Date: 2009-12-21
Speaker: PATTY MURRAY (democrat)
Chamber: S

the Presiding Officer. and the entire Democratic leadership for their support. That provision simply provides $10 billion over a 5year period to the Federally Qualified Health Center Program and the National Health Service Corps. In my view. these two programs are some of the best and most effective public health care programs in the United States. They enjoy widespread bipartisan support. President Bush was a supporter. JOHN MCCAIN. when he ran for President. was a supporter of community health centers. Many Republicans have spoken positively of community health centers. as have virtually all Democrats. The reality. however. is that both community health centers and the National Health Service Corps have been starved for funding for many years. We are finally. in this bill. doing right by them. I should mention. importantly. that while we have placed $10 billion in the Senate bill. in the House bill there is $14 billion. My strong hope. expectation. and beliefand I have talked to the White House about this and the Senate leadership and House leadershipis that when this bill is finally passed. we will adopt the House language which calls for $14 billion. Let me tell you why this money is so terribly important. In a few days. the Senate will be voting on final passage of a historic health reform bill that will insure an additional 31 million Americans who have no health insurance. That is a huge accomplishment. About half of the new people who will get health insurance will be enrolled in an expanded Medicaid Program. While this reduction in the number of uninsured is an essential step in achieving reform. we have to ask a very simple question: If 15 million more people go into Medicaid. where are they going to access the health care they need? It is no secret that today Medicare is a strained program. When some of my Republican friends make that point. I have to say they are right. it is a strained program. That is why expanding community health centers in the National Health Service Corps is so important. We talk about the number of people uninsureda very important number46 million. But we do not talk about the number of people who every day do not have access to a physician or a dentist on a regular basis. and that number is close to 60 million. These are people who. when they get sick. cannot find a doctor. Where do they go? Well. several things happen. They may end up going to the emergency room. which is the most expensive form of primary health care we havethat is where they goor even worse. they do not go to any doctor at all. What happens is. they get sicker and sicker. Then they go stumbling into a doctors office. and the doctor says: Why didnt you come in here 6 months ago? And the person says: I dont have any health insurance. I couldnt afford it. Then they go to the hospital. and we spend tens and tens of thousands of dollars treating somebody who is now suffering in a way they should not be suffering. at greater expense to the system than should have been the case. Now. what sense does that make? Let me tell you the worstcase scenario. The worstcase scenario is. they walk into the doctors office. and the doctor says: It is too late. I cant help you anymore. You should have been in here 6 months ago. I have talked to physicians who have told me about that. I suspect the Presiding Officer has as well. That is why this year we are going to see 45.000 of our fellow Americans die because they do not have health insurance. and they do not get to the doctor when they should. Now. one of the advantages of the community health care program is that it is an enormously costeffective program. One study recently reported that $20 billion is wasted every year in this country in unnecessary and inappropriate use of hospital emergency rooms for nonemergency care. When you walk into an emergency roomI do not know about West Virginiabut in Vermont it is about $600. If you get that similar care for a nonemergencytype ailment. the cost is $100. So think about all of the money we savewe savewhen we have community health centers expanding all over the country. One of the issues we have not focused on enough. in my view. in this whole health care debate is the very serious crisis in primary health care in general. The American College of Physicians. in a recent report. warned that the Nations primary care workforcewhich it called "the backbone of our health care system"-is. in its own words. "on the verge of collapse." That is the American College of Physicians. Over the past 8 years. for example. the number of family practice residents fell 22 percent. while the overall number of medical residents rose 10 percent. Currentlythis is an extraordinarily frightening statisticonly 2 percent of medical students interested in internal medicine intend to pursue primary care as their specialty2 percent. This growing crisis was recently underscored in a report by the Association of Academic Health Centers. which warned that the country is rapidly running "out of time to address what is out of order in our health workforce." The good news is that 20 million of those people who live in medically underserved areas are fortunate to live where there are federally qualified community health centers. Let me explain a bit. What is a federally qualified health centerwhich exists in all of our 50 States? It is a center which says: If you have no health insurance. you can walk in and do you know what. You will pay not only for primary health care but for dental carewhich is a huge problem all over this countryfor mental health counseling. and you will get the lowest cost prescription drugs available in America. And if you do not have any health insurance. you get it on a slidingscale basis. If you have Medicaid. you are welcome into the center. If you have Medicare. you are welcome. If you have private health insurance. you are welcome into these centers. Currently. these centers serve 20 million Americans in all of our 50 States. Conceived in 1965 as a bold. new experiment in the delivery of preventive and primary health care services to our Nations most vulnerable people and communities. community health centers are an enduring model of primary care for the country and are designed to empower communities to create locally tailored solutions that improve access to care and the health of those they serve. West Virginia centers will be different than Vermont centers. which will be different than California centers because they are designed and locally controlled to serve the needs of the local population. By mission and mandate. community health centers must see all those who seek their care regardless of health status. income level. or insurance status. If you are rich. if you are poor. you will gain access to these community centers. Nobody is tossed away. Today. these health centers are Americas health care home to one out of every four lowincome uninsured individuals. one out of every six rural Americans. as well as one out of every seven Medicaid beneficiaries. and one in four lowincome people of color. We need to guarantee that as we expand coverage. we expand community health centers as well. They are the one primary care provider who will see those on Medicaid without restrictions. Furthermore. community health centers already employ so many of the features of what we seek in the medical home model. They provide integrated health care. which is what we are talking about. A study recently by George Washington Universitywe are talking about spending money. What is so exciting about this whole concept is you are going to create more health care opportunities for people. and you save moneysave moneyby keeping them out of the emergency room and out of the hospital. A study by George Washington University found that patients using health centers have annual overall medical care costs that are more than $1.000 lower than those who do not use a health center-$1.000. That translated to more than $24 billion in savings for the health care system last year alone. We are keeping people out of the emergency room. we are keeping people out of hospitals. and we are keeping them from getting sicker than they otherwise would be. That is why I am so pleased Majority Leader REID has looked at this track record and concurred that we will guaranteeguaranteefunding of health centers over the next 5 years in order to provide health care to more people and to save money at the same time. Let me tell you in concrete terms what $14 billionthe amount of money that is in the House billwill mean to the American people. What it will do is it will increase the number of people who have access to community health centers. from the current 20 million to 45 million over a 5year period20 million to 45 million. We are more than doubling the number of people who will be able to walk into a clinic for health care. dental care. lowcost prescription drugs. primary health carein 5 years going from 20 million to 45 million people. This funding would create new or expanded health centers in an additional 10.000 communities10.000 communitiesfrom one end of our country to the other. In some cases. entirely new federally qualified health centers would be established. In other cases. new satellite centers would be created. In Vermont. for example. we have eight community health centers. We have 40 total sites. That is true all over this country. But can you imagine. Mr. President. that in the United States of America. within a 5year period. 10.000 new community health centers in this country would be established? People would not have to go 50 or 100 miles to find access to health care. It would be there in their own community. It would be in urban areas. in rural areas. This is extraordinary. Now. these community health centers and the growth of these community health centers do not mean much unless we have the medical personnel to adequately staff them. As I mentioned a moment ago. everybody concludes we have a real crisis in terms of access to primary health care in this country and the number of physicians and dentists and nurses who serve in the primary care area. What this language does. that we have just added. is it wouldif we adopt the House numberstriple funding in a 5year period for the National Health Service Corps. which provides loan repayments and scholarships to medical students. For the University of Vermont Medical School. if my memory is correctthis is fairly typical for Americathe average medical school student graduates with $150.000 of debt. Well. if you graduate with $150.000 of debt. what are you going to do? You are not going to do primary health care. You are going to go into some fancy specialty and start making a whole lot of money to pay off that debt. But what the National Health Service Corps will be able to do is provide debt forgiveness and scholarships for an additional 20.000an additional 20.000primary care doctors. dentists. and nurses. That is a lot of new medical personnel that is going to get out into underserved areas all over America. That is a very exciting thought. In short. when we more than double. in 5 years. the number of people who have access to community health centers. and within that same period of time we add an additional 20.000 primary health care doctors. dentists. and nurses. we are talking about nothing less than a revolution in primary health care in Americasomething which we have needed for a long time. So let me conclude by saying: I want to again thank the majority leader. Senator REID. I want to thank Senator DURBIN. Senator SCHUMER. Senator MURRAY. and thank the Presiding Officer and the Democratic leadership for their support of this concept. As you know. this idea was developed back in the 1960s with Senator Ted Kennedy. who developed this concept in the first place. It has expanded. and now we are going to take it a giant step forward and. in the process. I think we are going to make a differencea real differencein improving the lives and the wellbeing and the access to health care of tens of millions of Americans. Mr. President. thank you very much. With that. I yield the floor and suggest the absence of a quorum.