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Authorizing Safety Net Public Health Programs
Subcommittee on Health
The Honorable Angela Monson
Chairman
Bilirakis and distinguished members of the subcommittee: My
name is Angela Monson. I am a state
senator in Oklahoma where I chair the Senate Finance Committee. I am the Vice-President of the National Conference of State
Legislatures (NCSL) and also have the privilege of serving on the National
Advisory Council of the National Health Service Corp (NHSC).
It is a pleasure to be here today on behalf of NCSL to talk about
reauthorizing the National Health Service Corps. Last
year NCSL adopted policy urging you to make the reauthorization of the NHSC a
priority. The support for this
program is broad, uniting state legislators across urban/rural and racial/ethnic
lines. I am particularly pleased to
be a part of the effort to move this important reauthorization forward.
The
reauthorization of the NHSC is even more important this year.
President Bush's proposal to expand the number of Community Health
Centers will create an even greater need for clinicians to serve in underserved
areas. Just last month a
provision that excludes from gross income certain amounts received under the
NHSC Scholarship Program was enacted as part of the tax relief package.
This benefit is an added incentive to program participation. The
NHSC will be a valuable partner in the effort to expand the number of Community
Health Centers, but the value of the NHSC extends far beyond the health
profession shortage areas and the uninsured and underinsured individuals and
families who benefit from the service requirement.
The NHSC facilitates the training of health professionals who, through
their service and training, will bring special skills to all the venues they
practice in over their lifetime.
As our population becomes more diverse, the importance of culturally
competent health practitioners will grow. The
NHSC is certain to be an important asset.
The
Mission of the National Health Services Corps
NHSC
represents a model framework for providing health care services to uninsured and
underinsured individuals and families across this nation -- a unique
collaboration between the federal government, the states, and local communities.
Since its development in 1970, the NHSC has played a vital role in
expanding access to needed primary health care in communities throughout the
United States. Investment in the
NHSC pays continuing dividends to the communities in which its clinicians are
placed, since two-thirds of these clinicians remain in the community after
completion of their service. Since
1972, NHSC has recruited more than 21,000 health care clinicians to work in
areas where, because of financial, geographic, cultural or language barriers,
individuals have only limited access to primary medical care. The Corps' focus on minority recruitment has resulted in a
significantly greater representation of African-American and Hispanic clinicians
in the Corps than exists in the national health care force. These clinicians
make an immediate and significant contribution to the overall health of a
community. The
program attracts individuals from a variety of primary health care professions,
including physicians and physician assistants, nurse practitioners, certified
nurse midwives, dentists and dental hygienists, and mental health professionals.
State
Loan Repayment Program
In
addition to the NHSC Loan Repayment program, 34 states (Alabama, Arizona,
California, Colorado, Connecticut, Delaware, Georgia, Illinois, Iowa, Kentucky,
Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri,
Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio,
Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Virginia,
Washington, West Virginia, and Wisconsin) currently receive grants to operate
state-based loan repayment programs.
These grants match state and local community funds to assist in the
repayment of qualified educational loans for primary health care clinicians who,
in return for this assistance, agree to practice full time in public or
non-profit health facilities in Health Professional Shortage Areas (HPSAs).
The specific benefit and eligibility requirements vary by state. NHSC
Loan Repayment Program
The
NHSC Loan Repayment Program provides benefits to both the clinician and the
health facility. The clinician
receives an opportunity to retire debt associated with their health-related
training while gaining valuable experience.
The health care facilities are able to immediately fill vacancies when
loan repayment program participants are available.
Everybody benefits. NHSC
Scholarships
The
Scholarship Program provides a unique educational opportunity for
non-traditional students, especially minority students, low-income students, and
students living in rural areas, who might not otherwise be able to pursue a
career in primary health care. In 1998, for example, 46.2 percent of medical
students awarded scholarships were African-American and Hispanic. Upon graduation, students have an opportunity to make a
real difference in the lives of their patients.
In 1999, one-third of all patients treated by NHSC personnel had incomes
at or below the poverty live. Many
others are uninsured and have little access to medical care through traditional
providers. State
Initiatives State
efforts to provide primary health care services for their under-served
populations are long-standing and encompass a variety of approaches. Not the least important of these approaches are state
programs to increase the number of primary health care professionals.
The State of Florida, for example, provides 26 scholarship and loan
programs for disadvantaged and/or financially needy health professions students.
In addition, Florida provides training grants designed specifically to
improve access to health care by under-served populations, including training
for primary care physicians, dentists, and nursing professionals, as well as
training grants to improve public health. Texas and New Mexico have developed innovative programs using promotoras, or "health promoters," neighborhood women who act as health care advisors for others in the community. These women, in addition to bringing more people into the health care system, help break down language and cultural barriers contributing invaluably to improving the "cultural competence" of all who work beside them. Many
states are exploring, or have already developed, opportunities to use advances
in telecommunications to enhance the provision of medical training and health
care services, including the provision of mental health, pharmacy, and
"telemedicine." These efforts
contribute significantly to solutions for solving what has become a crisis in
access to primary health care in many communities. State
and local governments continue to explore the full range of approaches to
improve access to affordable, quality health care services.
These approaches include expansions of coverage through Medicaid and
SCHIP, as well as insurance reforms and innovative state-funded programs.
Despite the substantial efforts of the National Health Service Corps and
the states to develop creative approaches to providing access to primary health
care, there remains a significant unmet need for primary health care.
The National Health Service Corps, at current funding levels, is able to
meet barely twelve percent of this unmet need.
Recommendations
Increase
NHSC Funding Appropriations
should be sufficient to allow the NHSC to expand to meet the growing demand for
placement by clinicians to provide primary health care services in federally
designated underserved areas. The
Corps has been successful in recruiting a large number of trained clinicians to
its Loan Repayment Program, but funding for the program has not kept pace. Greater
Program Flexibility to Better Meet Community Needs The
goal of NHSC is to be able to educate and recruit primary health care
professionals for service in communities experiencing critical shortages of
health care providers. Many
of these communities consist largely of individuals with specific cultural
experiences or ethnic backgrounds. These
communities can present special challenges in recruiting and retaining health
care providers sensitive to the particular needs of the community.
The NHSC recognizes the importance of training culturally-competent and
responsive primary health care providers.
Reauthorization
of NHSC provides an opportunity to:
Greater Program Flexibility
to Better Meet the Needs of Participating Providers Retaining
clinicians in the Corps continues to be a challenge.
The reauthorization provides a unique opportunity to explore innovative
options to encourage clinicians to stay in the program.
Two ideas come to mind.
In
Conclusion I
look forward to working with this committee and your colleagues in both the
House and the Senate to reauthorize the National Health Services Corps this
year. I thank you for this
opportunity to discuss these important issues with you today and would be happy
to answer questions.
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