[Congressional Record Volume 140, Number 17 (Thursday, February 24, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 24, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
              THE COMMUNITY HEALTH IMPROVEMENT ACT OF 1994

  Mr. HOLLINGS. Mr. President, I join my colleagues Senators, McCain 
and Brown, today in introducing the Community Health Improvement Act 
which will provide greater access to high quality health care for 
underserved populations more efficiently and at lower cost. This will 
be accomplished by permitting States to develop 5-year demonstration 
projects in which community health authorities would contract with 
State Medicaid agencies to enroll and care for Medicaid recipients and 
expand services to uninsured low-income individuals as savings from 
efficiencies accrue.
  Let me say up front that this bill does not compete with any health 
care reform proposal; it can be implemented upon enactment to give 
States that choose to participate a running start in implementing more 
comprehensive reforms. The approach simplifies rather than complicates, 
adds no new government bureaucracy, restrains Medicaid cost increases, 
and just plain makes sense.
  A market-based system that counts on competition to restrain costs is 
just not a reality in far too many communities in this Nation. These 
communities, largely rural and inner-city, have neither incomes nor 
population to attract large managed care corporations to compete for 
their care; and most for-profit HMO-type plans that receive a per-
participant capitated rate do not want this population which is often 
comprised of individuals and families that require more extensive care 
due to age, language barriers, homelessness, lack of transportation, 
and other factors than the general population. Typically care has been 
received from a very fragmented nonsystem of health departments, badly 
strained hospital emergency rooms, free clinics that depend on 
volunteers, and in those communities fortunate enough to have them, 
from federally funded community, migrant, and homeless health centers. 
What these communities need is the ability to organize existing 
resources for maximum efficiency and to be able to fill holes in 
service delivery to create case-managed, integrated systems of care 
that serve the needs of their particular community.
  Under this bill the Federal Government and States can limit Medicaid 
increases while experimenting with new service delivery and financing 
mechanisms, communities would be empowered to determine and address 
their unique needs, all providers would be encouraged to participate 
and to negotiate a fair reimbursement with friends and neighbors they 
know and trust, families that have had no medical home would be 
provided one and coverage for services would be affordable. What the 
Community Health Improvement Act would do is create an environment in 
which all are winners, and I urge your consideration and passage of 
this bill.

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