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Public Statements

Statements on Introduced Bills and Joint Resolutions

Floor Speech

By:
Date:
Location: Washington, DC


STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS -- (Senate - November 19, 2008)

BREAK IN TRANSCRIPT

By Mrs. CLINTON:

S. 3706. A bill to amend part D of title IV of the Social Security Act to prohibit States from charging child support recipients for the collection of child support; to the Committee on Finance.

Mrs. CLINTON. Mr. President, in a time of rising prices and historic economic turmoil, single parents deserve our support more than ever. That is why I am introducing the Elimination of the Single Parent Tax Act of 2008. I am proud to join my colleague Congresswoman GILLIBRAND in introducing this important legislation to help single parents by suspending State fees to fund child support enforcement.

Many states, including New York, were forced to institute this fee after the Republican-lead Congress passed the Deficit Reduction Act of 2005, which slashed funding for child support enforcement. The fee is expected to affect 170,000 families in New York alone. These single parents need every penny of their child support income to go towards food, medicine, and other important expenses. The Elimination of the Single Parent Tax Act ensures that hard-working single parents don't face an extra tax.

In September, I joined my Senate colleagues in urging the Senate Appropriations Committee leadership to increase funding for child support enforcement to stave off these deep cuts. And today, I encourage my colleagues to join me in sponsoring this critical measure to support single parents.

For too long, single-parent households have been ignored at a time when raising children has only become more of a struggle. Yet despite these challenges, single parents heroically soldier on. This bill is only a critical first step to a more comprehensive approach to supporting single parents raising children. I look forward to continuing to fight in the Senate to stand up for our most vulnerable children and our hardest-working families.

By Mrs. CLINTON:

S. 3707. A bill to recruit, train, and support principals for high-need schools who are effective in improving student academic achievement; to the Committee on Health, Education, Labor, and Pensions.

Mrs. CLINTON. Mr. President, I rise today to introduce legislation to address the urgent need of our underserved urban and rural school districts by creating a corps of principals who are well-prepared, supported, and effective in improving student academic achievement in high-need schools and ensuring our schools are provided the leadership they need to prepare our children to compete in the 21st century.

The U.S. Department of Labor estimates that nearly 40 percent of the 90,000 principals in this country are nearing retirement, and over half the Nation's school districts are facing immediate administrator shortages. This problem is particularly prevalent in urban and rural districts with large concentrations of high-poverty schools, where turnover rates can reach as high as 20 percent per year, and academic achievement is persistently low.

That is why I'm introducing the National Principal Recruitment, NPR, Act, which seeks to address the impending shortage by establishing a corps of principals who are well-prepared, supported, and effective in improving student achievement in high-need schools. This corps is created through the recruitment of results-oriented candidates who possess personal leadership and management skills, knowledge of effective instruction, and commit to serve in high-need schools for over 5 years. Once selected, these candidates would undergo a year-long principal residency program, and receive support and mentoring to help them develop and maintain a data-driven, professional learning community.

This bill leverages non-Federal dollars with targeted funding to performance-based work done in partnership with school districts. It also includes an evaluation to capture knowledge and best practices and creates a prototype of a performance-based Federal education program by tying funding levels to an evaluation of student achievement results.

An effective and capable school leader can make the difference in providing the tools and instructional support needed to foster the type of school environment conducive to student academic success. The NPR Act will ensure that our neediest schools have effective leaders, who are well-equipped and supported, to close the achievement gap and prepare our students to compete in a global economy.

I am hopeful that my Senate colleagues from both sides of the aisle will join me today to move this legislation to the floor without delay.

By Mrs. CLINTON:

S. 3708. A bill to amend the Public Health Service Act with respect to health professions education, and for other purposes; to the Committee on Health, Education, Labor, and Pensions.

Mrs. CLINTON. Mr. President, today, I am introducing the Health Professions and Primary Care Reinvestment Act in order to improve access to quality health care for all Americans. By significantly reinvesting in the training and education of our health professionals, we are reinvesting in our communities where care is most needed.

This bill reinvests in health professional training in three ways--by expanding the training our health professionals receive, by improving our efforts to recruit and retain health professionals, and by increasing incentives for health professionals who are serving in community settings, particularly in rural and urban underserved areas.

Most Americans prefer to get their health care through a personal physician operating as part of a team-based primary care practice, yet the number of health professional students entering these fields is decreasing. We need more workers in primary care at the front lines of the health care system. Primary care professionals can help to establish a ``medical home'' for patients, providing preventive care to help people stay healthy and provide coordination of care for those with multiple or chronic diseases. This bill would achieve this goal by providing incentives for training primary care professionals, by strengthening primary care departments at the school and community level, and by supporting improved infrastructure to assist those serving in primary care settings.

Minorities, disadvantaged and rural students are underrepresented in our health professional workforce. We need to increase their numbers in the medical fields, and provide incentives for them to return to underserved areas to practice. As an example of what can be done, one program targeting rural students has returned eight times the usual number of trained family physicians to rural settings. We need to train people from all backgrounds--from underrepresented minorities, from disadvantaged backgrounds, from rural and urban underserved communities. This bill helps to achieve this goal by strengthening pipeline programs, expanding loans and scholarships, and by increasing the availability of care in underserved communities.

We need health care where people live and work. Americans should be able to access care in communities that are located far from hospitals and medical centers, in the poorest neighborhoods of cities and isolated rural areas. We need to support the institutions that the most vulnerable rely on for care, like community health centers, local departments of health, and nursing homes. This bill supports new models of care for training, recruiting, supporting and retaining faculty to serve in underserved settings, and provides infrastructure support for training students in community settings outside of the hospital, where patients need care.

In addition to addressing primary care, the legislation also works to address other health fields which are often inaccessible to patients. Dental care in the United States has become a luxury that is unaffordable to many people. Dentists are often unable to sustain careers by teaching in dental schools training the next generation of professionals, or to work in communities where the need is greatest. This bill provides support for dentists to pursue academic teaching careers and to provide general care to both adults and children. It targets underrepresented minority dentists and those who will serve in communities where the need is greatest.

One impediment to good health for people with mental health problems is lack of care coordination. Too often the psychological problem goes undiagnosed or untreated, because our health care system operates in silos. Patients are often asked to go one place to meet physical health needs and another place to meet mental health needs. This bill provides support for training and care where the health professionals work together to co-manage mental health and physical health problems toward better overall health.

We, as a nation, are getting older. As we age, our health concerns change. Many seniors take multiple medications which need to be coordinated by a team of doctors, pharmacists, and other caregivers. The Health Professions and Primary Care Reinvestment Act reinvests in our geriatric training programs by expanding opportunities for doctors, pharmacists, psychologists, dentists and others to work with patients in rehabilitation centers, at home, in nursing homes or other settings where people live or work.

Our public health and preventive medicine professionals respond to crises like SARS, anthrax, and other infectious disease outbreaks. But they also work to educate the public about ways to stay healthy, and prevent chronic diseases. They contribute to the health care safety net with services like adult and childhood vaccinations. This bill helps to support these efforts by reinvestment in training for prevention. It links schools of public health with local and State departments of health in order to train professionals to work and serve in settings where they are most needed.

Finally, and very importantly, we must better understand the demands that will be made upon our health professional workforce. This bill provides authorization for the formation of a national and multiple regional health workforce analysis centers, along with an advisory committee comprised of administrative and health professional leadership. These entities will assess, review and oversee health professional workforce needs so that we can plan and prepare a new generation of health professionals in our schools and communities.

The Health Professions and Primary Care Reinvestment Act addresses the multiple challenges facing healthcare workforce development in our country. It will invest in primary care, expand the number of health professionals truly representative of the communities they serve, and improve the availability of care in places where Americans need it most. I look forward to working with my colleagues in the Senate on the many issues of our health care workforce, and I would urge their support of this legislation.

Multiple organizations, including Advocating for Family Medicine, American Academy of Family Physicians, American Academy of Physician Assistants, American Association of Colleges of Osteopathic Medicine, American College of Preventive Medicine, American Dental Association, American Dental Education Association, American Geriatrics Association, American Osteopathic Association, American Psychological Association, Association of Departments of Family Medicine, Association of Family Medicine Residency Directors, Association of Minority Health Professions Schools, Inc., Association of Schools of Public Health, Hospital Association of New York State, National AHEC Organization, National Council for Diversity in the Health Professions, North American Primary Care Research Group, Society of General Internal Medicine, and the Society of Teachers of Family Medicine have endorsed this legislation.

Mr. President, I ask unanimous consent that letters of support be printed in the RECORD.

There being no objection, the material was ordered to be placed in the Record, as follows:

ADVOCATING FOR FAMILY MEDICINE,

Washington, DC, November 18, 2008.
Hon. HILLARY RODHAM CLINTON,
U.S. Senate,
Washington, DC.

DEAR SENATOR CLINTON: On behalf of the undersigned organizations, we would like to thank you for introducing the Health Professions and Primary Care Reinvestment Act. Health professions programs, authorized under Title VII of the Public Health Service Act, are vital to enhancing and expanding our nation's health workforce. The Health Professions and Primary Care Reinvestment Act reauthorizes, improves, and revitalizes these programs.

Within the primary care cluster (Section 747) we are very pleased to see the following:

Continued support for programs that have proven successful--training in primary care and capacity building in primary care.

New recognition that an environmental scan of the community and region is a necessary precursor to development of creative training programs that will get primary care physician training out into the community, rather than training remain mostly within the academic health centers.

Recognition that production of primary care physicians must be increased.

Recognition that funding for these programs must increase in order to provide a well-prepared workforce for the 21st century, particularly as we move to health care reform.

In addition, within the scope of the bill as a whole, we appreciate the modification of the statute so that all of the programs authorized by the bill have similar goals and expected outcomes.

As the Senate begins its work on overall health care reform, we support your efforts to have this bill serve as one of the foundations of reform. True health reform in this country will not be possible without including programs that increase the number of well-trained health professionals. As the Massachusetts experience clearly demonstrates, increasing the number of insured individuals will not ensure increased access to care if there are not enough doctors to treat the newly insured.

As you know, Title VII Health Professions Programs, particularly those authorized under Section 747, are designed to strengthen our primary care infrastructure. Studies have shown that areas which depend more heavily on primary care within their health care system spend less on health care and have better health outcomes. For example, a study published in Health Affairs from April, 2004 found, ``States with more general practitioners use more effective care and have lower spending, while those with more specialists have higher costs and lower quality.'' (Baicker and Chandra) We know that health reform has two goals: bettering the health of our nation and keeping it as cost efficient as possible. Increasing the proportion of primary care medicine is a major step towards meeting both of these goals, and Title VII, Section 747 programs are the only federal programs that aim to increase the number of primary care physicians.

Title VII programs have also demonstrated the ability to produce physicians that serve in underserved areas. A recent article in Annals of Family Medicine (Rittenhouse, et al 2008) shows that students and residents exposed to Title VII funding are more likely to participate in the National Health Service Corps or practice in a community health center upon completing their training. Both of these programs successfully place physicians where they are most needed.

Thank you for all of your hard work on the Health Professions and Primary Care Reinvestment Act and for your continued leadership and dedication to health care throughout your career. We urge you to ensure that this important piece of legislation makes its way through the legislative process and is passed as quickly as possible.

Sincerely,


Scott Fields, MD,


President, Society of Teachers of Family Medicine.


Eilssa Palmer, MD,


President, Association of Family Medicine Residency Directors.


Michael K. Magill, MD,


President, Association of Departments of Family Medicine.


Ted Epperly, MD, FAAFP,


President, American Academy of Family Physicians.


Allen Dietrich, MD,


President, North American Primary Care Research Group.

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AMERICAN ACADEMY OF

PHYSICIAN ASSISTANTS,

Alexandria, VA, November 19, 2008.
Hon. HILLARY RODHAM CLINTON,
U.S. Senate,
Washington, DC.

DEAR SENATOR CLINTON: On behalf of the nearly 75,000 clinically practicing physician assistants (PAs) in the United States represented by the American Academy of Physician Assistants (AAPA), I thank you for introducing the Health Professions and Primary Care Reinvestment Act of 2008. The reauthorization of the Public Health Service Act's Title VII Health Professions Programs is a top priority of the AAPA. Accordingly, AAPA is pleased to support this legislation, and looks forward to working with you and your colleagues in the Senate and House of Representatives to secure the strongest possible investment in and reinforcement of the nation's primary care workforce.

The Title VII safety net programs are essential to the development and training of primary health care professionals and, in turn, provide increased access to care by promoting health care delivery in medically underserved communities. Title VII funding is especially important for PA programs as it is the only federal funding available on a competitive application basis to these programs.

A review of PA graduates from 1990-2006 demonstrates that PAs who have graduated from PA educational programs supported by Title VII are 59 percent more likely to be from underrepresented minority populations and 46 percent more likely to work in a rural health clinic than graduates of programs that were not supported by Title VII.

The AAPA is very pleased to see included in this legislation several very important updates and additions to the Title VII statute related to physician assistant training. Specifically, the updated definition of PA education programs is long overdue and accurately reflects the educational preparation of PAs, as well as the definition and standards of the approximately 140 PA programs in the U.S. Additionally, we strongly support the inclusion of a set 15 percent carve-out for PA programs within the primary care medicine and dentistry cluster. Finally, we support the inclusion of PA education programs within many new or expanded programmatic sections of the bill, including geriatric training centers and continuing education programs for health professionals in underserved areas.

The AAPA applauds your efforts to support and expand America's primary care workforce through a clarified and strengthened Title VII. We are pleased to work with you and to support the Health Professions and Primary Care Reinvestment Act of 2008.

Sincerely yours,
William F. Leinweber,

Executive Vice President/Chief
Executive Officer.

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AMERICAN COLLEGE OF

PREVENTIVE MEDICINE,

November 18, 2008.
Hon. Hillary R. Clinton,
Russell Senate Office Building,
Washington, DC.

DEAR SENATOR CLINTON: On behalf of the American College of Preventive Medicine I write to express our sincere appreciation and thanks for your efforts to reauthorize the Title VII health professions training programs at the Health Resources and Services Administration, HRSA. As a result of your steadfast commitment to bolstering our health care safety net in underserved communities and extending the reaches of preventive medicine physicians, health care services--including important preventive services--will reach the doorsteps of countless Americans who currently lack access to a health care provider.

With your legislation the time has now come to reinvigorate and refinance the Title VII health professions training programs at the necessary levels in order to protect access to health care for vulnerable populations, improve disease prevention and health promotion efforts, and maintain our graduate medical education commitment to quality and workforce diversity.

While a limited number of preventive medicine residency training programs in New York and other states have benefited from Title VII funds, it is important that Congress act now to expand the reaches of Title VII's mission to enhance the supply, diversity, and distribution of the health care workforce in all underserved communities across the country. A key step toward addressing health system reform is ensuring availability of services across all communities.

We thank you for recognizing the importance of preventive medicine physicians in securing our health care safety net and promoting disease prevention and health promotion programs. We look forward to our continued dialogue and thank you for the opportunity to work with you and your staff to address this very important issue.

Sincerely,
Michael D. Parkinson, MD,

MPH, FACPM,
President.

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ADA/AMERICAN DENTAL ASSOCIATION,

Washington, DC, November 19, 2008.
Senator Hillary Rodham Clinton,
Russell Office Building,
Washington, DC.

DEAR SENATOR CLINTON: The American Dental Association, ADA, which represents 156,000 dentists, congratulates you on introducing the ``Health Professions and Primary Care Reinvestment Act.'' The ADA greatly appreciates the attention that you and your staff have given to the unique needs of Title VII federal dental programs and believe that many of the changes incorporated in this bill will help greatly to advance these programs.

We are especially pleased that your bill provides general practice and pediatric dental residency programs with a funding line. This acknowledgement underscores that oral health care is as equally important as medical care and should not be a subset of medical program funding. We believe that by creating Section 748 Training in General and Pediatric Dentistry that Congress will be better able to effectively address dental education training needs.

We also appreciate the inclusion of dentists in Section 9, which focuses on geriatric training. The ADA has placed a high priority on addressing the oral health needs of ``vulnerable'' older adults--individuals over age 65 with limited mobility and/or limited resources and/or complex health status. Older adults face a variety of special oral health challenges, including root and coronal caries, periodontal disease, tooth wear, edentulousness, oral cancer, complications from taking prescription and over-the-counter medications and other medical concerns that affect oral health. We recognize that a key component in addressing these needs is to enhance the educational infrastructure and dentist education and training. We believe that your bill has opened the door to accomplish these goals.

Addressing the oral health care needs of the older generation often overlaps with providing care to children and adults with intellectual and developmental disabilities. While the bill does not include a new section to address the training of dentists to work with these patients, we understand the time constraints your staff faced in getting this bill introduced this year. We look forward to continuing to work with you on this issue and remain hopeful that we will be able to include a provision dealing with this important issue next year.

Thank you and your staff, particularly Dr. Kathleen Klink, for working with the American Dental Association to enhance dental education programs. We believe that the ``Health Professions and Primary Care Reinvestment Act'' will contribute to the ADA's own efforts to improve dental education programs and improve the oral health care of all Americans.

Sincerely,

John S. Findley, D.D.S.,
President.

--

ADEA and AAPD,

November 19, 2008.
Hon. Hillary Clinton,
U.S. Senate,
Washington, DC.

DEAR SENATOR CLINTON: The American Dental Education Association (ADEA) and the American Academy of Pediatric Dentistry (AAPD) are pleased to endorse the Health Professions Primary Care Reinvestment Act. Our organizations represent dental education and the practicing pediatric dentists.

The primary care dental provisions contained in the legislation continue and enhance the cost-effective General Dentistry and Pediatric Dentistry residency training programs. The bill also authorizes support of dental loan repayment for those who teach or conduct research in General or Pediatric Dentistry residencies, which is particularly important to maintaining a cadre of well-trained dentists to meet the oral health care needs of the nation. Most importantly, we are delighted with the language which allows dental schools to apply for grants for faculty development and academic administrative units. We applaud the decision to provide a guideline authorization of $20 million for these important programs.

Our Associations appreciate the time and effort that you and your staff made to consider our analysis of important trends and needs in dental education, and to address our concerns about the bill. The Health Professions Primary Care Reinvestment Act is a significant improvement over legislation in the last Congress in terms of provisions affecting health workforce, information, evaluation and analysis, and geriatric training. Your staff is to be commended for drafting legislation that is performance-based and ensures that important strides made to date will not be diminished.

Please contact our legislative representatives if we can be of further assistance: Myla Moss at ADEA 202-289-7201 or Scott Litch at AAPD 312-337-2169 ext. 29.

Sincerely,


Beverly Largent, D.M.D.,


AAPD President.


John S. Rutkauskas, D.D.S., M.B.A., CAE,


AAPD Chief Executive Officer.


Charles N. Bertalomi, D.D.S., D.M.Sc.,


ADEA President.


Richard W. Valachovic, D.M.D., M.P.H,


ADEA Executive.

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ASSOCIATION OF MINORITY HEALTH PROFESSIONS SCHOOLS, INC.,

WASHINGTON, DC, NOVEMBER 19, 2008.
Senator Hillary Rodham Clinton,
U.S. Senate, Russell Senate Office Building, Washington, DC.

DEAR SENATOR CLINTON: The Association of Minority Health Professions Schools (AMHPS) applauds your introducing the Health Professions and Primary Care Reinvestment Act. The Title VII Health Professions programs help strengthen and diversify our nation's primary care workforce. The Health Professions and Primary Care Reinvestment Act reauthorizes these vital programs while greatly improving them.

AMHPS is particularly interested in your efforts to continue to strengthen the diversity cluster of the Title VII programs--Centers of Excellence (COI), Health Careers Opportunities Program (HCOP), Faculty Loan Repayment, and Scholarships for Disadvantaged Students (SDS). These programs have been a tremendous federal government investment into the institutions that focus on increasing the number of health professionals and the diversity of the health professions. In the November 2008 issue of Academic Medicine, the article ``Funding the Diversity Programs of the Title VII Health Professions Training Grants: An Urgent Need,'' written by two AMHPS institution presidents--Dr. John Maupin of Morehouse School of Medicine and Dr. Wayne Riley of Meharry Medical College--confirms that your efforts making a tremendous effort towards improving the health of all Americans.

Again. thank you for introducing the Health Professions and Primary Care Reinvestment Act. Your continued leadership and dedication to health care is greatly appreciated. We urge you to do all that you can to see that building a stronger workforce of primary care professionals that is more diverse is a top priority during the current health care debate. Ensuring passage of your important bill would be a very good first step,

Sincerely,


Wayne Harris, Ph.D.,


Chairman, Board of Directors, Association of Minority Health Professions Schools.

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ASSOCIATION OF SCHOOLS OF

PUBLIC HEALTH,

Washington, DC, November 18, 2008.
Hon. HILLARY RODHAM CLINTON,
Russell Senate Office Building,
Washington, DC.

DEAR SENATOR CLINTON: On behalf of the Association of Schools of Public Health (ASPH), I would like to thank you for introducing the Health Professions and Primary Care Reinvestment Act. Your leadership in introducing legislation that would reauthorize Title VII of the Public Health Service Act takes a vital step in providing support to the health care delivery system, health care and public health professionals.

By 2012 over 100,000 public health workers are eligible to retire (23 percent of the workforce). More importantly, in order to have the same public health workforce to population ratio in 2020 as existed in 1980, the public health workforce would need to add an additional 250,000 workers. As Congress begins to consider legislation that would overhaul the health insurance system in this country, we hope that the Health Professions and Primary Care Reinvestment Act will be considered to ensure a well trained health care workforce will be in place to meet the increased demand for basic health care services.

We would like to thank you for the inclusion of public health in several sections of the bill including the Health Professions Training for Diversity provisions of the legislation. Expansion of the program to include training for the next generation of researchers and educators is important as public health researchers in the early stages of their careers offer novel investigator-initiated research ideas that could transform science and policy.

We applaud the establishment of the Academic Health Department (AHD) Program to establish partnerships between accredited Schools of Public Health (SPH) and state or local public health departments. This program has demonstrated success in expanding SPH/health department partnerships with the goal of developing models of collaboration in the areas of teaching and service. The training programs offered by AHDs will provide learning opportunities for public health professionals throughout their careers. We also appreciate the continued support of the existing Public Health and Preventive Medicine Program which offers vital support to train health professionals in this important area.

Again, we would like to thank you for your leadership and we look forward to working with you as you work to advance this legislation. We are glad to see your commitment to addressing workforce shortage issues in health care and offer our support of the Health Professions and Primary Care Reinvestment Act.

Sincerely,

Harrison C. Spencer, MD, MPH,
President and CEO.

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NATIONAL AHEC ORGANIZATION,

Oak Creek, WI.
Hon. HILLARY RODHAM CLINTON,
U.S. Senate, Russell Senate Office Building, Washington, DC.

DEAR SENATOR CLINTON: On behalf of the National Area Health Education Center Organization (NAO), I would like to offer support for the Health Professions and Primary Care Reinvestment Act legislation that includes AHEC reauthorization.

Your ongoing support of the National AHEC Organization and the AHEC centers and programs that we represent across the country are critical to the health professions pipeline, quality education and training programs for health care professionals, allied health professional and students across the county.

The Health Professions and Primary Care Reinvestment Act will ensure the sustainability of the many critical programs offered by AHEC's throughout the nation.

Please feel free to call upon the NAO for additional support as you move forward with your efforts and be assured that our support and this letter may be used publicly to advance the Health Professions and Primary Care Reinvestment Act legislation.

Sincerely,

Rose M. Yuhos,
NAO President.

--

NATIONAL COUNCIL FOR DIVERSITY

IN THE HEALTH PROFESSIONS,

November 19, 2008.
Hon. HILLARY RODHAM CLINTON,
U.S. Senate, Russell Senate Office Building, Washington, DC.

DEAR SENATOR CLINTON: The National Council on Diversity in the Health Professions (NCDHP) applauds your introducing the Health Professions and Primary Care Reinvestment Act. The Title VII Health Professions programs help strengthen and diversity our nation's primary care workforce. The Health Professions and Primary Care Reinvestment Act reauthorizes these vital programs while greatly improving them.

NCDHP is interested in your efforts to continue to strengthen the diversity cluster of the Title VII programs, particularly the reauthorization of Centers of Excellence (COE) and Health Careers Opportunities Program (HCOP). For many years, these programs have demonstrated a tremendous federal government investment into the institutions that focus on increasing the number of health professionals and the diversity of the health professions.

Again, thank you for introducing the Health Professions and Primary Care Reinvestment Act. Your continued leadership and dedication to health care is greatly appreciated. We urge you to do all that you can to see that building a stronger workforce of primary care professionals that is more diverse is a top priority during the current health care debate. Ensuring passage of your important bill would be a very good first step.

Sincerely,

Wanda D. Lipscomb,
Chair.

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SOCIEIY OF GENERAL

INTERNAL MEDICINE,

Washington, DC, November 17, 2008.
Hon. HILLARY RODHAM CLINTON,
Russell Senate Office Building,
Washington, DC.

DEAR SENATOR CLINTON: On behalf of the Society of General Internal Medicine, I want to applaud your leadership in advancing national policies that promote improved patient care for all Americans. In particular, I want to commend you on the introduction of the Health Professions and Primary Care Reinvestment Act.

By any measure, primary care, including general internal medicine, is the cornerstone of our nation's health care system. Patients with primary care physicians have better health status, longer life expectancy and lower health care costs. Moreover, for the poor, the uninsured and the elderly, primary care functions as a safety net, serving as the first and often the only contact for care and treatment.

For more than three decades, the Title VII Training in Primary Care Medicine and Dentistry (TPCMD) program, in particular, has contributed significantly to improving the quality of education and training of the nation's primary care workforce, with special emphasis on individuals from disadvantaged backgrounds and underrepresented minorities. But challenges remain. For example, forecasts are that the demand for general internists will increase by 38 percent within the next 15 years, while the number of new physicians entering the field of general internal medicine continues to decline.

By strengthening and expanding the TPCMD program, your legislation recognizes that primary care is the linchpin of our health care system and that an adequate, well-trained primary care workforce is critical to the success of any health care reform measures Congress undertakes.

In addition, your legislation calls for a more comprehensive approach to addressing the systemic needs of our health care system, including the creation of primary care training institutes that will promote all-important collaboration across all primary care disciplines, as well as partnering with community health centers in a way that will speed the translation of research into community practice. Furthermore, the work of these institutes will help contribute to better health outcomes by fostering the development of the patient-centered medical home model.

At a time when 47 million Americans lack health coverage, when increasing numbers of elderly are entering the age of highest risk of chronic disease, and when racial and ethnic disparities persist, the Health Professions and Primary Care Investment Act provides a solid framework for meeting these challenges.

Again, thank you for introducing this important legislation. As in the past, our Society stands ready to assist you in whatever way we can.

Sincerely,

Lisa V. Rubenstein,
President.


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