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45–244 2008

THE HEALTH CENTERS RENEWAL ACT OF 2007; 

THE NATIONAL HEALTH SERVICE CORPS 

SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS REAUTHORIZATION ACT OF 2007; AND 

THE SCHOOL-BASED HEALTH CLINIC ACT OF 

2007 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

ON 

H.R. 1343, H.R. 2915, H.R. 4230 

DECEMBER 4, 2007 

Serial No. 110–76 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

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COMMITTEE ON ENERGY AND COMMERCE 

JOHN D. DINGELL, Michigan, Chairman 

HENRY A. WAXMAN, California 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

ALBERT R. WYNN, Maryland 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

Vice Chairman 

LOIS CAPPS, California 

MIKE DOYLE, Pennsylvania 

JANE HARMAN, California 

TOM ALLEN, Maine 

JAN SCHAKOWSKY, Illinois 

HILDA L. SOLIS, California 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

DARLENE HOOLEY, Oregon 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

CHARLIE MELANCON, Louisiana 

JOHN BARROW, Georgia 

BARON P. HILL, Indiana 

JOE BARTON, Texas 

Ranking Member 

RALPH M. HALL, Texas 

J. DENNIS HASTERT, Illinois 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

BARBARA CUBIN, Wyoming 

JOHN SHIMKUS, Illinois 

HEATHER WILSON, New Mexico 

JOHN B. SHADEGG, Arizona 

CHARLES W. ‘‘CHIP’’ PICKERING, 

Mississippi 

VITO FOSSELLA, New York 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

PROFESSIONAL STAFF

DENNIS B. FITZGIBBONS, Chief of Staff 

GREGG A. ROTHSCHILD, Chief Counsel 

SHARON E. DAVIS, Chief Clerk 

DAVID L. CAVICKE, Minority Staff Director 

(II)

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(III) 

SUBCOMMITTEE ON HEALTH

FRANK PALLONE, JR., New Jersey, Chairman 

HENRY A. WAXMAN, California 

EDOLPHUS TOWNS, New York 

BART GORDON, Tennessee 

ANNA G. ESHOO, California 

GENE GREEN, Texas 

Vice Chairman 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

TOM ALLEN, Maine 

TAMMY BALDWIN, Wisconsin 

ELIOT L. ENGEL, New York 

JAN SCHAKOWSKY, Illinois 

HILDA L. SOLIS, California 

MIKE ROSS, Arkansas 

DARLENE HOOLEY, Oregon 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

JOHN D. DINGELL, Michigan (ex officio) 

NATHAN DEAL, Georgia, 

Ranking Member 

RALPH M. HALL, Texas 

BARBARA CUBIN, Wyoming 

HEATHER WILSON, New Mexico 

JOHN B. SHADEGG, Arizona 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

JOE BARTON, Texas (ex officio) 

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(V) 

C O N T E N T S 

Page 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 1 

Hon. Nathan Deal, a Representative in Congress from the State of Georgia, 

opening statement ................................................................................................ 3 

Hon. Joseph R. Pitts, a Representative in Congress from the State of Pennsylvania, opening statement .................................................................................... 5 

Hon. Gene Green, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 6 

Hon. Tim Murphy, a Representative in Congress from the State of Pennsylvania, opening statement .................................................................................... 8 

Hon. Tammy Baldwin, a Representative in Congress from the State of Wisconsin, opening statement ................................................................................... 9 

Hon. Joe Barton, a Representative in Congress from the State of Texas, 

opening statement ................................................................................................ 10 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 11 

Hon. Marsha Blackburn, a Representative in Congress from the State of 

Tennessee, opening statement ............................................................................ 12 

Hon. Edolphus Towns, a Representative in Congress from the State of New 

York, prepared statement .................................................................................... 14 

Hon. Tom Allen, a Representative in Congress from the State of Maine, 

prepared statement .............................................................................................. 14 

Hon. Darlene Hooley, a Representative in Congress from the State of Oregon, 

prepared statement .............................................................................................. 15 

Hon. Heather Wilson, a Representative in Congress from the State of Mexico, 

prepared statement .............................................................................................. 15 

WITNESSES

Dennis P. Williams, Deputy Administrator, Health Resources and Services 

Administration ..................................................................................................... 16 

Prepared statement .......................................................................................... 20 

Answers to submitted questions ............................................................................. 93 

Wilbert Jones, chief executive officer, Greater Meridian Health Clinic, Meridian, MS .................................................................................................................. 47 

Prepared statement .......................................................................................... 49 

Steven Miracle, executive director, Georgia Mountain Health Service, Incorporated, Morgantown, GA ................................................................................... 55 

Prepared statement .......................................................................................... 57 

Ricardo Guzman, chief executive officer, Community Health and Social Services Center, Incorporated, Detroit, MI ............................................................... 67 

Prepared statement .......................................................................................... 69 

Answers to submitted questions ...................................................................... 89 

Michael Ehlert, M.D., president, American Medical Student Association, Reston, VA .................................................................................................................. 70 

Prepared statement .......................................................................................... 73 

SUBMITTED MATERIAL

H.R. 2915, to amend the Public Health Service Act to reauthorize the National Health Service Corps Scholarship and Loan Repayment Programs ..... 109 

H.R. 4230, to amend the Public Health Service Act to establish a schoolbased health clinic program, and for other purposes ........................................ 111 

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VI 

H.R. 1343, the Public Health Service Act to provide additional authorizations 

of appropriations for health centers program under section 330 of such 

Act ......................................................................................................................... 104 

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(1) 

THE HEALTH CENTERS RENEWAL ACT OF 

2007; THE NATIONAL HEALTH SERVICE 

CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS REAUTHORIZATION ACT 

OF 2007; AND THE SCHOOL-BASED HEALTH 

CLINIC ACT OF 2007 

TUESDAY, DECEMBER 4, 2007 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 2:09 p.m., in room 

2322, Rayburn House Office Building, Hon. Frank Pallone, Jr., 

(chairman) presiding. 

Present: Representatives Gordon, Green, Allen, Baldwin, Deal, 

Pitts, Murphy and Burgess. 

Staff present: William Garner, Katherine Martin, Melissa 

Sidman, Brin Frazier, Bobby Clark, Chad Grant, and Ryan Long. 

OPENING STATEMENT OF HON. FRANK PALLONE JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. I call the meeting to order. 

First let me welcome everybody back from our 2 weeks at home. 

I know we have got a lot to do over the next 2 weeks, so I wish 

us luck on a bipartisan basis. I know it is not going to be easy. But 

today we are having a hearing of the subcommittee on three bills, 

H.R. 1343, the Health Centers Renewal Act; H.R. 2915, the National Health Service Corps Scholarship and Loan Repayment Reauthorization Act; and H.R. 4230, the School-Based Health Clinic 

Act. 

I would now recognize myself initially for an opening statement. 

And let me first mention those who have been the sponsors of these 

bills. The Health Centers Renewal Act was introduced by our Vice 

Chair Mr. Green, the National Health Service Corps Scholarship 

and Repayment Programs Reauthorization by Mr. Braley, and the 

School-Based Health Clinic introduced by Ms. Hooley from the committee. And I wanted to thank all of them for their hard work in 

putting together these different bills. 

And I also want to call attention to the efforts of two of our colleagues on the subcommittee, Representative Bart Gordon and 

Representative Tom Allen. Both Mr. Gordon and Mr. Allen have 

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2 

also introduced legislation that reauthorizes the National Health 

Service Corps Scholarship and Loan Repayment Programs. Though 

the hearing today is on H.R. 2915, I wanted them to know that the 

subcommittee will be working very closely with you and your staff 

as we move forward with this legislation, and I laud your efforts 

to address this important public health issue. 

As far as the community health centers, the first bill, access to 

health care obviously has been a priority for this Congress, especially since the number of uninsured Americans continues to rise. 

And for the 47 million Americans without health insurance, as well 

as the millions more who are underinsured, there are simply too 

few options for them to receive the medical treatment they need. 

But for the past 40 years there has been one place that Americans 

have been able to go to receive the medical treatment that they 

need and deserve regardless of their ability to pay, and those are 

our community health centers. Since the mid–1960’s our community health centers have served as a first line of defense to provide 

quality preventative and primary health care services in medically 

underserved communities. 

But as more and more Americans join the ranks of the uninsured, the demands of our States’ health centers are growing exponentially. Increased demand, coupled with aging facilities and difficulties in recruitment and retention of health professionals has 

placed tremendous strain on our health centers. Accordingly, it is 

critical that this Congress act quickly to strengthen our community 

health centers and help them fulfill the role they play in guaranteeing access to high-quality health services. 

The most important step we could take to accomplish this goal 

is to pass this legislation that would reauthorize the community 

health centers program for another 5 years and provide them with 

adequate resources. And I think we can all agree that the community health centers provide a vital service to all of our communities. 

We shouldn’t waste any time in helping them carry out a mission 

that is of fundamental importance to so many Americans. 

Now the second bill on, the National Health Service Corps, as I 

mentioned, this bill would ensure that underserved American communities have access to health care through the recruitment and 

support of health service professionals. According to the Health Resources and Services Administration, which administers the National Health Service Corps programs, and we are going to be hearing from Dr. Williams today, approximately 50 million people live 

in communities with no access to primary health care. The National Health Service Corps works to address this disparity by recruiting and retaining health professionals through scholarships, 

loan repayment, and placement programs to serve in those communities, and the impact of this program is immeasurable. Since 1972, 

more than 27,000 health professionals have served in the National 

Health Service Corps, including 4,000 current Corps members, who 

are caring for 4 million people in underserved urban and rural 

areas. Many of these Corps members will continue to serve in the 

health professional shortage area even after fulfilling their 2-year 

commitment. 

Ensuring that all Americans have access to quality health care 

is obviously important, but this bill would provide the necessary resmartinez on PROD1PC64 with HEARING

3 

authorization and funding in the amount of $300 million through 

2011 to support the National Health Service Corps and promote expanded access to care. And again I want to thank Mr. Braley, Mr. 

Allen, and Mr. Gordon for all their diligent work in drafting this 

legislation. And obviously this is a collective effort, and we are 

going to work forward to move this legislation in the next few 

weeks, or I should say certainly in the new year. I don’t think we 

are going to be doing much in the next few weeks. But in the new 

year. 

The last bill is the School-Based Health Clinic Act of 2007. Of 

the 47 million uninsured Americans, nearly 9 million are children. 

We have spent a lot of time on SCHIP and trying to address that, 

and although some of our programs are aimed at insuring children 

specifically, some of those programs that we have are successful, 

obviously we need to do more. We went through all that with the 

SCHIP, which is still ongoing. 

There still remain too many kids who have no access to the basic 

health care that they need. According to the AMA, children between the ages of 13 to 18 have the poorest health indicators. And 

over 70 percent of the children who need psychiatric treatment 

have no access to mental health services. We have the opportunity 

today to tackle this problem head on through this act, the SchoolBased Health Clinic Act. 

School-based health centers treat children in a place that is convenient for parents and guardians, and children are seen by caregivers they know and trust. These health centers identify students 

at risk for health and behavioral problems, and can monitor and 

treat children with chronic illnesses, thus reducing health-related 

school absences. And school-based health centers are currently located in over 1,700 schools around the country. There are many in 

my district. I remember dealing with them both here in Congress, 

as well as a State legislator, and they provide health care to children regardless of their ability to pay. In fact, 45 percent of kids 

treated at school-based health centers are uninsured, and 44 percent of the children treated at these centers are enrolled in either 

Medicaid, SCHIP, or other public coverage. 

Considering these statistics, it becomes clear that these health 

centers provide access to health care professionals to children who 

otherwise would have limited or no access to health care services. 

I just want to say that I think all these bills are very important. 

Mr. Green and the others have been asking for this hearing for 

some time. We are going to try to move these bills when we come 

back in January of 2008. 

And I just want to thank everybody for being here today, and I 

would now yield to our ranking member, Mr. Deal. 

OPENING STATEMENT OF HON. NATHAN DEAL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA 

Mr. DEAL. Thank you, Mr. Chairman. First of all, I would like 

to welcome our witnesses on both of our panels, thank them for 

their attendance today. I would especially like to introduce and 

welcome Steven Miracle, who is the CEO of the Georgia Mountains 

Health Services, which has a health center in Morganton, Georgia, 

which is in my district. I really need to send Steven back to medsmartinez on PROD1PC64 with HEARING

4 

ical school because how would you like to be able to tell somebody 

who asked you who is your doctor to say Dr. Miracle? You know, 

he does a great job as an administrator, but if we had that ‘‘doctor’’ 

in front of his name, that would be great. But thank you for being 

here today. 

The Community Health Center Program has been a huge success, I think, and an asset, as community health centers are an integral part of this country’s health delivery system which provide 

quality health care services to people and communities that would 

otherwise not have access to that care. Last Congress I showed my 

support for this program by introducing a bill that would have extended for 5 years the reauthorization of this plan. It did pass the 

House by a large margin, but unfortunately the Senate failed to act 

on the legislation. 

I understand the measure we are considering today has a much 

higher authorization level than the bill last year, and I look forward to hearing a justification for these increases because I believe 

we have to all continue to be good stewards of the program and of 

the taxpayers’ dollars that fund the program. 

As we evaluate changes to the program during this reauthorization, I hope the witnesses will speak to the staffing needs of health 

centers during times of emergency. In particular, I know some 

health centers’ medical staff had trouble as they sought to serve 

areas affected by Hurricanes Katrina and Rita because of the lack 

of liability protection. Some have also expressed an interest in expanding liability protection to physicians who volunteer their services at health centers, while others have some concerns about the 

composition of the board requirements for health centers. These are 

all issues that I hope we will have a chance to talk about briefly 

today as we consider reauthorizing this particular program. 

The National Health Service Corps provides an important incentive for health care providers to serve an area with a shortage of 

health professionals, it certainly goes without question. This is 

done primarily through scholarships and loans. And having had 

constituent service issues on a particular situation, I know that 

firsthand that at times scholarship recipients don’t always have the 

certainty about their career path when they accept the scholarship. 

And so therefore I look forward to hearing testimony about the effectiveness of the scholarships compared with the loan program in 

encouraging students to serve in shortage areas. 

We also will be looking at school-based health clinics, and I hope 

our witnesses will be able to tell us the most effective way to provide services for school-age underserved populations. 

This should be a good hearing as we evaluate these programs 

that help ensure that the medically underserved have access to 

care. I look forward to the testimony of the witnesses, and I yield 

back my time. 

Mr. PALLONE. Thank you. 

Next is the gentleman from Tennessee Mr. Gordon, who is one 

of the sponsors on the National Health Service Corps. 

Mr. GORDON. Thank you, Mr. Chairman. As we all know, the National Health Service Corps is to provide primary health care providers to underserved communities. Unfortunately, when the Corps 

was restructured in 2002, primary eye care was unintentionally exsmartinez on PROD1PC64 with HEARING

5 

cluded from the program. As a result, access to basic eye-care services at community health centers has been severely curtailed. 

Today less than 17 percent of all centers have optometrists on staff. 

This is concerning, as the populations served by the community 

health centers are at high risk for vision loss from blindness caused 

by glaucoma or diabetes. Half of all these cases of blindness in this 

population can be prevented if we can get them screened and treated early. 

Earlier this year I introduced legislation to address this problem 

by reinstating optometry as a covered service under the National 

Health Care Service Corps. Importantly, I would also note that the 

Institute of Medicine recognized optometry as a primary health 

care service in its report Primary Care: America’s Health in a New 

Era. 

Clarifying that optometry is a primary care service covered by 

the Corps is consistent with the Corps’ primary health care mission 

and will prevent much suffering and costs to society. The bill has 

81 cosponsors, including 15 from this committee, and is endorsed 

by the National Association of Community Health Care Centers— 

and to prevent blindness. 

We have talked about this several times, and I appreciate your 

comments of trying to work together on this issue. I know that 

really the only argument that I have heard against it is that if optometry is allowed, or if we correct this error that was made with 

optometry, it could open the door for others. And I would just say 

that is not a good argument against this. I think all primary care 

services ought to stand on their own, and if there is other additions, then they should be made. 

So again, Mr. Chairman, thank you for having this hearing, and 

thank you for your willingness to review these arguments. 

Mr. PALLONE. The gentleman from Pennsylvania Mr. Pitts. 

OPENING STATEMENT OF HON. JOSEPH R. PITTS, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA 

Mr. PITTS. Thank you, Mr. Chairman. 

I strongly support reauthorization of community health centers 

and the National Health Center Services Corporation Scholarship 

and Loan Repayment Program. For more than 35 years, the NHSC 

has been recruiting caring health professionals to serve in medically underserved communities where the need is the greatest, in 

rural areas, where the closest provider is often many miles away, 

and in inner-city neighborhoods, where economic and cultural barriers prevent people from seeking and receiving needed care. 

In the past, the NHSC has made great advances in improving access to quality health care services for millions of Americans who 

might otherwise be forced to do without. As we all know, the NHSC 

allows selected health care professionals engaged in delivery of primary care services to be reimbursed for student loans in return for 

establishing and maintaining their practices in geographic areas 

designated as medically underserved by the Federal Government. 

However, optometrists, the Nation’s primary eye- and vision-care 

providers, are not eligible for participation in this program. 

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6 

The NHSC program aims to unite communities in need with caring health professionals by easing the debt burden associated with 

a professional education, allowing carefully selected clinicians, including primary care physicians, nurse practitioners, dentists, and 

other health professionals to undertake a multiyear commitment to 

safeguarding public health. However, the exclusion of optometry 

from the program has had a devastating impact on the level and 

fullness of care with these communities which they receive. 

Today, less than 20 percent of community health centers have an 

optometrist on staff, which severely restricts access to primary eyeand vision-care services, including comprehensive eye exams, detecting and diagnosing eye diseases, and treating eye diseases. 

Nonetheless, doctors of optometry have been active in some community and rural health centers despite optometry’s omission from 

the NHSC priority. 

Community health centers provide an invaluable service to those 

who need it most and promise to be a growing part of the U.S. 

health care system. They are seen to provide care in a more costeffective manner than hospital emergency rooms, and as a result 

have enjoyed much more Federal support from administrators. It 

is critical that part of the comprehensive primary medical services 

that these centers provide include eye and vision care, as these 

services are central to better overall health outcomes. 

Those living in the underserved communities in which CHCs are 

located are significantly more at risk of suffering vision impairment 

from high amounts of preventable vision loss from undiagnosed 

causes, such as diabetic retinopathy and glaucoma. And I am 

joined by the National Association of Community Health Centers, 

the National Rural Health Association, the American Optometric 

Association, and Prevent Blindness America in calling for the readmittance of optometry into the NHSC program. 

Congressional intent with regard to the inclusion of optometrists 

in the NHSC loan repayment program is clear. However, HRSA 

has indicated that a legislative response, not a regulatory response, 

is needed in order for optometrists to be added as eligible providers 

to the student loan repayment program. And so I would commend 

to my colleagues’ attention Representative Bart Gordon’s bill, H.R. 

1884, the National Health Services Corporation Improvement Act, 

which would allow optometrists to participate in the National 

Health Service Corps loan repayment program. And I would like to 

thank our witnesses for being here today, and again thank you, Mr. 

Chairman, for setting up this hearing. And I yield back. 

Mr. PALLONE. Thank you. 

Our next member is Mr. Green from Texas, who is our vice chair. 

And you should know that he has been lobbying, or whatever the 

word is, for a long time to have this hearing because he considers 

it so important, as we all do. But if it wasn’t for him, I don’t think 

we would be having this today. So thank you. 

OPENING STATEMENT OF HON. GENE GREEN, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. GREEN. Thank you, Mr. Chairman. I appreciate your patience in putting up with me for months. I know our committee had 

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a full schedule with FDA, PDUFA, a host of other things, but I appreciate you again not just turning me out the door. 

But thank you for holding the hearings on all three of these bills, 

and they are, all three, great bills. I especially am pleased we are 

discussing the Health Centers Renewal Act, a bill that I introduced 

with my colleague Mr. Pickering from Mississippi. We have 230 cosponsors in the full House and 70 percent of our committee. 

Nearly 40 years after the health centers program began as part 

of LBJ’s Great Society, more than 1,000 federally qualified health 

centers operate more than 5,000 sites, located in all 50 States, and 

serving about 16 million people. In order to qualify for Federal 

funding, health centers must be located in a medically underserved 

area, and be majority governed by community members utilizing 

the center for health care. The centers must also provide comprehensive primary and preventative care to all community residents regardless of the patient’s ability to pay. Ninety-one percent 

of health center patients are low income; thirty-six percent are 

Medicaid beneficiaries. In 2006 alone, health centers provided services to 6 million uninsured individuals, which is 40 percent of all 

health center patients. Without a medical home at which to receive 

treatment, these patients were likely to forego care until their medical problems require emergency treatment or inpatient hospital 

care. 

By providing primary, preventative and sometimes specialty 

care, health centers encourage patient treatment before medical 

problems escalate to emergency room visits and inpatient hospital 

treatment. As a result, health centers represent the Nation’s largest primary care system, with one in nine Medicaid beneficiaries 

and one in five low-income individuals receiving care at a health 

center. 

My State of Texas unfortunately ranks number one in the U.S. 

in the level of uninsured, with 25 percent of the population living 

without health insurance. More than 1 million uninsured individuals live in the Houston area, and we have fewer than 10 federally 

qualified health centers. And the demand for health centers is 

growing in our area. 

Houston is not the only area in need of more health centers, with 

studies showing more than 56 million Americans lack access to a 

health care home and primary care. The Health Centers Renewal 

Act would reauthorize the health centers program, put the program 

on the path to meeting this need. In fact, our bill would allow 

health centers to serve approximately 23 million patients in the 

next 5 years. That is 50 percent more than today. This funding authorized in the bill would ensure that care is provided to existing 

patients as well as new patients. It would also allow health centers 

to provide additional service such as mental health and dental 

care. 

This bill is a true investment in the future of health care of underserved communities across the country. And I am sure Mr. Pickering joins me in thanking the members of our subcommittee and 

the full committee and the Majority of the House who has co-sponsored this bill. Most of you know what an important issue this is 

to me and a number of members of our committee. And again, I 

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would like to thank my colleagues, thank our witnesses for being 

here, and I look forward to their testimony. 

I yield back my time. 

Mr. PALLONE. Thank you. 

Mr. Murphy from Pennsylvania. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF PENNSYLVANIA 

Mr. MURPHY. Thank you, Mr. Chairman. 

When we hear about the number of the people who are uninsured in America, perhaps 45 million is a number often thrown out 

from the Census Bureau, when one begins to dissect that number, 

we find a number of interesting things. First, a sizable amount of 

that 45 million are people who are indeed covered by Medicare or 

CHIP programs, but are not aware of that. When you pare them 

out, then there are several million people who remain who actually 

can afford health care by their income, but decide not to, many of 

them being the invulnerable people between 18 and 26 or so who 

think they will live forever and don’t need to buy health insurance. 

But there is also a group within that, perhaps 10 to 15 million, 

by various estimates, who have no insurance, cannot afford it, and 

do not qualify. They are not old enough for Medicare and not poor 

enough for Medicaid. Interestingly enough, that is about the number of people who are served by community health centers. But 

community health centers, we just have too few of them. Some of 

the counties in my district and throughout Pennsylvania have no 

health centers, and so therefore someone has no doctor or no health 

care home. And I venture a guess from my many years of working 

in health care, people would much rather refer to their doctor than 

their insurance company as the source of their health care. 

But one huge barrier exists with our community healthcenters, 

and that is there is simply not enough doctors. Right now it is estimated that federally funded community health centers that provide 

clinical services, there is a 13 percent vacancy rate for family physicians, 20 percent for OB/GYNs, and 22 percent for psychiatrists. 

Perhaps the numbers are even larger. 

We could fill these vacancies and moreso, and expand community 

health centers with volunteers. Unfortunately, there is only 100 

volunteer clinicians serving in health centers nationwide, 100 out 

of the hundreds of thousands that are out there who are specialists 

in the medical field. The reason is if you work in a community 

health center, you are covered under the Federal Tort Claims Act; 

therefore, your medical malpractice insurance is much less, and the 

clinic can afford to pay it. If you volunteer, however, you are not. 

And oftentimes, while characteristically that medical malpractice 

insurance is tens of thousands, perhaps scores of thousands of dollars more, then the clinic simply will not take on volunteers. They 

turn them away at the door. And yet there are OB/GYNs and family physicians and psychiatrists and dentists and podiatrists and 

others who would like to volunteer, perhaps as part of their ongoing practice, or they are nearing retirement and would like to dedicate some of their time to the community. That is why I introduced 

a bill last year and reintroduced it this year, it is H.R. 1626, to 

allow Good Samaritan doctors to volunteer. 

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And as we look at these issues about community health centers, 

yes, they are excellent; yes, they provide good care; they are vital 

parts of the community, and it is a great place for someone to have 

a health care home when they have their card saying that is where 

they get their services from, but I hope one of the issues we can 

address as we move forward in this legislation is also allowing 

medical practitioners to give of their time. Many of them have gone 

to school through scholarships and services provided by the government, and many of them want to return the favor to the community. We ought to open up the doors to them and not close the 

doors to them, and help provide more volunteer services as we deal 

with these issues in community health care. One of the bills we are 

dealing with, too, at this series, is also to provide some loan forgiveness. Perhaps we should allow them to have that loan forgiveness by giving their time back to the community that gave so much 

to them. 

I yield back. 

Mr. PALLONE. The gentlewoman from Wisconsin. 

OPENING STATEMENT OF HON. TAMMY BALDWIN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WISCONSIN 

Ms. BALDWIN. Thank you, Mr. Chairman. 

And thank you, Dr. Williams, and the witnesses that are on our 

second panel for joining us today. 

I am very pleased that this subcommittee is taking up such an 

important issue as providinghealth care to those without and those 

in need. The three programs that are the subject of the bills we are 

considering today all play a vitally important role in ensuring that 

those who are uninsured and those who live in medically underserved areas receive needed health care. 

As my colleagues all know, almost 16 percent of Americans, that 

is 47 million Americans, are uninsured. And while these three programs are not a comprehensive cure for the epidemic of 

uninsurance, they certainly are a treatment. And I am proud to be 

a sponsor of all three programs. 

I really can’t say enough good things about the amazing work 

that community health care centers do. The community health centers in the district that I represent, which are located in Madison 

and Beloit, Wisconsin, are incredibly vital parts of their communities. And I am continually amazed at the variety of needed services that they offer. For some people the community health center 

is the only place where they can access dental care. For others, it 

is the only place that they can access affordable care. And for yet 

others it is the only place where they can easily communicate with 

their health care providers without interference of language barriers. 

I am proud to be a cosponsor of Mr. Green’s bill to reauthorize 

the health center programs, H.R. 1343. This bill provides a muchneeded increase in the program’s authorization level, and will put 

health care centers on a path to serve 23 million patients within 

the next 5 years, and that is nearly 50 percent more than they 

serve today. 

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As we know from our rising number of uninsured Americans, the 

need for care at community health centers is very great. In Wisconsin, the number of patients receiving care at community health 

centers has doubled in the past 8 years from 85,000 annually to 

170,000 annually. This level of growth is significant, and we need 

to make sure that the program is updated with sufficient authorization levels to ensure that community health centers can continue to provide this much-needed care, continue to grow and provide care to more Americans, expand the services they provide to 

include much-needed mental and dental health care, and update 

their health services to keep up with changing technology. I thank 

my colleagues for their work on these bills, and I look forward to 

today’s discussion. 

Thank you, Mr. Chairman, for holding this hearing. 

Mr. PALLONE. Thank you. 

Our ranking member of the full committee is next, Mr. Barton. 

OPENING STATEMENT OF HON. JOE BARTON, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BARTON. Thank you, Mr. Chairman. Thanks for holding this 

legislative hearing on the community health centers, the National 

Health Services Corporation, and school-based health clinics. 

Last year the committee reauthorized the Community Health 

Center Program for 3 years. The legislation was endorsed by the 

National Association of Community Health Centers. It was passed 

by a voice vote in the committee, and also passed the House of Representatives overwhelmingly. Sadly, the Senate was not able to get 

its act together—what else is new—and the program failed to be 

reauthorized. I am glad to see that the committee intends to fulfill 

its obligation and responsibility this year and once again beginning 

to move forward on a bipartisan basis to reauthorize not only that 

program, but the other two programs that are on your legislative 

hearing agenda today. 

Community health centers have received widespread support not 

only at the Federal level, but at the local level. It is important to 

note that these centers are great sources of preventative health 

care, which helps to control the ever-increasing health care costs. 

It is our responsibility as Federal representatives to ensure that 

taxpayers’ money is being spent efficiently, and community health 

centers have demonstrated that they are effective in achieving this 

goal. 

As with any program, there is always room for improvement. I 

am going to be interested later in the hearing to hear from some 

of the witnesses how certain aspects of the program can be improved. For example, in Tarrant County, which both I represent 

and Dr. Burgess represent, along with Congresswoman Kay Granger, that particular county has had a very difficult time establishing 

a community health center. I think that right now in a county of 

well over a million people, approaching 2 million people, we may 

have two community health centers that have been designated, despite great need for such programs. 

I am concerned that there is a great geographic disparity in the 

establishment of new centers. I am very interested to understand 

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the application process and the issues that go into those particular 

reviews of those particular applications. 

Another issue of concern for members of this committee is the 

need for portable liability coverage during times of emergency. This 

need was greatly evidenced during Hurricane Katrina. I want to 

personally thank Mr. Jones for coming here from Mississippi to 

share his personal story with us. 

I am also interested in pointing out the President’s expansion 

initiative has been completed, and that there are over 1,200 new 

or expanded centers. The authorization levels dramatically spike 

upwards. I know it is a popular program, but it is still the responsibility to be good stewards of the taxpayer dollars. 

In addition to community health center reauthorization, we are 

considering legislation to reauthorize school-based health centers 

and the National Health Service Corporation. I have some concerns 

about these bills. I have got a little bit of a problem understanding 

why we want to create a new pot of money for a school-based 

health center program when they are already able to access a wide 

variety of Federal funding streams, one of which is the Community 

Health Center Program that I just talked about. There are other 

concerns inherent in the school-based health center program that 

should be explored regarding contraceptive distribution, confidentiality, and abortion referral, to name just a few noncontroversial 

items. 

The final bill that we are going to consider today is the reauthorization of the National Health Service Corps. The authorization 

amounts for the next 5 years are more than double current funding. That seems to me to be a bit much, but I am sure there may 

be a justification in this, so we want to hear what that justification 

is. 

I would like to know where the administration is in the process 

of redefining health professional shortage areas, or HPSAs. 

In examining this legislation, we should consider all the various 

sources for loan repayments and how this one is somehow unique. 

Again, Chairman Pallone, thank you for holding these hearings. 

They are very important in the oversight work of the committee as 

we move forward to reauthorize these programs. Thank you, and 

I yield back. 

Mr. PALLONE. Thank you. 

Mr. Burgess. 

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BURGESS. Thank you, Mr. Chairman. And I will try to be 

brief, because I know we have heard from everyone already. 

The issue with reauthorizing the federally qualified health center 

program, Ranking Member Barton is quite correct, we did do that 

last year. It unfortunately did not get across the finish line. It is 

an important program. It needs to be reauthorized. But Ranking 

Member Barton has touched upon what is a very, very important 

point: There does seem to be geographic disparities. There seem to 

be winners and losers in this program, and this committee, I think, 

needs to address that. 

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I represent an area of the city of Fort Worth, TX, that has two 

ZIP Codes with some of the highest infant mortality rates in the 

country. In fact, they rival some of the infant mortality rates in 

other areas of the world that we wouldn’t normally think of as 

being medically adequately served. And at the same time, we do 

not qualify, we do not meet the test, we do not meet the criteria 

for a federally qualified health center. I have spent the better part 

of the last 3 years, with full support of the hospitals in the area 

offering financial support. I have been unable to get this across the 

finish line. It is personally very troubling to me, and it makes me 

question whether or not the system indeed works as intended. 

One of the other bills before us, H.R. 2915, the National Health 

Service Corps and Loan Payment Reauthorization Act of 2007, is 

an attempt to address an issue also about which I spend a lot of 

time worrying and being concerned, and that is the issues surrounding the physician workforce for the future. The high cost of 

medical education keeps many qualified students from becoming 

doctors, and indeed keeps many interested high school students 

from even investigating a career in health care. But rather than 

just increasing the funding, perhaps we also could look for a way 

to address some of the underlying issues that drive students away 

from practicing primary care medicine in needed areas. 

An alternate bill, H.R. 2584, that was introduced much earlier in 

the year would provide targeted investments into our future medical workforce. And I, in fact, would look forward to working with 

the Chairman on this bill before we get to the final markup. 

Another issue, as was touched on by Ranking Member Barton, 

with the National Health Service Corps, is how the HRSA defines 

a health profession shortage area. Despite pleading with CMS, 

HHS, and HRSA, Louisiana officials at the highest levels in the 

last 3 years since Katrina just are absolutely baffled as to why the 

most devastated parishes in New Orleans have not been classified 

as health professional shortage areas. 

I know that the National Health Service Corps gives preference 

to sending providers to health profession shortage areas. Also these 

are areas which are still in great need and not getting the health 

professionals that they need. 

Mr. Chairman, I will submit the entirety of my statement. It is 

well written and very important. I encourage Members to read it 

and I will submit it for the record, and I will yield back. 

Mr. PALLONE. Thank you. 

The gentlewoman from Tennessee. 

OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE 

Mrs. BLACKBURN. Thank you, Mr. Chairman. And I thank you 

for our meeting today and for the discussion of what I think are 

three very important public health programs. 

The community health centers really are playing an important 

role in providing adequate care for many of our Tennessee families. 

And by providing health services to those in need, such centers are 

vital to the well-being of our Nation’s communities, and certainly 

to the continued quality of life of many in these communities. And 

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in my State, we have seen growth in these—just tremendous 

growth, and we are pleased with the expanded opportunities that 

are there for our constituents. 

A great example of this is in 2008, Hardiman County Community 

Health Center will receive 1.2 million in grant funding to provide 

discounted medical services in rural west Tennessee. This is for a 

population that is largely unserved or underserved. These funds 

are critical to those in our district. In the past year, this center has 

served over 6,200 patients in approximately 20,000 medical visits. 

Next year a new clinic will open in Chester County, Tennessee, to 

serve 1,000 more patients and 2,000 more visits in the first year. 

And it is an important development, and I look forward to working 

with the community health centers as they continue to provide the 

services and to fulfill this need. I do believe they have been tremendously successful, and are the right-type idea for delivering 

health services. 

While I appreciate the focus of this hearing on important public 

health programs, I believe this committee should and could be 

using some of this time to work on more critical and time-sensitive 

issues facing our Nation’s most vulnerable citizens. Those are children and also the elderly. While Congress is only scheduled to be 

in session until the end of next week, the House leadership has 

been unsuccessful in forging a compromise that will reauthorize 

and fund SCHIP in a responsible fashion. For many States, SCHIP 

funding runs out at the end of next week. We should get down to 

business and work out differences on SCHIP before moving forward 

on anything else. 

The committee should also focus on the impending 10 percent 

pay cut for physicians under Medicare, which is scheduled to go 

into effect on January 1, 2008. I have repeatedly supported congressional efforts to provide physicians with Medicare payment relief. It is unfortunate that Congress is waiting until the eleventh 

hour to prevent this payment cut from going into effect. The Sustainable Growth Rate, we all hear a lot about the SGR, has proven 

to be a flawed formula that does not account for the rapidly increasing volume of Medicare patients, and fails to accurately reflect 

the rising costs of caring for these patients. This negative fee 

schedule update presents an unacceptable situation, and I fear that 

many physicians will cease to serve Medicare beneficiaries if a solution is not implemented to fix the physician payment reduction. 

Congress should be focusing its efforts to reform Medicare’s physician payment scheme to ensure both access to care for beneficiaries 

and fair payment to our physicians for the services that they are 

providing, and, I will add, providing in good faith. 

A future Medicare package should not cut the Medicare Advantage program, which has expanded choice in the Medicare program 

through partnerships with private-sector plans. More choice means 

more control for beneficiaries over the provisions of their own 

health care. 

First and foremost, this committee has an obligation to reauthorize SCHIP with its original intent and to reform the Medicare physician payment formula. It is imperative that this Congress and the 

committee act on these critical issues immediately and stop playing 

politics with the issues behind closed doors. 

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Thank you, Mr. Chairman, and I yield the balance of my time. 

Mr. PALLONE. Thank you. 

I think that concludes our opening statements. Any other statements for the record will be included at this time 

[The prepared statements follow:] 

PREPARED STATEMENT OF HON. EDOLPHUS TOWNS, A REPRESENTATIVE IN CONGRESS

FROM THE STATE OF NEW YORK

Mr. Chairman and Ranking Member, thank you for your leadership in holding 

this informational hearing, concerning these very important pieces of legislation. 

Mr. Chairman, I am a proud co-sponsor of each item that we are addressing here, 

today. I will not waste time, by reiterating my previously documented support for 

this legislation. However, I would like to address my committee colleagues for the 

purpose of posing a question regarding H.R. 2915, ‘‘The National Health Service 

Corps Scholarship and Loan Repayment Programs Reauthorization Act of 2007,’’ 

which will continue the valuable program to recruit and retain healthcare professionals to work in underserved American communities. This program is certainly 

very worthy of our discussion today, and should be reauthorized. As an aside matter, I would like to ask this committee why it has chosen to address this piece of 

legislation without also considering H.R. 1134, ‘‘the Physical Therapists Student 

Loan Repayment Eligibility Act,’’ which has been referred to this subcommittee. 

H.R.1134 will add physical therapists practicing in underserved areas to the list of 

providers eligible to participate in the National Health Service Corps Student Loan 

Repayment Program. 

I believe that H.R. 1134 is worthy of our consideration. Therefore, I ask my colleagues why are we neglecting to consider this very relevant piece of legislation, 

today; and urge my colleagues to, also, contemplate this legislation, as we move forward. Additionally, I have a series of questions about the current measures, I am 

submitting for inclusion in the record to be addressed by the witnesses, subsequent 

to the hearing. I, respectfully, ask the chairman to honor this request. 

Thank you, Mr. Chairman and Ranking Member for this opportunity. 

PREPARED STATEMENT OF HON. TOM ALLEN, A REPRESENTATIVE IN CONGRESS FROM

THE STATE OF MAINE

Thank you Chairman Pallone for calling this important hearing to consider legislation to reauthorize three important programs which are critical to meeting the 

health care needs of millions of American’s across the country, and together comprise some of the strongest cords in our health care safety net. 

I want to thank Representative Green for his work on the Health Centers Renewal Act. The 5-year authorization funding levels specified in his bill would allow 

Health Centers to serve 23 million patients within the next 5 years, nearly 50 percent more than today. 

In 2005, federally-funded health centers served 125,255 individuals in the State 

of Maine. We have 16 grantees, of which 88 percent are rural. The funding targets 

in H.R. 1343 represent an investment not only in reaching new patients but ensuring that the care provided to new and existing patients is comprehensive and sustainable. 

The National Health Service Corps is a vital resource for underserved communities experiencing shortages of health professionals. Maine has 43 clinicians at 36 

sites, many in the most remote areas of our State. For over 35 years, National 

Health Service Corps clinicians have expanded access to primary and preventive 

health care, dental care, mental health and behavioral health services in underserved areas of the country and have improved health outcomes among difficult to 

reach populations. 

During the last reauthorization of the National Health Service Corps, this Committee granted Federally Qualified Health Centers and Rural Health Clinics automatic facility designation as Health Professional Shortage Areas (HPSAs) for the 

purposes of recruiting National Health Service Corps clinicians. The intent of this 

provision was to ensure that all such providers, already required to be located in 

medically underserved areas, be eligible to apply for National Health Service Corps 

personnel. 

Despite this, many health centers have continued to face difficulty in obtaining 

NHSC personnel, due to lack of overall funding and so-called ‘‘threshold scores’’ 

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within HPSA designation limiting placements to only those health centers with the 

highest scores. 

Community health centers across the country are finding it difficult to recruit and 

retain clinical staff. And even though more than half of National Health Service 

Corps placements go to community health centers, hundreds of those centers, representing millions of underserved patients, can’t access doctors from the National 

Health Service Corps. 

H.R. 4205, the bill that I introduced on November 15, would reauthorize the National Health Services Corps Scholarship and Loan Repayment programs, doubling 

the current investment, and also ensure that providers like health centers and rural 

health clinics, those who are serving rural and underserved populations, have the 

first opportunity bringing in these National Health Service Corps clinicians to serve. 

The number of new medical residents choosing a primary care discipline as a 

medical specialty is declining, and the National Health Service Corps Scholarship 

and Loan Repayment programs provide an important incentive for students to 

choose to pursue a career in primary care. 

I hope that the committee will consider the merits of making the HPSA designation permanent for Federally Qualified Health Centers and Rural Health Clinics for 

the purposes of recruiting National Health Service Corps clinicians. 

PREPARED STATEMENT OF HON. DARLENE HOOLEY, A REPRESENTATIVE IN CONGRESS

FROM THE STATE OF OREGON

Thank you for holding this important hearing, Mr. Chairman. 

I am very excited that the Subcommittee on Health is hearing testimony on my 

legislation, H.R. 4230, the School-Based Health Clinic Act of 2007, which will authorize funds to improve health care access for our Nation’s children. 

I also want to thank Congresswoman Shelly Moore Capito for working with me 

on this bill and for her strong leadership on school-based health. 

The School-Based Health Clinic Act authorizes a grant-based program for the operation and development of school-based health clinics (SBHCs), which provide comprehensive and accessible primary health care services to medically underserved 

children. My legislation gives priority to schools in communities with proven barriers to access to health care for children. Resources are thus targeted to schools 

with the greatest need. 

As a former school teacher, I know all too well the negative impact that poor 

health has on a child’s ability to learn and thrive at school. Unfortunately, far too 

many of our children do not have access to health care. Nearly 9 million children 

in the U.S. are currently uninsured. 

SBHCs bring care right to the child at his or her school—where it can most easily 

reach underserved students. This allows students to stay in school and prevents 

their health problems from becoming more severe. 

SBHCs play an important role in addressing high uninsurance rates by providing 

care to all children regardless of their ability to pay. Nationally 45 percent of children treated at SBHCs have no insurance and 44 percent are enrolled in Medicaid, 

SCHIP, or other public coverage. In Oregon, surveys indicted that 60 percent of clients are unlikely to receive care outside their school-based health clinic. SBHCs are 

therefore a critical lifeline for many of the approximately 2 million children currently attending a school with a clinic. 

The School-Based Health Clinic Act will help increase the number of clinics and 

expand their ability to reach even more children by providing much needed Federal 

funding. Because 45 percent of SBHC patients are uninsured, SBHCs need Federal 

funding to fill the gap between the cost of providing care and revenue collected from 

billing Medicaid, SCHIP, and private insurers. Although Federal funds are critical 

to expanding SBHCs, clinics will continue to effectively utilize resources by 

leveraging State and local government funds, private contributions, and Medicaid, 

SCHIP, and private insurance payments where possible. 

This legislation is a good start toward a brighter future for our youth by keeping 

them healthy and in school. 

Thank you Mr. Chairman. 

PREPARED STATEMETN OF HON. HEATHER WILSON, A REPRESENTATIVE IN CONGRESS

FROM THE STATE OF NEW MEXICO

Mr. Chairman, I would like to thank you for holding this hearing today on these 

bills before the committee. Today, we are meeting to discuss important issues regarding programs that improve access to health care for people in the United States, 

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and particularly in New Mexico. House Resolution 1343, the Health Centers Renewal Act, would reauthorize the community health center program for the next 5 

years, with funding increases each fiscal year. This funding would allow the Community Health Centers to establish new sites, add services such as mental health 

and dental care, and undertake other measures that will improve the quality and 

cost-effectiveness of delivery. I am proud to be a cosponsor of this legislation. 

Last year, I cosponsored House Resolution 5573, which renewed the health centers program grant for 5 additional years. The legislation was passed in the House 

but there was no action in the Senate regarding this legislation. 

Health centers are a beacon of hope for the most vulnerable populations- low income, uninsured, or underinsured individuals. Many of whom are struggling with 

chronic diseases, teen pregnancy, substance abuse, and HIV/AIDS infection. A large 

portion of these same people cannot afford even the most basic medical care. I 

proudly cosponsor this legislation, and believe that by reauthorizing this program, 

we can put community health centers on the path toward serving 30 million patients by the year 2015. 

In New Mexico, we have 15 federally qualified health center grantees, 79 percent 

of which are in rural areas. The centers serve predominantly low-income and uninsured patients. These centers provide a medical home for many, and for most, the 

community health center is their only point of access to primary care. In 2005, federally-funded health centers were the family doctor and medical home for approximately 223,000 individuals in New Mexico. 

I have visited community health centers in my district, and I have been impressed 

with the concept of ‘‘health commons’’ where low income patients can go to get medical, dental, mental health, substance abuse, and pharmacy benefits all in one location. These health centers help reduce health disparities and provide cost effective 

care in the most medically underserved communities. 

Health centers have both immediate and long-term benefits. Health centers reduce the need for more expensive hospital in-patient and specialty care, which result in significant savings for taxpayers. We are also here to discuss H.R. 2915, the 

National Health Service Corps Scholarship and Loan Repayment Programs Reauthorization Act of 2007. I support reauthorization of the program. It is vital to improving access to health care in rural and underserved parts of New Mexico by encouraging doctors and other health care providers to practice in Health Professional 

Shortage Areas. Thank you, Mr. Chairman. 

Mr. PALLONE. We will now turn to our witness on our first panel, 

which consists of Dr. Dennis P. Williams, who is Deputy Administrator for the Health Resources and Services Administration. We 

will recognize you for a 5-minute opening statement. And as I 

think you know, the statements are made part of the hearing 

record, but you may, in the discretion of the committee, submit additional brief and pertinent statements in writing for inclusion in 

the record. And thank you for being here, Dr. Williams. 

STATEMENT OF DENNIS P. WILLIAMS, DEPUTY ADMINISTRATOR, HEALTH RESOURCES AND SERVICES ADMINISTRATION 

Mr. WILLIAMS. Thank, Mr. Chairman. Good afternoon. And good 

afternoon to the members of the subcommittee. Thank you for the 

opportunity to meet with you today on behalf of the Health Resources and Services Administration to discuss the health center 

and National Health Service Corps programs. I appreciate your 

support and awareness of the importance and critical role these 

safety net programs play in ensuring the access to care for millions 

of Americans. 

I want to recognize the outstanding effort of the clinicians and 

the staff of the Nation’s health centers. Their contributions to remedying the problems of the underserved and uninsured are undeniable and significant. Their patients and communities know and 

rely on them. 

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Health centers are community-based and consumer-directed organizations that serve populations with limited access to health 

care. These include low-income populations, the uninsured, those 

with limited English proficiency, migrant and seasonal farm workers, individuals and families experiencing homelessness, and those 

living in public housing. 

Health centers provide comprehensive primary and preventative 

health services, as well as supportive services that promote access 

to health care. Services are available with fees adjusted based on 

one’s ability to pay. 

Health centers must also meet performance and accountability 

requirements regarding administrative, clinical, and financial operations. 

Health centers are located in medically underserved areas and/ 

or serve medically underserved populations. Nearly 82 percent of 

health center funding is awarded to community health centers, 

with the remaining 18.5 percent divided across migrant, public 

housing, and homeless health centers. This community-based primary care service delivery model has worked effectively over many 

years. We thank the committee for their efforts in reauthorizing 

this program. 

Let me update you on the success and growth of the program to 

date. By any measure, we have been enormously successful in implementing the President’s Health Center Expansion Initiative. In 

2001, the President committed to create 1,200 new or expanded 

health center sites to increase access to primary health care across 

the country. By 2006, these centers were serving over 15 million 

patients, an increase of 46 percent since 2001. The final fiscal year 

2007 congressional appropriation included an increase of more than 

$203 million for health centers. These additional funds are supporting the establishment of over 330 new and expanded health 

center sites. Of these awards, 80 are supporting new health center 

sites in counties with high rates of poverty that currently do not 

have access to health center services. These centers are part of the 

President’s initiative to provide a health center in every poor county that lacks a health center site and can support one, thus extending the benefits of health centercare to the hardest-to-reach, poorest areas of the country. As a result, health center sites will exist 

in more low-income counties than ever before, and some 300,000 

people in some of the poorest communities in the country will gain 

access to primary care, many for the first time. These expansion efforts continue to be a priority, because we know these funds go to 

provide direct health care services for our neighbors who are most 

in need. 

Health centers provide comprehensive, culturally competent, 

high-quality primary health care services to a diverse patient population. In 2006, health centers served 15 million individuals at an 

average cost of about $538 per patient, and provided over 59 million patient visits. The proportion of uninsured patients of all ages 

held steady at nearly 40 percent, while the number of uninsured 

patients increased from 4 million in 2001 to 6 million in 2006. 

A key goal of HRSA is to transform the systems of care for safety 

net populations through the effective use of health information 

technology. In order to improve the quality and safety of health 

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care, HRSA awarded in fiscal year 2007 a total of 46 grants, worth 

$31.4 million, to expand the use of health information technology 

at health centers. And 2 years ago HRSA created an Office of 

Health Information Technology within our organization in order to 

help deploy this new technology not only to health centers, but to 

all of our grantee service delivery programs. We partnered with the 

Agency for Health Care Research and Quality in order to provide 

information to our grantees so that they can make good business 

decisions as they consider the use of this technology, and we have 

also been partnering with the Office of the National Coordinator for 

Health Information Technology so that as he and his group sets 

health information technology standards for the country, that he 

understands the needs of the health care safety net in this country, 

and we have worked very closely together over the last 2 years. 

HRSA is also currently involved in an agencywide effort to improve quality and accountability in all of HRSA-funded programs 

that deliver direct health care. One of the steps we have taken in 

this area is to establish a core set of clinical outcome measures for 

all health centers. In the past, we have measured how many patients we serve. We have measured and kept track of what kind 

of services we provide to them. But it is important to us to understand what is the outcome of all of these services that we are providing? What is the health outcomes of these services? 

In our view, help for the poor should not be poor health care, so 

we have identified a core set of measures related to immunization, 

prenatal care, cancer, cardiovascular disease and hypertension, and 

diabetes, and these measures will help us assess how well our patients are doing relative to national norms and national statistics. 

Let me now talk briefly about the National Health Service Corps. 

The National Service Corps was created to place clinicians in areas 

of need. In 2002, the National Service Corps was reauthorized by 

Congress through fiscal year 2006, and was given greater flexibility 

to distribute funds between the scholarship and loan repayment 

programs. This change in the law enabled the National Health 

Service Corps to direct more funding to loan repayment. 

By 2006, the National Health Service Corps field strength grew 

to 4,109, a nearly 50 percent increase in the field strength since reauthorization in 2002. This is due in part to the increased flexibility the program now has to shift more funding to help meet the 

immediate needs of underserved communities and vulnerable populations, and in response to communities’ demand for services. 

In 2006, as throughout the history of the program, approximately 

60 percent of National Health Service Corps clinicians served in 

rural areas—— 

Mr. PALLONE. Dr. Williams, sorry to interrupt you, but you are 

up to 7 minutes, and I know you are about halfway through, so if 

you can kind of summarize because we want to ask you questions. 

But go ahead, but maybe just summarize. 

Mr. WILLIAMS. I will finish the one paragraph. 

As a significant source of highly qualified, culturally competent 

clinicians for the health center program, as well as other safety net 

providers, the National Health Service Corps can build on its success in ensuring access to residents of health professional shortage 

areas, removing barriers to care, and improving the quality of care 

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to these underserved populations. The National Service Corps program is working with many communities in partnership with 

State, local, and national organizations to help address their health 

care needs, and to help reduce the health disparities gap. 

We are proud of the accomplishments of the Health Center Program and the National Service Corps. These programs are delivering care to millions of underserved Americans with few health 

care alternatives. We look forward to working with the committee 

in reauthorizing these programs, and I would be happy to answer 

any questions you might have. 

Thank you, Mr. Chairman. 

[The prepared statement of Mr. Williams follows:] 

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Mr. PALLONE. Thank you. And we will submit your whole statement for the record. 

I apologize for interrupting, but we do want to ask you some 

questions, and I will recognize myself initially for 5 minutes. 

I cannot stress enough how important these community health 

centers are nationally, as well as in my own district. We have quite 

a few in my district. And with the increased number of uninsured, 

and with a lot of people who are undocumented, the needs of these 

health centers have just grown dramatically in my district, and I 

am sure that reflects the rest of the country. 

I want to commend the Bush administration for its initiative, 

which began when the President was first elected, to try to provide 

money for new centers, the infrastructure. I think, as you said, that 

has been very successful. But my questions really kind of go back 

to the same thing in some ways that Dr. Burgess mentioned. 

If I could use my own hometown as an example, we a few years 

ago built a new community health center which is federally qualified, unlike, I guess, some of the ones that Dr. Burgess mentioned 

which are not, but yet they have been denied the grants under the 

Section 330 program several times. So I guess, as you know, in this 

bill, in Mr. Green’s bill, we have increases in the authorized funding levels. The administration has not commented on those so far. 

So my question really relates to whether or not you or the administration would take a position on these authorized funding levels. I 

think they are needed, because I know that even though I have a 

qualified health center, we haven’t been able to get any money. 

And obviously Dr. Burgess is talking about those who haven’t even 

qualified. So if you could tell us what the administration’s or your 

position is on the authorizing levels and what the need is, because 

clearly there is a need for a lot more money, in my opinion. 

Mr. WILLIAMS. Well, there certainly is a lot of demand for health 

centers. When the President’s initiative started 6 years ago, and 

the amount of money devoted to the expansion of these health centers began to grow, I think a lot of us felt at that time that the— 

it might be difficult to attract the number of applications we would 

need to spend the money that was given to us and to get the quality of applications that we wanted in order to make these health 

centers successful. But as the initiative went on, to our surprise we 

got rapidly a very large number of increases in the number of applications every year. And as the initiative went on, the quality of 

those applications has also grown substantially over the 6-year period, so that by this time we are in a very—it is a very competitive 

market. 

About a third of all of the people who apply to us for a health 

center are successful, and many of them are not successful on the 

first try, but are successful after two or three attempts. And we, 

through the primary care associations and also through State governments, have been providing a lot of technical assistance to communities in order to prepare them to be successful applicants. 

Mr. PALLONE. So clearly you do see a need for additional funding? 

Mr. WILLIAMS. Well, I can say to you there is a demand for additional funding. Quality is important. But in any budget situation 

like this, it is a matter of priorities and balances. There are a lot 

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of things which this government supports, and what is the proper 

amount really comes down to a question of establishing a balance 

in one’s priorities. 

Mr. PALLONE. All right. Let me ask you this, because I only have 

5 minutes. You mentioned HIT, and I understand that the authorization under this bill or maybe under existing law doesn’t specify 

grants specifically for HIT. But I think that is very important. 

I visited one of my community health centers that in many ways 

is a model. I am not going to mention the name right now. But one 

of the things that I noticed is that they were not—they had no— 

you know, their records were still paper. Half of the building was 

devoted to the records, which seemed such a waste. 

It seems to me if you have more HIT, you can really save some 

money and use the money for other things. So would you advocate 

that we specifically provide in the legislation authorization for HIT, 

or how do you decide when you are dealing with these grants, how 

to allocate your funds for HIT versus other things? 

Mr. WILLIAMS. I don’t think it is a question of authorization. I 

think we have the ability to support health information technology 

in our grantees. It is a question—again, it is a question of how you 

wish to spend the money available to you. And we have worked 

hard to try to make money available within the appropriations 

given to us to support this new technology. 

Now, I think in our view it is not—we would like to support 

broader networks of grantees. We have what are called Health 

Center Controlled Networks. These are collections of grantees who 

come together for the purpose of managing this technology either 

as practice management systems or electronic health records. By 

coming together and pooling their resources, they are much more 

successful because this technology is expensive, and by coming together it makes it cheaper for people to afford it. But even more 

important than the cost is that the knowledge, the people who 

know how to use the technology, is as scarce or even more scarce 

than the money. So by becoming part of a network, that scarce 

knowledge base can be made available to a lot more of our grantees. That makes investment in health care technology a lot less 

risky because you have got—you are working with people who 

know how to use this technology. 

But we are never going to be probably in a position to buy all 

this technology for everybody, so we are also trying to provide information to our grantee base through ARC. We have set up a Web 

site dedicated to community health centers, and we have brought 

our health center community together in that Web site. They can 

talk to each other. They can learn from each other’s experiences. 

And we make available on that Web site information about electronic health records and other technology to help educate those 

who are going to buy this technology so they can make a good business decision. So those are some of the things we are trying to do. 

Mr. PALLONE. Thank you. 

Mr. Deal? 

Mr. DEAL. Thank you. 

Dr. Williams, I want to talk primarily about the National Health 

Service Corps. As I understand, about half of the people who go 

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34 

through that program wind up working in community health centers. Is that generally true? 

Mr. WILLIAMS. That is about right, yes. 

Mr. DEAL. All right. Is the Department currently examining 

ways in which changes can be made to the health professions 

shortage areas? And if so, what changes would you anticipate 

there? 

Mr. WILLIAMS. We are looking at that regulation. The regulation 

in place has been around for many years, and we are in the process 

of reviewing that regulation. And we hope in the short period of 

time to be putting out a proposal that the public can comment on 

with respect to that regulation. 

Mr. DEAL. Could you elaborate as to the kind of changes you are 

anticipating? 

Mr. WILLIAMS. I can’t at the moment because it is still on the decision side of the Department. We are talking with OMB about it, 

but we do expect to soon put it before the public as a notice of proposed rulemaking. And we will give the public the opportunity to 

comment, and then we would see whether the ideas are good or 

not. 

Mr. DEAL. OK. Would you explain the breakdown that exists now 

between the scholarship side of the program and the loan side? 

And which of those programs yields the best results? 

Mr. WILLIAMS. Under current law, we are required to provide a 

minimum of 10 percent of the National Service Corps recruitment 

dollars for scholarships. So we have a floor, which gives us actually 

a lot of flexibility as to how the money might be allocated between 

loan repayments and scholarships. There is a real trade-off that 

one has to think about here. On the one hand, when you invest in 

a scholarship, you might be investing a fair amount of money, let 

us say 4 years of medical school, and then that person would graduate from medical school, go off into residency, and 6, 7, 8 years 

later are available for service in an underserved area. That is a 

very long wait time to get the benefit of the money that we really 

put up front. 

The other dimension to that is—that you alluded to is somebody 

who is just starting medical school at the age of 22, by the time 

they are 30 and have to go out and serve, they may look at the 

world differently. Their circumstances might be different than they 

were when that individual was 22. So with that long lead time, 

people’s willingness to serve sometimes is different at the end than 

at the beginning. 

The advantage of a loan repayment is that they have already 

gone through—the individual has already gone through all that 

process. They have finished their medical school, they have finished 

their residency, they are ready to go to work. So we can give them 

incentives to come to work in underserved areas by buying—helping to buy down their loans, pay back their loans; and the service 

is immediate. 

There is a big advantage, in order to maximize the number of 

people you have in the field, to use loan repayment. Scholarships 

can also be useful to some extent to support those who might otherwise not go to medical school because of their income, but they 

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can’t get a scholarship until they have already been admitted to 

medical school. They would have wanted to have gone anyway. 

But there is some use to scholarships, I think, to promote the diversity in our workforce, but the long lead time has to be considered. 

Mr. DEAL. But in addition to having an available workforce, 

make your dollars buy up front as you have talked about, isn’t 

there also a difference in the retention rates that you see between 

a scholarship and a loan program? 

Mr. WILLIAMS. Yes. We—well, I don’t know the exact statistics 

on that, but certainly most people going into loan repayment are 

well committed to the work that they are going to do. In the overall 

program, our retention rate of scholars and loan repayers is very, 

very good. Fifty percent of the people we put into medically underserved areas are there many years after their commitment is over. 

It is a very cost-effective program either way you look at it. 

Mr. DEAL. Do you feel that the legislation before us today, which 

would require $30 million to be dedicated to scholarships, would 

that hurt or help your program? 

Mr. WILLIAMS. I think, in our view, it would reduce the flexibility 

that we have now. Right now, we have a floor of 10 percent for 

scholarships. That gives us a lot of room to maneuver and balance 

between scholarships and loan repayers. 

At the present time, we are devoting about 20 percent of our 

money to scholarships and 80 percent to loan repayers, so we are 

actually giving scholarships a little bit higher than the floor requires. $30 million, depending on the amount of money available, 

can be a substantial amount. Right now, we are—in 2007, we had 

$85 million for recruitment. If we would have had to devote $30 

million of that to scholarships, then we would have had to put 35, 

36, 37 percent of our money into scholarships. 

That reduces our ability to put our money where we think we 

can get the best return. 

Mr. DEAL. Thank you, Mr. Chair. 

Mr. PALLONE. The gentleman from Tennessee. 

Mr. GORDON. Thank you, Mr. Chairman. 

Dr. Williams, in 2005, the House and Senate appropriators directed HRSA to include optometry in the National Health Service 

Corps loan forgiveness program. 

Per this directive, do you believe that HRSA has the authority 

to include optometry in the Corps? 

Mr. WILLIAMS. No, I don’t believe we do. 

Mr. GORDON. Well, you are consistent with your statement. I 

don’t agree with it, but you are consistent, which I think demonstrates much more why we need to have legislation to accomplish 

that need. 

Thank you. 

Mr. PALLONE. Mr. Pitts. 

Mr. PITTS. Thank you, Mr. Chairman. 

Dr. Williams, what types of providers are eligible for the National Health Service Corporation loan repayment program? 

Mr. WILLIAMS. Doctors, dentists, nurses, a range of midlevel providers, psychiatrists—an exhaustive list. 

Mr. PITTS. Is that list exclusive? 

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Mr. WILLIAMS. I think that is most of them, but I could give you 

an exhaustive list for the record. 

Mr. PITTS. In your opinion, what would be the effect of adding 

additional skills to this list? 

Mr. WILLIAMS. Again, I think it is a matter of priority and tradeoffs. Right now, I think if you listen to community health centers, 

half our national service corps are going to community health centers, for example. That represents probably somewhere in the 

range of—I don’t know—10, 15, 20 percent of their clinicians. 

They buy a lot of health professionals outside of the National 

Health Service Corps in order to manage their program. They have 

increased their total staffing by about 50 percent in the course of 

this growth in the Health Center Initiative, so there is opportunity 

for health centers and others to make decisions about whether they 

buy an optometrist, which they are perfectly free to do, or to buy 

a clinician. 

What people tell us is that they need clinicians, they need doctors, they need dentists, they need nurses. I think, given the demand for those skills, adding additional professions to this list may 

not serve the purpose that it is designed to do. 

Mr. PITTS. I understand that only 17 percent of community 

health centers have an optometrist on the staff. In my home State 

of Pennsylvania, only 6 of our 29 community health centers have 

an optometrist on the site. 

Wouldn’t including optometric care in an HSC help achieve the 

goals of the program and HRSA’s public health goals? 

Mr. WILLIAMS. Well, I don’t think it would necessarily help the 

health center who wants an optometrist. If a health center wants 

an optometrist, and an optometrist is willing to serve, they can pay 

an optometrist to provide services in their health center. 

If the National Health Service Corps were to make an optometrist available, they would also have to pay the salary to that optometrist, so the question is, I think really in the end, are there 

optometrists willing to serve in medically underserved areas on 

their own, or would they need to be provided some additional incentive? I don’t think I know the answer to that question. 

Mr. PITTS. Are there any providers not on the list that you think 

should be added? 

Mr. WILLIAMS. Not at the moment, no. 

Mr. PITTS. Let me shift to H.R. 4230, the School-Based Health 

Clinic Act. Are school-based health clinics reimbursed for prescription contraception or the morning-after pill? 

Mr. WILLIAMS. I have no idea. We don’t manage school-based 

health clinics as you are describing it in this legislation. 

Some of our health centers do run—have sites that are located 

in schools, but they are part of the community health center normal operations. They just happen to have a site located at a school. 

But the school-based health clinics you are talking about authorizing in this program are freestanding. They are not associated 

with a community health center program, they would be a separate 

activity, a business that we don’t have any association with. 

Mr. PITTS. With the ones that you are involved in, are there any 

age restrictions or parental consent requirements for reimbursement? 

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Mr. WILLIAMS. To the extent that we—that a community health 

center manages one of its—has a site in a school, it would be subject to the same State and local rules, laws, as any other health 

care provider would be. That is going to vary by every State and 

local jurisdiction. 

Mr. PITTS. But as far as the Federal Government is concerned, 

there are no age restrictions or parental consent requirements? 

Mr. WILLIAMS. In terms of primary care services, no. In fact, we 

fund about—30, 35, 36 percent of the people we serve in health 

centers are kids under the age of 19. About 23 percent of the people 

we serve are school-aged kids, mostly in primary care settings outside of the school, but about 10 percent in school settings. 

Mr. PITTS. My time is up. 

Thank you, Mr. Chairman. 

Mr. PALLONE. Mr. Green. 

Mr. GREEN. Thank you, Mr. Chairman. 

Dr. Williams, I understand that HRSA provided funding for 

roughly 700 new community health center sites and more than 500 

expanded sites since the beginning of the health center expansion 

initiative in 2002. I know President Bush and this Congress and 

I supported that bipartisan effort to secure this increase. 

During that same time, however, I understand that upwards of 

1,000 additional applications were submitted and met all the program requirements, but were not approved due to the lack of available funding; is that correct? 

Mr. WILLIAMS. Well, some were certainly not funded because of 

the lack of available funding, but some did not meet our quality 

standards also. 

Mr. GREEN. Even though they met the program requirements, 

the quality standards are different from the program requirements? 

Mr. WILLIAMS. Well, it is a competitive situation; to be in the 

competition, you have to meet the standards of the law. After that, 

it then becomes a matter of what is the degree of need, how good 

is the program relative to others who are applying. 

It is a competitive environment in that sense, and about a third 

of the people who apply to us get funded in any given year. 

Mr. GREEN. What I am saying, I guess, I am trying to get to, is 

that there were 1,000 additional applications that were submitted 

and met all the program requirements, but they didn’t score as 

high because of the funding availability. 

I would assume my colleague from Tarrant County, maybe his 

FQHC they were seeking may have been in those 1,000 applications. I don’t know either. 

Mr. WILLIAMS. Possibly, it is; possibly, yes. 

Mr. GREEN. But when you have upwards of 1,000 that were submitted and met the program requirements, but weren’t funded because of the competition, it stands to reason that we might need 

more funding. 

Mr. WILLIAMS. Well, I am not saying that the program couldn’t 

use more funding. 

Mr. GREEN. That is fine. 

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Mr. WILLIAMS. You have to be concerned about the quality of the 

applications that you end up funding. Again, it is a question of 

budget priorities. 

Mr. GREEN. Oh, sure. I understand that. That is why I wish I 

could say we appropriate money in this committee, but we don’t. 

We just authorize it, and we still have to fight within the appropriations process to do that. 

I was looking at the numbers. Fiscal year 2008, the President requested $1,988,467,000, which is a little more than $400 million 

more than the year before for fiscal year 2007. The House actually 

appropriated—although again Labor-H didn’t pass, wasn’t signed, 

but about another $200 million. The House passed $2,188,000,000. 

Again, no matter what we authorize, we are still going to be 

struggling with getting $2,188,000,000. We are dealing with authorizations, and I think your point was made. 

Mr. WILLIAMS. Let me correct your numbers a little bit. The 

President’s budget in 2008 was actually—it was about $200 million 

more than the 2006 level, but it was about the same as the actual 

enacted level in 2007. 

Mr. GREEN. OK. But again, getting back to the original one, 

there were 1,000 additional applications that were submitted that 

met the program requirements, but because of competitiveness, 

they couldn’t be funded. 

While we support the expansion of the community health centers, it is no surprise to members of our committee that the need 

remains high for affordable and effective community centers. Earlier this year, a study found that 56 million Americans are medically disenfranchised, that is, without a regular source of care or 

lack a community health center. As we plan for the future, it is 

critical we know how many would-be health centers are out there 

that still haven’t received grant funds and, as a result, how many 

more patients we could reach through this successful program. 

What I would ask you, and I know you don’t have it today, if you 

could provide the committee with the total number of applications 

submitted for each year, beginning in fiscal year 2002, and the 

number that were scored as fully acceptable or higher, and the 

number that were actually funded, so we can look at it and base 

our authorization levels, hopefully, on the number of clinics that 

weren’t—that meet the requirements, but because of budget constraints, couldn’t qualify. 

Mr. WILLIAMS. We would be happy to do that. 

Mr. GREEN. Your testimony mentioned HRSA’s goal of improving 

quality health care at centers throughout with expanded health information technology. I agree with you. 

I am pleased that the agencies awarded grants to health centers 

for health IT expansion. Despite the increased emphasis on health 

IT in HRSA, we know that health IT adoption is not widespread 

among our centers. 

A recent ‘‘Health Affairs’’ article published the results of a national survey of FQHC’s foci on health IT. A study found that a 

quarter of health centers have some capacity for electronic health 

records, but only 13 percent of health centers have truly functional 

electronic health records. 

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It should be no surprise that the lack of capital is a cited as a 

top barrier to the health center adoption of IT. With more than 100 

health centers in this country and with only 13 percent truly functional for electronic health records, I can only imagine that HRSA 

has more than 46 centers in need of health IT grants. 

Can you speak to HRSA’s needs for health resources for those 

health IT grants? 

Mr. WILLIAMS. Yes. Let me say one thing. I think the health center community is a very diverse community, and it ranges from 

very small health centers and isolated rural areas to larger, one 

would say, almost big businesses. 

If you look at the very best of what we have—and not all of them 

are just the biggest, but if you look at the very best of our health 

center operations, especially with respect to health information 

technology, they are—our best health centers are on the cutting 

edge in the use of this technology, especially for clinics and medical 

operations of the size that we are talking about. 

A lot of—we are not a big hospital center where a lot of this technology is now deployed. But if you look at doctors’ offices or clinics, 

the best of our health centers do very well with this technology. 

There is more that we can do, and we are trying to encourage 

them to be wise in their business decisions, to come together as 

networks so that they can reduce the risk of the implementation 

of this technology. And we have also been working with—going 

around the country talking with foundations. 

States are also now investing in this technology and trying to 

make marriages, so to speak, between foundations that want to invest in the safety net and promote this technology, States that 

want to do the same thing and bring our health center community 

to the table and say we are a vehicle where this technology can be 

deployed to the very good benefit of the people we serve. 

Mr. GREEN. I agree, and I know my time is running out and ran 

out, Mr. Chairman, but that is the beauty of our community health 

center program, that they can draw money from lots of other 

sources, including foundations; but we are only dealing with authorization level. 

Mr. Chairman, I would like to submit that our increased authorization level fits the future needs of the health center program; and 

also the health IT adoption is a perfect example of the growth tool 

that our bill seeks and needs to provide to health centers. We can 

go to foundations, and I know lots of centers do that, but they still 

need that basic assistance from the Federal Government. 

I have one other question I will submit, basically on Dr. Williams’ testimony that driving the health centers program is cost-effective. I would like to follow up on that, but we will do that to 

show they are cost-effective, particularly with Medicaid. 

Mr. PALLONE. So ordered. 

Mr. Murphy. 

Mr. MURPHY. Thank you, Mr. Chairman. 

Dr. Williams, good to have you here. I saw a study that was reported a while ago from the National Association of Community 

Health Centers that stated that the community health centers even 

save Medicaid about 30 percent per Medicaid patient, or about $17 

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billion annually, due to reduced specialty referrals and fewer hospital admissions. 

Does that number sound about right, or do you think it is higher 

than that now? 

Mr. WILLIAMS. I don’t have any other information that would say 

it is any different, so I would guess that is probably correct. 

Mr. MURPHY. I am just thinking in terms of it not only saves people money when they don’t have any insurance, but it even saves 

money, the government money, on Medicaid. 

Also, a question with those professionals who participated in the 

National Health Service Corps: They are paid for their services? 

Mr. WILLIAMS. They are paid by the people who employ them, 

yes. 

Mr. MURPHY. They are employed by the community health centers, and I am assuming they are covered under the Federal Torts 

Claim Act. And you heard my earlier comments. 

Mr. WILLIAMS. Yes. 

Mr. MURPHY. Were aware of the issue out there, that volunteers 

are not covered by that? 

Mr. WILLIAMS. Yes. 

Mr. MURPHY. Do you know, has the Government in any way— 

looked in any way at what the cost savings would be if we allowed 

people to volunteer at these centers? 

Mr. WILLIAMS. Volunteer at community health centers? 

Mr. MURPHY. Yes. 

Mr. WILLIAMS. I don’t know the answer to that question. The 

statute clearly requires us to employ physicians. It doesn’t allow us 

to provide tort coverage to volunteers. 

Mr. MURPHY. The law would allow us to change that. 

Mr. WILLIAMS. There is, though, and this is worth looking at— 

the Congress authorized a program a couple of years ago, free clinics program. Their volunteers, if the clinic itself accepts no payment, and the physicians who practice there accept no payment, 

they can—if they apply to us and meet certain criteria, can get 

FTCA tort coverage. 

Mr. MURPHY. I always thought it was ironic that a community 

health center, if you are paid, you are covered by the Federal Torts 

Claim Act, and if you are volunteering, not. If you volunteer at a 

free clinic, you are covered, but if you are paid, you are not. 

Maybe we should look at what is the best way to help the patients out. I mean, only government could figure out that kind of 

a mess, how to do that. Yet if we recognize that just the savings 

alone from Medicaid may be upwards of $17 billion—and that was 

a couple of years ago—and we are trying to provide other open direct access of care for patients without even having to go through 

insurance carriers alike—without having to go through Medicare, 

Medicaid, everything, but directly with the physicians—it seems to 

me that it is an issue whose time is due. I hope that is something 

you all can look at. 

My understanding in the past—unfortunately, our CBO doesn’t 

score savings. Any time a Member tries to present legislation that 

saves the government money, the government says. We don’t know 

how to score that. And we hope that is something you can address 

to the chairman of the subcommittee and the full committee too. 

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I wanted to ask, of those who are part of the National Health 

Service Corps, those are generally people right out of school too? 

Mr. WILLIAMS. Right out of medical school and usually right after 

their residency—they complete their residency. 

Mr. MURPHY. You need just to draw attention that those who 

might want to volunteer—sometimes it is a physician who, oftentimes because of the cost of medical malpractice insurance—you 

may be aware of this—there may be an OB/GYN who declares it 

is too costly to deliver any more babies, so they stop doing prenatal 

care. They stop deliveries. 

I see many of these folks who say, I would love to volunteer some 

of my time somewhere. But, of course, if they do that, then their 

insurance climbs back up again and they can’t do it. It is a way 

of getting people who are highly experienced at these centers as 

well. 

I think we all agree in this community, these centers are just a 

tremendous asset for communities. It is sad, though, when I read 

an article that came out the other day in way off, faraway Anchorage, Alaska, that they are struggling to hire. They don’t have 

enough physicians there, and some funding issues. But again, it is 

an issue if someone could volunteer, they could do well, and I can 

save some money. 

I just want to leave my questions with the part of I hope that 

is something you will take a careful look at and provide some information back to the chairman of this committee. 

Mr. WILLIAMS. We would be happy to do that. 

Mr. MURPHY. I yield back. 

Mr. PALLONE. Thank you. 

Ms. Baldwin. 

Ms. BALDWIN. Thank you, Mr. Chairman. 

Dr. Williams, I have a couple of questions that actually relate 

pretty closely to the first question that Mr. Murphy just asked, basically the interrelationship between the Medicaid program and the 

community health centers. 

First, I just want to recall that obviously Congress a few years 

ago passed a Deficit Reduction Act which included cuts to the Medicaid program, giving the States the authority to figure out how 

they would extract those savings, but including increasing the 

amount of cost-sharing that Medicaid beneficiaries would have to 

pay for their health care. 

I know that during the debate those several years ago, many of 

my colleagues and I argued that we expressed our concerns about 

the cost-sharing provisions and how it could make health care 

unaffordable to some Medicare beneficiaries and potentially force 

them to forgo needed care. 

I am curious to know whether we are seeing any pivot of these 

people, turning to community health centers. 

As the representative of the agency that administers the grants 

for the health—for community health centers, has HRSA evaluated 

the data from community health centers of late, to measure the impact that increased Medicaid cost-sharing provisions have had on 

utilization of community health centers and the people they serve? 

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I would invite you also, if any of the other DRA requirements 

that were put in have increased utilization—I know there were numerous provisions, obviously, in the DRA. 

Mr. WILLIAMS. I can go back and take a look. I am not aware 

of any research that we have done that would pinpoint the answer 

to the question that you raised. 

Certainly, health centers are by law obligated to serve whoever 

comes to them. Whether more people are coming because they have 

higher copayments outside of Medicaid, I don’t know. Certainly, as 

the number of uninsured has grown, there are more people, I 

think, coming to health centers because they have no alternative. 

I will see what information we may have, but I am not sure that 

we can answer your question precisely. 

Ms. BALDWIN. OK. 

Also, following directly on Mr. Murphy’s first question, we certainly as a committee struggle with ensuring that American people 

have access to quality health care, but also maintaining fiscal discipline in our entitlement programs such as Medicare and Medicaid. 

In your testimony, you described health centers and their programs as cost-effective. I certainly and wholeheartedly agree with 

that, but I wonder if you could elaborate on the relationship between health center programs and the Medicaid programs, particularly with regard to the savings that the care provided in health 

centers translate into for the Medicaid program. 

Mr. WILLIAMS. A lot of the Medicaid reforms have shifted decision-making to the State level, so States have a lot more flexibility 

on how to design their programs and how to operate. 

That has been, actually, an incentive for our community health 

centers to talk and come to their States to lay out what they can 

do, demonstrate what they can do in the context of providing a 

value for the Medicaid services which they provide. 

Incidentally, health information technology, electronic health 

records, actually is a good tool to document the services you are 

providing and the results that people get. Chronic disease management with diabetes, for example, a lot of health centers are very 

good at controlling chronic disease. For Medicaid, it is a real value. 

I think, as we go around and talk to State Medicaid directors, a 

lot more of them are now conscious of the fact that health centers 

actually produce very good results and are willing to work with 

health centers as part of their managed care or other operations at 

the State level. 

I think it is beginning to penetrate that health centers are a very 

good deal. 

Ms. BALDWIN. That is great, and that is a really interesting point 

you raise about health centers actually approaching Medicaid administrators at the State level. 

Are there any States that have provided a role model for others 

to look at in terms of that collaboration and the cost savings that 

are generated from that? 

Mr. WILLIAMS. Well, let me take that back, and I will give you 

some feedback on that question. 

I know in some States—Texas, for example, understood early on 

that health centers were a very good investment and they actually 

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created what is called an incubator program in Texas and they 

worked with communities, States, that invested in the development 

of FQHC, what are called FQHC look-alikes. They would then 

apply for FQHC status, and that would give them good experience 

to apply to us for a section 330 grant. 

Other States, Louisiana and others, have picked up this idea and 

are also investing in their communities to try to develop good, competitive applications for the health center program because they 

have understood that it is a good investment. 

But I will see what other additional information I can give you 

that might point to some States that are very good at this. 

Mr. PALLONE. Thank you. 

Mr. Burgess. 

Mr. BURGESS. Thank you. 

Dr. Williams, you heard me reference Orleans Parish and Jefferson Parish in my opening remarks. As far as the National Health 

Service Corps is concerned, do you think that during the public 

health emergency that existed in the fall of 2005 and, really, to my 

understanding, persists to this day, do you think the National 

Health Service Corps has adequately addressed the needs of Orleans Parish and Jefferson Parish in Louisiana? 

Mr. WILLIAMS. Absolutely. We have worked—from the immediate 

aftermath of Hurricane Katrina in Louisiana, we worked very 

closely with the State as they provided us information for designating geographic areas in Louisiana as health professional shortage areas. 

The State has a very good mechanism. We gave it a high priority, and we told them that as they assembled information, 

brought applications to us, that we would turn them around in a 

very short period of time, and we have kept that promise. 

If you look at the number of health percentage—health professional shortage areas designated in Louisiana today, versus prior 

to Hurricane Katrina, you will see that we have kept our word. 

With respect to Orleans Parish, a lot of the health care providers 

live there. It is difficult to identify some geographic areas as health 

professional shortage areas, and actually I think Orleans is one, because there are so many providers that are there. We have tried 

to work with the State to actually identify shortage populations 

and other ways to try to make these designations available to the 

State. 

Mr. BURGESS. I don’t want to interrupt you. 

Mr. WILLIAMS. They have done a very good job working with 

them, and I think the State would say we have too. 

Mr. BURGESS. Well, but every time we have a hearing on either 

Oversight and Investigations, or this committee, that deals with 

health care in Louisiana, we hear about the fact that it is not 

working as it was intended. 

I will just tell you my own observation from being down there. 

In October of 2005 I met with groups of doctors in both Jefferson 

Parish and Orleans Parish, and they were struggling to keep the 

doors open. They were spending their kids’ college money to keep 

their doors open, and they couldn’t get any help out of Washington. 

I heard it over and over and over again. 

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Then our committee, the Subcommittee on Oversight and Investigations, went back down in January. It was pretty clear to me 

then that doctors were leaving the area in large numbers. If the 

doctor was not married to someone who was born and raised in the 

area, they were not very likely to stay there. 

Now—again just my personal observation, but again, it has been 

borne out by testimony we have had before this committee on numerous other occasions. I would just ask, in the interest of time, 

if you could detail some of those things for me in writing. 

Mr. WILLIAMS. We are not the only ones involved in this. CMS 

and others have also been very much engaged. Secretary Leavitt 

has been very much engaged in trying to make resources available. 

Mr. BURGESS. I understand. I will just tell you the level of frustration that is coming before this committee time and again does 

not indicate that a good job has been done. Quite honestly, I don’t 

know, really it been several months since we have had another 

hearing, and perhaps we need to go back down there, Mr. Chairman. I would be very interested in doing that. 

Let me just ask you a question, because we are going to run out 

of time. You talked a little bit about not having the availability to 

tie into the kinds of things that a big hospital system would and 

that you would rely on foundations and States that want to invest 

in the health care, the federally qualified health care system. 

What about partnering with some of the integrated health systems that are out there like Ascension Health, Covenant Health 

out in West Texas. What are the barriers that prevent the federally 

qualified health center from partnering with some of those groups? 

Mr. WILLIAMS. Partnering in the investment and information 

technology. 

Mr. BURGESS. Well, trying to get a specialist, trying to get a patient referred to a specialist, for example, when their primary care 

is a federally qualified health center—difficult to get them referred 

to a specialist, might be difficult to get them into a hospital. 

You have groups like Ascension Health and Covenant Health out 

in Lubbock that would welcome the opportunity to work with a federally qualified health center and that would be a win-win situation for both sides. 

Mr. WILLIAMS. Sure. 

Mr. BURGESS. Yet, they have had no success in getting past the 

starting blocks. 

Mr. WILLIAMS. Well, I think what Ascension—if you are talking 

about a health center making referrals for specialty care to Ascension Health, I don’t see that there are any barriers to that. If what 

you mean is that Ascension Health itself wishes to become designated as a FQHC, that is a different matter. 

It really has to do not with Ascension Health’s ability or—it 

could qualify. It does nothing about Ascension Health and its clinics that couldn’t qualify if it met all of the requirements of the statute. For a big hospital system like Ascension, traditionally the biggest stumbling block has been governance requirements, that the 

requirement for a majority, consumer-based board has been one of 

the biggest obstacles to big hospital systems. 

Mr. BURGESS. But, in concept, you would not be averse to that 

type of partnering if the governance issues could be worked out. 

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Mr. WILLIAMS. I think the governance issues are very important. 

Mr. BURGESS. If they can be worked out, then an amendment to 

our reauthorization bill that addressed that would be in accordance 

with HRSA’s desires. 

Mr. WILLIAMS. No. I think if Ascension Health can qualify for the 

section 330 health center requirements as they exist today, we 

would obviously like that. We wouldn’t necessarily propose to 

change those. 

Mr. BURGESS. Let me ask you this. Would it be possible for you 

to provide the committee with a map where the federally qualified 

health centers are located across the country? 

Mr. WILLIAMS. Yes. In fact we do have such a map. We have 

geospatial data capability. We can do that. 

Mr. BURGESS. You can provide that to the committee? 

Mr. WILLIAMS. Yes. 

Mr. BURGESS. When Congressman Green talked to you about the 

scoring and that some facilities might not score as high as others, 

do you ever look at the maps to see that you have six clinics in 

Chairman Pallone’s district and five in Congressman Green’s and 

none in Ranking Member Barton’s district and none in Congressman Burgess’ district? 

Mr. WILLIAMS. We don’t look at things that way. 

We do look at the maps and see where we have gaps. We have 

done that. One of our motivations for the President’s initiatives on 

high poverty counties was our recognition that some of the poorest 

counties in the country were not as competitive in the Presidential 

initiative, and so we felt the need to try to create a competition 

that would allow those poor counties to better compete. That was 

the motivation for that by looking at the map. 

Mr. BURGESS. The counties themselves are not amorphous. There 

can be pockets, deep pockets, of poverty within a county that otherwise just demographically can look quite affluent. 

Mr. WILLIAMS. Yes, people have pointed that out to us. I think 

that is a fair comment. 

Mr. BURGESS. Let me ask you this. You talked about performance and accountability standards within the federally qualified 

health center. Who draws up the business plan? Is that entirely 

drawn up by the board? 

Mr. WILLIAMS. They are responsible for doing that, yes. 

Mr. BURGESS. You have oversight over the business plans as they 

are drawn up? 

Mr. WILLIAMS. We do have oversight. We need to make certain 

that they meet statutory requirements and that they are doing 

what they are telling us what they are going to do in their applications. 

Mr. BURGESS. Decisions like the ratio of the number of administrators to the number of practitioners, who makes those decisions? 

Mr. WILLIAMS. That is a local board decision. 

Mr. BURGESS. Who makes the decisions about how many patients 

per day are seen by a given practitioner? 

Mr. WILLIAMS. We have some standards that we like to hold people—give people objectives to try to meet. In the end, it is a board 

decision. 

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Mr. BURGESS. I have got to tell you, in trying to work through 

some of these problems locally in Fort Worth, thinking back to my 

days of having run a clinic, looking at the guidelines that were provided by the existing federally qualified health center, I don’t know 

how in the world the thing could cash flow with the number of constraints they put on themselves. 

But those are entirely local board decisions and not decisions 

coming out of HRSA? 

Mr. WILLIAMS. We have some of productivity standards that we 

lay out for people, and we want them to try to meet them. They 

are not absolutes, but we do set some goals for them. We don’t 

want to subsidize very expensive health care. 

If you look at the cost per patient that I have cited to in my testimony, I think we are, by and large, a very productive system. 

Mr. BURGESS. Now, in a community where you have a federally 

qualified health center and a private practitioner side by side, a 

Medicaid patient comes to each facility, is the reimbursement rate 

different in a federally qualified health center than it would be for 

a private practitioner who is just out trying to earn a living next 

door? 

Mr. WILLIAMS. FQHCs do have some cost reimbursement advantages. 

Mr. PALLONE. Dr. Burgess, I am going to have to stop you, even 

though I like your questions, but you are 4 minutes over, so let’s 

wrap up. 

Mr. BURGESS. I guess what I am getting at is, would there ever 

be a situation where we would reimburse the actual physician in 

a neighborhood that doesn’t have a federally qualified health center? 

Why don’t we encourage the participation of physicians in those 

neighborhoods who are out there doing our work for us, seeing the 

Medicaid patient, seeing the SCHIP patient, seeing then insured 

patient? Why do we favor the physician who is working in a federally qualified health center when the physician who is working in 

a private practice in a similarly poor neighborhood is doing just as 

much good work? 

Mr. PALLONE. We will let you answer that, and that is going to 

be it. 

Mr. WILLIAMS. I think the underlying argument here is that in 

a health clinic setting such as we have, we are providing health 

care and a lot of wraparound support services for that individual 

and for the patients who come to that clinic; and the return for 

that is very good. 

Mr. BURGESS. Mr. Chairman, I would just submit if we paid physicians in poor areas fairly to begin with, maybe we wouldn’t have 

had to create this entire other bureaucratic structure. But that is 

another day’s question. 

Mr. PALLONE. Fair question. I know you are going to get back to 

us with some materials, particularly that map is of great interest 

to me as well. 

Mr. WILLIAMS. We would be happy to do that. 

Mr. PALLONE. Thank you very much. We appreciate your responses, and it has been very helpful in what you have been doing. 

Thank you. 

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Mr. WILLIAMS. Thank you. 

Mr. PALLONE. I will ask the next panel to come up. 

Our second panel—I will go from the left here: We start with Mr. 

Wilbert Jones, who is chief executive officer of the Greater Meridian Health Clinic in Meridian, Mississippi. 

Then we have Steven Miracle, who is executive director of the 

Georgia Mountain Health Service, Inc., in Morgantown, Georgia. I 

like that name, ‘‘Miracle.’’ 

We have Mr. Ricardo Guzman, who is chief executive officer of 

the Community Health and Social Services Center in Detroit, 

Michigan. 

Finally, Dr. Michael Ehlert, president of the American Medical 

Student Association. He is from Reston, Virginia. 

As I said before, we have 5-minute opening statements from each 

of you. They will be made part of the record. We may ask you to 

submit additional statements in writing for inclusion into the 

record. 

I recognize, first, Mr. Jones for an opening statement or for a 

statement. Thank you. 

STATEMENT OF WILBERT JONES, CHIEF EXECUTIVE OFFICER, 

GREATER MERIDIAN HEALTH CLINIC, MERIDIAN, MS 

Mr. JONES. Mr. Chairman, good afternoon, Chairman Pallone, 

Representative Deal and members of the subcommittee. 

I am honored to speak with you about health center programs 

and several pieces of Federal Tort Claims Act legislation that 

would help centers to deliver better care for the systems for the underserved communities. 

As chief executive director of the Greater Meridian Health Clinic, 

I am grateful to this subcommittee for supporting health center 

programs. 

I want to thank my Congressman, Representative Pickering, and 

Representative Green for introducing H.R. 1343, the Health Centers Renewal Act. All the health centers in my area support this 

bill and wish to renew the core elements of this program. This program would also authorize much-needed additional funding so that 

we can serve even more individuals in our communities. 

Mr. JONES. The Greater Meridian Health Clinic was established 

in 1986 to serve medically underserved residents in five counties 

in our rural areas. We operate six sites and a mobile health unit, 

and we pride ourselves on being a one-stop shop for the provision 

of primary care, preventive care, on-site dental, pharmacist services and important enabling services. 

I am very proud of the board of directors, who make sure that 

we are connected to our community, and I am equally proud of our 

staff, which now number over 100 employees, including health care 

providers, administrative staff, to support patient care in over 

seven sites. 

As the health center program has grown over the past 5 years, 

Congress has recognized key challenges that could keep health centers from maximizing delivery of health services to the medically 

underserved individuals. With this in mind, in 1992, Congress enacted legislation that would allow health centers to be covered 

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under FTCA in order to expand the availability of care and ensure 

that our providers are accountable for the care they provide. 

In the wake of Hurricane Katrina, the urgent need for further 

clarification of the FTCA statute came to light. The number from 

medically underserved individuals in our community has swelled as 

Greater Meridian Health Clinic served not only our regular patients, but a tremendous number of evacuees that were fleeing the 

storm. Three of our sites were directly affected by the hurricane, 

and our main site went off land for a short period of time. We estimated that we sustained over half a million dollars in damage and 

revenue losses. 

A number of health centers from outside of Mississippi were glad 

to come down to help relieve my staff. Unfortunately, the Health 

Resource and Service Administration clarified, in a program information notice, that health center medical staff would not be covered under the FTCA once they crossed State lines even if they 

were serving in a covered health center. 

Our center is located 14 miles from the Alabama border, and I 

am concerned that this process severely affected the health center 

response in my State and other States. I don’t want to see the 

same situation arise in other emergencies, potentially preventing 

health centers from going where patients need their services. 

H.R. 870, sponsored by Representatives Diana DeGette and the 

late Paul Gillmor, would cover health centers under FTCA to help 

in disaster situations, and I urge the committees to support it. 

Additionally, Greater Meridian Health Clinic would welcome a 

clarification to the FTCA statute that would allow volunteer physicians to serve at health centers and become accountable to our patients. As specified in H.R. 1626, this bill was sponsored by Representative Tim Murphy and Representative Susan Davis. 

We have been very pleased to have several physicians who have 

donated their time to see our patients, and we would like to accommodate more providers who want to volunteer at Greater Meridian 

Health Clinic. However, the confusion surrounding medical liability 

coverage often makes this a very challenging situation. 

At our center, we take pride and volunteerism to heart. We believe that extending the FTCA coverage, as outlined in H.R. 1626, 

would provide an incentive for clinicians who would volunteer to 

deliver critically needed health services to our patients at our 

health centers. 

Health centers look forward to working with members of the subcommittee to ensure that centers can continue to deliver high-quality, cost-effective health care services, and we thank this committee 

for your work and would be happy to answer any questions from 

this committee. 

[The prepared statement of Mr. Jones follows:] 

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Mr. PALLONE. Thank you, Mr. Jones. 

Next we have Steven Miracle. 

STATEMENT OF STEVEN MIRACLE, EXECUTIVE DIRECTOR, 

GEORGIA MOUNTAIN HEALTH SERVICE INC., MORGANTOWN, 

GA 

Mr. MIRACLE. Thank you. 

Mr. Chairman and members of the subcommittee, thank you for 

the opportunity to speak about the health centers bill and H.R. 

1343, the Health Centers Renewal Act. I appreciate the unwavering support that this subcommittee has offered to health centers as 

we seek to expand and enhance access to health care services for 

medically underserved individuals and their families. 

The health centers program should be swiftly reauthorized. A 

special thank-you to Representative Green and Representative 

Pickering for introducing H.R. 1343, which provides for a straightforward 5-year reauthorization of the program with funding authorization levels which will allow centers to serve additional individuals. 

With 230 cosponsors, including a majority of the members of this 

subcommittee and the full committee, I believe that passage of 

H.R. 1343 is the best way to guarantee the successful renewal of 

the program. In this reauthorization, nothing is more important 

than retaining the patient majority board governance of health centers and ensuring the enactment of the funding authorization levels included in the bill. 

I also applaud Chairman Pallone and my Representative, Congressman Deal, for their leadership this year in authoring a letter 

to the Appropriations Committee in support of a $200 million increase in fiscal year 2008 funding for the health centers program 

equal to the initial year funding in H.R. 1343, which will help fuel 

the next phase of the program’s growth. This expansion is supported by the funding levels in the bill and will put health centers 

on a path to eventually serve 30 million patients by 2015. 

The community empowerment and patient directed care model 

that began over 40 years ago is alive and well in my health center. 

Georgia Mountain Health began in 1984 as a result of a public-private initiative, in part to provide primary care services to residents 

of the Appalachian area in the northern part of our State. 

The first provider at our health center worked in a trailer, which, 

incidentally, doubled as her home as well as the medical office. 

Since then, that trailer has been replaced with a building with five 

exam rooms and our corporate office. 

We have grown to five service sites, including one site that provides dental services. We currently employ over 30 full-time employees. We have 11 health care providers and a bilingual staff to 

address the needs of our Spanish-speaking patients. 

Georgia Mountain Health provides services to over 6,500 individuals and over 16,000 total patient encounters. Almost 55 percent 

of our patients are uninsured. Nearly 27 percent are Medicaid recipients. The Latino population in our community is rapidly growing and accounts for nearly 15 percent of our patients today. 

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Our patient majority board is made up of retired people, small 

business owners, Latinos and Caucasians, and is a good reflection 

of both our service area and our patient population. 

Our board is committed to ensuring that the care we provide to 

our patients is community driven. Our board has been centrally involved in developing our strategic plan and identifying new service 

areas needing local access to medical services. In addition, individuals on our board are active volunteers and supportive of various 

outreach efforts in which our organization is engaged. 

We are proud of the high-quality, cost-effective care we provide, 

including basic family and geriatric medical care, dental services 

and key enabling services that make our care truly accessible. 

Nationally, the health centers program wins top marks for efficiency and performance from the Office of Management and Budget, the Institutes of Medicine, and the GAO. Our success and the 

success of health centers nationally is due to the four statutory requirements of the health centers programs: openness to all regardless of the ability to pay; location in medically underserved areas; 

provision of comprehensive, preventive and primary care services; 

and lastly and importantly, the governance of patient majority 

boards. 

We are making a difference in rural north Georgia. H.R. 1343 

will ensure continued access to quality care for residents of our 

area and for millions nationwide. 

Thank you once again, and I would be happy to answer your 

questions. 

[The prepared statement of Mr. Miracle follows:] 

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Mr. PALLONE. Thank you. Mr. Guzman. 

STATEMENT OF RICARDO GUZMAN, CHIEF EXECUTIVE OFFICER, COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, 

INC., DETROIT, MI 

Mr. GUZMAN. Good afternoon, Mr. Chairman, ranking member 

and members of the subcommittee. Before I go into my little 

speech, I wanted to again thank the committee for being able to 

make this presentation. 

It was interesting, listening to Dr. Williams and the members of 

the committee. We don’t always get kudos in terms of the work 

that we do in the community. So thank you very much. 

The second item, though, is Mr. Jones, Mr. Miracle and myself 

represent 81 years of providing services in community health centers to the citizens and the residents of the United States. 

My name is Ricardo Guzman, and I am chief executive officer of 

the Community Health and Social Services Center, a comprehensive, federally qualified health center with two community health 

centers and one school-based health clinic in Detroit, Michigan. I 

want to thank you for the opportunity to speak today on behalf of 

the Nation’s health care safety and our providers and to emphasize 

the importance of your support of school-based health clinics, which 

we refer to as SBHCs. The National Assembly of School Health 

Care, which I represent today, supports the continued growth of 

the consolidated health center program. 

As Congress moves towards reaffirming its support for a health 

care safety net system, it is incumbent upon each of you not to 

leave children and youth behind in this process. As a manager of 

health centers, I am here today to tell you that SBHCs are an important health care safety net provider for children and adolescents, and it is time for Congress to support the life-altering work 

that they do every day. 

Therefore, I want to thank Representatives Hooley and Capito 

for their leadership in introducing H.R. 4230, the School-Based 

Health Center Act of 2007, which authorizes a grant program to 

support and expand SBHCs nationwide, the only medical model 

solely dedicated to meet the health needs of children and adolescents in schools. 

For members who are here today who might not be as familiar 

with this model of health care, let me tell you more about SBHCs 

and the comprehensive care and mental health support they offer. 

These programs are like doctors’ offices in schools. There are 

1,700 school-based health centers in 44 States and the District of 

Columbia and Puerto Rico. These programs provide services ranging from acute medical care, chronic disease management, preventive medical care, health education, mental health and, in some 

programs, oral health services. They serve as a medical home and 

as a secondary access point for the students they see. When a medical home already exists, the relationships between the two has 

been documented as complementary, not duplicative. 

The daily educational experience of children and adolescents can 

be optimized by reducing obstacles to learning created by poor 

health. Providers have the advantage of proximity and time with 

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students to create substantive relationships with high-risk youth 

throughout their academic career. 

A nationwide poll found that voters looked to the Federal Government to set aside specific funds for SBHCs, yet only 36 percent 

of programs are eligible to receive funds from the Federal Government to support their efforts. 

In fact, in my SBHC we do not receive section 330 funds. The 

mental health of students, particularly the need for assistance with 

grief, peer pressure, bullying and suicide prevention is of special 

concern to voters and SBHCs are responding to this need. 

As an example, in our center, a young girl came to our SBHC requesting aspirin because of a headache. As the nurse practitioner 

spoke with the student, it became apparent that the student really 

came because she needed to talk with someone. She was thinking 

of killing herself. In our SBHC, we were lucky to have our social 

worker on staff who was able to see her immediately. 

In spite of the tremendous advantages afforded by SBHCs, significant policy and financial barriers threaten the sustainability of 

the model and prevent widespread replication. While we are fortunate in Detroit to sponsor and fund our program through our community health center, only 22 percent of the current programs nationwide are eligible for this funding. 

You heard from the government witness, funding exists for this 

segment of the school-based health center population. However, 

three-quarters of the field can’t receive these funds. Access to these 

funds is severely limited. Therefore, the vast majority of SBHCs operating throughout the country do not have access to the same 

sources of funding that we have. 

There is no specific Federal funding program for SBHCs. Because 

of inadequate funding forpreventive and mental health care services in primary care settings, SBHCs experience great difficulty in 

integrating and sustaining their comprehensive scope of services. 

SBHCs have had great difficulty being recognized as Medicaid 

service providers. Even when the clinics are recognized as providers, services outside of the traditional doctor-patient visit that 

are central to the success of the model are not reimbursed by Medicaid. 

Therefore, as the committee enters into discussions regarding the 

various models of health care currently administering to populations in need, I urge you to include H.R. 4230 in this discussion. 

The authorization of a grant program to support and expand 

SBHCs nationwide is an urgent need if we are to allow all students 

an opportunity to grow up healthy, strong, and achieving their educational potential. 

Our Nation is hungry for change. Americans are no longer willing to accept their ineffective health care system, the kind of system where a child can die from something as treatable as a dental 

abscess. School-based health clinics must be front and center as we 

transform our Nation’s health care system to gain equity, access, 

and opportunity for all children. 

Thank you very much. 

[The prepared statement of Mr. Guzman follows:] 

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STATEMENT OF J. RICARDO GUZMAN

Good afternoon Mr. Chairman and Members of the Subcommittee, 

I am Ricardo Guzman, the chief executive officer of the Community Health and 

Social Services Center, a comprehensive federally Qualified Health Center with two 

community health centers and one school-based health clinic in Detroit, Michigan. 

I want to thank you for the opportunity to speak today on behalf of our Nation’s 

health care safety net providers and to emphasize the importance of your support 

of school-based health clinics. The National Assembly on School-Based Health Care, 

which I represent today, supports the continued growth of the consolidated health 

center program. As this committee begins its consideration of H.R. 4230, The 

School-Based Health Clinic Establishment Act of 2007 and the Health Centers Renewal Act of 2007, I urge you to consider the needs of underserved populations 

throughout the country. 

As Congress moves toward reaffirming its support for a health care safety net system, it is incumbent upon each of you, not to leave children and youth behind in 

this process. As a manager of health centers, I am here today to tell you that schoolbased health clinics are an important health care safety net provider for children 

and adolescents and it is time for Congress to support the life altering work they 

do every day. I want to thank Congresswoman Hooley for her leadership in introducing, H.R. 4230, The School-Based Health Clinic Establishment Act of 2007, 

which authorizes a grant program to support and expand school-based health clinics 

nationwide. 

For Members here today who might not be as familiar with this model of health 

care, let me tell more about school-based health clinics and the comprehensive care 

and mental health support they offer. These programs are like doctors offices in the 

schools. There are 1,700 school-based health clinics in 44 states, DC and Puerto 

Rico. These programs provide services ranging from acute medical care, chronic disease management, preventive medical care, health education, mental health and in 

some programs, oral health services. They serve as a medical home and as a secondary access point for the students they see. When a medical home already exists 

the relationship between the two has been documented as complementary not duplicative. 

The daily educational experience of children and adolescents can be optimized by 

reducing obstacles to learning created by poor health. In our school-based health 

clinics, we work closely with teachers, parents, and school administrators to serve 

students in the best possible manner. 

A nationwide poll found that: 

Voters look to the Federal Government to set aside specific funds for the clinics. 

Yet only 36 percent of programs report receiving any funds from the Federal Government to support their efforts. 

Voters also believe that school-based health clinics should provide a wide range 

of services including prevention and treatment of chronic diseases such as asthma 

and diabetes. They are also supportive of providing students in school with health 

education on eating right and exercising, treatment of acute illness and sudden 

trauma. The great majority of existing programs provide these services. 

The mental health of students particularly the need for assistance with grief, peer 

pressure, bullying and suicide prevention is of special concern to voters, and schoolbased health clinics are responding to this need as well. 

School-based health care is vital to my community—and many like mine—because 

it provides unprecedented access to health, mental health and oral health services. 

The programs are designed with input from the community and school. Providers 

have the advantage of proximity and time with students, creating substantive relationships with high risk youth throughout their academic career. 

In spite of the tremendous advantages afforded by school-based health clinics, significant policy and financial barriers threaten the sustainability of the model and 

prevent widespread replication. While we are fortunate in Detroit to sponsor and 

fund our program through our community health center, only 22% of programs nationwide are eligible for this funding. Therefore the vast majority of clinics operating 

throughout the country do not have access to the same sources of funding that we 

have. There is no specific Federal funding program for school-based health clinics. 

Because of inadequate funding for preventive and mental health care services in primary care settings, school-based health clinics experience great difficulty in integrating and sustaining their comprehensive scope of services. For example since the 

proliferation of Medicaid managed care, school-based health clinics have had greater 

difficulty being recognized as Medicaid service providers. Even when the clinics are 

recognized as providers, services outside of the traditional doctor patient visit are 

not reimbursed by the Medicaid program. These services are central to the success 

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of the model and are identified by sponsors and insurers alike as the model’s added 

value. 

Therefore, as the committee enters into discussions regarding the various models 

of health care currently administering to populations in need, I urge you to include 

H.R. 4230, The School-Based Health Clinic Establishment Act of 2007 in this discussion. The authorization of a grant program to support and expand school-based 

health clinics nationwide is an urgent need if we are to allow all students an opportunity to grow up healthy, strong and achieving their educational potential. 

Our Nation is hungry for change. Americans are no longer willing to accept their 

ineffective health care system—the kind of system where a child can die from something as treatable a dental abscess. Momentum is building around improving children’s health access and quality in states across the country and in the halls of Congress. School-based health clinics must be front and center as we transform our Nation’s health care system to gain equity, access, and opportunity for all children. 

Thank you. 

Mr. PALLONE. Thank you. Dr. Ehlert. 

STATEMENT OF MICHAEL EHLERT, M.D., PRESIDENT, 

AMERICAN MEDICAL STUDENT ASSOCIATION, RESTON, VA 

Dr. EHLERT. I think we are still on. 

Mr. Chairman, members of the committee, my name is Dr. Mike 

Ehlert. I am president of the American Medical Student Association and a recent graduate of Case Western School of Medicine in 

Cleveland, Ohio. 

I have taken a year off from my clinical training, and I am proud 

to represent my members and offer the following testimony on the 

shortage of primary care physicians in the United States and on 

H.R. 2915 to reauthorize the National Service Corps. 

As background, AMSA is the Nation’s oldest and largest independent, student-governed organization of physicians-in-training. 

With a membership of more than 68,000 medical students, 

premedical students, interns, and residents, AMSA continues its 

commitment to improving medical training and the Nation’s health. 

We have proudly testified for each of the National Service Corps 

reauthorizations since our 1970 championing of the Emergency 

Health Personnel Act, the origin of the Corps. In academic medical 

centers, urban hospitals, and community based clinics, physiciansin-training are at the forefront of providing care to a wide range 

of patients, including the Nation’s most vulnerable. 

Through our rotations in emergency rooms, we see the impact of 

inadequate access to primary care daily. Our Nation is in a crisis 

of reliable primary and preventive care for all Americans. The absence of primary care physicians endangers not only the individual 

health of our patients but the community as well. 

For individual patients, primary care doctors can see a wide 

range of health problems, provide a place where patients can expect to have their problems resolved, as well as coordination of care 

where necessary. This teamwork allows patients to rely on a consistent and informed provider to take a greater role in decisions 

about their health. 

Primary care also allows appropriate attention to be given to 

health promotion and creates opportunities for early prevention of 

disease. The majority of health costs in America are incurred by 

preventable and reversible health risks, as well as easily detectable 

and treatable conditions. 

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According to a report by the Institute of Medicine, Primary Care: 

America’s Health in a New Era, primary care reduces the cost and 

increases access to appropriate medical services. Health outcomes 

improve because primary care enables individuals to obtain services before the illnesses become severe, to better control their 

chronic conditions, and ultimately reduce the inefficient use of 

emergency rooms. This all decreases the cost of care in America. 

The shortage of primary care physicians is, however, a problem 

that is not distributed evenly. Over 50 million Americans reside in 

areas designated as HPSAs, health professional shortage areas, by 

the Bureau of Health Professions. In 2000, HRSA estimated that 

an additional 26,000 physicians were needed to meet the desired 

clinician-to-population ratio in these shortage areas. 

There are currently over 4,000 professionals participating in the 

National Service Corps, and throughout its history over 27,000 professionals were placed in underserved areas. As you have heard, retention rates usually hover around or greater than 50 percent. 

Those eligible for Corps funding include primary care physicians, 

which by definition include pediatricians, internists, OB/GYNs, 

psychiatrists and family physicians and the other members of the 

primary care team, including nurse practitioners, physician assistants, midwives, dentists, dental hygienists, and mental/behavioral 

health professionals. 

The premise of the National Service Corps is a financial incentive for those clinicians who practice in locations not as rewarding 

as others. It is no secret that our financing system for health care 

does not reward those who prevent or coordinate care but rather 

those who perform procedures or provide hospital-based critical 

interventions. Further, student debt is at an all-time high. According to the most recent report by the Association of American Medical Colleges, the average medical student graduates with $120,000 

in educational debt. My fiancee and I will have over $300,000— 

$300,000—to repay. 

Primary care is the lowest-paying physician profession. It is no 

wonder that the number of U.S. graduates entering primary care 

fields has steadily decreased over the last decade. 

The Corps provides a crucial incentive to care for Americans who 

are most vulnerable and least likely to have access to care. Both 

the scholarships and loan repayments are a much-needed investment in our health care workforce and the health of these communities. The Corps allows committed and driven and compassionate 

physicians to follow their interests to provide care to the Nation’s 

neediest, instead of being forced to make career decisions based on 

high debt loads. Central to this service are the Nation’s federally 

qualified health centers; and, as you have heard, over 54 percent 

of Corps recipients work in community health centers. 

In a recent article published by JAMA, and as statistics quoted 

today, the average health center has a family physician staff vacancy of more than 13 percent. In rural areas, the rate approaches 

16 percent. 

As a physician-in-training and as the AMSA president, I strongly 

believe that continued support and increased funding for the Corps 

is crucial to improve the Nation’s health. There are a number of 

bills before this committee that would reauthorize the Corps. We 

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emphasize, however, the importance to authorize increased funding 

for the program. The Corps turned away half of the 1,800 physicians who applied last year, an even lower acceptance rate for students who apply for scholarships, with over 11 applicants for each 

available scholarship. 

As my time is up, I will just summarize to say that an immediate 

increase in funding for the Corps is crucial for an already proven 

vacancy rate, a paucity of primary care physicians, and a ballooning of student debt that push young physicians away from primary care and away from underserved areas. This would recognize 

the crucial role physicians play in coordinating and managing the 

health of their patients. 

Thank you, and I look forward to answering any questions. 

[The prepared statement of Dr. Ehlert follows:] 

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Mr. PALLONE. Thank you all, and we will start with questions. 

We will start with me. I will recognize myself for 5 minutes. 

I wanted to ask Mr. Guzman, we heard Ranking Member Barton 

raise concerns about creating a new pot of money for school-based 

clinics when other pots already exist. And you touched on this in 

your testimony, but I was going to ask you to comment further on 

why authorizing a new grant program is necessary and why relying 

on existing or other revenue streams is not adequate. 

And I, just from my own experience in New Jersey, I believe that 

most of the school-based clinics in my district or in our State are 

primarily State-funded. But I don’t know—knowing the situation in 

the State, I am sure that that money is not—there is not a lot to 

go around. So if you would talk about that. 

Mr. GUZMAN. Yeah. We are in the same boat in Michigan. 

I think there are two questions here. The first one is the funding. 

We need dedicated dollars to that. There are different models. This 

model of school-based health centers works, and it allows us to 

have different models that would include health departments, that 

would include hospitals. But I think that if you look at—if you accept the concept that there are no real dedicated dollars with the 

exception of FQHC dollars, which are very, very limited—— 

In our particular case, we did not get any encouragement by the 

Bureau to submit for a school-based clinic. There was several 

issues related to whether or not we had to provide the array of 

services required, have certain hours of operation that would have 

been contrary to—not contrary, but counter to the school and the 

local school district’s wishes in our particular case. 

Mr. PALLONE. Again, I don’t know if it was Mr. Murphy or one 

of my colleagues on the Republican side pointed out that everything we are talking about here is preventative; and, unfortunately, we don’t get it scored. But, I mean, we all believe that all 

these things save money in the long run; and it is unfortunate that 

we can’t score them. 

The other question I wanted to ask, I guess I could ask of Mr. 

Jones and Mr. Miracle, obviously, as was mentioned earlier with 

Dr. Williams, the authorization levels provide for increased—higher 

authorization, more funding in Mr. Green’s bill that is before us 

and if you wanted to indicate whether you are supportive of the authorized funding levels included in the bill. Do you think they are 

adequate to sustain the community health centers program over 

the authorization period, and is there sufficient increased demand 

to justify the increased authorization levels? Obviously, I think so, 

but I would like to hear from you. 

Mr. JONES. On two parts. The demand is definitely—at our 

health center, located in the State of Mississippi, not only are we 

dealing with the patients, our current patients, but continued 

growth in patients and relocation because of Katrina. We are still 

receiving patients, new patients in our clinic. The demand—because of the downturn of the economy, we have many of our patients that are not able to afford health insurance that are seeking 

the health center and seeking the availability of health center services. We are—in our most rural counties, we are seeing more and 

more patients that are not able to travel a long distance to work. 

They are again seeking our services. 

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So, yes, there is a demand. To meet that demand, we must have 

increased funding to not only sustain our existing base, our existing patients’ care and facilities but also to expand to meet the demand, the new demand. 

Mr. PALLONE. Mr. Miracle? 

Mr. MIRACLE. I would concur with that. In our community in 

rural north Georgia, we are a very tourist economy; and we also 

are a second-home-construction economy. We are having problems, 

and I foresee in the next 6 months that the unemployment rate in 

our area will skyrocket. Those folks that are employed because of 

the tourist economy are employed by small businesses who don’t 

typically provide insurance, and so we have a 20-plus uninsured 

rate in our community, and I envision that that will continue. 

We need the dollars to help us take care of the greater demand 

that I foresee in our community. We also need dollars to expand 

our services. We don’t currently provide mental health services at 

our center. There is a serious need in our community for that, and 

I see increased funding levels being able to help us to provide those 

additional services. 

And, lastly, there is just a general increase in the cost of supplies 

our organization faces as well as other providers. And with the 

large percentage of uninsured that we see, it would be very helpful 

to have additional funding to help us just keep up with the health 

care inflation. 

Mr. PALLONE. Thank you. 

Mr. Murphy? 

Mr. MURPHY. Thank you; and thank you, panelists. This is very 

enlightening to have you all here. But I know your jobs require a 

great deal of services above and beyond the call of duty, so I thank 

you for that. 

I should first relay a message, Mr. Miracle, from Ranking Member Deal. He is on the floor managing part of the debate on the 

Norwood organ donor bill, so he sends his apologies. He wishes he 

could be here. He may be back. 

But a question for Mr. Jones and Mr. Miracle on the issue I mentioned before about the medical malpractice costs for people under 

the Federal Torts Claim Act versus volunteers. Mr. Jones, you 

made specific reference to that. Do you have any idea what it costs 

your clinic to pay some of these medical malpractice costs under 

the Federal Torts Claim Act versus physicians who volunteer in 

clinics? Do you have any direct knowledge of what those difference 

in costs would be? 

Mr. JONES. Per physician I really would need to do some research on that, but I can tell you that prior to FTCA coverage our 

cost per physician, which was more than 5 years ago, exceeded 

$5,000 annually per provider. With 20-plus providers, you can see 

that is a substantial amount of money. OB/GYN and other services 

considerably higher in providing costs. In today’s market I would 

say it would be considerably higher per provider. 

Mr. MURPHY. And in some other States those numbers might 

even be—— 

Mr. JONES. Much higher. Much higher. 

Mr. MURPHY. Do you agree with that, Mr. Miracle, too? 

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Mr. MIRACLE. I don’t have any direct knowledge of professional 

liability insurance outside of our organization. But I know that it 

would be substantial, and it would be a burden to Georgia Mountain Health. 

Mr. MURPHY. And among the three of you involved with these 

clinics, too, your overall administrative costs, have you done any 

analysis of what the administrative costs would be compared to if 

you—other kinds of clinics or hospitals that would not be based 

upon this sort of like the clinic model that you use? 

Mr. JONES. At the current time, I don’t have those numbers for 

you, but I can tell you that, from observation, our administrative 

costs are much lower than what you would find in the private sector. 

Mr. MURPHY. That is helpful. 

Mr. JONES. But I would be glad to get those figures for you. 

Mr. MURPHY. Thank you. I appreciate it. 

Mr. Guzman, in your testimony, you said you are fortunate in 

Detroit to have other funding, but you said only 22 percent of programs nationwide are eligible for some specific funding. What kind 

of funding were you talking about and why is only 22 percent eligible for that? 

You need the microphone. 

Mr. GUZMAN. I am sorry. I think the mike is on. 

What I know about that is, of the FQHCs, only 22 percent is my 

understanding are eligible for funding for school-based health centers. The balance of that, which is over three-quarters of the 1,700 

school-based health centers, do not receive any Federal dollars. 

Mr. MURPHY. Is that something that you see there is some legislative corrections in some of the bills we are dealing with here? 

Mr. GUZMAN. Well, that would be the hope. 

When we were talking just a moment ago, when you were talking 

about malpractice insurance, because the school-based health center that our organization runs at the local high school, which is out 

of our scope, our Section 330 scope, we have to pay malpractice insurance. Even though we have FTCA coverage within the clinic 

physicians and medical providers as well as the other staff, we 

have to pay her malpractice insurance because she is not deemed— 

I guess she is out of system. 

Mr. MURPHY. Thank you. 

And, Doctor, thank you for not only your testimony but giving 

your time. Can I ask what it pays to be a family—or a primary 

practitioner under this program? 

Dr. EHLERT. Under the National Service Corps or in general? 

Mr. MURPHY. Under National Service Corps. 

Dr. EHLERT. It depends on the individual clinics, actually, but 

the Corps provides for each year, depending on the scholarship that 

it covers, but the loan repayment is $25,000 per year. And then 

there has been a focus—as Dr. Williams mentioned, there is actually—HRSA has decided to also increase that $35,000 for people 

that meet requirements and stay on past. 

Mr. MURPHY. But there is a salary, too. You get paid, correct? 

Dr. EHLERT. Correct. The payers, I think, are here. They would 

be better to comment on how much they are able to pay their physicians. 

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Mr. MURPHY. You are doing it now? 

Dr. EHLERT. No, I have graduated from medical school, but—— 

Mr. MURPHY. Can someone tell us how much they get paid? 

Mr. GUZMAN. Sure. Primary care docs, and again depending upon 

the region of the country, but in the Midwest primary care docs are 

averaging somewhere in the area of between $175,000 and probably 225. 

Mr. MURPHY. To the ones at the clinic or ones in private practice? 

Mr. GUZMAN. The ones in the clinics. 

Mr. MURPHY. And in private practice what would they make? 

Mr. GUZMAN. Private practice they are probably averaging a little bit more than that. 

Mr. MURPHY. Mr. Jones? You are not paying that? 

Mr. JONES. Pretty much depending upon experience and specialists, the range in our clinic is from $125,000 to $140,000. 

Mr. MURPHY. So quite a dramatic difference between what the 

private sector would be—— 

Mr. JONES. That is still much lower than the private sector. 

Mr. MURPHY. And people who, as you mentioned, Doctor, may 

have several hundred thousand dollars of debt in the family to deal 

with. 

Well, thank you so much for your testimony. I appreciate that. 

Mr. PALLONE. Costs more in the urban areas. Cost of living. 

Mr. GUZMAN. That is what we say, yeah. 

Mr. PALLONE. Sure. 

Mr. Green. 

Mr. GREEN. Thank you, Mr. Chairman. 

My staff just told me that in our clinics in Texas we have never 

heard the numbers, but, knowing doctors’ costs, I would say that 

is probably a little higher than what would be paid in urban Houston. But it is a benefit because you have the the loans payback. 

Mr. Miracle and Mr. Jones, I read several studies that point to 

the role of health centers in reduction of health care disparities. 

Specifically, it has been shown that these disparities don’t exist 

among health center patients even after controlling for socioeconomic factors. These are impressive health outcomes, especially 

given that health care center population is 23 percent African 

American, 36 percent Hispanic, much higher proportions of minority representation than the Nation at large. 

Can you speak to how health centers have achieved such success 

at eliminating these health disparities? And what role, if any, does 

the community board play in helping health centers to tailor their 

preventative and primary health care services to address the most 

pressing health needs of the minority populations within these 

communities? Like I said, I think some of these numbers are very 

good compared to the numbers we normally hear about health care 

disparities. 

Mr. JONES. One of the things that is part of our planning, our 

board participates in our planning. It begins from the board, the 

clinical staff, and the office of the corporation. We plan yearly, annually, and have strategic plans. 

But the main thing is making sure that we are very sensitive to 

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terpreters when needed but also making sure that we listen to our 

consumer board. They are there, they are patients of the clinic, 

they see the need of the clinic, and they report to us and make sure 

that we listen. 

And we try to respond. We are located in areas where our population is located, and we make sure that our facilities’ doors are 

open to everyone, and that is a part of our staff training, from our 

housekeeping staff to our doctors. We make sure that every patient 

is respected, and after 20 years of service, the community knows 

this. They know that they can come there. 

And it was evident of Katrina. The community health centers, all 

six of my community health centers were avenues for care; and 

from the mayor to the sheriff, they knew they could refer patients 

to our clinic because we were accustomed to dealing with patients 

that were homeless, patients that were disenfranchised. We have 

the experience to deal with those patients. And all of a sudden, 

when Katrina hit, everybody was homeless. So we became a site, 

an open-door site for the patients. 

Mr. GREEN. OK. Mr. Miracle? 

Mr. MIRACLE. I think from the health disparity standpoint, two 

things to make comment about. 

Number one is, where it relates to our Latino population, we deliver culturally competent care. I mean, we have a bilingual staff, 

and we have gone through separate training to help those folks, 

our staff communicate with our patient population. And I think 

that is very important to be able to talk to folks in a way, or—to 

talk to folks where they are, as opposed to from some other standpoint. So that has helped a lot. In fact, our organization was recognized recently, one of four health centers in Georgia to be recognized as a culturally competent health center. 

The other thing is, as a participant in HRSA’s disease collaborative program, we monitor, track, and communicate outcomes to 

our providers, and we hold ourselves accountable to specific outcome measurements. By identifying how well we are doing on A1C 

levels, for example, is very important, and that helps to make sure 

that we are providing the care that we need for those chronic disease cases. 

Mr. GREEN. OK. 

Mr. GUZMAN. If I could just add one other point, we are also required as FQHCs to provide a wide array of other services, wraparound services that encompass social work, nutrition, health education, et cetera. And I think that if you encompass that in the role 

in how we do things, that is why you see much of the differences 

along with all of the other things that have taken place. 

One of the things that in school-based health centers we have 

been trying to do is mirror that concept of not just a physician and/ 

or provider being in a location but the provider being there along 

with social workers and the availability of nutrition and health 

education programs. 

Mr. GREEN. Mr. Chairman, I know I am out of time. I had one 

more question for Mr. Miracle about the dental services he offers 

for adults and children, and our bill that Mr. Pickering and I have 

would authorize the funding for expanding those services, including 

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mental health, dental, and pharmacy services at every health center. 

And with that I won’t take up any more time, particularly since 

you said we would have the markup in early January when we 

come back. 

Mr. PALLONE. We don’t come back in early January. 

Mr. GREEN. Well, late January. Well, early and late January 

when we come back. 

Mr. PALLONE. We will do it as quickly as we can. I don’t think 

we come back until after the 15th of January, actually, but—OK. 

Mr. Burgess? 

Mr. BURGESS. Thank you, Mr. Chairman. 

Mr. Jones, I guess I was a little startled to hear your story about 

Katrina and individuals across the border in Alabama who could 

not come and help because they wouldn’t be covered under the Federal Tort Claims Act. Is that correct? 

Mr. JONES. Yes. We received an opinion, clarification from HRSA 

once we began to explore the idea. Which once they crossed—although they were deemed in their health facility, if they crossed 

State lines or if they moved from another health center you are 

only deemed at the health center that you are contracted to work 

for. 

Mr. BURGESS. So that was strictly encompassing that population 

of individuals who were covered at a health center under the Federal Tort Claims Act? 

Mr. JONES. That is right. 

Mr. BURGESS. Because the information was exactly different than 

I was given near Dallas. I am licensed but not insured; and, obviously, when we started taking in large numbers of displaced persons, they said—I called the Texas Medical Association for clarification. They said, well, you can’t go to Reunion Arena or you will 

be exposed to liability, but you could go to Louisiana and you 

wouldn’t. 

So it is just an odd situation where we find you got one set of 

information and I got a completely different set. But I guess it only 

encompassed that universe of people who are employed by the federally qualified health center and had their coverage as an employee, is that correct? 

Mr. JONES. Correct. Again, we are asking for clarification. 

Mr. BURGESS. It seems—we are the Federal Government. We 

don’t pay any attention to State boundaries anyway in so many 

things, so I am just surprised that we do in this one. 

Mr. JONES. Right. We were surprised, too. 

Mr. BURGESS. Maybe an educational program needs to be undertaken before our next end-of-the-world occurs. 

Dr. Ehlert, you testified very eloquently about the reauthorization of the National Health Service Corps scholarship and loan forgiveness. Is the scholarship and loan forgiveness under the National Health Service Corps, is that the only avenue that a medical 

student would have available to them for this type of help or are 

there other entities that might provide assistance? 

Dr. EHLERT. I don’t have a detailed list but certainly I know that 

there are regions, counties, and States that have designed repayment programs, as well as certain centers that do provide similar 

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incentives for people to go and work there. And certainly scholarships, there is a myriad of scholarships for student. 

Mr. BURGESS. When I started medical school in 1974, and they 

had just phased out at that time what was called the Berry Plan, 

which the Armed Services would pay for your education, books, and 

a stipend on which to live. Do the Armed Services provide any type 

of stipend or loan forgiveness program that you are aware of? 

Dr. EHLERT. There is a tremendous opportunity for people that 

includes both scholarship and stipend. However, your commitment 

through that is to serve in the military and at military health centers, not at community health centers. 

Mr. BURGESS. But it is a similar one-for-one trade, 1 year in for 

training and 1 year in repayment? 

Dr. EHLERT. I am not a scholar, but that is my understanding 

through my colleagues that have done it. 

Mr. BURGESS. And is that the type of help that is available, is 

it comparable? 

Dr. EHLERT. I feel it is more robust. 

Mr. BURGESS. Which is more robust? 

Dr. EHLERT. The military one, because they encompass more 

long-term benefits of having been in the military. 

Mr. BURGESS. I see. 

Dr. EHLERT. That is the same as anyone who served in the military. 

Mr. BURGESS. OK. But that is still a trajectory that is available 

to a medical student. 

Dr. EHLERT. Certainly. And my association supports those opportunities for students as well. 

Mr. BURGESS. Well, now, have you done the math as to if the 

funding increase—and do bear in mind—and this is something I 

did not know before I got here—we have got authorizers, and we 

have got appropriators, and we are talking about an authorization 

limit here that is extremely—then there is another hurdle to cross 

to actually get the appropriations. 

I found this out at the National Institutes of Health when I went 

out there—I have been out there for several field trips—and every 

building is named after an appropriator. There is none named after 

an authorizer. But if we authorize it at the level that is in the 

Braley bill, how many new scholarships will be created as a result 

of that? 

Dr. EHLERT. Again, there is discretion in HRSA. I don’t know 

how many. 

But I would just like to point out what I said in my testimony 

of 11 applicants for each scholarship recipient and about half of the 

physicians who apply for the stipend while they work in the centers has been turned down. 

Mr. BURGESS. But from the standpoint from the government side 

that is good because then we are getting the most qualified and 

highly motivated individuals. A lot of competition to get those 

scholarships? 

Dr. EHLERT. Certainly. And some of the greatest leaders I know 

that have come out of medical school have been denied these scholarships, which is ironic. So, true, it does drive quality, but there 

is still that need. 

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Mr. BURGESS. Are they awarded on a competitive basis? 

Dr. EHLERT. Yes. 

Mr. BURGESS. Grade point average and national boards and— 

they still do all that stuff? 

Dr. EHLERT. The last people I talked to who applied, there is a 

formula. I don’t know the details of the formula, but, yeah, there 

is a formula involved. 

Mr. BURGESS. So your opinion that the National Health Service 

Corps scholarships and loan forgiveness programs are a good deal 

for medical students or is it like the court of last resort? 

Dr. EHLERT. No, I think it is a tremendously good deal. 

Mr. BURGESS. And do you think that us increasing the authorization limit, you think that need, that pressure is still going to be 

there, still going to remain there? 

Dr. EHLERT. Absolutely. I didn’t include it in my oral testimony 

but in my written testimony. Medical tuition went up 11.1 percent 

last year. So there is actually less and less—if funding stays the 

same, it becomes less and less incentive. 

Mr. BURGESS. Yeah, but you have so much more to learn now. 

I just want to thank you for taking the time to come up here 

today. I know it is time you could have given to something else. 

And, Mr. Chairman, I yield back. 

Mr. PALLONE. Thank you. 

Mr. Deal. 

Mr. DEAL. Thank you, Mr. Chairman; and I think you have been 

told where I went. I was handling the Charlie Norwood organ 

transplant bill on the floor. As all of you know, that is an important piece of legislation honoring my good friend from Georgia, the 

late Congressman Charlie Norwood. I do apologize for missing your 

testimony. 

Let me be quick. Mr. Miracle, how long did it take for your center to qualify for the Section 330 funds and how difficult a process 

was that? 

Mr. MIRACLE. I don’t know how long it took because it happened 

before I got there. I can tell you that we applied in 2003 for an expansion for a new start-over in Union County, and we were denied. 

I can tell you that we tried again in this most recent round with 

the high poverty counties for Murray County, and we were successful. 

What happened between then and now partly was my maturity 

as a manager of an FQHC but also the help that was provided by 

the State PCA, the organization that community health centers in 

Georgia belong to. And the technical support that they provided, 

with help from HRSA, to our organization to put together a quality 

grant was tremendously helpful. 

Mr. DEAL. OK. What part of the process was the most onerous, 

do you think? 

Mr. MIRACLE. Writing 200 pages of—I think the most onerous 

part was understanding the community. It was onerous, but it was 

important. I mean, we, in putting that grant together, required not 

just sitting in the office in Morgantown and saying, oh, let’s do a 

community health center grant for Chatsworth, but I and my staff 

actually went to the community several times, met with the hospital there, with community leaders. 

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We understood from resources that were available the need in 

the community in terms of the underserved population, and I 

ended up where I felt that I know that community as well as I 

know the community where our home center is. And although it 

was onerous and difficult, it was the most important part of the 

process, as far as I was concerned. 

Mr. DEAL. OK. Do you know offhand how many community 

health centers we have in the State of Georgia? 

Mr. MIRACLE. I can give you an estimate. I think there are some 

22 organizations. My guess is that there is some 35 or 40 service 

sites. But I will have to get back to you with the exact number. 

Mr. DEAL. OK. Obviously, since the one in Union County was denied I assume you think there is still a need for some more in our 

State? 

Mr. MIRACLE. Well, I do; and some of that is—as we talked about 

earlier, there are pockets of needs. And Union County is one of 

those areas where on the surface it may look like there is no need 

but there are certainly—as you know, there are certainly some serious pockets of underserved areas in that county. We have 159 

counties in Georgia. There are many that would be deserving of a 

community health center. 

Mr. DEAL. Is there any kind of geographical bias in the process, 

in your opinion? 

Mr. MIRACLE. Well, not that I can tell. We serve—we are in 

north Georgia. We see patients from Tennessee and North Carolina. When we were denied the grant for Union County, my opinion 

was, well, we needed to just go back and do a better job next time. 

Mr. DEAL. OK. Anybody disagree with any of those assessments? 

Mr. Guzman? 

Mr. GUZMAN. Yes, Congressman, I would disagree with that. 

I think there appears to be some type of bias. In Michigan, as 

an example, and specifically in Detroit, we have a significant population. You only have four community health center organizations 

that represent probably another 10 clinics, points of access for a 

population of almost 900,000 people. In our particular center, as an 

example, we see about 78 percent of the folks are uninsured. So 

that is clearly a need, and we are not quite sure what the status 

is at the Bureau, but we don’t think we got our fair share. 

Mr. DEAL. Yours is a metropolitan area. 

Mr. GUZMAN. Correct. 

Mr. DEAL. Mr. Jones, yours is a rural area. 

Mr. JONES. Very rural. 

Mr. DEAL. What do you see? 

Mr. JONES. I would not say there is a bias. I am concerned about 

the formula. I am concerned about a county not looking at the— 

looking at the county as being a county of economic growth when 

in fact there are pockets in that county that the—there is created 

a situation where there is a few with a tremendous amount of 

wealth, but the majority of the county is poor. Unfortunately, that 

county is not a high priority. The majority of the population in that 

county has tremendous need, but it is not rated because of the formula. 

Mr. DEAL. In a rural area, that percentage of wealth tends to distort it even more than it would in a metropolitan area. 

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Mr. JONES. Very much so. 

Mr. DEAL. OK. My time is up. Thank you all very much, and I 

apologize again for not hearing your testimony. Thank you. 

Mr. PALLONE. Well, let me thank all of you for participating. This 

is obviously a very important issue with all three of these bills; and 

I know, as I said before, Mr. Green is pushing us to move quickly 

on trying to markup the legislation and move it. We are certainly 

cognizant of the fact that we need to get moving because of the 

need, and your testimony has helped us a great deal in that respect. So thank you all. 

Let me mention that members may submit additional questions 

to you to be answered in writing. Those should be submitted to the 

clerk within the next 10 days, and then we will notify you if we 

have some additional questions. 

But thank you again; and, without objection, this meeting of the 

subcommittee is adjourned. 

[Whereupon, at 4:37 p.m., the subcommittee was adjourned.] 

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