1.This Act may be cited as
the Build, Update, Improve, Lift, and
Design Health Centers Act of 2007
or the BUILD
Act
.
2.Congress makes the following
findings:
(1)Many health care
experts believe that lack of access to basic health services is our Nation’s
single most pressing health care problem. There are 56,000,000 Americans that
do not have access to a primary care provider, whether they have health
insurance or not. In addition, more than 45,000,000 Americans lack health
insurance and have difficulty accessing care due to the inability to pay for
such care.
(2)Health centers,
including community health centers, migrant health centers, health centers for
the homeless, and public housing health centers, address the health care access
problem by providing primary care services in thousands of rural and urban
medically-underserved communities throughout the United States.
(3)Health centers
provide basic health care services to 16,000,000 Americans each year, including
nearly 9,500,000 minorities, 850,000 farmworkers, and 750,000 homeless
individuals. One in five children from low-income families receives care
through health centers.
(4)Studies show that
health centers provide high-quality and cost-effective health care. The average
yearly cost for a health center patient is approximately $1.25 per day.
(5)One of the most
effective ways to address America’s health care access problem is by
dramatically expanding access to health centers, as both the Senate and the
President have proposed.
(6)Many existing
health centers operate in facilities that desperately need renovation or
modernization. Thirty percent of health centers are located in buildings that
are more than 30 years old, with 12 percent of such centers operating out of
facilities that are more than 50 years old. In a survey of health centers in 11
States, 2/3 of those centers identified a need to improve, expand, or replace
their current facility. An extrapolation based on this survey indicates there
may be as much as $2,200,000,000 in unmet capital needs in our Nation’s health
centers.
(7)Dramatically
increasing access to health centers requires building new facilities in
communities that have access problems and lack a health center.
(8)Health centers
often do not have the means to pay for capital improvements or new facilities.
While most health centers raise some funds through private donations, it is
difficult to raise sufficient amounts for capital needs without a
middle-upper-class donor base similar to other nonprofit organizations like
universities and hospitals.
(9)Health centers
have a limited ability to support loan payments. Due to an increasing number of
uninsured patients and the fact that many health care reimbursements are less
than the cost of care, health centers rarely have more than minimal positive
operating margins. Yet lenders are rarely willing to take risks on nonprofit
organizations without these positive margins.
(10)While the
Federal Government currently provides grants to health centers to assist with
operational expenses used to provide care to a medically underserved
population, there is no authority to provide grants to assist health centers to
meet capital needs, such as construction of new facilities or modernization,
expansion, or replacement of existing buildings.
(11)To assist health
centers with their mission of providing health care to the medically
underserved, the Federal Government should supplement local efforts to meet the
capital needs of health centers.
3.Amendments to
the Public Health Service
Act
(a)Health care
facility grants and loan guaranteesSubpart I of part D of title
III of the Public Health Service Act
(42 U.S.C.
254b et seq.) is amended by adding at the end the
following:
330R.Health care
facility grants and loan guarantees
(a)Eligible health
center definedIn this section, the term eligible health
center means a health center that receives—
(1)a grant, on or
after the date of enactment of this section, under subsection (c)(1)(A),
(e)(1)(A), (e)(1)(B), (f), (g), (h), or (i) of section 330; or
(2)a subgrant, on or
after the date of enactment of this section, from a grant awarded under such
provision of law.
(b)
(1)The Secretary may award grants to eligible health centers
to pay for the costs described in paragraph (2).
(2)An eligible health center that receives a grant under
paragraph (1) may use the grant funds to—
(A)modernize,
expand, and replace existing facilities at such center; and
(B)construct new
facilities at such center.
(3)
(A)Subject to subparagraph (B), the Federal share of a grant
awarded under paragraph (1) to expand an existing, or construct a new, facility
shall not exceed 90 percent of the total cost of the project (including
interest payments) proposed by the eligible health center.
(B)The
Federal share maximum under subparagraph (A) shall not apply if—
(i)the total cost of
the project proposed by the eligible health center is less than $750,000;
or
(ii)the Secretary
waives such maximum upon a showing of good cause.
(c)
(1)
(A)The Secretary shall establish a program under which the
Secretary may guarantee not less than 90 percent of the principal and interest
on the total amount of loans made to an eligible health center by non-Federal
lenders in order to pay for the costs associated with a capital needs project
described in subparagraph (B).
(B)Capital
needs projects under this subsection include—
(i)(I)acquiring, leasing,
modernizing, expanding, or replacing existing facilities;
(II)constructing new facilities; or
(III)purchasing or leasing equipment;
or
(ii)the costs of
refinancing loans made for any of the projects described in clause (i).
(C)Any loan guarantee issued pursuant to this subsection
shall not be deemed a Federal subsidy for any other purpose.
(2)Authority for
loan guarantee programWith respect to the program established
under paragraph (1), the Secretary shall assume such authority—
(A)as the Secretary
has under paragraphs (2) and (4) of section 330; and
(B)under section
1620 as the Secretary determines is necessary and appropriate.
(3)Health center
project applicationsThe Secretary shall require that all
applicants for grants and loans under this section—
(A)comply with the
conditions set forth in section 1621, as in effect on the date of enactment of
this section, with respect to activities authorized for assistance under
subsections (b)(2) and (c)(1)(B) in the same manner that applicants for loans,
loan guarantees, or grants for medical facilities projects under such section
are required to comply with such conditions, unless such conditions are, by
their terms, otherwise inapplicable; and
(B)(i)give priority to
contractors that employ substantial numbers of workers who reside in the area
to be served by the health center; and
(ii)include in the construction
contract involved a requirement that the contractor will give priority in
hiring new employees to residents of such area.
(4)In
this subsection:
(A)The
term facilities means a building or buildings used by a health
center, in whole or in part, to provide services permitted under section 330
and for such other purposes as are not specifically prohibited under such
section as long as such use furthers the objectives of the health
center.
(B)The term non-Federal lender means any entity
other than an agency or instrumentality of the Federal Government authorized by
law to make loans, including a federally-insured bank, a lending institution
authorized or licensed to make loans by the State in which it is located, a
community development finance institution or community development entity (as
designated by the Secretary of the Treasury), any such lender as the Secretary
may designate, and a State or municipal bonding authority or such authority’s
designee.
(d)Not
later than 3 years after the date of enactment of this section, the Secretary
shall prepare a report containing an evaluation of the programs authorized
under this section. Such report shall include recommendations on how this
section can be improved to better help health centers meet such centers’
capital needs in order to expand access to health care in the United
States.
(e)For
the purpose of carrying out this section, the Secretary shall use not more than
5 percent of any funds appropriated pursuant to section 330(s) (relating to
authorization of appropriations). In addition, funds appropriated for fiscal
years 1997 and 1998 under the Departments of Labor, Health and Human Services,
and Education, and Related Agencies Appropriations Acts of 1997 and 1998, which
were made available for loan guarantees for loans made by non-Federal lenders
for construction, renovation, and modernization of medical facilities that are
owned and operated by health centers and which have not been expended, shall be
made available for loan guarantees under this
section.
.
(b)Authorization
of appropriationsSection 330(r)(1) of the
Public Health Service Act (42 U.S.C.
254b(r)(1)) (relating to authorization of appropriations) is amended
by striking this section
and inserting this section and
section 330R
.