Statement of Senator Bernie Sanders on the Introduction of FQHC Legislation

Mr. President:

Today in the United States of America there are 47 million people that are without health insurance and 35 million Americans that are completely without access to the most basic health care services. As a result, in the richest country in the world, 18,000 Americans die each year because their basic health care needs are not met. Despite the fact that we spend twice as much per person on health care than any other industrialized nation, Americans have a lower life expectancy and a higher infant mortality rate than Canada, Japan and most of Europe.

We are also faced with an alarming dental care crisis in this country. The Surgeon General has reported that tooth decay has become the single most common chronic childhood disease in this countryfive times more common than asthma and seven times more common than hay fever. Surveys have also shown that dental problems cause children to miss more than 51 million hours of school and adults to miss more than 164 million hours of work each year.

This health care and dental care crisis bears down particularly hard on those who live in rural communities where there are few local health care centers and patients must travel many miles to seek the care that they need. Those living in inner city neighborhoods also often have difficulty receiving the care they need because they lack health insurance and have no means to pay for regular doctors visits. As a result, far too many Americans do not have a primary care doctor or dentist and do not seek preventative care.

This means the only time they see a doctor is when their situation has become so advanced and so dire that they must seek treatment at a hospital emergency room. This is a result that is bad for patients, bad for doctors, and bad for American taxpayers.

Providing underserved patients with better access to primary care will allow doctors to catch problems before they become advanced and require invasive and expensive procedures. It will also, of course, benefit the patient--in many cases saving their lives. Studies have shown that patients with a primary care provider are far more likely to receive appropriate preventative care, need fewer prescription drugs, and spend less time in hospitals and emergency rooms.

The good news is that we have a program in this country that provides primary health care services to those who need it most. Forty years ago, Senator Kennedy had the foresight to author legislation creating community based health care centers that treat underserved patients. These centers, now called Federally Qualified Health Centers or FQHCs, provide high quality primary health care for millions of Americans, regardless of their income.

In addition to treating those who have Medicare, Medicaid, and private insurance, FQHCs primarily serve those who have no health insurance and charge fees on a sliding scale basis. That means that whether you make $50,000 per year or 15,000 per year you will be able to afford treatment. No one who walks into one of these centers is turned away because he or she lacks payment.

In addition to providing the quality care that patients expect to receive when they visit their local doctor's office, these centers also make sure that patients are able to afford the drugs they need by providing them with significant discounts on their prescriptions. The centers also provide critical dental and mental health careoften offering the only available services for those in need.

FQHCs provide primary, dental, and mental health care that is not only high quality but also tailored to meet the needs of the local community. In order to create an FQHC, federal law requires not only that there be substantial community input in the development of the center, but also that a majority of the members on the governing Board of Directors are actual users of the facility.

In other words, those who know the most about the needs of their local community are responsible for overseeing the centers. It is a model that has been highly successfully throughout the country, including my own state of Vermont, which has five of these health center organizations serving more than 10% of Vermont's population at 18 different locations.

These community health care centers serve as the family doctor for 16 million Americans in more than 5,000 communities across the country. Their success has been well documented with studies repeatedly showing that these centers are highly cost-effective method for ensuring that underserved patients receive quality health care. In fact the Office of Management and Budget has reported that FQHCs use federal taxpayer dollars more efficiently than any other federally-funded health care program. In addition, studies have found that FQHCs save the Medicaid program 30% or more in annual spending by providing preventative treatment that reduces the need for specialty care referrals and hospital admissions.

There are not many issues on which President Bush and I agree but the importance of community health care centers is one area where we have found some common ground. The success of this program has earned support and praise from the White House as well as members of this body on both sides of the aisle. With Congressional support, over the past five years nearly 900 underserved communities were able to establish or expand a health centers, bringing the number of Americans served by these centers to more than 5 million patients.

Unfortunately, during that same period more than 800 centers were denied FQHC status, and the federal funds that go with it, not because they were not qualified, but simply because there was not sufficient funding to incorporate them. That's 800 communities throughout this country that are left desperately in need of the quality, low-cost preventative care that these centers provide.

Existing centers throughout this country are also in jeopardy. Over the past two years, federal grant support for these centers has been reduced, threatening their ability to serve all of those in need.

It is for that reason that today I am introducing a bill today, along with Senator Lisa Murkowski of Alaska, to increase federal support for Community Health Centers over the next 8 years and ensure that millions of Americans living in medically-underserved areas receive the care that they need. This legislation would start by authorizing a funding level commensurate with our current needan increase of $575 million for the upcoming year and increases between $400 and $600 million for the following seven years. That will provide enough resources to fund not only the backlog of the 800 approved, but unfunded health centers, but also future applicants that meet the criteria for FQHC status. It would also make sure that existing centers are able to grow with the communities that they serve by giving them annual funding increases that are commensurate with the number of patients they serve and the increased costs they incur.

This legislation would also correct the unfair and outdated system these centers are forced to contend with for Medicare reimbursements. While health centers provide care to more than 1 million medically underserved Medicare beneficiaries, their Medicare payments are subject to an arbitrary payment cap that was established in 1991 and adjusted only marginally since. The result is more than $50 million in lost Medicare reimbursement funds that health centers now are forced to find a way to subsidize. This legislation would correct this system and ensure that these centers are reimbursed fairly for the care they provide to seniors and disabled patients.

Finally, this important legislation would also ensure that our nation's community health centers have the workforce they need by expanding the National Health Service Corps. Currently, health centers rely on the National Health Service Corps for more than 20% of their physician workforce. Unfortunately, last year, health centers experienced a 15% physician vacancy rate and a 19% dentist vacancy rate nationally. This legislation would more than double funding for the National Health Service Corps over the next 8 years in order to train and send more primary care doctors and dentists into rural and inner-city communities.

In the richest country in the world, no American should have to go without basic primary health care. Federally Qualified Health Centers serve as a lifeline for millions of low-income Americans and we should build on their success by expanding this program for all those in need.