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OCT 15.'93 17:19 FROM GOV'T OPERATIONS
TO 94566220
PAGE. 002
cc. Melanne, Chus
JOHN CONTERS. a MICHIGAN,
WILLIAM B. CLINGER a PENN
BANKING MINORITY MEMB
CHAIRMAN
AL McCANOLESS. CALIFORNIA
CARDIES COLLINS. ILLINOIS
ONE HUNDRED THIRD CONGRESS
& DENNIS HARTENT. ILLINOIS
BLENN ENGLISH. OKLAHOMA
JON L ML ARIZONA
MEMRY A. WARMAN CALIFORNIA
CHRISTOPHER SHAYS. COMME
MAKE GYNAR, OKLAHOMA
STEPHEN L NEAL NORTH CAROLINA
Congress of the Hnited States
STEVEN SCHIPE, NEW MEXICO
c CHRISTOPHER COX CALIFOR
TOM LANTOS. CALIFORNIA
CRAIG THOMAS. WYOMING
MAJOR R OWENS. NEW YORK
ILEANA ROBLEHTINEN. FLORID
EDOLPHUS TOWNS. NEW YORK
House of Representatives
DICK IMMER NEW JERSEY
JOHN M. SPRATT, JR., SOUTH CAROLINA
WILLIAM M. EXCLIP. JR. NEW -
GARY A CONDIT. CALIFORNIA
JOHN M. MONUCH NEW YORK
COLLIN C. PETERSON. MINNESOTA
STEPHEN MORN, CALIFORNIA
KAREN L TRURMAN, FLORIDA
COMMITTEE ON GOVERNMENT OPERATIONS
DEBORAH PRYCE OHIO
BOSBY L RUSH. ILLINOIS
JOHN L MICA FLORIDA
CAROLYN a MALONEY. NEW YORK
2157 RAYBURN House OFFICE BUILDING
ROB PORTMAN,
THOMAS M. BARRETT. WISCONSIN
DONALD No. PAYME, NEW JERSEY
FLOYD M. PLAKE NEW YORK
JAMES A. MAYES, LOUISIANA
WASHINGTON, DC 20818-6143
BERNARD BANDERS. VERY
CAUG A. WASHINGTON, TEXAS
INDEPENDENT
BARBARA-NOSE COLLINE, MICHIGAN
CORRINS BROWN FLORIDA
MARJONE FENNSYLVANIA
MAJORITY-(202) 228-1
LYNN C. WOOLSEY. CALIFORNIA
MINORITY-
111.0
COME GREEN, TEXAS
BART STUPAK MICHIGAN
October 15, 1993
Mr. Howard Paster
Assistant to the President
for Legislative Affairs
The White House
Washington, D.C. 20500
Dear Mr. Paster:
I wanted to bring the attached letter to the First Lady to
your attention because of your important role in formulating the
President's Health Care Reform bill. The letter signatories have
expressed their concerns about Community Health Center/Migrant
Health Center funding and the manner in which money would be
distributed to community-based providers under the
Administration's health care plan. I hope the Administration can
properly address these concerns.
If you need any assistance contact Frank Clemente of my
staff at 225-5051. Thank you for your prompt consideration of
this pressing matter.
Sincerely,
HRC Tooh a
yers, ncoweys Jr
1
call from
him 11/15
fc. Melanne
China
Congress of the United States
house of Representatives
lashington, DC 20515
October 15, 1993
First Lady Hillary Rodham Clinton
PAM
NOV
Office of the First Ladv
Old Executive Office Euilding, Room 100
Washington, D.C. 20500
Dear Mrs. Clinton:
We wish to bring to your attention a serious concern that we have with respect to the
Administration's current Access Initiative contained in the national health reform plan and its
impact on medically underserved populations -- most notably underserved inner-city
neighborhoods and rural communities.
As we understand it, the Administration's plan recognizes that medically underserved
communities suffer from an acute shortage of accessible health services, especially preventive
and primary health care services, and that the people living there will need additional support
services beyond those covered in the plan's comprehensive benefit package (such as
community outreach, transportation, or translation services), in order to make the provision
of covered services effective for them.
We applaud your recognition of these special needs, and the proposed new resources
for the National Health Service Corps and school-based clinics. We are, however, quite
concerned at both the ( "ceedingly limited amount of funding specified in your plan for
Community and Migrant Health Centers (C/MHCs) and with the manner in which the plan
would distribute funds to community-based primary care providers.
It appears the Administration only plans to make available an additional $100 million
annually for C/MHCs in 1996 (current funding level is $644 million). An additional $700
million would be available annually for "flexible capacity and enabling services" in 1996.
We have three concerns. First, the increase for C/MHCs is very small given the
need and their proven track record. Today, Community Health Centers provide
comprehensive preventive and primary care to more than 7 million medically underserved
Americans only 15% of the 43 million medically underserved Americans who need access
to such care. Despite the poorer overall health of their patients, studies have shown that
health centers are tremendously cost-effective, and have dramatically improved the health of
their patients and the communities they service.
Second, it appears that the $800 million increase is partially paid for by offsets in
other necessary Public Health Service programs that serve these same population groups.
Our understanding is that the offsets in 1996 may be as high as $342 million, or 43 percent
of the proposed increase.
Third, we understand that most of the funds under the new "flexible capacity and
enabling services" category would be administered under a totally new program, which
parallels the existing C/MHC program in every respect except the governing board
requirements, eligibility for funding, and Federal acc ountability (reporting/auditing)
requirements. The new program would make grants available to a wide variety of
organizations, including private health plans, with little or no community involvement. The
C/MHC program has, for the past three decades, provided funds to community-owned and
community-operated organizations, whose governing boards are required to have at least a
majority-consumer membership. This Community Board Requirement has assured grants go
to the right place, and that the services of health centers are responsive to community needs.
Health centers were founded with a vision of community and consumer
empowerment, and their experience over the past 30 years provides an object lesson on how
consumer involvement and community empowerment can succeed where other models have
failed. In this sense, health centers may be our best (and perhaps last) hope for communities
in shaping their health care system and making it responsive to their needs. This will be
particularly important if health reform is to rely on managed care systems and market forces
for its success. Managed care entities and HMOs historically have avoided the poor and
underserved because of their unique needs and inherently higher costs. The poor and
underserved are in the health care predicament they are in because they have been neglected
by the current health care market.
We truly believe that any Access Initiative should build on what works. Therefore,
we urge you to significantly increase the proposed funding level for health centers in the
Administration's plan and maintain the "community involvement requirements" for any
flexible capacity and enabling services. Finally, we believe that no offsets should be taken
from existing programs. Funds provided to health centers, family planning and other vital
programs should be retained and re-invested in these programs to expand their capacity to
meet vital needs, which will continue even after health reform is implemented.
We ask your personal attention to the matters raised herein, and we stand ready to
discuss these concerns with you in further detail, should you so desire.
Sincerely,
smlongary Tom Banett Naucey Pelosi
Many J. Jronn Gith
Hams 7L L
Lymcwoolary Came P.Mak Pere Star
Mel Reynolds W. Olve
Cra in. Clayton Meling Lwall Jane Evan
Bilty L Rush Maline Obersta
Majn R.Doens Rahali
land fidney R.Yate
Alice I Hastings Eas L. Engs
Earl 7. Nively Vils reft
Balsad ConsldWarpe Lucille Roybal-ale
Tobat A. Undermood Pate
-4-
Mil Aberciombic
HBmllc
Ron Cala
Dan John helles
Gle Poshard
Members Signed on Community Health Center Letter
To The First Lady
Rep. Conyers
Rep. Reynolds
Rep. Evans
Rep. Olver
Rep. Dellums
Rep. Roybal-Allard
Rep. Torres
Rep. Stark
Rep. Owens
Rep. Clayton
Rep. Towns
Rep. Oberstar
Rep. Hilliard
Rep. Rahall
Rep. Fields
Rep. Watt
Rep. Meek
Rep. Barrett
Rep. Waters
Rep. Woolsey
Rep. Pelosi
Rep. Hinchey
Rep. Payne
Rep. Sanders
Rep. Yates
Rep. Engel
Rep. Hastings
Rep. Corrine Brown
Rep. Don Edwards
Rep. Rush
Rep. Velazquez
Rep. Bonilla
Rep. Underwood
Rep. Fish
Rep. Flake
Rep. Abercrombie
Rep. E.B. Johnson
Rep. Poshard
Rep. Lewis
Rep. Serrano
Rep. Wheat
Rep. Nancy Johnson
Rep. Ron Coleman
Rep. Collin Peterson
THE WHITE
)
-
[DATE]
The Honorable John Conyers, Jr.
U.S. House of Representatives
Washington, D.C. 20515
Dear Congressman Conyers:
Thank you for writing about your concerns with the Access
Initiative in the Health Security Act. We recognize, as you do,
that a Health Security Card will not alone guarantee that all
Americans receive appropriate medical care. The programs in the
Access Initiative are designed to assure that individuals in
medically underserved communities have real access to the full
range of services in the comprehensive benefit package, needed
support services, and an adequate choice of culturally sensitive
providers and health plans. The Health Security Act proposed by
the President builds on the community and migrant health center
program and provides support for these centers and other
community-based providers.
You have raised specific concerns about the level of funding
for community and migrant health centers. The Health Security
Act authorizes $600 million in new funds for community and
migrant health centers over fiscal years 1995 through 2000. In
addition, a new capacity expansion program ($2.7 billion over
fiscal years 1995 to 2000) will be available to community and
migrant health centers as well as other providers in medically
underserved areas to build new health care facilities, support
capital improvements for existing facilities, and link current
primary care providers with inpatient institutions through
information systems and telecommunications. The enabling
services program ($1.2 billion over fiscal years 1996 to 2000)
will be available to community and migrant health centers as well
as other providers in medically underserved areas to provide
translation, transportation, child-care and outreach services.
Expansion of the National Health Service Corps ($950 million over
fiscal years 1995 to 2000) will increase the supply of
practitioners available to serve in community and migrant health
centers.
You also raised concerns about offsets in funding for Public
Health Service programs. The offsets do not represent a
reduction in the ability of Public Health Service programs like
community and migrant health centers to provide services. The
offsets represent the amount of federal appropriations that will
not be needed because, with universal coverage, health plans will
make payments for those services for those individuals who were
previously uninsured or underinsured.
Finally, we agree that Access Initiative grants should
continue to reward community-based providers. The Access
Initiative will integrate publicly-funded providers with private
providers and health plans. To receive funding under this
program, providers and plans must demonstrate significant
community involvement as well as the ability to provide access to
health services for all individuals in underserved areas.
The Health Security Act calls for substantial new funds for
the Access Initiative over fiscal years 1995 through 2000. We
are committed to assuring a secure funding stream for these
programs and look forward to working with you and other members
of Congress to define the appropriate mechanism to do SO.
Please feel free to contact me with any additional concerns
or questions.
yours
Sincerely,
Hillary Rodham Clinton
DRAFT RESPONSE TO CONYERS ET AL LETTER
Dear:
Thank you for taking the time to write to me J about your concerns with the Access Initiative
contained in the Health Security Act. You raise many important issues in your letter
including the level of funding for community and migrant health centers, offsets in funding,
and the ability of new programs to meet community needs. In response, I would like to
provide you first with a full description of the proposed access programs and then address
your specific concerns.
access to additional support
Provide
proposal
services and
The President recognizes, as you do, that a Health Security Card will not, in and of itself,
guarantee that all Americans receive appropriate medical care. The programs in the Access
Initiative are designed to assure that underserved populations -- including Americans living in
inner-city and rural areas not only have access to the full range of services included in the
comprehensive benefits package under health care reform, but also have an adequate choice
of culturally sensitive providers and health plans. The policies that the President has put
S
forward build on the success of the community and migrant health center program and assure
S
that community health centers and other providers currently supported through public funds
are given the resources they need to participate successfully in the new system.
The Health Security Act uses six interrelated approaches to expand capacity in underserved
areas and to remove barriers that isolated, culturally-diverse, or hard-to-reach populations
face in obtaining access to care.
Current Safety-Net Programs. First, current safety-net programs such as
community and migrant health centers, programs for the homeless, family planning,
Ryan White, and maternal and child health will be maintained and strengthened under
reform.
Providers funded under these programs will receive automatic designation as essential
community providers. This will guarantee them payment for covered services from all
health plans. Equally important, it will assure that vulnerable populations have
continuing access to practitioners with experience meeting their special needs,
regardless of which health plan they choose to enroll in
Practitioner Supply. The supply of practitioners in underserved areas will be
increased under reform. This will be accomplished by expanding the National Health
Service Corps approximately five-fold from its current field strength of 1,600; by
1
redirecting residency training to substantially increase the ratio of primary care
physicians to specialist physicians; and by supporting the training of primary care
physicians, physician assistants, and advanced practice nurses.
Special programs to increase the representation of minorities among health
professionals will help to overcome access barriers that stem from cultural gaps.
be expanded
Capacity Expansion. Capacity expansion in inner-city and rural areas will be
actively supported under reform. This will be accomplished both by expanding the
successful community and migrant health center program and through a new
competitive grant and loan program supporting the development of community-
oriented practice networks and health plans.
The new program is designed to integrate federally funded providers with other
providers in underserved areas, bolstering their ability to coordinate care, negotiate
effectively with health plans, and form their own health plans. It will increase the
level of service available in underserved areas by supporting the creation of new
practice sites and by renovating and converting existing practice sites, including
public and rural hospitals. In addition, it will improve access to specialty care in
urban and rural underserved areas -- and improve coordination of care -- by linking
providers in practice networks with each other and with regional and academic
medical centers through information systems and telecommunications.
Grants and loans under the new program will be made to groups of providers working
in medically underserved areas or caring for underserved populations. In making
awards, preference will be given to groups that include the maximum number of
different types of federally funded providers and that link these providers with those
not supported by public funds. All providers included in the community practice
networks will receive automatic designation as essential community providers.
To be designated by the Secretary to receive grants and loans under the new program,
a community practice network or health plan must:
Show evidence of significant community involvement in the initiation,
development, and ongoing operation of the project;
Brovide health services to all individuals, including those not covered under
the Health Security Act;
Brovide services in the language and cultural context most appropriate to the
populations residing in the area;
eliminate other access barriers to the maximum extent possible; and
2
Conduct an ongoing quality assurance and community health status
improvement program.
Outreach/Enabling Services. The Access Initiative also incorporates a new
competitive grant program that will expand federal support for enabling services, such
as transportation, translation, child-care, and outreach.
These grants will assure that isolated, culturally-diverse, hard-to-reach persons not
served by other programs get the supplemental services they need to obtain access to
medical care. They will also help individuals who have been denied access to the
current medical care system shift their care patterns away from emergency rooms and
receive earlier and more appropriate primary care services
and have resorted orange
to the emergency room
Awards in this program will be made to community practice networks, community
ror all
health plans, and other public and private not-for-profit organizations (such as
care to
community health centers) with experience and expertise in providing outreach and
enabling services for underserved populations. These grants will supplement support
for enabling services provided through existing Public Health Service programs.
Mental Health and Substance Abuse Initiatives. The Health Security Act also
includes new funds to assure that low-income, hard-to-reach individuals know about
and take advantage of the expanded mental health and substance abuse treatment
benefits included in the comprehensive benefits package.
illness
Working through the existing Community Mental Health Services and the Substance
Abuse Prevention and Treatment formula grants, these funds will support enabling
services -- community and patient outreach, transportation, translation, education --
for low-income individuals and other vulnerable groups (such as the homeless, dually-
diagnosed, or severely mentally ill). In addition, they will build up the currently
inadequate infrastructure for delivering mental health and substance abuse services in
communities and facilitate integrating these services within the broader health care
system.
OUP
in
School-Age Youth. Finally, the Access Initiative incorporates two new programs to
reach out to one of Nation's most vulnerable groups school-age youth and
adolescents. The Comprehensive School Health Education initiative will establish a
national framework within which States can create school health education programs
that improve the health and well being of students grades K through 12 by
addressing locally relevant priorities and reducing behavior patterns assóciated with
problems
preventable morbidity and mortality. This program will be targeted to areas with
problems
associated
such as
high needs, including poverty, births to adolescents, and sexually-transmitted diseases
among school-aged youth.
The School-Related Services program will support the provision of health services
3
including psychosocial services and counseling in disease prevention, health
promotion, and individualized risk behavior - in school-based or school-linked sites.
Grants will be made to states for the development and implementation of state-wide
projects targeted at high-risk youth ages 10-19. In states that do not take this
initiative, grants will be available to local community partnerships including public
schools, experienced providers, and community organizations.
As you can see, the President has chosen a multifaceted approach to achieve real access to
medical care for all Americans. Under the current system, our challenge is to find and fund
providers to care for indigent populations. Under the Health Security Act, the challenge
shifts to creating a single tier system in which newly insured people have an adequate choice
of culturally-sensitive providers and health plans. Expanding the community and migrant
health center program will be the cornerstone of this strategy in some communities, but it
will not be sufficient to achieve this objective in all parts of the country. We also need
flexible programs that will help diverse types of underserved communities attract the types of
primary care practitioners and specialists that are currently in short supply in their areas,
offer their residents an array of practitioners and practice settings from which to receive
health care services, meet the enabling needs of diverse populations, and link up providers
with each other so as to assure the availability of the full range of services in the
cortiprehensive benefits package.
You have raised specific concerns about [insert from P.1] The President
Community and migrant health centers should thrive under the new programs. The Health and
I
Security Act authorizes $600 million in new funds for community and migrant health centers
strongly
over fiscal years 1995 through 2000. In addition to this targeted funding, a substantial
support
portion of the resources from other programs will also benefit community and migrant health your view
centers.
can
that we
The new capacity expansion program ($2.7 billion over FY 1995-2000) will
provide funds that can be used to build new health centers, to support capital
should
improvements of existing centers, and to link centers with other providers and
build on
institutions through information systems and telecommunications.
the
community
Expansion of the National Health Service Corps ($950 million over FY 1995-2000) Burdro
and other workforce initiatives ($820 million over FY 1995-2000) will increase the
health
supply of practitioners from which health centers can draw.
centers
given the
than have
0- The new enabling services program ($1.2 billion over FY 1996-2000) will provide
madersa
health centers with an additional source of funding to provide their populations with
inormous
translation, transportation, child-care, and outreach services.
Contributor
then have made
wr the
The essential community provider designation program will assure health centers of
payment for covered services from all health plans.
Programs.
PASA
You also raised concerns about offsets in Public Health Service)
In response to the offset issue that you raise, it Is worthwhile pointing out that community
por
4
will
only because
and migrant health centers will continue to get paid in full for all of their services even if
federal appropriations for Public Health Service programs decrease to account for increased
and
revenues from health plans. The source of payment will change, however. Payment for
covered services will come from health plans instead of the federal government. Payment Funds for
for enabling services will come from the community and migrant health center program as
Need
are more's PHS
well as the new enabling services program.
Finally, we agree that grants should continue to reward community
With regard to your final point, the new programs do not make grants available to private involvement.
health plans with little or no community involvement. Instead, the Access Initiative supports
the development of community health plans centered around community health centers,
integrating these centers with other publicly and privately funded providers caring for
underserved populations. As you can see from the description above, the requirements of the
new program oblige providers in the community practice networks and health plans to work
together to meet the needs of their populations. They must provide services to all comers,
consumers
provide translation services to individuals who do not understand or speak English, eliminate
access barriers to the maximum extent possible, and work to improve community health
status.
The President has made a strong commitment to providing the necessary funds to assure
access to medical care under reform. The Health Security Act authorizes $9.345 billion to
be appropriated for the programs in the Access Initiative over fiscal years 1995 through
2000. We are committed to assuring a secure funding stream for these programs and look
forward to working with Congress to define the appropriate mechanism to accomplish this
end.l
doso.
I hope the information in this letter is helpful and I will be pleased to arrange a briefing to
address any further concerns you may have. The President and I appreciate the important
we
role that you have played in advocating for underserved and vulnerable populations and the
and
enormous contribution that community health centers have made in meeting these needs
look
Americans with real health security.
One of our foremost goals is to build on this dedication dedication and expertise to provide all
Forward
to
Sincerely yours,
working
with
you
and.
hope
Hillary Rodham Clinton
to
draw on
In the
coming
months
5
THE WHITE HOUSE
WASHINGTON
November 18, 1993
The Honorable John Conyers
Chairman
Committee On Government Operations
2157 Rayburn House Office Building
Washington, DC 20510
Dear Mr. Chairman:
Director Brown asked me to provide you with information on
provisions of the Health Security Act related to substance abuse.
This legislation will provide more comprehensive substance abuse
coverage than currently is available to most Americans.
For the first time, all Americans will have coverage for
substance abuse treatment. Right now, only one in five Americans
have any coverage for substance abuse disorders. And, many of
those who do have substance abuse coverage face lifetime limits
which can effectively short circuit ongoing access to relapse
treatment. The Health Security Act does not have any lifetime
limits.
Currently some Americans, who might otherwise be eligible for
health insurance, are denied coverage based on a pre-existing
substance abuse disorder. The Health Security Act makes exclusion
based on pre-existing conditions illegal.
By January 1, 2001, the Health Security Act requires that limits
on treatment be eliminated and replaced by a managed benefit.
Until that time, the structure of the substance abuse benefit is
designed to provide incentives to expand the existing inadequate
capacity. This means in 2001, when limits have been replaced by a
managed benefit, capacity sufficient to provide treatment
services will be in place.
The structure of the benefit is designed to offer a flexible,
continuum of care that allows health plans to tailor treatment
programs appropriate for individuals' special needs. The emphasis
is on encouraging health plans to move to a more flexible managed
benefit approach which offers a wide array of services.
Page 2
At first the benefit continues to use day and visit limits
similar to current insurance policies. However, from the start it
provides coverage for a wider range of services than in typical
insurance today, using substitution structuring to encourage
flexibility and care management.
You also should know that under the Act, screening and
assessment, diagnosis, crisis services and medical management
services, such as methadone treatment, do not have visit limits.
The article in today's Washington Post indicated that the length
of some substance abuse and mental illness treatments had been
"cut in half". In the draft legislative language a 60 day annual
aggregate limit for inpatient days was included. It continues to
be true that individuals may receive up to 60 days inpatient
treatment if they meet certain criteria.
However, the policy intent never was to use 60 inpatient days as
the base for substitution for intensive non-residential and
outpatient treatment. The intent was to use 30 inpatient days as
the base for the substitution for intensive non-residential and
outpatient, therefore, the article was misleading when it says
the benefit was cut in half.
Another important aspect of the benefit is that treatment options
are not limited to residential settings and traditional
outpatient treatments. Less restrictive, non-residential
treatment such as partial hospitalization, home based services,
crisis services, ambulatory detoxification and behavioral
services prevention and day treatment can be provided up to 120
days, or outpatient substance abuse counseling and relapse
prevention visits may be available up to 120 days.
The inclusion of this array of treatment options in various
settings represents a new direction for the delivery of substance
abuse treatment services. The growth of new types of service
providers in response to this benefit structure should stimulate
the development of the additional provider capacity so
desperately needed.
The Health Security Act also provides funding for services
designed to help remove barriers to treatment for substance
abusers, including community outreach, transportation and
translation services. Other initiatives include, new school-based
programs aimed at educating school children about substance abuse
prevention, including tobacco and alcohol, and increased support
for existing school-based programs such as the Prevention,
Treatment and Rehabilitation Model Projects for High-Risk Youth.
In addition, the National Institutes of Health will be provided
increased funding for medical and behavioral research projects,
giving priority to substance abuse as a target for new research
dollars.
Page 3
The coverage for substance abuse in the Health Security Act is
intended to complement existing federal support for drug abuse
treatment services directed at the hard-core user population. The
Administration's Interim National Drug Control Strategy makes it
a priority to add to our Nation's treatment capacity. Pursuant to
the President's Executive Order of this week, Dr. Brown will
submit his recommendations for appropriate FY 95 funding levels
for treatment services to expand capacity and target the
treatment needs of hard-core drug users.
You can be assured of this Adminstration's commitment to
addressing the serious substance abuse problems facing our
Nation. If I can be of further assistance please contact me
directly.
Regards,
lemp
Ira C. Magaziner
Senior Advisor to the
President for Policy
Development
THE WHITE HOUSE
WASHINGTON
February 1, 1994
The Honorable John Conyers, Jr.
U.S. House of Representatives
Washington, D.C. 20515
Dear Congressman Conyers:
Thank you for writing about your concerns with the Acoess
Initiative in the Health Security Act. We recognize, as you do,
that a Health Security Card will not alone guarantee that all
Americans receive appropriate medical care. The programs in the
Access Initiative are designed to assure that individuals in
medically underserved communities have real access to the full
range of services in the comprehensive benefit package, needed
support services, and an adequate choice of culturally sensitive
providers and health plans. The Health Security Act proposed by
the President builds on the community and migrant health center
program and provides support for these centers and other
community-based providers.
You have raised specific concerns about the level of funding
for community and migrant health centers. The Health Security
Act authorizes $600 million in new funds for community and
migrant health centers over fiscal years 1995 through 2000. In
addition, a new capacity expansion program ($2.7 billion over
fiscal years 1995 to 2000) will be available to community and
migrant health centers as well as other providers in medically
underserved areas to build new health care facilities, support
capital improvements for existing facilities, and link current
primary care providers with inpatient institutions through
information systems and telecommunications. The enabling
services program ($1.2 billion over fiscal years 1996 to 2000)
will be available to community and migrant health centers as well
as other providers in medically underserved areas to provide
translation, transportation, child-care and outreach services.
Expansion of the National Health Service Corps ($950 million over
fiscal years 1995 to 2000) will increase the supply of
practitioners available to serve in community and migrant health
centers.
You also raised concerns about offsets in funding for Public
Health Service programs. The offsets do not represent a
reduction in the ability of Public Health Service programs like
community and migrant health centers to provide services. The
offsets represent the amount of federal appropriations that will
not be needed because, with universal coverage, health plans will
make payments for those services for those individuals who were
previously uninsured or underinsured.
Page 2
February 1, 1994
Finally, we agree that Access Initiative grants should
continue to reward community-based providers. The Access
Initiative will integrate publicly-funded providers with private
providers and health plans. To receive funding under this
program, providers and plans must demonstrate significant
community involvement as well as the ability to provide access to
health services for all individuals in underserved areas.
The Health Security Act calls for substantial new funds for
the Access Initiative over fiscal years 1995 through 2000. / We
are committed to assuring a secure funding stream for these
programs and look forward to working with you and other members
of Congress to define the appropriate mechanism to do so.
Please feel free to contact me with any additional concerns
or questions.
Sincerely yours,
Hilary Hillary Rodham Clinton