[Congressional Record Volume 140, Number 57 (Wednesday, May 11, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: May 11, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                          AMENDMENTS SUBMITTED

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                          HEALTH SECURITY ACT

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                      BINGAMAN AMENDMENT NO. 1697

  (Ordered to lie on the table.)
  Mr. BINGAMAN submitted an amendment intended to be proposed by him to 
the bill (S. 1779) to ensure individual and family security through 
health care coverage for all Americans in a manner that contains the 
rate of growth in health care costs and promotes responsible health 
insurance practices, to promote choice in health care, and to ensure 
and protect the health care of all Americans; as follows:

       On page 14, line 22, add after the period the following new 
     sentence: ``An eligible health care provider shall be 
     compensated for health care services provided to an 
     undocumented alien if such services are determined by the 
     Secretary to be essential health services under subtitle I of 
     title III.''.
       On page 15, line 14, add after the period the following new 
     subsection:
       ``(d) Public Health.--Upon application by a state, in a 
     form and manner designated by the Board, the Board may make 
     eligible to obtain the comprehensive benefits package, 
     individuals described in subsections (a), (b), and (c) and 
     regulate the nature of the eligibility of such individuals, 
     to preserve the public health of communities while inhibiting 
     travel and immigration to the United States for the sole 
     purpose of obtaining health care services.''
       On page 577, between lines 8 and 9, insert the following 
     new subtitle:
                 Subtitle I--Border Health Improvement

     SEC. 3801. SHORT TITLE.

       This subtitle may be cited as the ``Border Health Act of 
     1994''.

     SEC. 3802. FINDINGS.

       Congress finds the following:
       (1) The cost of health care in the United States has 
     reached extreme proportions, accounting for \1/7\ of our 
     economy and more than 14 percent of our Nation's gross 
     domestic product. In 1992, United States health care spending 
     totaled $823,000,000,000.
       (2) It is estimated that 37,400,000 Americans are currently 
     without health insurance.
       (3) A serious and growing problem of uncompensated health 
     care exists along the international border of the United 
     States and Mexico.
       (4) Increased movement across the border of United States 
     and Mexico, rapid population growth, poverty, and the lack of 
     a health care infrastructure contribute to the severity of 
     this problem.
       (5) Recent economic changes, including the passage of the 
     North American Free Trade Agreement, will further stress this 
     region.
       (6) The Federal Government is charged with the 
     responsibility of mediating problems that arise along our 
     international borders.
       (7) The cost of care provided to undocumented individuals 
     has placed an undue burden on the hospitals, health clinics, 
     other health facilities, and providers delivering medical 
     services in the United States along the United States-Mexico 
     border.
       (8) The responsibility for funding health care services 
     provided to undocumented individuals along the United States-
     Mexico border should rest with the Federal Government. 
     Currently the disproportionate share of that burden is born 
     by States.
       (9) Without an increase in Federal security at the border, 
     and in a time of significant economic development in that 
     region, the number and cost of cases of uncompensated care 
     will not be reduced over the coming years.
       (10) Because of the excessive cost of this problem and the 
     Federal Government's responsibility to address these issues, 
     a mechanism for direct provider reimbursement of the cost of 
     care provided to undocumented individuals should be developed 
     by the Federal Government.

     SEC. 3803. PURPOSE.

       It is the purpose of this subtitle to establish a mechanism 
     through which the Secretary will reimburse health care 
     providers for specific care provided to undocumented 
     individuals along the United States-Mexico border.

     SEC. 3804. DEFINITIONS.

       As used in this subtitle:
       (1) Commission.--The term ``Commission'' means the United 
     States-Mexico Border Health Commission established under 
     section 3806.
       (2) Eligible health care provider.--The term ``eligible 
     health care provider'' means those providers delivering 
     essential health services (as defined in this section) within 
     the United States-Mexico Border Area (as defined in this 
     section).
       (3) Essential health services.--The term ``essential health 
     services'' means
       (A) emergency care (as defined under section IX of the 
     Consolidated Omnibus Budget Reconciliation Act of 1985);
       (B) public health services, including immunizations, 
     intended to prevent or treat communicable diseases; and
       (C) family planning services.
       (4) Health problem.--The term ``health problem'' means a 
     disease or medical ailment or an environmental condition that 
     poses the risk of disease or medical ailment. Such term 
     includes diseases, ailments, or risks of disease or ailment 
     caused by or related to environmental factors, control of 
     animals and rabies, control of insect and rodent vectors, 
     disposal of solid and hazardous waste, and control and 
     monitoring of air quality.
       (5) Resident alien.--The term ``resident alien'', when used 
     in reference to a country, means an alien lawfully admitted 
     for permanent residence to the United States or otherwise 
     permanently residing in the United States under color of law 
     (including residence as an asylee, refugee, or parolee).
       (6) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (7) Undocumented individual.--The terms ``undocumented 
     individual'' and ``the undocumented'' means an individual not 
     lawfully admitted for permanent residence to the United 
     States and not otherwise permanently residing in the United 
     States under color of law.
       (8) United states-mexico border area.--The term ``United 
     States-Mexico Border Area'' means the area located in the 
     United States and Mexico within 100 kilometers of the border 
     between the United States and Mexico.

     SEC. 3805. PROVIDER COMPENSATION PROGRAM.

       (a) Establishment.--The Secretary shall establish a 
     provider compensation program under which the Secretary will 
     implement a procedure for reimbursing health care providers 
     for essential health care services provided to undocumented 
     persons who are not eligible for coverage under section 1005. 
     Such a program shall include--
       (1) procedures for determinations by the Secretary that 
     health care services provided to undocumented individuals are 
     essential health services for which reimbursement under this 
     subtitle is available;
       (2) the establishment of a fee schedule with respect to 
     such reimbursements that is based on the Medicare 
     Disproportionate Share Hospital formula; and
       (3) the provision of reimbursements to health care 
     providers directly or through a contract with an 
     intermediary.
       (b) Essential Service Requirements.--
       (1) In general.--Reimbursement under this subtitle may not 
     be provided for health care services that are provided to 
     undocumented individuals if such services do not qualify as 
     essential health services.
       (2) State reimbursement.--The provision of Federal funds 
     for the purpose of providing reimbursements under this 
     subtitle shall not preclude States from providing 
     reimbursements using State resources.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this section, $600,000,000 
     for fiscal year 1995, and such sums as may be necessary for 
     each of the fiscal years 1996 through 2000.

     SEC. 3806. BORDER HEALTH COMMISSION.

       (a) Establishment.--The President is authorized and 
     encouraged to conclude an agreement with Mexico to establish 
     a binational commission to be known as the United States-
     Mexico Border Health Commission.
       (b) Duties.--It should be the duty of the Commission--
       (1) to conduct a comprehensive needs assessment in the 
     United States-Mexico Border Area for the purposes of 
     identifying, evaluating, preventing, and resolving health 
     problems and potential health problems that affect the 
     general population of the area;
       (2) to develop and implement a comprehensive plan for 
     carrying out the actions recommended by the needs assessment 
     through--
       (A) assisting in the coordination of public and private 
     efforts to prevent potential health problems and resolve 
     existing health problems,
       (B) assisting in the coordination of public and private 
     efforts to educate the population, in a culturally competent 
     manner, concerning such potential and existing health 
     problems; and
       (C) developing and implementing culturally competent 
     programs to prevent and resolve such health problems and to 
     educate the population, in a culturally competent manner, 
     concerning such health problems where a new program is 
     necessary to meet a need that is not being met through other 
     public or private efforts; and
       (3) to formulate recommendations to the Governments of the 
     United States and Mexico concerning a fair and reasonable 
     method by which the government of one country could reimburse 
     a public or private person in the other country for the cost 
     of a health care service that such person furnishes to a 
     citizen or resident alien of the first country who is unable, 
     through insurance or otherwise, to pay for the service.
       (c) Other Authorized Functions.--In addition to the duties 
     described in subsection (b), the Commission should be 
     authorized to perform the following functions as the 
     Commission determines to be appropriate--
       (1) to conduct or support investigations, research, or 
     studies designed to identify, study, and monitor, on an on-
     going basis, health problems that affect the general 
     population in the United States-Mexico Border Area;
       (2) to conduct or support a binational, public-private 
     effort to establish a comprehensive and coordinated system, 
     which uses advanced technologies to the maximum extent 
     possible, for gathering health-related data and monitoring 
     health problems in the United States-Mexico Border Area; and
       (3) to provide financial, technical, or administrative 
     assistance to public or private persons who act to prevent or 
     resolve such problems or who educate the population 
     concerning such health problems.
       (d) Membership.--
       (1) Number and appointment of united states section.--The 
     United States section of the Commission should be composed of 
     13 members. The section should consist of the following 
     members:
       (A) The Secretary of Health and Human Services or the 
     Secretary's delegate.
       (B) The commissioners of health or chief health officer 
     from the States of Texas, New Mexico, Arizona, and California 
     or such commissioners' delegates.
       (C) Two individuals residing in the United States-Mexico 
     Border Area in each of the States of Texas, New Mexico, 
     Arizona, and California who are nominated by the chief 
     executive officer of the respective States and appointed by 
     the President from among individuals--
       (i) who have a demonstrated interest or expertise in health 
     issues of the United States-Mexico Border Area; and
       (ii) whose name appears on a list of 6 nominees submitted 
     to the President by the chief executive officer of the State 
     where the nominees resides.
       (2) Commissioner.--The Commissioner of the United States 
     section of the Commission should be the Secretary of Health 
     and Human Services or such individual's delegate to the 
     Commission. The Commissioner should be the leader of the 
     section.
       (3) Compensation.--Members of the United States section of 
     the Commission who are not employees of the United States--
       (A) shall each receive compensation at a rate of not to 
     exceed the daily equivalent of the annual rate of basic pay 
     payable for positions at GS-15 of the General Schedule under 
     section 5332 of title 5, United States Code, for each day 
     such member is engaged in the actual performance of the 
     duties of the Commission; and
       (B) shall be allowed travel expenses, including per diem in 
     lieu of subsistence at rates authorized for employees of 
     agencies under subchapter I of chapter 57 of title 5, United 
     States Code, while away from their homes or regular places of 
     business in the performance of services of the Commission.
       (e) Regional Offices.--The Commission should designate or 
     establish one border health office in each of the States of 
     Texas, New Mexico, Arizona, and California. Such office 
     should be located within the United States-Mexico Border 
     Area, and should be coordinated with--
       (1) State border health offices; and
       (2) local nonprofit organizations designated by the State's 
     governor and directly involved in border health issues.

     If feasible to avoid duplicative efforts, the Commission 
     offices should be located in existing State or local 
     nonprofit offices. The Commission should provide adequate 
     compensation for cooperative efforts and resources.
       (f) Reports.--Not later than February 1 of each year that 
     occurs more than 1 year after the date of the establishment 
     of the Commission, the Commission should submit an annual 
     report to both the United States Government and the 
     Government of Mexico regarding all activities of the 
     Commission during the preceding calendar year.
       (g) Authorization of Appropriations.--There are authorized 
     to be appropriated for payment of the United States share of 
     the expenses of the Commission, such sums as may be 
     necessary.

 Mr. BINGAMAN. Mr. President, last fall, President Clinton set 
forth several specific goals for the Nation when he presented the 
Health Security Act. Over the past several months, three goals have 
emerged as the most important: universal health coverage for all 
Americans; cost containment; and quality health care. Very shortly, the 
members of the Senate Labor and Human Resources Committee, of which I 
am a member, will be discussing these goals in great detail.
  Today, I would like to focus the attention of my colleagues on one 
specific aspect of comprehensive health care reform: the very serious 
and growing health problems being experienced along our international 
border with Mexico. This is an issue of tremendous concern to me, as a 
New Mexican, but it should be of concern to all of us. Developing 
solutions will require that we work together, in a bipartisan and 
binational manner, toward common goals.
  I was born a short distance from the United States-Mexico border, and 
I grew up in Silver City, a small New Mexico town less than 90 miles 
north of the border. My father still lives there today.
  Over the years, I have seen the border area change and grow. The 
over-developed environments of the Texas, Arizona, and California 
borders have been seriously degraded by water and air pollution from 
unregulated industries, widespread lack of sanitation facilities, toxic 
waste and other ground contaminants, and rapidly growing populations. 
Today, the threats these hazards pose are spreading. No longer are 
these problems exclusive to a geographic region or a State. Disease and 
death do not know political boundaries. They threaten all of us, 
Americans and Mexicans alike.
  I have seen the problems first-hand, and I know we face an enormous 
task. I also know that our task will grow in urgency and importance as 
the United States and Mexico continue to open their borders and the 
NAFTA agreement is implemented. For these reasons, I am committed to 
seeing that this amendment is part of the Senate's health care reform 
effort.
  New Mexico's border region is one of the State's fastest growing 
areas. Dona Ana County, our State's most populous border county, grew 
by 40 percent between 1980 and 1990. It is projected to grow another 30 
percent before the year 2000. Despite this rapid growth, or perhaps 
because of it, New Mexico's border region is one of the poorest areas 
of the State and the Nation. Dona Ana County has been ranked as the 
10th poorest county in the Nation, in terms of per capita income. Of 
the county's total population, 56 percent are Hispanic. More than one-
third of them live below the poverty line.
  These statistics alone would force tremendous stress on the health 
care infrastructure of any region. But the residents of Dona Ana County 
and the rest of New Mexico face another serious challenge: they, along 
with the people of Texas, Arizona, and California, are on the front 
line of our country's environmental and health problems. Local 
hospitals and health clinics are being crippled by the burden of 
uncompensated health service delivery to undocumented people who reside 
illegally in the United States or cross the border to receive health 
care.
  The amendment I am filling today places the financial responsibility 
for providing care to undocumented immigrants in border regions where 
it rightfully should be, with the Federal Government, rather than the 
States. It also incorporates the concept of a binational Border Health 
Commission, which I introduced as S. 1229 last summer.
  Through this amendment, the Secretary of Health and Human Services 
would be required to establish a provider compensation program to 
reimburse providers for essential health services they provided to 
undocumented individuals. These services include: emergency care, as 
defined under title X of COBRA 1985; public health services intended to 
prevent or treat communicable disease; and family planning services. 
The Secretary would establish fee schedules for these services, based 
on the Medicare disproportionate share hospital formula, and develop a 
method for providing payment.
  In conjunction with the Federal compensation program, a Border Health 
Commission would be established through this amendment. The concept for 
the commission grew out of a 1991 border health conference sponsored by 
the Texas Medical Association. At that time, the medical societies of 
the border States--Texas, New Mexico, Arizona, and California--made a 
commitment to draft legislation that would lay the groundwork for a 
high-level, Binational Commission, which would work in coordination to 
protect the health and well-being of the residents of both countries.
  In July 1993, Representative Ron Coleman introduced the Border Health 
Commission Act in the House of Representatives. At the same time, I, 
along with Senators McCain, and Simon, introduced S. 1225, the Border 
Health Commission Act, making the commitment of the border area medical 
associations a reality. I remain committed to the concept of the 
Commission and, as I stated earlier, have included those provisions in 
this amendment today. The Commission's key duty would be to develop a 
comprehensive long-term plan of action to target the border health 
problem.
  Mr. President, with this amendment, we have the opportunity to assess 
our border problems in the proper framework. We also have the 
opportunity in New Mexico to create a model for developing 
comprehensive solutions to these serious binational problems. We have a 
lot of work ahead of us, but together, with a common plan and common 
goals, I believe we can make great strides in addressing the health 
problems of our Nation's southern border.

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