[Congressional Record Volume 140, Number 45 (Thursday, April 21, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: April 21, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                COMPREHENSIVE HEALTH ACCESS DISTRICT ACT

                                 ______


                          HON. EDOLPHUS TOWNS

                              of new york

                    in the house of representatives

                        Thursday, April 21, 1994

  Mr. TOWNS. Mr. Speaker, I am proud to rise today to introduce the 
Comprehensive Health Access District Act. This legislation would reform 
the health care system where reform is needed most--in our inner cities 
and other medically and economically disadvantaged communities. The 
bill recognizes that health care cannot be delivered in a vacuum. 
Health care delivery systems must take into account all of the 
factors--social, cultural, and economic--that affect well-being.
  A comprehensive approach to tackling health care problems, one that 
both expands access to health care and creates economic opportunities, 
is needed in my district in Brooklyn and in communities like it 
throughout the country. The Comprehensive Health Access District Act 
provides the structure for just such a comprehensive approach.
  First, the legislation designates communities whose indicators of 
basic health are significantly worse than those of the Nation as a 
whole as ``Comprehensive Health Access Districts'' or ``CHAD's.'' 
CHAD's are the neighborhoods where residents receive primary care in 
hospital emergency rooms, where children do not receive age-appropriate 
immunizations, where the incidence of AIDS and tuberculosis is soaring, 
and where lack of attention to chronic conditions such as diabetes and 
high blood pressure force people into the hospital. These are 
communities, too, where unemployment is the norm and where poverty is a 
fact of everyday life.
  The bill next encourages the development of specialized 
comprehensive, community-based managed care programs to serve CHAD's. 
Each State with a CHAD within its borders would be required to contract 
with such a plan to serve the health access district. Health alliances 
or similar structures created as a result of the enactment of 
comprehensive health care reform would also have to assure that a 
specialized health access plan is available to serve people living in 
comprehensive health access districts.
  The legislation then spells out the service, access, quality, and 
other performance standards that managed care programs will have to 
satisfy in order to be certified as qualified to serve a comprehensive 
health access district.
  CHAD programs will, first of all, be comprehensive. They will provide 
a broad range of health care services, with the emphasis on preventive 
and primary care. CHAD programs will be required to link each person 
served with a primary care physician, and guarantee round-the-clock 
access to that doctor. These requirements will take treatment out of 
the costly hospital emergency room and assure that individuals receive 
regular, timely, and appropriate care.
  To make sure that happens, CHAD programs will institute aggressive 
quality assurance programs. Providers who do not meet CHAD quality 
standards will be penalized and, if necessary, terminated from 
participation.
  In addition to providing medical care and services, CHAD programs 
will stress health education and outreach, and develop programs that 
come to grips with the social, cultural, and economic factors that can 
influence health and well-being. CHAD programs will identify the 
leading causes of illness and death within their community, and develop 
appropriate interventions to address these problems. Problems related 
to poor housing, lack of education, substance abuse, and family 
breakdown will be addressed. Linkages will be forged between CHAD 
programs and other community services so that health issues are not 
dealt with in isolation.
  Just as important as the comprehensive range of services provided by 
CHAD programs is the fact that they will be community-based. A CHAD 
program's primary offices must be located in the access district being 
served, so that it contributes to the economic development of the 
health access zone. CHAD programs will hire people who live within the 
CHAD, and its provider network will be sensitive to the cultural and 
racial backgrounds of the people being served.
  CHAD programs will also strengthen the communities they serve by 
utilizing existing health care providers, such as community health 
centers and public hospitals. These entities have been the backbone of 
health care in medically disadvantaged communities; CHADs need to draw 
upon their expertise and make them integral parts of CHAD-provider 
networks. In addition, CHAD programs will invest in the communities 
they serve and to develop new health resources, such as school-based 
clinics, clinics in public housing and mobile screening programs.

  CHAD programs will be publicly accountable, their performance 
measured by their record in controlling costs, their members' expressed 
satisfaction, and their impact on the health status of the community. 
Each CHAD will also be subject to regular quality evaluations by 
independent evaluators.
  On a national level, outcomes and other data from all CHAD plans will 
be collected and analyzed. In this way, we can determine which 
approaches are most successful in improving health status and replicate 
them in other communities across the country.
  Finally, in order to facilitate States' ability to contract with 
health access plans, the bill exempts such plans from the so-called 75-
25 composition of enrollment rule. This rule prohibits a State from 
contracting with a managed care plan unless the plan has at least 25 
percent commercial enrollment. The 75-25 rule was intended originally 
to promote quality of care, by ensuring that a plan's Medicaid members 
would receive the same services as its private-pay members.
  The 75-25 rule, however, ignores the realities of the inner-city 
neighborhoods where most Medicaid recipients live. In those 
neighborhoods, there are not likely to be enough privately insured 
individuals for a plan to satisfy the 25 percent commercial enrollment 
requirement. Imposing the 75-25 rule on health access plans would 
therefore be counterproductive, since it would divert their energy and 
resources from the medically and economically disadvantaged communities 
they are intended to serve. Therefore, rather than attempt to achieve 
quality indirectly by means of the 75-25 rule, the bill approaches the 
issue head on by imposing rigorous quality assurance standards on 
health access plans.

  Health care is a significant factor in rebuilding inner-city 
communities. If we want to produce an employable work force, 
individuals living in these communities must be healthy and free of 
high-risk and destructive behaviors. Health care, in short, is the 
cornerstone of economic opportunity. This legislation is intended to 
erect that foundation by rebuilding the health care infrastructure in 
low-income communities, by coordinating the delivery of health care, 
and by linking health care with economic revitalization. This is an 
ambitious goal, and one which has been put off for far too long.

                          ____________________