Remarks to the National League for Nursing Conference

by HRSA Administrator Mary K. Wakefield

September 23, 2009
Philadelphia, Pa.

It is a privilege to be here, among colleagues of the National League for Nursing and members of the nursing profession – and in particular among nurse educators, because I’ve taught in nursing schools myself.

So much of my background is so similar to many of yours.  To be with nurses and nurse faculty feels a bit like coming home – home to so many personal friends, home to shared professional experiences, to common values, and to the belief that while we’ve accomplished a great deal as a profession, there is, of course, a great deal to be done.

I’m pleased to say that the federal government has the benefit of a number of nurse leaders, inside and outside of my agency, HRSA.  In fact, in HRSA, we have nurses in key leadership positions.  One of them is here this afternoon:  Michele Richardson, the director of our Division of Nursing, which administers the Title VIII Nurse Workforce Development Programs.  Can you please stand for your fellow nurses?

The person in charge of our HIV/AIDS Bureau is Dr. Deborah Parham-Hopson, a nurse.  She administers a $2 billion budget and oversees the delivery of life-saving services to more than half a million people in the United States living with HIV.

Kerry Nesseler directs our offices of International Health Affairs and of Commissioned Corps Affairs.  Kerry also is the incoming chief nurse in the U.S. Public Health Service.

The director of our Center for Quality is Dr. Denise Geolot, a nurse.  The Center for Quality coordinates efforts across HRSA to improve the care our grantees provide.

And I’ve named Dr. Regan Crump to an acting director position.  He is responsible for our 10 regional offices across the country.

Additionally, Joan Weiss directs the Division of Diversity and Interdisciplinary Education in our Bureau of Health Professions.

Collectively, these nurse leaders are a big part of the great team I work with at HRSA.

For those of you who may not know the full range of work we do at HRSA, let me take a minute to tell you about us:

• HRSA is probably best-known for the health center network that we support.  Our 1,100 grantees provide quality primary care to more than 17 million medically underserved people at 7,500 sites.  Forty percent of health center patients have no health insurance.  Everyone who enters the door is served.  Payment is determined by sliding fee scales; the poorest pay nothing.
  
  
• We’re equally well-known for our administration of the Ryan White HIV/AIDS Program, under Deborah Parham Hopson’s direction.  Our grantees provide some of the best care for people living with HIV/AIDS that can be found anywhere – it’s a model, really, for HIV/AIDS care worldwide. 
  
  
• Experts in HRSA's Maternal and Child Health Bureau lead the federal government's efforts to improve the health of mothers and their children, touching the lives of tens of millions across the country.  Every year, its block grant funds to states provide health services that reach six out of 10 women who give birth in the U.S.
  
  
• Our Bureau of Health Professions staff helps train the next generation of the health care workforce and, through the National Health Service Corps, we place them where they're needed most.  The NHSC repays up to $50,000 in student loans for advance practice nurses, doctors, dentists and others who serve a minimum of two years in areas with too few health professionals.  I’ll come back to the NHSC later.
  
  
• We also run the 340B Drug Pricing Program, which gives safety-net providers access to discounted pharmaceuticals.  And we have a range of other programs – from Poison Control Centers, to our oversight of Federal Organ Procurement and Donation efforts, to the National Vaccine Injury Compensation Program.
  
  
• In addition, we have a new program to help states expand health care coverage for the uninsured.  It’s called the State Health Access Program, and earlier this month we announced grants to 13 states worth $71 million.  States can use their grants to provide affordable insurance to specific uninsured groups, like children and seniors, or to develop new plans for reaching the uninsured.  The new program builds on the success HRSA had between 2000 and 2007 administering the State Planning Grant Program.  Many states – including, most notably, Massachusetts – used funds from that program to develop strategies to increase health insurance coverage for uninsured residents.

That’s a summary of HRSA’s core programs.  However, in the last few months, we’ve been administering a tidal wave of new funds directed to HRSA through the American Reinvestment and Recovery Act, which President Obama signed soon after taking office.  The Recovery legislation committed $2.5 billion over 2009 and 2010 to HRSA – this is the largest single investment in primary care in recent memory and a big addition on top of the $7 billion that is HRSA’s core funding.

Our Recovery funds were split three ways:

• First, we were given $2 billion to expand, improve and renovate the health center system.  With those additional billions – about two-thirds of which has already been released -- our health centers have served hundreds of thousands of new patients seeking help in the economic downturn.
  

• Second, we received $300 million to add thousands of new clinicians to the ranks of the National Health Service Corps.  More than half of all NHSC clinicians work in health centers, so the expansion of their ranks is an essential part of the expansion of the health center system.
  
  
• Third, we received $200 million to counter health workforce shortages by expanding training and educational opportunities.   This investment reflects President Obama’s historic commitment to attract and retain more nurses, doctors, and other health care professionals.  The new funds are expected to train 8,000 students and credentialed health professionals by the end of fiscal year 2010.
  
  Ten days ago, Secretary Sebelius and I announced the release of $33 million of the workforce investment funds to train more health care professionals, especially those from disadvantaged backgrounds.  That total included $19.3 million for the Scholarships for Disadvantaged Students program, with about a third of that money supporting nursing scholarships.  Another $2.6 million was awarded under the Nursing Workforce Diversity program.
  
  Those funds followed the release in August of Recovery grants worth $8.1 million for the Nurse Education Loan Repayment Program and $5.3 million for the Nurse Faculty Loan Program.
  
  We’ll have more training-related grants to announce later in the year and in 2010, including more awards for the Nurse Faculty Loan program.

Looking forward to 2010, the President’s proposed budget targets more than $715 million for health professions programs. 

The President wants another $5 million increase for Nurse Faculty Loan program in 2010.  And if you add Recovery Act funds to the 2010 budget request, investment in the program has risen by $17 million.  The President is expanding the faculty loan program because he knows we need to address the educational bottleneck in nursing education that significantly contributes to up to 50,000 nursing students being turned away each year.

For the Nurse Loan Repayment and Scholarship Program, President Obama proposes a huge increase of $88 million to reach a total of $125 million in 2010.  We estimate that the influx of dollars for this program will allow us to make 580 new scholarships and 1,340 new loan repayment awards.

The President is committed to resolving the workforce shortage as part of health reform, and we’re working with Congress to get the job done.

The President's 2010 budget also includes $169 million for the National Health Service Corps; that’s an increase of $34 million over the 2009 appropriation.  And it follows, as I said a moment ago, the influx of $300 million for the Corps that was included in the Recovery Act.

President Obama knows that we need more primary care providers.  It is why his administration and the Congress invested so heavily in the NHSC, and it will put thousands of health care professionals into some of the neediest, most underserved communities in America as we move forward on health insurance reform.

The president knows we must produce more primary care providers, nurses, nurse practitioners, and physician assistants – professionals who look at the whole patient, who look for health problems before they become chronic diseases, who work with patients to take steps for themselves and their children to live healthier lives.

And it’s important for all of you to know and merits repeating: the NHSC is not just for doctors and dentists.  We have identified about 1,000 vacancies for advance practice nurses on the NHSC Job Opportunities site.  I can’t tell you how much we need your help to connect your soon-to-be graduates with this program.

So please, tell all your advance practice nurses:  With the Recovery Act funds, with the President’s proposed increase in the FY 2010 budget, and with his commitment to primary care and health care reform, there has never been a better time to explore the opportunities to have student debt paid down significantly while serving America through the National Health Service Corps.

Speaking of health care reform, let me take a few moments to talk about the crossroads we face as a nation.   There’s been a lot of static in the air, so let me tell you what it is that President Obama is setting out to accomplish.

Simply put, he wants people with health insurance to have security and stability -- to not be one job change or one illness away from losing their insurance.  He wants people to have the security health insurance brings, and he wants to slow the unsustainable rate of growth in spending.

More specifically, for the hundreds of millions of Americans who have health insurance, nothing in what the President proposes will require them, or their employer, to change the coverage or the doctor they have.

What the President’s plan will do is make insurance work better for people: it puts in place strong consumer protections to prevent insurance companies from denying a person coverage on the basis of a pre-existing condition.

In addition, the President’s plan will place a limit on how much folks have to pay for out-of-pocket expenses.  His plan puts prevention on the front end, rather than the back end of health care – focusing on keeping people healthy, not just on caring for them when they’re sick.

For the tens of millions of Americans who are uninsured, President Obama’s plan will create an insurance exchange, a marketplace where uninsured Americans and small businesses can choose health insurance at competitive prices from a number of different options.

By pooling the uninsured and small businesses together as one big group, the plan gives insurance companies an incentive to participate and give consumers leverage to bargain for better prices and quality coverage, just as large businesses currently do.

To see the difference the President’s plan will make in your state, go to www.healthcare.gov

Well, let me conclude by telling you what a privilege it is to work for a president who cares deeply about what nurses care about – that all Americans have access to high-quality health care.  This president sees – from both personal and professional experience – the pivotal role nurses play and the respect they have from the American public.

Reflecting on his professional ties, at a recent White House event with nurses, President Obama noted his having worked side-by-side with nursing organizations while he was in the Illinois state senate.

And from a personal level, from the birth of his children to tougher times, when his mother passed away from cancer and when his grandmother passed away last year, the President said, quote: “Each time nurses were there to provide extraordinary care, and extraordinary support.”

And he urged the nurses at the event to do their part to support reform.  And I’m here to carry that message to this important meeting of nurses.

The President noted that “nurses have a lot of credibility; you touch a lot of people's lives; people trust you.  If you're out there saying it's time for us to act, that we need to go ahead and make a change -- then we will bid farewell to the days when our health care system was a source of worry to families and a drag on our economy.”

When that happens, he said, “America will finally join the ranks of every other advanced nation by providing quality, affordable health insurance to all of its citizens.”

So let me echo and emphasize President Obama’s appeal to nurses.  All of us need to speak out on why health reform is so important.  Who knows better than nurses do about what happens when individuals don’t have access to health care?  Too often if costs people their health and it can cost them their lives.  It’s time to add our voices to make America’s health and health care so much better.  In this debate, nurses can make an important difference – if only we will.

Again, thank you for all you do on behalf of the health of the American people – most notably by preparing the next generation of nurses.