Remarks to the Children's Health Fund

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration

Washington D.C.
June 25, 2002

I am delighted to be here today with all of you. Thank you for inviting me. I want to commend the Children’s Health Fund and its Corporate Council for America’s Children for giving the business community a way to help children get the essential health care services they all need. Your leadership ensures that the health and well-being of our children remain front and center on the national agenda.

These are exciting times at the agency I head, the Health Resources and Services Administration, because President Bush has put us at the core of an unprecedented push to increase direct health care to uninsured and underinsured Americans – many of whom, of course are children.

First, I’d like to tell you about three presidential initiatives we’re implementing at HRSA. These initiatives represent the foundation of HRSA’s current and future efforts to expand access to health care and close the health disparities gap. Then I will briefly discuss HRSA’s work promoting the medical home concept and our continuing efforts to enroll children in the State Children’s Health Insurance Program.

The first initiative is President Bush’s five-year plan to expand the health center system. The initiative will create 630 new health centers and affiliated clinics and significantly expand services at another 570 health center sites.

The Health Centers Presidential Initiative aims to increase annual patient visits to 16 million by 2006, up from just over 10 million currently. Ultimately the President wants to double the number of patients treated at health centers. For fiscal year 2003, President Bush is asking for almost $1.5 billion for health centers – that’s a $114 million increase over this year’s budget and a two-year increase of almost $280 million.

Health centers serve disproportionate shares of poor, uninsured and minority Americans: 66 percent of health center patients are low-income; 40 percent are uninsured; and 64 percent are people of color.

Of the approximately 10 million people served annually by health centers, about 40 percent -- nearly 4 million -- are children and adolescents 19 years of age and under. Of these 4 million young people, about a third -- more than 1.2 million -- are uninsured. Data experts at HRSA’s Bureau of Primary Health Care estimate that health centers serve 15% of all uninsured children in the United States.

If we presume that similar populations will continue to visit an expanded health center network, then the President’s plan will have beneficial effects on several levels:

• more underserved and uninsured low-income people will have access not just to health care but to a broader range of services;

• greater numbers of poor and uninsured children and teens will be served; and

• more minority Americans will have access to care.

These gains in access, together with the expansion of services offered at health centers, will improve the health of U.S. minorities and reduce existing disparities in health outcomes between our minority and majority populations.

To staff the expansion, we estimate that about 4,500 additional primary care providers – and a total of 30,000 new employees -- will be needed throughout the health center system over the next five years. That leads us to the second presidential initiative that affects HRSA: expanding and reforming the National Health Service Corps. It only makes sense. Since a large percentage of Corps clinicians are assigned to health centers, if one part of the system expands, so must the other.

To that end, the President has targeted important new resources for the NHSC. The FY 2002 budget contained an increase for the NHSC of about $20 million, to a total of $145 million. The President’s 2003 budget proposal would give the Corps an increase of another $45 million to a total of just over $191 million. These added funds would provide scholarships or loan assistance to about 1,800 professionals practicing in underserved areas -- an increase of more than 500 participants over the current fiscal year.

Reforming the way NHSC does business is the other leg of the Presidential initiative for the NHSC. Earlier this month, I announced a plan to reengineer Corps’ business processes, fruit of a collaboration between NHSC staff and the management firm Booz, Allen and Hamilton. Even great organizations can be made better, more productive, more customer-focused. These changes are geared to get more NHSC staff members out of administrative positions and into “front-line” areas of greatest need. That’s what we have to do.

And about two months ago, Secretary Thompson announced the launch of NHSC’s “Ready Responders” -- 40 highly skilled Commissioned Officer physicians and dentists who will spend most of their time in health professional shortage areas treating the underserved. But they also will receive special training and will be ready at a moment’s notice to deploy to medical emergencies nationwide.

While I’m talking about health professionals, let me add a plug for a HRSA program Secretary Thompson helped us unveil in February. It’s called “Kids Into Health Careers,” and it aims to attract young people, especially those from minority and medically underserved communities, to careers in nursing and other health professions where future workforce shortages are expected.

We’ve assembled information on more than 270 health careers, information on salary forecasts, required education, and on obtaining financial assistance to enroll in course of study. It’s information that parents, teachers and civic organizations can use to motivate and encourage our nation’s promising young talent to pursue health professions careers. You can find out more about it at its Web site: http://bhpr.hrsa.gov/kidscareers/.

The President’s third initiative at HRSA is called the Healthy Communities Innovation Initiative. The President’s 2003 budget proposes $20 million for HRSA to set up demonstration programs in five communities. This interdisciplinary effort will bring together experts from throughout HHS to focus on ways to prevent asthma, diabetes, and obesity. These three chronic illnesses are among the fastest growing in the United States and present severe problems in many minority communities. And obesity and certainly asthma are growing concerns among our young people.

The Healthy Communities initiative builds on the model established by our Maternal and Child Health Bureau’s Healthy Start program, which targets funds to specific geographic areas to reduce exceptionally high infant mortality rates.

Also, under the President’s Homeland Security Initiative, HRSA will have specific responsibility for: assuring that the Nation’s hospitals are prepared to deal with bioterrorism and other mass emergencies; for training the public health and health care workforce; poison control centers; and for emergency medical services for children.

Specifically, our EMS program for children helps states develop system improvements that ensure that an effective EMS system is in place for children. And our Poison Control Centers, which have traditionally served many parents and children, will continue to enhance expert services, especially related to chemical exposures.

As some of you may know, children were a huge priority for us at HRSA in the immediate aftermath of 9/11. In fact on September 12, less than 24 hours after the attacks, our EMSC program created and distributed via the internet a special publication addressing the special needs of children after a disaster. Further, the EMSC program has issued a special grant award for the development of a color coding schema for special medication doses of the most commonly used antibiotics for biological agents used in terrorism.

In addition, during the anthrax terrorism in South Florida, the regional poison control center responded to more than 1400 telephone calls in three days, including many from concerned parents and health care providers.

All these initiatives taken together have one all encompassing goal: to expand access to quality health care for all Americans who need it. And by expanding access, we can do a better job of meeting the many needs of the people we serve, including millions of children and their families.

HRSA partners with states to ensure that babies are born healthy and that women and their children have access to quality health care – serving more than 26 million women, infants and children with special health care needs.

We believe in family-centered care, thus the concept of a medical home, particularly for children with special health care needs, is one that we wholeheartedly support. Our mantra at HRSA is that the medical home makes care accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and delivers care in a culturally competent environment. I applaud your efforts in this area through your National Children’s Health Project Network that provides medically underserved children comprehensive primary care at mobile medical units, clinics, and school-linked programs.

In recent years, HRSA’s Maternal and Child Health Bureau, through its Division of Services for Children with Special Health Care Needs, has provided demonstration and model project grants furthering the development of the medical home concept. Currently, there are approximately 15 active implementation grants and cooperative agreements totaling over $2 million under HRSA’s Medical Home Initiative. Also, through a cooperative agreement with the American Academy of Pediatrics, training on a national basis is being given to physicians and providers on the establishment of medical home programs in their regional locations.

I’d also like to update you on several things going on with the State Children’s Health Insurance Program, which we all refer to now as SCHIP. SCHIP, as you all know, is a partnership between the federal and state governments to help provide children with the health coverage they need to grow up healthy and strong. SCHIP requires that states use their allotted funds to cover uninsured children – and not replace existing health coverage. It also includes important cost-sharing protection so that low-income families are not burdened with heavy out-of-pocket expenses.

To date, we have enrolled nearly 5 million children in SCHIP. HHS has approved SCHIP plans for all 59 states, five U.S. territories, and the District of Columbia. To expand coverage to even more children and adults, the Department has also approved more than 100 amendments to SCHIP plans as well as demonstration projects in the states of Arizona, California, Minnesota, New Jersey, Rhode Island and Wisconsin, This past February, HHS issued a proposed regulation that would allow states to expand prenatal care for low-income women under SCHIP. Under current regulations, states need to apply for a demonstration waiver for such coverage.

President Bush’s fiscal year 2003 budget plan would strengthen the SCHIP program by making an estimated $3.2 billion available to states in unused SCHIP funds that would otherwise return to the federal treasury. These additional matching funds would be made available through FY 2006 to expand SCHIP coverage.

The Insure Kids Now! campaign links the families of uninsured children with their State’s Children’s Health Insurance Program. As part of this effort, the National Governors’ Association and HHS have created a national toll-free number - 1-877-KIDS-NOW. The hotline, which automatically connects callers to their State’s Children’s Health Insurance Program or Medicaid program is maintained by HRSA and has nearly one million calls.

HRSA also maintains a national Web site -- -www.insurekidsnow.gov - that provides links to eligibility and contact information for each State and the District of Columbia. Since the launch of the site in March of 2001, nearly a half million visitors have used it.

HHS has worked with states, private foundations, businesses and other federal agencies to promote state outreach efforts through Insure Kids Now! These promotional efforts include partnerships with the Kaiser Family Foundation, CBS, Wal-Mart, H&R Block, the U.S. Postal Service, the Pampers Parenting Institute, the Robert Woods Johnson Foundation’s Covering Kids Initiative and others.

Starting this month, the CBS Television Network, the Viacom Outdoor Group and the Kaiser Family Foundation began a yearlong national public education partnership to inform parents of uninsured children that their kids may be eligible for Medicaid and SCHIP health coverage. All television PSAs will promote the toll-free 1-877-KIDS-NOW number.

In closing, I share with you my belief that strengthening partnerships is the best way to create healthy families and communities. We must continue working together to reach the goals we all share. We all want to see an America where good health care is a steppingstone to childhood success and a future of fulfilled ambitions. We all want an America where children everywhere are able to enjoy active, productive lives. Our children are the hope of tomorrow, and we must do all we can to help them meet their full potential.

We can be proud that our work improving child health has a tremendous payoff for the Nation. With you -- and people like you in communities across America -- working collectively and collaboratively to build quality systems of care, I am confident we can do an even better job of meeting the needs of children and their families.

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