[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.

                          ____________________