legal systems, education, and human rights with the museum's director her. we will also take your calls during the program. watch this weekend on the c-span networks. q&a, aay, on c-span's college professor, tom cronin talks about his book -- imagine a great republic. of majork a reading american political classic is very empowering in terms of this country stands for something very special. and the great writers like stowe that we want to be someone special. not just a city on a hill but a city that loves one another and is willing to work with one another and understand that politics is indispensable to

bringing about progress for as many people as possible. >> q&a, sunday night at 8:00 eastern on c-span. >> washington journal continues. host: joining us now is dan hawkins, the senior vice president of public policy and research at the national association of community health centers and he is here to discuss the role of community health centers in health care and caring for underserved communities. thank you for joining us today. isst, tell our audience what the national association of community health centers and how it is funded. knack, as we like to call it is a trade association representing community health centers all across the country. it advocates for continuation and growth of health centers

based on tremendous unmet need across the country. it also engages in research, training, to ensure that the staff of the health centers over clinical and nonclinical staff are fully trained to work at the top of their training to provide the best quality care as well. explain to us what exactly are these community health centers and what services they provide that are the same or different from other health facilities. havemmunity health centers been around for about 52 years now. founded in the mid-1960's. accessible,reate available, affordable health care for we call it underserved, think resource poor communities. low income. hard-working folks that do not have health insurance or other ways to afford health care. and intracity urban areas as well.

the care they provide, preventive and diagnostic medical services, dental care, behavioral health care, from a suitable assistance and other related services that help to make the care that they provide both available, such as transportation and the like, and effective. including job training, .ssistance with housing, food helping them sign up for feeding programs, etc.. host: and who uses these community health centers --are they open to everyone? aree love to say that they open to everyone regardless of the ability to pay. that haveindividuals goldplated -- i wouldn't call it bad but private insurance. medicaid. half of the 27 million people served eye center is today. but about a quarter of them have no health insurance whatsoever.

of all of those patients, 70% have incomes low the federal poverty level. these are people, who even if they have insurance, cannot afford the co-pay or pay for services that are not covered by their insurance. host: and according to you, the down a for knack breaks little bit about who is being served. 26 million patients. sinces a 33% increase 2010. and it serves nearly a million migrant and seasonal agricultural workers. serves more than a million homeless patients and 330,000 veterans. talk a little bit about what is driving that increase. that one third it has grown in int -- in less than a decade some of these underserved populations. >> health and human services

2500tary addressed the health center advocates that are in town yesterday. he praised health centers for the work they do serving some of the hardest to serve. you mention people that are homeless. and veterans who have difficulty getting care even from the da -- from the v.a. and from workers. -- and farm workers. they need the care of the centers are able to provide. secretary a czar said that they were leaders. host: we are joined by dan hawkins.

we have regional lines for this discussion. let us talk about sunday. how are these health centers funded and how much of it comes from the government? >> not a significant chunk of funding comes from the government and that is what makes it possible for the centers to offer assistance to people even for those that have insurance. medicare does not covered dental care for example. and has pretty significant deductibles and co-pays.

15% of health center patients are privately insured but they are also working at minimum wage jobs. their insurance coverage is pretty sparse. these resources make it possible for the health centers to and havehat care patients pay on a sliding scale according to their income. about 18% of health center funding comes in the form of federal grants. thethen, about 43% of funding comes in the form of reimbursement from medicaid. another 6% or 7% from medicare and roughly the same percentage from private insurance. those resources, like every health care provider, you of income a system that comes from various sources. you pull that together in order to provide the care you are able to provide. host: we are coming up with the

spending bill that has to be passed this week. has there been any cues from the current administration about its priorities for the community health centers? both the bush and obama administrations pushed to expand these health centers but it says the costt now funding, of funding these health centers is small compared to other communities. 7.4 billion dollars compared to $18 billion for the first phases of the border wall or one point $5 trillion for the cost of the corporate tax cut. the secretary yesterday assured that the 2500 advocates in town this week of the

administration's solid support for health centers. we pridehours -- ourselves that the centers have enjoyed long and deep bipartisan support. act thatced budget passed a month ago voted for continued funding. it took longer than we expected for that to happen. we will have to go back to revisit that in a year and a half or less but in the meantime, in the appropriations bill, there is a billion and a half dollars that hangs there. we do believe that this administration, to the extent that we can divine their priorities, supports the health center program and we enjoy bipartisan support in congress. host: we have a lot of colors that use community -- we have a

lot of callers that use community health centers. emily. caller: good morning. i was giving a shout out about using the health center. i used them when i first started working and i did not have a lot of money or insurance for my children. i got top-notch quality health care. they were like learning institutions where they have a doctor that went to school and another doctor that was really experienced in that field. now that i am retiring and on forcare i went back to them myself because i enjoy them. have gone up since mr. trump has been in office. i do not know how that happened. i guess it was through obamacare

but anyway -- they are great and i recommend them for everybody. >> i appreciate your comments, really. a satisfied customer. nothing better. talk aboutting, you co-pays increasing. i assume you mean the medicare and that is by virtue of policy both the administrative action and congressional action. but, the good news again is that if the co-pays become too much of a burden, that is when health centers will reduce the charge to you based on your income and make it affordable for you. and that is one of the hallmarks of a what health centers do. host: janet also uses community health centers calling from here in washington, d.c. good morning. caller: thank you for having me. i wanted to add my voice to those that support community health centers. i first learned about them when

i lived in small town, georgia and many of my clients that were underserved and poor used to help centers for their primary health care. and then i came to washington and my nonprofit organization was not able to provide health care insurance. i purchased insurance on the affordable care act exchange and they are close to me. i found a very nice community health center and it has been my primary provider. they provide the ancillary services. the fees are reasonable. i can walk in without an appointment. the doctors are committed. it ought to be a model for how we provide health care to everyone. i am not poor and i have a good salary but it is still a good option for me. >> the wonderful part about those comments is a clear indication -- i ran a health lifer in texas early in my in the 19 70's.

i remember one day that my pediatrician on my staff came to me and said -- the mayor wants his kids to get care here. alreadyiatrician had earned some renown in the community. stand, i doo him, not object to that as long as no low income kid is knocked out of the availability -- availability of care. and he said -- if i have to work extra hours i will make sure that that happens. 90% of the population served by health centers have incomes below the federal poverty level but there are people who, as this young woman said, earned a pretty good income but are happy to use a health center as

their health care home because of the quality of care. one thing that health centers have been highlighted for is the high quality of care. even better than that of private practice providers. secretary saide you are not only a part of the solution. talk to me about how you recruit physicians and other health care practitioners to these community health centers. thecolors are talking about good care provided. how have you managed to do that? >> because health centers are located in sometimes hard and difficult to serve communities, rural outposts that are far from or even inn centers, inter-cities like here in washington, d.c. where it can be difficult because of the competition.

you have hospitals. group practices and others recruiting these physicians and other providers. the way health centers have this -- have successfully recruited and retain quality health care providers is by operating their own training programs, collaborating with the government via programs that provide assistance through scholarships in return for service, not dollars, paid back to pay the loans back or scholarships act in service to underserved communities. those programs are vitally important to help centers. -- two health centers. and these centers also make significant use of nonphysician providers. i love doctors. physiciantioners and

assistants are some of the very best because they relate to the individual on a personal level. we make extensive use of nonphysician providers both in the medical, dental, and behavioral health area. host: gabriel is calling from clayton, north carolina. hello. caller: good morning, kimberly. love the show as always. i am actually unique. i am a duke university medical student and i am there he happy attached and affiliated with the university that cares suspend -- substantially about this aspect of community health. they see it as something that needs to be on the forefront. we put together a primary leadership cared tracked. it allows for people to stay in primary health. quite often, two thirds of the

physicians in the pipeline go into specialties. that does a disservice. when you are trying to recruit -- those in the pipeline, especially from universities dukeshe harvards and of the world. feel that dukei is trying to push that envelope further and recruit the people diversified understanding and environment that can bring that aspect of medical care forward. the last thing i will say that is important about the community health component. there has to be -- because i was also in the military. i have seen what the military system looked like for accountability across the board.

it does make sense to have .tandards care andollaborative communication between the two. i would like to get your comment on establishing the relationships between people, patient, doctors, more accountable on both sides so the weight -- host: i just want to make sure that can has enough time -- that dan has enough time to comment. >> regardless of where you as a duke student or where any of your colleagues go to provide care, primary care is so important. family medicine, pediatrics, internal medicine for adults and the elderly etc. that kind of training is so 16 ofand yet barely

medical students in this country go on to primary care careers. the rest go into specialties. in terms ofuch more primary care. ofondly, one of the beauties health centers is that each one operates independently. they are not government operated. there is a local community board a majority of whose members are registered patients who received care there. it ensures that each health center is responsive to the unique needs of the community it serves. lapsedunding recently between september and last week for these health centers. what did you do during that time to deal with that? >> fortunately, the way the government funds these programs

-- they had provided funding for the health centers beyond the september 30 expiration of the fund. but, there were several health centers whose funding ran out december 31. the government had to cobble together some resources that were available to allow them to continue going. but i heard from dozens of health center executives who clinicians,ed physicians, nurse practitioners and dentists because they could not commit to a year-long or multiyear contract or employment agreement. some had to close centers because they could not commit to a rental agreement on the facilities. that kind of craving -- craziness was going on. we believe the ship has been righted now and we pray it never

happens again because these are that often live hand to mouth. they cannot afford that uncertainty. host: stephanie is calling from pennsylvania, also a community health center user. to shout out not only to the community health center but for the physician assistants and nurse of assistance. insurance best health money can buy. lou cross blue shield. i prefer to go to the community health center because it is in my backyard. and i alwaysle -- see a physician assistant. once in a while when i question what they told me, i will drive to and a half hours to john hopkins where i can also get care. and it is always right on the money, both of them. like to hope that there would be a community health center in every single

county in the country. -- thatthing i think -- it might be bad for your long-term existence because you are so in competition with the doctors. i am not too good on real doctors. a couple three things that strike me about that. one thing that we say about health centers is that we strive to be the provider of first choice and not last resort. from what they young lady said, and thank you for those comments, that the health center is seen as a high quality provider. that is vitally important. and by offering the services they offer, one stop shopping for people. if you are stressed or depressed

and in part because you have diabetes or high blood pressure or some other chronic condition, health centers will deal with both ends of that and keep you healthy both mentally and physically. host: linda is calling from orange, connecticut. caller: good morning. your tie reminds me to wish you all happy st. patrick's day. i am calling because my brother went to a community health center as a last resort due to employment problems. and now it is his first choice. contractedately hepatitis c from a blood transfusion in the 1970's when we did not screen our blood supply and has dealt with it his whole life. but, the community help the center, due to the way they run it, has gotten him where his

diet is in balance, and this is where -- and this is with the physicians assistant. regular blood screenings. early 60's in his who is healthier now than he was in his 40's. the outside from looking in because i do not use one and say the amount of money they have saved the taxpayers and of course my brother with the catastrophic health care they have avoided because of the interaction between the patient and the doctor's. -- and the doctors. this is another aspect we are looking into is and of health being catastrophic. host: in addition to linda's comments, i also want you to react to house speaker paul ryan saying that republicans may target at a care and medicaid spending in 2018. how that might impact these

centers' abilities to function. >> depending on how they are going to do so, you can deal with large programs like medicare and medicaid with a careful scalpel or you can take a bludgeon and do great harm. the case of medicaid 75 million people who rely on medicaid as their safety net to make the care that they need to get affordable. i always worry because it is not just begun arriving. there are 434 other members of the house and of course the entire u.s. senate that sometimes, when they get together as a group, what comes out the other end is not necessarily the best thing. i would like to respond to the call on three points. .ne, she talked about hep c health centers never shy away

from caring for folks with difficult or difficult to treat it doesn't matter what problem you have, they will address it. she talked about nutrition, and how they help center was helping her brother get access to new christian -- nutrition. they will try to treat and prevent illness and conditions, to address the conditions that , foodwill have insecurity, transportation, even multilingual translation services, if you make them accessible and effective. she talked about saving money. studies have shown and that's why i believe the biggest part they enjoy support, they save billions.

the last study said it $24 billion a year and saved costs because of the care that health centers provide. host: gladys is calling from connecticut. caller: good morning. go to a clinic here in hartford. doctors and finally physicians assistant to diagnose me for years later that i had lyme disease. i never had a rash that was circular of any kind carried i go back tomorrow to see if i get a second round of antibiotics. , in connecticut, fore's a path on dental

$1000. how does a community health center negotiate with the government for the procedure? -- have three teeth hold, how do i use that thousand dollars? x-rays are not cheap. that's a good question. when i hear about a $1000 cap on dental care, you could run through that quickly. that could be a limit on the insurer or it may be the state maximum program is willing to pay for care like that. regardless of what those caps are, health centers will provide and render the care you need irrespective of whether you've gone past the cap. they will work with you to make sure you are having costs as low

as possible. it's happy to talk to my friend from hartford. she mentioned lyme disease. health centers are the first places where the monkey pox illness was found. zika virus, when the federal government declared a one square mile piece of miami as a hot zone for secret, three quarters of the people living there were going to the community health center. the health center providing the care that was needed to reduce the impact of that disease. they are on the front lines. as they say about the firefighters and others, they are running toward the fire, not away from it. host: betty is calling from virginia beach. good morning greatest caller:

happy st. patrick's day. i like your green. i wanted to say i didn't go to a community health center, but i'm from connecticut. i lived in dan very and went to a wonderful community there. now, they can't cut medicare and medicaid because in december i was diagnosed with lung cancer. i only have medicare and medicaid. i've got the most excellent doctors. they were so wonderful to me, the surgeon. i have to go back to the oncologist. they weren't expecting me to have other treatment. he took out a team lymph nodes and found to for cancer. the wonderful news i heard yesterday, my oncologist prescribed a drug instead of chemo that he thinks in my case would work better.

mine is not that serious. i never expected medicare and medicaid to pay for that drug. is girl in the office working on getting it for you. host: we wish you all the best in your treatment. timet wanted to get some in the few seconds we have. guest: at this point, i mentioned medication services and pharmacy services that health centers offer. that is become so vitally important. child, today the use of medication and medicine to care for any condition is much more ubiquitous. it is also more expensive. there's a small program called 340 b that allows you to buy from the manufacturer for prices

well below what they sell them to others, insurers, pharmacies, etc.. it's a stuff that makes the medication affordable. that is vitally important. you again. medicare and medicaid are crucially important programs today. slashed.ld not be columns fore such seniors and hard-working people who don't have the good fortune to work someplace. not work hard for employers and don't provide insurance. that's where medicare and medicaid any community health centers become so vitally important. the: dan hawkins, he is at

national organization of community health centers. you can find down on twitter. thank you for joining us. up, matt forte will be here with our spotlight on magazines. stay tuned. we will be right back. >> c-span cities tour takes you to winston-salem. we will explore the literary scene in history. today at noon on book tv, like

forest university dean michelle glaspie on her book catherine and rj reynolds. >> they were a rather extraordinary couple. founder ofds was the the tobacco company. he turned the factory into one of the top 100 or so corporations in america by the early 20th century. have a lot ofrine vision and was committed to a progressive way of shaping society for the early 20th century american south. >> see memorabilia from lewis carroll, author of alice in wonderland. >> i began to look at his diaries and letters. i learned about what kind of typewriter it was. he typed a few letters and

documents. he used it to entertain his friends when they would come visit. he would type volumes and volumes of poetry. this was quite a novelty in 1888, to reprint something that looked like a printed document. >> on american history tv, a visit to old salem, settled in 1766 by german protestants. here about the hidden town of project that explores. watch the cities tour of winston-salem today at noon on c-span2 and sunday on american history tv on c-span3. working with our cable affiliates as we explore america. >> washington journal continues. joined by matt ford, a staff writer at the new republic.