Washington House Call

Physicians Seek Federal Support to Improve Border Health

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Legislative Affairs Feature -- May 2004  

By  Ken Ortolon
Senior Editor  

In 1994, physicians from Texas, New Mexico, Arizona, and California descended on Washington, D.C., and succeeded in a strong grassroots lobbying effort to pass legislation creating a binational commission to combat health problems along the U.S.-Mexico border. Although it took six years of bureaucratic wrangling and international negotiations with Mexico, the U.S.-Mexico Border Health Commission is up and running.

The commission has completed a major report outlining shared goals for improving health care on both sides of the border and has launched its first binational public health project -- a program that helps tuberculosis patients receive treatment on either side of the border. It also has received a $5.4 million federal grant to prepare for possible bioterrorism attacks in the region.

Ten years later, border doctors returned to Washington to launch a new initiative. They hope it will once again raise awareness in our nation's capital about the border's special health needs, gain continued support of the Border Health Commission's work, and secure new federal resources to tackle a myriad of health problems in the area.

"I think this is an amazing opportunity to call attention to the fact that we have in our border states issues to address that really transcend the border and extend into the other 46 states of the United States," said Texas Commissioner of Health Eduardo Sanchez, MD. He joined more than 40 border state physicians and their spouses, county medical society executives, and other border health advocates in a lobbying blitz of Capitol Hill on March 24-25.

"This is a not only a way to highlight what's going on along the border but also a way to demonstrate that what is happening on the border is important to those who aren't living on the border," said Dr. Sanchez, who also serves on the U.S.-Mexico Border Health Commission.

Laying the Groundwork  

The trip launched what border doctors foresee as a long-term strategy to improve the health of border residents.

"Our goals are to increase public and congressional awareness of border health problems and solutions and to promote the U.S.-Mexico Border Health Commission," said Texas Medical Association President Charles W. Bailey Jr., MD, who, along with his wife, Sue, joined the border physicians on the trip.

Dr. Sanchez says much has been accomplished on the border since the passage of the Border Health Commission legislation. "We have made significant progress," he said. "We have a U.S.-Mexico Border Health Commission that convenes 12 jurisdictions -- the 10 border states and two national governments. We are making good progress on identifying health problems and working together on solutions."

But much more remains to be done. Environmental issues, such as lack of potable water and adequate sewage treatment, remain an issue. Chronic illnesses such as diabetes continue to prevail on the border. And infectious diseases such as tuberculosis are a continuing concern.

Hugo Barrera, MD, a general surgeon from Chula Vista, Calif., says access to care also remains a primary concern for border communities. "The important issues [for California doctors] are the ones I think are shared by the three other states," Dr. Barrera said. "That is access to care, the high number of uninsured patients, the high number of Medicaid patients, issues with cultural and language barriers, and disparities in health."

Eva Moya , LMSW, executive director for the U.S. half of the Border Health Commission, says she sees the new initiatives as an "incredibly important" next step in tackling these issues.

"It is the first time again after 10 years that the four state medical associations are coming together with the commission to echo some key messages and core recommendations for policy," Ms. Moya said. "That, in my opinion, is not only historic but also necessary."

Family physician Arthur A. Islas , MD, who practices medicine in the colonias surrounding El Paso, says the effort is not a "quick, flash-in-the-pan, try to get something now" endeavor.

"This is a groundwork-laying effort," said Dr. Islas , an assistant professor of family and community medicine at Texas Tech University Health Sciences Center in El Paso and medical director of the Kellogg Community Partnership Clinic. "This is the cement for the foundation. I think it's bridging the differences between the border and D.C. and trying to create those friendships and create awareness here in D.C. so they will be much more intelligent and informed about border issues to make better decisions." 

Making the Right Friends  

The effort kicked off with a reception hosted by the American Medical Association. U.S. Secretary of Health and Human Services Tommy Thompson made a surprise appearance at the reception and pledged his support for efforts to improve border health.

"My whole department is committed to do more on the border than ever before," Secretary Thompson said. "And the more you help us, the better are our chances to get more resources down on the border."

The reception also was attended by Elizabeth Duke, PhD, administrator of the Health Resources and Services Administration (HRSA), and Rear Admiral Richard S. Walling, RPh , MHA, director of the Office of the Americas and the Middle East, Office of Global Health Affairs, Department of Health and Human Services. Admiral Walling is Secretary Thompson's representative to the Border Health Commission.

Dr. Duke echoed Secretary Thompson's statement that the Bush administration is committed to helping the border region. She has personally made numerous trips to the border in recent months.

"The reason for going was basically to get a sense of the level of need," she said. "It's one thing to read about something. It's another to experience those things through the eyes of the people who live there, who are trying to identify that need and also find ways to meet it."

Dr. Duke says her agency, with the support of President Bush, already is carrying out a five-year plan to increase the number of federally funded health centers from 3,200 to 4,400 and has instituted a "very aggressive portfolio" of grants to help local communities address health needs.  

Hitting the Hill  

The following day, physicians, Border Health Commission members, and other participants fanned out across Capitol Hill for a full day of meetings with members of Congress, or their aides, from border states.

The delegation met personally with Texas Sens . Kay Bailey Hutchison and John Cornyn , and with staff members of Sens . Diane Feinstein (D- Calif .) and John McCain (R- Ariz .). The group also met with eight House members or their health aides from Texas and Californiaand held an hour-long briefing for House and Senate staffers.

In addition to educating lawmakers, the group sought support for legislation introduced by Senator McCain in 2003 that would provide some $200 million in federal grant funds to improve the infrastructure of, access to, and delivery of border health care. The bill, S 1447, and its House companion, HR 2807 by Rep. Jim Kolbe (R- Ariz .), also would increase funding for the Border Health Commission.

During the meetings, Senator Hutchison -- who sponsored the Border Health Commission bill as a freshman senator in 1994 -- agreed to cosponsor S 1447. Senator Cornyn and Rep. Silvester Reyes (D-El Paso) also are cosponsors.

Border doctors also made a side trip to visit with staff of Senate Majority Leader Bill Frist , MD, (R- Tenn .), who has filed legislation designed to eliminate health disparities among racial and ethnic minorities.

At the end of the day, the physicians felt they had made a favorable impact on border legislators. While they had no illusion that Senator McCain's bill is likely to pass quickly or that larger sums of federal dollars will begin to flow to the border immediately, they felt they laid the groundwork for their long-term goals.

Looking to the Future  

"I think we got a very good reception," said El Paso nephrologist Manny Alvarez, MD, chair of the Border Health Caucus, created two years ago to advocate for Medicaid and other issues important to Texas border physicians and their patients. "It was warm. It was well received from both sides. We felt we were welcome."

Dr. Alvarez says efforts such as this show that the Border Health Caucus, while only a part of the larger group during the Washington, D.C. events, has matured into a very effective advocate for border health needs.

"The caucus has grown tremendously, both in numbers and in our experience in the political arena. We're learning now to deal more politically, and I think it's about time that doctors get more politically involved."

Edinburg internist Linda Villarreal, MD, president-elect of the Hidalgo-Starr County Medical Society, says this was her first experience with this type of grassroots advocacy. It probably won't be her last.

"This should be one of those things all physicians are required to do once a year," she said. "It's been very, very successful. It's exposed me to what needs to be done, what hasn't been done. It's exposed the physician group to the congressmen, letting them know that we do not expect them to do things alone. I would really like to go back and tell one doctor, 'You do it next time,' and then propagate it that way."

While the delegation members believe border state lawmakers recognize the special health needs of the border region, much work is still needed to bring their non-border state colleagues up to speed.

"This border is a very porous border," Dr. Barrera said. "So whatever affects us at the border eventually will affect the country as a whole. A person who comes from over the border can easily in a matter of hours end up in Chicago or Boston or any other city in the United States. If patients can cross borders so easily, then clearly any sort of biological agent can cross the border just as easily. That's a potential impact for the whole country."

Dr. Villarreal says that's a message the border legislators know well, "but maybe the guy from Missouri or the guy from Wisconsin doesn't. I would love to have those people come down and walk a mile in my high heels, so to speak."

Ken Ortolon can be reached at (800) 880-1300, ext. 1392, or (512) 370-1392; or by email at Ken Ortolon.  

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