NACHC’s 40th Annual Community Health Institute & Expo
Chicago, IL - August 23, 2009
Remarks as prepared for delivery
Thank you, Tom, for that kind introduction. I want to tell you all how lucky you are to have Tom as a leader. Community health centers couldn’t ask for a better spokesman or advocate.
I’d also like to acknowledge Representative Danny Davis. He’s been a great progressive leader on health care and so many other issues in Congress.
I’m so pleased that Cindy Mann and Jim Macrae are on your agenda here in Chicago, along with other outstanding members of the HHS staff participating in your breakout sessions.
You know Cindy’s commitment from her previous tour with HHS. I am not sure we’d have a Children’s Health Insurance Program without Cindy. And I know we will have a CHIP with the right priorities now that Cindy is heading up Medicaid and CHIP.
Finally, I’d like to acknowledge all the Community Health Center leaders and providers here today…not just for the care you provide, but for the example you set for the rest of our health care system.
II. Praise for Community Health Centers
I’ve seen the difference you make firsthand. When I was Insurance Commissioner in Kansas, part of my job was to be an advocate for consumers. And I saw how valuable community health centers were – not just for the uninsured, but also for Kansans who had insurance.
Then I became Governor. And as many of you know, Kansas is a mostly rural state. And I saw how in some of these areas, health centers became the backbone of the community. They weren’t just where you went for your check-up. They were where you went to get your medicine and your teeth fixed…to get counseling if you needed it or help finding a job.
And then I would go to meetings of the National Governor’s Association. And I’d talk to my colleagues and they’d tell me the same stories from their states – about how community health centers were achieving great results while keeping costs down.
You hear a lot at these meetings about “pockets of excellence” – like the Mayo Clinic or the Cleveland Clinic. But community health centers are the biggest primary care network in the country. They’re generating top results while treating 1 out of every 18 Americans. It’s as if there was a five star restaurant with 7,500 franchises across the country.
And then this April, I was confirmed as Secretary of Health and Human Services. So I moved to Washington. And you always hear that Democrats and Republicans can’t agree on anything when it comes to health care. But I learned there’s actually one part of health care policy that everyone agrees about – and that’s how great community health centers are.
And you have a new huge fan in the Administration. Vice President Joe Biden went to his first community health center visit as part of an announcement on new recovery money. He tells everyone not only how impressed he was with the services, but how amazed he was at the enthusiastic support generated in the community by the health providers.
So I come here today knowing that I’m not the only member of your fan club. But I want to make sure you know how much this administration and this agency value the work that you do.
And by the way, my Deputy Secretary Bill Corr knows something about community health centers too. As folks from Tennessee know, Bill is kind of a community health legend. Back in the 1970s, he ran a community health center that served all of Eastern Tennessee. He had one doctor who worked for him and one dentist.
And that’s not uncommon for community health centers. You also take the patients that other providers can’t. I remember talking to a woman who runs a community health center in rural Ohio, east of Cincinnati where I grew up. Her health center served five counties. In some areas, pregnant women would have had to drive more than 90 minutes to deliver their babies if it weren’t for their local community health center.
In fact, here’s one way to think about the value of community health centers. Say you asked every uninsured or poor American whether they had access to the medical care they needed. Then you took all the people who said yes and put a dot on a map of the United States where they lived. What you’d see is a lot of clumps – about 7,500 of them. Those are community health centers.
But community health centers are not just providers of last resort. They’re also many Americans’ first choice for care. We saw this in Massachusetts. A lot of people said that when Massachusetts expanded health coverage, demand for community health centers would go down. Instead, the exact opposite happened. The percentage of uninsured patients went down 30%. But the number of patients using community health centers actually went up.
These are people from all walks of life—people with income and people without income, people in urban areas and living in the country.
The common denominator here is community. In a health care culture that has become more about the treatment than the person being treated, the kind of treatment you get in a community health center should be what we mean when we talk about “personalized medicine.” The staff knows you and your family. They call you once a week to make sure you’re taking medicine for your diabetes. They speak to you in Spanish if your English isn’t good enough to describe what’s wrong.
Community health centers are “health homes.” They don’t write you a prescription or a mental health referral and then send you away. The pharmacy and psychiatrist are next door in the same building. And integrated care is often better care. Compared to other patients, health center patients control their blood sugar better. Babies delivered at health centers are less likely to have low birth weights.
But statistics alone don’t capture the value of the work you do. A couple months ago, one community health center leader from Nashville told me about a family that came into her center. The father had just been laid off, and they had lost their home. So they had moved into a motel in a low-income neighborhood. They didn’t know anyone, didn’t know what to do, and they had three kids who needed medicine.
So they went to the community health center. Now if all the community health center had done was help the kids get their medicine, we would say the community health center did a great job. But the center also signed the kids up for the CHIP program. They found a local school for the kids to attend. They gave them the physicals they needed to enroll in school. They provided counseling to the whole family. And they connected the family with a church, which is how the father ended up getting another job that allowed them to get an apartment.
You hear this story over and over again. Someone loses their job. They go to a community health center because they have nowhere else to go. Sometimes they had never even heard of community health centers before. And then they’re so impressed with the care they get that they say, “Whether I get insurance again or not, I’m still coming back here the next time I need to see a doctor.”
That’s the value of community health centers. And by the way, you do all of this while keeping cost increases 20% below the national average every year for four years straight. According to a recent report, care at community health centers in Indiana costs half what it does at other outpatient centers.
III. The Obama Administration and Community Health Centers
So I want you to know how much President Obama and I appreciate the work that you do. This administration believes that community health centers are an irreplaceable part of our health care system. There is no other group that delivers such high-quality care…to the people who need it most…in their own communities…on such a broad scale.
Your work has never been more important than it has been over the last twelve months. As Americans lost their jobs and coverage and their medical bills piled up, you stretched your resources to plug the holes in the system. And just as you’ve supported Americans, we’re committed to supporting you.
That’s why, over the last six months, we’ve made a historic investment of over $1.3 billion in community health centers under the American Recovery and Reinvestment Act. That funding will support the construction of new health center sites, expansion of services, and the treatment of 2 million additional patients over the next two years.
Another $500 million from the Recovery Act will be awarded shortly to support major capital and construction projects in health centers.
The Recovery Act designates substantial capital improvement funds to adopt and expand use of electronic health records, upgrade equipment and even purchase health IT systems. This is so important.
Recovery Act funds are already helping the Health Care Center for the Homeless in Orlando. This community has been hit hard by the recession—over the past several months, the center’s caseload has increased almost one-third.
Many of the centers new clients are experiencing homelessness for the first time because they’ve lost their jobs and run out of savings. With a Recovery Act grant of a little over $400,000 to upgrade its electronic health record system, the Health Care Center for the Homeless can make the efficiencies that will help them meet this new need.
Because new facilities are only useful to patients if there are doctors there to staff them, the Recovery Act also provides another half billion dollars to expand our primary care workforce through the National Health Service Corps and other programs.
And, totally apart from these new Recovery Act funds, I’m happy to announce over $25 million in new community health center funding from the Health Resources and Services Administration. This money will provide grants that can be used in two ways: to help existing sites add new services like substance abuse and mental health treatment and to plan and develop new health centers in underserved areas.
And I want to be clear: we are not making these investments so that states can take money away from community health centers and spend it elsewhere. These funds are intended to supplement state money so that community health centers can meet the growing demand for their services in this time of need.
IV. Community Health Centers and Health Reform
We will continue to support community health centers. But the challenges you face are also connected to larger problems in the health care system.
The reason you have so many patients in your waiting rooms is because 46 million Americans are uninsured and millions more are underinsured. You have budget problems because medical costs have been skyrocketing for decades. The investments you are trying to make in prevention and health IT are investments our entire health care system needs to make.
I won’t go through the whole case for health insurance reform today. You understand the urgency behind reform better than anyone. But I do want to share one letter with you that I got the other day. It was from a Kansan named Charley Griffin. Charley and his wife Linda owned a small business in Salina, Kansas for 28 years. Because they thought it was their responsibility, they always provided health care coverage for their employees.
When they retired, they tried to buy insurance policies for themselves from the same company that had covered their small business. Even though they were both healthy, their application was denied. Charley, because he took blood pressure medicine. Linda, for some conditions that had been resolved years ago.
This is hardly the worst story you hear about our health care system. But this is the question in the back of every American’s mind: if our health care system lets down Charley and Linda, who are middle class, who are healthy, who had coverage for 28 years, how secure can I be?
Stories like this one are why there is more momentum behind health insurance reform than ever before. A majority of Americans support major changes to our health care system. The President has made it his top domestic priority. And four out of five committees in Congress have already produced bills that would expand access, lower costs and increase quality.
But change won’t be easy. We’ve seen over the last few weeks that opponents of reform will use every trick in the book to keep the status quo. They’ll yell over people who disagree with them. They’ll try to scare people with stories about death panels and socialism.
People’s health care should not be held hostage to partisan politics. So we need you to apply some of your knowledge and experience to raise the level of discourse in this historic debate. You understand what doesn’t work in our health care system better than anyone. And no one has more credibility when they talk about how we can do better.
We don’t need to yell over the other side or exaggerate the benefits of reform. We just need to give Americans the facts. So talk to your colleagues, your neighbors, your softball teammates, the folks at your church or temple or mosque. And talk to your members of Congress. If Americans can clearly see the risks of the status quo and the benefits of change, I have no doubt that we will achieve health reform this fall.
There’s one other area where we need your help. As you know, we are dealing with a new public health threat– the 2009 H1N1 flu. And our scientists predict that infections will go up this fall as our kids return to school.
We have been working with President Obama and leaders across the country since April to prepare for flu season. We’ve reached out to Governors, local health officials, hospitals, schools, and the business community. And we’re pushing vaccine makers to have an H1N1 vaccine by mid-October. But until the vaccine comes, we hope you will offer the pneumococcal vaccine to your high-risk patients, especially those with chronic heart or lung diseases, diabetes, or compromised immune systems.
I don’t want to minimize the challenge this flu season creates for all of you. But we’re depending on you to meet it. Community health centers serve so many vulnerable population groups in many cases you are the only access for those groups. So much will be riding on your care.
You need to be flexible and reach out to other un- and underinsured people who are not yet your patients. You—not emergency departments—know how to take the time to see patients when they are worried or sick, and—this is critical—we need you to serve as vaccination sites.
When I was in Cincinnati on Friday, I visited the Neighborhood Health Center. At three of their school-based clinics kids who attend these schools—and their siblings who don’t—can get primary care, behavioral health care, and dental care. It’s a logical step to offer the H1N1 vaccine at school-based clinics like these in Cincinnati.
We need you to start talking to patients now about what to do about H1N1. Link up with your state health department so you can help distribute vaccine and antivirals to patients. Please consider giving your highest risk patients antiviral prescriptions to have at home to “fill” just “in case.”
Please plan now so you can provide 24/7 access for patients who might get sick, and know where you can refer a very sick patient for care. And I hope you will support each other in creating a plan that every community health center can use as we get further into the flu season.
The battle against the flu will be won on the front lines in places like community health centers. We won’t know how bad the 2009 H1N1 flu will be for a couple of months. But by preparing now…by educating Americans, stocking up on vaccine and antivirals, and planning for extra patients…community health centers can help minimize the damage it does this fall.
Usually, community health centers let their actions do the talking. But over the next few months, I hope you will also speak up about these important issues. Your voices can make a huge difference.