[Congressional Record Volume 140, Number 140 (Friday, September 30, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: September 30, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
           UNITED STATES-MEXICO BORDER HEALTH COMMISSION ACT

  Mr. LEVIN. Mr. President, I ask unanimous consent that the Senate 
proceed to the consideration of calendar No. 616, S. 1225, a bill to 
authorize and encourage the President to conclude an agreement with 
Mexico to establish a United States-Mexico Border Health Commission.
  The PRESIDING OFFICER. Without objection, it is so ordered. The clerk 
will report.
  The legislative clerk read as follows:

       A bill (S. 1225) to authorize and encourage the President 
     to conclude an agreement with Mexico to establish a United 
     States-Mexico Boarder Health Commission.

  The Senate proceeded to consider the bill.


                           amendment no. 2606

            (Purpose: To provide for a substitute amendment)

  Mr. LEVIN. Mr. President, I send a substitute amendment to the desk 
on behalf of Senator Bingaman.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Michigan (Mr. Levin), for Mr. Bingaman, 
     for himself, Mr. McCain, Mr. Simon, and Mrs. Hutchison, 
     proposes an amendment numbered 2606.

  The amendment is as follows:

       Strike out all after the enacting clause and insert in lieu 
     thereof the following

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``United States-Mexico Border 
     Health Commission Act''.

     SEC. 2. ESTABLISHMENT OF BORDER HEALTH COMMISSION.

       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.

     SEC. 3. 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 implement the actions recommended by the needs 
     assessment through--
       (A) assisting in the coordination and implementation of the 
     efforts of public and private entities to prevent and resolve 
     such health problems, and
       (B) assisting in the coordination and implementation of 
     efforts of public and private entities to educate such 
     population, in a culturally competent manner, concerning such 
     health problems; 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 entity in the other country for the cost 
     of a health care service that the entity furnishes to a 
     citizen of the first country who is unable, through insurance 
     or otherwise, to pay for the service.

     SEC. 4. OTHER AUTHORIZED FUNCTIONS.

       In addition to the duties described in section 3, 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 nonprofit entities who act to 
     prevent or resolve such problems or who educate the 
     population concerning such health problems.

     SEC. 5. MEMBERSHIP.

       (a) 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:
       (1) The Secretary of Health and Human Services or the 
     Secretary's delegate.
       (2) The commissioners of health or chief health officer 
     from the States of Texas, New Mexico, Arizona, and California 
     or such commissioners' delegates.
       (3) Two individuals residing in 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 individual who have demonstrated ties to community-
     based organizations and have demonstrated interest and 
     expertise in health issues of the United States-Mexico Border 
     Area.
       (b) 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.
       (c) Compensation.--Members of the United States section of 
     the Commission who are not employees of the United States or 
     any State--
       (1) 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
       (2) 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.

     SEC. 6. REGIONAL OFFICES.

       The Commission may 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 
     chief executive officer 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.

     SEC. 7. 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.

     SEC. 8. DEFINITIONS.

       As used in this Act:
       (1) Commission.--The term ``Commission'' means the United 
     States-Mexico Border Health Commission.
       (2) 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. The 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.
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (4) 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.

  Mr. BINGAMAN. Mr. President, I am pleased that the Senate is taking 
action on S. 1225, the United States-Mexico Border Health Commission 
Act, which I introduced last year. Joining me as cosponsors of this 
bipartisan effort are the distinguished Senators from Arizona, 
Illinois, and Texas, Senators McCain, Simon, and Hutchison. We have had 
the pleasure of working on this initiative with our colleagues in the 
House, the chairman of the House Border Caucus, Representative Coleman, 
and the members of the House Border Caucus.
  Through this legislation, we can begin to lay the foundation for 
effectively addressing the serious and far-reaching border health 
challenges that face our Nation and the Republic of Mexico. Although 
this issue is particularly important to those of us living in the 
border region, it is an issue that should be of tremendous concern to 
all of us. Developing solutions will require that we work together, in 
a bipartisan and binational manner, toward common goals.
  Before discussing this legislation, I first want to commend the House 
Border Caucus, the American Medical Association, and the Texas Medical 
Association in particular for their efforts to increase awareness 
nationally about border health issues. Their commitment to develop 
long-term solutions to the many border health problems we face has been 
the key to our legislative success.
  Mr. President, I was born a short distance from the United States-
Mexico border, and I grew up in a small New Mexico town less than 90 
miles north of the border. My father still lives there--in Silver 
City--today. Over the years, I have seen the border area change and 
grow. 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 increase international trade and development. That is why I 
have been committed to the enactment of the United States-Mexico Border 
Health Commission Act.
  In October 1991, the Texas Medical Association hosted a Border Health 
Conference in McAllen, TX, which members of my staff attended. The idea 
for the legislation being acted upon today was born at that conference. 
In McAllen, a commitment was made by the medical societies of the 
border States--Texas, New Mexico, Arizona, and California--to draft 
legislation that would lay the groundwork for a high-level, binational 
Commission which would encourage coordination to protect the health and 
well-being of the residents of both countries. The Commission's key 
duty would be to develop a comprehensive, long-term plan of action. The 
plan would include goals, priorities, and methods for measuring and 
reaching those goals.
  My home State of New Mexico was still in its infancy with respect to 
border health problems and border awareness in 1991, but we knew it was 
time for action. We knew we needed to develop strategies for dealing 
with the future. We knew that if we acted quickly and rationally, our 
State could avoid many of the environmental and health problems that 
already threatened our neighboring border States.
  New Mexico--like the other border States--has grown and changed since 
the McAllen conference. Today, the need for this legislation and the 
binational Commission is greater than ever.
  In New Mexico, the border region is one of the State's fastest 
growing areas. Dona Ana County, which is our State's most populous 
border county, grew by 40 percent between 1980 and 1990. It is 
projected to grow by another 30 percent before the year 2000. But 
despite this rapid growth, or perhaps because of it, New Mexico's 
border region is one of the poorest areas of the United States. 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.
  Las Cruces, the county's largest city and the State's third largest, 
ranks as the fifth poorest city in the Nation in terms of per capita 
income. The average per capita income is less than $9,500 in Las 
Cruces, with children under the age of 18 making up 30 percent of the 
population.
  These statistics alone would force tremendous stress on the health 
care infrastructure of any region. But the residents of Las Cruces, 
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 frontline of our country's environmental and 
health problems.
  Already, 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.
  With this legislation, 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.
  The Commission we are advocating, composed of officials and experts 
from the United States and Mexico, will develop a workable binational 
plan of action. It should be a long-term plan, with clear goals and 
mechanisms for measuring progress. To further explain the Commission 
and its duties to my colleagues, I ask that a summary of the bill be 
printed in the Record at the conclusion of my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See Exhibit 1.)
  Mr. BINGAMAN. We have a lot of work ahead of us, Mr. President, but 
together, with a common plan and common goals, I am confident we can 
improve the quality of life for our border residents and for all the 
people of the United States and Mexico.

                               Exhibit 1

       Summary: United States-Mexico Border Health Commission Act

       The bill authorizes and encourages the President to enter 
     into an agreement with Mexico to establish a Binational 
     Commission on Border health. The Commission will:
       (1) conduct a needs assessment to identify, evaluate, 
     prevent, and resolve health problems affecting the border 
     population of both countries;
       (2) develop and implement an ``action plan'' for carrying 
     out the activities recommended by the needs assessment, 
     through:
       (a) helping to coordinate and implement public-private 
     efforts to prevent and resolve border health problems;
       (b) helping to coordinate and implement public-private, 
     culturally-competent border health education efforts; and
       (3) develop a reasonable method, to be recommended to the 
     governments of both countries, by which one government could 
     reimburse a provider (public or private) for providing health 
     care to a resident of the other country.
       The Commission would be authorized to:
       (1) conduct and support investigations, research, and 
     studies that will identify, study, and monitor border health 
     problems;
       (2) conduct and support a binational, public-private health 
     data collection and monitoring system for the U.S.-Mexico 
     border area; and
       (3) provide financial and technical assistance to public 
     and private efforts aimed at addressing border health 
     problems.
       Details of the U.S. section of the Commission are:
       (1) 13 members: including the Secretary of Health and Human 
     Services; the four commissioners of health for the U.S.-
     Mexico border states; two individuals residing in the border 
     area in each of the four border states who have demonstrated 
     interest or expertise in border health issues.
       (2) Regional offices: the Commission should designate or 
     establish one border health office in each of the four border 
     states to facilitate its work. These offices should be 
     coordinated with state border health offices and local 
     nonprofit organizations.
       (3) Annual Reports: the Commission will report annually on 
     its activities to the governments of both countries.
       (4) For purposes of the Commission, the border area will be 
     defined as the areas located in the U.S. and Mexico within 
     100 kilometers of the U.S.-Mexico border.

  Mrs. HUTCHINSON. Mr. President, I rise today in support of the Border 
Health Commission Act. I join my colleagues along the border to 
emphasize the growing health concerns along the United States-Mexico 
border. The Border Health Commission Act will address these problems in 
cooperation with our neighbors in Mexico.
  The president of the American Medical Association has called public 
health conditions along the United States-Mexico border a ``ticking 
time bomb.'' A binational effort to combat what have been termed 
``biblical plagues'' which flourish there is long overdue.
  In terms of public health, the border region is a Third World 
country. According to the Texas Medical Association, its residents 
suffer from a higher rate of deadly, infectious diseases than anywhere 
else in the Nation--diseases such as tuberculosis, hepatitis, 
gastrointestinal ailments, typhus, and cholera.
  According to Dr. Miguel Escobedo of the El Paso County Health 
District, the incidence of tuberculosis in border cities is twice the 
national average. In El Paso, the TB rate is 20 persons per 100,000 
residents; in communities such as Denver and Cincinnati, it is 7 per 
100,000. Moreover, Dr. Escobedo says, we are importing drug-resitant 
strains of the disease from Mexico--which has a direct impact on a 
border community's ability to provide treatment to all of those 
entitled to it.
  Public health organizations spend $1,200 to treat an uncomplicated 
case of TB. The complications involved in treating drug-resistant 
strains drives up that cost to $200,000, he says.
  Several other common border diseases are directly attributable to the 
lack of amenities most people in this country take for granted--clean 
water, sewage disposal, and electricity. A burgeoning population on 
both sides of the border has caused what Dr. Laurance Nickey, director 
of the El Paso County Health District, has called an infrastructure 
breakdown.
  In the El Paso area alone, nearly 200,000 people live in 300 colonias 
built on often illegally subdivided land. Their residents live amid 
uncontrolled sewage disposal and shallow wells, a source of 
contaminated drinking water. As a result, 30 percent of residents 
tested show evidence of hepatitis A infection.
  Public health officials have long been aware that these conditions--
in a setting which straddles two sovereign nations--must be addressed 
through a binational effort. Among the United States and Mexico, alone, 
there are 400 million border crossings annually. Establishing the 
United States-Mexico Border Commission would allow health officials of 
both countries to cooperate in tracking, preventing, and working to 
cure communicable diseases--as well as cope with other health issues 
unique to their border setting.
  The commission would also serve as an early warning system for the 
rest of the country, detecting and perhaps preventing major outbreaks 
of infectious disease--such as cholera and salmonella--which already 
are spreading beyond the border.
  As an international authority, this commission will be equipped as no 
other to devise a coordinated strategy to implement badly needed public 
health care solutions. Communicable diseases don't recognize 
international boundaries. The need for this legislation is immediate 
and imminent. Dr. Nickey recently expressed to our colleagues that if 
we do not address these issues soon, they may escalate to a point such 
that we cannot capture them.
  Mr. LEVIN. Mr. President, I ask unanimous consent that the amendment 
be agreed to; that the bill be read a third time and passed; that the 
motion to reconsider be laid upon the table; and that any statements 
thereon appear in the Record at the appropriate place as though read.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  So the bill (S. 1225) was deemed read the third time and passed, as 
amended.
  (The text of the bill will be printed in a future edition of the 
Record.)

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