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“I said it loud and clear the first time — for all who want to hear,” Sablan said and quoted his June 20th announcement of the grant:
So many people have worked for so long to have the Kagman CommunityHealth Center approved for federal funding. And now that work has paid off.
“Short of listing every person who worked on the many grant applications going back over a decade – running the risk of leaving someone out – I really don’t know how much more inclusive to be in recognizing this accomplishment,” Congressman Kilili added.
“So many people did work for so long. And their work did pay off.
“What is sad is that instead of joining me in saying what good news this is for the people of Kagman, who will now have greater access to health care, there are those who want to argue over who gets credit.
“But what the people of Kagman want to hear is what the next steps are.
“When will the Health Center be open for business?
“When can we start getting health care in our own village?
“When can we have basic dental care again for our children?
“Prenatal care, immunizations, case management services for those with diabetes – when?
“People in Kagman have waited for their health center for a very long time. Now that the money hasbeen awarded they want to start seeing results. They want to see the promises in the grant put into action.
“I will continue to work with anyone who is interested in results and do all I can to make sure that in Congress we continue to provide the necessary annual funding for Community Health Centers nationwide, including Kagman,” Congressman Sablan said.
“And once Kagman proves successful we need Community Health Centers on Tinian and Rota.
"I will support those grant applications here in Washington, too, just as I supported Kagman's Community Health Center.”
A history of support for the Kagman Community Health Center
When Congressman Sablan was sworn in to the U.S. House of Representatives in 2009, one of the firstconstituent groups who came to ask for his help was the CNMI Department of Public Health. DPH had made several unsuccessful applications for a start-up grant for the Kagman Community Health Center, as far back as 2003 in the administration of Governor Juan N. Babauta. Public Health had been turned down for a planning grant, too, which could have helped improve the quality of the applications for a Community Health Center.
On March 26, 2009 members of the Board of the Pacific Islands Primary Care Association also met with Sablan, concerned about the Northern Marianas’ lack of success in getting funding. The Board is composed of the Executive Directors of the Pacific Island Community Health Centers in American Samoa, the Federated States of Micronesia, Guam, the Marshall Islands, and Palau. Only the Northern Marianas had no Community Health Center.
In response Congressman Sablan had his staff contact the Health Resources and Services Administration (HRSA) at the U.S. Department of Health and Human Services to see what the newly opened congressional office could do to help the Northern Marianas win a Community Health Center grant.
Members of Congress operate under ethics rules that prevent them from applying political pressure to federal agencies. Members can, however, make the case for consideration of constituent needs. So, Sablan wrote to James Macrae, Associate Administrator for Primary Care at HRSA, in support of a new application for a planning grant that CNMI Public Health was submitting; and Macrae responded, promising full and fair consideration of the application.
Sablanwrote to Governor Benigno R. Fitial, informing the Governor of this action; and Sablan also reported his support of the planning grant to constituents in the June 19, 2009 e-Kilili newsletter.
“This is not the first time the CNMI has applied for this grant, which Yap, Guam, and other areas in the Pacific have qualified to receive,” Sablan said in the newsletter. “I hope that adding my voice as NMI Congressman will help.”
The same issue of the e-Kilili newsletter also reported that Democratic leaders in the U.S. House of Representatives had that week released a draft of health care reform legislation that would eventually become the Affordable Care Act, or Obamacare. The new funding for Community Health Centers that was the source of the $608,333 Kagman grant announced last week was part of that original legislation.
On July 22, 2009 Sablan followed up with officials of the U.S. Department of Health and Human Services both to keep abreast of the CNMI's planning grantapplication and to signal the Congressman's continuing support. And on August 23 Health and Human Services announced an award of $80,000 for the planning grant.
Far from taking credit for himself Congressman Sablan congratulated the Department of Public Health onthis success. In the e-Kilili newsletter of September 21, 2009 he reported:
First step taken for Kagman Community Health Center — I offer my congratulations to the Commonwealth’s Department of Public Health, which was recently awarded an $80,000 competitive grant by the U.S. Department of Health and Human Services. The grant will help DPH develop the Kagman Community Health Center, a proposed model health facility to provide primary and preventative care services to the Kagman Community. I commend DPH on its successful application.
Sablan made no mention at all of his work on behalf of the planning grant application.
Sablan’s support for the Kagman Community Health Center grant application was not an isolated event.After that planning grant was awarded, the Acting Secretary of the CNMI Department of Public Health met with Sablan in Washington asking for more assistance. This time the application was for a Health Information Regional Extension Center; and Sablan again provided the requested letter of congressional support.
When the Northern Mariana Islands Legislature established an Office of Grants Management with Public Law 16-48, Sablan offered Governor Benigno Fitial continued assistance of this kind tosupport grant applications. Sablan wrote the Governor on February 2, 2010:
…Members of Congress will often provide letters of support for grants, once applied for. Many applicants may not know that this means of reinforcing grant applications is available – again, because the Northern Marianas has never before had a Member of Congress to turn to.
…I want you to know that you can request similar support from me for projects and grant applications coming through your new [Office of Grants Management].
…I look forward to helping to make this office as successful as possible in partnership with you for the benefit of the people of the Northern Mariana Islands.
The Governor never replied.
Later in 2010, the Department of Public Health submitted a new application for the Kagman Community Health Center, incorporating the work underwritten with the 2009 planning grant. The Governor did not ask Sablan to submit a letter of congressional support. When the Department of Health and Human Services announced awards in August 2011, again the CNMI had failed to win a grant.
Years of effort finally pay off
Sablan continued to reach out to the Fitial administration with suggestions for action to improve health care and offers of help. On September 1, 2011 the Congressman wrote Acting Governor Eloy S. Inos suggesting that in light of the failed Community Health Center grant application the administration consider seeking certification of a Federally Qualified Health Center Look-Alike, which can be a stepping stone to a full-fledged Health Center and which would be eligible for enhanced Medicare reimbursement, reduced price drugs, and the services of medical personnel from the National Health Service Corps or with a J-1 visa.
Sablan also wrote to newly appointed Commonwealth Health Corporation Chief Executive Officer Juan N. Babauta congratulating him and offering to work together to obtain federal support for health care in the Northern Mariana Islands.
And Sablan continued his support for the Kagman project with the encouragement of the Pacific Islands Primary Care Association. The Congressman learned that the CNMI's most recent application had received a high review score that ordinarily would have meant a grant award had there not been a shortage of funds available for the Community Health Center program nationally.
He also learned that the Bureau of Primary Health Care at HRSA had concerns about the CNMI application because the original co-applicant, the Department of Public Health, was being transitioned into a semi-autonomous, quasi-governmental Commonwealth HealthCorporation.
Sablan again stepped in. New funding had become available in 2012. The Affordable Care Act, or Obamacare, which Sablan and other territorial delegates had worked diligently to have island areas added to, provided money for Community Health Centers as one of its many benefits.
“I am writing in support of reconsideration of the New Access Point application to establish the Kagman Community Health Center,” Sablan wrote to Associate Administrator James Macrae on April 17, 2012. “I understand that the application is among those with sufficiently high scores to be eligible now for reconsideration without the necessity of an entirely new submission.”
Far from attempting toexert political influence on the agency, as CEO Juan Babauta has recently accused, Sablan specifically asked Macrae to “provide full and fair consideration of the Kagman application consistent with all applicable law,rules, and regulations.”
Subsequently, the Health Resources and Services Administration did decide to fund 219 New Access Point grants with $128.6 million of Obamacare money, using the scores from the FY 2011 round of applications. HRSA also had received assurances from the Commonwealth Health Corporation that the change in organizational structure of the CNMI Department of Public Health would not affect the management of the Kagman Community Health Center, as it had been proposed in the grant application.
Kagman was awarded $608,333.
In announcing the good news Congressman Sablan acknowledged the long years of effort by so many that finally resulted in the grant.
“So many people have worked for so long to have the Kagman Community Health Center approved for federal funding. And now that work has paid off,” he said.
“This is good news.”
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