Expanding Primary Care Access

Congress and President Obama assigned HRSA primary responsibility for implementing 50 provisions of the Affordable Care Act, the healthcare reform law signed by President Obama in early 2010. Most of HRSA’s ACA funds – together with investments from the 2009 Recovery Act – have been used to expand access to primary care through growth in our health center network and the National Health Service Corps, and to bolster the training of primary-care practitioners. 

The ACA invested $11 billion through 2015 in the expansion of the health center network; that followed a $2 billion investment under the Recovery Act.  That support helped health centers increase the number of patients they serve from 17.1 million in 2008 to about 19.5 million patients in 2010, the latest year for which figures are available.

The increase in the National Health Service Corps as a result of ACA and Recovery Act investments totaling $1.8 billion has been even more dramatic.  Since President Obama took office, the number of Corps clinicians has nearly tripled.  Today, more than 10,000 NHSC members – doctors, nurse practitioners and other healthcare providers – provide primary-care for underserved Americans. The NHSC pays down the academic debt of certain health professionals in exchange for their pledge to practice in an underserved community.  For a two-year commitment, HRSA pays up to $60,000 in school loans – and up to $170,000 for five years.

An important benefit of the expansion of the health centers and the NHSC is that an increase in the provision of primary care means new jobs for communities that often are struggling with high rates of unemployment. In fact, the expansion of the health center network has led to the hiring of thousands of new healthcare professionals and support staff, increasing employment from 113,000 employees to more than 131,500 full-time positions nationwide.  Furthermore, construction jobs have been created where new grantees have built facilities and where existing grantees have renovated or expanded existing centers.

Recently, President Obama announced a new initiative to support the hiring of military veterans at health centers, challenging health centers to hire at least 8,000 veterans in the next three years – with a particular focus on those with backgrounds as military medics and corpsmen. On a parallel track, the president also has directed HRSA to give priority in awarding grants to universities and colleges in support of physician-assistant programs that help train veterans.  In addition, HRSA will give funding priority to nursing schools that offer pro-veteran learning environments, recruit and support veterans interested in pursuing nursing careers, and facilitate academic credit for enlisted healthcare training. 

More broadly, all health professions have benefited from ACA and Recovery Act funds directed to HRSA to train the next generation of primary-care professionals. HRSA invested $200 million from the Recovery Act in colleges, universities and other training centers to advance a variety of health professions goals – with an emphasis on retaining and expanding primary care faculty, boosting the participation of disadvantaged and minority candidates and promoting continuing education curriculum development.  Adding to that, the ACA included a $250 million package of grants to training institutions.

Together, these ACA and Recovery Act investments will support the training and development of thousands more primary care providers over the next five years. 

Emphasizing Prevention

A major focus of our work has emphasized the integration of public health and primary care services. This is critically important because the health of an individual is, to a significant degree, influenced by the health of the larger community, and the health of America’s myriad neighborhoods and communities determines the nation’s overall health. Investments in primary care result in fewer expenses down the road – fewer clinic visits or trips to the hospital. The best, most cost-effective way to manage chronic illness is to prevent it in the first place.  This pro-prevention theme runs throughout the Affordable Care Act.

Provision after provision of the new law drives toward these goals, including more and better screening services – at low or no cost to patients – to catch health problems early. For example, the ACA gives HRSA responsibility for administering a new $1.5 billion Maternal, Infant, and Early Childhood Home Visitation Program in partnership with state governments. Under this model, nurses, social workers and others engage with pregnant women and their families in high-risk communities.  There they provide evidence-based counseling and intervention services that are known to improve health outcomes.

States apply most of the Home Visiting funds they receive from us to implement one of several proven home visiting models – based on community needs assessments to determine which might work best in a particular location. This program addresses a glaring need.  Too often, high-risk mothers and infants are wrapped in state-of-the-art technology while at the hospital, then sent home with very little help, only to return later through the emergency door. That isn’t in the interest of the infant, the mother, or the public imperative of holding down healthcare costs.

To summarize, HRSA’s programs play a pivotal role in the federal effort to provide healthcare to underserved families and communities across the United States.  In 2012, we will work to expand the benefits of the Affordable Care Act through the programs we administer.  In addition, we will use the resources entrusted to us to make primary health care more available to all Americans.

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