Washington, D.C.
February 24, 2003

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It is a pleasure to have this opportunity to address the National Association of Towns and Townships. This is a perfect time and place for us to address the many health care challenges we face in rural and small communities throughout the nation.
 
As you know, the Department of Health and Human Services is an enormous department, with 11 separate agencies and an annual budget of $460 billion. It has the responsibility to expand access to quality health care; help low-income families; guard the safety and reliability of the food we eat and the drugs we take; protect the public health; and improve the overall welfare of our fellow citizens.  We do these things in every corner of the country.
 
And we also have a deeply rooted commitment to rural health. I am proud to work for a President and Secretary who are adamant that rural Americans have access to quality health care when they need it and where they live.
 
We understand the difficulties of providing quality care in rural areas where needs are growing and resources are often scarce. We know that small towns and rural communities experience dramatic disparities when it comes to mental health, substance abuse, oral health and public health-related outcomes.  These communities have higher rates of poverty and more citizens without insurance.  Rural hospitals are strapped by lack of access to capital and few incentives for providers to come there to live and work.  And residents in rural America also face higher rates of unintentional injury and death, especially from machinery and motor vehicle accidents.
 
During my tenure as Administrator for the Health Resources and Services Administration, I have seen firsthand some of the health care challenges many of you face.  From Alaska to Massachusetts, I have visited many small communities and heard the cry that we in the federal government do a better job of reaching those areas that lie outside the medical and economic mainstream of America.
 
These experiences underscored for me some key points that I want to share with you. First and foremost, there is no “one-size-fits-all” answer to the problems faced by rural communities.  Solutions that work in the Midwest may not work in the Southeast.  Solutions that work for a New England rural community may not work for a Southwestern frontier community.
 
When Secretary Thompson took office, his mandate to us was clear: make sure our policies don’t get in the way of meeting the needs of the 65 million people who call rural America home.  He told us to be more innovative and creative than ever before…to bring a fresh perspective to finding solutions to some old lingering problems.
 
In fact, he was so concerned about this issue that, in July 2001, he launched a department-wide task force to improve our Department’s response to rural America.  It was the job of the task force to determine the barriers that rural communities face in trying to access health and social service programs and to make recommendations on how we, as one Department, can do a better job.
 
The task force built its work around five important goals:

• Improve rural communities’ access to quality health and human services;
• Strengthen rural families;
• Strengthen rural communities and support economic development;
• Partner with States, local and Tribal governments to support rural communities; and
• Support rural policy and decision-making and ensure a rural voice in the consultative process.

We also made sure we had input from people and organizations outside of Washington. The task force requested public comment on how HHS could better serve rural America and more than 450 people and organizations answered the call. We learned a lot from these comments.
 
For example, we learned what we already knew that transportation is a critical issue in determining access to rural health care…that multiple program application and evaluation processes make it hard for rural organizations with limited resources and staff to take full advantage of funding opportunities…and that there is great demand in rural areas for more oral and mental health care. These issues and many more were addressed by the task force and Secretary Thompson when the final report was released in July 2002 at a Summit on Rural America in Denver.
 
Since the release of this report, we’ve been working tirelessly to bring life to the Secretary’s Rural Initiative. We began immediately to act on a number of the recommendations, and we are well on our way to making a profound difference in the lives of millions of our rural citizens.
 
With this far-reaching effort we are changing the way we do business within HHS.  The Centers for Medicare & Medicaid Services is sponsoring rural listening sessions.  HRSA, the Substance Abuse and Mental Health Services Administration and the Administration for Children and Families all have agency-wide rural workgroups.  And for the first time ever, the U.S. Public Health Service is looking at their Commissioned Corps to see if we have sufficient numbers serving in rural areas.
 
Last year, we launched the Rural Assistance Center that will serve as single point of entry for anyone seeking information about health policy and social services for rural communities. And, we’ve also expanded and strengthened the National Advisory Committee on Rural Health and Human Services under the leadership of former South Carolina Governor David Beasley who serves as the Chair of this important committee.  Governor Beasley brings an important state-level perspective to the Committee, and he has an impressive reputation as a pioneer in rural health and is a great leader for this advisory group.
 
And at my agency HRSA, we are playing a lead role in this increased focus on outreach to rural communities. We sponsor a range of programs that can directly impact and improve access to health care services for the many people in your areas.
 
Let me tell you, for example, about an unprecedented assignment President Bush has given us – one that will be a major focus at HRSA for years to come.  The President is so determined to increase direct health care to uninsured and low-income Americans that he has launched an initiative to expand the community health center network we administer by 60 percent over five years.  Over the long term, he wants to double the number of patients served at health centers.
 
To make sure we have enough health care professionals to work in these health centers, the President gave us a second, related initiative to reorganize and substantially boost the ranks of the National Health Service Corps.  In fiscal year 2002, the Corps awarded a record $89.9 million in scholarships and loan repayments to about 1,300 primary health care professionals, half of whom will practice in health centers.
 
Secretary Thompson also has announced new regulations to help rural and other communities with a shortage of health care providers by allowing HHS to request waivers of a return-home requirement for foreign physicians who trained in the U.S. In the past, foreigners who came to the U.S. under the State Department’s J-1 visa program were required to return to their home countries for two years after they completed their training.  Now, HHS will be able to expand its efforts to ensure that qualified physicians are able to stay here and provide needed care in our health centers and other underserved areas.
 
Currently America’s health centers serve about 10 million people each year.  In fiscal year 2002, the first full year of the expansion, we exceeded our targets by funding 171 new access points and by expanding capacity at 131 existing centers.  That puts us slightly ahead of schedule to meet the President’s goal of increasing the number of patients served annually to 16 million by 2006.
 
With Congress’s continued support for the President’s vision for the health center network, we hope to create new or expanded sites in another 900 communities by 2006.
 
That increase represents a huge opportunity for all of you, because we are committed to expand the network in parts of the country where the need for health care is greatest.  In other words, in the towns and townships where all of you work.
 
And let me note here that these health center grants don’t just bring more health care to your communities, they bring good jobs that put money in people’s pockets.  I was recently in Massachusetts to present a check for $236,000 to the Holyoke Health Center, recipient of a HRSA grant to open a satellite clinic in nearby Chicopee.
 
Those funds will be used in combination with state and local dollars to treat more than 5,000 patients – many of them immigrants – over the next two years.  They’ll also give a big economic boost to a community struggling with an influx of immigrants.  The HRSA grant not only will help pay the salaries of health care professionals at the clinic, it will spark a demand for office staff and construction workers and maybe even cooks and waiters and parking lot attendants as activity in the area near the clinic picks up.
 
HRSA’s Office of Rural Health Policy specifically targets grant dollars and staff expertise to rural America.  For example, HHS Secretary Tommy Thompson recently announced almost $27 million in grants to support small rural hospitals and to pay for defibrillators to help heart attack victims in rural America.  Both programs are part of the Secretary’s Initiative on Rural Communities, which I mentioned earlier. And most of the funds went to state-level health departments for distribution to local areas and organizations.
 
We also feel strongly that telehealth and telemedicine technology have the potential to revolutionize the delivery of health care, especially for those who live in remote or underserved communities.  When I visited Alaska I was very impressed with “the cart,” a telehealth initiative which provides better care in that frontier setting.  About two-thirds of the villages have a cart and more are on the way.  At a modest investment, the cart provides technology links for teledermatology; ob/gyn; eye, ear, nose and throat; telepsychology; and teleradiology.  The links go to specialists in sites remote from the clinic – in Anchorage, Seattle and Ohio.  The result: better, more timely care at home.
 
HRSA also is developing new geomapping technology to identify medically underserved locations that have the fewest HRSA and other federal resources to address health needs.  By utilizing our geomapping technology, we hope to do an even better job of identifying the communities that need us most.
 
And we’re working with a variety of regional commissions – the Appalachian Regional Authority, the Delta Regional Authority, the U.S.- Mexico Border Commission and the Denali Commission – to increase avenues for cooperation and collaboration in our efforts to better address the health and human service needs in small communities around the country.
 
These are just a few examples of what we at HHS are doing to improve our service to rural America.  In the weeks and months ahead, Secretary Thompson and the entire HHS family will continue to improve outreach to rural America, but we need your help. We must work together to expand access to quality systems of care and build programs that better serve rural residents. We all want the same thing – an America where all individuals and families can get the care they need when they need it most.