Congressional Record—Senate S2429
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April 11, 2019 CONGRESSIONAL RECORD — SENATE S2429 and hypertension, and remove minor skin age a chronic condition or get a referral to a four other federal health programs, which cancers right in his office. specialist. Today, I am interested in hearing are all set to expire at the end of this fiscal Second, by keeping you out of the emer- more about specific recommendations to im- year. gency room. For $60 a month, patients have prove access to affordable primary care. Community health centers actually fit unlimited office visits, and they can also f into a larger topic of great interest to this email, text, call and use an app to contact Committee, which is primary care. There are his office—anytime, day or night. So for ex- ACCESS TO CARE: HEALTH CEN- more than 300,000 primary care doctors in ample, if you have stomach pains at 11 pm, TERS AND PROVIDERS IN UN- the United States, according to the Amer- you could text Dr. Gross, who knows that it DERSERVED COMMUNITIES ican Medical Association. This is the doctor might just be a side effect of a new medicine Mr. ALEXANDER. Mr. President, I that most of us go to see for day-to-day med- he prescribed you. ical care—an annual physical, flu vaccine, or And third, primary care is patients’ access ask unanimous consent that a copy of help managing a chronic condition like dia- point to more advanced care. When Dr. Gross my opening statement at the Senate betes. It is our access point to additional refers people for additional care, he is able to Health, Education, Labor, and Pen- medical care, and can refer us to specialists, provide cost and quality information about sions Committee be printed in the if, for example, we need to get our hip re- the different options, so his patients can RECORD. placed or a MRI. choose the best option. There being no objection, the mate- Adam Boehler, who leads the Center for For example, one of his patients with rheu- rial was ordered to be printed in the Medicare and Medicaid Innovation, esti- matoid arthritis was quoted $1,800 for blood mated that primary care is only 2–7 percent RECORD, as follows: work, but Dr. Gross was able to find a lab- of health care spending but could help to im- oratory to offer the blood tests for under ACCESS TO CARE: HEALTH CENTERS AND pact as much as half of all health care spend- $100. This echoes what Adam Boehler, who PROVIDERS IN UNDERSERVED COMMUNITIES ing. leads the Center for Medicare and Medicaid Mr. ALEXANDER. This is the first hearing We will be having a hearing next week on Innovation, recently told me. He estimated of the new Congress so let me take a few how primary care can help control health that primary care is only 3–7 percent of minutes to talk about what we hope to ac- care costs. Today, we are talking about a health care spending but affects as much as complishment these next two years. prime example of primary care: 27 million half of all health care spending. And as Dr. Number one, reducing health care costs. Americans receive their primary care and Roizen of the Cleveland Clinic has said be- And number two, making sure a college de- other services at community health centers. fore this Committee, regular visits to your gree is worth students’ time and money. For example, in Tennessee, after Lewis primary care doctor, along with keeping On health care costs, this Committee has County’s only hospital closed, the closest your immunizations up to date and main- held five hearings on reducing the cost of emergency room for its 12,000 residents was taining at least four measures of good health care. Testimony from Dr. Brent 30 minutes away. The old hospital building health, such as a healthy body mass index James, a member of the National Academy was turned into the Lewis Health Center, a and blood pressure, will help you avoid of Medicine, said that up to half of health community health center which operates as chronic disease about 80 percent of the time. care spending is unnecessary. something between a clinic and full hospital. That startled me and it should startle the This is important because, according to Dr. Lewis Health Center estimates they can American people. That is a massive burden Roizen, over 84 percent of all health care deal with about 90 percent of patients that on American families, businesses, and state spending is on chronic conditions like asth- walk in the door. The center has a full lab- and federal budgets. ma, diabetes, and heart disease. I believe we oratory to run tests, can perform X-rays or I sent a letter to health experts, including can empower primary care doctors, nurse give IVs, and keeps an ambulance ready to the witnesses at our five hearings, asking for practitioners, and physicians assistants to take patients to a partnering hospital if they specific recommendations to reduce health go even a step further. need more care. Because the Lewis Health At our fourth hearing, we heard about how care costs. I’d like to encourage anyone with Center is a community health center, they the cost of health care is in a black box—pa- a specific recommendation to submit your charge patients based on a sliding scale tients have no idea how much a particular comment by March 1 to which means more people have access to and treatment or test will end up costing. Even [email protected]. can afford health care. if information on the cost and quality of A second priority is updating the Higher Community health centers like Lewis health care is easily accessible, patients still Education Act to ensure that the expense of Health Center are one way American fami- have trouble comparing different health care a college education is worth it for students. lies can have access to affordable health care options. The last time we seriously addressed higher For example, earlier this year, hospitals education was in 2007. A lot has happened close to home. This includes a wide range of began to post their prices online, as required since then. health care, including preventive care, help by the Centers for Medicare and Medicaid In 2007, there was no iPhone. A micro- managing chronic conditions like asthma or Services, but to the average consumer, this blogging company named Twitter had just high blood pressure, vaccines, and prenatal information has proved to be incomprehen- gained its own separate platform and started care. There are about 1,400 federally-funded sible. to scale globally. And Amazon released health centers that provide outpatient care And while the data may be incomprehen- something called Kindle. In a new book, New to approximately 27 million people, includ- sible today, it is a ripe opportunity for inno- York Times columnist Tom Friedman puts ing 400,000 Tennesseans, at about 12,000 sites vation from private companies, like Health his finger on the year 2007 as ‘‘the techno- across the United States. These other loca- Care Bluebook, a Tennessee company that logical inflection point.’’ So we need to take tions could be a mobile clinic or at a home- testified a hearing last fall, and non-profit a look at this federal support for higher edu- less shelter or school. organizations to arrange the data so primary cation that affects 20 million students and Community health centers have also been care doctors, nurse practitioners, and physi- 6000 universities, colleges, and technical in- an important part of combating the opioid cians assistants can help their patients have stitutions. And our goal includes simplifying crisis that has impacted virtually every com- better outcomes and better experiences at the federal aid application; a fairer way for munity across the country. lower costs. students to repay their loans; and a new sys- Last year, the Department of Health and There are other ways to lower health care tem of accountability for colleges. Human Services provided over $350 million in costs through expanded access to primary I will be working on these priorities with funding specifically to support community care. Dr. Gross’ direct primary care clinic is Ranking Member Patty Murray, with mem- health centers providing care for Americans one example. Another is community health bers of the HELP Committee, and other Sen- in need of substance use disorder or mental centers, which we talked about at our last ators interested reaching a result on low- health services. hearing and that are where 27 million Ameri- ering health care costs and updating the And in 2017, 65,000 Americans received cans go for their primary care. And employ- Higher Education Act. medication-assisted treatment for substance ers are increasingly taking an active role in We hope to complete our work on both of use disorders at a community health center. their employees’ health and in the cost of these things in the first six months of this These centers accept private insurance, health care. year. Medicare and Medicaid, and charge patients One of our new committee members, Sen- And in addition, in these next few months, based on a sliding fee scale so that those who ator Braun, was an employer of a thousand we need to reauthorize the Older Americans are in need of care receive it, regardless of people and was aggressive about helping his Act, which supports the organization and de- ability to pay. employees reduce health care costs. Like pri- livery of social and nutrition services to Community health centers also receive mary care doctors, more good data could older adults and their caregivers and reau- federal funding to help cover their costs.