Subcommittee on Health Hearing, RE: H.R. 1343, H.R. 2915, and H.R. 4230
WASHINGTON, DC,
Dec 4, 2007 -
H.R. 1343, the Health Centers Renewal Act of 2007, would reauthorize the funding for a program that has been successful at meeting the health care access needs of many underserved populations. For many years, North Texans tried to navigate the complexities of the Federally Qualified Health Center program requirements and have just recently, after many years, secured one of these valuable community assets. But the need persists and we should take a hard look at the program. Many people still do not have regular access to basic primary care. Health centers need to be more integrated into existing health care institutions. Patients should be able to see specialists and access community hospital services without having to navigate a completely different system. The more difficult it is to get care, the less likely a patient is to follow through successfully. Also, patient education needs to be improved. Patients need to be involved in every aspect of their care in order to improve compliance with treatment and preventative care. Can health centers meet these challenges as they are currently structured or do we need to change the program to help them grow?
One of the ways we could help health centers is to provide the future physician workforce to staff them. H.R. 2915, the National Health Service Corps Scholarship and Loan Repayment Programs Reauthorization Act of 2007, is an attempt to address the physician workforce issue by throwing money at the problem. There is no doubt that the high cost of a medical education keeps many qualified students from becoming doctors, but I am not sure that increasing the size of an existing program is a sufficient solution. Rather than increasing the funding for this program, we should look for a way to address the underlying issues that drive students away from practicing primary care in needed areas. I’ve introduced H.R. 2584 that would provide more targeted investments into our future medical workforce, and I look forward to working with the Chairman on this bill.
Another issue on National Health Service Corps we need to address is how the Health Resources and Services Administration determines whether or not areas qualify as Health Professional Shortage Areas. Despite pleading with Centers for Medicare and Medicaid Services, Health and Human Services, Health Resources and Services Administration, and Louisiana officials at the highest levels in the nearly 3 years since the Storm, I remain baffled as to why all the most devastated parishes in the New Orleans area have not been classified as Health Professional Shortage areas. I know that National Health Service Corps gives preference in sending providers to Health Professional Shortage areas. So, these areas which are clearly still in great need, are not getting the health care professionals they need.
In a hearing before this committee on August 1, 2007, Chairman Stupak and I asked the Acting Surgeon General Kenneth Moritsugu to make sure that the New Orleans area has the health care providers it needs. His response was that they did not want to compete with the providers there. While I understand and respect that rationale, I remain concerned that the hospitals still do not have adequate funding and personnel to take care of the health care needs of that community.
I strongly support the National Health Service Corps, but Mr. Chairman, I would like some assurances that this money will be in the most appropriate, in other words, it will serve those in greatest need. Do we know if the National Health Service Corps adequately addressed the needs of the New Orleans area after Hurricane Katrina? More specifically, are there National Health Service Corps providers in the area now, and if so, how many and in what professions, settings, and specialties?
Finally, H.R. 4230, the School-Based Health Clinic Act of 2007, is quiet about many important issues. I believe in getting children the medical care they need regardless of their financial situation, but I do not believe that school-based clinics are the way to do it. Providing care without a parent’s supervision takes away that parent’s protection and decision-making capability. The first level of defense against medical errors is a patient speaking up and questioning the provider’s actions. At what age can a child be responsible for his or her own defense? Can a six year old know to ask about possible allergic reactions before being given a medication? And when the issue of birth control pills and abortion pills comes up in fifth grade, parents will not necessarily be told if their children are on the pill or have become pregnant. Also, the cost of this program may be higher than predicted. The education system is open to all children without proof of citizenship or status, so there is no way to reliably keep illegal immigrants from using tax payer dollars for routine health care from six years old until 18 or 20 years old. I look forward to hearing from the panel today about these issues.
