[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]




                EXAMINING EXISTING FEDERAL PROGRAMS TO 
                 BUILD A STRONGER HEALTH WORKFORCE AND  
                 IMPROVE PRIMARY CARE

=======================================================================

                                HEARING

                               BEFORE THE

                         SUBCOMMITTEE ON HEALTH

                                 OF THE

                        COMMITTEE ON ENERGY AND  
                                COMMERCE
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                               __________

                             APRIL 19, 2023

                               __________

                           Serial No. 118-24 
                           
                           
                           
                           
                                                    
                      
              [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]                        
                           
                           
                           
                                                      
                                                     

     Published for the use of the Committee on Energy and Commerce

                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov 
                        
                                 ------ 
                                 
                   U.S. GOVERNMENT PUBLISHING OFFICE 

55-100 PDF                WASHINGTON : 2024 
















                    COMMITTEE ON ENERGY AND COMMERCE

                   CATHY McMORRIS RODGERS, Washington
                                  Chair
MICHAEL C. BURGESS, Texas            FRANK PALLONE, Jr., New Jersey
ROBERT E. LATTA, Ohio                  Ranking Member
BRETT GUTHRIE, Kentucky              ANNA G. ESHOO, California
H. MORGAN GRIFFITH, Virginia         DIANA DeGETTE, Colorado
GUS M. BILIRAKIS, Florida            JAN SCHAKOWSKY, Illinois
BILL JOHNSON, Ohio                   DORIS O. MATSUI, California
LARRY BUCSHON, Indiana               KATHY CASTOR, Florida
RICHARD HUDSON, North Carolina       JOHN P. SARBANES, Maryland
TIM WALBERG, Michigan                PAUL TONKO, New York
EARL L. ``BUDDY'' CARTER, Georgia    YVETTE D. CLARKE, New York
JEFF DUNCAN, South Carolina          TONY CARDENAS, California
GARY J. PALMER, Alabama              RAUL RUIZ, California
NEAL P. DUNN, Florida                SCOTT H. PETERS, California
JOHN R. CURTIS, Utah                 DEBBIE DINGELL, Michigan
DEBBBIE LESKO, Arizona               MARC A. VEASEY, Texas
GREG PENCE, Indiana                  ANN M. KUSTER, New Hampshire
DAN CRENSHAW, Texas                  ROBIN L. KELLY, Illinois
JOHN JOYCE, Pennsylvania             NANETTE DIAZ BARRAGAN, California
KELLY ARMSTRONG, North Dakota, Vice  LISA BLUNT ROCHESTER, Delaware
    Chair                            DARREN SOTO, Florida
RANDY K. WEBER, Sr., Texas           ANGIE CRAIG, Minnesota
RICK W. ALLEN, Georgia               KIM SCHRIER, Washington
TROY BALDERSON, Ohio                 LORI TRAHAN, Massachusetts
RUSS FULCHER, Idaho                  LIZZIE FLETCHER, Texas
AUGUST PFLUGER, Texas
DIANA HARSHBARGER, Tennessee
MARIANNETTE MILLER-MEEKS, Iowa
KAT CAMMACK, Florida
JAY OBERNOLTE, California
                                 ------                                

                           Professional Staff

                      NATE HODSON, Staff Director
                   SARAH BURKE, Deputy Staff Director
               TIFFANY GUARASCIO, Minority Staff Director 
               
               
               
               
               
               
               

               
               
               
               
               
                         Subcommittee on Health

                        BRETT GUTHRIE, Kentucky
                                 Chairman
MICHAEL C. BURGESS, Texas            ANNA G. ESHOO, California
ROBERT E. LATTA, Ohio                  Ranking Member
H. MORGAN GRIFFITH, Virginia         JOHN P. SARBANES, Maryland
GUS M. BILIRAKIS, Florida            TONY CARDENAS, California
BILL JOHNSON, Ohio                   RAUL RUIZ, California
LARRY BUCSHON, Indiana, Vice Chair   DEBBIE DINGELL, Michigan
RICHARD HUDSON, North Carolina       ANN M. KUSTER, New Hampshire
EARL L. ``BUDDY'' CARTER, Georgia    ROBIN L. KELLY, Illinois
NEAL P. DUNN, Florida                NANETTE DIAZ BARRAGAN, California
GREG PENCE, Indiana                  LISA BLUNT ROCHESTER, Delaware
DAN CRENSHAW, Texas                  ANGIE CRAIG, Minnesota
JOHN JOYCE, Pennsylvania             KIM SCHRIER, Washington
DIANA HARSHBARGER, Tennessee         LORI TRAHAN, Massachusetts
MARIANNETTE MILLER-MEEKS, Iowa       FRANK PALLONE, Jr., New Jersey (ex 
JAY OBERNOLTE, California                officio)
CATHY McMORRIS RODGERS, Washington 
    (ex officio) 
    
    
    
    
    
    
    
      
    
    
                             C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Brett Guthrie, a Representative in Congress from the 
  Commonwealth of Kentucky, opening statement....................     1
    Prepared statement...........................................     4
Hon. Anna G. Eshoo, a Representative in Congress from the State 
  of California, opening statement...............................     6
    Prepared statement8..........................................
Hon. Cathy McMorris Rodgers, a Representative in Congress from 
  the State of Washington, opening statement.....................    10
    Prepared statement...........................................    12
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................    16
    Prepared statement...........................................    18

                                Witness

Carole Johnson, Administrator, Health Resources and Services 
  Administration, Department of Health and Human Services........    20
    Prepared statement...........................................    23
    Questions submitted for the record \1\.......................   177

                              Legislation

H.R. 2559, the Strengthening Community Care Act of 2023..........    76
H.R. ___, a Bill to reauthorize a program of payments to Teaching 
  Health Centers that operate Graduate Medical Education 
  programs, and for other purposes...............................    78
H.R. 2569, the Doctors of Community (DOC) Act....................    81
H.R. 2547, the Special Diabetes Program for Indians 
  Reauthorization Act of 2023....................................    84
H.R. 2550, the Special Diabetes Program Reauthorization Act of 
  2023...........................................................    86
H.R. 2544, the Securing the U.S. Organ Procurement and 
  Transplantation Network Act....................................    88
H.R. 2411, the National Nursing Workforce Center Act of 2023.....    92
H.R. ___, a Bill to amend the Public Health Service Act with 
  respect to the Covered Countermeasure Process Fund, and for 
  other purposes.................................................   103

                           Submitted Material

Inclusion of the following was approved by unanimous consent.
List of documents submitted for the record.......................   107
Statement of Traci Couture Richmond, Executive Director, Spokane 
  Teaching Health Center, April 19, 2023.........................   108
Letter of April 19, 2023, from Mary R. Grealy, President, 
  Healthcare Leadership Council, to Mr. Guthrie and Ms. Eshoo....   113
Statement of the National Indian Health Board, April 19, 2023....   116
Letter of April 19, 2023, from Christopher S. Kang, President, 
  American College of Emergency Physicians, to Mr. Guthrie and 
  Ms. Eshoo......................................................   120
Statement of Lori J. Pierce, President, Association for Clinical 
  Oncology, April 19, 2023.......................................   123

----------

\1\ Ms. Johnson did not answer submitted questions for the record by 
the time of publication. Replies received after publication will be 
retained in committee files and made available at https://
docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=115759.
Statement of the American College of Obstetricians and 
  Gynecologists, April 19, 2023..................................   129
Statement of the Lone Star Family Health Center, Conroe, Texas...   136
Statement of Hon. Young Kim, a Representative in Congress from 
  the State of California, April 19, 2023........................   137
Letter of April 17, 2023, from Garrett Chan, President and Chief 
  Executive Officer, HealthImpact, to Mrs. Rodgers and Mr. 
  Guthrie........................................................   139
Letter of April 19, 2023, from Marina Zhavoronkova, Senior 
  Fellow, Workforce Development, and Bradley Custer, Senior 
  Policy Analyst, Higher Education, Center for American Progress, 
  to Mrs. Rodgers and Mr. Pallone................................   143
Letter of April 18, 2023, from George R. Sheply, President, and 
  Raymond A. Cohlmia, Executive Director, American Dental 
  Association, to Mr. Pallone....................................   145
Letter of April 19, 2023, from Sterling N. Ransone, Jr., Board 
  Chair, American Academy of Family Physicians, to Mr. Guthrie 
  and Ms. Eshoo..................................................   146
Statement of the Association of American Medical Colleges, April 
  19, 2023.......................................................   155
Letter of April 18, 2023, from Clifton Porter II, Senior Vice 
  President, Government Relations, American Health Care 
  Association, to Mrs. Rodgers and Mr. Pallone...................   162
Letter of April 19, 2023, from Lanelle Weems, President, Board of 
  Directors, National Forum of State Nursing Workforce Centers, 
  to Mrs. Rodgers and Mr. Pallone................................   164
Statement of the PA Education Association, April 19, 2023........   167
Statement of the American Hospital Association, April 19, 2023...   170
Letter of April 17, 2023, from D. Scott Casanover, General 
  Counsel/Senior Vice President of Government Affairs, West Coast 
  University, to Rep. Young Kim..................................   176

 
                  EXAMINING EXISTING FEDERAL PROGRAMS 
                  TO BUILD A STRONGER HEALTH WORKFORCE 
                  AND IMPROVE PRIMARY CARE

                              ----------                              


                       WEDNESDAY, APRIL 19, 2023

                  House of Representatives,
                            Subcommittee on Health,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 10:01 a.m., in 
the John D. Dingell Room 2123, Rayburn House Office Building, 
Hon. Brett Guthrie (chairman of the subcommittee) presiding.
    Members present: Representatives Guthrie, Burgess, Latta, 
Griffith, Bilirakis, Johnson, Bucshon, Hudson, Carter, Pence, 
Crenshaw, Joyce, Harshbarger, Miller-Meeks, Rodgers (ex 
officio), Eshoo (subcommittee ranking member), Sarbanes, 
Cardenas, Ruiz, Kuster, Kelly, Barragan, Blunt Rochester, 
Craig, Schrier, and Pallone (ex officio).
    Staff present: Kate Arey, Digital Director; Jolie Brochin, 
Clerk, Health; Sarah Burke, Deputy Staff Director; Kristin 
Flukey, Professional Staff Member, Health; Grace Graham, Chief 
Counsel, Health; Sydney Greene, Director of Operations; Nate 
Hodson, Staff Director; Tara Hupman, Chief Counsel; Peter 
Kielty, General Counsel; Emily King, Member Services Director; 
Molly Lolli, Counsel, Health; Emma Schultheis, Staff Assistant; 
Michael Taggart, Policy Director; Lydia Abma, Minority Policy 
Analyst; Waverly Gordon, Minority Deputy Staff Director and 
General Counsel; Tiffany Guarascio, Minority Staff Director; 
Una Lee, Minority Chief Health Counsel; Juan Negrete, Minority 
Professional Staff Member; and Rick Van Buren, Minority Senior 
Health Counsel.
    Mr. Guthrie. The subcommittee will come to order.
    The Chair recognizes himself for an opening statement.

 OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN 
           CONGRESS FROM THE COMMONWEALTH OF KENTUCKY

    Today the healthcare subcommittee is taking an important 
step in reauthorizing critical programs within the Health 
Resources and Services Administration. The policies before us 
today each play a unique role in providing greater access to 
care for millions of Americans, particularly those in rural and 
underserved communities. Many of these programs expire on 
September 30th. By taking early action, we are providing 
reassurance that they can continue without disruption.
    Early action also provides subcommittee members with the 
chance to review the impact of--the policies are currently 
having, and ensure all future funds are directed in the most 
effective and appropriate way possible. It also gives us time 
to work together and find bipartisan offsets for mandatory 
spending in future years.
    The first bill, the Strengthening Community Care Act of 
2023, would extend the Community Healthcare Fund and the 
National Health Service Corps through 2028. Both programs allow 
millions of Americans across the country in medically 
underserved communities to receive access to high-quality 
primary care services, including pharmacy, mental health, 
substance use disorder, and dental care services.
    Across Kentucky, HRSA's Uniform Data System data shows that 
25 health systems received grant funding in 2021. Nearly 
600,000 patients were served, many of which were served by 
providers who participated in the National Health Service 
Corps.
    I want to thank Dr. Joyce for leading on this important 
issue, especially at a time in which we are facing primary care 
provider shortages across the Nation.
    I am hopeful we can come to a bipartisan agreement on a 
path forward to extend funding and--on the necessary offsets 
for the Teaching Health Care Center Graduate Medical Education 
program. I am committed to working with my colleagues to 
continue these essential programs. However, I do think we do 
not make--should not make these programs permanent at this 
time.
    We are examining the National Nursing Workforce Center Act, 
led by Representatives Kim and Blunt Rochester. This bill is 
designed to help bolster our nursing workforce and would 
specifically require HRSA to work with State nursing workforce 
centers to help streamline their nursing workforce programs. 
This would ultimately provide more targeted investments that 
reflect the need of local communities.
    I thank my colleagues for working on this bipartisan bill.
    I also would like to thank Representative Blunt Rochester 
for working with me on one of my nursing workforce priorities, 
the Building America's Health Care Workforce Act. This would 
address very serious nursing workforce shortages in the long-
term care community. I will continue my push to advance 
legislation like this that cuts red tape, especially as we near 
the expiration of the COVID-19 public health emergency on May 
the 11th.
    We will also consider proposals to provide continued access 
to key programs for chronic conditions such as diabetes. The 
Special Diabetes Program Reauthorization Act of 2023 and the 
Special Diabetes Program for Indians Reauthorization Act will 
provide continued funding for both programs through 2028. Over 
1.6 million Americans living with Type 1 diabetes--these 
programs will allow patients to continue receiving 
comprehensive diabetes care, and will lead to a higher quality 
of life and lower healthcare costs for patients.
    I thank Representatives Bilirakis and Cole for leading on 
these issues.
    We are also considering legislation that will promote more 
transparency and greater access to care for over 100,000 
individuals in need of an organ transplant. Dr. Bucshon's 
Securing the U.S. Organ Procurement and Transplantation Network 
Act would ensure the Nation's organ procurement system is 
operating more efficiently, which will ultimately lead to 
greater access to organ transplants for vulnerable populations.
    Lastly, we are examining a proposal to increase 
transparency within the Covered Countermeasures Injury 
Compensation program to help ensure claimants are receiving 
adequate information in a timely manner.
    I look forward to today's discussion. I thank the witnesses 
for being here, for being with us today.
    [The prepared statement of Mr. Guthrie follows:]
    
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]  
             
    Mr. Guthrie. And I yield back. The Chair now recognizes my 
good friend from California, the ranking member of the 
subcommittee, Ranking Member Eshoo, for 5 minutes for an 
opening statement.

 OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN 
             CONGRESS FROM THE STATE OF CALIFORNIA

    Ms. Eshoo. Thank you, Mr. Chairman.
    And good morning, Administrator Johnson. Welcome back to 
the Health Subcommittee, and thank you for your superb 
leadership at the helm of the Health Resources and Services 
Administration, overseeing more than 90 programs that improve 
the health and well-being of all Americans. You head up the 
agency with grantmaking, and it is the dispersal of those funds 
in HHS that really make the policies dance. So thank you.
    Today our subcommittee is considering eight bills to extend 
critical public health programs, bolster the health workforce, 
and address the broken organ transplant system. We are going to 
hear testimony about five health programs that expire on 
September 30th: Community Health Centers that are really core, 
you know, operations in our congressional districts; the 
National Health Service Corps; the Teaching Health Center 
Graduate Medical Education program; the Special Diabetes 
Program; and the Special Diabetes Program for Indians.
    First, we are considering a bipartisan bill to extend 
mandatory funding for Community Health Centers and the National 
Health Service Corps for 5 years. The Community Health Center 
Fund provides support to nearly 14,000 health center locations 
across our country. These health centers provide primary care 
to 1 in every 11 Americans. We cannot do without them--
including 1 in 5 Californians--regardless of their ability to 
pay.
    A Community Health Center in my district, the Asian 
Americans for Community Involvement, provides a full spectrum 
of care through a multilingual team of doctors, nurses, and 
patient navigators. They have earned a superb reputation for 
the care that they give to people in the community. And at this 
health center the team can speak more than 40 languages to 
ensure their services are responsive to cultural beliefs, to 
practices, and preferred languages.
    The National Health Service Corps is a highly effective 
program that has been connecting providers to patients in need 
for over five decades. I am disappointed that funding for these 
programs is not adjusted for inflation, despite the clear need. 
But I support the bipartisan reauthorization.
    We are also considering programs to improve access to 
primary care. We have to stay on this, because that is the 
entrance to the entire healthcare system in our country, 
including the Teaching Health Center GME Program and the 
Special Diabetes Programs. They support viable primary care 
workforce for low-income communities by providing residency--
and we spoke about this on the phone--residency training at 
Federally qualified health centers.
    The Affordable Care Act enabled the Teaching Health 
Centers--can we not talk in the background here? It is 
distracting. Please.
    The Affordable Care Act enabled Teaching Health Centers to 
train residents. Thirteen years later, these centers have 
proven they can successfully train residents who will build 
their practices in rural and underserved urban communities. 
This is--you know, a giant bravo on this, because it really is 
working. But funding for this program remains elusive and 
inconsistent, preventing it from reaching its potential. I 
support the legislation we are considering today to permanently 
authorize the THC GME program and fund new training sites to 
increase resident physician spots. And I believe that this 
subcommittee can get to a bipartisan agreement on this 
reauthorization.
    The other expiring programs include Special Diabetes and 
the Special Diabetes Program for Indians, which provide 
critical investments in research and care for those living with 
diabetes.
    I have more to say, and I will say it as we move through 
our hearing today because my time is almost up. But I want to 
thank you for your leadership, and I want to thank you also for 
sending out to each one of us--HRSA--in our congressional 
districts, because this really brings it home about what HRSA 
is doing, the grantmaking, and the difference that it is making 
in the lives of our constituents.
    [The prepared statement of Ms. Eshoo follows:]
    
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]    
  
    Ms. Eshoo. So with that, Mr. Chairman, thank you for 
holding the hearing, and I yield back.
    Mr. Guthrie. Thank you----
    Ms. Eshoo. And welcome to the chairwoman's daughters. Are 
they still here? Right here.
    Mr. Guthrie. Oh----
    Ms. Eshoo. Oh, yes, yes.
    Mrs. Rodgers. She outed you.
    [Laughter.]
    Ms. Eshoo. Yes, yes.
    [Applause.]
    Ms. Eshoo. Future women Members of the Congress.
    Mr. Guthrie. Absolutely.
    Ms. Eshoo. Yes.
    Mr. Guthrie. We do welcome you here today, and I thank the 
gentlelady for yielding back, and the Chair now recognizes the 
chair of the full committee, Chair Rodgers, for 5 minutes for 
an opening statement.

      OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

    Mrs. Rodgers. Thank you, Mr. Chairman. And I too would like 
to welcome my two daughters, two most important advisors, 
Brynn--Brynn Rodgers--and Grace Rodgers, who are on spring 
break. It is great to have them in DC today.
    Yes, so welcome to the Energy and Commerce Committee. Yes, 
it is great to have you.
    And also welcome to Carole Johnson, the Administrator for 
the Health Services and--Health Resources and Services 
Administration, known as HRSA. And I too want to say thanks for 
the detailed district analysis that you have given each one of 
us, and also coming to Spokane and spending some time in my 
district.
    Today we will discuss several existing Federal programs and 
proposed legislation related to healthcare workforce, primary 
care services, organ procurement, competition, countermeasure 
injury compensation transparency, and diabetes research and 
treatment.
    The healthcare workforce shortage is leaving people without 
the primary care they need, which is why we are considering the 
Strengthening Community Care Act of 2023, led by Representative 
Joyce. This legislation will reauthorize the Community Health 
Center Fund and the National Health Services Corps that will 
help support both primary care services and the healthcare 
workforce.
    I am especially proud of the work Community Health Centers 
in my district are doing to expand services and increase job 
opportunities. New Health currently offers a medical assistant 
preapprenticeship program in partnership with local high 
schools. They are also working with a local school district to 
develop a workforce training center, where rural high school 
students can gain access to clinical and nonclinical 
internships.
    Additionally, CHAS Health in Spokane is giving high school 
students the opportunity to participate in training sessions 
where they can learn about the different aspects of the health 
clinic and related professions. I am hopeful that these efforts 
will help bring more healthcare workers into our community.
    Next we will discuss proposals to continue the Teaching 
Health Center Graduate Medical Education Program funding. I am 
a long-time supporter of this program, which helps to bring 
more primary care doctors, OB-GYNs, mental health providers, 
and others to rural areas. Spokane, Washington, has recognized 
this and is a national leader on recruiting the next generation 
of healthcare workers. The mandatory funding for this program 
runs out September 30th, and I am committed to working to 
extend it. I hope that we can come to a bipartisan agreement 
and find the offsets needed.
    We will also consider the National Nursing Workforce Center 
Act of 2023, led by Representative Young Kim. This bill will 
help enhance existing State-based nursing workforce centers so 
that we can better access workforce challenges and address any 
gaps.
    I am thankful for Representative Bucshon's leadership on 
the Securing of the U.S. Organ Procurement and Transplantation 
Network Act. It will allow for HRSA to make the Organ 
Procurement and Transplantation Network process more 
competitive, with the ultimate goal of making organs available 
to more people in need, one area where more work needs to be 
done.
    We will also consider a proposal to increase transparency 
within the Countermeasures Injury Compensation Program. This is 
administered by HRSA and provides compensation for covered 
injuries or deaths that occur as a direct result of using 
certain countermeasures used to treat ailments from a public 
health emergency or security threat.
    Lastly, we will discuss two programs critical to improve 
the lives of people with diabetes, including Representative 
Bilirakis' Special Diabetes Program Reauthorization Act of 2023 
and Representative Cole's Special Diabetes Program for Indians 
Reauthorization Act of 2023.
    With that, I am looking forward to today's discussion, and 
I yield back.
    [The prepared statement of Mrs. Rodgers follows:]
    
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]     
   
    Mr. Guthrie. I thank the gentlelady. The Chair yields back.
    The Chair now recognizes the ranking member of the full 
committee, the gentleman from New Jersey, Mr. Pallone, for 5 
minutes for an opening statement.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pallone. Thank you, Mr. Chairman. Today the committee 
continues its critical work of strengthening our healthcare 
systems by building a stronger healthcare workforce and 
improving access to primary care.
    I am delighted that we will be considering my bill, the DOC 
Act, which permanently authorizes and increases funding for the 
Teaching Health Center Graduate Medical Education Program. And 
this program supports the training of primary care medical and 
dental residents in high-need communities. It is the only 
Federal program that invests in this training of future 
physicians in a community-based setting rather than a hospital 
setting. And this is important for a number of reasons.
    We know that physicians often choose to practice close to 
their training sites. By moving primary care training into the 
community, Teaching Health Centers help to address the 
workforce shortages in underserved areas and increase access to 
primary care.
    This program has been incredibly successful since it was 
established by the Affordable Care Act. Today there are 72 
Teaching Health Center programs in 24 States, with 969 medical 
residents handling more than 1 million patient visits annually 
in rural and urban communities. It is because of this success 
that the program has been reauthorized several times with 
strong bipartisan support.
    Reauthorization is critical, but oftentimes these 
reauthorizations have often been short-term, leaving the 
program in a state of uncertainty. The threat of expiration 
makes it difficult for Teaching Health Centers to plan and 
recruit for their residency programs. Low funding levels also 
jeopardize the sustainability of programs and their ability to 
address primary care workforce shortages in underserved areas.
    Unfortunately, unlike the Medicare Graduate Medical 
Education--GME--program, which funds GME slots and teaching 
hospitals at over $16 billion a year, the Teaching Health 
Centers program is not permanently authorized or funded, and my 
bill provides the long-needed security that these programs have 
asked for. It will create a reliable stream of doctors for 
high-need communities with funding for 48 new programs across 
the country, and creating an estimated 1,060 new residency 
slots. It is still a tiny fraction of the GME slots that we 
fund in teaching hospitals, but this kind of investment is 
exactly what we need to increase access to primary care in 
underserved areas.
    We will also discuss legislation that will extend funding 
for Community Health Centers, which provide primary care to 
more than 30 million people across the country, including many 
living in poverty and in rural areas. While I am disappointed 
the funding included in this legislation today does not reflect 
increases in the costs of providing care, it is critical that 
we do not allow this funding to lapse. So I am pleased that the 
legislation we are discussing today provides for long-term, 
stable funding for these centers.
    We will also examine legislation that will reauthorize 
other expiring public health programs, including the Special 
Diabetes Program and the Special Diabetes Program for Indians. 
Both of these programs provide critical research and care. And 
particularly the Special Diabetes Program for Indians funds 
critical treatment and prevention efforts for American Indians 
and Alaska Natives, who have the highest prevalence of diabetes 
in this country.
    I am also pleased that we will be considering legislation 
introduced by Representative Blunt Rochester to address 
shortages and bolster the nursing workforce by expanding State-
based nursing workforce centers and establishing a national 
nursing-focused research center.
    We will also discuss legislation that seeks to improve 
existing programs at the Health Resources and Services 
Administration, HRSA, including the Organ Procurement and 
Transplantation Network, or OPTN. More than 6,000 Americans die 
each year while waiting for organ transplants, and this problem 
is even more pronounced for people of color and people in rural 
communities. HRSA has undertaken a number of efforts to 
modernize the OPTN, and the legislation before us today seeks 
to complement those efforts. It would make OPTN contracts more 
competitive in order to increase oversight and enhance the 
performance of the program.
    So I look forward to continuing work with my colleagues on 
these important pieces of legislation, but I would like to once 
again request that the committee immediately schedule a hearing 
to examine the very real health impacts of all Americans by 
these extremist right-wing judges who are attacking the Federal 
drug approval process by the FDA.
    Today we expect a decision from the Supreme Court, but the 
decisions to date challenging FDA's decade-old approval of the 
drug mifepristone are not grounded in science or in law. We 
should hold a hearing on the detrimental impacts these 
decisions could have on the drug approval process so we can 
ensure Americans continue to have access to FDA-approved 
medication.
    There is no time to wait, and that is why every Democrat on 
this committee has requested the Republican majority schedule a 
hearing immediately. We must examine the very real impacts that 
these dangerous court decisions could have on the American 
people.
    And with that, Mr. Chairman, I thank you, and I yield back.
    [The prepared statement of Mr. Pallone follows:]
    
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 
    
    Mr. Guthrie. I thank the gentleman for yielding back, and I 
will--the Chair will move into witness testimony, and our 
witness today is Carole Johnson, administrator of the Health 
Resources and Services Administration at the Department of 
Health and Human Services.
    We appreciate you being here today and look forward to 
discussing these bills before us with you. But you are now 
recognized for 5 minutes for your opening statement.

 STATEMENT OF CAROLE JOHNSON, ADMINISTRATOR, HEALTH RESOURCES 
  AND SERVICES ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN 
                            SERVICES

    Ms. Johnson. Thank you so much, Mr. Chairman.
    Chair McMorris Rodgers, Ranking Member Pallone, Chair 
Guthrie, Vice Chair Bucshon, Ranking Member Eshoo, and members 
of the subcommittee, thank you for the opportunity to speak 
with you today about improving primary care and the healthcare 
workforce. I am Carole Johnson, Administrator of the Health 
Resources and Services Administration, the agency of the 
Department of Health and Human Services that supports 
delivering healthcare in the Nation's highest-need communities, 
building the healthcare workforce, improving maternal and child 
health, supporting individuals with HIV, and meeting the 
healthcare needs of rural America.
    I would like to begin by thanking the subcommittee for your 
longstanding bipartisan support for HRSA's programs. With your 
help we have made significant gains in expanding access to 
healthcare services, particularly in communities that have 
struggled for far too long to recruit and retain healthcare 
providers and access high-quality care. Yet we know there is 
much more work to do.
    I particularly appreciate the opportunity to focus today on 
three vital programs HRSA--three vital HRSA programs that are 
designed to help meet these needs. Mandatory funding for each 
of these programs is expiring at the end of this fiscal year.
    First, the Community Health Center program, which provides 
high-quality, cost-effective care to 30 million people through 
1,400 local healthcare centers, operating nearly 15,000 sites 
that see patients regardless of their ability to pay. Health 
centers are a vital source of care for individuals and families 
who are uninsured, people who live in rural areas, folks who 
are enrolled in Medicaid, and others who find it hard to find a 
doctor or pay for the cost of care.
    Second, the National Health Service Corps program, through 
which we provide scholarships and loan repayment to students 
and clinicians in return for them practicing in health 
professional shortage areas. Last year, at a time of critical 
workforce challenges across the country, we reached a historic 
high of 20,000 National Health Service Corps clinicians 
practicing in underserved and rural areas, thanks to this 
program, as well as about 3,000 medical students currently 
receiving National Health Service Corps scholarships in return 
for their service commitment to practice in high-need 
communities.
    And third and finally, the Teaching Health Center Graduate 
Medical Education program, which funds medical and dental 
residency programs in settings like health centers, recognizing 
that most primary care takes place in community settings, not 
acute care hospitals. This fiscal year--by the end of this 
fiscal year, we will have close to 1,100 primary care medical 
and dental residents in training in these community settings, 
with recruitment of new residents for a Resident Match Day 2024 
beginning as early as this fall.
    The President's fiscal year 2024 budget includes 3 years of 
mandatory funding for each of these critical programs. 
Multiyear funding will help to prevent disruptions in care or 
training for millions of patients and thousands of students and 
clinicians, while also giving health centers, medical 
residents, and students predictability and confidence in the 
sustainability of these programs as they grow.
    With respect to health centers, the proposed budget 
includes funding to sustain current services and reach more 
people in need through longer hours and additional sites. 
Importantly, the budget also recognizes the overwhelming need 
to better integrate mental health and substance use disorder 
services into primary care by both funding and requiring 
behavioral health as a health center service.
    With respect to the National Health Service Corps, the 
budget would allow us to maintain the historic level of 20,000 
providers currently practicing in health professional shortage 
areas.
    And for Teaching Health Centers, the budget would ensure no 
disruption for current residents, allow Teaching Health Centers 
to take on new residents as current cohorts complete their 
training, and help programs with planning grants to--programs 
that currently have planning grants to begin to come online.
    I would like to emphasize the key point that clinicians who 
are trained through these two programs tend to stay and 
practice in rural and underserved communities, yielding a 
valuable long-term return on the Federal Government's 
investment in these programs.
    I have recently had the opportunity to visit a host of 
healthcare centers, including those that serve individuals 
experiencing homelessness, school-based health center clinics, 
health centers that are partners in our HIV work, in our Cancer 
Moonshot work, and others that demonstrate how much health 
centers are reflective of and trusted by the communities they 
serve.
    I have also had the opportunity to meet with National 
Health Service Corps members who, to a person, report that 
Health--the National Service Corps has helped enable them to 
practice in the community where they want to serve, often a 
rural community. And often, without National Health Service 
Corps money, they would have had to make a different choice 
about their practice.
    In addition, I have had the good fortune to visit a couple 
of Teaching Health Centers, both with Chair McMorris Rodgers, 
and a planning grant awardee with Ranking Member Pallone to see 
up close and in person how important this program is to the 
next generation of the healthcare workforce, and really 
building primary care in the communities where we want people 
to serve.
    These are just a few examples of the exciting and important 
work happening in communities across the country as a result of 
these critical programs. And I look forward to working closely 
with the subcommittee to sustain and build on this work.
    Thank you, and I look forward to your questions.
    [The prepared statement of Ms. Johnson follows:]
    
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 
       
    Mr. Guthrie. I thank the witness for her statement, and we 
will now move to Member questions, and I will begin questioning 
and recognizing myself for 5 minutes.
    So Administrator Johnson, HRSA operates workforce 
programming both in scholarship programs and loan repayment 
programs, as we have discussed just recently--thanks for the 
meeting--in exchange for individuals working in medically 
underserved communities. So my--what I want to kind of explore 
is staying in medical-served communities, as we talked about 
before.
    So can you explain how HRSA measures success within these 
programs?
    And for providers practicing in healthcare provider 
shortage areas, do you have long-term data on how many of those 
providers stay within the communities in which they are 
practicing, or practice in other healthcare provider shortage 
areas?
    Ms. Johnson. I thank you so much for that question, Mr. 
Chairman. It is really important to us that we are tracking as 
well as we can continued participation, continued practice in 
the communities where we are encouraging people to serve.
    So we--as a matter of practice, we know how long people are 
practicing as part of their service commitment. That is part of 
their contract with us through the National Health Service 
Corps. And in some instances we are able to offer people 
continuations that keep them in a community longer if they 
continue to have eligible medical debt.
    But we also are tracking whether people stay in underserved 
and rural communities. We do that most directly through our 2-
year survey tracking, which shows our rate of people continuing 
to practice 2 years out from when they have completed their 
service agreement--not when they start practicing in the 
community, but when they have completed their service with us, 
and so they are no longer under contract with us. And that 
retention rate is 86 percent.
    And then what we are working to do, and what we have been 
doing is building the capacity to continue to monitor and be 
informed by where people choose to practice beyond that. And we 
are working closely with CMS on national practitioner 
identifier data so that we can continue to monitor that over 
time.
    Mr. Guthrie. OK, thank you. And also, I know that we want 
to get people out into these areas through the programs that we 
just discussed, and hopefully remain in the areas. The other 
way that we like to do it is in Teaching Health Center Graduate 
Medical Education, if they are in those same kind of areas.
    So I guess my question is how many residents practice 
within the same area or community within a healthcare provider 
shortage area, especially in rural communities?
    Ms. Johnson. Yes----
    Mr. Guthrie. So how does that get people out into the--how 
does the Graduate Medical Education get people out into----
    Ms. Johnson. I appreciate the question, sir. The Teaching 
Health Center Graduate Medical Education program doesn't have 
the same kind of service commitment tied to it that the 
National Health Service Corps does.
    Mr. Guthrie. Right.
    Ms. Johnson. In the National Health Service Corps you get 
our resources in return for practicing. And so then you are 
obligated to do that. In the Teaching Health Center program, 
our model is to try to make sure that we are training people in 
the communities where we hope that they will continue to serve 
by having people have direct experience of working in rural 
areas, in underserved communities.
    And we find, you know, our--after our residencies are 
completed--now, you know, as Mr. Pallone mentioned, we are--we 
still--we have about 1,400 people who have completed the 
training. You know, more than half of them are still in their 
communities. And we are continuing to work to ensure that we 
are doing everything we can to keep people in rural and 
underserved communities.
    Mr. Guthrie. So how would you define the success of those 
programs?
    And I know that you measure, and you had 86 percent staying 
for it. So I guess an anecdotal--or how would you define 
success in these?
    Ms. Johnson. I think that, from the strict requirements of 
the law, our success is the overwhelming demand we have for 
people who come to these programs, and the reports we get from 
people who come to these programs that they would have made a 
different choice about where they had to practice if not for 
these programs giving them the support to pay down their 
medical debt, to let them go to communities that are 
underserved or rural, that allow them to do that work which we 
all--which is our shared goal and why these programs have been 
in place for so long, and we have all worked to continue to 
grow them.
    I think it is also an added benefit of these programs that 
we see people continue to stay in those communities long after 
their obligation to us, and that is part and parcel of what I 
suspect the clinicians on this panel would say, which is what 
we see, which is that people tend to stay in the environments 
and communities where they train or where they have mentors or 
where they start their practice. And so we get that benefit 
from the programs as well.
    Mr. Guthrie. Well, and it is important to have these 
graduate medical programs outside of the bigger city, in the 
rural areas, because, you know, a lot of southern States, in 
particular, like Alabama, the universities are in Tuscaloosa 
and Auburn, but the teaching hospital, the medical center's in 
Birmingham and Mississippi, the same way Oxford is where their 
main school--and Starkville, which are small towns. And then 
there are medical centers in Jackson, Tennessee, Memphis 
versus--Knoxville is not a small town, but it is important.
    And I am going to close, because--and without responding, 
because I am out of time. But it is important that we get 
outside of those major health centers and get people in the 
community so they will hopefully put down their--as we talked 
the other day, their--you are graduating from medical school 
and residency, you are almost at the time you are putting down 
roots and picking where you are going to be.
    Ms. Johnson. That is right.
    Mr. Guthrie. And it is a good opportunity to be exposed to 
rural areas if they haven't before. So thanks for that. I 
appreciate that.
    I now recognize the ranking member of the subcommittee, Ms. 
Eshoo, for 5 minutes for questions.
    Ms. Eshoo. Thank you, Mr. Chairman.
    In 1997 this subcommittee held a joint hearing with the 
Senate Labor Committee to review our Nation's system for organ 
transplant. I was at that hearing, and I have long remembered 
it and how the witnesses from the United Network for Organ 
Sharing seemed to resent any questions being asked of them. 
That is what stands out to me from that hearing, amongst other 
things. But I recall that very well.
    Now, 26 years later, that organization continues to have a 
stranglehold on the Organ Procurement and Transplantation 
Network, OPTN, which has been plagued by inefficiencies, 
oversights, and errors along the way.
    I know a key part of your plan to modernize the transplant 
system is to establish a competitive and open bidding process 
for the next OPTN contract. Why don't you tell us, in your 
words, why you think this is necessary?
    Ms. Johnson. Well, thank you so much for the question, 
Ranking Member.
    You know, if you are an individual, or your family member 
is in need of an organ transplant, this is the absolute most 
critical system that you depend on to make sure that the system 
is fair and treats everyone the same and gives everyone equal 
access, and that it is run well. And my responsibility in this 
seat is that it is run well.
    And as you point out, there has been--you know, the statute 
is 40 years old, and there have been limited opportunities, 
limited work in the past to modernize that, which is why we are 
so excited to work with the subcommittee on modernizing the 
system.
    We think that we need best-in-class contractors rather than 
having all functions of the Organ Procurement and Transplant 
Network tied up in one single competitive bid. We think there 
is the opportunity for competition here, which will allow----
    Ms. Eshoo. Let me ask you--because I only have 2 minutes 
and 43 seconds left--in fiscal year 2024, the budget proposal, 
the President requested congressional authority to update tools 
governing the OPTN. Do you think that the legislation that we 
are considering today fulfills this request?
    Ms. Johnson. I think we are continuing to provide TA to the 
committee on the particulars of the legislation.
    Ms. Eshoo. OK.
    Ms. Johnson. But we are very pleased to be able to work 
with you on this----
    Ms. Eshoo. Good.
    Ms. Johnson [continuing]. Going forward.
    Ms. Eshoo. Great. When the Community Health Center Fund 
lapsed for 5 months in 2017, how were the community centers, 
health centers, impacted, and what would happen, very 
importantly, if this Congress allowed the Community Health 
Centers authorization to lapse again?
    Ms. Johnson. Yes, thank you for the question. I mean, 
nothing is more important, particularly at this moment in 
healthcare delivery, than predictability and stability of 
funding, particularly as healthcare facilities are trying to 
recruit new workers, trying to hold on to their current 
workforce.
    You know, workforce is a big challenge in the field right 
now----
    Ms. Eshoo. It is.
    Ms. Johnson [continuing]. And instability in funding, or 
fear of not being able to maintain their capacity, it not only 
creates disruption in their day-to-day services, but it really 
creates challenges with stability of the healthcare workforce. 
And everybody is competing for their workforce.
    Ms. Eshoo. OK. As of April 1st, certain States have begun 
removing Medicaid recipients who are no longer eligible for the 
program, and more than 40 States will begin this process in the 
coming months. How are the Community Health Centers preparing 
for this change?
    Ms. Johnson. Oh, thank you for raising this question. This 
is an incredibly important moment for the people that health 
centers serve, and it is important that we ensure that people 
who remain eligible get redetermined and maintain their 
Medicaid eligibility. Those who aren't can get to affordable 
marketplace coverage. And we are using our sisters at health 
centers to be able to do that. We are providing a little bit of 
extra funding to our State primary care offices to coordinate 
that.
    But if people who otherwise would be eligible lose 
coverage, health centers will still need to see them, which 
puts an even greater burden on health centers at a time when we 
have the--we are approaching this issue with respect to 
continuing funding.
    Ms. Eshoo. Terrific. Thank you for your leadership.
    And I would like to point out that our former chairman of 
this committee, Congressman Greg Walden, is here.
    It is great to see you, Greg. You can come and sit behind 
me, if you would like.
    [Laughter.]
    Ms. Eshoo. It is wonderful to see you, a friend to all of 
us, really great to see you.
    I yield back, Mr. Chairman.
    Mr. Guthrie. The gentlelady yields back.
    He would like to sit behind you, but he couldn't admire his 
picture from sitting there.
    [Laughter.]
    Mr. Guthrie. Or portrait, I should say, not a picture.
    The Chair now recognizes Dr. Burgess from Texas for 5 
minutes for questions.
    Mr. Burgess. Thank you, Mr. Chairman.
    Good to see you again, Mr. Chairman. Always welcome in this 
hearing room.
    I do have a number of questions, Ms. Johnson, on the 340B 
program. I may run out of time, and I may need to submit those 
for the record.
    I do need to ask--the Sickle Cell Disease Partnership had 
asked that their statement for the record--be made part of the 
record, and I would ask unanimous consent to----
    Mr. Guthrie. Seeing no objection, so ordered.
    [The information appears at the conclusion of the hearing.]
    Mr. Burgess. So, of course, I do get to meet with doctors 
all across the country. They come in and they talk to me about 
all kinds of issues. And you can imagine after the physicians 
fee schedule and reimbursement--the number 1 issue--the number 
2 issue is always workforce.
    So we have just been through this bad pandemic, put a lot 
of stress on our healthcare system, a lot of stress on our 
doctors. Now we have got inflation that has reared its ugly 
head, in combination with low reimbursement. And the 
consequence of that is doctors are leaving practice.
    Last Congress--and I can't believe I am going to say this 
out loud, but last Congress Mr. Sarbanes had a very good idea 
about physician reentry. I don't know if he is going to 
reintroduce the bill this year. We were never quite able to get 
to a place where we could actually partner on the bill. But the 
concept is one that I think is worthy of some discussion: to 
create a training program for--in his version it was for 
primary care doctors who would like to return to clinical 
practice--to unretire, if you will.
    So there is no question about it, we are at a time in this 
Congress we have got to be so diligent with all our spending. 
But would something like a physician reentry program work if 
Federal dollars were used strictly for offsetting the costs of 
training and recredentialing reentering physicians?
    Ms. Johnson. Well, thank you for the question, sir, and for 
your attention to this really important issue. I would love to 
talk to you about the particulars of it, but conceptually, you 
know, getting physicians who have the ability or the capacity 
to come back into the workforce is a great goal that I would 
love to work with you on, and love to think about how we can 
work together to achieve that. I think that is true of nurses, 
it is true of the workforce writ large.
    And, you know, I recruited physicians to come to work in 
the Federal Government for some time, and I see them having to 
make choices about what credentials they retain. And I think it 
is really important for us to think about how to make sure we 
get people back into the workforce when they are able to.
    Mr. Burgess. Sure. After you have left the bedside, it 
can--for any number of years or months, it can be very 
difficult to then reemerge on that path.
    Do you--I assume that one of your principal tasks is 
assuming--assembling data information available on the 
effectiveness of the current healthcare workforce programs.
    Ms. Johnson. That is right. We collect a lot of data on 
both the--who participates and the outcomes associated with it.
    Mr. Burgess. So would it be possible to consolidate or 
reimagine some of these programs to be more effective with 
Federal spending? Broad question, I get it, but could you do a 
better job?
    Ms. Johnson. Well, sir, we are constantly looking at the 
programs, both for--from a couple of ways: (1) from the front 
end, to make sure everyone who can be competitive is 
competitive, because sometimes it is hard to apply for Federal 
grants, and we are trying to make our entry door easier; (2) 
from ensuring that we are getting the best outcome data and we 
are not having people collect data for data's sake; and then 
(3) constantly looking at where can we get efficiencies in the 
design and implementation of our programs.
    Mr. Burgess. So recently, Optum disclosed they employ 
70,000 physicians, 7 percent of the total workforce. They 
acquire new health systems, literally, every month. And they 
want to add 10,000 physicians a year to their growing base.
    Does HRSA collect data on whether the National Health 
Service Corps physicians--or any physicians, for that matter--
stay independent, or do they join these large practices?
    Ms. Johnson. We collect data on our National Health Service 
Corps members when they are fulfilling their service 
obligation, and then we do our 2-year outlook. And we are 
continually working to build to figure out where they are going 
in--beyond that. And so, you know, we, obviously, are looking 
for where they are billing from in the future.
    Mr. Burgess. Sure. Well, I mean, it leads up to--one of my 
pet peeves is--in this country, because of the Affordable Care 
Act, it is legal for hospitals and health systems to own 
doctors, but doctors can't own hospitals, and we are in the 
best position to understand the allocation of those resources. 
I hope this committee will work on the concept of physician 
ownership of hospitals. It is one that remains, I--should 
remain at the forefront of our minds.
    And Mr. Chairman, I yield back.
    Mr. Guthrie. The gentleman yields back. The Chair now 
recognizes Mr. Sarbanes from Maryland for 5 minutes for 
questions.
    Mr. Sarbanes. Thanks very much, Mr. Chairman, and let me 
thank our witness today for your good work. It is so important.
    And let me thank Rep. Burgess, as well, for saying such 
kind things a moment ago--apparently, against all of his 
impulses. But I appreciate that.
    [Laughter.]
    Mr. Sarbanes. And I look forward to continuing to work on 
the Physician Reentry Initiative. And I appreciate the 
conversations that we have been having over the last couple of 
years about--or really, I guess, over the last 6 months. I 
think there is good opportunity there to collaborate and think 
about an innovative design that can encourage that cohort to 
come back into the practice of medicine, particularly in those 
areas of shortage.
    And we would certainly look forward to input from you, Ms. 
Johnson, about how that can be designed, and what sort of 
resources could be brought to bear to assist with this, because 
we understand--and you certainly understand--that the shortages 
across the country in just about every category of the health 
workforce, if not, frankly, every category of the entire 
workforce in the country, those shortages are significant and 
need to be addressed. And I thank you for all of the work that 
you are doing.
    I do also want to commend my colleague, Representative 
Blunt Rochester, for the work that she has been doing. And we 
have been collaborating on this, as well, in terms of 
advocating for funding for HRSA's efforts to collect and 
analyze, disseminate information about healthcare workforce 
dynamics through the National Center on Health Workforce 
Analysis, which is a very important resource for your agency 
and, frankly, for the country in terms of understanding what 
these dynamics are and making sure we are, again, being 
creative in addressing them. We need to enact policies that 
will lead to a stronger, more diverse workforce, one that can 
address the current and projected provider shortages that we 
face.
    In addition, there is the National Nursing Workforce Center 
Act, which is another bill that Representative Blunt Rochester 
has been working on. And I again thank her for those efforts. 
It will be interesting to understand a little bit better what 
you envision the design of that could be, if you get authority 
around it.
    I know that the Biden administration has made clear, 
including through its proposed Health Care Workforce Innovation 
Program, that it definitely understands the need to 
comprehensively and innovatively approach healthcare workforce 
issues, particularly now. And there is, I think, bipartisan 
focus on this as we continue to confront a mental and 
behavioral healthcare crisis that seems to be growing by the 
day and as we are serving an aging population. So these 
innovative approaches have to span provider types, geographics, 
and other things in order to be effective. And no solution is 
too small to make a difference.
    I do know, as well, that there's workforce programs that 
provide educational, other financial assistance. You have 
mentioned that in terms of the Corps and this idea of 
exchanging for service, that support in exchange for service at 
the Community Health Centers and other critical access points.
    Can you speak just briefly--I have about a minute left, but 
I would be interested to hear you speak again or emphasize what 
it would mean to increase our commitments to the National 
Health Services Core, other service-based programs like a kind 
of reentry program that was mentioned earlier by Congressman 
Burgess, but these efforts to help us recruit, train, retain a 
diverse and community-focused--and I think this is very 
important--workforce that can meet our current and projected 
demand.
    Ms. Johnson. Thank you so much for the question, 
Congressman.
    There is--I suspect this is true for your experience as 
well--there is nowhere that I go, to any of our grantees, to 
anyone in the community-based health workforce, where workforce 
isn't the first, second, and third list on their priorities of 
the issues that they are facing right now, which is why we 
think it is so critically important to sustain the level that 
we are at when it comes to what we have been able to do with 
the National Health Service Corps and be able to help place 
clinicians in the communities that need them most in return for 
loan repayments and scholarships, that that service commitment 
is so critical.
    We also think--outside the scope of the hearing today, but 
we also think the other investments we are making in our 
budget, as you pointed to, our new innovation program that 
would help--really help bubble up good, community-based ideas 
for how we more effectively train and more efficiently train in 
the healthcare workforce is a vital pillar of how we kind of 
move the process forward. Our new investments in training more 
mental health providers, our new investments in breaking some 
of the bottlenecks that make it harder to move more people into 
nurse training, we really think that, comprehensively, the 
budget is focused on workforce as a priority.
    Mr. Sarbanes. Thank you very much.
    I yield back, Mr. Chairman. I appreciate it.
    Mr. Guthrie. Thank you. The gentleman yields back. The 
Chair now recognizes Chairwoman McMorris Rodgers for 5 minutes 
for questions.
    Mrs. Rodgers. Thank you, Mr. Chairman.
    In a report published in December of 2015, GAO reported 
that HHS has 72 workforce programs that were funded in fiscal 
year 2014. In that report, GAO looked at the 12 programs with 
the highest obligations. Seven of those were at HRSA, including 
the National Health Service Corps.
    How many workforce programs does HRSA currently administer?
    Ms. Johnson. I believe our workforce number now is about 
50.
    Mrs. Rodgers. OK. Well, how many----
    Ms. Johnson. And that is considered the individual----
    Mrs. Rodgers [continuing]. Workforce programs----
    Ms. Johnson [continuing]. Programs.
    Mrs. Rodgers. So 50 different workforce programs?
    Ms. Johnson. Different funding opportunities.
    Mrs. Rodgers. OK. And then would you speak to how you 
measure performance outcomes of these programs?
    Ms. Johnson. Yes. Thank you for the question.
    Performance outcomes is a weighted factor in awarding our 
grants. We make sure that we are collecting outcomes associated 
with the grant. That will factor into future funding for the 
potential awardee, it factors into decisions about the current 
award, and then we collect performance metrics in detail about 
the participants in the program and the outcomes associated 
with the programs.
    Mrs. Rodgers. OK. Would--could you provide the committee 
with an updated list of the programs, including basic funding 
and performance----
    Ms. Johnson. Absolutely.
    Mrs. Rodgers. OK, thank you. As I mentioned in my opening 
statement, I have been a long-time supporter of the Teaching 
Health Center GME program. I have led its authorization--
reauthorization, not authorization--reauthorization of the 
program during several Congresses. And I understand HRSA plans 
to use resources from the American Rescue Plan to expand to new 
residency programs.
    How will this impact existing Teaching Health Centers like 
the Spokane Teaching Health Center in my district?
    Ms. Johnson. Thank you so much for the question, and thank 
you for your leadership on this issue, Madam Chairwoman. It has 
been incredibly helpful to have the impact of your vision here, 
and what it means for residents on the ground, and so inspiring 
to hear the residents we talked to in Spokane about how they 
intend to continue to work in rural communities.
    The President's budget is actually built so that we can 
both take advantage of resources that we have had from the 
American Rescue Plan to help new planning, new--there is a lot 
of interest in the health center program, the Teaching Health 
Center program, and so to help new folks plan and develop and 
get ready to potentially apply in the future.
    But our budget is built to fund current awardees and then, 
over time, be able to bring on new folks if they meet the 
accreditation thresholds going forward and they are 
competitive.
    Mrs. Rodgers. OK. In 2019 GAO reported that between 2010 
and 2017 Community Health Centers saw an increase in revenue 
coming from insurance, both public and private pay. How has 
health centers' revenue changed since 2017?
    Ms. Johnson. I can't speak to the details, but I can tell 
you that what has happened is that health centers have 
continued to be the resource in communities for people who are 
underserved and/or underinsured. And so across the country in 
communities, whether they have expanded Medicaid or not, health 
centers are still the resource that is seeing people who have--
who lack health insurance or who have Medicaid and don't have 
another usual source of care.
    Mrs. Rodgers. So does HRSA anticipate any further changes 
to the public and private revenue sources the health centers 
receive?
    Ms. Johnson. I think what we--the one thing that we did see 
was some growth in people--a small growth, but people who got 
marketplace coverage who had previously been uninsured may 
continue to see their health center provider for the continuity 
of care.
    Mrs. Rodgers. OK, OK, thanks. As a mom with a son with Down 
syndrome, I am extremely concerned by the continued reports of 
individuals with disabilities being denied an organ transplant 
solely based upon an individual's disability. As the agency 
tasked with administering the Organ Procurement and 
Transplantation Network, or OPTN, what steps has HRSA taken to 
address discrimination against individuals with disabilities in 
the organ transplant system?
    Ms. Johnson. Thank you so much for the question. We are 
laser-focused on reforming the system so that we have better 
accountability and better transparency and oversight in the 
OPTN system. And part of that is about bringing more 
competition into the program so that the structures, the 
functions that govern our IT and our policy and our 
governance--right now, the--our vendor, the Organ Procurement 
and Transplant Network, and the private corporation that runs 
outreach and the like is the same vendor. And we think that we 
need to separate the boards, have more accountability in the 
board, and that that will be a venue for us getting better 
fairness and equity across the system.
    Mrs. Rodgers. OK. Well, I appreciate hearing more about 
those additional steps that you are taking----
    Ms. Johnson. Absolutely.
    Mrs. Rodgers [continuing]. At HRSA, and thanks for being 
here today.
    Ms. Johnson. Absolutely.
    Mrs. Rodgers. I yield back.
    Mr. Guthrie. I thank--the Chair yields back. The Chair now 
recognizes the ranking member of the full committee for 5 
minutes for questions.
    Mr. Pallone. Thank you, Chairman Guthrie. I appreciate the 
opportunity to discuss these important programs today, and 
thank you and Administrator Johnson for being here today. And I 
also thank the Administrator for coming to my Community Health 
Center in Red Bank recently. I really appreciate you doing 
that.
    However, before I discuss primary care I must note that I 
remain very concerned by the recent efforts of extremist 
Federal judges putting their beliefs between doctors and their 
patients, particularly with regard to the abortion pill 
mifepristone. If we are to have a full discussion on ways to 
grow our healthcare workforce and protect patients, we must 
start with ensuring that healthcare providers can provide the 
care their patients need and prescribe the medications that 
have been proven safe and effective. And I hope my majority 
colleagues recognize how detrimental these recent court actions 
like the FDA v, Alliance for Hippocratic Medicine could be, not 
only for patients but also for providers.
    So let me ask Administrator Johnson about this.
    From your perspective, what impact do you think these 
decisions like this recent one in FDA v, Alliance for 
Hippocratic Medicine by what I consider extremist judges have 
on the healthcare workforce in this country?
    Ms. Johnson. Well, thank you for the question, Ranking 
Member. Obviously, we are--there is actually--there is, 
obviously, ongoing litigation, so I won't speak to the 
particulars of that. But I will say, you know, in healthcare 
services for a very long time we have recognized the value and 
the importance of the relationship between the provider and the 
patient, and respecting decisions that happen between the 
provider and the patient. And that is what our policies and our 
training programs are organized around, and that is what is 
important, is making sure that the--that we are centered on the 
patient and the provider.
    Mr. Pallone. Well, let me ask--well, I guess Chair Rodgers 
isn't here. Let me ask Chair Guthrie.
    Every Democratic member of the committee sent you and Chair 
Rodgers a letter last week requesting that you immediately hold 
a hearing on the impact of this case. And I think we have to 
hear from experts on how detrimental this case could be for 
women and for all the Americans who rely on FDA-approved drugs. 
Even the pharmaceutical industry agrees that this case has 
dangerous precedent-setting implications. I haven't received a 
response.
    So if you could, tell me, Chair Guthrie, whether you will 
hold a hearing on this important issue.
    Mr. Guthrie. Well, we are going to continue to do oversight 
over the FDA, so we will have that under our committee's 
jurisdiction.
    Mr. Pallone. Well----
    Mr. Guthrie. We will continue to do oversight.
    Mr. Pallone. Do you know when that is likely to be?
    Mr. Guthrie. I don't have a time for it.
    Mr. Pallone. Yes. I mean, the problem is, you know, that 
today--I don't know if anything happened this morning yet, but 
as of, I think, midnight tonight the stay of the lower court's 
decision could be lifted, unless the Supreme Court acts. And 
that would mean that this pill would not be available, for the 
most part, in the country. And so I really think we need to do 
something immediately. And I just want to reiterate that again. 
We should have the hearing as soon as possible.
    But I wanted to--I do want to see if--I know I only have a 
little time left. I want to ask Administrator Johnson about the 
primary care workforce. And, you know, many people in this 
country struggle to access primary care because of a lack of 
providers. We have already discussed this. There was a report 
from the Kaiser Family Foundation that said over 97 million 
Americans live in a designated primary care health professional 
shortage area. And of course, the Teaching Health Center 
Graduate Medical Education Program is designed to address that.
    So let me ask you a question: Can you explain the value of 
medical residence training in community-based settings rather 
than in hospitals, and what kind of impact the program, like 
the Teaching Health Center Graduate Medical program, has, 
particularly in underserved communities?
    You have got about a minute.
    Ms. Johnson. Well, I will just say that we are so excited 
about the way this innovative program has sort of changed the 
game for what primary care training can and should look like 
and anchoring it in the community in the places where we want 
primary care providers to serve. It makes it more likely that 
they will practice there, it gives them the kind of experience 
and access to the kind of training experiences that will then 
be useful to them in their primary care practice. And so it has 
been transformational, and it makes a huge difference in 
communities across the country.
    Mr. Pallone. And just the challenges, particularly because 
of unstable funding--you know, we have had this discussion 
about how, if you do this short-term and the funding is not 
there, it really presents challenges for the program. If you 
could, respond quickly.
    Ms. Johnson. It has been very difficult for programs to 
plan appropriately. Funding cliffs make it hard to know whether 
with security you can recruit your next class of residents. It 
makes it hard for residents who really want to train in the 
community to make that commitment if they are not sure the 
funding is there. So it creates problems, challenges for 
programs, existing residents, and future residents.
    Mr. Pallone. Thank you so much. I appreciate everything you 
have been doing on this.
    And thank you, Chairman.
    Mr. Guthrie. Thank you. The ranking member yields back. The 
Chair now recognizes Mr. Griffith for 5 minutes for questions.
    Mr. Griffith. So I have lots of questions about the Black 
Lung Program. But unfortunately, all the questions I have are 
in areas that are not under your jurisdiction, so I will have 
to save those for somebody else.
    Ms. Johnson. OK.
    Mr. Griffith. But there are a lot of things I think we can 
do to help black lung victims as we move forward. So if I can 
ever be of help to you on that, let me know.
    Ms. Johnson. I very much appreciate that, and we will do 
all we can with our--from our vantage point as well.
    Mr. Griffith. Thank you. So let's talk 340B. Some of the 
nonprofit hospital systems, in my opinion, have been exploiting 
the 340B program to reap huge profits that fuel expansion into 
affluent communities instead of continued reinvestment in 
communities of greatest need. In fact, my district is 
relatively economically stressed. We are 409th out of 435 for 
median household pay. So I have got for-profit hospitals that 
are doing a substantial amount, and my hospitals in my area 
that get 340B are using it--through my analysis, at least--they 
are using it to help people. They don't have much choice, 
frankly. So it is a great program, and I support it.
    That being said, there are bad actors out there. And one 
notable example happened in Virginia in what was then the 
district of my friend, Don McEachin. And it appears that Bon 
Secours Hospital System used the Richmond Community Hospital, 
which is clearly 340B-eligible, to expand its use of 340B at 
the expense of Richmond Community Hospital and their patients 
in that economically stressed community. Over the years, 
services at the Richmond Community Hospital were cut and 
departments closed, while at the same time Bon Secours, it 
appears, was transferring millions out of the Richmond Hospital 
to other hospitals within the system--some in their system 
maybe even as far away as Ohio, I am told.
    So this is important to me. How do we make these--how do we 
make reforms? What exactly do you plan to do with the 
information that you all are collecting? I know you have sent a 
number of letters out to hospitals asking them how they are 
using it. What do you plan to do with that information when you 
get it? And if you don't get it, should we be passing 
legislation?
    I know I am adding two or three things in there. Should we 
be passing legislation for more transparency?
    Because I made a promise to Don that I wouldn't let this 
go, and neither one of us knew he was going to pass away. He 
called me a couple of weeks before his death and said, ``Hey, 
as chairman of Oversight and Investigations on Energy and 
Commerce, I need your help.'' I promised him I would help. Help 
me keep my promise.
    Ms. Johnson. Well, thank you so much for raising this 
issue. Thank you for your work on this issue.
    I had the opportunity to talk to him before he passed as 
well, on this topic, and know how passionate he was about 
making sure resources are going to the places where they are 
intended.
    As you noted, 340B plays a vital role for some critical 
safety net providers, but we need to make sure that there is 
accountability and transparency in the system. Our recent 
letters to a number of covered entities were part of that 
process. Our request in the President's budget that we actually 
get specific designated authority for reporting--for covered 
entities report--to report on the savings from the program, and 
how that is benefiting the communities they serve is a specific 
ask we have made in the budget.
    We look forward to working with you on that. We really 
would benefit from your assistance in making sure that we have 
all the tools necessary. As you probably know, we are in a lot 
of litigation on 340B, and so clarity about our scope and 
authority would be incredibly important to us.
    Mr. Griffith. All right, and I look forward to working with 
you on that.
    Let's switch gears and go to Community Health Centers, 
another group that does great work in my region. I am glad to 
have them.
    But it has come to my attention in talking with some of my 
Community Health Centers that pharmacy benefit managers are 
taking predatory actions against the health centers by 
effectively forcing them to sign what they believe to be unfair 
contracts. They are forced to sign these contracts, which 
include provisions which give the savings, or a part of the 
savings, back to the PBM, the pharmacy benefit manager, instead 
of helping the poor folks who really need these services of the 
health centers.
    So do you all have legal authority to address the matter, 
or is this an issue that we need to--Mr. Carter and I need to 
put legislation in on?
    Ms. Johnson. I would ask----
    Mr. Griffith. Oh, I should have--shouldn't have left out 
Mrs. Harshbarger.
    Ms. Johnson. Thank you. I would ask for your assistance 
here.
    We--as you may know, we also have had the issue of 
manufacturers not selling to covered entities via their 
contract pharmacy arrangements. We issued violation letters 
associated with that. That has been a source of considerable 
litigation, as well. Clarity about our authority and scope here 
to be able to--because I share your view that accountability in 
this system is critical and would love to work with you on 
that.
    Mr. Griffith. All right. I look forward to working with 
you. And if we need legislation, you have got three people on 
this committee that are more than happy to help you in any way 
you need.
    Ms. Johnson. Thank you.
    Mr. Griffith. I yield back, Mr. Chairman.
    Mr. Guthrie. Thank you. The Chair yields back, and the 
Chair now recognizes Mr. Cardenas from California for 5 minutes 
for questions.
    Mr. Cardenas. Thank you very much, Chairman Guthrie, and 
also Ranking Member Eshoo, for holding this very important 
hearing.
    And thank you, Administrator Johnson, for coming forward. I 
like your answers. Your answers are very concise. You are not 
copying what they do in the Senate, which is filibustering. 
Sometimes some of our witnesses kind of do that. But thank you 
for being so direct with your answers and so helpful.
    I am concerned about shortages in pediatric care. We need 
to look no further than this past winter, when a combination of 
COVID, RSV, and flu wreaked havoc on our kids and left many 
without access to care.
    Administrator Johnson, what role will increased funding for 
the THC GME program play in boosting the pediatric care 
workforce?
    And how can the program increasingly prioritize physicians 
who will work in medically underserved communities?
    Ms. Johnson. Thank you so much for the question, 
Congressman.
    The Teaching Health Center Graduate Medical Education 
program, because it is so primary-care-focused, we have worked 
really hard to encourage programs to stand up pediatric 
programs. We have a few. We hope, with our planning and 
development grants, we will get more. We have trained probably 
close to 50 pediatricians through the program so far. We hope 
to continue to grow that and--as we go forward, to ensure that 
this vital program is actually doing what we want in terms of 
training not only internal medicine and family medicine docs, 
but family--but pediatricians in community-based settings.
    Mr. Cardenas. Thank you. And also I want to take a moment 
to discuss the critical role that Community Health Centers 
play.
    Personally, I grew up in a household of 11 children and 2 
parents. And for a good portion of my childhood we did not have 
health coverage. We didn't have access to healthcare. Honestly, 
it came down to prayers and aspirin, which are--which was the 
way that we handled things most of the time. And the place 
where we showed up, unfortunately, was the emergency room. And 
that still goes on to this day with too many families, whether 
it is one child or many children. And that--we need to do what 
we can in this great country to make sure that that is not the 
alternative, it is either no coverage or going to the emergency 
room.
    CHCs and FQHCs, literally, are a lifeline for families 
with--like mine. For example, FQHCs, when I was about 10 years 
old, were created, and one of them showed up in my community, 
and that is when we finally got access to healthcare. So they 
are the reason why I received care when I was 10 years old and 
beyond.
    NAVHC was the place that we went, and other CHCs are still 
doing this essential work in my district to this day, and they 
are getting creative about caring for as many people as 
possible. For example, some are using mobile clinics to provide 
care to hard-to-reach populations. Also, in many cases, centers 
are even keeping extended hours to try to keep ERs, you know, 
out of the picture as much as possible. I am proud of the work 
that the CHCs do in my community, and so many questions are 
really focused on how to grow these lifesaving resources.
    So, Administrator Johnson, what else can we do from a 
policy standpoint to increase the reach of CHCs, especially in 
medically underserved and rural communities?
    Ms. Johnson. Oh, thank you so much for the question, 
because that is what our budget is about. Our budget is saying 
we not only need to sustain where we are, but this is a proven 
model and we know it works, so we need to ensure that we are 
building on it to get to more people in need. And so our budget 
focuses on new access points.
    We know from all the health centers--as you said, when a 
health center shows up in your community it makes a difference 
for families. So getting more health centers into more 
communities, extended hours, making sure--you know, if you work 
shift work, getting to a regular office hour appointment is 
hard. Health centers try really hard now, but we want to invest 
in making sure that they have extended hours.
    And integrating mental health and substance use disorder 
services into the core of what health centers do, so that 
primary care isn't, you know, medical services on one side and 
then refer you to mental health and substance use disorder, but 
primary care is integrated care.
    Mr. Cardenas. When--one of the big issues is workforce 
recruitment. And how will this--how will funding help ensure 
that CHCs are adequately staffed?
    Ms. Johnson. Yes, the funding--the continuation and 
expansion of our health center resources are absolutely vital 
to them retaining their health workforce and growing their 
health workforce. And uncertainty about the future of their 
funding will make it challenging when it comes to retaining 
workforce at a time like this, when the workforce competition 
is so intense in the healthcare field.
    Mr. Cardenas. Well, thank you.
    My time is about expired. Thank you, Mr. Chairman. I yield 
back.
    Mr. Guthrie. Thank you. The gentleman yields back. The 
Chair now calls on Mr.--recognizes Mr. Bilirakis for 5 minutes 
for questions.
    Mr. Bilirakis. Thank you, Mr. Chairman, I appreciate it. 
Again, thanks. This is a very important conversation today, as 
you know. And we are looking at multiple reauthorizations that 
provide such vital care and services for many of my 
constituents, for Floridians and all Americans.
    My question is--and I appreciate you being here, thank you. 
To start, I am very thankful that legislation I am working on 
to extend the funding for the Special Diabetes Program and the 
Special Diabetes Program for Indians has been noticed at this 
hearing.
    I appreciate it, Mr. Chairman. Working with my friends Ms. 
DeGette, Mr. Cole, and Dr. Ruiz, we have introduced bills that 
would provide a level of funding for these programs for 5 more 
years. These programs are vitally important, as you know, an 
essential resource in our Nation's investment in diabetes 
research, treatment, education, and prevention programs.
    Diabetes is our country's most expensive chronic disease in 
both human and economic terms, affecting people of all ages, 
races, and in every region of our country. It is the leading 
cause of heart disease and stroke. Additionally, it is the 
number 1 cause of kidney disease blindness in working-age 
adults and lower limb amputations, unfortunately. Reauthorizing 
these programs will provide stability and hope for the millions 
of Americans impacted by diabetes. This is truly a bipartisan 
effort, and I look forward to working with all my colleagues to 
get these programs extended long-term.
    Ms. Johnson, thank you again for being here. You have not 
mentioned diabetes in your testimony today, but I am sure you 
recognize its impact on the American people. I know that. What 
role do you believe the primary care workforce plays in 
addressing prediabetes and diabetes in the U.S. in general, 
please?
    Ms. Johnson. Thank you so much, Congressman, for your 
comments. And I do defer to my colleagues in the other agencies 
who run the Special Diabetes Program but know from the long 
history of those programs how valuable they are to the public 
health and healthcare services.
    Diabetes is a--it is such a--it, in and of itself, is such 
a challenging chronic disease for people to manage. And the 
risk factors for it are just as challenging. And having an 
established relationship with a community health provider who 
often speaks your language or is from your community makes such 
a difference in identifying risk early, in doing the kind of 
modifications and work necessary to try to forestall the onset 
of diabetes, to try to help people manage their condition if 
they have diabetes. It just makes such a difference to have a 
usual source of care.
    And when you are uninsured or underinsured, having a usual 
source of care is very hard unless you can turn to a Community 
Health Center that will see you regardless of your ability to 
pay. And those Community Health Centers are often staffed by 
National Health Service Corps members. So all of this works 
together to make sure that we have that critical work.
    I would also say we run a lot of maternal and child health 
programs as we work on maternal mortality crises and infant 
mortality issues. Addressing diabetes is such an important part 
of that equation as well.
    Mr. Bilirakis. Thank you very much. The next question, 
because I still have some time, another very important program 
we must reauthorize, of course, is the Community Health Center 
Fund. I have been an outspoken advocate for the role that 
Community Health Centers play in providing whole healthcare for 
so many Americans, and I am proud to have led efforts to 
reauthorize the Community Health Center programs in the past 
years. I am very grateful to join forces with Dr. Joyce, and I 
thank him for his leadership on this particular bill.
    Locally, I am also very proud of the work that Florida 
Community Health Centers are doing throughout my home State. 
One CHC, Suncoast Community Health Center, has developed and 
built its own subsidiary training academy, Suncoast Academy, 
that provides training for dental assistants, pharmacy 
technicians, and later this year, medical assistants. It is 
really fantastic. Several CHCs around the State have begun 
planning or have already implemented registered apprenticeships 
without--within their organizations.
    So a question for you, Ms. Johnson--and again, I know that 
Florida CHCs are extremely resourceful--and I am sure they are 
around the country as well, it is a great program--and have 
found creative ways to increase access for patients. You have 
touched on this. They have a true sense of understanding of the 
needs of our neighborhoods and communities. How do you intend 
to partner with State CHCs to support and leverage the 
strength--the strengths, as well as their efforts to grow the 
workforce and expand services? If you could elaborate on that--
I know you touched on it--I would appreciate it.
    Ms. Johnson. Yes, thank you. Thank you so much for the 
question.
    I mean, one of the things that I am really excited about in 
the President's budget this year is a new initiative that we 
have proposed on the discretionary side called our Health Care 
Workforce Innovation Program, which would be our way to sort 
of--in many ways, our healthcare workforce programs are defined 
by statute, and we lay out what the requirements are. Here we 
are really trying to get the best ideas from the field, like 
the models that Florida's health centers are implementing, and 
figure out what works and what we can start taking to scale so 
that we can actually be seeding some of these initiatives as 
well. Because we hear time and time again med techs, farm 
techs, like a lot of the support, the critical folks who are 
early in the career ladder----
    Mr. Guthrie. Yes, thanks. We are going to have to round up 
this series of questions and----
    Mr. Bilirakis. Yes, yes, I yield back.
    Mr. Guthrie [continuing]. Time has expired, and I thank you 
for that, your answer. I know we are going to get to more of 
that as we--as you continue to talk, so--but the Chair now 
recognizes Dr. Ruiz from California for 5 minutes for 
questions.
    Mr. Ruiz. Thank you, and thank you for holding this 
important hearing today.
    I have been a long-time advocate for the Teaching Health 
Center program and have introduced bills to extend the 
authorization time and as well as increasing funding because I 
believe in its mission, and I believe that it works.
    I grew up, practiced medicine, and now represent an area 
that is in desperate need of healthcare providers. The doctor 
shortage is a nationwide problem, both in absolute terms and 
also in the distribution of physicians, but more acute in some 
communities like those in my district, where in research that I 
did back in 2010, there was 1 full-time equivalent physician 
per 9,000 people. And as you know, the medically underserved 
criteria is 1 to 3,000.
    So, as you know, where a doctor is from and where they 
train are the two biggest indicators of where they will 
practice. So training physicians in health centers that are 
located in and directly serve communities in need is critical 
in addressing the provider shortage. More importantly, taking 
individuals from those underserved communities and training 
them in their underserved communities increases the probability 
that those communities will have physicians who will care about 
them and take care of them.
    That is why I am proud to have joined Ranking Member 
Pallone to introduce the Doctors of Community Act, which will 
permanently fund the Teaching Health Centers program and result 
in the largest expansion of the program since its creation. 
Administrator Johnson, is there a demand for this program on 
the physician side, meaning do Teaching Health Centers receive 
a significant number of applications for residency slots, or 
are they struggling to get residents to apply?
    Ms. Johnson. Oh, there is demand for this program, 
Congressman. There is a lot of interest both in establishing 
residency programs and then in recruiting residents themselves 
to the programs. There is a lot of interest and a lot of 
enthusiasm. I think people who have a dedication to a 
community-based service, who want to practice in high-need 
communities or rural areas are drawn to this program.
    What is challenging both for programs and for the 
recruitment of residents is if there is instability in the 
program funding or not--or folks not having confidence that it 
will be there for them through the full term of their 
residency.
    Mr. Ruiz. And what do you see in terms of outcomes for this 
program? What is the percentage of physicians that stay in the 
communities that they train in?
    Ms. Johnson. Well over half of them stay in the community--
in communities or in underserved communities. But we continue 
to see that number increasing, and we know that people are 
interested in making sure that--we know that the data all 
supports that people who train in the community are more likely 
to stay in the community.
    Mr. Ruiz. So jumping topics to address another one of my 
policy priorities, in this hearing we are considering H.R. 
2547, the Special Diabetes Program for Indians Reauthorization 
Act of 2023, which I introduced with Congressman Cole. Although 
these programs do not fall squarely within HRSA's jurisdiction, 
the resources provided by the SDPI program have significantly--
impacts in the communities that HRSA serves and the health 
workforce that provides diabetes care.
    And as a doctor, time and time again I saw patients in the 
emergency department with preventable conditions related to 
their diabetes, the silent killer. And these problem--this 
problem is continuing to get worse, particularly in communities 
of color with low access to healthcare prevention and chronic 
care for their chronic illness. And data shows that the 
incidence of type 1 diabetes is increasing among all 
population. Nevertheless, American Indian and Alaska Native 
populations have the highest prevalence of diabetes, which 
leads to renal failure, neuropathies, amputations, blindness, 
and other chronic comorbidities.
    I believe that reauthorizing this program is critical to 
reducing the incidence and mortality of diabetes, which overall 
is the seventh leading cause of death and the number 1 cause of 
kidney failure and lower limb amputations and adult blindness.
    What actions is HRSA taking to address the growing 
incidence of diabetes, and how is HRSA coordinating with other 
agencies such as the Indian Health Service to serve communities 
acutely affected by diabetes?
    Ms. Johnson. There is no doubt how critical the Special 
Diabetes Programs are to both the work that they do directly, 
but then also building the models that our primary care 
providers can learn from and implement. And that is what we do, 
is create learning environments and learning collaboratives 
across health centers so that we are sharing the best practices 
and knowledge so that we are able to help do the cutting-edge 
prevention and treatment work.
    Mr. Ruiz. Thank you. I do believe that these Teaching 
Health Centers should also participate in pipeline development 
programs----
    Ms. Johnson. Yes.
    Mr. Ruiz [continuing]. Working with local high schools in 
these underserved communities, local colleges, and medical 
schools so that from an early start they can start in high 
school, finish in medical school in residency training, like 
the Future Physician Leaders Program that I initiated back when 
I was senior associate dean at UC Riverside School of Medicine.
    Ms. Johnson. Terrific. We also fund on the discretionary 
side some of those programs. So building those bridges is 
really important to us.
    Mr. Ruiz. Wonderful, thank you.
    Ms. Johnson. Thank you.
    Mr. Guthrie. Thank you. The gentleman yields back. The 
Chair now recognizes Mr. Johnson for 5 minutes for questions.
    Mr. Johnson. Well, thank you, Chairman Guthrie, and thank 
you, Administrator Johnson, for making yourself available 
today.
    I also want to thank you for--you and HRSA--for your 
response to the February 3rd train derailment in East 
Palestine, a small village in my district. It is critically 
important that all levels of government continue to work hard 
and hand in hand to ensure the health and long-term viability 
of that small village that I represent.
    Locally, the Community Action Agency of Columbiana County 
stepped up immediately after the East Palestine train 
derailment, deploying a mobile health unit to a local church 
that enabled physicians and toxicology experts to perform 
health assessments for those individuals looking for care in 
the aftermath of the disaster. For residents without a 
physician, the health center provided quality medical and 
dental care to help the community recover from the event.
    So my question for you, Administrator Johnson, yours is the 
primary Federal agency responsible for improving access to 
healthcare for people who are uninsured, isolated, or medically 
vulnerable. And I would argue that that encapsulates the 
village of East Palestine. What has HRSA's involvement been 
with ensuring access to those medically vulnerable citizens 
there?
    Ms. Johnson. Yes, thank you so much for the question and 
for recognizing the resources we were able to provide soon 
after the incident to ensure that the health center in the 
community was able to staff and support the mobile clinic and 
other resources.
    We think it is vitally important that health centers are 
able to surge in a response, because they have community 
relationships and because they know where their patients are. 
Often for some of our centers that serve individuals who are 
experiencing homelessness, they have--they are the connection 
to that individual and their services. So we are anxious to 
continue to build on that work, and we were delighted to be 
able to do that short-term. And we look forward to working with 
you and with the community on response going forward.
    Mr. Johnson. And what are you doing to coordinate the 
efforts on the ground?
    How have you assisted Community Health Centers like the 
Community Action Agency on the ground to ensure that resources 
are being allocated and used efficiently and effectively?
    Ms. Johnson. Yes, we have a partnership with State primary 
care offices, which are often the coordinating entity for 
Community Health Centers across the State. In the event of an 
emergency, we often work directly with the State primary care 
agency----
    Mr. Johnson. OK.
    Ms. Johnson [continuing]. To make sure that we are touching 
all of the relevant health centers in the community. And then 
we work closely with our disaster response colleagues at the 
Federal--at our Department and across FEMA.
    Mr. Johnson. All right. Another broader challenge that many 
in my district and much of rural America deal with is 
workforce.
    Ms. Johnson. Yes.
    Mr. Johnson. Every industry, from manufacturing to 
healthcare, is having trouble recruiting and maintaining a 
necessary and sufficient workforce. Why is this?
    I mean, it could be because Washington paid countless 
individuals to stay at home and sit on the couch, or because we 
don't have things like work requirements on able-bodied 
Americans to receive Federal assistance. We, Washington, has 
incentivized people not to go to work.
    To this point, can you please explain for us today how the 
Federal Office of Rural Health Policy is working with Community 
Health Centers in rural communities to train and place 
healthcare professionals in regions like Appalachia, where I 
call home?
    Ms. Johnson. Yes, sir. I would say, you know, what we are 
seeing in healthcare is really--we asked a lot of the 
healthcare workforce over the last several years, and it was 
incredibly traumatic and stressful for a lot of people. And we 
have seen some people, you know, either retire or move on to 
other work because of the strain of that, which is why we have 
made an investment in supporting the mental health and well-
being of the healthcare workforce. We have done awards to 
medical centers across the country to help them focus on 
retaining their workforce by supporting their mental health and 
well-being.
    Our Federal Office of Rural Health Policy focuses on 
building rural residency programs so that we can train in rural 
communities. It focuses on making sure we are supporting the 
viability and financial viability of rural hospitals by 
providing support for them directly to ensure their long-term 
sustainability. We provide a ton of technical assistance in 
rural communities. We are very focused on workforce in rural 
communities.
    Mr. Johnson. OK. Well, my fear--and something that I would 
continue to sensitize you to--is that we are seeing--and we are 
seeing it daily--is that these rural communities are often left 
behind for--in favor of more urban areas with regards to this 
program. And I appreciate it that you are sensitive to that.
    We have got a long way to go to equate healthcare access 
and the quality of healthcare for people in rural America.
    Ms. Johnson. No doubt.
    Mr. Johnson. I yield back.
    Ms. Johnson. No doubt that there is a lot of work to be 
done in rural America, but a lot of our National Service Corps 
members are in rural communities. Thank you, sir.
    Mr. Johnson. Thank you.
    I yield back.
    Mr. Guthrie. The gentleman yields back, and the Chair now 
recognizes Ms. Kuster from New Hampshire for 5 minutes for 
questions.
    Ms. Kuster. Thank you very much, Mr. Chairman, I appreciate 
it.
    Thank you to Administrator Johnson for being with us today. 
As has been highlighted throughout this important hearing, we 
are at a key point for supporting Community Health Centers. In 
New Hampshire, Community Health Centers serve as a critical 
site of care, filling gaps in rural areas and ensuring people 
of all backgrounds can access the healthcare that they need.
    Cost-effective preventative care is under attack by 
conservative courts across the country trying to politicize our 
healthcare system. And it is essential we defend the healthcare 
providers who are delivering lifesaving services.
    The National Association of Community Health Centers finds 
that, overall, Community Health Centers save the healthcare 
system $24 billion annually by increasing access to 
comprehensive, high-quality, preventative, and primary care. If 
Congress does not invest in our Community Health Centers, 
American health will suffer, and the cost of care will 
increase.
    I applaud my colleagues for introducing a bill that would 
not lead to cuts in funding, but we must do more. We know that 
flat funding will prevent Community Health Centers from meeting 
our constituents' needs. While I am hopeful our colleagues in 
the Senate will be able to raise the funding levels, the 
conversation must start here.
    Administrator Johnson, can you speak to the importance of 
increasing funding for Community Health Centers and how 
increases could benefit CHCs in States like New Hampshire?
    Ms. Johnson. Thank you so much for the question. That is 
very consistent with the way our budget is structured. We 
recognize that it is vitally important that we sustain where we 
are with health centers, but we are not meeting the needs of 
communities that--to their fullest. And we have the opportunity 
to do that here, in particular in a couple of key areas.
    We think it is important to make sure that we are expanding 
health centers into communities that need more sites. You know, 
convenience and access to healthcare is critical to delivery, 
as is making sure that we have expanded hours in health 
centers. Again, people who work shift work or who have child 
care issues, there are a host of things that can make it hard 
to see a doctor during normal business hours. We can expand 
business hours in health centers. We can make it more 
convenient for people to get the care they need, and then they 
can go to a health center instead of going to an emergency 
room, which clearly costs more.
    And at the same time, we think it is vitally important to 
recognize the moment that we are in when it comes to the needs 
of families around mental health and substance use disorder. 
And time and time again when I talk to primary care providers, 
they say visits that started out being about hypertension or 
other issues quickly become about a mental health issue. And so 
making sure that we can provide those services and provide that 
support in health centers is part of what we think is essential 
to meeting this moment for families' needs.
    Ms. Kuster. Great. You practically took the words out of my 
mouth, because I visited a site in my district just recently, 
and they are embedding the mental healthcare in the healthcare 
facility and vice versa, embedding mental healthcare in the--
embedding healthcare into the mental health facilities.
    So Community Health Centers do play an essential role in 
combating addiction and mental health. And I am the cochair of 
the bipartisan Mental Health and Substance Use Disorder Task 
Force, and I have seen firsthand the innovative ways that our 
health centers are helping meet people where they are to 
deliver the care that they need, as you mentioned, conveniently 
and in hours that fit people's real lives.
    Addiction and mental health challenges affect people of all 
ages, incomes, and backgrounds, which is why it is essential 
that Community Health Centers remain accessible. Can you 
explain the importance of including mental and behavioral 
health funding for Community Health Centers in future funding 
packages?
    Ms. Johnson. Thank you so much for the question. We--you 
know, this is just vital to what primary care needs to be going 
forward. Family--an individual doesn't experience a mental 
health condition separate from their physical health condition. 
They are one person, and we need to be able to treat them where 
they--and when someone raises their hand and says they need 
help, we need to be able to meet that moment and help them.
    Today health centers are only able to meet about 25 percent 
of the mental health needs of their patients and about 6 
percent of the substance use disorder needs of their patients. 
We clearly need to do more to make sure that we are taking care 
of families and meeting their critical healthcare needs.
    Ms. Kuster. Great. Well, thank you so much. I appreciate 
all your efforts.
    And thank you to the committee for raising this important 
conversation about how we can improve access to both healthcare 
and mental health and substance use disorder, and improve 
workforce. Thank you, and I yield back.
    Mr. Bucshon [presiding]. The gentlelady yields back. I now 
recognize Mr. Latta from Ohio for his 5 minutes.
    Mr. Latta. Well, thank you, Mr. Chair.
    And Administrator, thanks for being with us today. You 
know, health professional shortages are everywhere. And I know 
that when I am out in my district, I don't think I can go into 
a facility that--it is not one of these things that is like a 
few people, or a sort of many people. I mean, it is 
unbelievable, the numbers of individuals that we have to have 
filling our healthcare slots out there.
    And, you know, it is everything from primary to dental to 
mental health, and--as you were just talking about on the 
mental health side. But what trends have you seen in the 
distribution of healthcare professionals between HPSAs, and how 
is this distribution tracked at this time?
    Ms. Johnson. Thank you so much for the question, because 
you are right, it is not just about producing more healthcare 
providers. It is about the distribution of healthcare 
providers. Because if we just train more, those folks will go 
where, you know, reimbursement is highest, or where they are--
they can get their--make enough revenue to pay down their 
medical debts.
    That is why the National Health Service Corps is so focused 
on not just training new providers but incentivizing them to 
practice in the communities that need them most. And we do that 
through our Health Professional Shortage Area designations, 
where we work closely with States on identifying the provider-
to-population ratios in a community, the need in a community, 
the distance to providers in a community, and are able to 
define where highest needs are and be able to place National 
Health Service Corps members based on need.
    And thanks to the resources that we have had over the past 
couple of years, we have been able to fund a sizable amount of 
the request for that. Without the resources in the President's 
budget to sustain those National Service Corps numbers, we 
won't be able to place nearly as many.
    Mr. Latta. Wait, let me follow up on that, because, again, 
I was just out--you know, this is a work period that we just 
came back from, so I was on the road extensively. And I know 
that, going through some of my rural providers out there, they 
are really struggling. And the problem then, of course, is they 
say, ``Well, what we try to do is get somebody from a 
metropolitan area to come up for 2 to 3 days.'' And so they 
have this going back and forth.
    But when you are tracking this, I think it is really going 
to be important because, again, I don't want to have a 
situation where somebody--maybe somebody, they might say that, 
oh, they have got somebody up here at this period of time, but 
they need somebody there all the time. And so--but, you know, 
they are doing everything they possibly can to make sure that 
they can make--treat their patients in a timely manner.
    Let me go on. You know, I understand that on the--payment 
and reimbursement are an issue, and that there are a lot of 
ideas on how to expand the workforce and provide timely care. 
However, do you believe there are any regulatory barriers that 
hinder that workforce growth at this time?
    Ms. Johnson. Well, you know, I think that one of the things 
that we are looking at with our new proposed healthcare 
innovation program is for the healthcare community to come to 
us with good new ideas for how to address workforce challenges. 
And sometimes what we see in some of those places is folks have 
suggested to us there are models that have sort of accelerated 
training, or they have, you know, broken through some of the 
accreditation issues or licensing issues, or those kinds of 
things.
    And so what we are hoping is that this new program allows 
us to look at creative ideas from the community to break 
through any barriers.
    Mr. Latta. You know, and again, you know, following up 
again on this, because, again, this is one of my concerns--and 
I am sure it is everybody's concern--what this is, that 
scenario that everybody has in the back of their mind. What 
happens when we don't have a sufficient number of personnel to 
be in a facility that is, you know, under regulation, so you 
have to have X number of people, and all of a sudden they say 
we don't have those people, but they have the great need to 
serve all these patients that, all of a sudden, they can't do 
anymore?
    So, you know, here is the horrible thought: What do they 
start saying? ``Number 1, we don't accept anybody else in. 
Number 2, we have to almost do a triage in there in saying 
that, well, for those who we think that don't have as great a 
need, we are just going to have to release back to their 
families.'' And then what are we going to do?
    Ms. Johnson. Well, so I would say, sir, obviously, we have 
much more work to do to incentivize people to come into the 
healthcare pipeline. But we are looking at those kind of 
pipelines. Like, where do we have people who are on the first 
ladder in their career that we can get from an LPN to an RPN, 
and so that we can get more nurses in the workforce? Where do 
we have opportunities to bring high school students, as others 
have mentioned, into the workforce? So how do we do 
apprenticeship programs?
    We have been investing in community health worker 
apprenticeship programs to start to get people on a path to the 
healthcare workforce. And so, while this conversation is 
focused on the National Health Service Corps, we have a host of 
investments on the discretionary side related to training more 
nurses, physicians, behavioral health providers as part of that 
effort.
    Mr. Latta. Well, it is really important because, again, 
seeing what I saw in the last week, you know, we are doing a 
tremendous job from even in our high schools. I saw things that 
if--I told the students that I think people have been working 
on their Ph.D.s, and we would have been in--back when I was in 
high school, what these kids are doing today, absolutely 
unbelievable. But we just have to get these people out there.
    Mr. Chairman, my time is expired, and I yield back.
    Mr. Bucshon. The gentleman yields back. I now recognize Ms. 
Kelly from Illinois for her 5 minutes.
    Ms. Kelly. Thank you, Chair Guthrie and Ranking Member 
Eshoo, for holding today's hearing. Ms. Johnson, thank you for 
being here today.
    And 1-year postpartum suicide and substance use are the 
leading causes of maternal death, with suicide accounting for 9 
percent of the maternal mortality rate. Maternal mental health 
conditions such as anxiety, perinatal postpartum depression, 
and birth-related PTSD are the most common complications of 
pregnancy and childbirth, affecting one in five women.
    Among those affected, 75 percent go untreated. While women 
of color are more likely to experience these conditions. They 
are also less likely to seek help. What remains so surprising 
is 100 percent of these conditions respond to early 
intervention and/or treatment.
    So what current resources does HRSA have to help close the 
access gap to maternal mental health services?
    And what additional resources are needed to improve access 
to mental health services for moms?
    Ms. Johnson. Yes, thank you so much for the question. It is 
such a critical issue. We talk about the maternal mortality 
crisis. I don't know that we talk enough about the maternal 
mental health needs of individuals and families.
    What we have been able to do at HRSA, two programs--we do a 
number of things, but two programs that are--I am particularly 
excited about in this space that I think are going to make a 
real difference.
    One, our maternal depression and screening program. This is 
a program where what we are trying to do is help--in the same 
way we are talking in this conversation about primary care 
providers integrating mental health, helping OB-GYNs get access 
to mental health experts, and so that if--in real time, through 
teleconsultation--so that if you have a pregnant woman in your 
office and you have--and you are aware of significant concerns, 
you can get real-time teleconsultation access to mental health 
providers to help you manage that, so that person isn't sent 
off on their own with a referral--good luck getting an 
appointment--that it can actually happen in the office.
    We haven't had a ton of discretionary funding for this 
program, so we have only been able to fund seven States so far. 
But this year we got some additional money. We think we will 
get up to 14 States. We are very excited about the opportunity 
this program presents.
    And then second, I would note we have launched--last 
Mother's Day we launched the National Maternal Mental Health 
Hotline. We have had thousands of calls to the hotline. It is 
844--833-9-HELP4MOMS. It is our way of helping moms have a safe 
space, pregnant women and family members have a safe space to 
have a conversation, confidential conversation, with a 
counselor. And we have seen incredible demand for it.
    We have--we had a limited amount of resources to launch it. 
We have got some more in the last appropriations bill, which is 
going to allow us to do more outreach to get--to make awareness 
better and continue to bring people in and provide that kind of 
support.
    Ms. Kelly. That is fantastic to hear. And anything I can do 
to help you along with that----
    Ms. Johnson. Thank you.
    Ms. Kelly [continuing]. I would love to do that.
    Shifting gears, 17 individuals die each day waiting for 
organ transplant. Black people are four times more likely to 
develop kidney failure than White people but are much less 
likely to receive a lifesaving kidney transplant. Additionally, 
Black people also experience the highest rate of health failure 
but receive heart transplants at a lower rate than their White 
counterparts. These are tragic inequities that are 
unacceptable, and that is why I was glad to see HRSA's 
leadership last month in announcing the Organ Procurement 
Transplant Network Modernization Initiative--long title.
    As our country continues to move forward at a rapid pace, 
with new technologies becoming available every day, we owe it 
to our constituents to bring our medical practice into the 21st 
century and save lives. Yet in a report from the U.S. Digital 
Service, the Government's own top technologist said that the 
current OPTN contractor lacks sufficient technical capabilities 
to modernize the system. And this is one of the many reasons I 
am proud to cosponsor with my colleague Congressman Bucshon the 
Secure the U.S. OPTN Act.
    How would you--how would opening up the management of the 
OPTN network to multiple contracts improve outcomes for 
patients?
    Ms. Johnson. Thank you for the question, Congresswoman.
    You know, I have been in this seat for about 15 months. 
When I first started in this role, it was crystal clear to me 
that we had a lot of work to do here, that the statute was old, 
that the systems were--needed to be modernized. And our team 
has been working nonstop since then to really focus on what it 
is going to take to modernize the system.
    And what it is going to take is more competition. And what 
it is going to take is us being laser-focused on ensuring we 
are getting best-in-class in all of the categories of work 
associated with the OPTN. And that is our priority, and that is 
what we are going to do. And we appreciate your help in that 
regard. The legislative action and additional tools will make 
it that much easier for us.
    Ms. Kelly. Well, hopefully, we can get this bipartisan bill 
passed.
    And I yield back.
    Mr. Bucshon. The gentlelady yields back. I now recognize 
myself for 5 minutes for my line of questioning.
    I want to start out by saying one of the ways we can get 
more physicians in underserved areas is properly reimburse 
primary care doctors for their services instead of continuing 
to cut reimbursement in a failed attempt to control healthcare 
costs, which--the physicians are only about 10, 15 percent of 
the healthcare dollar. And in the long run, this would actually 
save us money because it would make our population much more 
healthy.
    I want to highlight again--Congresswoman Kelly just 
mentioned H.R. 2544--I am proud to introduce that with 
Congresswoman Kelly. Again, it seeks to improve the system, the 
OPTN program, through competitiveness because, according to 
increasing numbers of reports, the OPTN struggles to obtain and 
distribute organs in an efficient, timely, and appropriate 
manner. In fact, it is believed that thousands of donated 
organs go to waste each year because the process of obtaining 
organs, matching them to a recipient, and transporting them is 
not happening effectively. With the technology and expertise 
available today, that is just unacceptable. And there 
definitely are also disparities in distribution amongst 
different populations of our fellow citizens.
    This bill allows HRSA to improve the OPTN program. It 
clarifies that HRSA does not have to implement a single 
contract for all aspects of the program and encourages a 
competitive process to choose the best contractors for each 
OPTN function. I don't have a question. Those have already been 
answered by you. But that is why I feel like legislative action 
is necessary.
    I also want to say I was a surgeon before I was in 
Congress. And during my residency in the early nineties I spent 
time on the transplant service at the Medical College of 
Wisconsin in Milwaukee, Wisconsin, a strong, solid organ 
transplant program at that time, and still is today. And so, 
talking to the faculty members when I was a resident, I began 
to understand how the system worked, or didn't work, even 30 
years ago after what had been put in place 40 years ago. So I 
have direct experience with this, and it needs fixed.
    Again--I would like to again draw your attention to the 
340B program. Multiple Members have talked about it. I think 
Dr.--Morgan Griffith really outlined one of the problems that 
happened in Virginia. This is widespread, in my view. I have 
been working on this for 5 or 6 years.
    As you know, Congress failed to establish clear parameters 
for the program, in my view, forcing HRSA to try to determine 
how it should be run. I am in the process of working with many 
others, including the committee, to draft legislation to 
increase the transparency in 340B so that Congress and the 
public can better understand when the program does or does not 
benefit patients. And that is the goal of the program. It was 
instituted to make pharmaceuticals available in underserved 
populations, including rural America and many areas of urban 
America. And that is the goal.
    I appreciate that Secretary Becerra, who was here 
testifying recently, concurred during a hearing last month that 
more transparency is needed. Understanding that we must move 
forward in the most efficient, least burdensome manner 
possible, I would like to know--and you may have answered some 
of this--what data HRSA already collects on 340B. What data 
points does HRSA already collect from program participants in 
the 340B program?
    Ms. Johnson. Thank you for the question. Thank you for your 
leadership on this issue.
    As I mentioned previously, we are very anxious to work with 
you on transparency issues, on accountability issues, because 
at the end of the day this is a safety net program that is 
vital to many safety net providers, and we want to make sure 
that, across the system, that there is accountability and that 
resources are going in the appropriate direction.
    We obviously--we collect a series of data related to 
allocations and acquisition. We do some of that through 
mechanisms that are specific to individual providers, 
individual manufacturers. And so--but to the extent we have 
publicly shareable data, we will get that to you.
    Mr. Bucshon. Great, yes. Can you--if you can, commit to 
providing that list.
    Does HRSA track the total dollar value of 340B drugs that 
each covered entity is buying?
    Ms. Johnson. We track the total in aggregate.
    Mr. Bucshon. OK, in aggregate but not individually.
    Am I correct that, up until last year, HRSA did not 
regularly post any sales data on the program?
    Ms. Johnson. I am not sure that I can speak to what 
happened before last year, but we can get you that answer.
    Mr. Bucshon. OK. And it is my understanding that in the 
past researchers have had to use FOIA requests to obtain 
limited sales data showing covered entity purchases at the 340B 
price, although information on discounts and chargebacks have 
never been provided when requested. Why is that?
    Ms. Johnson. So, again, I am really interested, we are 
really interested in transparency in this program.
    We have found ourselves to be somewhat limited by some 
recent Supreme Court decisions related to FOIA issues, but we 
will be happy to work with you on what we can.
    Mr. Bucshon. Yes, I want to just say I strongly support the 
340B program, but we certainly need more transparency.
    I yield back. I now yield to the gentlelady Ms. Blunt 
Rochester for her 5 minutes.
    Ms. Blunt Rochester. Thank you, Mr. Chairman, and thank 
you, Administrator Johnson, for your testimony.
    Today we are examining several pieces of legislation to 
strengthen healthcare access for vulnerable communities and 
bolster the healthcare workforce. Having served as Delaware's 
deputy secretary of health and social services, our secretary 
of labor, and head of personnel, I am particularly pleased that 
we are considering H.R. 2411, the National Nursing Workforce 
Center Act, legislation I am leading with my Republican 
colleague, Congresswoman Young Kim.
    This bill will strengthen the nursing workforce and arm 
States with the tools that they need to implement solutions 
based on local conditions. Many disciplines in the healthcare 
sector are facing workforce challenges. But as the largest 
healthcare profession, nurses are the canary in the coal mine.
    Just last week the National Council of State Boards of 
Nursing released new research showing the impact of the COVID-
19 pandemic on the nursing workforce. The report shows that 
100,000 registered nurses have left the workforce over the past 
2 years due to pandemic-related burnout, and that in total 
almost 1 in 5 of the more than 4.5 million licensed nurses in 
the U.S. intend to leave before 2027.
    As the nursing landscape rapidly evolves, stakeholders need 
up-to-date, actionable information on emerging nursing trends, 
and this must occur more frequently than once every 4 years. In 
HRSA's 2021 Health Workforce Strategic Plan, HRSA acknowledges 
that workforce supply and demand data is not static. The 
demographics of the Nation's population shift over time, as do 
factors such as labor force participation, and that for data 
that do exist, data analysis is difficult, as the quality and 
granularity vary widely, and data sources, formats, and 
occupational definitions are inconsistent.
    Based on this assessment and what I am seeing in my own 
community, I believe we need a strategy to not only centralize 
the study and development of nursing workforce practice and 
policy, but we also need to better support State-level entities 
in addressing State-specific nursing workforce challenges.
    State-based working--State-based Nursing Workforce Centers 
who have a consistent mandate and reporting structure to HRSA 
can help fill this gap. And a core function of Nursing 
Workforce Centers is to collect and analyze data at the State 
and local levels. But they can do so much more to support a 
more resilient, dynamic, and engaged nursing workforce, 
including training, mentoring, and leadership development.
    Administrator Johnson, does HRSA's Health Workforce 
Research Centers program have the authority to fund a nursing-
focused research or technical assistance center? Yes or no?
    Ms. Johnson. Thank you so much for the question, 
Congresswoman. Thank you for your focus on this.
    And it would be hard to talk about nurses without saying 
that we owe them an incredible debt of gratitude for what they 
have done historically, and what they have--especially what 
they have done in the last several years. And it shouldn't just 
be about our gratitude, but it should be in action. And so we 
really do look forward to working with you on this issue.
    I think we are working with our lawyers to assess our 
statutory authority with respect to what we can and can't do 
under current regulations, and I look forward to working----
    Ms. Blunt Rochester. So the answer is you are not sure.
    Ms. Johnson. Yes.
    Ms. Blunt Rochester. OK, thank you. How might HRSA 
collaborate with State-based entities? And more specifically, 
could this collaboration contribute to the stabilization of the 
nursing workforce in this country?
    Ms. Johnson. We think it is really important across all of 
our workforce analysis to work with States. There are academic 
centers in many States that are focused on nursing. There are 
academic centers focused on other parts of the workforce. It 
doesn't make sense for us to do this work alone or to replicate 
what is happening on State levels. It should be in 
collaboration, and that is our goal, and that is what we hope 
our National Workforce Center is doing.
    Ms. Blunt Rochester. Great. Thank you, Mr. Chairman. I ask 
unanimous consent to enter into the record a statement from my 
dedicated colead, Congresswoman Kim, and letters of support 
from AARP, the Center for American Progress, the National Forum 
of Nursing Workforce Centers, Health Impact, the American 
Hospital Association, and the American Health Care Association.
    And I want to just quickly shift to the Strengthening 
Community Care Act, which I am coleading with Representatives 
Joyce, Fletcher, and Stefanik. We are very proud of this bill, 
and we know it is very important and timely as we reauthorize 
the National Health Service Corps and the Community Health 
Center Fund for 5 years. I am going to go right to my question, 
because I have, like, 10 seconds.
    Since most health centers are already providing care 
related to mental health and substance use disorder, as you 
mentioned, how can us having a requirement improve access to 
these services and help address the opioid crisis?
    Ms. Johnson. Thank you for the question. It is--what--we 
are doing what we can with what we have. We are nowhere meeting 
demand. And so there is an incredible opportunity here in 
communities across the country that have been ravaged by the 
opioid epidemic to leverage the footprint of healthcare 
services that are already in their community to deliver the 
kind of substance use disorder services that will get people on 
a pathway to recovery.
    Ms. Blunt Rochester. Thank you so much.
    And thank you, Mr. Chairman. I yield back.
    Mr. Guthrie [presiding]. Thank you, I appreciate it.
    Without objection, the documents you have requested are 
submitted for the record.
    [The information appears at the conclusion of the hearing.]
    Mr. Guthrie. We appreciate your work on this. I think you 
have several pieces of legislation before us today, so--I was 
looking at the list. So this might be the Blunt Rochester 
hearing today. So thanks for your hard work on these issues.
    The Chair now recognizes Mr. Hudson from North Carolina for 
5 minutes.
    Mr. Hudson. Thank you, Mr. Chairman.
    Ms. Johnson, thank you for being here today, and I 
appreciate your long history of public service. And I also want 
to acknowledge what a feat it must be to juggle over 90-plus 
programs. And I really appreciate that, and appreciate you 
being here today.
    Based on recent reporting, it is my understanding that the 
Biden administration is launching a $5 billion-plus program to 
accelerate the development of new coronavirus vaccines and 
treatments dubbed Project NextGen. I would just like to note 
the committee has not been briefed or received any information 
on this initiative. So unfortunately, I have to go on what has 
been reported in the national media. But I am both concerned 
and interested to know where the $5 billion came from for this 
program. Reporting that I have read indicates that ``the pot of 
money'' was financed through money ``saved from contracts 
costing less than originally estimated.''
    What are these contracts? I specifically asked Secretary 
Becerra when he was in front of this committee just a few weeks 
ago about approximately 5 to 6 billion dollars of unexpired, 
unobligated funding. And Secretary Becerra claimed this funding 
was, in fact, committed and, again, ``in the pipeline to be 
signed on the dotted line.'' Was he referring to Project 
NextGen?
    I have also heard from my Appropriations colleagues this 
funding came from the Provider Relief Fund and the American 
Rescue Plan funding and was intended for testing. Administrator 
Johnson, can you please provide any clarity on this? Was any 
amount of funding intended for HRSA Provider Relief Fund 
reallocated to the recently announced Project NextGen?
    Ms. Johnson. Thank you for the question, sir. I can't speak 
to the particulars of the NextGen project. I don't know the 
details there and would refer you to our department of budget 
experts on that question.
    I will say that, as we get to the end of the Provider 
Relief Fund allocations, there are some instances where there 
are resources that we might have held for applications or for 
reviews of reconsiderations, where reconsideration applications 
came in less than we anticipated. So there are resources that 
are available through the Provider Relief Fund.
    Mr. Hudson. But to your knowledge, have those been 
transferred to this new project, NextGen?
    Ms. Johnson. I believe that--again, the budget office will 
be able to answer that for you more directly. I don't know that 
resources have to be transferred for that purpose, so----
    Mr. Hudson. OK. And then you talked a little bit about some 
of these unobligated funds or unspent funds. Can you please 
speak to any contracts that you are aware of that ``cost less 
than originally estimated'' or were used to subsidize this new 
project? Are there any specific----
    Ms. Johnson. I am sorry, I don't know the details. I don't 
know what that is referring to.
    Mr. Hudson. Well, could you get back to us if you talk to 
your budget folks----
    Ms. Johnson. I am happy----
    Mr. Hudson [continuing]. About funds----
    Ms. Johnson [continuing]. Happy to----
    Mr. Hudson [continuing]. That are transferred to Project 
NextGen?
    Ms. Johnson. I am happy to talk to the budget team and ask 
them to--and raise the questions that you have asked.
    Mr. Hudson. I mean, honestly, they will probably respond to 
you quicker than they would respond to me.
    Ms. Johnson. Well, I----
    Mr. Hudson. So if you could get back to us on that, I would 
really appreciate it.
    Ms. Johnson. Thank you, sir.
    Mr. Hudson. And then in your written testimony--just 
shifting gears here--I appreciate you mentioned the importance 
of assistance to rural communities. I represent a rural 
community, and I work very closely with our Community Health 
Centers, and they do a tremendous job.
    And during a recent visit to one of these--Moncure 
Community Health Center--I saw the need for more flexibility, 
like the legislation that came out of this committee that 
authored the Mobile Health Care Act, which allows them to use 
those funds in rural and underserved communities for things 
like mobile health units, and we have had a lot of success with 
those. We have been able to provide mental health access to 
schools that normally wouldn't have access to mental health. As 
you know, that is a real crisis right now. So, you know, 
anything we can do to continue to offer flexibility to these 
rural Community Health Centers, I would encourage you. But that 
has been a real success story.
    And then Representative Pallone mentioned another critical 
need in healthcare today--I hear everywhere I go--is workforce. 
And, you know, throwing money at a solution is not always the 
best--or a problem is not always the best solution. We have had 
some success in North Carolina. Numerous Community Health 
Centers have formed partnerships with the University of North 
Carolina as well as Meharry, an HBCU, to provide workforce.
    One huge success story also has been increased training 
resources and furthering wellness activities in Randolph 
County, North Carolina, resulting in decreased costs for 
employee health insurance over the past 3 years. You know, 
these kind of partnerships, this kind of innovation is really 
showing results. So I would just encourage you any way that 
HRSA can help encourage this kind of innovation and this kind 
of creativity, it is working. So we would love to see more of 
it.
    Ms. Johnson. I very much appreciate that. Thank you. We 
actually fund Meharry through a host of our discretionary 
programs on workforce training. So I am really pleased to hear 
that you have seen these programs in action.
    Mr. Hudson. Great, thank you.
    Mr. Chairman, I yield back.
    Mr. Guthrie. Thank you. The gentleman yields back. The 
Chair recognizes Ms. Barragan from California for 5 minutes for 
questions.
    Ms. Barragan. Well, thank you. Thank you, Mr. Chairman, for 
having this important hearing.
    Administrator Johnson, our Nation faces a healthcare worker 
shortage. Just last week in my congressional district I met 
with one of my hospitals who was telling me about the worker 
shortage and the impact it is having.
    So the worker shortage--and the dental sector is not exempt 
from these workforce challenges currently being discussed. The 
shortage of dental providers impacts patients' access to oral 
healthcare across the country. In fact, research by the ADA's 
Health Policy Institute indicates that one in three dentists do 
not have full appointment schedules because of staffing issues.
    What is HRSA doing to address the dental industry workforce 
shortages, particularly with respect to dental hygienists?
    And does HRSA have plans to reopen any of the oral health 
training programs, such as the State Oral Health Workforce 
Program?
    Ms. Johnson. Thank you for the question and for 
highlighting what is a critical need. Far too often, oral 
health gets overlooked when we talk about critical healthcare 
issues, and it is essential to overall health, and is a place 
where we need to make sure that there are providers in 
underserved and rural communities.
    We--dentists and dental hygienists are part of the National 
Health Service Corps. They are all--dentistry is also an 
eligible discipline in the Teaching Health Center GME program. 
So we are training dentists directly, and we are supporting 
loan repayment for dentists to get into the communities in 
need.
    And as you mentioned, we have our discretionary programs as 
well. And we are, in that regard, limited by appropriations. 
And so we will do what appropriations resources allow us to do 
in that regard.
    Ms. Barragan. Great, thank you. In January the Geiger 
Gibson Project on Community Health at George Washington 
University noted the potential effect of the Medicaid unwinding 
on Community Health Centers, stating that the Medicaid 
unwinding is expected to have significant ramifications for 
Community Health Centers. The unwinding is estimated to 
decrease total health center revenue, with an associated loss 
in patient capability of 1.2 to 2 million patients and a 
staffing capacity loss of 10 to 18,500 staff members.
    Medicaid is a critical funding source for Community Health 
Centers. Medicaid is really important in my congressional 
district, very working class. And I am concerned that the loss 
of Medicaid coverage for millions of patients will decrease the 
ability of health centers to serve all the patients who need 
care, not to mention the number of Latinos. As a chair of the 
Congressional Hispanic Caucus, I am concerned about the amount 
of Latinos that may lose coverage.
    How does HRSA plan to help Community Health Centers as the 
Medicaid population is expected to decrease? And is there more 
Congress can do to help?
    Ms. Johnson. Well, thank you for raising it. We share your 
concern. It is vitally important that people who remain 
Medicaid-eligible don't lose Medicaid coverage for some 
paperwork or bureaucratic reason, because they don't get the 
right paperwork or don't know to respond. That is why we are 
really focused on making sure all of our enrollment assistors, 
all of the ways that we can partner with health centers and 
with other community organizations, our other grantees to get 
the word out to people that they are--that these reviews are 
coming, and they need to be able to respond to them, and to 
support people in that is critical.
    But there are going to be people who are transitioning off 
of coverage. So we want to also make sure that they get into 
marketplace coverage as quickly as possible. That matters not 
just for those individuals and their families, but for the 
fiscal viability of the health centers that we are talking 
about here today. And so that is why it is so important that we 
work together on the continuation of mandatory funding for 
these providers.
    Ms. Barragan. Great, thank you. My last question is just a 
really general question.
    When I had my meeting last week with Long Beach Memorial 
about the worker shortage issue--I have a sister who is a nurse 
too. You hear firsthand the stories of how challenging it is 
for those in the field. You know, what can we be doing?
    I know that there is, you know, the children's, you know, 
medical education, like, training program and the adult version 
of that, and I know there is a huge disparity in funding there. 
We know that there is a, you know, nursing shortage bill. But 
what would you--be your suggestion on how to best address this?
    Ms. Johnson. The workforce issues writ large? Yes?
    Ms. Barragan. Yes, the shortages that we are having.
    Ms. Johnson. Yes. The path we have laid out in the 
President's budget is sustaining the commitment we have made to 
National Service Corps at the level we have made it over the 
next 3 years, training more nurses by solving some of the 
bottleneck issues that make it harder for people to get into 
nursing because we don't have enough faculty, training more 
mental health and substance use providers through our existing 
programs.
    Our budget proposal would allow us to train 18,000 new 
providers, and ensuring that we create our Health Care 
Workforce Innovation Program to develop new models for more 
rapidly training people to get into the workforce.
    Ms. Barragan. Thank you. We also need to make sure that 
people can afford to go to nursing school, student loan debt 
relief, and other programs of that nature.
    Thank you, and I yield back.
    Mr. Guthrie. Thank you. The gentlelady yields back. The 
Chair now recognizes Dr. Joyce from Pennsylvania for 5 minutes 
for questions.
    Mr. Joyce. Thank you for yielding, Chairman Guthrie, and 
thank you for holding this important hearing.
    One of the most consistent issues that I have heard in my 
district in Pennsylvania is the shortage of physicians and 
healthcare workers and barriers to access to primary care. For 
this reason, last week I introduced H.R. 2559, the 
Strengthening Community Care Act, with Chairwoman Stefanik, 
Representative Blunt Rochester, and Representative Fletcher.
    And I would further like to thank Representatives Carter, 
Bilirakis, DeGette, and Spanberger for their support of this 
measure.
    This critical piece of legislation would provide for 
Community Health Centers across the country, including centers 
in my own district like Keystone Rural Health Center, Broad Top 
Area Medical Center, and Heineman Area Health Center, which 
helps serve the needs of over 250,000 individuals, patients in 
Pennsylvania's 13th district.
    This bill will also reauthorize the National Health Service 
Corps, which supports more than 20,000 primary care medical, 
dental, and behavioral health providers through scholarships 
and loan repayment programs.
    I, like many on this panel, have heard from communities 
throughout my district about the need for expanded access to 
behavioral healthcare and substance use disorder treatment, and 
Community Health Centers play an incredibly valuable role in 
providing mental and behavioral healthcare to vulnerable 
populations.
    Administrator Johnson, what percentage of CHCs provide 
these specifically behavioral health services in communities 
today in America?
    Ms. Johnson. Yes, thank you for the question. I think most 
health centers try to provide some level of mental health 
services, but it is a significantly smaller percentage. We can 
get to the particulars on substance use disorder.
    What we know is that, even when they do, they can only meet 
about a quarter of the demand for mental health services and 
about 6 percent of the demand for substance use disorder 
services.
    Mr. Joyce. Thank you. And how important is the stable and 
sustainable Federal funding in the Strengthening Community Care 
Act to our health centers' ability to continue to provide this 
access to behavioral healthcare?
    Ms. Johnson. Yes, thank you. I don't know that I have seen 
the particulars of the bill. I will say, writ large, 
sustainable, predictable funding makes an incredible difference 
to retaining the health workforce, to delivering services in 
the community, to planning for what you can do going forward to 
surging to meet critical health needs.
    Mr. Joyce. Again, I thank you. How do Community Health 
Centers typically comply with the requirement to provide 
emergency services and ensure continuity in primary care 
services that a patient should receive?
    Ms. Johnson. So Community Health Centers are required and 
closely monitored by us to ensure that they have in place all 
of either directly or contracted relationships that allow them 
to comply with all of the section 330 requirements.
    Mr. Joyce. And on an additional matter, we are hearing from 
Community Health Centers and other providers who rely on 340B 
that large PBMs are pickpocketing their 340B savings through 
predatory contracts and without sharing any of the savings with 
their patients.
    There has been plenty of talk about the need for more 
transparency on how 340B is being used. You mentioned earlier 
in the discussion here today that you collect specific data at 
HRSA. But on this matter specifically, can you speak to whether 
HRSA can address these issues through the existing authority, 
or does it need Congress to intervene?
    Ms. Johnson. I believe, Congressman, that we would benefit 
from your assistance in this regard, because we are continually 
reaching roadblocks when it comes to our authority. So we would 
benefit from working with you on this topic.
    Mr. Joyce. And I agree with you. It is time for Congress to 
intervene and stop those roadblocks from occurring.
    Once again, I thank you for being here today.
    And Mr. Chairman, I yield the remainder of my time.
    Ms. Johnson. Thank you.
    Mr. Carter [presiding]. The gentleman yields. The Chair now 
recognizes himself for 5 minutes for questions.
    Ms. Johnson, thank you for being here. I appreciate this 
very important--obviously, what you do, and this agency is 
extremely important.
    I too want to chime in, as I know some of my colleagues 
have already, about the 340B program because, as the oldest 
pharmacist in Congress, I am very concerned about it, and I am 
very concerned because of my FQHCs and because of the 
hospitals, the rural hospitals.
    I represent the entire coast of Georgia and a lot of south 
Georgia. As we like to say in Georgia, there are two Georgias: 
There is Atlanta, and everywhere else. And I represent 
everywhere else. And a lot of that is rural areas. And 
certainly, the rural hospitals depend on this program, and they 
have been very concerned about what has happened with some of 
these manufacturers who are refusing to participate. And quite 
honestly, I can't blame them.
    I think the program needs guardrails. It does not need to 
be eliminated. It needs to go back to what it was intended to 
be, what it was intended to serve, and the population that it 
was intended to serve. Unfortunately, as has been pointed out, 
there are a lot of hospitals, a lot of healthcare systems that, 
unfortunately, are not using it and utilizing it the way that 
it should be.
    So having said that, I know that there was a report in--by 
the New York Times, the Wall Street Journal, and other outlets 
by investigative journalists that some of the nonprofit 
hospitals are doing exactly that, and that is that they are--
some of the DSH hospitals are using the program to pad their 
profits without regard to the needs of the vulnerable patients.
    And the second is how--the second thing that I want to 
point out is, of course, the PBMs. And I am no fan of the PBMs, 
as I am sure you know, but they are getting into the 340B 
program. And it doesn't surprise me one bit that they are. But 
they are getting in. They are stealing discounts that were 
intended for the patients.
    Both of these issues need to be addressed. Both of them 
need to be addressed. And just as my colleague Dr. Joyce just 
mentioned, we want to help, and legislatively, if we need to. 
And as you indicated, it appears that we need to.
    So let us help you. There has been suggestions of starting 
a 340C program--I am sure you have heard of that--just to 
quantify and to specifically identify who this program is to be 
for.
    Now, I am not suggesting that all DSH hospitals are abusing 
the program or pushing the envelope on the program, if you 
will. But there are those that are doing that, and particularly 
in the oncology practices, particularly with cancer patients. 
And that is a big concern as well. Some of these healthcare 
systems are buying out oncology practices for no other reason 
except to utilize the 340B program. And that is not what it was 
intended for. You know that as well as anyone.
    So again, we stand ready to help you with any kind of 
legislation that you need.
    Specifically, what is the agency doing to curb these 
abuses?
    I know we have got a couple of lawsuits that are out there 
right now, and we are expecting to hear the results of some of 
them, hopefully, soon.
    Ms. Johnson. Yes, thank you for raising the issue. We have 
been taking action such as, you know, when--where we have seen 
manufacturers not selling to covered entities via their 
contract pharmacy arrangements, we have sent violation letters 
to manufacturers in that instance. We have--that is the source 
of a considerable amount of litigation, and our authority is 
being challenged in that regard.
    We also recently sent a series of letters just to covered 
entities as part of our ongoing compliance work with questions 
containing--concerning their use of--you know, their compliance 
with covered entity requirements.
    We are working to use all the tools that we have. We 
recognize that there--that we would benefit from additional 
tools here for the--because we share the goal of accountability 
in this program.
    Like you, we recognize there is a critical role for 340B 
for safety net providers and community--across community. It 
makes a real difference. But we also want to make sure that 
there is accountability.
    Mr. Carter. Good, good. Very quickly, with what little time 
I have left, Community Health Centers have been successful in 
expanding access to affordable and quality healthcare all 
throughout my district, and I am very proud of that.
    Last year I was proud to support the Mobile Health Care Act 
that gave Community Health Centers the flexibility to use 
Federal funding and establish new mobile unit delivery sites, 
and many of them have done that to the benefit of a lot of 
people in our rural area. So how will the additional 
flexibility around new access points funding support mobile 
health units and Community Health Centers' ability to reach 
more underserved communities and patients, which is what we 
want them to do?
    Ms. Johnson. Yes, I mean, the provisions in our budget that 
are really about trying to do more access points is because 
what we hear from Community Health Centers again and again is 
we could better reach the population who needs us most if we 
had a little more startup resource to get into a few more 
communities. And that is what we--that is why we included that 
in the budget.
    Mr. Carter. Good. Thank you very much, again, for being 
here today.
    My time is expired, and at this time I am going to 
recognize the gentlelady from Washington, Dr. Schrier, for her 
5 minutes.
    Ms. Schrier. Thank you, Mr. Chairman.
    And thank you, Administrator Johnson, for coming today to 
speak on these critical programs that strengthen our healthcare 
provider pipeline and bolster our healthcare workforce.
    First let me just say about the Special Diabetes Program, I 
have type 1 diabetes, and I just want to thank Representatives 
DeGette, Bilirakis, Ruiz, and Cole for their work to 
reauthorize the Special Diabetes Program and the Special 
Diabetes Program for Indians. They are vital programs that can 
help ensure progress on predicting and delaying, treating, 
possibly curing one day with an artificial pancreas--something 
that I have been hoping for for 38 years now. These programs 
are also critical to helping patients manage diabetes and 
complications, and I am extremely supportive and look forward 
to their passage.
    Second, I want to highlight, as some of my colleagues 
already have, the shortage of providers in the U.S., and we are 
feeling this most acutely in rural areas and underserved areas. 
But we saw early retirements and, really, mass resignations, 
much of that related to the pandemic. So we need a bigger 
pipeline and a faster pipeline for new providers, and we also 
need ways to incentivize those providers to practice in rural 
communities like parts of my district and in underserved 
communities.
    What I have heard in some of the Community Health Centers 
in my district--like HealthPoint, for example--they have 
highlighted the importance of stable and consistent funding for 
Teaching Health Center Graduate Medical Education. In fact, 
some of the residents who I met were pretty anxious that the 
funding for their program might dry up before they finished 
their 3-year residency program.
    So, Administrator Johnson, Ranking Member Pallone noted the 
importance of sustained and stable funding for these programs, 
along with several of my colleagues. Can you talk about why 
stability of funding is so important for Community Health 
Centers and graduate medical education to continue to generate 
providers in rural areas?
    Ms. Johnson. Thank you so much for the question. We ask a 
lot of Community Health Centers, and then we ask a lot of 
residents who come to train in Community Health Centers. We 
want them to manage people who have complex health conditions, 
who lead complex lives, and ensure that they have a usual 
source of care and are available to them as readily as possible 
so that they are as healthy as possible and we are keeping 
people out of emergency rooms and we are getting them primary 
care. All of that is challenging work on a good day.
    When the source of your funding is uncertain and variable 
and not guaranteed for the full life of your time in residency 
or for the full life of your budget planning as the head of a 
health center, that is very distressing and hard for us to 
recruit residents. It is hard for us to retain leadership in 
health centers. It is hard for our health centers to recruit 
staff. All of that is difficult without sustainability and 
without really understanding the growth path that we know 
health centers need to be able to continue to meet demand by 
having extended hours, by having more sites.
    Ms. Schrier. Thank you. I don't recall when I graduated 
from medical school having these rural opportunities, distant 
opportunities, or even having to think about whether a 
residency program that I chose to start would have funding all 
the way through. And so I can understand that anxiety.
    You know, I also wanted to highlight some of the work being 
done on the ground in Washington State by our Community Health 
Centers and Teaching Health Centers. Both Columbia Valley 
Community Health, CVCH, and Community Health of Central 
Washington offer these rural residency training programs. In 
fact, Washington State University's medical school has been a 
big driver of this.
    I was wondering if you could talk specifically about rural 
residency programs and why they are so important for 
maintaining a workforce in rural communities.
    Ms. Johnson. Yes, it is just--it is hard to start up a 
residency program. It is--it takes a lot of work. It takes 
getting accredited. It takes having the staff and the faculty, 
and it takes recruiting a strong faculty and a good curriculum 
and all of that work. That is hard to do in a rural area if you 
don't have some support.
    And so our Office of Rural Health Policy is able to support 
the development of rural residency programs to get them on the 
path so that then they can come into other GME programs, and it 
makes a huge difference in communities across the country.
    Ms. Schrier. Thank you. We talked about see one, do one, 
and teach one, and this is reminding me of that. Go to a rural 
area, train there, stay there, teach the next generation of 
rural providers. So thank you very much.
    I am out of time. I yield back.
    Ms. Johnson. Thank you.
    Mr. Carter. The gentlelady has yielded. The Chair now 
recognizes the youngest pharmacist in Congress, the gentlelady 
from Tennessee, Mrs. Harshbarger, for 5 minutes.
    Mrs. Harshbarger. Thank you, Mr. Chair, and thank you, 
Administrator Johnson.
    You know, I represent a rural district in east Tennessee, 
and I believe your agency reports that more than 80 percent of 
rural counties in the U.S. are considered medically 
underserved. Does that sound about right, 80 percent?
    Ms. Johnson. I would have to validate that for you, but I 
agree with you.
    Mrs. Harshbarger. But I have seen statistics that only one-
third of NHSC placements are in rural communities. And after 
they complete a typical 2-year commitment, too many of those 
members leave for higher-paying jobs. In part, they--to 
continue paying down their school debt, for example.
    And I guess my question to you is, what can we do to ensure 
that the NHSC adequately serves the country's rural, medically 
underserved areas?
    Ms. Johnson. Thanks for the question, because this is a 
great part of the National Service Corps that is not totally as 
well understood, which is we will further incentivize you after 
you complete your first obligation with us. We will give you a 
continuation and continue to help pay down more of your debt if 
you stay in the community you are in.
    So we have--I actually just visited a site in a rural 
community where we had people who had been there for more than 
the 2-year service commitment because we were continuing--as 
long as they had eligible debt, we were continuing to help them 
pay down. And they were starting a family, they were going to 
live there----
    Mrs. Harshbarger. Well----
    Ms. Johnson [continuing]. Because that is where they----
    Mrs. Harshbarger. Yes, we want them to. You know, we need 
to look at innovative solutions to keep these physicians in the 
area.
    And I helped introduce a bipartisan Rural American Health 
Corps Act with David Kustoff here in the House and Senator 
Blackburn in the Senate. And I would just recommend my 
colleagues sign on to that legislation. And it is sort of a 
sister program to NHSC, and it helps with loan repayment in a 
lot of ways. So--and I would love to work with you for 
technical feedback on that bill. So----
    Ms. Johnson. We would be----
    Mrs. Harshbarger [continuing]. That would be----
    Ms. Johnson. We would be delighted to do that. Thank you.
    Mrs. Harshbarger. Absolutely.
    But I do want to talk about yesterday the administration 
announced a $1.1 billion program to continue to provide COVID-
19 vaccines and therapeutics to underserved Americans, the HHS 
Bridge Access Program. And it is my understanding that 1.1 
billion to fund this program was pulled from the Provider 
Relief Fund. And what I want you to do, can you confirm that 
that 1.1 billion came from the HRSA Provider Relief Fund for 
this new, unrelated program?
    Ms. Johnson. We had previously been funding supports and 
services for individuals who are uninsured. And as the--as 
vaccines and therapeutics transitioned to commercialization, it 
has been recognized that it would be very important that we are 
reaching underserved communities and uninsured communities. And 
so, as an allowable use of Provider Relief Funds, funds are 
being used to support----
    Mrs. Harshbarger. So is that----
    Ms. Johnson [continuing]. Program.
    Mrs. Harshbarger. Will that program be ended in December of 
2024?
    Ms. Johnson. I believe that is accurate.
    Mrs. Harshbarger. OK. I guess my question is, how did you 
come to that specific $1.1 billion number that you need between 
now and next December?
    Ms. Johnson. Yes, I believe that--and again, I would need 
to consult with our colleagues across the department who helped 
design the program.
    Mrs. Harshbarger. Yes.
    Ms. Johnson. But I believe it was looking at where 
uninsured needs are, and where we thought, because of the cost 
associated with administration of these vaccines and 
therapeutics----
    Mrs. Harshbarger. Well----
    Ms. Johnson [continuing]. What that would look like.
    Mrs. Harshbarger. OK, that brings me to another question. 
Was there an assumption that annual boosters would be 
recommended and incorporated into that 1.1 billion?
    Ms. Johnson. I don't know the answer to that question, but 
I am happy to get back to you on that.
    Mrs. Harshbarger. OK. If you could find that, because--I 
guess I am asking that because assumptions were made around 
anticipated demand, and there has clearly been a decrease in 
COVID-19 vaccine uptake. So, you know, that is just my 
question: How did you get to that 1.1 billion?
    But if you could do that, that would be fantastic----
    Ms. Johnson. I am happy to follow up with you on that 
point. Thank you.
    Mrs. Harshbarger. And I know I have got a minute left. I 
wanted to talk about Countermeasures Injury Compensation 
Program, and I thank you for your recent response to the 
congressional letter that was sent by our colleague, Rich 
McCormick of Georgia. And a lot of the colleagues here signed 
on to that.
    In our letter we expressed concerns over the delays that 
are being experienced by individuals making claims under the 
CICP and sought information regarding how your agency intends 
to address the barriers to compensation reported by our 
constituents. My question is, how many reviewers are being used 
for the nearly 12,000 COVID vaccine injury claims on file?
    Ms. Johnson. I believe we have done a series of hiring 
because we have recognized the need to grow this program, 
which, you know, historically, for the 10 years it had been 
around, had only gotten 500 claims over the life of the 
program.
    Mrs. Harshbarger. Yes.
    Ms. Johnson. So we have scaled up hiring.
    Mrs. Harshbarger. Many more now, yes.
    Ms. Johnson. And I believe we are at 38 now.
    Mrs. Harshbarger. Thirty-eight? How is the CICP 
prioritizing these claims? And in particular, is there any 
focus on death claims?
    Ms. Johnson. We are--I will need to get back to you on the 
particulars----
    Mrs. Harshbarger. OK.
    Ms. Johnson [continuing]. Of that. Yes.
    Mrs. Harshbarger. Yes, well, I have got other questions, 
but I will submit them to you.
    And with that, thank you for being here----
    Ms. Johnson. Thank you.
    Mrs. Harshbarger [continuing]. And I yield back.
    Mr. Carter. The gentlelady yields back. The Chair now 
recognizes the gentlelady from Iowa, Dr. Miller-Meeks.
    Mrs. Miller-Meeks. Thank you very much, Chair Carter, and 
thank the committee for having this hearing.
    So let me first say that I am a physician as well as a 
former director of the Iowa Department of Public Health, so 
very familiar with Health Professional Shortage Areas, HPSA, 
our Maternal and Child Health Grants.
    But I just want to say that workforce is a complicated 
issue, and it is complicated because it--when you are looking 
at physician workforce, especially, people just don't locate 
where reimbursement is the highest. And let me just say that in 
our small community of 26,000 people we had a very vibrant 
medical community. And I am fully supportive of our FQHC, but 
our FQHC also decimated our provider community. Our FQHC does 
not pay property tax, which put an increased burden on the 
private practices that got displaced, which were paying 
property taxes.
    You know, who pays for electronic health records when you 
have to institute that, or electronic billing, or all of the 
other mandates that individual practices have had?
    And so you have had from the start and the inception of the 
Affordable Care Act, 50 percent of physician practices were 
independent or a small group, meaning not consolidated. And now 
only 20 percent of those practices. So the majority of 
physicians are now either hospital employees or large group 
employees.
    With that, noticing in your testimony you had mentioned 
that you had reached a milestone of 20,000 family medicine 
providers, pediatricians, obstetricians--I won't go through the 
entire list. That was a historic high. So is that 20,000 people 
that are in practice now, or is that 20,000 people over the 50 
years?
    Ms. Johnson. That is 20,000 people who are in the field 
today.
    Mrs. Miller-Meeks. OK. You also mentioned that you have a 
retention rate of 2 years beyond the service obligation. What 
is the current service obligation in the National Health 
Service Corps?
    Ms. Johnson. The service obligation is 2 years for the 
first award, and then the options for continuations depending 
on allowable----
    Mrs. Miller-Meeks. And what is an award?
    Ms. Johnson. $50,000.
    Mrs. Miller-Meeks. So 2 years for each $50,000 in loan----
    Ms. Johnson. Two years for the first $50,000, that is 
right.
    Mrs. Miller-Meeks. Of loan repayment.
    Ms. Johnson. Loan repayment.
    Mrs. Miller-Meeks. OK. And so what is the total cost of the 
program?
    Ms. Johnson. The total appropriation for the National 
Service Corps today--this year we are at $417 million.
    Mrs. Miller-Meeks. And what is your overhead cost--i.e., 
how much of that money goes out to loan repayment, and how much 
of that stays within the institution?
    Ms. Johnson. I don't know the answer to that off the top of 
my head.
    Mrs. Miller-Meeks. Could you get me the answer to that?
    Ms. Johnson. Absolutely.
    Mrs. Miller-Meeks. And so--and what is the retention rate 
beyond 2 years? Because I can tell you what the retention rate 
is on our J-1 visa programs beyond the 3 years of obligation.
    Ms. Johnson. Beyond the 2 years--the first 2 years beyond 
the 2 years of obligation, our retention rate is 86 percent.
    Mrs. Miller-Meeks. How many stay beyond? So after 2 years--
so, like, for 5 years, what is the retention rate?
    Ms. Johnson. I have--what I can tell you is the--like, 
after the completion rate of 2 years, the 2 years that 
followed--at the end of the 2 years that follow that, the 
retention rate is 86 percent.
    Mrs. Miller-Meeks. OK. Thank you for clarifying that.
    Are you also aware of--in the National Residency Matching 
Program, have you looked at the stats on matching rates for 
family practice and emergency medicine?
    Ms. Johnson. We keep abreast--our team keeps abreast of 
matching rates.
    Mrs. Miller-Meeks. OK. And so is the matching rate 100 
percent for family practice?
    Ms. Johnson. I don't know the answer to that off----
    Mrs. Miller-Meeks. The answer to that is no, and you just 
told me that you keep track of those.
    Ms. Johnson. Our team keeps track of that. That is correct.
    Mrs. Miller-Meeks. OK. So the matching rate for family 
practice--we do not fill the number of slots that are 
available. And if you look at a university academic medical 
center, their slots will be 100 percent filled. Those at a 
training health center are not 100 percent filled.
    So--and when we are talking about increasing providers, 
what is it that we can do to increase or narrow that delta 
between the number of slots that are available and the number 
of unfilled positions? And 25 percent of those positions are 
currently filled by foreign medical graduates, which I think is 
great.
    Ms. Johnson. You know, it is critically important that we 
have as much lead time on recruitment. And so that is why we 
think stability in the program is really important, because it 
is hard to recruit. You know this better than I do. It is hard 
to recruit----
    Mrs. Miller-Meeks. Well, the delta has been increasing. So 
I can send that data to you. I should have put up a graph.
    Ms. Johnson. No, it--but it----
    Mrs. Miller-Meeks. But the delta is increasing. So from--
even from, you know, 2013, prior to the pandemic, there has 
always been a gap between the number of programs offered and 
the fill rate. That delta has been increasing, certainly a 
little bit exacerbated by the pandemic, but it was also fairly 
significant before the pandemic.
    Ms. Johnson. Yes, there have always been challenges with 
the fact that the funds have to be renewed. And early on in the 
program there were challenges with the stability of the fact 
that the dollars were allocated on the fiscal year, not the 
academic year.
    Mrs. Miller-Meeks. OK, thank you for that. I would say to 
investigate that more.
    My last question is, you know, as a physician I practice, I 
see patients on weekends. I see patients at night when I am 
practicing. So why do we have to have 250 million investment to 
extend office hours?
    I would just say you have to have evening and weekend 
office hours. As a Federal Government, if we are subsidizing an 
FQHC, a Training Health Center, a Community Health Center, I 
would make that part of that program, is that they have 
extended office hours in order to be able to adapt to and 
respond to their patient consumer demand.
    Thank you. I yield back.
    Mr. Carter. The gentlelady has yielded back. The Chair now 
recognizes the gentleman from Texas, Mr. Crenshaw, for 5 
minutes.
    Mr. Crenshaw. Does that mean I can schedule an eye 
appointment with you? I didn't know that. All right.
    Mrs. Miller-Meeks. I would see you.
    Mr. Crenshaw. I need a checkup.
    Mrs. Miller-Meeks. I would drive you to your----
    Mr. Crenshaw. I got issues. All right.
    Thank you for being here. Look, when we evaluate these 
programs--I agree with my colleague here about the need to use 
our money wisely. We have to assess how effective the money is 
that we are spending. So I want to drill down on a couple of 
policies, make sure we are actually strengthening our access to 
care and continuity of care.
    You know, many of the programs we are talking about today 
are meant to advance primary care. That is a big passion of 
mine. I think that is where any patient enters the healthcare 
system, so that is where, legislatively, we should enter 
healthcare reform. And look, I think there's a few 
opportunities that we could look at here to make this better.
    Inflation, soaring workforce costs, that has caused a lot 
of problems. It means it is really hard to recruit health 
professionals and retain them. This is particularly true for 
Community Health Centers. So I would like to submit a record--
for the record a statement from Lone Star Family Health Center, 
which serves thousands of people in my district to show that 
these workforce challenges are real for them as well.
    Community Health Centers are supposed to improve access to 
primary care services that can reduce costs to public insurance 
programs, while also preventing emergency room visits that are 
extremely costly. So that is the value-add that we are looking 
for. But when you can't hire anyone--and we are not just 
talking about physicians here, we are talking about dental 
hygienists, we are talking about medical assistants--it becomes 
pretty difficult to provide that care.
    So I have supported legislation to remove unnecessary red 
tape for licensing medical professionals. Can you comment on 
this in general terms?
    What do you need to help us hire more people, make it 
easier to hire more people? What are the barriers that we need 
to overcome?
    Ms. Johnson. Thanks for the question. One of the things 
that we have been working on lately is ensuring that we are 
linking some of our grant dollars to apprenticeship programs so 
that we are not just training, but we are training and doing 
on-the-job training as well so that we can prepare people for 
that first step in the health professions career ladder and 
then really working to bring people up the career ladder as we 
move people into the healthcare workforce.
    We also in our budget this year have a new initiative--
proposed initiative--that we call our Health Care Workforce 
Innovation Proposal, which is really about addressing some of 
the key barriers, getting ideas and new innovative ways to do 
healthcare training and to try to scale what works best.
    Mr. Crenshaw. Is it you are trying to reform training? Can 
you be more specific? I am curious about that.
    Ms. Johnson. So I think that, you know, what we hear from 
some places is maybe the training period is longer than it 
needs to be----
    Mr. Crenshaw. OK.
    Ms. Johnson [continuing]. Or maybe we could do some things 
creatively to match people differently, those kinds of things.
    Mr. Crenshaw. OK, that is good. Licensing reform, any 
thoughts on that?
    Ms. Johnson. You know, we--through some of our telehealth 
work we have actually been working on the compacts that States 
use to--in health professions to ensure that providers can work 
across State lines. We are really interested in ways to 
encourage those kind of best practices.
    Mr. Crenshaw. OK. I think you would like the bill that we 
are supporting. I hope we can--I hope we could pass that.
    As you know, National Health Service Corps is supposed to 
be a deal where physicians receive scholarships and loan 
repayment in exchange for practicing in at-need communities. 
But a recent study prepared for the Department of Health and 
Human Services suggests clinicians who don't participate in 
that, without those benefits, actually practice in Health 
Professional Shortage Areas more often and for longer than 
those who do. So that tells me we might be wasting money on 
some of these folks.
    There was an average 13 percent gap between nonprogram 
providers and participating providers. That is just strange. So 
how long--I have a couple of questions. How long does the 
average National Health Service Corps participant practice in a 
shortage area after their obligation is complete?
    I think I am repeating these questions, but----
    Ms. Johnson. Yes, and so there is the base obligation to 
stay in the service. They have a service obligation to stay for 
2 years. If they get a continuation, sometimes they stay for 
multiple years.
    And our data is--where we look 2 years after they complete 
their service obligation, 86 percent of people are still in 
underserved communities.
    Mr. Crenshaw. OK. There is obviously some kind of problem 
here, isn't there? So are we not using this money correctly? Is 
there better ways to incentivize, or at least exploring better 
ways to incentivize practitioners in those underserved areas?
    Ms. Johnson. We are always looking for ways to continue to 
grow the workforce in the communities that need them the most, 
which is why we also have the Teaching Health Center program, 
which is about not just--you know, loan repayment is about 
getting people there who are already through residency. 
Teaching Health Centers is actually about doing the residency 
in the community where you want people to practice. And then we 
also have National Health Center scholarship programs, where 
people make the commitment as part of their medical school 
education.
    Mr. Crenshaw. OK. Well, I am out of time.
    Thank you, I yield back.
    Mr. Carter. The gentleman yields back. I believe that is 
all the witnesses.
    I ask unanimous consent to insert in the record the 
documents included on the staff hearing documents list.
    Without objection, that will be the order.
    [The information appears at the conclusion of the hearing.]
    Mr. Carter. I remind Members that they have 10 business 
days to submit questions for the record, and I ask the 
witnesses to respond to the questions promptly. Members should 
submit their questions by the close of business on May 3rd.
    Ms. Johnson, thank you for being here.
    Ms. Johnson. Thank you.
    Mr. Carter. I appreciate it, and appreciate the work that 
your committee--your agency does.
    Without objection, the subcommittee is adjourned.
    [Whereupon, at 12:35 p.m., the subcommittee was adjourned.]
    [Material submitted for inclusion in the record follows:]
    
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