August 23,2009

NACHC Board Chair Anita Monoian Addresses the General Session at the 2009 NACHC Community Health Institute & Expo

By: Anita Monoian

What a pleasure to be in Chicago with colleagues, friends and partners of the National Association of Community Health Centers. And on behalf of the Board and Officers of NACHC, welcome to this our 40th Annual Community Health Institute and Expo. I think we all share the same feeling. We’ve been through an historic year/challenging year. And, it isn’t over yet as America strives to put its stamp of approval on a health reform bill, hopefully this fall, with its promise of accessible and affordable health care for all.

In NACHC we stand tall. Because of our work and the goals put forth in our ACCESS for All America plan, Community Health Centers are part of health reform. And, if enacted in some form of the House/Senate versions now on the table, we are looking at an expansion of the community health system to reach between 20 - 50 million additional people – over the next 10 years.
Above all, the reform bills make primary care -- I repeat -- it will make primary care a key focus in transforming the nation’s health care.

Everyone in this room deserves credit. All of you have been leaders: Health Center Boards/ Administrators, doctors and clinicians. You have shown that good health is more than hospitals and specialty care. That good health begins with access, disease prevention and a primary care health care home. Your work has proven the tremendous savings in models of practice that promote wellness, chronic disease management and education to help people take care of their health.
More, your work in providing the best care to those who otherwise would be forgotten or left behind – has earned great recognition.

Today, you give me highest honor to serve as Chair of the NACHC Board at this crucial moment in our history. It is often said that the reward for a job well done is more work!
And, we have been asked to do our part helping this nation build a higher quality health system – one that is affordable and one that guarantees every American access to health care.

Tomorrow’s challenges will stretch every bit of our skills, experience and commitment to take on a greater leadership role. So today, I stand before you and pledge to work with you – and with our NACHC Board and Officers and PCAs as we carry forward the Health Center Mission and prepare for the future ahead. And what a privilege to be a part of this great association of ours.

Like you, I started out in my career – fresh and idealistic – believing that I could make a difference and save the world. NACHC has given me the chance to work with men and women who believe as I do that health care is a basic human right. That ours is a moral responsibility to help those in greatest need. It has provided me with the tools and resources needed to do my job and keep my health center going. More than that: NACHC has joined my voice with thousands of others across this land. And together in our work and advocacy, I am proud to say, we have made a difference.

So I thank you and the many who have helped and mentored me along the way.
And this includes the good folks at my center in Washington State – Yakima Neighborhood Health Services. I am so proud of them and the progress we have made as a Federally Qualified Health Center. Not only have we expanded our programs, we have built a new facility and established ourselves as a training center for students pursuing careers in health.

Let me also acknowledge NACHC’s Board and Officers. This year with health reform on the horizon, each and every one of these good people have been on call. They have devoted hours of time as we have worked to develop the strategies and forge the decisions to move our centers front and center. They’ve done a great job for all of us – so please join me in a round of applause showing our appreciation.

Together, we have scored tremendous victories:

The Health Center Reauthorization
The CHIP Expansion and inclusion of PPS
The CHC funding increase of $125 million for the current fiscal year with its largest-ever base adjustment $56 million dollars.

And, it all led up to the $2 billion dollar investment in health centers under the American Recovery and Reinvestment Act. Most important -- it has helped us secure a prominent place in health reform.
That’s quite a record – so please join in giving a big hand to Lil Anderson in gratitude for a truly remarkable job as Board Chair these past two years.

Today as we begin a new year – the nation is fighting its way toward health reform. And, I use the word fight because, in every sense of the word, this is a fight. The battle for universal health care has been ongoing for the last 100 years since President Teddy Roosevelt.  And it's high time we win it.  At this hour, after months of congressional hearings and debate, the fate of health reform is still uncertain.  As legislation works its way to the House and Senate floors, it is impossible to predict what the final compromises will be. Whether the plan will broad or limited, whether it will include a public insurance option or be limited to insurance market reforms, or whether it will carry a mandate. Or just how it will be paid for in the long term. Granted there is growing public concern about the near trillion dollar costs of health reform plan in an economy ridden with debt.
There is also legitimate concern as to whether controls are sufficient to contain costs, or if the savings anticipated will be sufficient to ensure a budget- neutral plan, as called for by the President.   At the same, a lot of misinformation is being spread on television, radio and the Internet – as opponents of reform, once again, open up huge war chests in the effort to defeat passage.We all understand that change is often unsettling. Change can even seem threatening to some.
I believe that fear – more than any other factor is at play as we watch the contentious public debate now taking place at town meetings across the country.  And it is clearly being stoked by the opponents of reform and those who oppose our President, who, let’s all remember, ran and won election as an agent of change.

For our purposes, the bills meet NACHC’s core principles needed for successful reform.

Expansion of affordable health insurance coverage
Comprehensive coverage – with emphasis on primary care and preventive health services
Access to a quality community-based health care home for everyone

I stated earlier that the bills make provision for the growth of our community health system.
This potentially includes resources that will bring new health centers into areas of need, and strengthen existing health centers. In addition, the bills call for dramatic growth in the National Health Service Corps – up to a ten-fold increase in the program. Moreover, the bills would expand Medicaid coverage with PPS and require insurance plans offered in the marketplace exchanges to contract with health centers and other safety net providers. Clearly, health centers have been recognized in a substantial way. And, in the words of former Senator Tom Daschle, lawmakers, see us as part of the solution to addressing the issues of access, quality and cost in health care. It means that our message has resonated: That beyond insurance coverage, there is need for a strong primary care health system to expand access and deliver the quality care needed for savings in health and prevention.It also means that lawmakers recognize the value of health centers keeping people healthy and out of emergency rooms. So, yes, health reform presents an historic opportunity to build a new and better health care for tomorrow.

But first, we need a health reform package out of Congress and put on the President’s desk.
The jury is still out! So each and every one of us in the days and weeks ahead need to be drumming up support, moving our Representatives and Senators to do what’s right and what’s best for the nation and pass a comprehensive health reform bill!

Our voice is critically needed in the ongoing debate, letting people know how health reform stands to benefit all of America – and why health centers are a key component of that package.
People must understand: Neglected/untreated health problems carry a price tag -------
It’s an enormous price which YOU and I and everyone pays for in deteriorating community health status – lost productivity – multiple social ills and costly debilitating disease.

The stakes for health centers and the country are high! We cannot let the debate on health reform degenerate and be driven by fearmongers – and those who have a vested interest in the status quo. With nearly 50 million Americans uninsured and underinsured – and millions more without providers, America needs health reform and a strong primary care foundation to help meet those needs.
Yet, as we await the outcome of health reform and anticipate a new health care landscape --- we must ready ourselves for new challenge. First: Sustaining a stable resource base will be a paramount in the coming year. Already, we are seeing this play out with our health center appropriations for FY 10, which are level funded. At the same time, states are slashing budgets due to the recession and declining tax revenues. It’s not a pretty picture: cutbacks in Medicaid, CHIP and other programs affecting the lives of vulnerable populations. In my own state of Washington --- we are confronting a $1.2 billion dollar cutback in Medicaid! For health centers the prospect is more uncompensated care – the loss of state primary care grants and reduced provider payments.
While support for health centers may be at its strongest – times are perilous as our nation struggles for fiscal stability. Make no mistake, we face a prolonged period of austere budgets as lawmakers clamp down on expenditures. We will all have to work harder to ensure a stable resource base –and that includes fair and reasonable provider rates and participation in any reformed insurance package. And I need not remind you: The $2 billion stimulus investment under the Recovery Act was one- time funding only. That’s why it’s so important that a comprehensive health reform is passed to help us sustain what we have put in place under the stimulus, and to ensure that we have the financial base and workforce needed for future growth.

Yet, looking ahead, it is the shortage of primary care providers that stands as our biggest challenge. To meet the goal of serving all 60 million of the nation’s medically disenfranchised, health centers will require as many as 50,000 additional clinicians. Thanks to Lil Anderson, our State Primary Care Associations and others, we have made headway. Our work has produced results. The first funding increases for the National Health Service Corps in many a year. The stimulus itself directs $300 million to double the size of the Corps. Another $200 million of the stimulus is targeted to strengthen health professions and nurse training programs. Yet – all of it is not near enough to provide solution. Dr. Wakefield calls it a “booster shot.”But surely, we are not about to give up! Now the work begins as we move with HRSA and others and give priority to a long-range national strategy that can meet this challenge head on. In addition, we have to build the pipelines running from our centers to our medical schools and hospitals and directly into our communities. It entails leading and mentoring young people into careers in community health – similar to what we are currently doing at A.T. Still University in Arizona. It also involves working with medical schools to refocus teaching curriculums. Changing attitudes toward primary care open new opportunity for us – and we need to take every advantage! And no question: We definitely need more residency training programs established at health centers. I, for one, see great promise in this based on our programs at Yakima that expose students to the health center model.

Another challenge of no less importance is advancing health information technology. President Obama and Congress are placing great faith in technology as part of the health reform equation. Stimulus funding of as much as one billion dollars for health centers will provide a tremendous boost for the acquisition of HIT. Every FQHC is eligible for Medicaid payments of up to $64,000 for each physician, dentist, nurse practitioner, and physician’s assistant over the next 6 years for the adoption and use of Electronic Health Records. Our job will be to integrate these complex systems into our practices to facilitate data collection and to maximize their use to promote quality initiatives and best practice models.

In the new health care – health centers must be positioned as leaders, paving the way for an improved, well-coordinated, and innovative health delivery system. Technology is the key that will help us do that. Finally – We need strong leadership as we are engage in the massive challenge of building a primary care foundation for All of America. The nation and its leaders have placed great confidence in us. Now we must shoulder that responsibility and deliver. It demands all of us working together to bring forth the ideas, innovations and leadership that can improve the health of this nation. It means a strong commitment to learning, sharing knowledge and collaboration. Moreover, we must partner with our communities, governments, hospitals, medical schools, and others to ensure that primary care and community health are recognized and sustained as national priorities. Today, we are building a system of care for the nation and we have to do it together to succeed. And, it requires membership and active participation in NACHC and our State PCAs.

Trainings, technical assistance and support services will be essential helping us do our jobs. That includes:

Board trainings to enhance governance
Financial trainings to help health centers manage resources and strengthen accountability
Clinical trainings to drive quality improvements
Leadership development to enhance skills and business acumen.

And, once again, statewide strategic planning will be imperative to guide us in growth and all that will be required for development and success. Our history has taught us that to achieve ambitious goals WE NEED EACH OTHER. Moreover, we need to be a team now and into the future so that we continue to be the strongest advocates for our health centers and the patients and communities we serve.

So let us move forward. Together, let us meet the challenges of tomorrow, leading our nation to a more equitable health care system and a stronger and healthier America.

I look forward to your support and I thank you, again, for your commitment and leadership. You continue to inspire the dream and vision for America’s Health Centers.

Thank you.

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