March 31, 2000
Frist Safety Net Hearing Addresses NHSC Reauthorization
The Senate Health, Education, Labor and Pensions Subcommittee on Public Health and Safety, chaired by Sen. Bill Frist (R-Tenn.), held a hearing March 23 on the role of safety net providers in providing health care to the uninsured. The hearing focused on three programs, the National Health Service Corps (NHSC), the Community Health Centers (CHC) program, and the Community Access Program (CAP). The NHSC is up for reauthorization this year, the CHC program in 2001 and the CAP, an administration initiative to help community providers link into more modern and efficient networks, currently is funded but not authorized by Congress.
In the first panel, Claude Earl Fox, M.D., M.P.H., administrator of the Health Resources and Services Administration, described the "huge untapped potential" of the NHSC program and decried the program's "terribly inadequate resources." Dr. Fox called the NHSC and CHC programs the "linchpin" of the CAP and hoped the three programs could help weave together a better system to make sure uninsured people receive care. In response to questioning from full Committee Chairman Jim Jeffords (R-Vt.), Dr. Fox stated that the current tax liability associated with the NHSC scholarship and loan repayment programs is reducing the incentive to participate, as well as reducing the number of potential awards as the NHSC provides extra payments to cover the additional liability.
Jan Heinrich, Dr.P.H., R.N., associate director of health financing and public health issues at the U.S. General Accounting Office (GAO), testified that while both the NHSC and CHC programs are important safety net providers, improvements could be made. With regard to the NHSC, Dr. Heinrich made four recommendations. The first recommendation is to modify the current ratio of funding between the scholarship and loan repayment programs and focus the scholarship program on areas with critical needs that cannot be met through the loan repayment program. GAO justified this recommendation with data showing that loan repayment costs less than the scholarship program, and that participants are more likely to remain in underserved areas following their service requirement. Second, GAO recommended improving the current system for designating shortage areas. Specifically, GAO would like to see non-physician health professionals and current NHSC scholars and loan repayers figured into the calculations. Third, Dr. Heinrich recommended that the current placement system be improved to ensure that minimal needs are met in all areas before multiple providers are assigned to one site. The fourth and final recommendation from GAO was to improve coordination between the NHSC and the J-1 visa program. Currently J-1 visa physicians in underserved communities outnumber NHSC physicians and no federal agency has direct oversight responsibility for the program. GAO recommends establishing a distinct program for J-1 visa physicians and coordinating their placement with NHSC placements to address the needs of as many underserved communities as possible.
Information: Jonathan Fishburn, AAMC Office of Governmental Relations, 202-828-0525.
