Remarks upon receiving the Joseph F. Boyle Award for Distinguished Public Service from the American College of Physicians

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U.S. Department of Health & Human Services
Health Resources and Services Administration
HRSA Press Office: (301) 443-3376

 

By HRSA Administrator Mary K. Wakefield

May 22, 2014
Washington, D.C.

Thank you very much for this award.  And while I am certainly honored to be the recipient, as the Administrator of HRSA, what we have accomplished at that Agency is very much a product of the outstanding work of my colleagues.

What all of us at HRSA are fully committed to -- is  improving health and achieving health equity by ensuring access to quality health care services, and by strengthening the supply, the skill set and the distribution of  physicians and other health care providers.

Our programs and our efforts are designed to disrupt the status quo, to address challenges head on, whether by getting thousands of people off waiting lists for HIV AIDS drugs to launching new efforts to procure more organs and sign up more organ donors or by clearly documenting the disconcerting trends in rural population health status versus their urban counterparts, or by working to improve the physician workforce landscape.

Changing the status quo in these and scores of other areas are what -- at HRSA -- we work on every day.  

From what I can tell, this orientation isn’t all that different from that of Dr. Boyle’s – for whom this award is named. Looking across his career, Dr. Boyle spoke out on issues of inequity and fairness.  He worked to raised awareness about important health issues and he wasn’t afraid to challenge the status quo.  So, I certainly see the alignment between what he aimed for and what we aim for at HRSA -- making this honor that much more meaningful to me.

And, I think that it is with much of that same orientation, that the President made health care reform a signature issue of his presidency. It has been seen as a risky priority to have taken on but the gaps in access to timely health care, predicated in large part on a rising tide of uninsured in this country clearly pointed to the need to act – to ensure the availability of health insurance coverage that could guarantee access to health care -- and provide a clearer shot at getting or staying healthy -- for individuals, families and communities across the nation.

Data certainly support drawing a direct line between insurance coverage and health status. Most recently, a study published in the Annals of Internal Medicine -- that many of you may have read -- found that in the four years following the enactment of health insurance reform in Massachusetts, that state saw a decline in the number of deaths by three percent -- even as no similar declines were occurring in other states.

Out of the health reform gate, Massachusetts had lower rates of uninsured populations than other states, so as some have noted, it’s possible that the reduction we see over the next few years in states across the country has the potential to be even larger.

The benefits of the law – a ban on insurance companies’ pre-existing condition exclusions; no cap on annual insurance benefits; the fact that women can’t be charged more than men; and breaking the link between job loss and loss of health insurance – all of that – and more – means that both people who have been insured and people historically without insurance will -- going forward – have a better opportunity to get the health care that they need.

While we now know that 8 million Americans have signed up for health insurance coverage through the Marketplaces – and millions more through Medicaid – we also know that there are still too many Americans who remain uninsured--- making both Medicaid expansion in states that have yet to do so – and the next open enrollment period for insurance through the Marketplace that begins on November 15 -- extremely important.

However, what a lot of folks may not know is that people can sign up for health care coverage whenever a life circumstance has changed their connection to health insurance, say through divorce, death of a family member, job loss, or college graduation.  And anyone eligible for Medicaid or CHIP can, of course, enroll at any time through those programs.  In addition, members of federally-recognized Tribes can enroll in and buy health insurance coverage through healthcare.gov at any time.

But, the ACA has been about more than access to health insurance. While lesser known by consumers, the ACA is also very much about access to primary care services and, in the communities that need them most, access to primary care physicians and other health care providers.

Three of the ACA provisions for which HRSA has responsibility are emblematic of this focus throughout the law and perhaps it is what we’ve done with those and other provisions that is  the central reason I’ve been invited to be here this morning with you.  

The first has been – largely with ACA resources -- our building out of the health center infrastructure that stretches across the nation to include now over 9,000 sites from mobile vans, converted warehouses to new multistory bricks and mortar offices.  So that between 2009 and 20012, the number of patients seen at health centers has increased from 17 million to over 21 million.

In fiscal year 2015, we are expecting that number to increase to 31 million patients. This massive boost to primary care infrastructure -- particularly for those who are uninsured and on Medicaid, has seen an expansion in hours open and the range of services provided to include more oral health, behavioral health and vision care, for example.  And health centers over the past few months provided education and enrollment assistance to over 4 million people.

As you probably know, health centers operate in medically underserved areas.  For those with an income below 200%, fees are charged on a sliding scale based on income.  No one can be turned away due to an inability to pay.

Over these past few years, the growth HRSA has supported in health centers -- with ACA resources -- has been accompanied by growth in positions for physicians and others.  In fact, health centers have added more than 35,000 new full-time positions over that period, including more than 2,000 physicians.  Of those additional physicians, 230 are internists, bringing the total number of internists working at health centers to almost 1,700 (1,691).

Internists play crucial roles delivering primary care at health centers, and physicians in internal medicine subspecialties often participate through referrals, as health centers place greater emphasis on coordinating comprehensive care and managing patients with multiple health care needs.

President Obama made very clear the continuing importance of health centers by asking Congress for $4.6 billion for health centers in his FY 2015 budget request, almost $1 billion more ($960 million) than the FY 2014 allocation.

Those funds will allow health centers across the nation to expand access to comprehensive primary health care services to address the increase in demand for services from millions of newly insured patients.  In addition, the FY 2015 funds also will create 150 new access points, helping health centers to serve a projected 31 million patients nationally. 

Bottom line, we see health centers as an essential part of the U.S. health system that provides an accessible and dependable source of high-quality primary care services in underserved communities.

In addition to building out infrastructure are our ACA funded efforts to further strengthen the production, skill set, and distribution of the primary care workforce -- a major workforce priority for this administration given the well-established relationship between patient outcomes, decreased costs and availability of primary care providers.

Our signature program to impact distribution to high need urban and rural communities is the National Health Service Corps -- a HRSA program that provides loan repayments and scholarships to primary health care professionals – physicians, advanced practice nurses, dentists and dental hygienists, physician assistants, and behavioral health providers.

Largely as a result of the ACA, the ranks of the NHSC have more than doubled, from about 3,600 clinicians in 2008 to nearly 8,900 primary care providers today.

The number of physicians in the Corps has risen from about 1,450 in 2008 to more than 2,400 (2,402) as of the end of Fiscal Year 2013(September 30, 2013). That’s an increase of more than 65 percent (65.5) over just five years!

Of those NHSC physicians currently in the field, about 11 percent are internists.  And of some 750 physicians receiving NHSC scholarships to attend medical school, 12 percent (91) specialize in internal medicine.

In 2012, we added a loan repayment option to the NHSC specifically targeted to medical students, which we called the Students to Service Program.  The pilot program offers loan repayment assistance of up to $120,000 to medical students (MD and DO) in their last year of school, in return for a commitment to provide primary health care services in areas of great need for at least three years.  Through this new track , last year for example, , we made 78 Students to Service Loan Repayment awards totaling $9.3 million to medical students committed to primary care.

And going forward, President Obama remains a strong supporter of the NHSC.  His 2015 Budget includes a total of nearly $4 billion ($3.95B) in new mandatory funding to the Corps to support an annual field strength of 15,000 health care providers.  And with more than 85 percent of clinicians staying to serve in high-need areas after they fulfill their service commitment, the NHSC helps ensure that underserved communities have access to quality health care now and in the future.

Another way we’re adding to the number of primary care providers likely to practice in underserved communities is through the Teaching Health Center GME program, which the ACA created with funds of $230 million over five years to expand residency training in primary care and dentistry in community-based, ambulatory settings.  The Teaching Health Center program has grown quickly over the past three years and now supports 44 sites with more than 300 full-time residents (in academic year 2013-14).  By our count, over 50 of those residents are in Internal Medicine. 

Of course, the federal government has other powerful policy levers – administered by HRSA -- that support the training of primary care physicians.  During the 2012-2013 academic year, for example, our Primary Care Residency Training Program supported the training of 691 Internal Medicine residents.  And other grants to graduate medical education programs helped develop and enhance primary care curriculum that trained 1,170 Internal Medicine residents.

We rely on “pipeline programs” like these to expand the number of physicians and other health care professional who are committed to delivering primary care in underserved areas.  These programs train many internal medicine specialists and, in that way, they are important tools we use in our ongoing quest to increase access to primary health care in communities that have limited access to such care.

I’ll end by saying that the partnership HRSA has with the American College of Physicians – not just in helping to fill that health care workforce pipeline – but also in expanding access to health coverage and primary care services is an important partnership for us.  And clearly, the legacy of Dr. Boyle embodies the commitment of leaders in internal medicine to these efforts.  And on that front, from the vantage point of the U.S. Department of HHS, let me also thank each of you for your work every day to improve patient access to high quality care.

Many of us in government are fortunate to know members and leaders of ACP personally and thereby know the incredible difference all of you make.  For me, Dr. Julie Blehm, a friend and colleague from our shared home state of North Dakota is just one such leader.  And finally, thank you again for connecting Dr. Boyle to HRSA and to me through this award.

 

Date Last Reviewed:  March 2016