in 2017, 65,000 Americans received medication-assisted
treatment for substance use disorders at a community health
center. These centers accept private insurance, Medicare and
Medicaid, and charge patients based on a sliding fee scale so
that those who are in need of care receive it, regardless of
ability to pay.
Community health centers also receive federal funding to
help cover their costs. In Fiscal Year 2019, these centers
received $4 billion in mandatory funding and $1.6 billion in
discretionary funding. Congress has to act by the end of
September to make sure community health centers continue to
receive this federal funding and keep their doors open.
[[Page S2430]]
Two weeks ago, Senator Murray and I took the first step by
introducing legislation that will extend funding for
community health centers for five years at $4 billion a year
in mandatory funding.
The legislation also extends funding for four additional
federal health programs set to expire in September: the
Teaching Health Center Graduate Medical Education Program;
National Health Service Corps; Special Diabetes Program; and
Special Diabetes Program for Indians.
Today we will hear about how the community health centers
program is working and how to ensure 27 million Americans can
continue to have access to quality health care closer to
their homes and at a more affordable cost.
Community health centers, and hospitals across the country,
rely on a well-trained health care workforce.
Two federally funded workforce programs, which train
doctors and nurses, expire this year.
The first is the Teaching Health Center Graduate Medical
Education Program that helps train primary care doctors and
dentists in community-based settings, often at community
health centers.
And second, the National Health Service Corps, which
provides scholarships and loan repayment for health care
professionals who go to work in rural or underserved areas.
More than half of these doctors choose to work at one of
the 12,000 community health centers and affiliated sites
across the country as part of their service requirement.
I look forward to hearing from the witnesses today and
learning more about all three of these programs, and
discussing how we can work together to ensure funding for
these programs is extended so Americans can continue to have
access to affordable health care closer to home.
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