THE CRITICAL ROLE OF 

COMMUNITY HEALTH CENTERS IN 

ENSURING ACCESS TO CARE 

HEARING 

BEFORE THE 

SUBCOMMITTEE ON HEALTH 

OF THE 

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED NINTH CONGRESS 

SECOND SESSION 

MAY 4, 2006 

Serial No. 109-86 

Printed for the use of the Committee on Energy and Commerce 

Available via the World Wide Web: http://www.access.gpo.gov/congress/house 

U.S. GOVERNMENT PRINTING OFFICE 

WASHINGTON : 2006 

For sale by the Superintendent of Documents, U.S. Government Printing Office 

Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC area (202) 512-1800 

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28-514PDF 
COMMITTEE ON ENERGY AND COMMERCE 

JOE BARTON, Texas, Chairman 

RALPH M. HALL, Texas 

MICHAEL BILIRAKIS, Florida 

 Vice Chairman 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

PAUL E. GILLMOR, Ohio 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

CHARLIE NORWOOD, Georgia 

BARBARA CUBIN, Wyoming 

JOHN SHIMKUS, Illinois 

HEATHER WILSON, New Mexico 

JOHN B. SHADEGG, Arizona 

CHARLES W. “CHIP” PICKERING, Mississippi 

 Vice Chairman

VITO FOSSELLA, New York 

ROY BLUNT, Missouri

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

CHARLES F. BASS, New Hampshire 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

C.L. “BUTCH” OTTER, Idaho 

SUE MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

JOHN D. DINGELL, Michigan 

 Ranking Member 

HENRY A. WAXMAN, California 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, JR., New Jersey 

SHERROD BROWN, Ohio 

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 

TED STRICKLAND, Ohio 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MIKE DOYLE, Pennsylvania 

TOM ALLEN, Maine 

JIM DAVIS, Florida 

JAN SCHAKOWSKY, Illinois 

HILDA L. SOLIS, California 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

BUD ALBRIGHT, Staff Director 

DAVID CAVICKE, General Counsel

REID P. F. STUNTZ, Minority Staff Director and Chief Counsel

SUBCOMMITTEE ON HEALTH 

NATHAN DEAL, Georgia, Chairman 

RALPH M. HALL, Texas 

MICHAEL BILIRAKIS, Florida 

FRED UPTON, Michigan 

PAUL E. GILLMOR, Ohio 

CHARLIE NORWOOD, Georgia 

BARBARA CUBIN, Wyoming 

JOHN SHIMKUS, Illinois 

JOHN B. SHADEGG, Arizona 

CHARLES W. “CHIP” PICKERING, Mississippi 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO, California 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE MYRICK, North Carolina 

MICHAEL C. BURGESS, Texas 

JOE BARTON, Texas 

 (EX OFFICIO)

SHERROD BROWN, Ohio 

 Ranking Member 

HENRY A. WAXMAN, California 

EDOLPHUS TOWNS, New York 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

GENE GREEN, Texas 

TED STRICKLAND, Ohio 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

TOM ALLEN, Maine 

JIM DAVIS, Florida 

TAMMY BALDWIN, Wisconsin 

JOHN D. DINGELL, Michigan 

 (EX OFFICIO)

(II)
CONTENTS 

Page 

Testimony of: 

Handley, Elisabeth, Division Director for Policy and Development, Bureau of Primary 

Health Care, Health Resources and Services Administration, U.S. Department of 

Health and Human Services.......................................................................................... 14 

Brooks, Roy C., Commissioner, Tarrant County, Texas.................................................... 37 

Grant-Davis, Kathy, Executive Director, New Jersey Primary Care Association ............. 40 

Hawkins, Dan, Vice President for Federal, State, and Public Affairs, National 

Association of Community Health Centers, Inc. ........................................................... 43 

(III) 

(1) 

THE CRITICAL ROLE OF COMMUNITY 

HEALTH CENTERS IN ENSURING 

ACCESS TO CARE 

THURSDAY, MAY 4, 2006 

HOUSE OF REPRESENTATIVES, 

COMMITTEE ON ENERGY AND COMMERCE, 

SUBCOMMITTEE ON HEALTH, 

Washington, DC. 

The subcommittee met, pursuant to notice, at 2:42 p.m., in Room 

2123 of the Rayburn House Office Building, Hon. Nathan Deal 

(chairman) presiding. 

 Members present: Representatives Deal, Bilirakis, Gillmor, Shimkus, 

Ferguson, Burgess, Pallone, Rush and Green. 

 Staff present: Ryan Long, Counsel; Katherine Martin, Professional 

Staff Member; Brandon Clark, Policy Coordinator; Chad Grant, 

Legislative Clerk; John Ford, Minority Counsel; and Jessica McNiece, 

Minority Research Assistant. 

MR. DEAL. The committee will come to order and the Chair 

recognizes himself for an opening statement. I am proud to say that we 

have four expert witnesses appearing before us this afternoon that will 

help us examine the issues relating to the reauthorization of enabling 

legislation for community health centers. 

 Without question, community health centers are an integral part of 

our country’s healthcare delivery system, providing healthcare services 

to people in communities that would not otherwise have access to such 

care. 

 As many of you know, this subcommittee has exclusive jurisdiction 

over legislation regarding community health centers and we are 

committed to being good stewards of this program. We join the 

President in strong support of community health centers and we applaud 

the thousands of community health centers, employees and volunteers 

that contribute so much to the success of the program. 

 Again, I want to welcome our witnesses and I will introduce the 

panels as they appear and I thank them for their participation. As you 

have probably determined, the House has now completed its work on the 

floor and this gets to be a little bit of a hairy time for us at this point. So 

I am going to cut my opening statement short in hopes that my fellow 

committee members might follow suit. But we do welcome you here. 
2

 [The prepared statement of Hon. Nathan Deal follows:] 

PREPARED STATEMENT OF THE HON. NATHAN DEAL, CHAIRMAN, SUBCOMMITTEE ON 

HEALTH

The Committee will come to order, and the Chair recognizes himself for an opening 

statement. 

I am proud to say that we have four expert witnesses appearing before us this 

afternoon that will help us examine the issues related to the reauthorization of enabling 

legislation for Community Health Centers. 

Without question, Community Health Centers are an integral part of our country’s 

health care delivery system, providing health care services to people and communities that 

would not otherwise have access to such care. 

As many of you know, this Subcommittee has exclusive jurisdiction over legislation 

regarding Community Health Centers, and we are committed to being good stewards of 

this program. We join with the President in our strong support of Community Health 

Centers, and we applaud the thousands of Community Health Center employees and 

volunteers that contribute so much to the success of this program. 

Again, I welcome our witnesses and thank them for their participation. 

In the interest of time, I would ask my fellow Committee Members to waive their 

opening statements or keep them as brief as possible so that we can allow our witnesses to 

leave at decent hour. I would also like to ask for Unanimous Consent that all Committee 

Members be able to submit statements and questions for the record. 

I now recognize the Ranking Member of the Subcommittee, Mr. Brown from Ohio, 

for five minutes for his opening statement. 

 MR. DEAL. And at this time I would recognize my good friend from 

Texas, Mr. Green, for an opening statement. 

 MR. GREEN. Thank you, Mr. Chairman, and I would like to ask 

unanimous consent for the statement from our Ranking Member, John 

Dingell, be placed into the record. 

 MR. DEAL. Well, I would ask unanimous consent that all committee 

members have the right to submit their statements and their questions for 

the record. Without objection, so ordered. 

 [Additional statements submitted for the record follow:] 

PREPARED STATEMENT OF THE HON. JOHN D. DINGELL, A REPRESENTATIVE IN CONGRESS 

FROM THE STATE OF MICHIGAN

Mr. Chairman, thank you for calling this hearing today to highlight the critical role 

that Community Health Centers play in ensuring access to care for millions of Americans 

nationwide. 

 Community Health Centers are local, non-profit, community-owned healthcare 

providers that serve low-income and medically under-served communities. They provide 

healthcare services to more than 15 million people annually, 6 million of whom have no 

health insurance coverage. They are located in more than 3,400 communities in every 

single State, including my home State of Michigan where we have approximately 30 

health centers. Community Health Centers are vital to the health and well-being of our 

country’s most vulnerable citizens. 

Currently, there are over 41 million uninsured Americans and untold numbers of 

under-insured persons. Due to the slowing economy, this number is increasing at a rapid 
3

pace. As a result, demand for healthcare services has increased drastically, forcing risky 

delays for important primary and preventive healthcare services. 

 For almost 40 years, America’s Health Centers have helped communities meet 

escalating health needs and address costly and devastating health problems, from infant 

health development to chronic illness, to mental health, substance addiction, 

homelessness, domestic violence, and HIV/AIDS. Community Health Centers span 

urban and rural communities across the Nation and their remarkable success has earned 

them broad bipartisan support among Federal, State, and local policy-makers. We should 

continue to do everything within our power to support these Health Centers and provide 

them with the resources they need so that they can continue to do their jobs as 

successfully and effectively as they have for the past four decades. 

 Legislation reauthorizing Community Health Centers should be considered soon by 

this Committee. But I note that we should also not forget the valuable contribution 

school-based health centers also make to communities across our Nation. I hope that we 

can consider developing some program enhancements for school-based health centers 

either during the consideration of the Community Health Centers reauthorization or at 

some time in the near future. 

PREPARED STATEMENT OF THE HON. JOE BARTON, CHAIRMAN, COMMITTEE ON ENERGY 

AND COMMERCE

Good morning. Mr. Chairman, I commend you for holding this hearing. I look 

forward to working with you and the rest of the Subcommittee as we consider the role 

played by community health centers in the health care delivery system. 

At the end of this year the authorization of community health centers will expire and 

this Committee needs to examine how we can ensure that this program continues to 

provide affordable and quality care to those who need it most. Community health centers 

have received widespread support not only at the federal level but more importantly, at 

the local level where the care is being administered. It is important to note that these 

centers are great sources of preventative health care, which helps to control everincreasing health care costs. It is our responsibility as federal representatives to ensure 

that taxpayer’s money is being spent efficiently and community health centers have 

demonstrated that they are effective in achieving this goal. 

The statistics are impressive. There are over 900 community health centers 

providing a broad spectrum of health services to 3600 localities, both urban and rural, 

located in every state and territory in the nation. Of the total number of community 

health center patients, 90% live below 200% of the federal poverty line. The list of 

primary health care services administered by community health centers is long—

mammograms, dental services, immunizations, prenatal care, mental health services, 

chronic disease management, and cholesterol checks. 

Community health centers are at the heart of our nation’s health care safety net. 

They work to provide care to the medically underserved and are able to identify services 

unique to each community, constantly focusing on building on their successes. Most 

importantly, these centers provide a favorable alternative to patients who would 

otherwise utilize emergency rooms for non-emergency services, which results in 

alarmingly high costs. By providing preventative care, we keep people in the community 

healthier. Healthy people use fewer services and this decreases the burden on our health 

care delivery system, including the Medicare and Medicaid programs. 

Certainly, as with any program, there is room for improvement. However, we 

should continue to keep in mind that community health centers are highly successful both 

in containing costs but more importantly, serving the health care needs of local 

communities. I am interested to hear from our witnesses how they believe the program 

can be strengthened. 
4

 I look forward to hearing from our witness from the Health Resources Service 

Administration about how this program is administered and what the goals are for the 

final year of the President’s Expansion Initiative. I also look forward to hearing from our 

three witnesses on the second panel. Mr. Hawkins, from the National Association of 

Health Centers, for the perspective he can provide in examining the program through the 

numerous centers across the nation. Likewise, I want to thank Ms. Grant-Davis for 

testifying as to how the various community health centers in the state of New Jersey 

serve their patients. And finally, I especially want to thank Tarrant County 

Commissioner Roy Brooks for coming in all the way from Texas to share how his 

community was able to create and new community health center and how the community 

is benefiting from this achievement. Thank you Chairman Deal for calling this hearing 

today and I welcome the witnesses. 

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

THE STATE OF MAINE

Mr. Chairman, thank you for holding this hearing today to examine the important 

role of Federally Qualified Community Health Centers in providing access to health care 

for Americans living in medically underserved communities. 

President Bush and I agree about the importance of federal investment in 

Community Health Centers (CHCs). I am pleased that the President’s budget includes a 

request for an additional $181 million for CHS, which would bring the overall federal 

investment in CHCs to almost $2 billion in FY07. This federal investment will go a long 

way to fulfill the President’s commitment to create 1,200 new or expanded health center 

sites by the end of next year. 

CHCs have a unique place in our health system, abiding by four key principles: 

serving all citizens regardless of their ability to pay; targeting resources to high need 

areas; providing access to comprehensive primary care services; and governance and 

direction by the community being served. 

CHCs are a particularity important component of Maine’s health care infrastructure. 

We have twenty-nine centers operating in federally designated Health Professions 

Shortage Areas (HPSAs) throughout the State. Twenty percent of Maine residents live in 

HPSAs for primary care, 18 percent in mental health HPSAs; and 65 percent in dental 

HPSAs. One in ten Maine residents receives care at a CHC during a given year. 

Approximately fifteen percent of Maine Medicare (MaineCare) beneficiaries statewide 

are CHC patients. 

CHCs are a model of efficient, cost-effective primary care delivery which save 

health system dollars. For example, CHCs save the MaineCare program more than thirty 

percent in annual spending per beneficiary due to lower emergency department 

utilization, reduced specialty care referrals, and fewer hospital admissions. 

I look forward to working with my colleagues to reauthorize the Community Health 

Centers program. CHCs are a shining example of how federal investment in health care 

can improve access across this nation for citizens in underserved communities, many of 

whom have no other means of health care coverage. 

PREPARED STATEMENT OF THE HON. TAMMY BALDWIN, A REPRESENTATIVE IN CONGRESS 

FROM THE STATE OF WISCONSIN

Thank you Mr. Chairman and thank you to the witnesses who are joining us today. 

I cannot say enough good things about the amazing work that Community Health 

Centers do. The Community Health Centers in my district—in Madison and Beloit, 

WI—are incredibly vital parts of their communities and I am continually amazed at the 

variety of critical services that they offer. 
5

For some people, the Community Health Center is the only place where they can 

access dental care. For others, it’s the only place that provides affordable care. And for 

yet others, it’s the only place where they can easily communicate with their health care 

providers without the interference of language barriers. 

The tie between Community Health Centers and the communities they serve is 

invaluable and is something that must be preserved through continuing the majoritypatient requirement for governance boards. The requirement that 51% of board directors 

be patients provides Community Health Centers with an incredible tool to ensure that 

they are, indeed, meeting the needs of the community. 

 I think it’s important to note that we are currently in the middle of Cover the 

Uninsured Week. As we know, there are currently 45.8 million Americans without 

health insurance, and millions more are underinsured. 

We all know that Community Health Centers play a vital part in providing the 

uninsured and underinsured with access to affordable care, but I think it’s important for 

us to take one moment to reflect that while this access is fantastic and greatly appreciated, 

it is still not health insurance. Community Health Centers cannot—and should not—bear 

the burden of providing care for all of our nation’s uninsured, and I look forward to this 

Subcommittee addressing the need for systematic change of our crumbling health care 

system. 

Lastly, I’d like to voice my support for H.R. 5201, the reauthorization bill that my 

colleagues Mr. Bilirakis and Mr. Green (of Texas) have introduced and of which I was 

proud to be an original cosponsor. I look forward to working with members of this 

Committee to move forward a reauthorization that preserves the current structure of 

Community Health Centers and ensures their continued ability to be vital parts of our 

communities. 

Thank you Mr. Chairman. 

PREPARED STATEMENT OF THE HON. ANNA G. ESHOO, A REPRESENTATIVE IN CONGRESS 

FROM THE STATE OF CALIFORNIA

Thank you, Mr. Chairman, for holding this important hearing on Community Health 

Centers (CHCs). I believe the witnesses today will highlight the crucial role that CHCs 

play in providing quality health care to underserved communities across America. 

For over 40 years, CHCs have provided high-quality, affordable primary care and 

preventive services to the nation’s most vulnerable populations. Today, there are over 

900 CHCs operating in 3,600 urban and rural sites in every U.S. state and territory. In 

2003, CHCs treated over 12 million people in underserved areas, including 4.8 million 

uninsured patients. They performed mammograms on over 200,000 women, gave checkups and preventive services to 1.6 million children, and administered 2.2 million 

immunizations. 

CHCs also offer services that many other providers do not, such as transportation, 

translation, and culturally sensitive health care that helps overcome common barriers to 

health care. 

In my home state of California, over 1.8 million Californians were served at CHCs 

in 2004. In California’s 14th Congressional District, which I’m proud to represent, there 

are 14 CHCs. I cannot emphasize enough what an important part of the health care safety 

net CHCs are, providing care to the uninsured and underinsured who would otherwise 

lack access to health care. Community Health Centers are essential, efficient, and 

effective and I’m proud to support efforts to enhance their important mission. 

The Health Centers Program, set forth in Section 330 of the Public Health Service 

Act, was renewed in 2002 and is set to expire on September 30, 2006. I thank my 

colleagues, Representatives Michael Bilirakis and Gene Green, for introducing H.R. 

5201, the Health Centers Renewal Act of 2006 and I’m proud to be an original cosponsor 
6

of this important bipartisan legislation which reauthorizes the Community Health Centers 

Program through 2011. 

I urge my colleagues on this Subcommittee and in Congress to support H.R. 5201 

and reauthorize the Community Health Centers Program so we can continue to provide 

health care services to those who need them most. 

PREPARED STATEMENT OF THE HON. PAUL E. GILLMOR, A REPRESENTATIVE IN CONGRESS 

FROM THE STATE OF OHIO

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

Earlier this week, I visited Fremont Community Health Services, a Community 

Health Center located in my district. As some of you may know, shortly after Hurricane 

Katrina hit last summer, Fremont Community Health Services raised $20,000 to send two 

doctors, three nurses, and a mobile health unit to assist a sister Community Health Center 

in Biloxi, Mississippi. However, the medical team was soon hit in the form of 

government red tape, delaying their departure – The Health Resources and Services 

Administration (HRSA) advised Fremont that they would not be covered in terms of 

malpractice insurance under the Federal Tort Claims Act (FTCA) should they choose to 

provide medical services in temporary locations, across state lines. While the Fremont 

mobile unit was eventually granted temporary FTCA coverage from HHS by allowing 

permanent federal employees onsite to swear-in the group as “temporary federal 

employees,” the same temporary federal liability coverage was not extended to Fremont 

Community Health Services last January when they attempted to assist the Biloxi Health 

Center yet again - because there would not be a permanent federal employee on-site this 

time around to temporarily “federalize” the medical team. 

The Community Health Center in my district is not alone. In fact, as a result of 

Hurricane Katrina, many Community Health Center sites were either totally destroyed or 

closed due to damage, or damaged but still operating. Although these Health Centers 

were calling for the help of sister facilities throughout the country, Health Centers ready 

and willing to provide that help simply could not, due to a lack of FTCA coverage. It 

took so long for a team of Iowa Health Center volunteers to get the “federal green light” 

that after a week in New Orleans waiting, and not working, they went back home. A 

group of Texas Health Centers looked to by-pass the federal review process by 

purchasing private liability coverage for health care providers coming in from out of 

state, but were unsuccessful – it turned out that the insurance market would not support 

new coverage for such a high-risk hurricane relief effort. 

After raising this issue several times with HHS, and encouraging them to exhaust all 

avenues of administrative authority to provide FTCA coverage for such instances of 

natural disaster and public health emergency, HRSA has indicated that a legislative 

change will be needed to address this issue. And H.R. 3962, introduced last fall by Mr. 

Schwarz of Michigan would do just that – extend FTCA liability coverage for Health 

Center employees who travel offsite, or across state lines to provide care at health centers 

affected by President-declared natural disasters and public health emergencies. 

I encourage my colleagues on this panel to join me in need to bring further 

awareness to this issue and debate the merits of H.R. 3962, with the hopes of enacting it 

soon. By doing so, we can do our part to ensure access to care, and not deny it when 

people need it the most. We cannot wait for another natural disaster or potential public 

health emergency. 

Without objection, I would like to insert an Associated Press article into the public 

hearing record reporting on this matter in further detail. With that, I welcome the panel 

of witnesses today, look forward to their testimony, and yield back by time. 
7

PREPARED STATEMENT OF THE HON. CHARLIE NORWOOD, A REPRESENTATIVE IN CONGRESS 

FROM THE STATE OF GEORGIA

Thank you Mr. Chairman. 

We are approaching 1,000 community health centers with 3,600 sites serving over 

13 million Americans. 

There are over 80 in Northeast Georgia alone. They operate in rural communities 

where health services are either scarce or non-existent. They provide care for the poor, so 

they don’t use the emergency room. 

I don’t think I can say it any simpler -- health centers are working and should be 

reauthorized. While I’d be open to modest changes, I think the current program is a 

success. 

While 25% of our population lives in rural areas, only 10% of physicians practice 

there. 

Rural Americans, like many folks in my district are more likely to live below the 

poverty level and be uninsured. 

Health centers address their needs, including treatment, preventive, and emergency 

care. They treat anyone from the area regardless of their ability to pay. They are also 

Medicare and Medicaid providers – guaranteeing access for our poor and elderly. 

While healthcare costs have risen, health centers have kept theirs well under those of 

other providers. Patients of health centers are healthier, use emergency rooms less and 

save money. In Georgia they save the state $13.4 million each year in Medicaid costs 

alone! They are a good deal for poor Americans and taxpayers.

I have been an enthusiastic supporter of this program and am glad the President has 

supported the expansion of centers in 200 new communities. 

However, they cannot meet the demand for their services without the right funding and 

staffing. 

I have worked with Mr. Bilirakis to increase funding and more people will be served 

and centers will open as a result. 

As for staffing I’d like to point out that Title 7 funding, which I have defended with 

Congresswoman DeGette for years, exists to recruit health professionals to serve in rural 

areas.

I hope the appropriators are listening --We preserve Title 7 and we alleviate the 

health professions shortages described by the Journal of the American Medical 

Association that exist in rural health centers. 

Recognizing and reauthorizing this program is critical to ensuring our nation’s 

uninsured and rural populations have access to affordable, quality preventative and 

primary care services. 

Thank you and I yield back 

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

FROM THE STATE OF GEORGIA

Mr. Chairman, thank you for having this hearing on the nation’s community health 

centers. The panels today will testify to the great importance of the work of these centers 

in providing care for those most at risk in our communities. Our goals here today should 

not be to change the structure of what has already been successful. Rather we should be 

talking about enhancing and expanding what has already worked. 

The cost effective services provided by health centers contribute to the social and 

physical well-being of millions of Americans from school children and the elderly to 

adults who have NOWHERE else to go for health care. That is why I am in favor of a 

substantial increase in funding for community health centers. 
8

Mr. Chairman, in Brooklyn, New York, Twelve Community Health Centers serve 

almost 200,000 people a year, an increase of nine percent over three years. They provide 

cost effective health services for our low-income residents, including immunizations, 

mammograms, prenatal and perinatal services, cancer screenings, child health services 

and a host of other critical services. We should expand these services so that thousands 

of other low income residents can have access to critical care. 

Thank you. 

PREPARED STATEMENT OF THE HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM 

THE STATE OF MICHIGAN

Mr. Chairman, I am a strong supporter of the Community Health Center program 

and look forward to working with you on reauthorizing this vital health care safety net 

program. We are very fortunate that the poor, uninsured or underinsured, homeless and 

migrant populations in urban and rural communities in my Southwest Michigan 

Congressional district are well-served by three networks of community and federally 

qualified health centers, with a total of ten clinic sites providing accessible, high-quality 

primary and dental care services. I have great respect for the commitment and dedication 

to our most vulnerable citizens that I have witnessed in the administrators and health 

professionals at these health centers. They are a special breed fulfilling a challenging 

mission. 

 MR. GREEN. Mr. Chairman, I wish I could tell you I am going to 

keep mine short but I think this is such an important issue. I want to 

thank you for holding the hearing as Democratic co-sponsor on this with 

Congressman Bilirakis from Florida. I think it is fitting our 

subcommittee is holding this hearing on Cover the Uninsured Week, 

since health centers are a critical part of our country’s safety net. 

 In 2005, health centers provided care to six million uninsured 

individuals who represented 40 percent of the patient population at health 

centers. Ninety-one percent of the health center patients are low-income 

and 36 percent are Medicaid beneficiaries. Without a doubt, health 

centers are meeting their vision of providing much needed healthcare to 

medically underserved in our country. Much of this success can be 

attributed to core elements of the section 330 statute Congress put in 

place to authorize the health center program. 

 To be eligible for Federal funding, health centers must be located in 

medically underserved communities, the majority governed by 

community members utilizing the centers for healthcare. And they must 

provide comprehensive primary and preventative healthcare with 

services available to all community residents regardless of the patient’s 

ability to pay. This focus on primary and preventative healthcare has 

yielded a tremendous savings for our healthcare systems as health centers 

provide the uninsured and underinsured with access to care that they 

would otherwise seek from a hospital emergency room. 

 Access to affordable primary care health centers has reduced the 

need for inpatient and specialty care because medical problems in health 
9

center patients are treated earlier before they reach emergency 

proportions that require a trip to the emergency room or inpatient 

hospital care. In fact, studies suggest that health centers save Medicaid 

approximately 30 percent in annual spending on beneficiaries receiving 

care at our Nation’s health centers. 

 The successful result is these health centers have become the medical 

home for more than 15 million Americans. Health centers also represent 

the Nation’s largest primary care system with one in nine Medicaid 

beneficiaries and one in five low-income individuals receiving care at 

these centers. 

 I have a personal interest in this issue, as we have been working for 

years in the Houston area to establish additional community health 

centers to serve our growing uninsured and underinsured population. My 

State of Texas unfortunately ranks number one in the level of uninsured 

with 25 percent of Texans living without health insurance. The statistics 

for the Houston area are just as troubling, more than 30 percent of Harris 

County residents living without health insurance. 

 Despite the obvious need for additional community centers in the 

Houston area, we have been playing catch up for quite a while. Last 

year, our area was awarded five additional FQHCs, bringing our total to 

nine, including look-alike centers. When you consider nine sites, more 

than one million uninsured however in the Houston area will still have 

fewer than ten FQHCs while other cities, such as Chicago, have more 

than 70 sites. 

 In the Houston area we know that our work is not done. As a Nation, 

we have a long way to go before we meet the President’s goal of locating 

a health center in every low-income county in this country. In fact, 

studies suggest that there are still more than 904 counties in the U.S. in 

need of a health center. To ensure these goals are met, it is crucial we 

reauthorize the health center program, whose reauthorization expires this 

year. 

 Mr. Bilirakis and I have introduced H.R. 5201 to do just that. In our 

legislation, we authorize a program until 2011, keeping intact the core 

elements of the program that has been critical to its success. I would like 

to thank the majority of the subcommittee for co-sponsoring the 

legislation and hope our committee leadership will put the 

reauthorization at the top--at the important part of the top of our agenda. 

 And again, I want to thank our Chairman, the Ranking Member, and 

our witnesses who are appearing today and I look forward to the 

testimony. And I will give thoughts toward the next step we need to take 

to ensure continued success of health center programs. Thank you, Mr. 

Chairman. 
10

 MR. DEAL. I thank the gentleman. I now recognize my friend, Dr. 

Burgess, for an opening statement. 

 MR. BURGESS. Thank you, Mr. Chairman. And I, too, will not use 

all of the time. But I do want to thank you for calling the committee 

today, a subject that is important to me and the community that I 

represent. 

 Community health centers comprise an important component of our 

healthcare system. By providing comprehensive primary health, mental 

health, oral screenings and substance abuse to low-income and 

underinsured patients, health centers fill an important gap in the 

healthcare safety net. As Mr. Green just pointed out, more than 60 

percent of federally qualified health centers patients have no other health 

insurance and many others are underinsured. It is essential that the 

health clinic exist in every community where need exists. Unfortunately, 

this is not the case in every community, especially the area of Texas that 

I represent. 

 President Bush has made a serious commitment to expand 

community health centers to more underserved communities. I have 

been working over the last several months with my county 

commissioner, Roy Brooks, who is here today, to establish another 

federally qualified health center in Tarrant County, Texas. Over that 

time, there have been difficulties, but the stakeholders involved 

understand the importance of establishing a clinic in the southeast part of 

the city of Fort Worth. Diseases, chronic diseases, such as congestive 

heart failure, hypertension, diabetes and some of the highest rates of 

infant mortality anywhere in the country persist in this corner of Texas 

and the need for a health center is indeed critical. 

 After the devastation of Hurricane Katrina with so many Louisiana 

residents taking flight to Texas and especially North Texas, the need has 

only been compounded. So I look forward to working with 

Commissioner Brooks and our friends at HRSA and the National 

Association of Community Health Centers to make this goal a reality. 

 And Mr. Chairman, just a point of personal privilege, I do want to 

thank Commissioner Brooks. He readjusted his schedule, came all the 

way up here today to be with us. As often pointed out back home 

during--we just had our primary a few months ago in Texas and Mr. 

Brooks and I are not on the same ballot but we are frequently on the 

same page, especially when it comes to issues like a community health 

center. And I believe, if I am not mistaken, Mr. Brooks is here with his 

daughter and we are very happy to welcome you to the committee today. 

Thank you, Mr. Chairman. I will yield back. 

 MR. DEAL. I thank the gentleman and I recognize Mr. Ferguson, the 

Vice Chairman of this subcommittee, for his opening statement. 
11

 MR. FERGUSON. Thank you, Mr. Chairman. Thank you for holding 

this important hearing on community health centers. I want to begin by 

welcoming Ms. Kathy Grant Davis, who is Executive Director of the 

New Jersey Primary Care Association, which is in Princeton, New 

Jersey. Our community health centers in New Jersey provide critical 

care and services to many underserved populations in my home State, 

including migrant and homeless health centers. Ms. Davis’ organization 

and community health centers throughout our Nation are a valuable 

resource for taking care of people in our communities. 

 For more than 40 years, health centers have provided high quality, 

affordable primary care and prevention services. The people served by 

these organizations are from underserved populations, as I say, and are 

often isolated from other forms of care used by the community. They 

may be isolated by language and economic factors, and community 

health centers are there to serve them. 

 I look forward to Kathy’s testimony today and testimony from our 

other panelists, and I look forward to working with the committee and 

you, Mr. Chairman, to reauthorize these valuable community healthcare 

partners and I yield back. 

 MR. DEAL. I thank the gentleman. Well, we made good progress 

there. I am pleased to introduce our first panel, which consists of Ms. 

Elisabeth Handley, who is the Division Director for Policy and 

Development of the Bureau of Primary Healthcare at U.S. Health and 

Human Services, commonly referred to as HRSA. And the subject of 

today’s hearing is The Critical Role of Community Health Centers in 

Ensuring Access to Care. Ms. Handley, you are certainly in a unique 

position to comment on that and we would welcome your opening 

statement. I would say to all of those who will testify that your written 

statements have been made a part of the record and you may feel free to 

elaborate on anything that you would like to. But we are pleased to have 

you and will recognize you at this time. 

STATEMENT OF ELISABETH HANDLEY, DIVISION 

DIRECTOR FOR POLICY AND DEVELOPMENT, BUREAU 

OF PRIMARY HEALTH CARE, HEALTH RESOURCES 

AND SERVICES ADMINISTRATION, U.S. DEPARTMENT 

OF HEALTH AND HUMAN SERVICES 

 MS. HANDLEY. Thank you, Mr. Chairman, and members of the 

subcommittee for the opportunity to meet with you today on behalf of the 

Health Resources and Services Administration to discuss the critical role 

of health centers and access to care. I have this oral statement and I 
12

believe you have just given me permission to submit my entire written 

statement for the record. Thank you. 

 For more than 40 years, the health centers program has helped build 

high quality and cost-effective primary care delivery systems that serve 

low-income residents in inner cities and in rural and isolated areas. I am 

proud today to update you on the success and growth of the health 

centers program. 

 The President’s Health Center Initiative, which began in fiscal year 

2002, complements the President’s proposals to increase health insurance 

coverage in private and public insurance programs and to help all 

Americans gain access to affordable, high-quality healthcare. By any 

measure, we have been enormously successful implementing the 

President’s Health Center Expansion Initiative. 

 In 2005, the health center system served an estimated 14 million 

people. That is over 3.5 million more than in 2005 at more than 3,740 

delivery sites. This represents an increase of more than 770 new and 

expanded sites since 2001. The fiscal year 2007 budget will continue the 

President’s commitment to create 1,200 new or expanded sites to serve 

over 15.8 million people in fiscal year 2007. 

 The President proposes an additional $181 million for the sixth year 

of the President’s expansion plan to significantly expand the health 

center safety net by increasing the number of access points and the 

people served. The requested increase would fund the development of 

182 new access points. That is new starts administered by a new grantee 

organization and satellites of existing grantees, 120 expanded existing 

sites and serve 1.2 million new patients. 

 New access points will be competitively established through health 

centers targeting the neediest populations and communities by replicating 

existing models of success. Expanded access points will be targeted in 

communities where an existing health center’s ability to provide care 

falls short of meeting documented service delivery needs of the 

uninsured and underserved populations. By significantly expanding the 

number of existing access points, increased penetration into these 

populations will be achieved. 

 In addition, the President has established a new goal to help every 

poor county in America that lacks a health center by establishing a new 

health center or a rural health center. Within the total request, $52 

million will be directed for a new initiative to fund health centers in poor 

counties around the Nation. With the fiscal year 2007 requested 

increase, the President’s Health Center Initiative is on track to establish 

or expand 1,200 sites and to serve an additional 3.5 million patients over 

the 2001 level. 
13

 However, there is a likelihood that without special attention some 

high-poverty counties throughout the country may not successfully 

secure a health center site. So this new initiative will target 80 high 

poverty counties without a health center site. The goal of the new 

initiative is to carry the success of the current initiative further to ensure 

that every poor county that can support one healthcare center site has 

one. 

 Access to primary and preventative health services is critical, 

especially in poor counties that are medically underserved. Health 

centers are unique among primary care providers for the array of 

enabling services they offer, including care management, translation, 

transportation, outreach, health education. They commit significant 

resources to managing chronic conditions, too, diabetes, asthma and 

cardiovascular disease, for example. In 2004, health centers provided 

over 52 million encounters, over 250,000 mammograms, 1.5 million 

PAP tests and nearly 2.4 million encounters for immunizations, as well 

as over 425,000 HIV tests and counseling and prenatal and delivery care 

for 364,000 women. Over 95.7 percent of the grantees also provided 

translation services. 

 The overall effectiveness of the health center program has been 

proven in numerous studies and evaluations. Under the Administration’s 

ratings of Federal programs, the health center program receives the 

highest possible ranking, effective. Programs rated effective, according 

to OMB, set ambitious goals, achieve results, are well managed and 

improve efficiency. The program achieved this rating based on the fact 

that it’s designed to have a unique and significant impact and that 

evaluations indicate that the program is effective at extending highquality healthcare to underserved populations. 

 Mr. Chairman, in conclusion, I would like to note that health centers 

offer high-quality, prevention-oriented, case-managed, family-focused 

primary care services that result in appropriate and cost-effective use of 

ambulatory, specialty, and inpatient services. Primary care is delivered 

for all life cycles and includes a full range of health services. In 

administering grants for the health centers program, we take great pride 

in the high evaluation given the program and in the bipartisan support of 

the Congress for the program. And we fully recognize that the program 

works only as a partnership with those extraordinary local primary care 

providers who provide indispensable quality clinical services to 

underserved Americans with few healthcare alternatives. Thank you. 

 [The prepared statement of Elisabeth Handley follows:] 
14

PREPARED STATEMENT OF ELISABETH HANDLEY, DIVISION DIRECTOR FOR POLICY AND 

DEVELOPMENT, BUREAU OF PRIMARY HEALTH CARE, HEALTH RESOURCES AND SERVICES 

ADMINISTRATION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Mr. Chairman, Members of the Subcommittee, thank you for the opportunity to 

meet with you today on behalf of the Health Resources and Services Administration 

(HRSA) to discuss the Health Centers Program. 

 We testified before the Subcommittee on August 1, 2001, to discuss the most recent 

reauthorization of the Health Centers Program. At that time, the funding for the program 

was approximately $1.2 billion. We thank you for both your efforts in reauthorizing the 

program and ensuring funding to expand this worthwhile program to accomplish the 

President’s Initiative, with a requested FY2007 funding level of approximately $2 billion. 

Today, I am proud to update you on the success and growth of the program to date. 

By any measure, we have been enormously successful implementing the President’s 

Health Center Expansion initiative—an effort designed to establish or expand 1,200 

health center sites and serve over 15.8 million patients in FY 2007. This continues to be 

a priority because we know that these funds go to provide direct health care services for 

our neighbors who are most in need. 

In 2005, the health center system served an estimated 14 million people—almost 3.5 

million more than in 2001—at more than 3,740 service delivery sites that represents an 

increase of more than 770 new and expanded sites since 2001. Health Centers are located 

in all 50 States, the District of Columbia, and the territories. 

The President’s 2007 budget proposes an additional $181 million for the sixth year 

of the President’s expansion plan to significantly expand the Health Center safety net by 

increasing the number of access points and people served. Approximately $181 million 

would fund the development of 182 new access points (new starts administered by new 

grantee organizations and satellites of existing grantees), 120 expanded existing sites, and 

serve 1.2 million new patients. New access points will be competitively established 

through Health Centers targeting the neediest populations and communities by replicating 

existing models of success. Expanded access points will be targeted in communities 

where an existing Health Center’s ability to provide care falls short of meeting the 

documented services delivery needs of the uninsured and underserved populations. By 

significantly expanding the number of existing access points, increased penetration into 

these populations will be achieved. 

With the FY 2007 requested increase, the President’s Health Center Initiative is on 

track to establish or expand 1,200 sites over the 2001 level. However, there is the 

likelihood that without special attention, some high poverty counties throughout the 

country may not successfully secure a Health Center site. Included in the President’s 

commitment is the goal to create a Health Center site in every poor county that lacks a 

Health Center site and can support one. Within the total request, $52 million will be 

directed to fund 80 new Health Centers sites in poor counties around the Nation. Access 

to primary and preventive health care services is critical, especially in poor communities 

that are medically underserved. 

Health Centers Program

The distinguishing mission of the Health Centers Program is to empower 

communities to solve their own local access problems and to improve the health status of 

their under served and vulnerable populations by building community-based primary care 

capacity and by offering case management, home visiting, outreach, and other enabling 

services. The program also addresses significant challenges facing communities by 

targeting public housing, homeless, and migrant health center development as well. 

Health Centers provide access to high quality, family oriented, comprehensive primary 

and preventive health care, regardless of ability to pay. 
15

Health Center grantees, as a result of their receiving from HRSA a grant under 

section 330 of the Public Health Service (PHS) Act, are eligible for enhanced benefits 

including Medicaid/Medicare reimbursement, access to the Federal Tort Claims Act 

(FTCA) program for health center malpractice coverage, and access to the program for 

discount drugs for patients under section 340B of the PHS Act. 

Under section 330, Health Centers are required to provide primary health services, 

including those related to family medicine, internal medicine, pediatrics, obstetrics, or 

gynecology that are furnished by physicians and where appropriate, physician assistants, 

nurse practitioners, and nurse midwives. Additional required basic health services 

include diagnostic laboratory and radiological services and a series of preventive health 

services, including prenatal and perinatal services; appropriate cancer screening; wellchild services; immunizations against vaccine-preventable diseases; screenings for 

elevated blood lead levels; communicable diseases and cholesterol; pediatric eye, ear, and 

dental screenings; and preventive dental services. 

Health Centers Requirements

To receive section 330 grant funds, a clinic must meet a number of statutory 

requirements. The Health Center must: be located in a federally designated medically 

underserved area (MUA) or serve a federally designated medically underserved 

population (MUP); be a public or private nonprofit health center; provide comprehensive 

primary health services, referrals, and other services needed to facilitate access to care, 

such as case management, translation, and transportation; have a governing board, the 

majority of whose members are patients of the Health Center; provide services to all in 

the service area regardless of ability to pay; and offer a sliding fee schedule that adjusts 

according to individual family income. 

The requirement that a majority of board members be Health Center patients makes 

these clinics unique among safety net providers and is designed to ensure that the centers 

remain responsive to community needs. Under section 330, a Health Center applicant 

needs to demonstrate the establishment of a governing board that has a 51 percent 

consumer majority, meets monthly, selects the Health Center’s services and hours, 

approves the Health Center’s annual budget, selects the Health Center’s director, and 

establishes the Health Center’s general policies. 

Health Centers Awards Process

HRSA accepts, on a competitive basis, applications from eligible organizations 

seeking a grant for operational support for new and existing Health Centers. Eligible 

organizations are public or nonprofit entities including tribal, faith-based and communitybased organizations. 

The largest category of grant awards includes new access points encompassing both 

new clinic starts and satellites of existing clinics. Other categories include grants to 

expand medical capacity at existing locations. 

All eligible and responsive grant applications are referred to an Objective Review 

Committee (ORC), comprised of experts in the delivery of community health care 

services, for their independent review and recommendations. When funding decisions 

are made, each applicant receives a notification letter listing strengths and weaknesses of 

each section of their application as noted by the ORC. This review approach provides 

valuable technical assistance for improving future applications for both awardees and 

those we were not able to approve during a particular cycle. 

Technical Assistance

HRSA works directly with communities to develop needed resources through the 

primary care associations in each State. These primary care associations, funded by 

HRSA, provide ongoing technical assistance involving guidance and options for 
16

organizations interested in applying for Health Center grants and to existing Health 

Center grantees interested in expanding their comprehensive primary care services. 

In addition, HRSA assists applicants through grant-writing workshops and other 

technical assistance activities that are provided through a cooperative agreement with the 

National Association of Community Health Centers. Such activities assist applicants to: 

demonstrate a high level of need in the community; present a sound proposal to meet this 

need; show that the organization is ready to rapidly implement the proposal; display 

responsiveness to the health care environment in the service area; and demonstrate 

collaborative and coordinated delivery systems for the provision of health care to the 

underserved in their communities. 

Federally-funded health centers are similar to other health care businesses. Like 

most businesses, at any point in time, approximately 4 percent of health centers are 

experiencing significant challenges to their viability. HRSA, with assistance from 

interdisciplinary teams that may include contractors, grantees and staff, provides 

intensive technical assistance to grantees to address problems. At all times, continuity of 

service for the affected population is the first priority under consideration in addressing 

such challenges. 

Health Centers Services

Health Centers offer ambulatory services that reflect the diverse needs of the 

populations they serve. Because of the combination of low incomes, linguistic barriers, 

and frequently poor health status, Health Center patients require access to enabling 

services as well as comprehensive primary care services. 

Health Centers are unique among primary care providers for the array of enabling 

services they offer, including case management, translation, transportation, outreach, 

eligibility assistance, and health education. Health Centers commit significant resources 

to managing chronic conditions including diabetes, asthma, and cardiovascular disease. 

In 2004, Health Centers provided more than 52 million encounters, over 250,000 

mammograms, over 1.5 million pap tests, and nearly 2.4 million encounters for 

immunizations, as well as over 425,000 HIV tests and counseling, perinatal and delivery 

care for 364,000 women. Over 95.7 percent of grantees provided translation services 

either directly or by referral. 

Health Centers are staffed by a combination of clinical, enabling, and administrative 

personnel. They are typically managed by a chief executive officer and a clinical 

director. Depending on the size of the patient population, the clinical staff consists of a 

mixture of primary care physicians, nurse practitioners, physician assistants, substance 

abuse and mental health specialists, dentists, hygienists, and other health professionals. 

Health Centers Financing

Health Centers receive funding from a variety of sources. A majority of Health 

Centers revenue comes from Federal resources including Medicaid, Medicare, the section 

330 grant, SCHIP and other Federal programs. On average nationwide, HRSA grants 

comprise 23 percent of Health Center revenue, but as little as 15 percent depending on 

the individual community and grant application. At 35 percent, Medicaid is the largest 

source of revenue for Health Centers, followed by Federal grants. Health Centers serve 

about 10 percent of all Medicaid enrollees nationally. 

For Health Centers’ revenues, in addition to Medicaid and the section 330 Federal 

grant funding, Medicare accounts for 6 percent, self-pay for 6 percent, other third-party 

payers 7 percent, other State/local government or foundations account for 18 percent and 

the remaining 5 percent from other sources. 
17

Health Centers Background

The development of the Consolidated Health Centers Program began over 40 years 

ago with the creation of the migrant health center program and followed by the 

neighborhood health center demonstration projects initiated in 1965 and first funded by 

Congress as part of the War on Poverty. By the early 1970s, about 100 neighborhood 

health centers had been established under the Economic Opportunity Act. These centers 

were designed to provide accessible, dignified personal health services to low-income 

families. Community and consumer participation in the organization and a patientmajority governing board were features of the Health Center model. With the phase-out 

of the Office of Economic Opportunity in the early 1970s, the centers supported under 

this authority were transferred to the Public Health Service. The mandate of the centers 

was broadened so that comprehensive primary and preventive services were provided to 

all who came through the doors. The Community Health Center program, as authorized 

under section 330 of the Public Health Service Act, was established in 1975. A 

reauthorization that consolidated the separate authorities of the Community, Migrant, 

Homeless and Public Housing Health Centers under section 330 took place in 1996. 

Most recently, the Health Care Safety Net Amendments of 2002 reauthorized the 

Consolidated Health Centers Program through 2006. The 2002 Health Center 

reauthorization requires that grants be awarded for FY 2002 and beyond in such a way 

that maintains the proportion of the total appropriation awarded to migrant, homeless and 

public housing applicants in FY 2001. In general, about 81 percent of funding is awarded 

to community health centers, with the remaining 19 percent divided across migrant, 

public housing, and homeless health centers. 

Health Centers’ Effectiveness

The overall effectiveness of the Health Center program has been proven in 

numerous studies and evaluations. Under the Administration’s rating of Federal 

programs, the Health Center program receives the highest possible ranking – “Effective.” 

Programs rated “Effective,” according to the Office of Management and Budget, “set 

ambitious goals, achieve results, are well-managed and improve efficiency.” The 

program achieved this rating based the fact that it “is designed to have a unique and 

significant impact,” and that “evaluations indicate the program is effective at extending 

high-quality health care to underserved populations.” 

Conclusion

Health Centers offer high quality, prevention-oriented, case-managed, familyfocused primary care services that result in appropriate and cost-effective use of 

ambulatory, specialty and in-patient services. Primary care is delivered for all life cycles, 

and includes a full range of health services. In administering grants for the Health 

Centers Program, we take great pride in the high evaluation given the program, and the 

bipartisan support of Congress, and fully realize that the program works only as a 

partnership with those extraordinary local primary care providers providing indispensable 

quality clinical services to underserved Americans with few health care alternatives. 

We look forward to working with the Committee and the Congress in reauthorizing 

the Health Center program. I would be happy to answer any questions at this time. 

 MR. DEAL. Thank you. I will begin the questioning. First of all, we 

understand that the President’s Initiative is designed to try to help the, as 

we would call them, poor counties. Would you explain the criteria that 

are used to determine who gets priority in the grant process? I have a 

rural district by and large, but it is on the fringe of the Atlanta 

metropolitan area. And some of my counties that do not have a hospital 
18

and in some cases do not have a doctor, do not qualify based on income, 

because we have some of those commuters who are commuting into 

Atlanta that have rather high incomes that skew the average income for 

the county. But it is still a medically underserved area in terms of 

personnel available in the community. Does the issue of medically 

underserved, is that a criteria that you consider, as well? 

 MS. HANDLEY. Let me describe a little bit about the way the 

program might look or the concepts behind the program. First of all, let 

me give you a sense of the way the money part of it would work. 

 We anticipate HRSA awarding $48 million to 80 new access points 

with the fiscal year 2007 budget and $4 million for 50 planning grants. 

And the conceptual framework for the program is to have a health center 

in high poverty counties where there is no existing health center and 

there is high poverty but where there is also an ability to support a health 

center. We haven’t determined all of the program parameters at this 

point in time. 

 MR. DEAL. One of the issues that Dr. Burgess has raised with us 

privately, and he may get back to ask the question in greater detail, is the 

requirement as I understand it, that 51 percent or a majority of the 

makeup of the board must be patients themselves. And in new startup 

centers I would think that would be a difficult situation. There has been 

some suggestion that perhaps we should look at some alteration on 

startup centers in order to be able to satisfy that. Have you found that to 

be a deterrent and a problem in new startup centers? 

 MS. HANDLEY. Mr. Chairman, what you are referring to, the 

governance requirement is that a majority, which is generally speaking 

about 51 percent of the board, be comprised of consumers. And we 

believe that it is sort of a cornerstone of the program in that it provides a 

consumer input to the leadership and decision making that takes place in 

the organization. We do understand that new starts will need to have 

time to come into compliance with the requirements. How they will 

come into compliance is a part of their application but we give them 

additional time after they have actually become a new start and been 

funded, to come into compliance with our requirements. We have not 

found this to be an issue with a great number of health centers, even 

with--it hasn’t been an issue in the program. 

 MR. DEAL. One of the things that we have struggled with in this 

committee dealing with the cost of healthcare, is an effort to try to 

decrease the number of emergency room presentations, especially for 

non-emergency reasons. Do you have any evidence that community 

health centers help to deal with that number of emergency room 

presentations? 
19

 MS. HANDLEY. I have not come prepared with any data today but 

we would be happy to provide data later. What I can say is that the 

primary healthcare provision that the health centers do is really essential 

to providing a medical home for millions of Americans. And the fact 

that they have a medical home where they can get primary and very 

comprehensive primary care services means that they are going to have 

less of a need for using an emergency room or going to other kinds of 

providers. 

 MR. DEAL. Well, I think you have hit on the term that I have heard 

repeatedly and that is medical home. When I ask in my local community 

some of the people who are conducting the questioning of various 

individuals who had repeat performances or repeat appearances at the 

ER, they were asked who their medical home doctor was and they gave 

the name of the ER doctor. We would like to change that pattern and 

obviously, I do think that community health centers do a good job of 

providing that alternative medical home, which has the effect I think of 

reducing those ER visits, especially the non-emergency presentations. 

Thank you very much. I am going to recognize Mr. Green for his 

questions. 

 MR. GREEN. Thank you, Mr. Chairman. And we have some stats, at 

least for Harris County because we have a small number but because we 

are partnering with creating these current hospital systems in the area, 

that will show in their participation based on their belief, and these are 

both for-profit and non-profit, their belief that they will lower the number 

of visits if there is a community health center close that will take them. 

But we will get that information at least. And again, ours is small in 

Harris County compared to the number of centers, but I am sure we can 

get that information nationwide. Ms. Handley, the President stated as a 

goal having a community health center in every poor county in the 

country. And the National Association of Community Health Centers 

teamed with George Washington University estimated that 929 poor 

counties in our country are without a health center. The Administration’s 

budget proposed a $181 million increase in health center funding for 

fiscal year 2007, which would bring the total funding to nearly $2 billion 

next year. As we consider the authorization through 2011, what 

authorization levels does HRSA believe we need in the out years, the 

2010 or 2011, to keep us on the path to achieve the President’s goal? 

 MS. HANDLEY. I am not in a position, sir, to respond to what we 

need in additional out years to meet the goal. 

 MR. GREEN. Okay. Coming from-- 

 MS. HANDLEY. We can get that for the-- 

 MR. GREEN. Coming from our side, of course, we would like to 

have no cap on it and get whatever we can get through the appropriations 
20

process, but sometimes that is not always possible. I appreciate that 

information you shared with the committee. Last summer the GAO 

issued findings from a study of the Health Center Program. Under the 

Health Center Program, centers are required to provide referrals for 

specialty care that are not deliverable at the center. And about only one 

of the beauties of it is that you do have full gamut of access--dental, 

psychiatric. The GAO found that many health centers are having 

difficulties finding specialty care for patients, especially for the 

uninsured. Many of the difficulties are due to a shortage of available 

specialists. The result, according to the GAO, was long waiting lists for 

health center patients to see specialty care. Can you comment on the 

actions HRSA has taken to remove the barrier to care and what was 

posed as a threat to the patient’s health and in my view works against the 

success of our centers to achieve reducing health disparities? Has that 

been an issue with some of our health centers in other parts of the 

country? 

 MS. HANDLEY. I am not aware of whether it has been an issue in 

other parts of the country, sir. I think I would have to get back to you 

with an answer for that. 

 MR. GREEN. Okay. If you could just get back to me whenever you 

can. 

 MS. HANDLEY. Sure. 

 MR. GREEN. Mr. Chairman, that is all the questions I have. Thank 

you. 

 MR. DEAL. I thank the gentleman. Dr. Burgess, I haven’t stolen all 

of your questions but I did steal the one about the makeup of the board. 

But you are recognized for questions. 

 MR. BURGESS. Thank you, Mr. Chairman. You can steal my 

questions all you like. Did you get a satisfactory answer? 

 MR. DEAL. I expected you to explore it further. 

 MR. BURGESS. Well I guess, Ms. Handley, that remains a concern of 

mine. I heard part of your answer to the Chairman and I will admit I 

haven’t been here very long. I’ve only been in Congress three years, but 

my observation of the startup time for the only clinic in Tarrant County 

was years. One of the stumbling blocks of setting that up was having to 

constitute the board. And the education of board members to be able to 

run what is realistically--I mean, I have run a clinic before. I have run a 

medical practice and it is a difficult financial venture that if you make the 

wrong decisions can all come apart at the seams. What would be wrong 

with relaxing some of those requirements for a short period of time, 

particularly in an area like Tarrant County or maybe down in Houston 

where we have had people displaced by Hurricane Katrina and so the 

ranks of the uninsured have swelled in those areas? What would be 
21

wrong with relaxing those board requirements for a short period of time 

to allow the clinic to become up and functional and then identify people 

who are served by the clinic to become additional board members and 

ultimately make up the 51 percent? 

 MS. HANDLEY. Well sir, currently the way the process works is if 

they want to become a new access point they don’t actually have to have 

the 51 percent. They have to have a plan to getting to the majority on the 

governance board. So in essence, there is a time period during which 

they can get the board and accumulate the board. 

 MR. BURGESS. How long a time period is that, if I may? 

 MS. HANDLEY. I think the period is a reasonably long period that 

might extend to as long as a-- 

 MR. BURGESS. Could you get that information to the committee? 

 MS. HANDLEY. Yes. 

 MR. BURGESS. And perhaps the precise language that a group would 

need to follow if they were to do that? You know, one of the problems I 

have is I look at that map of where the Federally qualified health centers 

are in this country and I see a bunch in the east, I see a bunch paralleling 

the Mississippi River. I see a bunch in California. I don’t see many in 

north Texas. What are they doing right that we are doing wrong that 

allows them to have the clinics and us not? 

 MS. HANDLEY. I think there has been a lot of interest and activity in 

your State. As you pointed out in the beginning, really, health centers 

are a small business and it takes time to get a small business up and 

running. And I think there has been a lot of activity in the Primary Care 

Association and the Primary Care Office in the State of Texas to grow 

the health center program. And we have in fact worked closely with 

them so that there have been some new look-alikes, which provide the 

organizations, the health centers, with increased revenue from Medicare 

and Medicaid and decreased costs for pharmaceuticals. So the State and 

us through our funding of the Primary Care Association and the PCO 

actually have been working together to grow these organizations. 

 MR. BURGESS. But let me interrupt you because Tarrant County, I 

am not sure of the precise population but about a million. Just North 

Denton County, population 480,000. Tarrant County has one Federally 

qualified health center that opened this year and I don’t remember the 

trajectory for the number of years that it took to get there but I have 

heard five, six, seven, even eight years length of time to get that started 

up. Denton County has zero Federally qualified health centers. What do 

we need to be doing in North Texas to make these facilities available to 

our patients who are just as much in need as patients in states that border 

the Mississippi or in the Northeast or out west? How do we develop the 

program so that we can get the facilities where they are needed? 
22

Something has been missing from North Texas and I would like you to 

help me identify what that is and how to correct that problem because I 

have got zip codes in my district that have infant mortality rates that 

should not be in this country. They simply should not be. I have got 

healthcare disparities in zip codes in my county that just should not be. 

And I think part of the problem is the lack of this type of facility in those 

communities has not just hurt access but it hurts utilization. People have 

to go so far to a county health facility that they just simply don’t bother 

or they don’t bother to get the blood pressure checked or the routine 

checks that are going to hold the costs down. Help me with what those 

other places are doing right that we are not doing. 

 MS. HANDLEY. Well, I think part of--two responses. One is that it 

is, again, it is a small business that does take time to grow and is a 

partnership within a local community. I think the second part of the 

answer is that in addition to the Primary Care Association within the 

State and the Primary Care Office, which is a part of the State 

Department of Health, we are certainly willing to talk with you further 

about how it might be possible. 

 MR. BURGESS. Well, I hope so because I have got the CEOs of 

every hospital in Tarrant County sitting down in boardrooms with me. 

They get it. They understand. They are ready to be good partners in this 

but we can’t move off dead center. And I guess because I am new and I 

don’t understand how bureaucracy works or doesn’t work, I am having a 

lot of difficulty understanding why I can’t get these services for my 

constituents. Mr. Chairman, thank you. I will yield back. 

 MR. GREEN. If I could ask you to yield? I know your time has run 

out but since I am the only one on our side I am going to take the 

phantom time, I guess. But one of the things we identified years ago was 

before we get to a healthcare center is that the CAP Program that we had 

for the early ‘90s--I know Congressman Bilirakis-- 

 MR. BURGESS. Mr. Green, I am reclaiming my time. With all due 

respect, we have been working at this. This is not just something that has 

started in the last few months. 

 MR. GREEN. I know but-- 

 MR. BURGESS. And I will be happy to visit with you after. 

 MR. GREEN. Okay. 

 MR. BURGESS. But I will save the committee’s time. I don’t think I 

need that lecture today. 

 MR. DEAL. Well, the next person for questioning is Mr. Bilirakis 

from Florida. 

 MR. BILIRAKIS. Thank you, Mr. Chairman. I have an opening 

statement and I ask unanimous consent that it might be made part of the 

record. I am sorry I wasn’t here when you started out. 
23

 MR. DEAL. They have already been approved for admission in the 

record. 

 MR. BILIRAKIS. Oh, okay. It is my understanding that over the past 

four years HRSA has funded over 700 new community health center 

sites with the increased funding that Congress has provided and for 

which I really strongly feel the Administration should be commended. I 

know that the President feels very, very strongly about this subject and I 

have been pleased to lead, along with my colleagues Mr. Brown and Mr. 

Green and others, the bipartisan effort to secure those increases. 

 Can you tell me over the past four years--well, let me back up first. 

Can you tell us with certainty whether Section 330, grant funds in 

general and expansion funds in particular, are being targeted to 

communities with the greatest need? In other words, there is a strong 

feeling for additional funding and whatnot and it has been there, it isn’t 

being used the way that we intend that it be used. That is the general 

question. 

 MS. HANDLEY. Yes, sir, I do believe it is. We have need built into 

the application process in a couple of ways and we are working on 

strengthening the process for the future. The way it works now is that 

we look at need in the application process. It is an eligibility sort of 

review criteria. If you don’t have a high enough need, you don’t even go 

through the objective review process that all competitive applications go 

through if you don’t meet that threshold score of need. In addition, 

within the application itself there is a score that is assigned for need so 

we are looking in two ways in the current process. In the future, we have 

added more weight to need so for future funding cycles we anticipate that 

need will become even a larger part of the process. It won’t be a 

screening factor. It will be built into the actual application score so that 

it is 35 points out of 100. And we believe that this will make sure that 

we are targeting our scarce Federal dollars to the places of greatest need 

and we are providing flexibility for the applicants in that we are going to 

have standardized data. But not that they have to provide every--they get 

to pick from among the data items. So we think what we have for the 

future will even move towards exhibiting greater need. And we 

published in the Federal Register, April 26, our response to the proposed 

revised need process and now have this available for the future. 

 MR. BILIRAKIS. Do we have many applications for a center that 

basically would be approved or even have been approved but that we 

don’t have construction because there is inadequate funding? 

 MS. HANDLEY. I don’t think I could really comment on that because 

the statue does not make construction money available. So it is not a part 

of the grant that we make with the 330 dollars. 
24

 MR. BILIRAKIS. Well, you know, I guess there is a criteria and 

something about how the dollars have to be used for construction, buying 

property, things of that nature. There are already a lot of storefront type 

of community health centers, which are county centers and whatnot. I 

mean, shouldn’t we be flexible? I had just raised this question. I hadn’t 

really given much thought to it. But shouldn’t we be flexible enough to 

feel that maybe that can be done or some of our Federal dollars can be 

used in that way, rather than say hey, it has got to be used this way? Or 

it has to be used to purchase property. It has got to be used for a new 

construction. Any opinion on that? 

 MS. HANDLEY. Well, our dollars are not used for construction. 

They are really used for direct services for patients to get care. And 

having the program requirements that we do in place assures that people 

are protected. They get the full range of services that are required under 

the law, as well as the organization is going to be there and be able to 

continue to provide care. That it will be fiscally solvent and around for 

the long-term so there is continuity of care. 

 MR. BILIRAKIS. Well, getting off of that a moment, I know for 

instance I have visited some of these centers. Now granted, some would 

be county centers, state supported, county supported. But I find that they 

are 8:00 to 5:00 centers and no Saturdays and Sundays. Now, is that the 

best use of that center, the best use of that money? We are talking about 

people who--hopefully they work—need, but they are not going to be 

able to get there during the day and not be able to get there on a Saturday 

or Sunday or particularly on a Sunday. Any opinion about that? Are 

there any criteria there that in terms of enabling these centers to open 

other hours, even mandating that they work other hours? 

 MS. HANDLEY. What we require of them is that they provide care 

that will meet the needs of their target population. So there is flexibility 

built into our requirements. We would expect that they could provide 

care at different times. That they would have some evening hours, for 

example, or that they would--some of them are sometimes open on 

weekends to meet the needs. And obviously if you have a migrant 

community health center they are going to have a definitely different 

way of delivering care and a different number of hours. 

 MR. BILIRAKIS. Well, it isn’t just the migrant community. We are 

talking about most people, particularly low-income people working 8:00 

to 5:00 hours, also and not being able to-- 

 MS. HANDLEY. Right. 

 MR. BILIRAKIS. It is something that I think we should explore, Mr. 

Chairman. We talk about the money and we talk about this and that and 

I don’t know, I have got to go into this construction and purchase of 

property thing with my staff on that because maybe I didn’t understand it 
25

well enough. But I am also concerned that it is there and it is not really 

being utilized as well as it should be, to the fullest extent because of 

these hours that they keep. Well thank you, Mr. Chairman. I am sorry I 

took up lots of time. 

 MR. DEAL. I thank the gentleman. Mr. Rush from Illinois is 

recognized for questions. 

 MR. RUSH. Mr. Chairman, I ask do you think that we would have 

maybe time for a second round of questioning if we don’t get through 

our questions? 

 MR. DEAL. Well, let us wait until we see how many people stick 

around for the second panel, okay? 

 MR. RUSH. Okay. All right. Real good. Thank you. Ms. Handley, 

I appreciate you coming in before the committee. And let me just tell 

you that I also appreciate the Administration’s proposal to increase 

funding for community health clinics. I know that they are on the front 

line of providing basic healthcare to constituents such as mine. And I 

also believe that they could also be and hopefully it won’t get to this 

point but I believe that it will also ultimately be a part of the overall 

defense against a terrorist attack against urban areas in our nation. I 

think that this country or this Congress really has not paid attention to the 

role that community-based health clinics will play in regard to some kind 

of outbreak or some kind of terrorist attack, especially chemical terrorist 

attack, in our urban centers. I think the potential for them to be on the 

front line in terms of the defense of our Nation hasn’t been paid close 

attention to. I am an advocate, a strong advocate for community based 

health clinics. In my other life as a civil rights activist I played a role in 

having free health clinics. There was a free health clinic movement back 

in the Sixties and I think that was a forerunner of the Government’s 

participation. 

 I am excited about the fact that there are new access points. I think it 

is 80 new access points that we are going to be providing for under the 

President’s budget. And let me just ask you, in my city in the Inglewood 

community, which is one of the poorest communities in my city, one of 

the poorest communities in the Nation, there is a scarcity of health 

clinics. And I am working with a number of individuals trying to help 

get that situation resolved. What is the role that your organization, your 

agency, play in regards to student-based health clinics? And how do you 

see student-based health clinics lining up with health clinics that are 

FQHCs, okay? Do you see a role for student-based health clinics and 

what is the role? 

 MS. HANDLEY. There are a number of student-based clinics that are 

really part of other FQHCs that are already existing and operating 

successfully around the country. There is no separate program 
26

specifically for school-based programs but again, many of the existing 

grantees that we have that are FQHCs have a component as a part of 

them that is school-based and they are doing this successfully now. 

 MR. RUSH. In my experiences with this organization and with 

others, it seems to me that there is not enough advance notice given to 

new applicants that will give them enough time to apply for FQHCs. Is 

there anything that your agency is doing to try to help remedy that 

problem in terms of making sure that they know when there is going to 

be applications accepted at HRSA for new clinics? You know, at one 

time I understand it was, there might possibly be an application process 

in December. Then maybe May. You know, these organizations are 

never really given any information they can really work with that will 

give them enough time to prepare for the application and to prepare an 

adequate application, a competitive application. Do you have any 

remedies for that type of problem? 

 MS. HANDLEY. You raise an important point, which is that these 

small businesses need time to prepare applications. We generally 

publish a preview once a year that lists what the opportunities will be and 

what the timeframes will be for applications. Sometimes the challenge 

with the dates that are listed in what we call the preview that has the 

funding opportunities is that we don’t yet have a budget. And so we 

don’t want to have organizations spend time and resources preparing an 

application if there isn’t going to be funding for that opportunity. So it is 

definitely a challenging situation in terms of not wanting them to prepare 

applications and the preview is our mechanism for advertising what we 

believe, based on the information we have, will be the dates for the 

opportunities. 

 MR. DEAL. The gentleman’s time has expired. I recognize Mr. 

Shimkus from Illinois for questioning. 

 MR. SHIMKUS. Great. Thank you, Mr. Chairman and I appreciate 

you being here, Ms. Handley, and thanks for your time. 

 When I first got elected in ‛96, of course my district was a little 

different. I didn’t have a single community health clinic in my district. 

Since then and my lines have been redrawn a little bit, I have 13 and they 

have really proved a great benefit to the underserved or unserved. And 

so I want to echo some of the other comments about the great work that 

they are doing. Illinois has had a history of medical liability issues 

because of litigation and the fact that they have the Centers for Federal 

Tort Claims Program, it really helps our State meet those needs. And we 

continue to have other type of providers wanting the same type of 

protection or help or assistance but those are all kudos. 

 I do have some questions on the President’s Health Center Initiative, 

in which his desire to place new community health centers in every poor 
27

county and I have quite a few of those myself and some very, very rural. 

I have one county that has got 5,000 citizens in it, and so have you all 

discussed or debated or come up with the criteria you are going to use to 

determine the eligible counties? And how will you all or OMB 

determine the top poorest counties? So how are you going to define a 

poor county and then how are you going to rank them? 

 MS. HANDLEY. What I mentioned before is that we are looking to 

make $48 million worth of awards in fiscal year 2007, based on the 

President’s budget and that will be 80 new access points. Another $4 

million would provide for 50 planning grants. And we haven’t worked 

out all of the program parameters but generally speaking, the eligibility 

would be limited. We would have a limited competition with all the rest 

of the requirements applying, except for it would be a limited 

competition for the counties that were the poorest or that could support a 

health center. So we haven’t gotten to the point of determining-- 

 MR. SHIMKUS. So you don’t know the answer right now? 

 MS. HANDLEY. We haven’t gotten to the point of determining which 

counties and all of the details of the program. 

 MR. SHIMKUS. I think a lot of us would be interested in 

understanding what that criteria was. And if that is going to be the role 

by which the Administration wants to present it then they are going to--

and I am a great supporter of the Administration and believe they are 

well intentioned. But I mean, there is going to be competition for these 

and if there is going to be criteria, that criteria needs to be known and 

fully vetted. So that when awards are given, that if we are going to make 

that determination, this is the standard we are going to use. Then we in 

essence comply with those and people know it and we feel good that the 

money that is being spent is being directed in the intent that you all and 

we would support. 

 As I mentioned, my one county is 5,000 residents. I don’t know how 

you are going to define in this proposal sparsely populated. Is that 

another term that we are going to have to decide on how we are going to 

define before we move forward? 

 MS. HANDLEY. Well, I understand your concern about wanting to 

know the details of the program. And what I would say is that when we 

do have a funding opportunity that is available, those kinds of details will 

have to go into what is advertised so that people will understand the 

eligibility criteria. We are just not yet at that point. 

 MR. SHIMKUS. Mr. Chairman, if I could just ask for the committee’s 

attention, to just follow this process through? And as the agency moves 

forward, that we are fully apprised and given some notice on how the 

Administration would prepare to move in this direction. And that is all 

the questions I have on this, Mr. Chairman. I yield back. 
28

 MR. DEAL. I thank the gentleman. And we would appreciate that 

kind of follow-up with the committee, if you would. 

 MS. HANDLEY. Sure. 

 MR. DEAL. I’m pleased to recognize the gentleman from Ohio, Mr. 

Gillmor, for questions. 

 MR. GILLMOR. Thank you, Mr. Chairman. And we are happy to 

have you here, Ms. Handley. I have got to say I think that the 

community health centers are just a wonderful asset in this country and 

they are doing a great job. I have an outstanding one in my district in 

Fremont, Ohio. In fact, I visited there once again on this past Monday. 

 But there is one matter that concerns me and it came up as a result of 

that health center. And we are talking about access to care and this is a 

situation which is a great impediment to access to care that shouldn’t be. 

After Hurricane Katrina the Fremont Health Center sent a lot of people 

down to help and we found out that once they crossed the State border 

they weren’t covered by the Federal Tort Claims Act. Now, that 

situation got handled in a convoluted way because there were some 

Federal workers down there and they were made Federal temporary 

employees so then they were covered. But they wanted to go down later 

and that could not be done. And there have been other members who 

have had the same problem. My colleague, Joe Schwartz, had a group in 

his district that wanted to do the same thing. 

 The bottom line is, you had qualified people that are willing to help 

in a situation of great need and couldn’t because of the Federal law. 

Representative Schwartz and I introduced a bill which would modify that 

so they could get Federal Tort Claims coverage and that bill is H.R. 

3962. 

 Now, we did bring this to the attention of your agency. I wrote a 

letter back in January referencing the situation and that bill and asking 

specifically whether you thought it was a good idea and if not, did you 

have another idea to deal with this situation? That was in January. In 

April I did get a response from Administrator Duke. The only problem 

was, it didn’t answer the question, so we have absolutely nothing. So I 

guess my question to you is, do you think we ought to be doing 

something to remove that barrier to access the care in a way that we 

could let qualified people go in situations like that and still have 

protection of the Federal Tort Claims Act? And I would appreciate if 

you could take a look at H.R. 3962 and see if that is a good approach or 

if you have some other suggestions to make. Because I think as we go 

through this process, this is something we certainly ought to correct and 

correct it fairly soon. 

 MS. HANDLEY. Well, the Administration doesn’t yet have a position 

on the legislation that you are talking about. As you know only too well, 
29

our Department’s Office of General Counsel determined that the Federal 

law as it is currently written does not allow the healthcare providers in 

one community health center to take their health center Federal Tort 

Claims Act coverage with them to the other area, the other community. 

So we are not in a position that-- 

 MR. GILLMOR. Well, I know that because that is what I told you and 

I know that. My question is, because you are the agency responsible, is 

that the way it ought to be? And if not, how do we correct it? And I am 

not directing this at you personally but it appears from your answer and 

the inner workings of your agency, which I am not blaming you for, we 

might wait until next year for an answer. So let me ask you, do you have 

any objection if we move forward to solve the problem, with or without 

you? 

 MS. HANDLEY. I can’t speak on behalf of the Administration. I am 

sorry. 

 MR. GILLMOR. Okay. I understand the constraints you are under so 

I appreciate that. Thank you. 

 MR. DEAL. I have had a request from Mr. Rush that we have 

additional time for questions. I would propose that any Member who 

wishes to ask additional questions would have an additional three 

minutes. I would ask unanimous consent, and without objection, we will 

proceed, and I will not exercise my time. Mr. Green, I would recognize 

you next. 

 MR. GREEN. Mr. Chairman, I will defer to my colleague. 

 MR. DEAL. All right. Mr. Rush is recognized. 

 MR. RUSH. Mr. Chairman, thank you so much. I want you all to 

know you all are spoiling me. You are setting a precedent here involving 

all these deferments. 

 MR. DEAL. You just remember that. 

 MR. RUSH. Ms. Handley, look-alikes, can you tell me the purposes 

of look-alikes and how they fit into your overall game plan as it relates to 

community-based health clinics, FQHCs? 

 MS. HANDLEY. Yes, I would be happy to do that. The look-alike 

program is one where the organizations, the community health center 

don’t actually get health grant funds from the Federal government. But 

what they do get is the designation as an FQHC, which is important to 

them for several different reasons, actually three reasons. The first 

reason is it makes them eligible to get Medicare and Medicaid-enhanced 

reimbursements, so they get increased revenue sources, in essence. The 

second reason is with that eligibility they can also get access to the 340-

B Program, which is a program for discounted pharmaceutical prices. 

And then finally, they are also eligible for HPSA designation, Health 

Professional Shortage Area designation. So it is a good program for 
30

organizations. As you know from your area there is a lot of competition 

for the grant dollars that are made available each year for each 

opportunity. 

 Some organizations make a business decision that is still worthwhile 

for them if they aren’t, for whatever business reasons, either ready to or 

maybe not interested in applying for the grant money, to apply for the 

look-alike program. And we have worked with a lot of different 

organizations around the country to get them look-alike status. The 

number of look-alike organizations has been growing over time and we 

continue to work to make the program available and provide technical 

assistance to potential applicants. 

 MR. RUSH. So the look-alike program is like a developmental league 

for the FQHCs? What is the percentage of look-alikes that graduate into 

FQHCs? 

 MS. HANDLEY. I don’t remember the number off the top of my 

head. I can supply it for the record but I know it is exactly as you 

suggest, though not everybody who is a look-alike necessarily wants to 

become a new access point. In fact, I remember speaking with a woman 

at a large health center who for many years had a board that was just not 

interested in getting any Federal funds. So it can be a really great way 

for organizations to understand what the requirements are under the 330 

grant program because basically a look-alike is just that. It meets all of 

the requirements. But it can also be something that organizations 

continue to do on their own. 

 MR. RUSH. Finally, for the advocates for community-based health 

clinics in the Congress and on this committee, what are some of the 

suggestions that you might have where we might be more helpful to your 

program? And to programs that really address a need, particularly in the 

poor and underserved areas? What assistance do you need? What can 

we do to help you? 

 MS. HANDLEY. Well, the current statute has really been very helpful 

in being able to make healthcare available to 14 million Americans so we 

are very pleased with the program that currently exists. 

 MR. RUSH. Thank you, Mr. Chairman. I yield back the balance of 

my time. 

 MR. DEAL. I thank the gentleman. Dr. Burgess, you have additional 

questions? 

 MR. BURGESS. Yes, Mr. Chairman. I have two to ask. This is such 

an important hearing that if we could be allowed to submit written 

questions for the record and can we-- 

 MR. DEAL. Yes. We have already had a UC to that effect. 

 MR. BURGESS. Well, Ms. Handley, going back to the issue of the 

board and formation of the board and you said there are some relaxations 
31

on time. What happens if a clinic is up and running and you all give the 

go-ahead, and that board isn’t ready to go when you say start the clinic? 

 MS. HANDLEY. I guess what I was trying to convey before was that 

when you have a new organization that has not been in existence before, 

we can provide grant funding for before the organization actually is 

started and there is-- 

 MR. BURGESS. But what then happens if they are not ready to go 

when the clinic is started though? Is there a penalty? 

 MS. HANDLEY. I am not aware of a penalty, per se, in that I am not 

aware of a penalty. But I do know that we have worked with 

organizations to help them come into compliance, and that most 

organizations are able to come into compliance, all organizations. 

 MR. BURGESS. Is HRSA able to waive certain requirements for 

starting up a federally qualified health center? 

 MS. HANDLEY. We do have the capacity to waive requirements for 

certain kinds of health centers. 

 MR. BURGESS. Can you give us examples of what you can waive? 

 MS. HANDLEY. I believe we can waive the governance requirements 

for the migrant and homeless health centers. For example, with the 

homeless population, it is going to be difficult to get 51 percent of your 

members to be serving on the board. 

 MR. BURGESS. And what is the procedure that the clinic follows to 

seek those waivers? 

 MS. HANDLEY. They make the request when they are applying for 

their grant. 

 MR. BURGESS. Am I understanding when a clinic applies there are 

certain windows every year that are open where the applications can be 

taken and this occurs twice a year? Is that correct? 

 MS. HANDLEY. Generally speaking, it has been once a year. It 

depends. There are different funding opportunities. The new access 

points are probably the ones you are thinking about where a new 

organization gets funded to operate. There is also another opportunity 

that has been offered for the last 5 years and that is expanded medical 

capacity. So for an existing new access point, like the one in your county 

for example, in a future year might decide we would like to ask for 

additional money to expand the hours of service that we have or the 

number of providers we have because there is enough need that isn’t 

being met. So those are basically the kinds of two opportunities you are 

talking about. 

 MR. BURGESS. It is my understanding that has been started in 

Tarrant County, they would make application in June, learn in November 

that they weren’t accepted and the next application point would be a 

month later. So the timing of that proved to be very, very awkward to try 
32

to correct the deficiencies and have a new application in within a 

month’s period of time. For that reason, it took three cycles to get the 

funding approved because obviously on that second cycle it was difficult 

to get everything arranged to have it in order to make a successful 

application. If they are only once a year, then of course that brings up 

the other problem. If you miss the grant then you have got to wait all 

that time. And again, we are talking about a community that is in health 

despair, if I can use that term, and if I seem anxious about it, it is these 

timelines become so tragic in people’s lives because they are definitely 

negatively impacted. So I do have some written questions I will submit, 

Mr. Chairman, but my plea would be that we reauthorize this program, 

we have got to look at ways of streamlining. Yes, we want to be good 

stewards with the taxpayers’ dollars but we want to look at ways of 

streamlining this process so that we serve those people that the program 

was intended to serve. 

 Mr. Chairman, you have been very generous. I will yield back. 

 MR. DEAL. I thank the gentleman. Mr. Bilirakis, do you have 

additional questions? 

 MR. BILIRAKIS. I am going to probably pose the questions and then 

let them respond in writing. One would be reviews. HRSA undertakes 

periodic reviews in a way that assesses community need and the relative 

weight that it gives in the award process, right? 

 MS. HANDLEY. Yes. 

 MR. BILIRAKIS. Can you share with the committee the results of 

those reviews? I mean, the process that you take and the results of 

those? I mean, this goes to John’s questions, Mr. Shimkus’ questions 

and whatnot. You can do that for us, would you? 

 MS. HANDLEY. Yes. 

 MR. BILIRAKIS. All right. And you know, these are all questions 

that will be asked of us by our colleagues in the process of trying to 

move forward this legislation. So it is critical that we get this sort of 

information. 

 And also as a follow-up to Dr. Burgess, I wonder if you could 

provide the committee the total number of applications submitted each 

year, beginning in fiscal year 2001 and the number that were scored as 

fully acceptable or higher and the number that were actually funded. 

That will give us the answer to I think an awful lot of questions. Will 

you do that? 

 MS. HANDLEY. Yes, we can do that. 

 MR. BILIRAKIS. All right. What are we talking about here as far as a 

timeline is concerned, intending to be fair? You set the timeline rather 

than we. But you know, we want to move this legislation. This is a 

tough year. It is going to be a tough year for legislation. I think that 
33

there is a feeling here that we want to get it moved this year, which 

means you know, two or three weeks? 

 MS. HANDLEY. We will move hopefully quicker than that. 

 MR. BILIRAKIS. Okay, great. Thank you. Thank you, Mr. 

Chairman. 

 MR. DEAL. I thank the gentleman. Ms. Handley, we thank you for 

being here today and if you would follow up on the issues that have been 

raised for further response, we would appreciate it. Thank you very 

much for being here. 

 MS. HANDLEY. Thank you very much. Thanks. 

 MR. DEAL. We will now ask the second panel if they would take 

their seats? I am pleased to introduce the three members of the second 

panel. First of all, Mr. Roy C. Brooks, Commissioner of Tarrant County 

in Texas, who has already been referred to and introduced I think by Dr. 

Burgess previously. Ms. Kathy Grant-Davis, Executive Director of the 

New Jersey Primary Care Association, and Mr. Dan Hawkins, who is 

Vice President for Federal, State, and Public Affairs of the National 

Association of Community Health Centers, Incorporated. Gentleman 

and lady, we are pleased to have you here. And I know Mr. Brooks is 

under a time constraint about a flight so we are going to begin with you 

and hopefully you will be able to stay until we get a few questions, as 

well. You are recognized and we thank you for being here. 

STATEMENTS OF ROY C. BROOKS, COMMISSIONER, 

TARRANT COUNTY, TEXAS; KATHY GRANT-DAVIS, 

EXECUTIVE DIRECTOR, NEW JERSEY PRIMARY CARE 

ASSOCIATION; AND DAN HAWKINS, VICE PRESIDENT 

FOR FEDERAL, STATE, AND PUBLIC AFFAIRS, 

NATIONAL ASSOCIATION OF COMMUNITY HEALTH 

CENTERS, INC. 

MR. BROOKS. Thank you, Mr. Chairman and members of the 

subcommittee. I an honored to come before you today not only to 

advocate on behalf of community health centers but to urge you to take a 

hard look at increasing the number of these centers in shortage areas, 

such as Tarrant County, Texas. 

 The network of health centers in rural and urban portions of the 

United States is vital to this Nation’s system for providing 

compassionate, culturally and linguistically sensitive comprehensive 

primary care services to indigent populations. Community-based health 

centers promote a continuum of high-quality, family-oriented, 

comprehensive primary and preventive healthcare regardless of ability to 

pay. 
34

 These patients receive a wide range of primary and preventive care 

services, including adult medicine, infectious diseases, 

obstetrics/gynecology, pediatrics, dentistry, pharmacy, mental health, 

substance abuse treatment, school health programs, as well as disease 

prevention and healthy lifestyle promotion programs. Health centers 

overwhelmingly serve clients that are low-income and minority, 

including targeted efforts to serve migrant and seasonal farm workers, 

homeless individuals, and families and people living in public assisted 

housing. 

 The service population includes individuals living in areas of high 

crime, large numbers of unemployed and impoverished persons, many 

individuals with chronic diseases such as diabetes, pregnant teens, and 

substance abusers. These conditions lead to a variety of acute healthcare 

problems. Many people in these areas face numerous barriers to 

accessing healthcare services, including those imposed by geography, 

language, culture, poverty, housing status, and immigration. 

 It is tragic that bureaucratic red tape, unreasonable expectations, 

misguided rules, and the unbelievable administration of Federal funding 

for community health centers has led to many people being deprived of 

services essential to their health and well-being. I would like to discuss 

with you some of my observations from a local perspective regarding 

problems we have experienced during the process of establishing our 

first FQHC. 

 Much of the red tape tangle can be attributed to program information 

notices, which are known as PINS. Regarding the application process 

itself, FQHC regulatory guidance is a barrier to more FQHCs being 

created. Specifically the program information notices are vague and 

have inherent barriers to collaborative relationships with other 

community organizations, do not ensure those reviewing FQHC 

applications have an understanding of community and operations issues, 

and allow State CHC associations and State primary care offices to 

impose their own agendas when interacting with organizations wanting 

to pursue FQHC status. 

 In terms of affiliation agreements, the current PINS do not afford 

enough flexibility to allow FQHC applicants to utilize providers 

affiliated with other organizations. In the Tarrant County instance, these 

would include the University of North Texas Health Science Center and 

the county hospital district. These organizations have the capacity to see 

patients of any other organization. As you might expect, it is hard for a 

start-up clinic located in a medically underserved area and to recruit and 

retain an adequate number of providers without the assistance of 

organizations that are willing to collaborate with the FQHC applicant and 

see their patients. 
35

 FQHC applicants should be able to utilize providers from other 

community organizations if it can be demonstrated that such individuals 

will be qualified and able to satisfy the agency’s expectations. 

 Regarding management requirements and specialty services, the 

PINS contain requirements on the type of executive staffing for FQHCs. 

While the PINS recognize that some FQHCs may be smaller and may not 

require a full-time executive director, medical director, and finance 

director, it has been extremely difficult to obtain the agency’s approval to 

have less than full-time management. As you might expect, it is hard for 

a clinic with one full-time physician to financially justify a full-time 

executive director, medical director, and finance director. FQHC 

applicants should be able to utilize management from other community 

organizations if it can be demonstrated that such individuals will be 

qualified and able to satisfy the agency’s expectations. 

 Regarding supplantation, the PINS also prohibit the supplantation of 

funds. The principle of no supplantation of funds is limiting the 

willingness of some organizations to assist in the creation of new 

FQHCs. Organizations that are interested in facilitating the creation of 

an FQHC have been told that they will be required to commit to 

maintaining their initial funding amount or risk the application being 

denied because of perceived supplantation of funds. This interpretation 

has discouraged some organizations that find themselves with a one-time 

surplus of funds from assisting in the start-up of an FQHC. 

Supplantation is a misguided rule and one of the biggest obstacles we 

have to overcome in getting strong support from the Texas Bureau of 

Primary Care in the 330 grant application process. 

 It is essential that proper safeguards be in place to assure that State or 

local money is not being replaced or supplanted by Federal funds. 

However, prudent consideration of community interest and support 

should also be part of the equation. In our case, we spent over 2 years 

trying to convince the Bureau of Primary Health Care at the Department 

of Health that a clinic closed by the University of North Texas Health 

Science Center had no relationship to a new site subsequently obtained 

by UNT and the John Peter Smith Health Network, which is our county 

hospital. This new location was offered at no charge to be the prime 

location for the Fort Worth North Side Health Center in their efforts to 

gain a 330 grant designation. 

 This is a perfect example of what all of us at the Federal, State, and 

county level should be encouraging in efforts to create more access 

points for healthcare, a partnership of healthcare providers and 

community leaders working together for the common good. I would 

encourage each of you to consider ways we can make this process easier, 

not more difficult. 
36

 During the process of working with HRSA on our application, 

representatives from Senator Cornyn’s office and Representative 

Granger’s office were shocked to learn that only ten percent of a 330 

grant application was based or weighted on need. The core principle for 

federally qualified health centers is the requirement that they be located 

in medically underserved areas or health professional shortage areas. 

Logic screams at me that need is of paramount importance and should be 

weighted much higher in the scoring process. 

 MR. DEAL. Mr. Brooks, could you summarize for us? We are way 

over your allotted time. 

 MR. BROOKS. Sure. My last point is about proportionality. There 

are areas in our country, particularly in North Texas, as Dr. Burgess has 

indicated, where we have significantly less FQHCs than any other part of 

the country. In particular until the last funding round, the metropolitan 

area of Boston had more FQHCs than the entire state of Texas. I would 

encourage taking into consideration proportionality in the next rounds. 

 We have already addressed the board composition, the 51 percent 

requirement. Let me just state that that requirement poses two concerns. 

One is that there may not be the expertise in the clinic area to mount a 

start-up business. The second concern is that requiring 51 percent before 

the clinic is funded puts us in a position where we have got a problem 

with the relationship of our chickens and our eggs. We are required to 

have consumers on a board when there is no clinic for them to be 

consumers at. 

 In conclusion, community health centers are often the only care 

option for those who need it most. And these centers have become adept 

at breaking down barriers to access and providing continuity and 

preventive care. 

 A very sad example of why we need these is in my own county in 

Texas. While the infant mortality rate in Texas is just slightly lower than 

the national average of 6.9 per 1,000 births, Tarrant County’s rate is 7.5. 

The city of Fort Worth is 8.7, and in three targeted zip codes it exceeds 

12 per 1,000, which is a rate approaching that in many third world 

countries. We need more FQHCs in Tarrant County to address that 

concern. 

 Finally, I want to thank Dr. Burgess for his willingness to be a 

strategic partner with me in addressing the issues of health disparities 

and infant mortality for our joint constituents. And I appreciate the 

opportunity to share my views with the committee. 

 MR. DEAL. Thank you. 

 MR. BROOKS. Thank you, Mr. Chairman. 

 [The prepared statement of Roy C. Books follows:] 
37

PREPARED STATEMENT OF ROY C. BROOKS, COMMISSIONER, TARRANT COUNTY, TEXAS

Federally Qualified Health Centers: Benefits and Challenges 

• Supplantation - One of the biggest obstacles we had to overcome in getting strong 

support from the Texas Bureau of Primary Care in the 330 grant application process 

was the supplantation issue. It is essential that proper safeguards be in place to 

assure that state or local money is not being replaced or supplanted by federal 

funds. However, prudent consideration of community interest and support should 

also be part of the equation. In our case, we spent over two years trying to convince 

the BPC at the Department of Health that a clinic closed by the University of North 

Texas Health Science Center had no relationship to a new site subsequently 

obtained by UNT and JPS Health Network, our county hospital district. It was 

offered at no charge to be the prime location for the Fort Worth Northside 

Community Health Center in their efforts to gain 330 Grant designation. 

This is a perfect example of what all of us at the federal, state, and county level 

should be encouraging in efforts to create more access points for health care, and 

that is a partnership of health care providers and community leaders working 

together for the common good. I would encourage each of you to consider ways we 

can make this process easier, not more difficult. 

• Need – During the process of working with HRSA (Health Resources and Services 

Administration) on our application, representatives from Sen. Cornyn’s office and 

Rep. Granger’s office were shocked to learn that only 10 per cent of a 330 grant 

application was based, or weighted, on need. The core principle for Federally 

Qualified Health Centers is the requirement that they be located in Medically 

Underserved Areas (MUA’s) or Health Professional Shortage Areas (HPSA’s). 

Logic screams at me that Need is of paramount importance and should be weighted 

much higher in the scoring process. It is my understanding that HRSA 

representatives assured the congressional staffers that this part of the scoring 

process would be reviewed. I strongly encourage you to insure that HRSA address 

this glaring deficiency in the scoring process. 

• Board Composition – Another core requirement of the application process is that 

at least 51 per cent board of directors be composed of patients to the clinic. This 

requirement is needed to assure that the board adequately represents the community 

it serves. However, starting a new business requires special skills and expertise 

sometimes not readily found in the population base of the CHC. In order to 

maximize the efficiency and financial soundness of a new business start-up, HRSA 

should relax the 51 per cent rule for the first two years of a board’s existence to 

allow business expertise on the board. This two year window would allow the board 

to more fully exercise its fiduciary responsibility to the community and the federal 

government in the spending of federal funds. 

• Proportionality – For a whole host of reasons, some clear and others not so clear, 

FQHC’s are not distributed proportionate to population throughout the country. For 

example, it is my understanding that, until the last funding cycle, there are more 

FQHC’s in the Boston Metropolitan area than in the entire state of Texas. Further, 

in the third most populous county in Texas, my own Tarrant County, we only have 

the one CHC referred to earlier. With a population in excess of 1.7 million people, 

we should easily have three or more community health centers. We are actively 

working on an additional location at the present time. I would hope that HRSA will 
38

take proportionality in mind in the next round of applications and perhaps give 

added weight to those applications from underserved areas such as our county. 

In conclusion, I urge you to reauthorize funding of Community Health Centers, for I 

believe they represent the highest and best use of federal funds in improving health care 

delivery to those citizens who have the greatest need. Properly established and 

maintained, an FQHC can have a critical impact in the community it serves. 

 MR. DEAL. Thank you. Ms. Grant-Davis, you are recognized. 

MS. GRANT-DAVIS. Thank you. I want to thank you for this 

opportunity to speak-- 

 MR. DEAL. Pull that microphone a little closer, please. 

 MS. GRANT-DAVIS. Okay, how is that? I want to thank you for the 

opportunity to speak with you today and for the unwavering support the 

subcommittee has given to America’s health centers. I want you to know 

that your steadfast commitment to the health center program and its 

expansion has made a real difference in the lives of many underserved 

Americans across the country, including my State of New Jersey. 

 Earlier this year I received a letter from a grandmother, which 

actually really made my day, who wrote to thank our Primary Care 

Association for its work in opening a new health center in Glassborough, 

a very rural community where she lives. She wrote that her daughter, a 

young, uninsured mother of two children who suffers from severe asthma 

now has medical care and access to medications and I just want to read 

part of it. She wrote, “I cannot thank your program enough for opening 

the Community Health Center of Glassborough, where my daughter saw 

a doctor today and received prescriptions for her asthma and for a 

bronchial infection. She will be able to get well and breathe comfortably 

thanks to you. Because of you she will be able to take her son for a bike 

ride and run and be outside. Do you realize what a gift you have given 

her.” 

 Chairman Deal, Representative Green, and members of the 

committee, I want you to realize the gift that you have given to this 

mother and the 15 million people currently served by health centers: the 

gift of a medical home where they can obtain high quality healthcare, 

regardless of insurance status or ability to pay. Indeed, access to care at 

health centers allows individuals to be productive members of their 

families and their communities. I would like to ask permission to have 

the letter from this New Jersey grandmother inserted into the record. 

 MR. DEAL. Without objection. 

 [The information follows:] 
39

 MS. GRANT-DAVIS. Thank you. New Jersey’s health centers deliver 

comprehensive primary care in 90 sites to more than 322,000 patients. 

Eighty-eight percent of our patients are people of color. Seventy-eight 

percent have incomes at or below 100 percent of the Federal poverty 

level and nearly 45 percent are uninsured. New Jersey’s 21 health 

centers form an essential component of the State safety net and we are 

committed to providing high quality and comprehensive care. 

 MR. GREEN. Mr. Chairman? 

 MR. DEAL. Yes. 

 MR. GREEN. Could I ask because I know that time is late and we 

don’t have many members? We have read your statements. In fact, both 

the Commissioner and yours. If you could summarize and then we could 

get the questions and that would make it better I think for everyone, if 

possible. 

 MS. GRANT-DAVIS. Then there are really just three points that I 

would like to make. 

 MR. GREEN. Okay. Thank you. 

 MS. GRANT-DAVIS. And this actually is in response to some things 

that I have heard before. But I think one of the benefits of having 

community health centers is that they can develop many partnerships. 

And one of the things I think is important to realize that we do work very 
40

closely with hospitals to triage people out of the emergency rooms. That 

is critically important. In New Jersey we are working with the Medical 

Society of New Jersey to make sure that we have specialty care. We are 

working with Susan G. Coleman Foundation. So there are many 

partnerships and by having a health center it allows you to bring more 

parties to the table so that you have comprehensive care. 

 And the last point that I would like to make is that we urge you to 

provide a straightforward reauthorization of the Health Center Program 

through the fiscal year 2011. And the community board, nothing 

succeeds more than this because the patients have direct control of the 

care that they actually are receiving. So we urge you to reaffirm these 

core principles as you consider the reauthorization of the Health Center 

Program and I thank you for the opportunity to talk today. 

 [The prepared statement of Kathy Grant-Davis follows:] 

PREPARED STATEMENT OF KATHY GRANT-DAVIS, EXECUTIVE DIRECTOR, NEW JERSEY 

PRIMARY CARE ASSOCIATION

Good Afternoon. My name is Katherine Grant Davis and I am here representing 

New Jersey’s health centers, which include community, migrant, and homeless health 

centers. I am the Executive Director of the New Jersey Primary Care Association, a 

membership organization of health centers dedicated for advocating on behalf of the 

medically underserved. 

I want to thank you for this opportunity to speak with you today and for the 

unwavering support the Subcommittee has given to America’s health centers. I want you 

to know that your steadfast commitment to the Health Centers program and its expansion 

has made a real difference in the lives of millions of medically underserved Americans 

across the country including my state. Earlier this year, I received a letter from a 

grandmother, who wrote to thank our PCA for its work in opening the Community Health 

Center of Glassboro, NJ where she lives. She wrote that her daughter, a young uninsured 

mother of two children, who suffers from severe asthma, now has medical care and 

access to medications through the new health center. She wrote: 

“I cannot thank your program enough for opening the Community Health Center of 

Glassboro where [my daughter] saw a doctor today and received prescriptions for 

her asthma and for a bronchial infection. She will be able to get well and breathe 

comfortably thanks to you. Because of you, she will be able to take her son for a 

bike ride on her bike and run and be outside when it is cold or very hot without 

wheezing, and no longer have pain with each breath. Do you realize what a gift you 

have given her?” 

Chairman Deal, Ranking Member Green and Members of the Committee, I want 

you to realize the gift you have given to this Glassboro, NJ mother and the 15 million 

people currently served by health centers – the gift of a medical home where they can 

obtain high-quality health care regardless of her insurance status or her ability to pay. 

Indeed, access to care at health centers allows individuals to be productive members of 

their families and their communities. I would like to ask permission to have the letter 

from this New Jersey grandmother inserted in the Record. 

New Jersey’s health centers deliver comprehensive primary care in 90 sites to more 

than 322,000 persons. 88% of our patients are people of color, 78% have incomes at or 
41

below 100% of the Federal Poverty Level, and nearly 45% are uninsured. New Jersey’s 

21 health centers form an essential component of the state’s safety net for health care 

services. We are committed to providing high quality, comprehensive health care services 

in federally designated medically underserved areas and underserved populations. 

New Jersey health centers provide a comprehensive set of primary care services and 

enabling services to all people, regardless of their ability to pay. Our centers not only 

provide care to families, they also provide care to high risk and special populations 

including people with changing insurance coverage and those with chronic conditions 

and disabilities. Research has repeatedly shown that these groups cost the system a 

disproportionate share of available resources and we are committed to providing them 

with the best service in a cost-effective manner. And our record of success is hard to 

ignore. 1 out of every 15 poor persons in New Jersey is served by a health center. Since 

2000 we have increased capacity in every county in New Jersey except for two. Dental, 

medical, and mental health capacity have been increased in over 80% of our existing 

centers. We have doubled the number of uninsured they we see in just 5 years. 

However, in communities across our state, the need to expand health centers is still 

growing steadily. 

Our PCA is committed to the expansion of the health center model of care in New 

Jersey. Toward that goal and with the support of HRSA’s Bureau of Primary Health Care 

and NACHC, the NJPCA provides training and technical assistance to the health centers 

in our state in order to assist our centers in carrying out the requirements of the statute 

and program requirements. NJPCA also conducts extensive planning and 

implementation activities to ensure the success of the health center expansion effort in the 

highest need areas of New Jersey. 

I am also happy to report that the NJPCA are our health centers are major forces for 

community-wide collaborative efforts to expand access to underserved individuals and 

families. We have rolled up our sleeves and have joined together to form partnerships 

with other safety net providers that truly bring people into care and improve the health of 

entire communities. As an example, we are working hand in hand with the New Jersey 

Hospital Association to ensure that patients are triaged to our centers since we are a more 

appropriate setting for non emergent patients. In addition, we are working with the Susan 

G. Komen Foundation to ensure that all women, regardless of insurance status, are 

screened for breast cancer and that they have a medical home. Lastly, we were one of the 

original partners of the RX for New Jersey program, which is a company started by the 

drug manufacturers in New Jersey. This program is designed to ensure that patients, who 

can not afford their medication, have access to free prescriptions. We stand ready to 

continue our activities in all of these areas to ensure that the health centers in our state 

can build on their record of success over the years and in this current expansion effort. 

Health centers are doing the job expected of them and they need the continued 

support of this Subcommittee, and indeed of the entire Congress, in order to continue 

fulfilling the long-range plan endorsed by the President and the Congress to expand the 

reach of the Health Centers program in underserved communities. That is why we urge 

the Subcommittee to provide a straightforward reauthorization of the Health Centers 

program through FY 2011 at an initial funding level of $1.963 billion for FY 2007. Our 

New Jersey health centers believe that a straightforward reauthorization of the program is 

the best path forward to the continued success of the Health Centers program in 

expanding access to cost-effective, high-quality health care services to underserved 

communities. 

Reauthorization of the program would renew the most important requirements of the 

Health Centers program, including governance by a patient-majority board, health 

centers’ openness to all regardless of ability to pay, location in medically-underserved 

areas, and the provision of comprehensive preventive and primary care services. In 

particular, our centers would not be able to help change the health status of their patients 
42

without patient-majority boards. Nothing succeeds like community control and health 

centers know that better than anyone else. Our health center boards are stewards of the 

health of fellow neighbors. Health centers are truly consumer-driven – they put patients 

in the driver’s seat to tailor services to best meet the needs of their local communities. 

NJPCA and New Jersey health centers urge the Subcommittee to reaffirm these core 

principles as you consider the reauthorization of the Health Centers program. 

Thank you for this opportunity to talk with you. If there are any questions, I would 

be pleased to answer them at this time. 

 MR. DEAL. I thank the gentlelady. Mr. Hawkins, you are recognized 

for your statement. 

MR. HAWKINS. Thank you, Mr. Chairman, and members of the 

subcommittee and I appreciate the opportunity to be with you this 

afternoon to talk about the Health Center Program. I want to ask with 

Dr. Burgess here, is there a doctor in the house? A little hoarse but we 

are going to get through this and I will do it in much less than the allotted 

time. You have a written statement so I don’t need to repeat those 

things. 

 I would say I actually began my career in a health center. I actually 

helped start one in south Texas. Not Tarrant County but we did it with a 

community group. Got it together, got funded. That center serves 

40,000 people today and it has a community board, functions like a 

dream. In fact, it is the regional ambulatory health center for UTSA and 

San Antonio Medical School. So it can be done. 

 In this reauthorization, Mr. Chairman, on behalf of the Association, 

the health centers and the 15 million people they serve today, we do 

count the look-alikes that Mr. Rush mentioned in our patient counts. 

Nothing is more important than retaining the patient majority governing 

board requirements at these health centers. It is the one small place in 

America’s healthcare system, the only place where healthcare is of the 

people, by the people, for the people, patient democracies. We believe 

the Health Center Program is already a well-proven model of care and 

we fully support its reauthorization without change. 

 I want to extend this very special note to a long-time friend and 

supporter of health centers, Mr. Bilirakis and Mr. Green for introducing 

H.R. 5201, with now better than 80 cosponsors to provide a 

straightforward five-year reauthorization of this program. We think it is 

the best starting point and hope it will serve as a marker for the 

successful renewal of this program, Mr. Chairman, as you move 

legislation to make that happen. 

 The second thing we would like to point out, it was already pointed 

out earlier by Mr. Gillmor, is that there are some things we do need. One 

is that the FTCA, the Federal Tort Claims Act statute does need to be 

updated to take care of the problems that occurred along the Gulf Coast 

following Katrina to ensure that health center clinical staff can go where 
43

they are needed most. And so we urge you to move legislation, H.R. 

3962, Mr. Schwartz and Mr. Gillmor’s bill, to do that. 

 We also want to thank Dr. Burgess for his support in sponsoring 

H.R. 1313 with Mr. Murphy. The Act that would--and to answer a 

question provided earlier by a member of the subcommittee--what can 

we do to help with the problem of specialty care for uninsured people? 

H.R. 1313 would extend Federal Tort Claims Act coverage to physicians 

who volunteer to work at health centers or to serve health center patients. 

We think it is a perfect example of something that would both provide 

immediate assistance and give local doctors the opportunity to make a 

real, real difference. 

 For all of these things we thank you. We thank you, Mr. Chairman, 

for your steadfast and longstanding support for the Health Center 

Program over time and in particular last year. We thank you for that and 

we look forward to working with you as this program is reauthorized to 

reach that day when health centers are truly able to offer a healthcare 

home. Medical yes but really healthcare. Medical, dental, mental health, 

et cetera, to everyone who needs it in America. Thank you and we 

would be happy to answer your questions. 

 [The prepared statement of Dan Hawkins follows:] 

PREPARED STATEMENT OF DAN HAWKINS, VICE PRESIDENT FOR FEDERAL, STATE, AND 

PUBLIC AFFAIRS, NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, INC. 

Mr. Chairman and Members of the Subcommittee, my name is Dan Hawkins and I 

am Vice President for Federal, State, and Public Affairs for the National Association of 

Community Health Centers. On behalf of America’s Health Centers and the 15 million 

patients they serve, I want to express my gratitude for the opportunity to speak to you 

today about the federal Health Centers program and its role in expanding and enhancing 

access to health care services for medically-underserved individuals and families. 

NACHC and health centers appreciate the unwavering support that this Subcommittee 

has offered to health centers in carrying out their mission and we look forward to 

continuing to work with you to further strengthen the program to serve additional 

medically underserved communities. 

Mr. Chairman, I have personally seen the power of health centers to lift the health 

and the lives of individuals and families in our most underserved communities during my 

time as a health center director in south Texas from 1971 to 1977. The health center is 

still in operation today, and has expanded to serve over 40,000 patients annually. The 

community empowerment and patient-directed care model thrives today in every health 

center in America and I am honored to be here to share with you their success story. 

Background and History of the Health Centers Program 

 Conceived in 1965 as a bold, new experiment in the delivery of health care services 

to our nation’s most vulnerable populations, the Health Centers program has a 41-year 

record of success that serves as an enduring model of primary care delivery for the 

country. Congress established the program as a unique public-private partnership, and 

has continued to provide direct funding to community organizations for the development 

and operation of health care systems that both address pressing local health needs and 
44

meet national performance standards. This federal commitment has had a lasting and 

profound effect on health centers and the communities and patients they serve in every 

corner of the country. Now, as in 1965, health centers are designed to empower 

communities to create locally-tailored solutions that improve access to care and the health 

of the patients they serve. 

Current Statistics 

 Today, America’s health centers serve almost 16 million people in every state and 

territory. Health centers provide care to 10 million people of color, 6 million uninsured 

individuals, 725,000 seasonal and migrant farmworkers, and 700,000 homeless 

individuals. Over 1,000 health centers are located in 3,600 rural, frontier, and urban 

communities across the country. The communities served by health centers are in dire 

need of improved access to care, and in many cases the centers serve as the sole provider 

of health services in the area, including medical, dental, mental health, and substance 

abuse services. 

 Patients can walk through the doors of their local health center and receive one-stop 

health care delivery that offers a broad range of preventive and primary care services, 

including prenatal and well-child care, immunizations, disease screenings, treatment for 

chronic diseases such as diabetes, asthma, and hypertension, HIV testing, counseling and 

treatment, and access to mental health and substance abuse treatment. Health centers also 

offer critically important enabling services designed to ensure that health center patients 

can truly access care, such as family and community outreach, case management, 

translation and interpretation, and transportation services. 

 As a result of health centers’ focus on the provision of preventive and primary care 

services and management of chronic diseases, low-income, uninsured health center 

patients are more likely to have a usual source of care than the uninsured nationally. 99% 

of surveyed patients report that they were satisfied with the care they receive at health 

centers. Communities served by health centers have infant mortality rates from 10 to 

40% lower than communities not served by health centers, and the latest studies have 

shown a continued decrease in infant mortality at health centers while the nationwide rate 

has increased. Health centers are also linked to improvements in accessing early prenatal 

care and reductions in low birth weight. 

 This one-stop, patient-centered approach works. The Health Centers program has 

been recognized by the Office of Management and Budget as one of the most effective 

and efficiently run programs in the Department of Health and Human Services (HHS). 

In fact, the Institute of Medicine and the Government Accountability Office have 

recognized health centers as models for screening, diagnosing, and managing chronic 

conditions such as cardiovascular disease, diabetes, asthma, depression, cancer, and 

HIV/AIDS. A major report by the George Washington University found that high levels 

of health center penetration among low-income populations results in the narrowing or 

elimination of health disparities in communities of color. 

 

From Demonstration Program to Formal Authorization 

 The legislative history of the Health Centers program is one of continued 

reaffirmation of the patients’ voice in the ownership and operation of their health care 

system. The Health Centers program began in rural Mississippi, and in inner-city Boston 

in the mid- 1960s, to serve rural, migrant, and urban individuals who had little access to 

health care and no voice in the delivery of health services. In 1975, Congress 

permanently established the Community Health Centers program at Section 330 of the 

Public Health Service Act and the Migrant Health Center program at Section 329, as part 

of the Community Health Extension Amendments Act. The 1975 authorization was also 

notable because it also formally established the patient-majority governing board, 

location of centers in high-need areas, and minimum service requirements for service in 
45

statute for the first time. In the 1980s and 1990s, the Health Care for the Homeless and 

Public Housing Health Centers Programs were created. In 1996, the Community, 

Migrant, Public Housing and Health Care for the Homeless programs were consolidated 

into a single statutory authority within the Public Health Service Act (PHSA). 

 The Health Centers program was last reauthorized in 2002, as a part of the Health 

Care Safety Net Amendments Act. As you know, the program is scheduled for 

reauthorization this year. Health centers are grateful to the Subcommittee for its 

leadership role in strengthening and improving the Section 330 statute in 2002, further 

modernizing it to serve millions of new patients. During the 2002 reauthorization, this 

Committee and Congress importantly reaffirmed the program’s four core elements, as it 

has consistently over the entire life of the program. These core elements, which have 

greatly contributed to its continued success, require that health centers: 1) be governed by 

community boards a majority of whose members are current health center patients, to 

assure responsiveness to local needs; 2) be open to everyone in the communities they 

serve, regardless of health status, insurance coverage, or ability to pay; 3) be located in 

high-need medically-underserved areas; and 4) provide comprehensive preventive and 

primary health care services. 

2006 Reauthorization of the Health Centers program 

 As we look forward in the life of this 41-year experiment in community health 

empowerment, the National Association of Community Health Centers believes that the 

Health Centers program is already a well- proven model of care, with core elements that 

have stood the test of time. It is for that reason that NACHC fully supports the 

reauthorization of the program without changes; in other words, a “straight 

reauthorization.” We believe that this is the best way to ensure that health centers can 

continue in their critical role in providing access to health care services in underserved 

communities. 

I would like to extend a very special note of gratitude to Mr. Bilirakis and Mr. Green 

for introducing H.R. 5201, the “Health Centers Renewal Act,” legislation that would 

provide for a straight reauthorization of the program through FY 2011 at an initial 

funding level of $1.963 billion in FY 2007. The bill, supported by many Members of the 

Subcommittee and full Committee, also continues intact the key program requirements 

that enable health centers to provide high quality, cost –effective care that is tailored to 

the specific health care needs of the communities where they are located. We believe that 

H.R. 5201 provides the best starting point for this reauthorization and we hope that the 

legislation can serve as a marker for the successful renewal of the Health Centers 

program. 

 In Congress’s previous reauthorizations of these bedrock requirements, it has sent a 

clear message that it sees patient involvement in health care service delivery as key to 

health centers’ success in providing access and knocking down barriers to health care. In 

this reauthorization, nothing is more important than retaining the patient-majority board 

governance of health centers in our view. Active patient management of health centers 

assures responsiveness to local needs. This begins with community empowerment, 

through the patient-majority governing board that manages health center operations and 

makes decisions on services provided, and leads to the fulfillment of the other core 

elements of the program. 

 Through the direction and input of these community boards, health centers can 

identify their communities’ most pressing health concerns and work with their patients, 

providers, and other key stakeholders to address these issues. This has been particularly 

valuable as health centers address and work to eliminate health disparities in their patient 

population. Board members with unique and direct community connections determine 

the best approach for removing barriers to health care, helping health centers to meet 

their patients where they are, not where someone might want them to be. The critical, 
46

distinguishing feature of the health center model of community empowerment is that the 

community has been directly involved in virtually every aspect of the centers’ operations, 

and, in turn, each health center has become an integral part of its community, identifying 

the most pressing community needs and either developing or advocating for the most 

effective local solutions. 

 I also want to expand on the other core features of the Health Centers program, 

each of which has played a key role in the continued success of the program. First, health 

centers are unique among health providers and systems in the federal statutory 

requirement that they be open to all in the community regardless of ability to pay. Like 

the community board requirement, this element is what links health centers to the local 

neighborhoods they serve. There is no cherry picking at health centers; everyone – the 

uninsured, underinsured, those on Medicaid and Medicare, and those who have private 

coverage can receive quality health care at health centers. Health centers are interested 

in addressing health needs on a community-wide basis, and the requirement that they be 

open to all in the areas they serve allows them to do just that. 

 Second, health centers are required under the statute to be located in high-need, 

medically-underserved areas. In reauthorizing the provision in 2002, Congress sought to 

ensure that much-needed, precious resources were allocated to the communities most in 

need of health center services. Location of health centers in federally-designated MUAs 

prevents the duplication of services, and establishes health centers in identified 

underserved communities where there are well-documented gaps in care. 

 Third, health centers are distinctive in the broad range of required and optional 

primary and preventive health and related services they provide under Section 330. This 

also includes a range of enabling services that ensure optimal access to care. In 2002, 

Congress not only reauthorized this requirement, but added to the list by including 

appropriate cancer screenings and specialty referrals as required services and behavioral 

health, mental health, substance abuse, and recuperative care treatment as optional 

services that health centers may provide. 

 We believe that these core statutory requirements provide the crucial framework for 

success of the Health Centers program. The program simply would not be where it is 

today without these critical elements. We commend Congress for safeguarding these 

requirements in every previous reauthorization of the Section 330 program since its 

inception and urge you to renew these core elements in this reauthorization. 

Health Centers Meeting New Challenges 

In their four-decade history, health centers have faced down and overcome many 

challenges. Health centers in the 21st century are now facing two particularly tough 

challenges: first, the struggle to provide health care services in the wake of natural 

disasters, and second, the uphill battle against the growing shortage of health care 

providers in underserved communities. 

 Even as access to health care services has expanded through the growth of the 

Health Center program, center administrators and community boards are coping with a 

dramatic decline in both the number of graduating medical students choosing a primary 

care field and in the number of dental students. This reality led the American College of 

Physicians (ACP), in a recent report, to warn that the nation’s primary care workforce – 

which it called “the backbone of our health care system” – is, in its own words, “on the 

verge of collapse.” 

 The ACP report noted that too few young physicians are going into primary care, 

while 35% of all currently practicing physicians are already over the age of 55 and will 

soon retire. Indeed, over the past 8 years alone, the number of Family Practice residents 

has fallen 22%, while the overall number of medical residents has risen 10%. 

There is a very direct connection between the findings of that report and those in a 

more recent article in the Journal of the American Medical Association (JAMA), which 
47

found significant vacancies in physician and other health professions positions at health 

centers across the country. Not surprisingly, the greatest vacancy rates were in rural and 

inner-city health centers, ranging from 19% to 29% of their current workforce. By 

discipline, there were vacancies for more than 760 primary care physicians, 290 nurse 

practitioners, physician assistants, and nurse midwives, and 310 dentists. Health center 

vacancy rates nationwide varied from 13% for primary care physicians to 7% for nonphysician providers and 18% for dentists. While health centers, as they have always 

done, continue to make lemonade out of lemons, they could use some additional 

assistance from Congress in this endeavor. 

Health Center Rely on Other Key Programs to Address Challenges 

Health centers believe that one key solution to addressing workforce challenges is 

the reauthorization of the National Health Service Corps (NHSC) program, as its 

authority also expires this year. Health centers thank the Committee for reauthorizing the 

program in 2002 and for designating health centers as Health Professional Shortage Areas 

for NHSC placements. Renewal of the NHSC is critical to ensure that there are adequate 

numbers of health care providers to deliver care to health center patients. As many of 

you know, the Health Centers and National Health Service Corps programs have grown 

up together, and have weathered innumerable storms over the years. In that time, the one 

constant in the relationship between health centers and the Corps has been the decadesold connection to local communities and a commitment to fill the gaps in our health care 

safety net. This foundation in the community spurred the establishment of both 

programs, guides their current operations, and will fuel their growth and expansion to 

more underserved communities in the years to come. Nearly 4,000 NHSC clinicians, 

including physicians, dentists, nurse practitioners, physician assistants, nurse midwives, 

and behavioral health professionals, currently provide health care services to millions of 

medically underserved Americans. Approximately 50% of NHSC clinicians serve in 

health center sites. 

Indeed, the JAMA study mentioned above also found a high degree of reliance 

among health centers on providers fulfilling a service obligation under the NHSC 

program, state loan repayment programs, and the J-1 visa waiver program. Overall, 30% 

of health center physicians and 26% of dentists are fulfilling a service obligation under 

one of those programs. Again, the highest such reliance was among rural and inner-city 

health centers, where up to 45% of the current workforce consists of either NHSC, state 

loan repayment and J-1 visa waiver obligors. 

 The threat of a public health emergency is a second critical challenge for health 

centers in the 21st century. Health centers in Mississippi, Alabama, and Louisiana were 

hard hit by Hurricane Katrina. In these Gulf Coast states, approximately 54 health center 

grantees in 302 communities serve nearly 750,000 patients. For many communities, the 

health center is the first place people turn in the event of a public health emergency. 

Indeed, health centers worked with other responders to provide services to those affected 

by the disaster and HHS expedited funding to open new centers in areas most directly 

impacted by Katrina in order expand access to health care services. Health centers from 

California to Maine have treated tens of thousands of hurricane evacuees, and many 

centers nationwide sent medical teams and mobile health vans to the Gulf Coast to help 

their fellow health centers besieged by people in need of medical treatment. However, 

their current Federal Tort Claims Act (FTCA) medical liability coverage did not cover 

them once they crossed state lines because of a ruling by HHS limiting such coverage. 

 The experience of many health centers who mobilized to help their sister health 

centers in the wake of Hurricane Katrina points to the need to update the FTCA statute to 

ensure liability coverage for other health centers and their employees who travel offsite to 

provide care at health centers affected by a public health emergency. HHS has indicated 

that FTCA coverage is only available within a state, therefore limiting health center 
48

medical staff that could travel to help serve displaced individuals. A center in one state 

may be the nearest source of primary care should an emergency occur in another state. 

Texas is bearing a heavy burden of support for victims from Louisiana. Many centers 

across the country stand ready to help our Texas centers, but under HRSA’s 

interpretation, they cannot do so. We can see no reason for limiting this to state lines in 

emergencies and we strongly urge the Committee to enact H.R. 3962, legislation 

sponsored by Rep. Joe Schwarz, and cosponsored by several members of the Committee, 

which would address this issue before the start of the 2006 hurricane season. 

 Additionally, the FTCA must also be modernized to allow health centers to better 

address these looming physician shortages I outlined earlier. Health centers would like to 

better utilize volunteer physicians to help meet this need; however, the confusion 

surrounding medical liability coverage often makes this prohibitive. Unfortunately, the 

liability protection afforded to health center physicians under the FTCA does not 

currently cover doctors who wish to volunteer their time – causing undue difficulty at 

health centers. In turn, health centers have been reluctant to recruit volunteer physicians 

for fear that their current malpractice coverage may be inadequate or insufficient. 

NACHC and health centers support H.R. 1313, legislation sponsored by Rep. Tim 

Murphy that would extend FTCA coverage to physicians who volunteer to provide care 

to health center patients. We believe that H.R. 1313 will provide immediate assistance to 

health centers to address workforce shortages and, most importantly, give doctors a 

chance to make a real difference in communities. NACHC and health centers look 

forward to working with the Committee to address these challenges as health centers 

continue their mission and work to deliver health care services to underserved individuals 

and families. 

Reauthorization Key to Historic Expansion of Access Through Program 

 Health centers recognize the relationship between timely program reauthorization 

and continued funding and believe that expedited reauthorization will make it possible for 

even greater expansion of access to affordable, high-quality health services to 

underserved communities. Additionally, the core elements of the Health Centers statute 

ensure that health centers funded by Congress will be held to the highest possible 

standards and will be accountable to the patients and communities they propose to serve. 

I want to briefly expand on our vision for the expansion of the Health Centers 

program in order to provide further guidance to the Subcommittee on the funding 

authorization level beyond FY 2007. In 1999, bipartisan Congressional Resolutions 

introduced in the House and Senate recognized the importance of continued growth in the 

federal investment in health centers. The resolution endorsed the doubling of Health 

Center appropriations over five years. Combined with President Bush’s expansion 

initiatives, this goal has nearly been achieved, and as a result, millions more Americans 

have access to the affordable, effective primary and preventive care available at our 

nation’s health centers. 

 NACHC and health centers are deeply grateful to Congress for its support of the 

Health Centers program. In Fiscal Year (FY) 2006, Congress appropriated $1.78 billion 

in overall funding for the Health Centers program. The increases since 2001 have 

enabled hundreds of additional communities to participate in the Health Centers program 

and to deliver community-based care to more than 4 million people in the past 4 years. 

We are also very grateful that Congress has provided additional funding for base grant 

adjustments for existing health centers, which have seen unexpected increases in the 

number of uninsured patients coming through their doors at the very same time they 

continue to battle the continuously rising cost of delivering health care in their 

communities. These base grant adjustments have allowed health centers across the 

country to stabilize their operations and continue to provide care to their existing patients, 

while also looking for ways to expand access to necessary care. 
49

 We also appreciate the President’s strong support for the program and his request 

for a $181 million increase in FY 2007, which would bring overall health center funding 

to $ 1.963 billion. This year we expect health centers to serve 16 million people in every 

state across the country. 

 Despite the expansion of the program, the demand for health centers is at record 

highs – in 2004, we estimate that there were over 430 applications for new access points, 

only 91 of which received funding – a 21 percent success rate. Indeed the application 

process is rigorous, and it should be. Health Center program funds are awarded on a 

nationally competitive basis, ensuring that the highest possible quality projects receive 

approval. 

Yet the need for these services is still largely unmet. 36 million Americans remain 

underserved today – individuals and families with little or no access to medical care. 

With continued growth in the program and in the federal investment, health centers can 

continue the successful expansion effort in order to meet that need. 

NACHC believes that a growth rate of 15% over the next five years in the program 

authorization level will enable health centers to serve over 20 million Americans by 

2010. Indeed, at this rate, health centers will meet the need in America and rise to the 

challenge of their charter – to serve all of the underserved within fifteen years. 

 Given the increasing need for health centers, we are extremely grateful that the 

President has committed to continue the growth of the program by announcing the 

continuation of his Health Center Expansion Initiative into the future. This new 

announcement will focus on placing new health centers in poor counties that currently 

lack a health center site, a very ambitious goal. Our own analysis indicates there are more 

than 920 poor counties without a center today. Through this continued expansion, we 

believe that millions of additional patients will have access to care at a health centers in 

the foreseeable future. We commend the President for his continued support of the 

Health Centers program and we look forward to working with Congress to ensure that it 

soon reaches every community in need. 

Conclusion 

 Health centers appreciate the unwavering support of Congress for the program over 

the past four decades. Over that period, health centers have produced a return on the 

federal investment in the program, by providing access to care and a health care home to 

millions of patients in medically-underserved communities across the country. Because 

Congress has continued to reaffirm the core elements of the program; that health centers 

are open to all, run and controlled by the community, located in high need medicallyunderserved areas, and provide comprehensive primary and preventive services, the 

program has successfully responded to the challenges posed by our ever-changing health 

care system. On behalf of health centers across the country, their staffs, and the patients 

they serve, we stand ready to work with you to ensure that the Health Centers program is 

reauthorized this year in order continue to providing a health care home for everyone who 

needs their care. Thank you once again and I would be happy to entertain questions from 

the Committee. 

 MR. DEAL. Well, thank you and let me say to Mr. Hawkins and to 

your membership that we appreciate what your members do across the 

country. They provide a very vital service and please relay that on behalf 

of our committee today. 

 MR. HAWKINS. I certainly will do, Mr. Chairman. Thank you. 
50

 MR. DEAL. Let me touch on just a few and I will be brief. And we 

do have people, including myself, who have got airplanes to catch and I 

am going to be mindful of that. 

 You have mentioned several things, one being the bill that Mr. 

Gillmor is the cosponsor of, on the portability and effect of Federal Tort 

Claims Act coverage. Mr. Green and I were recounting some of the 

incidents that came out of the Katrina situation where that was a real 

concern. I suppose that you would say that your organization would 

support that portability and also the issue of volunteers being covered by 

it. I think that is a separate bill that has been proposed so that volunteers 

who come into an environment could have that degree of liability 

protection. Do you support that? 

 MR. HAWKINS. That is correct, Mr. Chairman. There is not a health 

center in the country who hasn’t reported to me that there are many, 

many local doctors who would gladly, gladly volunteer to provide care, 

including specialists. Orthopedists, cardiovascular surgeons who would 

provide that care in the health center or even in their office, pro bono, no 

charge, if only their malpractice, their liability were covered and that is 

crucially important. 

 And yes, to answer your other question, the ability of health centers, 

the outpouring of support and response for all of the health centers and 

communities in the Gulf Coast following Katrina and Rita and even 

Wilma was just, it was heartening. As much as the devastation was 

heart-rending; heart-uplifting it was to see the response of America in 

general and health centers were no different. It is only a matter of time. 

It is only a question of when, not if, we are going to have the next 

disaster, the next public health emergency. We need to fix this problem 

so that health centers can move to where their help is needed most before 

that happens. 

 MR. DEAL. I think we heard during testimony at a previous hearing, 

even a health center that was dislodged by Katrina was told that if the 

same people moved to a different location, that they might not have this 

coverage. 

 MR. HAWKINS. That is correct and they nevertheless did it. 

 MR. DEAL. They just do. 

 MR. HAWKINS. They moved to a shelter area in a tent and provided 

the care. 

 MR. DEAL. That just doesn’t seem very logical to me so we are 

hopeful that we might be able to make some progress on that front. 

 The other issue I would ask you to address very quickly and that is 

the makeup of the board itself, majority patients served members 

makeup. I recognize that you and Ms. Grant-Davis both subscribe to the 

idea that that is a good principle. But we heard in the previous HRSA 
51

testimony that in the start-up situation where Mr. Brooks says that was a 

concern that HRSA perhaps would give some flexibility in that. Do you 

have any knowledge as to whether or not in start-up situations HRSA has 

been a little more lenient on that issue at the beginning? 

 MR. HAWKINS. Well, they should be because in the statute today is a 

two-year waiver of the governing board requirement. So as long as--and 

this is a key factor--the entity is committed to meet that 51 percent 

patient majority governance expectation by the end of the 2 year period, 

there is language in the law itself. This subcommittee wrote it some 

years ago, that allows for a waiver of not only that. It says the Secretary 

may make a grant with respect to which he or she is unable to make all of 

the determinations required in Section 330. So not only the governing 

board but other requirements, as well. In fact, there is great flexibility in 

this statute on location and the designation of medically underserved 

areas. There is a provision that allows Governors to request the 

designation of an area that doesn’t meet the MUA requirements. On the 

delivery of services, Commissioner Brooks indicated and I am rather 

surprised to hear that affiliation agreements were not allowed or that 

there were bureaucratic barriers. I am here to say on behalf of the 

National Association that we strongly encourage affiliation agreements. 

It is the only way to maximize care to those folks. Now, there has to be a 

core staff. This can’t be a sham, virtual health center. But once there is 

that core staff there should be affiliation agreements with good partners, 

like the hospitals and the other--the medical community, et cetera, to 

really have a collaborative process that can work. 

 MR. DEAL. All right. I am sure, Mr. Brooks, that you will have a 

chance to elaborate on your point. And I agree with your point of view 

that it is pretty hard when you have got only one doctor to have a 

requirement that is sort of inflexible in some regards about having three 

other permanent folks. That to me sort of flies in the face of common 

sense. But I am going to let someone else explore that with you since my 

time is up. Mr. Green? 

 MR. GREEN. Thank you, Mr. Chairman. And I think all three of 

these witnesses brought up things that we can deal with and one is the 51 

percent. I am glad to know that there is a 2 year, in the statute, that is not 

something that I have seen and that gives the flexibility. I do think 51 

percent after you are up and running is very important because that way 

you have the community managing their own facility. And practically on 

the ones we have worked with, you have to be in business for six months 

anyway and by then you have a patient base and you know who may be 

willing to take the time to be on the board. And also your patients who 

may have leadership ability or who want to do it and keep it in their 

communities. So I think if we have to, the 2 years, I am glad it is in the 
52

statute. I want to make sure it is in the reauthorization so we will utilize 

that because we have had some concern about that with the board 

makeup. 

 But the proportionality, I agree. You know, in Texas for many years 

we haven’t felt like we wanted these FQHCs. My colleague, Bobby 

Rush, I think Chicago has 70, but they started in 1960’s doing it each 

year, so we have a lot of catch-up to make, and I know that same case 

with HRSA for Houston area, and I didn’t even make it for Texas and 

Tarrant County and that is where you need to look where the need is not 

being met right now and have centers that are there and you can put them 

together as local collaboratives. 

 Mr. Hawkins, let me ask a question because I like the idea of patient 

referral efforts, and one of my goals in my areas is to have medical 

schools brought in to be a referral. We will have family physicians, we 

will have them do their residency, but also get substantially better care if 

we have a teaching facility there. Do you know of any problem any of 

our medical centers or community centers had in affiliating with medical 

schools that would be providing some of that specialty care? 

 MR. HAWKINS. To the contrary, Mr. Green. And matter of fact, I 

tell you within the first year that my health center down in Brownsville, 

Texas operated, our friends and colleagues at UTMB in Galveston were 

flying down all of the family practice residents to rotate through our 

health center for a 3 month family practice rotation. Because they said 

on Galveston Island they could not find need like there was in south 

Texas. And as I mentioned, my old health center, I can take no credit for 

its great success today, is today-- 

 MR. GREEN. I am glad to know it is in Cameron County. My son 

lives there. 

 MR. HAWKINS. Home of the brave, yeah. But it is a 40,000 patient 

center and it is the regional ambulatory health center for the UT San 

Antonio Medical School. Every third and fourth year medical student, 

every single one of them and every family practice resident at UTSA and 

ever pediatric resident, every OB/GYN resident, rotates through that 

center now for six to twelve months and they are out of their residency 

period. So that is a perfect example of where the collaboration--I mean, 

it is synergistic. It is working all the time and that is not the only center 

in America where that is happening. 

 MR. GREEN. Mr. Chairman, one of the things I have heard from 

medical schools, is that there is not a funding base for doing that and it is 

difficult for the school to be able to fund it. And I know we have a 

hearing next week on graduate medical education and we might look at, 

whether it is this bill or something else, to encourage medical schools to 

provide that through the FQHCs. Because again, I think we raise the 
53

level of the healthcare but we also train the next generation of family 

practitioners that we need in the community. And also, you know, we 

have that quality that we get from having a teaching institution. 

 Let me ask one other question before my time is up, in the 50 

seconds. I read several studies that point to the role of health centers in 

the reduction of healthcare disparities. And Ms. Grant-Davis or 

Commissioner Brooks, can you speak to the role of health centers that 

really show that we are eliminating the disparities? That that is the goal 

originally of the community health centers and I want to make sure it is 

continued even though 40 years and even though some states were a little 

behind but we are trying to play catch up. 

 MS. GRANT-DAVIS. Yes, I would be happy to address that. In our 

State we know that hypertension, asthma, and diabetes are our top three, 

and so we have reengineering programs. They are called disease 

collaboratives where it is a care model that is based on the particular 

disease. And we have been able to demonstrate, and there are actual 

national studies that demonstrate, that by using a collaborative care 

model, that you can decrease the incidences of chronic diseases. Which 

allows the patient to have a better quality of life and it also reduces the 

disparities amongst the healthy and those that have these chronic 

diseases. So there have been some wonderful care models put in place, 

not only in my State but on a national basis, as well. 

 MR. BROOKS. In our one community health FQHC in Tarrant 

County, it is located in a predominantly Hispanic community and the 

community board has been able to structure a health delivery, a model, 

that addresses health disparities experienced in that population, 

particularly diabetes and hypertension. I don’t want to leave the 

impression with this committee that I am opposed to community control 

of the FQHC boards. I am not. I just want to make sure that there is 

enough flexibility in the application process to allow us to gear up 

without penalty to 51 percent control. 

 From what I understand, the language says that the statute allows and 

the Secretary may. This is equivocal language and we need something 

perhaps a little more definite. 

 MR. GREEN. In what little time or few seconds I have left, I agree 

and if we have to do something but I think the board makeup, 

particularly after it is up and running, is important to make sure they 

continue to serve that particular community. 

 MR. BROOKS. We agree on that. 

 MR. GREEN. Thank you. 

 MR. BROOKS. Thank you. 

 MR. BURGESS. [Presiding] Thank you for yielding back. I 

recognize Mr. Bilirakis for five minutes. 
54

 MR. BILIRAKIS. Well, thank you. Mr. Chairman. I won’t take that 

time because I think we are all going in danger of missing our airplanes. 

 I would just ask Ms. Davis, Grant-Davis--I am sorry. 

 MS. GRANT-DAVIS. Yes. 

 MR. BILIRAKIS. You in your testimony referred to--basically we 

refer to it as a clean bill, the legislation to reauthorize. We say a clean 

bill and we want a clean bill means we discourage any amendments, that 

sort of thing, that might sort of knock it off track. But you have heard 

the concern here on the 51 percent during the startup period, whatever 

that period turns out to be and we have talked here about the liability 

protection. Would you be against those being offered as amendments 

and possibly becoming part of the bill? I believe you--well, go ahead. 

 MS. GRANT-DAVIS. You are asking if I would be opposed to 

amending the bill to include those? 

 MR. BILIRAKIS. Yes, right. 

 MS. GRANT-DAVIS. My experience has been that we in New Jersey 

have asked for waivers before for the community board and we have had 

every single one of our health centers able to meet that stipulation. As a 

primary care association, my role is for technical assistance and training. 

And even for a health center that has been in existence for 20 years, we 

still do board training. And so once you become a board we just don’t let 

you out there. There is still continuation of making sure that you keep 

meeting the board requirement. 

 MR. BILIRAKIS. Yeah, all right. But I am not sure really what your 

answer is. You are very eloquent but the trouble is we are all kind of 

rushed here. 

 MS. GRANT-DAVIS. Thank you. 

 MR. BILIRAKIS. And we all want to do the right thing. So would 

you oppose amending the legislation because you want a clean bill, as 

you had referred to earlier? 

 MS. GRANT-DAVIS. Okay. I am going to defer that to Mr. Hawkins. 

 MR. BILIRAKIS. Well, Mr. Hawkins, you don’t find any problem 

with the idea that the 51 percent maybe should not be applicable to a 

start-up period, do you? 

 MR. HAWKINS. No, but Mr. Bilirakis, we absolutely support the 

notion of flexibility in the start-up. 

 MR. BILIRAKIS. Okay. 

 MR. HAWKINS. I heard what Commissioner Brooks said and he may 

have a very good point. That sometimes bureaucrats read the statute as 

may but that doesn’t mean I have to. But the language, I would strongly 

recommend that you never change the shell. I don’t think you want to 

mandate that being the most unreasonable but-- 

 MR. BILIRAKIS. To let the local people provide a basis. 
55

 MR. HAWKINS. But you can certainly, this committee, can make it 

imminently clear in report language that may means that upon any 

reasonable request by an organization asking for that time period, it 

should be or if you will, must be granted. The committee can make clear 

the intent. You wrote the language. You can specify that. 

 MR. BILIRAKIS. Yes, right. Ms. Grant-Davis, as far as the liability 

protection, whether it be in the form of some sort of Good Samaritan 

protection or whether it be actual liability protection from the standpoint 

of subsidizing that protection, you would not have any problems with 

that? 

 MS. GRANT-DAVIS. My understanding is that there are separate bills 

that are moving. 

 MR. BILIRAKIS. Well, there are. 

 MS. GRANT-DAVIS. Right. I absolutely support them. 

 MR. BILIRAKIS. But I am here to tell you that this is the one that in 

all probability, would have the best opportunity of getting through the 

process and this is why we talk in terms of amending. You see what I 

mean? Attaching thereto. So you would be a supporter of that? 

 MS. GRANT-DAVIS. If I can get volunteer docs under Federal Tort-- 

 MR. BILIRAKIS. Amen to that. Right. And Commissioner Brooks, 

very quickly. No questions. I just want to say to you that Dr. Burgess 

has said that he is new here and doesn’t understand the bureaucracy. I 

am here to tell you that is probably his top issue and he has many top 

issues but probably the top one is community health centers, particularly 

the one in his district. He and I have already talked about that long 

before this hearing. So I want you to know that his heart is really with 

you as far as that is concerned. Thank you very much. Thank you, Mr. 

Chairman. 

 MR. BROOKS. As Dr. Burgess indicated, we are on different sides of 

the political aisle but we find each other to be reliable partners and have 

gained a great appreciation for each other through working on these 

particular issues. So I appreciate him as well. 

 MR. BURGESS. I thank the gentleman for yielding back. We have 

been joined by the gentleman from New Jersey, Mr. Pallone. He is 

recognized for 5 minutes for questions. 

 MR. PALLONE. Thank you, Mr. Chairman, and I apologize that I 

wasn’t here earlier, particularly since--and I am apologizing mainly to 

Kathy Grant-Davis because she is from New Jersey and she is someone I 

have known for a few years now. But we had another hearing on 

Rutgers Undersea Program. Would you believe that? So I had to go to 

that, too. Anyway, I just wanted to extend a special welcome to Kathy, 

who serves as Executive Director of New Jersey’s Primary Care 

Association, a non-profit that represents New Jersey’s community health 
56

centers. And I can honestly say there are few people who have worked 

harder than Kathy to ensure New Jersey’s uninsured and underinsured 

have continued access to quality health services. And I want to thank 

you for being here today and the service you provide to our State. Thank 

you. Now, I have got four questions here. I am going to have to try to fit 

them in 4 minutes. I don’t know if I can. But I wanted to mention, 

Kathy, I am always delighted to visit the community health centers in my 

district and I am impressed with the array of healthcare services they 

provide to my constituents. 

 You mentioned the importance of the community board I guess in 

your statement and I agree with you. Could you give me an example of 

how a patient majority board at one of the health centers in my district, 

for example, has contributed to the success of that health center in 

expanding access to healthcare services? 

 MS. GRANT-DAVIS. I would be delighted to. We just actually 

opened a new site in Red Bank in your district. 

 MR. PALLONE. Oh, great. 

 MS. GRANT-DAVIS. We opened it last week and that was as a result 

of many discussions with the board about the need to expand services 

into that area. 

 MR. PALLONE. This is separate from the--there is another private 

one that exists there, right? 

 MS. GRANT-DAVIS. This is the VNA of Central Jersey has now 

expanded a new site into Red Bank and it was that board that looked at 

the demographics. They looked at the financial concerns. They looked 

at where people had to travel, patient origin. I met with them on many 

occasions and it was because of that board that they decided that there 

was a new site that needed to be opened in the Red Bank area. 

 The same with the Plainfield Health Center. You remember how 

their old facility looked. It was four or five exam rooms. It was that 

board that did the capital campaign, the fundraising, everything to get 

that new state of the art building up and running. 

 MR. PALLONE. Well, great. Thank you. 

 MS. GRANT-DAVIS. You are welcome. 

 MR. PALLONE. I am going to number two now. You mentioned in 

your testimony, again that I missed, that the centers in New Jersey are 

working with hospitals to triage more patients out of hospital emergency 

rooms to the health centers. Can you just expand on that initiative a 

little? 

 MS. GRANT-DAVIS. I would be delighted to. After years of 

discussion with the hospitals about what our role should be, we have 

decided to do really formal programs to make sure that we were the 

primary care providers. We share facilities. We share staff. In many 
57

cases, the health center staff is on-site in the emergency room and will 

set up appointments immediately for the patients so that they have a 

medical home. 

 And on the flip side, the hospitals are serving for what we need, 

which is some specialty, diagnostic, lab. And so there is the primary care 

piece and now our sister agencies are able to help us with the other piece, 

as well. And so those are really formal programs and the wonderful 

thing about that is that we are looking into technology. When a patient 

presents at the emergency room the hospital can see right away that they 

are a health center patient and there can be a sharing of records. 

 And so it is a really formal program and I am delighted to be 

working with the Hospital Association on that. 

 MR. PALLONE. Well, great. Now, I am going on to number three. 

You know the Robert Wood Johnson Foundation in our State recently 

released a report highlighting the problems of the uninsured on a Stateby-State basis. I just wanted to ask you, what trends are you seeing in 

New Jersey for the uninsured and how has that affected the health centers 

and their ability to meet the need? 

 MS. GRANT-DAVIS. I will go back to the year 2000. We were 

serving approximately 78,000 uninsured amongst all of the health 

centers. In the year 2005, that number jumped to 142,000 so it almost 

doubled. So in order to meet the need we have gone from approximately 

40 or 50 sites now up to 90 sites in really just about every county. So as 

that number continues to grow we are trying to open new sites with both 

the HRSA money, as well as some State money, as well. There is still 

1.1 million in New Jersey so we serve about ten percent. 

 MR. PALLONE. Okay. And then Mr. Chairman, I will ask one more 

question here. As many of you know, the President has introduced a new 

plan on how to respond to the outbreak of Avian influenza and I am 

curious, what role would the health centers play in such a crisis or in a 

bio-terrorism crisis? And specifically, would the health centers be able 

to respond to surged capacity and do you have contingency plans in 

place? 

 MS. GRANT-DAVIS. Yes. That is a wonderful question. I am glad 

you asked that. And this is an area where as a primary care association 

we have spent an inordinate amount of time to make sure that our health 

centers are ready. We have written policies and procedures but I think 

the most important thing we have done for them is that we make them do 

drills. We just did a drill down in Camden. We had some sort of 

emergency situation so everybody knows their role. We do tabletop 

drills. We provide all types of training. And we have also made sure 

that each health center in New Jersey is tied into its county emergency 
58

medical system. Every single health center in New Jersey knows the 

incident command system. 

 And so we have put together many different documents, which in 

fact we have shared with many different health centers to make sure that 

they are ready. We are now in the process of writing surged capacity 

plans for each one of them and will be doing a major training for health 

centers in New York, New Jersey, Puerto Rico, and the Virgin Islands 

around a pandemic. 

 MR. PALLONE. Okay, thanks. Mr. Chairman, I could just ask if I 

could include my opening statement in the record because I didn’t--thank 

you. 

 MR. BURGESS. Yes. 

 MR. PALLONE. Thank you, all the panelists. 

 MR. BURGESS. The gentleman’s time has expired and time is 

critical. I may not use all of my time for questions. I feel like the kid in 

medical school who was asked a question he couldn’t answer so he told 

the professor, do you want the theory or the application? I feel with Mr. 

Hawkins we have got the theory. With Commissioner Brooks we have 

got the application. 

 Mr. Hawkins, I mean I absolutely agree with Commissioner Brooks. 

I value and I respect the 51 percent board makeup but I don’t know if the 

theory is matching the application on this. We heard testimony from the 

HRSA Commissioner that the points where the Secretary may waive are 

for migrant, homeless, rural, and public housing populations. And I 

think that Commissioner Brooks is exactly correct where he says the 

language is not specific enough. And that is where we may wish to 

address that in the language of the reauthorization bill because clearly, 

you have got a man here of significant intellect and capability, well 

respected in his community, and he had to move heaven and Earth in 

order to get his first clinic started in a community of, if I am correct, now 

it is 1.7 million in the county, 1.7 million. Just a little ways to the 

southeast of where that clinic is, we have got a significantly underserved 

area, the type of area that this clinic was designed for. It is what people 

had in mind when they said let us have a federally qualified health 

center. Let us tackle this 12 per 1,000 infant mortality rate. Let us tackle 

these unconscionable health disparities that we are seeing. 

 So it is not with any intent to harm anything that is working well but 

it needs to work well, as Mr. Brooks so eloquently put it, there needs to 

be proportionality. It needs to work in all areas of the country. 

 Commissioner Brooks, no question that the hurricane of course, the 

two hurricanes, didn’t affect our area of Texas directly but we certainly 

felt the aftershock from that. Can you relate to the committee just a little 

bit of what we went through in Tarrant County after the hurricanes hit? 
59

 MR. BROOKS. Thank you for the question, Dr. Burgess. Tarrant 

County was one of the areas to which evacuees were bussed. Initially, 

we set up an intake center at one of our public school facilities and 

staffing that intake facility was a cadre of doctors from our public 

hospital. And every person who got off of a bus, before they were 

assigned a pallet was assessed for their medical condition. During the 

course of the peak of dealing with Katrina evacuees, we dealt with some 

7,000 evacuees in Tarrant County. Of those, our public hospital serviced 

about 2,500 in outpatient visits, 400 or 700 ER visits, almost 7,000 

prescriptions were filled. 

 MR. BURGESS. Now, there is probably no way to know how many of 

those 7,000 remain in Tarrant County today. Was there any type of a 

guess as to the number? 

 MR. BROOKS. The best guess that I have been able to come up with 

is somewhere between 800 and 1,000 still in Tarrant County, most of 

which are in my precinct. 

 MR. BURGESS. In your precinct and this is of course the precinct that 

has some of the greatest medical need. So in an area of great medical 

need, we have added 1,000 more lives that would definitely benefit from 

having this type of facility within easy access for them. 

 MR. BROOKS. Absolutely correct. 

 MR. BURGESS. You mentioned and my time is about up, too but just 

something that struck me. You have got an executive director, a medical 

director, a finance director, all supported by the revenue generation of 

one physician? Is that-- 

 MR. BROOKS. That is what the regulations require. 

 MR. BURGESS. And we haven’t even talked about the nurse, the lab 

technician, or the guy that empties the trash can at the end of the day. 

 MR. BROOKS. It appears to be a little top heavy in management. 

 MR. BURGESS. How many patients does that physician see then 

during the day, during the average clinic cycle? Is there a limit or is it 

just he can see as many as can walk in the door? 

 MR. BROOKS. I am afraid that that is a question that I can’t answer. 

 MR. BURGESS. Just doing my calculations, I mean he would almost 

have to see 70 or 80 folks to pay for the overhead that you are carrying 

behind you. Mr. Hawkins, do you have-- 

 MR. HAWKINS. I would just like to say that the average health center 

today has 15,000 patients. That is about the equivalent of about a seven 

and a half FDE physician or clinician practice. So the one doctor 

practice--in fact, my understanding, I wish they were here, of HRSA’s 

rules is normally they really require--I mean, when they fund a $650,000 

new start health center, they expect that center to get up to 3,000 or 4,000 

patients within two years. That is a one and a half to two FDE doctor 
60

practice and growing from there. So again, you may have anomalies like 

this, but the average health center is running from seven to ten FDE and 

that is just physicians. We are not even talking dentists. 

 MR. BURGESS. Well, my time--we may be able to get HRSA to 

clarify that for us on the record in writing. But I want to thank our panel 

for being here today. This has been an informative discussion that we 

have had. My staff keeps reminding me I have got a three-star General 

waiting so with that, I am going to adjourn the hearing since there are no 

other members here to ask questions. 

 MR. HAWKINS. Ours is not to reason why, right? 

 MR. BURGESS. The subommittee is adjourned. 

 [Whereupon, at 4:36 p.m., the subcommittee was adjourned.] 

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