On March 23, the Senate Health, Education, Labor, and Pensions Subcommittee on Public Health held a hearing to examine health safety nets for low-income individuals. Subcommittee Chair Bill Frist (R-TN) opened the hearing, saying, “As we look at ways to improve access to health care, we must support the lifesaving role of our safety net providers in serving our most vulnerable populations who can’t afford health care.” The hearing focused on the National Health Service Corps (NHSC), the Consolidated Health Centers Program, and the Community Access Program (CAP). All three programs are designed to provide health care services to uninsured and underserved populations and are administered through the Health Resources and Services Administration (HRSA).
NHSC was established in 1972 to place health care providers in areas where there is a shortage. Over four million individuals in over 4,000 shortage areas receive their health care through NHSC; however, only 12.5 percent of the overall need is being met by the program. Addressing the need to provide additional funding for the program, Dr. Thomas M. Dean of the National Rural Health Association told the subcommittee, “Just last year, the Corps had to turn away half the underserved communities that requested a provider, because the program did not have the necessary funding to support additional clinicians.”
The Consolidated Health Centers Program supports community health centers, migrant health centers, and health centers for the homeless and residents of public housing. These health centers serve nine million people. Of that number, 41 percent are uninsured, with children representing one-third of the uninsured. Of the patients that are seen at health centers, 40 percent are children and 30 percent are women of childbearing age. Dr. Claude Earl Fox of HRSA said that health centers have been extremely effective in reaching their targeted populations. “Health Center low birth weights approximate the national average for all infants and are lower than the national average for African American infants,” he said, adding: “Women served at Health Centers received more up-to-date mammograms than women in the general population.”
CAP helps communities develop infrastructure to participate in integrated health systems. The program received $25 million in FY2000, although it has not been authorized. Highlighting the importance of the program, Dr. Fox told the subcommittee that “the level of interest and commitment evidenced to date suggests that communities across the country are eager to work together to develop better ways to improve access to care for the uninsured and are greatly in need of federal assistance to kick start their efforts.”
Agreeing about the importance of the programs in serving the uninsured and underserved, Janet Heinrich of the General Accounting Office (GAO) told the subcommittee that “certain improvements would enhance the effectiveness of these programs.” According to a March 2000 GAO report, “Recent developments in the health care environment—such as the steady growth in the number of uninsured, a dramatic increase in the use of managed care by Medicaid, and increased competition and consolidation among health care providers—have presented new challenges.” The GAO recommends that health centers form partnerships and participate in managed care in order to be more successful. Additionally, the GAO recommends that HRSA work with health centers to better identify effects of Medicaid program changes, plan strategically, and participate in managed care. The GAO also recommends that HRSA be more timely in its problem identification and intervention with health centers.
