99–006 

112TH CONGRESS REPT. 112–66 " ! HOUSE OF REPRESENTATIVES 1st Session Part 1 

TO REPEAL MANDATORY FUNDING FOR SCHOOL-BASED 

HEALTH CENTER CONSTRUCTION 

APRIL 27, 2011.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. UPTON, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

together with 

DISSENTING VIEWS 

[To accompany H.R. 1214] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 1214) to repeal mandatory funding for school-based 

health center construction, having considered the same, report favorably thereon without amendment and recommend that the bill 

do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 8 

Statement of General Performance Goals and Objectives .................................... 8 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 8 

Earmark ................................................................................................................... 8 

Committee Cost Estimate ....................................................................................... 8 

Congressional Budget Office Estimate ................................................................... 8 

Federal Mandates Statement ................................................................................. 10 

Advisory Committee Statement .............................................................................. 10 

Applicability to Legislative Branch ........................................................................ 10 

Section-by-Section Analysis of the Legislation ...................................................... 10 

Changes in Existing Law Made by the Bill, as Reported ..................................... 10 

Dissenting Views ..................................................................................................... 12 


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PURPOSE AND SUMMARY

H.R. 1214, a bill to repeal mandatory funding for school-based 

health center construction was introduced on March 29, 2011, by 

Rep. Michael Burgess (R–TX), and referred to the Committee on 

Energy and Commerce. 

The purpose of H.R. 1214 is to reduce federal spending, deficits, 

and debt by repealing mandatory programs with limited Congressional oversight. 

BACKGROUND AND NEED FOR LEGISLATION

The Patient Protection and Affordable Care Act (PPACA) contained numerous provisions that contained mandatory spending for 

public health programs that have been traditionally discretionary 

in nature. In contrast the health care bill that passed the House, 

H.R. 3962, contained a division dedicated to public health and 

workforce issues but programs under that division did not contain 

mandatory appropriations but rather were authorizations subject to 

future appropriations. 

The federal government is now borrowing 42 cents of every dollar 

it spends. The current projected deficit for this fiscal year is $1.6 

trillion while the national debt has exceeded $14 trillion. 

Section 4101(a) of PPACA provides $50 million a year through 

2014 for construction, land acquisition and other capital costs for 

School-Based Health Centers (SBHCs). However, there is an express prohibition in the law on using these funds for personnel or 

providing health care services. Section 4101(b) of PPACA authorized a separate discretionary grant program to provide care at 

these clinics. This program was not provided mandatory funding 

and the President’s budget did not request any money for the grant 

program that actually provides care. H.R. 1214 does not repeal section 4101(b) of PPACA. Providing funds for construction without 

funds to staff these clinics and provide health services is an incoherent policy. 

Supporters of the program claim that any school based health 

center that receives funds must indicate how the school based 

health center will support its operating costs. However, there is no 

guarantee that the health center will be able to sustain its operation in the future. Traditionally in the context of community 

health centers, Congress has provided grants to help offset the cost 

of operating the center, not for construction costs. This ensures 

that federal dollars are not wasted to build centers that may never 

provide care. The program under Section 4101(a) of PPACA provides funds for the construction of school based health centers, the 

purchase of land for a center, or for capital equipment cost with no 

guarantee the center will ever see patients. 

Additionally, the stimulus and the health care law each provided 

$1.5 billion for the construction of community health centers. Many 

school based health centers qualified to receive grants from this 

funding. Providing an additional $50 million a year for additional 

construction grants is duplicative and unwarranted particularly in 

these economic times. 


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HEARINGS

The Committee on Energy and Commerce held a hearing on draft 

legislation that became H.R. 1214 on March 9, 2011. The following 

witnesses testified at the hearing: 

• The Honorable Ernest J. Istook, The Heritage Foundation 

• Dr. John Goodman, President and CEO, National Center 

for Policy Analysis 

• The Honorable Joseph F. Vitale, New Jersey State Senate 

COMMITTEE CONSIDERATION

H.R. 1214 was introduced by Mr. Michael Burgess on March 29, 

2011, and was referred to the Committee on Energy and Commerce. 

On March 31, 2011, the Subcommittee on Health met in open 

markup session to consider H.R. 1214. Subsequently, the Subcommittee ordered H.R. 1214 favorably reported by a recorded vote 

of 14–11. 

On April 5, 2011, the Energy and Commerce Committee met in 

open markup session to consider H.R. 1214. Subsequently, the 

Committee ordered H.R. 1214 favorably reported by a vote of 27– 

15. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. 


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COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the oversight findings and recommendations of 

the Committee are reflected in the descriptive portions of this report, including the finding that reigning in mandatory spending is 

necessary to avoid a debt crisis. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the performance goals and objectives of 

the Committee are reflected in the descriptive portions of this report, including the goal that reigning in mandatory spending is 

necessary to avoid a debt crisis. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee finds that H.R. 1214 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARK

In compliance with clause 9(e), 9(f), and 9(g) of rule XXI, the 

Committee finds that H.R. 1214 contains no earmarks, limited tax 

benefits, or limited tariff benefits. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate provided by 

the Congressional Budget Office pursuant to section 402 of the 

Congressional Budget Act of 1974: 

H.R. 1214—A bill to repeal mandatory funding for school-based 

health center construction 

Summary: H.R. 1214 would repeal a program established by the 

Patient Protection and Affordable Care Act (PPACA) that provides 

grant funds to eligible entities to establish health centers in schoolbased settings and would rescind any unobligated funds appropriated to that program. 

CBO estimates that enacting the legislation would decrease direct spending by $100 million over both the 2012–2016 period and 

the 2012–2021 period. Pay-as-you-go procedures apply because enacting the legislation would affect direct spending. 

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA). 


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1 If the bill were to be enacted sooner than the end of fiscal year 2011, a larger unobligated 

balance may remain than is estimated here. In that case, the amount of budget authority that 

could be rescinded by this legislation would increase, resulting in a corresponding increase in 

savings. 

Estimated cost to the federal government: The estimated budgetary impact of H.R. 1214 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 

By fiscal year, in millions of dollars— 

2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2012– 

2016 

2012– 

2021 

CHANGES IN DIRECT SPENDING 

Estimated Budget Authority ............ ¥50 ¥50 0 0 0 0 0 0 0 0 ¥100 ¥100 

Estimated Outlays ........................... ¥23 ¥50 ¥28 0 0 0 0 0 0 0 ¥100 ¥100 

Note: Numbers may not sum to totals because of rounding. 

Basis of estimate: For this estimate, CBO assumes that the legislation will be enacted by the end of September 2011.1 CBO estimates that H.R. 1214 would prevent the Health Resources and 

Services Administration from obligating any unobligated funds appropriated by PPACA for the construction and renovation of health 

centers in school-based settings. CBO expects that $100 million of 

the $200 million appropriated under PPACA for those health centers will be obligated by the time the bill is enacted. As a result, 

CBO estimates that enacting H.R. 1214 would reduce direct spending by the remaining unobligated amount: $100 million. Those savings would fall in fiscal years 2012, 2013, and 2014. 

Pay-as-you-go considerations: The Statutory Pay-As-You-Go Act 

of 2010 establishes budget reporting and enforcement procedures 

for legislation affecting direct spending or revenues. The net 

changes in outlays and revenues that are subject to those pay-asyou-go procedures are shown in the following table. Enacting H.R. 

1214 would have no impact on federal revenues. 

CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 1214, AS ORDERED REPORTED BY THE 

HOUSE COMMITTEE ON ENERGY AND COMMERCE ON APRIL 5, 2011 

By fiscal year, in millions of dollars— 

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2011– 

2016 

2011– 

2021 

NET DECREASE (¥) IN THE DEFICIT 

Statutory PayAs-You-Go 

Impact ...... 0 ¥23 ¥50 ¥28 0 0 0 0 0 0 0 ¥100 ¥100 

Note: Numbers may not sum to totals because of rounding. 

Intergovernmental and private-sector impact: The bill contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. By rescinding grant funds, the bill would decrease the 

amount of assistance that state, local, and tribal governments receive to construct or equip school-based health centers. 

Estimate prepared by: Federal Costs: Lisa Ramirez-Branum; Impact on State, Local, and Tribal Governments: Lisa RamirezBranum; Impact on the Private Sector: Sarah Axeen. 

Estimate approved by: Holly Harvey, Deputy Assistant Director 

for Budget Analysis. 


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FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office 

pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Repealing Mandatory Funding for School Based Health 

Center Construction. 

H.R. 1214 would repeal Section 4101(a) of the Patient Protection 

and Affordable Care Act which provides mandatory funding for the 

construction of school based health centers. The grants under Section 4101(a) are prohibited from being used to provide health service or for personnel. The legislation would rescind unobligated 

funds made available under Section 4101(a). 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets and existing law in which no 

change is proposed is shown in roman): 

PATIENT PROTECTION AND AFFORDABLE CARE ACT 

* * * * * * * 

TITLE IV—PREVENTION OF CHRONIC DISEASE AND 

IMPROVING PUBLIC HEALTH 

* * * * * * * 

Subtitle B—Increasing Access to Clinical Preventive 

Services 

SEC. 4101. SCHOOL-BASED HEALTH CENTERS. 

ø(a) GRANTS FOR THE ESTABLISHMENT OF SCHOOL-BASED HEALTH

CENTERS.— 

ø(1) PROGRAM.—The Secretary of Health and Human Services (in this subsection referred to as the ‘‘Secretary’’) shall establish a program to award grants to eligible entities to support the operation of school-based health centers. 

ø(2) ELIGIBILITY.—To be eligible for a grant under this subsection, an entity shall— 


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ø(A) be a school-based health center or a sponsoring facility of a school-based health center; and 

ø(B) submit an application at such time, in such manner, and containing such information as the Secretary may 

require, including at a minimum an assurance that funds 

awarded under the grant shall not be used to provide any 

service that is not authorized or allowed by Federal, State, 

or local law. 

ø(3) PREFERENCE.—In awarding grants under this section, 

the Secretary shall give preference to awarding grants for 

school-based health centers that serve a large population of 

children eligible for medical assistance under the State Medicaid plan under title XIX of the Social Security Act or under 

a waiver of such plan or children eligible for child health assistance under the State child health plan under title XXI of 

that Act (42 U.S.C. 1397aa et seq.). 

ø(4) LIMITATION ON USE OF FUNDS.—An eligible entity shall 

use funds provided under a grant awarded under this subsection only for expenditures for facilities (including the acquisition or improvement of land, or the acquisition, construction, 

expansion, replacement, or other improvement of any building 

or other facility), equipment, or similar expenditures, as specified by the Secretary. No funds provided under a grant awarded under this section shall be used for expenditures for personnel or to provide health services. 

ø(5) APPROPRIATIONS.—Out of any funds in the Treasury not 

otherwise appropriated, there is appropriated for each of fiscal 

years 2010 through 2013, $50,000,000 for the purpose of carrying out this subsection. Funds appropriated under this paragraph shall remain available until expended. 

ø(6) DEFINITIONS.—In this subsection, the terms ‘‘schoolbased health center’’ and ‘‘sponsoring facility’’ have the meanings given those terms in section 2110(c)(9) of the Social Security Act (42 U.S.C. 1397jj(c)(9)).¿ 

* * * * * * * 


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1Strolin-Goltzman J, The Relationship Between School-Based Health Centers and the Learning 

Environment, Journal of School Health, 2010; 80(30): 153–159; Van Cura M, The Relationship 

Between School-Health Centers: Rates of Early Dismissal from School and Loss of Seat Time, 

Journal of School Health. 2010; 80(8): 317–377; Walker SC, Kerns S, Lyon AR, Brun EJ, Cosgrove TJ, Impact of School-Based Health Center Use on Academic Outcomes, Journal of Adolescent Health. 2010:46(3): 251–257. 2Strozer J, Juszczak L, Ammerman A, 2007–2008 National School-Based Health Care Census, 

National Assembly on School-Based Health Care (2010). 3 National Assembly on School-Based Health Care, About School-Based Health Care (online at 

http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.2561553/k.843D/about_sbhcs.htm). 4 Juszczak L, Melinkovich P, Kaplan D, Use of Health and Mental Health Services by Adolescents Across Multiple Delivery Sites, Journal of Adolescent Health. 2003; 32S:108–118. 

DISSENTING VIEWS 

We, the undersigned members of the Committee on Energy and 

Commerce, oppose the passage of H.R. 1214, a bill to repeal the 

program to fund school-based health center construction (established in the Patient Protection and Affordable Care Act). Accordingly, we submit the following comments to express our concerns 

about this very misguided and deeply devisive legislation. 

INTRODUCTION AND BACKGROUND

Teachers and other educators, parents, and students alike all 

agree: Students perform better in the classroom when they come to 

school healthy and ready to work. And study after study has shown 

this to be true.1

School-based health centers (SBHCs) were initially conceived and 

are specifically designed to help achieve this goal. In essence, they 

bring the doctor’s office to a school so that students can avoid unnecessary health-related absences and remain in the classroom prepared to study and learn. 

Currently, there are more than 1,900 SBHCs across the country 

in 44 states and the District of Columbia, providing access to 

health-related services to some 2 million children and adolescents.2

Located in schools or on school grounds, SBHCs share a number 

of characteristics in common. In general, SBHCs: • Provide a comprehensive range of health-related services, including check-ups and mental health services. • Employ a multidisciplinary team of providers, including physicians, nurse practitioners, social workers, and other health professionals. 

• Provide clinical services through a qualified health provider 

such as a hospital, health department, or private medical practice.3

• Provide services to medically underserved children and adolescents who lack access to a primary health care provider.4

In addition—and at their core—SBHCs are community-based and 

student-centered organizations. Each SBHC has an advisory board 

made up of parents, youth, and family organizations representing 

the community. These groups give guidance on SBHC planning and 


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5 National Assembly on School-Based Health Care, About School-Based Health Care (online at 

http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.2561553/k.843D/about_sbhcs.htm). 6 National Assembly on School-Based Health Care, Funding (online at http://www.nasbhc.org/ 

site/c.jsJPKWPFJrH/b.3844823/k.7FCD/Basics_Funding.htm). 7 Juszczak L, Melinkovich P, Kaplan D, Use of Health and Mental Health Services by Adolescents Across Multiple Delivery Sites, Journal of Adolescent Health. 2003; 32S:108–118. 8Kisker EE, Brown RS, Do SBHCs Improve Adolescents’ Access to Health Care, Health Status, 

and Risk-Taking Behavior?, Journal of Adolescent Health. 1996; 18:335–343. 9Strolin-Goltzman J, The Relationship Between School-Based Health Centers and the Learning 

Environment, Journal of School Health. 2010; 80(30): 153–159. 10 Van Cura M, The Relationship Between School-Health Centers, Rates of Early Dismissal 

from School and Loss of Seat Time, Journal of School Health. 2010; 80(8): 317–377. 11 Adams EK, Johnson V, An Elementary SBHC: Can It Reduce Medicaid Costs?, Pediatrics. 

2000; Apr;105 (4 Pt. 1): 780–788. 12Strozer J, Juszczak L, Ammerman A, 2007–2008 National School-Based Health Care Cen- sus, National Assembly on School-Based Health Care (2010). 13Lake Research Partners (poll conducted on behalf of the W.K. Kellogg Foundation) (2006). 14The ACA is comprised of two public laws, P.L. 111–148 and P.L. 111–152. 15 ACA Section 4101. This is not the first instance in which Congress has acknowledged the 

value of SBHCs. Under the federal Child Health Insurance Program, states are allowed to provide Medicaid coverage for services furnished through SBHCs (Social Security Act Section 

2103(c)(8)). 16 ACA Section 4101(a). 

oversight activities. And services offered by SBHCs are designed to 

meet the specific physical and behavioral health needs of the children and adolescents living in the community they assist.5 In brief, 

SBHCs exist only in those places that want them and operate 

strictly in accordance with local standards and policies. 

Most SBHCs are supported through a diversified portfolio of 

funding sources, including federal, state, and local grants; foundations; corporations and other private sector sponsors; patient revenue; and in-kind contributions. According to one national survey, 

state government has provided well over half (65%) of all grant 

funding while the federal government has provided slightly more 

than one-quarter (28%). The same survey found that some 80% of 

all SBHCs bill students’ health insurance for the service provided.6

As a result of all this, SBHCs have been enormously successful 

in helping to improve students’ access to health care; 7 promote 

healthy behaviors among children and adolescents; 8 improve students’ academic performance; 9 decrease school absenteeism; 10 and 

reduce health care expenditures.11 This in turn, has lead to a proliferation in the growth of SBHCs around the country. Indeed, over 

the last 15 years, the number of SBHCs has doubled.12

This powerful track record has engendered strong support for 

SBHCs—across the country and across the political spectrum. Public support for the centers is also robust. Polling data indicate that 

two-thirds of voters support the provision of health care services in 

school settings.13

In recognition of the contributions SBHCs have made in addressing the health care needs of youth most in need, as well as the 

pent-up demand for the establishment of new SBHCs and for improvements to existing programs, a new authority was created in 

the Patient Protection and Affordable Care Act (ACA) 14 to provide 

support for SBHCs.15 This authority includes two components. The 

first establishes a mandatory spending program ($50 million for 

each of FY 2010 through 2014) for the construction, expansion, or 

replacement (other facility improvements) of SBHCs.16 The second 

establishes a discretionary spending program (‘‘such sums as may 


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17 ACA Section 4101(b). 18 National Assembly on School-Based Health Care, Why Should We Keep Funding for SchoolBased Health Centers under PPACA? (online at http://www.google.com/#sclient=psy&hl= 

en&source=hp&q=NASBHC+why+should+we+keep+funding+for+school+based+health+centers+ 

under+PPACA&aq=f&aqi=&aql=&oq=&pbx=1&bav=on.2,or.r_gc.r_pw.&fp=38378e84586d88e6). 19 Id. 20 Ironically, Republicans rejected an amendment offered by Rep. Towns during the full Committee mark up of H.R. 1214 structured to address this very concern, highlighting the hypocrisy 

of this argument. Under the amendment, mandatory spending would be provided for SBHC operations rather than for construction/renovations. (House Committee on Energy and Commerce, 

Business Meeting to Mark Up H.R. 1213 et al., 112th Cong., pp. 197–209) (Apr. 5, 2011) (transcript of the proceeding). 

be necessary’’ for each of FY 2010 through 2014) for the operations 

of SBHCs.17 H.R. 1214 seeks to terminate the former. 

To date, some 350 applicants in 46 states and the District of Columbia are seeking funding through the first round of competitive 

grants to be awarded under the new SBHC construction/renovation 

authority.18 (This includes 45 applications from centers and/or 

school districts represented by members of the Committee.) The 

vast majority of these projects are ‘‘shovel ready.’’ 19 All are eager 

to carry on with the good and important work for which SBHCs 

have become well known and are greatly appreciated. 

SBHC SUSTAINABILITY AND FUNDING SUPPORT

Despite the many contributions of SBHCs to child and adolescent 

health, the health care savings they produce, the strong bi-partisan 

and public support they engender, and both the need and desire to 

expand their presence in communities across the country, Republicans are determined to bring the SBHC construction/renovation 

program to an end. We believe this position is unfounded and very 

short-sighted. 

In addition to their main objection—the program’s mandatory 

spending requirement (discussed below)—Republicans argue in this 

report that the program should be repealed because (1) SBHCs receiving construction/renovation funds may not be able to sustain 

their operations,20 and (2) other potential funding sources are 

available to provide support for SBHC construction/renovation efforts. Neither of these claims accurately reflects program reality, 

especially the competitive environment in which applicants find 

themselves today. 

Program sustainability is a top concern for virtually all grant 

programs funded by the federal government—and for us as well. 

No review committee, no program official, no department secretary, 

and no member of Congress wants to provide monetary support to 

a program applicant whose future—financial, operational or otherwise—is in serious doubt or in jeopardy. The SBHC construction/ 

renovation program is viewed no differently and thus, has been designed to ensure that once their capital needs have been met, 

SBHCs will be—and will continue to be—in a position to sustain 

their work. 

The application form issued by the Health Resources and Services Administration (HRSA) (the agency within the Department of 

Health and Human Services charged with managing the program) 

underscores this point. Among other things, applicants to the 

School-Based Health Center Capital (SBHCC) Program are required to: 


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21 Bureau of Primary Care, HRSA, U.S. Department of Health and Human Services, Grants 

for School-Based Health Center Capital Program, Announcement Number: HRSA–11–127, 

p. 13 (Oct. 4, 2010) (online at https://grants.hrsa.gov/webExternal/DisplayAttachment.asp? 

ID=7921A744-841E-40DF-B93E-CC6B0130736E). 22P.L. 111–5 (Feb. 17, 2009; 123 stat. 175). 23 ACA Section 10503. 24 National Assembly on School-Based Health Care, Why Should We Keep Funding for SchoolBased Health Centers in PPACA? (online at http://www.google.com/#sclient=psy&hl=en&source 

=hp&q=NASBHC+why+should+we+keep+funding+for+school+based+health+centers+under+ 

PPACA&aq=f&aqi=&aql=&oq=&pbx=l&bav=on.2.or.rlgc.rlpw.&fp=38378e84586d88e6). 

• Describe the overarching impact of the SBHCC proposal on the 

operational budget and how the proposal will promote organizational sustainability once the project has been completed. • Indicate how the applicant organization will support operating 

costs, including increases in utilities, daily maintenance and repair, 

and capital investment for the identified project(s). • Explain how the SBHC will maintain access/services resulting 

from the project(s) within its existing/anticipated operational budget. • Describe how the applicant organization will leverage other 

primary health services provided in the service area. • If appropriate, describe how the organization will pay for or retire the capital debt related to the proposal. • Describe the plan for recruiting and retaining key management 

staff and health care providers as appropriate for achieving the 

proposed staffing plan for the project(s).21

With such requirements in place, it is clear that HRSA intends 

to support only those SBHCs that are ‘‘in it for the long haul’’ and 

not for the short term. We agree that it should not be otherwise 

and believe HRSA has established adequate application and application review requirements to meet this standard of sustainability. 

We also believe that SBHC construction/renovation needs have 

not been and will not be met through other funding authorities. 

SBHCs were not eligible for direct support under the 2009 stimulus 

package (the American Recovery and Reinvestment Act, or ARRA, 

as it is frequently known) that included $1.5 million in construction/renovation funds for community health centers (CHCs).22 Nor 

are they eligible to directly participate in the more recent $1.5 million CHC construction/renovation program established in the 

ACA.23 In both instances, only programs funded through Section 

330 of the Public Health Service Act are qualified to apply for funding. While SBHCs that are affiliated with CHCs may benefit from 

these programs, they can only do so only if their sponsoring CHC 

elects to apply for construction/renovation funds—they cannot act 

on their own. Moreover, less than 25% of SBHCs are engaged in 

such a relationship, leaving the vast majority of centers outside the 

reach of these laws.24 But even if the percentage were higher, there 

would be insufficient funds to adequately address the capital needs 

of both CHCs and SBHCs. It is for this reason that the SBHCC 

program was created—to provide a dedicated source of funding targeted solely on SBHCs. 

MANDATORY SPENDING

Republicans chief objection to the SBHC construction/renovation 

program lies in their opposition to its being funded through mandatory spending. Given the program’s purpose, SBHCs’ track record 


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25See, e.g., Republican comments made in support of SBHCs during the full Committee mark 

up of H.R. 1215. (House Committee on Energy and Commerce, Business Meeting to Mark Up 

H.R. 1213 et al., 112th Cong. (Apr. 5, 2011) (transcript of the proceeding): 

• Rep. Burgess: ‘‘I am not against health centers. I want to do more in this realm. . . .’’ (p. 

157 of transcript of the proceeding). • Rep. Burton: ‘‘We certainly support . . . school based health clinics. I have gone to openings 

in my district. I have supported funding for . . . school based clinics.’’ (p. 186 of transcript of 

proceeding). 26For examples of various federal programs that are supported through mandatory spending, 

see Committee on Energy and Commerce, Democratic Staff, The Pitts Proposal to Block Mandatory Funding in the Affordable Care Act (Mar. 9, 2011) online at http://democrats. 

energycommerce.house.gov/sites/default/files/imageluploads/Fact%20Sheetl03.09.11.pdf). 27 House Committee on Energy and Commerce, Subcommittee on Health, Hearing on Setting 

Fiscal Priorities in Health Care Funding, 112th Cong. (Mar. 9, 2011). 28 House Committee on Energy and Commerce, Subcommittee on Health, Business Meeting to 

Mark Up H.R. 1213 et al., 112th Cong. (Mar. 31, 2011); House Committee on Energy and Commerce, Business Meeting to Mark Up H.R. 1213, et al., 112th Cong. (Apr. 5, 2011). 29 Although the House of Representatives has passed legislation to repeal the ACA, that legislation will not become law since the Senate has defeated the proposal. (H.R. 2, Repealing the 

Job-Killing Health Care Law Act, passed the House of Representatives in January 2011 (Congressional Record, H322–323 (Jan. 11, 2011)). The Senate defeated a similar proposal a month 

later. (Congressional Record S475 (Feb. 2, 2011)). 

of accomplishment to date, and general Republican support for 

SBHCs,25 it comes as a great disappointment that they have taken 

this position. 

This is especially true since both Republican and Democratic 

members of Congress frequently make choices—often very difficult 

choices—about which programs should benefit from mandatory 

spending.26 Congress made such a choice in establishing the SBHC 

construction/renovation program in 2010. In our view, that decision 

was fully considered and well grounded. We learned nothing during 

either the hearing on H.R. 2014 27 or the mark up of the legislation 28 that would bring us to a different conclusion. Indeed, in the 

14 months since the ACA was signed into law, our resolve to see 

this program move forward has only grown stronger. 

AN ANTI-HEALTH REFORM IDEOLOGICAL AGENDA

In our view, the Republicans’ three-pronged opposition to the 

SBHC construction/renovation program is without merit. Moreover, 

we do not believe their arguments in support of H.R. 1214 go to 

the heart of their defiance to end the program. 

Rather, we believe H.R. 1214 represents the Republicans’ new 

line of attack to disrupt, dismantle, and ultimately destroy the 

ACA—even those programs that make good health policy sense, in 

or out of the health reform law. What they have not been able to 

achieve whole cloth,29 Republicans are now attempting to do piece 

by piece. H.R. 1214 puts SBHCs and the SBHC construction/renovation program in the frontline of this ongoing assault. 


tjames on DSKG8SOYB1PROD with REPORTS
17 

From our perspective, this is not where this program should be. 

Instead, it should remain exactly what it is and where it is—at the 

forefront of building our capacity to provide access to health services to children and adolescents in need. 

HENRY A. WAXMAN. 

DORIS O. MATSUI. 

MIKE DOYLE. 

ANTHONY WEINER. 

CHARLES A. GONZALEZ. 

ELIOT L. ENGEL. 

JOHN D. DINGELL. 

DIANA DEGETTE. 

TAMMY BALDWIN. 

G.K. BUTTERFIELD. 

FRANK PALLONE, Jr. 

ANNA G. ESHOO. 

DONNA M. CHRISTENSEN. 

EDOLPHUS TOWNS. 

LOIS CAPPS. 

EDWARD J. MARKEY. 

JAY INSLEE. 

JAN SCHAKOWSKY. 

BOBBY L. RUSH. 

GENE GREEN. 

Æ 


tjames on DSKG8SOYB1PROD with REPORTS