Elizabeth M. Duke Ph.d
Health Resources and Services Administration
U.S. Department of Health and Human Services
Fiscal Year 2008 President’s Budget Request
Committee on Appropriations
Subcommittee on Labor, Health and Human Services, Education and Related Agencies
U.S. House of Representatives
Wednesday February 28, 2007
Mr. Chairman and members of the Committee, thank you for the opportunity to meet with you today on behalf of the Health Resources and Services Administration (HRSA) to discuss the Fiscal Year (FY) 2008 Budget request to Congress.
HRSA is the primary agency for improving access to health care services for people who are uninsured, isolated, poor, or medically vulnerable. HRSA’s programs reach into every corner of America, providing the foundation for a safety net of health care services relied on by millions of our fellow citizens. The agency works to expand access to top-quality primary and preventive health care for low-income and uninsured people, mothers and their children, people with HIV/AIDS, and residents of rural areas. HRSA programs also seek to improve the diversity of the U.S. health care workforce and encourage placement of health professionals in communities where health care is scarce. In addition, the agency oversees a National organ and tissue transplantation system.
HRSA’s FY 2008 Budget focuses on key agency priorities, supporting programs that have shown success in providing direct care and reducing or eliminating funding for programs that have failed to demonstrate results or are similar to other activities.
For more than 40 years, the Health Center program has helped build cost-effective, high-quality primary care delivery systems serving low-income residents in inner cities and in rural and isolated areas. The Budget continues to target investments to improve the health of underserved and vulnerable populations. Through Health Centers, affordable primary and preventative care will be made available to individuals with low incomes or without health insurance.
The President’s Health Center Initiative, which began in FY 2002, will significantly impact over 1,200 communities through the support of new or expanded access points. The Health Center Initiative complements the President’s efforts to increase health insurance coverage and to help all Americans gain access to affordable, high-quality health care.
The Health Center program focuses on three key elements: 1) Strengthening existing Health Centers; 2) Managing the growth of new Health Centers; and 3) Improving the quality of health care at Health Centers. Through FY 2006, this strategy has resulted in the creation of 514 new access points, the provision of 385 grants to significantly expand the medical capacity of existing service delivery sites, and the award of more than 340 grants to existing grantee organizations to add or expand oral health, mental health and substance abuse services.
We plan to build on the success of the Health Center Initiative, by establishing up to 120 new access points in high poverty counties that currently lack one. Health care organizations in targeted counties will also be eligible for planning grants to aid the development of viable proposals to establish new health center sites that meet Federal requirements for governance, community involvement, quality of care and financial feasibility.
In FY 2008, Health Centers will serve over 16.3 million patients. Of the population served by Health Centers, over 91 percent are at or below 200 percent of the Federal poverty level, 64 percent are from racial/ethnic minority groups, and 40 percent are uninsured. In addition to medical services, 85 percent of Health Centers provide pharmacy services on site or by paid referral, 84 percent provide preventive dental care, and 77 percent provide mental health and substance abuse services.
The FY 2008 Budget invests in programs with a demonstrated impact on placing health professionals in underserved areas. Since 1972, when the first 20 clinicians were assigned to serve underserved communities, the National Health Services Corps (NHSC) has made nearly 27,000 health professionals available to serve in underserved areas across the country. In addition, the NHSC works with the Health Center program to help meet its provider needs.
Currently, approximately 54 percent of the NHSC’s doctors, dentists, nurses and mental and behavioral and other health care professionals serve in Health Centers around the Nation. The NHSC also places clinicians in other community-based systems of care that target Health Professional Shortage Areas of greatest need.
The FY 2008 Budget requests $116 million for the NHSC program, reflecting a Federal administrative cost savings of $9.6 million below the FY 2007 Appropriation. Funding for the NHSC Scholarship and Loan Repayment is held steady. The request will enable the NHSC to support a field strength of approximately 3,400 clinicians in 2008.
The Nursing Education Loan Repayment (NELRP) and Nurse Scholarship Programs (NELRP) provide an economic incentive to registered nurses (RNs) to start or continue to practice at health care facilities with a critical shortage of nurses. NELRP repays 60 percent of the principal and interest on nursing education loans of RNs with the greatest financial need in exchange for two years of full-time service at a health care facility with a critical shortage of nurses. Participants may be eligible to receive an additional 25 percent of the original loan balance for an additional year of full-time service in a critical shortage facility. These programs reduce the financial barrier to nursing education for all levels of professional nursing students, and thus will increase the number of nurses working in the future.
The FY 2008 Budget requests $44 million for these programs, reflecting an increase of $13 million above the FY 2007 level. This request will support 1,016 loan repayment contract awards for RNs who agree to work in designated public or nonprofit health facilities, and provide 275 scholarships for people who need for financial aid to obtain a nursing education. Scholarships provide funds for tuition, school fees and student stipends.
The budget also consists of $37 million for basic nursing education, $26 million for physician and nursing diversity programs, and over $8 million in loans for nurse faculty and support for comprehensive geriatric education. These programs will support the recruitment, education, and retention of an estimated 17,600 nurses and nursing students, and recruitment activities targeting approximately 14,000 elementary and high school students.
In December of 2006, the Ryan White HIV/AIDS Treatment Modernization Act of 2006 was signed into law by President Bush. This reauthorization of the Ryan White CARE Act targets money to core life-saving and life-extending medical services, increases accountability through more aggressive oversight, provides more flexibility to direct funding to areas of greatest need, standardizes minimum requirements for the AIDS Drug Assistance Program, and codifies the Minority AIDS Initiative.
After Medicaid and Medicare, the Ryan White programs are the largest single source of Federal funding for health care for low-income, uninsured, and underinsured Americans living with HIV/AIDS. As a result, these programs are the major source of Federal discretionary resources for medical care and support needs in the United States for persons living with HIV disease, including women, children, and youth.
Since Ryan White programs are the “payor of last resort,” the statutory mandates in the Act regarding participatory planning help insure that these programs truly meet the needs of persons living with HIV/AIDS. The programs have targeted dollars toward the development of an effective service delivery system by partnering with States, heavily impacted metropolitan areas, community-based and faith-based providers, and academic institutions.
Each year the Ryan White programs provide services to approximately 531,000 individuals with little or no insurance. The FY 2008 budget request of $2.2 billion for Ryan White activities will support a comprehensive approach to address the health needs of persons living with HIV/AIDS, consistent with the reauthorization principles. The budget will provide funding to target HIV care and treatment funds to areas of greatest need and includes an increase of $25 million for the State AIDS Drug Assistance Program (funded under Part B, Title II of the CARE Act, as amended) to pay for additional medications in States with limited ADAP formularies, and for the increased cost of HIV/AIDS related pharmaceuticals, including anti-retrovirals.
HRSA focuses on uninsured, underserved, and special needs populations in its goals and program activities. We take great pride in our significant accomplishments, but we also look toward the future with an ambitious strategic plan that sets out the following goals: 1) Improve Access to Health Care; 2) Improve Health Outcomes; 3) Improve the Quality of Health Care; 4) Eliminate Health Disparities; 5) Improve the Public Health and Health Care Systems; 6) Enhance the Ability of the Health Care System to Respond to Public Health Emergencies; and 7) Achieve Excellence in Management Practices.
This concludes a brief overview of some of HRSA’s major initiatives in support of the Nation’s health care safety net, whose strength relies on collaboration among partners in each community and at all levels of government. In FY 2008, HRSA will continue its efforts to strengthen the safety net by providing more and better community-based primary care, services for low-income individuals and people with HIV/AIDS, health services for mothers and children, and targeted health professions training. These efforts will reduce unnecessary hospitalizations and help prevent chronic disease and disability. HRSA will also continue to work in partnership with State and local governments and private organizations to expand access to care and thus improve the health and lives of millions of Americans.
In pursuing its goals, HRSA requests total funding of $5,795,805,000, a decrease of $592,781,000 from the FY 2007 Appropriation. Mr. Chairman and members of the Committee, I will be pleased to address any questions or comments you may have on specifics of this Budget request.
Last revised: April 19, 2011