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House Committee Examines Health Safety Net Programs

On August 1, the House Energy and Commerce Committee held a hearing to discuss reauthorizing public health safety net programs. Subcommittee Chair Michael Bilirakis (R-FL) opened the hearing, noting the importance of these programs given the increasing shortage of workers in the nursing, pharmaceutical, and medical technology fields. The hearing focused on the National Health Service Corps (NHSC) and the community health centers program.

The NHSC was created in 1970 and helps expand access to needed primary health care in communities throughout the United States. Since 1972, the NHSC has recruited more than 21,000 health care clinicians to work in areas where individuals have only limited access to primary health care because of financial, geographic, cultural, or language barriers. However, the recent increase in the shortages of nurses and other health care providers, as well as their retention, have become a problem throughout the country.

Addressing the need for more health care practitioners, Sen. Angela Monson of the Oklahoma State Senate and Vice-President of the NHSC told the subcommittee that “the NHSC is certain to be an important asset” in the recruitment process. The NHSC plays a vital role in recruiting more health care clinicians with scholarships, loan repayments, and minority recruitment and retainment.

Community health centers offer family-oriented preventive and primary health care services to approximately 10.5 million people living in medically underserved rural and urban communities. The President’s FY2002 budget request included $1.3 billion for community health centers. The $124 million increase over FY2001 would allow health centers to expand services to up to one million additional people, including 460,000 who are uninsured.

Kathryn Benjamin of Southeast Lancaster Health Services (SELHS) in Pennsylvania told the subcommittee that SELHS “has all but eliminated racial and ethnic disparities in the area of low birth-weight babies.” Dr. Betty James Duke of the U.S. Department of Health and Human Services noted that of those served by community health centers, 40 percent are children and 30 percent are women of child-bearing age.

Senate Action
The same day, the Senate Health, Education, Labor, and Pensions Committee approved, by voice vote, a bill (S. 1281) sponsored by Sens. Edward Kennedy (D-MA) and Bill Frist (R-TN) to reauthorize community health centers and the NHSC, and to authorize the Healthy Communities Access Program (HCAP) to help states and localities coordinate services for the uninsured and underinsured.

Sen. Kennedy noted that he had introduced the legislation first establishing the community health centers program in the late 1960s; the program now serves 9.5 million of “the poorest of the poor.” He acknowledged the President’s support for increased funding for community health centers.

During the mark-up, the committee approved, by voice vote, an amendment offered by Sen. Christopher Dodd (D-CT) to provide $5 million for technical assistance to school-based health centers. While Sen. Dodd mentioned that some opposition had been raised to the amendment due to teen reproductive health services provided by some school-based centers, he indicated that decisions regarding specific services provided by the centers are left up to the individual schools to determine. He further stated that school-based health centers are increasingly serving as the entry point to the health care system for school-aged children, providing a “unique opportunity” to better address their health needs. Sen. Barbara Mikulski (D-MD) spoke in support of the amendment, referring to school-based centers as “one-stop shops” that properly manage the medical needs of students and often catch early warning signs of abusive behaviors.

Another amendment offered by Sen. Hillary Rodham Clinton (D-NY) was approved, by voice vote, to authorize $125 million for HCAP, a program created by former President Clinton. Sen. Clinton urged adoption of the specific funding level for HCAP because it was being newly authorized and was not funded in the FY2002 budget resolution (H. Con. Res. 83). Sen. Judd Gregg (R-NH) countered that he opposed establishing a specific funding level, given current fiscal restraints.

Several other demonstration programs and technical changes to the bill were approved by voice vote. Additional amendments were debated briefly and withdrawn for possible future floor consideration.

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