Service Members Home Ownership Tax Act Of 2009

Floor Speech

Service Members Home Ownership Tax Act Of 2009

BREAK IN TRANSCRIPT

Mr. SANDERS. Mr. President, there are at least two major goals we have to achieve in health care reform and that is we have to expand access to everyone in America, and we have to control costs. We focus a lot on expanding insurance but expanding insurance is not expanding access. There are people today in America who have insurance but they do not have access. The fact is, we have 60 million people who do not have access to a physician on a regular basis and many of those people--according to recent studies, 45,000--may die because they do not get to a doctor in a timely manner. By the time they walk into the doctor's office their situation is terminal.

We need substantially improved access to health care. When we improve access, we save money because people do not go to the emergency room, they do not end up in the hospital, sicker than they otherwise would have been. We need a revolution in primary health care in America. Unless we do something and do it now, our primary health care system infrastructure is close to collapse.

We have an aging primary care workforce which is not being replaced. At a Senate hearing I chaired earlier this year, it was noted that only 2 percent of internal medicine residents were choosing primary care as their specialty. Happily, there are two Federal programs that can both assure access and control costs, and I refer to the Community Health Center Program and the National Health Service Corps. Both are well-established programs that have garnered broad bipartisan support because of their proven cost effectiveness.

What a federally qualified community health center is about--and I believe they exist in all States in this country. They have widespread support from Members of the Senate and the House of both political parties. What they are about is saying that anyone in an underserved area can walk into that facility and get health care, either Medicaid, Medicare, private insurance, or a sliding scale--if you don't have enough money, you pay on a sliding scale basis--and low-cost prescription drugs.

This is a very successful program that now provides health care to over 20 million Americans and it is a 40-year-old program, again supported widely in the House and the Senate.

I am pleased that in the Senate bill, it recognizes the importance of both federally qualified community health centers and the National Health Service Corps. The National Health Service Corps is a long-established Federal program which says to people in medical school: We are prepared to provide debt forgiveness to you--on average, I know in Vermont, people are coming out $150,000 in debt--if you are prepared to work in primary health care in an underserved area.

In the Senate bill we recognize the importance of the federally qualified community health centers and the National Health Service Corps. In fact, our bill calls for authorization levels that, if appropriated, would enable the Community Health Centers Program to expand to every underserved area within 5 years, and would result in supporting at least 40,000 more primary care professionals in the next 10 years--doctors, nurses, dentists.

But we can and must improve the Senate bill. I favor very strongly the language in the House bill which calls for a dedicated trust fund with mandatory annual spending for community health centers and the National Health Service Corps. In other words, in the Senate we have authorized funding. The House has established a trust fund to actually pay for it. The Senate bill contains authorization levels that would be sufficient to fund a community health center in every underserved area in America and thus provide primary health care to 60 million more people by the year 2015. These are people who do not have to go into the emergency room, they don't have to go into the hospital because they are sicker than they should have been. They are going to get timely, cost-effective health care at a community health center.

Therefore, let me be very clear: I favor the language in the House bill which includes community health centers in its Public Health Investment Fund and guarantees mandatory funding for health centers totaling $12 billion over the next 5 years. This is in addition to the $2.2 billion current annual appropriation for community health centers which, it is anticipated, would also continue to be appropriated in each of the next 5 years. While this House funding level will not achieve a community health center in every underserved area, it will take us very far toward that goal, bringing primary care health services to some 40 million citizens living in underserved areas. Also in the House bill there is appropriated money to greatly expand the National Health Service Corps.

In the middle of all this discussion on health care, health insurance, let us not forget a few basic points. Sixty million Americans do not have access to a doctor. We need a revolution in primary medical care. We need to make sure we have the physicians, nurses, and dentists who are going to get out in underserved areas. The Senate bill provides authorization. The House bill provides a trust fund for community health centers and for disease prevention in general. My strong hope--and I am going to do everything I can to make sure it happens--is that the Senate adopts the House provisions.

If we are serious about providing health care to all Americans, we have to expand community health centers, we have to make sure there are primary health care doctors, dentists, nurses out there.

In addition, we need to focus on disease prevention. I know my colleague from Iowa has worked very hard on that. So we have to support the trust fund in that area.

I yield to my friend from Iowa.

BREAK IN TRANSCRIPT

Mr. SANDERS. Let me mention to my friend, in the State of Vermont, the poorest region of our State borders on Canada. It is called the Northeast Kingdom, in the northeast part of the State. For 30 years we have had a number of community health centers in that region. Do you know what? Amidst all of the poverty, all of the unemployment, all of the economic problems, we do not have a problem in terms of primary health care in the poorest area of the State of Vermont precisely because of these community health centers, which you indicate address dental care, which we often forget about, mental health counseling, we forget about, low-cost prescription drugs.

I look forward to working with the chairman of the HELP Committee and others to make sure we fund the kind of revolution we need in disease prevention, in primary health care, which at the end of the day improves people's health, keeps them out of the emergency room, keeps them out of the hospital, saves us money.

Study after study: Saves us money.

BREAK IN TRANSCRIPT

Mr. SANDERS. Let me concur. In the State of Vermont we have gone from 2 to 8 with 40 satellites. Over 100,000 people in Vermont are now accessing community health centers for their primary health care.

The other point we don't often make about community health centers is they are democratically run, they are run by the communities themselves. My experience is exactly that of the Senator from Iowa. They are community health centers.

In rural areas it is not rich or poor. By and large, most of the people, regardless of income, go there. The doctors are there for a long time. The dentists are there. It is, in fact, in the best sense of the word, a community health center open and accessed by all people. People take responsibility for it because it is democratically run. It is a program--one of the bright shining stars of public health in America. I hope to work with the chairman of the HELP Committee to make sure these programs are funded adequately in this bill and that we adopt the language in the House, which goes a long way.

I yield the floor.

BREAK IN TRANSCRIPT

Source