October 13, 2005
Las Cruces, N.M.

---

 
I’m delighted to be here in Las Cruces to participate in this Community Health Luncheon.  I want to thank Paul Herzog, Chief Executive Officer of Memorial Medical Center, and all the great folks at the Dona Ana County Health and Human Services Department, for inviting me to be here today.  And, most important, I thank you all for coming together today to focus on access to care – especially this week as we celebrate the second Border Binational Health Week.
 
To see so many of you from so many different local organizations is heartwarming.  This is exactly what we had in mind when the idea for Border Binational Health Week was born.  The plan was to organize activities that would promote sustainable health improvements among border residents and build community structures and relationships that will allow these improvements to continue well into the future.  And here we are today meeting together to find new and different ways to strengthen and expand the health care safety net along the U.S.-Mexico border.
 
At HRSA, we have a long-standing interest and involvement in the border region.  When I became HRSA administrator in March of 2001, my challenge was to solidify the agency’s commitment to improve health along the border.  I wanted to make sure HRSA’s focus on border health did not depend on any one administrator or on any single initiative.  My intention is, and has been, to bring greater coherence to our efforts on the border so that we can provide more direct health care services to the many border communities that need our help.
 
In fact, whether it’s in our community health center program, maternal and child health, or our HIV/AIDS outreach efforts, the special concerns of our border communities are a top priority for all of us at HRSA and HHS.  
 
HRSA is often referred to as the Federal government’s “access agency,” because we work to expand access to primary and preventive health care for low-income and uninsured people.
 
Americans saw the people HRSA grantees often serve wading through the waters of New Orleans.  Poor and minority, lacking health insurance, one calamity away from personal ruin.
 
The disaster caused by Hurricane Katrina dealt a terrible blow to those citizens and their city.
 
As you saw on your television sets, the health care infrastructure in New Orleans has been decimated.  In the city, all 8 of the health center sites HRSA supports with grants were destroyed, along with the entire HRSA-funded system of delivering services to HIV-positive patients there. 
 
Naturally, evacuees sought health care in the areas where they took refuge.  Fleeing disaster, they of course arrived with nothing.  No medical papers, no prescriptions, no evidence of current treatment, no way to verify their medical conditions without going through some initial assessment in the crush of the chaos.  And, many of these individuals arrive at new health care venues with a long history of chronic diseases, and often undiagnosed conditions.
 
Medical personnel, often including Commissioned Corps officers of the U.S. Public Health Service, responded heroically under the circumstances. I am proud to say that we have sent about 10 percent of HRSA’s total staff – 200 Commissioned Corps officers out of a total agency workforce of just under 2,000 – to deliver direct health care to hurricane victims.
 
HRSA-funded health centers just outside the hardest-hit areas treated 35,000 evacuees from New Orleans.  We estimate that almost 22,000 evacuees received treatment from health center personnel in Texas, along with more than 2,500 in Arkansas.  Another 11,000 evacuees received treatment at health centers in outlying parts of Louisiana.
 
Grantees of HRSA’s Ryan White CARE Act program in 13 states, the District of Columbia, and parts of Louisiana and Mississippi treated some 1,200 evacuees with HIV.  That assistance was especially crucial, since interruption of drug treatment can send these patients into a spiral from which they would never recover.
 
People running those states’ AIDS Drug Assistance Programs – known as ADAPs and funded through the Ryan White program – did what they had to to help the evacuees. They made emergency enrollments, wrote prescriptions and honored those written elsewhere, and worked with pharmaceutical companies to obtain donated medications.
 
Katrina’s devastation has made us all acutely aware of the importance of accessible health care, especially during a public health emergency.  Yet, I know each of you face your own health care emergencies every day. And that’s why today’s focus on “access to care” is so vitally important.
 
The health care challenges along the border are staggering.  Thousands of people live daily with the health risks of polluted water, soil and air. Millions are uninsured. We know that you face dramatic disparities when it comes to issues like mental health, substance abuse, and oral health. And, the rate of chronic disease is on the rise -- higher than in other areas of the country.
 
What we all must do is join together and make a renewed commitment to expand access to care for all those people who need it most. 
 
When President Bush issued his FY 2006 budget proposal, he stressed that the people’s money should only be invested in those programs that can demonstrate good results. He also emphasized the need to strengthen the Nation’s health care safety net by continuing investments in more direct health care services. So what does this mean for us at HRSA?
 
It means that we must look carefully at our spending priorities to make sure that we are supporting programs that give us the most impact in our continuing mission to meet the health care needs of the Nation’s underserved. 
 
As many of you know, we have been enormously successful implementing the President’s Health Center Expansion initiative – an effort designed to establish or expand 1,200 health center sites and serve an additional 6.1 million patients annually by the end of 2006.  And this continues to be a priority because we know that 100 percent of these funds go to provide direct health care services for our neighbors who are most in need.
 
In 2004, the health center system served an estimated 13.2 million people – about 3 million more than in 2001 – at more than 3,650 service delivery sites, an increase of almost 500 sites since 2001.
 
At the end of FY05, we had created 427 new access points, provided for 349 expanded medical capacity grants and awarded more than 340 grants to expand oral and mental health and substance abuse services.  In addition HRSA has announced a commitment to provide 88 new access point grant awards for $55 million in FY06 under the president’s initiative, should funds become available.
 
President Bush is also very concerned about those poor counties that are still without health center capacity.  He has proposed $26 million for a new initiative to fund health centers in about 40 high-poverty counties without a site.  In addition, funding would be provided for 25 planning grants to help community organizations plan and develop health centers in these high poverty counties. We will know more about this once we have a final FY 2006 budget.
 
As you know, one of the biggest challenges we face in an expansion of this size and scope is finding the right people to fill many new positions.  We estimate that we will need to add 36,000 new health center staff through 2006 to meet the President’s goals, including more than 11,000 clinicians.
 
National Health Service Corps clinicians have always played a fundamental role in our staffing strategy.  Remember that as part of his plan to expand the health center system, President Bush also directed us to reform and expand the Corps.
 
The NHSC is doing a fabulous job for us as it continues to place thousands of health care professionals in the field.
 
Today, we have nearly 4,000 NHSC personnel on board, up from about 2300 in 2001. In fact, since 1972, the NHSC has placed nearly 26,000 primary care, oral, mental and behavioral health clinicians in health professions shortage areas all across this country. 
 
We’ve been working hard to address the nursing shortage, and we have made a great deal of progress.  For example, more than 8,300 individual applications were submitted in 2004 for the Nursing Education Loan Repayment Program and the Nursing Scholarship Program.  And, today, more than 11,000 students are enrolled in HRSA-supported projects designed to expand enrollment in baccalaureate nursing programs.  And, nearly 54,000 clients were seen last year at 18 nurse-managed health centers around the nation that we support.  These efforts play a key role in our continuing push to get more and better health care services to all those people who need care the most.
 
As we look ahead, we at HRSA will concentrate more directly on supporting efforts that improve health professional shortages and improve our focus on emerging workforce trends and demands. And we’ll be looking for ways to better support the wonderful work of community health workers.  At HHS, we have long known the value of having a trained cadre of community health workers available in local areas.   Promotores, community health advisors, community health aides, family health promoters – whatever names they may use – they play key roles in those geographic areas that lack vital health care resources and personnel. 
 
Community health workers are in the best position possible to reach those families facing the greatest barriers to quality health care services, because they are trusted members of the community and they understand the psycho/social needs of the communities they serve. They are often the critical link to wellness and prevention programs that can mean so much to local families.  And at HRSA, we find the work of these outreach workers invaluable in our continuing effort to reach as many people in need as possible. We know many of these outreach workers face a host of unique workforce issues in spite of their commitment to serve.  As we go forward, we must get a better handle on these issues so that we can keep the efforts of community health workers going well into the future.
 
We also recognize the ongoing need to develop more health care leaders with a specific knowledge about the border’s many diverse communities.  Each year HRSA, through its grant programs, comes into contact with many such talented individuals, and we would like to encourage grantees to become more involved in the larger ongoing health care discussion.  Mejorando la Salud, or Border Voices for Better Health, will help us identify local border health leaders, expand their focus to the state and national level, and help create a cadre of leaders better prepared to give voice to border health concerns.  This program is currently in the planning stage.  HRSA hopes to solicit applications for the first cohort of participants in the coming months. 
 
We know that you face many workforce challenges in this region. And we believe with creativity and innovation we can work to address issues as they arise and produce positive outcomes as long as we all work together.
 
At HHS and HRSA, we also continue to place critical importance on having high quality prevention programs in place. Right here along the border, I know you are seeing more and more patients with costly chronic diseases like diabetes, asthma, obesity, heart disease and cancer.
 
There is growing support for HRSA’s Health Disparities Collaboratives and these are a vital element in our status as a model for primary care in quality and chronic care management. 
 
Health centers and their patients increasingly see the value of participating in the Collaboratives, especially in the last two years. 
 
After starting with 1,685 patients in March of 1999, Collaboratives have enrolled over 400,000 (401,212) patients as of July 2005.
 
In the diabetes registry, health center patients are seeing improved clinical outcomes.  The results are dramatic.  Contrary to national trends, health centers are seeing decreases in our diabetes rates!  Patients’ average HbA1c is currently at 7.87, down from 7.96 last year at the same time.
 
We see these results even as the total diabetes registry has increased from 15,045 in July 2000 to 249,032 patients by July of this year.
 
Gateway Community Health Center in Laredo is in the process of establishing a training center to train three Texas health centers located near the U.S.-Mexico Border on several integral components of Diabetes/Cardiovascular Diseases, utilizing the Promotora Model as an extender of the medical team. 
 
The Salud Para Su Corazon Project, or Your Heart Your Health, promotes cardiovascular health along the Border to increase the quality and years of life and eliminate disparities in select border counties.  There are four health centers involved in this project: Mariposa Community Health Center in Nogales, Ariz.; Centro San Vicente in El Paso; Gateway Community Health Center in Laredo; and North County Health Services in San Mateo, Calif..
 
HRSA, in partnership with National Center for Farmworker Health, is sponsoring the U.S./Mexico Border Binational Health E-Group.  The purpose of this E-Group is to establish a mechanism for communication among and between U.S. and Mexico health professionals in order to identify common health and environmental problems which impact the status of public health along the border region. 
 
HRSA is also working with the National Center for Farmworker Health on an assessment of community health centers’ ability to address respiratory and cardiovascular illness related to air pollution.  The purpose of this project is to assess the resources currently available in selected health centers along the border, and to determine their level of knowledge and need for additional information in order to provide appropriate promotion of respiratory health, and prevention of contamination and disease as a result of exposure to airborne contaminants. 
 
I also want to talk a bit about the implementation of Medicare’s Prescription Drug Coverage. HRSA’s sister agency, the Centers for Medicare and Medicaid Services – CMS – has the lead on this effort, which will extend prescription drug coverage for the first time to all 43 million Medicare beneficiaries, giving them substantial help in paying for their drugs.
 
It’s now time for everyone with Medicare to start thinking about their options under the new plan.  Some important dates are arriving soon:
 
This month will begin CMS’ massive public education campaign to explain the new prescription drug coverage.  Specifically, a copy of the “Medicare & You 2006 Handbook” will be available on CMS’ and every Medicare beneficiary should have received a copy by mail by Oct. 15. 
 
In late October, CMS will mail auto-enrollment information to dual-eligible Medicare beneficiaries to inform them of the drug plan they will be enrolled in unless they select a different one. 
 
Medicare beneficiaries can begin to enroll in a specific plan on Nov. 15; coverage, of course, begins Jan. 1.
 
HRSA’s goal, of course, is to help CMS implement the new drug benefit as smoothly as possible.  As we receive additional information from CMS, HRSA will do our part to help our grantees and their patients understand their choices and make good decisions.
 
At HHS and HRSA, we sincerely hope that this year’s Border Binational Health Week is successful beyond anything we imagined.  
 
Keep in mind that as we collaborate and cooperate across borders and other traditional barriers, we also strengthen the ties that bind us together. We demonstrate for all to see that individuals working together can make a real and lasting difference in the lives of others.
 
In the weeks and months ahead, I look forward to continuing this marvelous endeavor so that border residents and their families can lead much healthier lives. Thank you for listening.