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Congress OKs health safety net measures

Legislation authorizes spending for community health centers and the National Health Service Corps.

By Markian Hawryluk, amednews staff. Nov. 11, 2002.

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Washington -- While most health care legislation got stuck in partisan gridlock this year, a bill expanding the health care safety net is one of the few to get signed into law.

But communities in need of the help may have to wait a while longer, because Congress has yet to appropriate the funds needed to implement the programs.

The Health Care Safety Net Amendments authorize funding for community health centers through 2006 and provide grants to communities to better organize and deliver care to the poor and uninsured. The measure allows Congress to expand spending for the National Health Service Corps. That program provides scholarships and loan guarantees to medical students who agree to practice in areas with physician shortages after graduation.

Health and Human Services Secretary Tommy Thompson said the legislation was a key part of the Bush administration's plan to address the challenge of the uninsured. "We're opening the door to new opportunities to improve the way underserved populations receive needed health services," Thompson said.

In 2000, community health centers provided preventive and primary care to more than 9.6 million people at more than 3,000 sites across the country. Of those served, 500,000 people were homeless, 600,000 were migrant and seasonal farm workers, and 55,000 were residents of public housing.

"Clearly, this program has been successful in meeting the goals of its creators," said Sen. Edward Kennedy (D, Mass.), who shepherded the legislation through the Senate. "Passage of the Safety Net Amendments is the first step to closing the dangerous gaps in our health care system."

Community health centers nationwide provided care to 9.6 million people in 2000.

The bill furthers the president's goal of doubling the funding for community health centers over five years, and to build or expand 1,200 health centers by 2006.

The measure strengthens the community health center program through a variety of approaches, including loan guarantees to acquire, build, lease or modernize clinics. It also makes available mental health and substance abuse treatment at the centers.

The bill was heralded by health care and consumer advocate groups as an essential piece of the health care puzzle. "Community health centers cannot do the work they do without the enactment of this measure," said Dan Hawkins, director of policy for the National Assn. of Community Health Centers. "At the heart of this legislation are doctors, nurses and trained health staff who care for one in 10 uninsured Americans, one of every six low-income children, and over half a million homeless people every day, every week, regardless of their ability to pay."

Community health centers are also heavily dependent on the NHSC, which has served as a pipeline of physicians, nurses, physician assistants and other health workers. The program has placed more than 20,000 health care practitioners in shortage areas in the last 30 years.

"However, to help communities meet their basic health care needs, more clinicians are needed in these areas," Sen. Bill Frist, MD (R, Tenn.), said on the Senate floor during debate on the bill. "The legislation improves recruitment and retention of health care professionals through expanded use of scholarship and loan repayment programs and added flexibility for local communities."

Dr. Frist said the bill also relieves pressure for the private, office-based physicians who provide 75% of the ambulatory care for uninsured patients with Medicaid coverage.

The NHSC has placed 20,000 health care practitioners in shortage areas during the last 30 years.

The legislation also moves to stem chronic work force shortages by designating health centers as automatically eligible for placements under the NHSC.

The measure authorizes nearly a 20% increase in federal funding for NHSC, setting aside 10% of funds for nurse practitioners, nurse midwives or physician assistants.

"The National Health Service Corps is the most successful federal program to bring physicians and other health care providers to underserved rural and inner-city communities," said Jordan Cohen, MD, president of the Assn. of American Medical Colleges. "Reauthorizing the program is an essential step toward strengthening the nation's health care safety net."

Awaiting the funds

While the bill authorizes Congress to spend the money on the community health centers and the NHSC, lawmakers must still appropriate the funds for those programs. At press time, however, Republicans and Democrats had yet to come to an agreement on the myriad appropriations bills for fiscal 2003, which began Oct. 1. Congress has resorted to short-term extensions at 2002 spending levels.

The Bush administration called for an increase for the NHSC of $44 million over fiscal 2002 levels in its budget proposal for fiscal 2003. The Senate included that funding in an appropriations bill passed earlier this year, but at press time, the House had not finalized 2003 spending levels.

For health centers, Bush proposed boosting funding by $114 million, bringing the total to almost $1.5 billion. The Senate passed an increase of $190 million in July, but the House hasn't voted on the funding level.

Congress will resume work on the appropriations bills when lawmakers return for a lame-duck session in mid-November. That means communities might not see any of the increased funding until well into the fiscal year.

Areas with physician shortages also may benefit from the expansion of the J-1 visa waiver program as part of the Justice Dept.'s fiscal 2003 authorization bill. The program allows foreign doctors to remain in the United States to work in medically underserved communities after completing medical school.

The bill extends the program for two years and increases the number of J-1 visas that states can request from 20 to 30 per year. The J-1 visa program was temporarily suspended last year after the Sept. 11, 2001, attacks based on domestic security fears.

Bush is expected to sign that measure into law as well.

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 ADDITIONAL INFORMATION: 

Improving local access

The Health Care Safety Net Amendments would help strengthen community health care through measures that include:

• Authorizing community health center funding through 2006.
• Extending funding for the National Health Service Corps through 2006.
• Stipulating that federally qualified health centers and rural health clinics be automatically eligible for NHSC placements.
• Authorizing funding for rural health care outreach services and telehealth grants.
• Codifying the Healthy Community Access Program, which develops delivery systems to help coordinate care for the uninsured and underinsured.

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Weblink

Fact sheet from the National Assn. of Community Health Centers Inc. on the Health Care Safety Net Amendment Act (S 1533), in pdf (http://www.nachc.com/news/attachments/nachc%20fact%20sheet%20on%20s.%201533.pdf)

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