[Congressional Record Volume 140, Number 145 (Friday, October 7, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: October 7, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
 CONFERENCE REPORT ON S. 1569, MINORITY HEALTH IMPROVEMENT ACT OF 1994

  Mr. WAXMAN. Mr. Speaker, pursuant to House Resolution 574, I call up 
the conference report on the Senate bill (S. 1569) to amend the Public 
Health Service Act to establish, reauthorize and revise provisions to 
improve the health of individuals from disadvantaged backgrounds, and 
for other purposes.
  The Clerk read the title of the Senate bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 574, the 
conference report is considered as having been read.
  (For conference report and statement, see proceedings of the House of 
Thursday, October 6, 1994, at page H 11037.)
  The SPEAKER pro tempore. The gentleman from California [Mr. Waxman] 
will be recognized for 30 minutes, and the gentleman from Virginia [Mr. 
Bliley] will be recognized for 30 minutes.
  The Chair recognizes the gentleman from California [Mr. Waxman].
  Mr. WAXMAN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am pleased to present the conference report on S. 
1569, the Minority Health Improvement Act of 1994. This report 
represents the culmination of months of hard work and compromise by 
Members and staff to create legislation that reflected the spirit of 
both the House and Senate bills.
  The conference agreement honors two Americans--Cesar Chavez and 
Thurgood Marshall--through the establishment of health professions 
scholarship programs in their name. These programs will provide an 
enduring legacy for their work in the cause of civil rights by 
providing hundreds of young Americans the opportunity to attend health 
professions schools and to work in medically underserved areas.
  The agreement underscores the Congress' commitment to increasing the 
numbers of disadvantaged students in the health professions through the 
establishment of new academic consortia. These consortia will promote 
the recruitment and enrollment of students by placing greater emphasis 
upon stimulating the interest of younger children in the health 
sciences. If we are to increase the enrollment of African-American, 
Hispanic, American Indian and Asian students as physicians, dentists, 
nurses, and mental health providers, we must devote increased resources 
at the secondary and college level.
  Mr. Speaker, the success of this agreement would not have been 
possible without the critical participation of Members representing the 
Hispanic and Black Caucuses. The result is a series of reforms that 
will achieve a genuine and quantifiable improvement in the availability 
of programs and health services targeted toward minority and other 
disadvantaged communities. The reforms reflected in this agreement 
address what we understand are the most critical needs of minority 
communities today: improving health status by increasing access to 
primary and preventive health care.
  Mr. Speaker, allow me to briefly summarize three of the most 
important provisions.
  First, establishment of two scholarship programs that will provide 
tuition assistance to students in exchange for a service commitment 
among a medically underserved population. The agreement offers hundreds 
of disadvantaged students who desire a health professions career the 
opportunity to attend school without the fear of insurmountable debt. 
It allows talented students the ability to attend the school of their 
choice and the financial freedom to practice in disadvantaged 
communities.
  Second, reauthorization of the Nation's community, migrant and 
homeless health care centers. These centers provide invaluable services 
to millions who lack access to basic primary and preventive health 
care.
  Third, reauthorization of the Healthy Start Program which is designed 
to reduce infant mortality in communities with high rates.
  Mr. Speaker, we know that discretionary funding next year is under 
severe budgetary caps. Common sense dictates that in times of fiscal 
austerity, we must prioritize federal programs to address the most 
pressing needs. The reforms contained in the conference agreement will 
help increase access to health services and target limited Federal 
funding to those individuals and communities in greatest need.
  I would like to thank all my colleagues on the conference committee 
for working so cooperatively to achieve these important reforms. The 
conference report was approved unanimously by all Members--House and 
Senate.
  I want to single out the contributions of several Members who deserve 
special praise for their concern and commitment to improving the health 
status of minority populations. Bill Richardson and the Members of the 
Hispanic Caucus have been strong supporters of efforts to improve the 
health status of minority populations. With their assistance we have 
incorporated strong provisions to strengthen the Centers of Excellence 
Program and assure the collection of accurate health status data used 
in identifying medically underserved communities.
  Ed Towns and the dean of the Black Caucus, Louis Stokes, worked 
tirelessly to strengthen the conference agreement and expand 
opportunities for talented students to enter a health professions 
career. When the hundreds of students who will benefit from this bill 
complete their education, the communities in which they serve will owe 
an important debt to the efforts of these valued colleagues.
  Finally, I want to thank our Republican conferees, particularly the 
gentleman from Virginia [Mr. Bliley], who were so helpful in 
facilitating this agreement. They are all strongly committed to the 
objectives of these programs and it has been an honor to work with 
them.
  Mr. Speaker, I urge support for the conference report. Members can 
take great pride in the ideals and objectives embodied in this 
important legislation. I urge support for the legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BLILEY. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. BLILEY asked and was given permission to revise and extend his 
remarks.)
  Mr. BLILEY. Mr. Speaker, this conference agreement largely reflects 
the House-passed bill with several amendments that improve on that 
legislation.
  First, the conference agreement provides that 30 percent of the funds 
appropriated for scholarships can be awarded to students who have not 
declared a medical specialty. This compromise provides much more 
flexibility for students who under the House-passed bill would have 
been required to choose primary care upon entering medical school. The 
conference agreement also provides that in return for scholarship funds 
students who enter primary care must serve in a health professions 
shortage area for each year of funds received and students who select a 
specialty field incur a two-for-one service requirement. By making 
these changes all students who receive Federal scholarship funds will 
now receive full tuition and incur a service requirement.
  I am also pleased that the conference agreement eases the new 
matching requirements imposed by the House bill on health careers 
opportunities programs. These are programs which recruit and help 
retain disadvantaged minority students in health professions programs. 
The conference agreement caps the matching requirements for these 
programs at 50 percent. Under the House bill these programs were 
ultimately required to fully fund their programs. We received letters 
from nearly every program across the country expressing their concern 
about this provision.
  In addition to reauthorizing the health professions programs the 
conference agreement codifies in law the Healthy Start Program which 
was initiated by the Bush administration to prevent infant mortality. 
It also reauthorizes the Community and Migrant Health Centers Programs. 
All of the programs included in this conference report are intended to 
improve the health of individuals who live in areas where there is a 
shortage of health care providers or severe access barriers to health 
care services.
  I urge my colleagues to join me in supporting the conference report 
on S. 1569.
  Mr. Speaker, I would like to commend the gentleman from California 
[Mr. Waxman], the chairman of the Subcommittee on Health and the 
Environment; the gentleman from Michigan [Mr. Dingell], the chairman of 
the full committee; and my colleague, the gentleman from California 
[Mr. Moorhead], the ranking Member, for their working in turning out 
this bill and conference report.
  With that, Mr. Speaker, I reserve the balance of my time.
  Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Colorado [Mrs. Schroeder].
  (Mrs. SCHROEDER asked and was given permission to revise and extend 
her remarks.)
  Mrs. SCHROEDER. Mr. Speaker, I thank the gentleman from California 
for yielding me the time.
  Mr. Speaker, I compliment the gentleman and his committee for 
reporting this Minority Health Improvement Act. The Congresswomen's 
Caucus certainly supports this and supports it fully. I was very 
pleased that there is also a women's health provision in here because 
we know how difficult all of this has been in making our whole health 
community much more sensitive to the diversity in America.
  Mr. Speaker, my colleagues who were horrified by the CNN Program on 
female genital mutilation (FGM) in Egypt, or heard from their 
constituents about it, should support the Minority Health Improvement 
Act. This bill does something about it.
  FGM is a traditional practice that involves the cutting off of all or 
part of the female genitalia. There is no comparison to male 
circumcision. Over 100 million girls and women in the world have 
undergone some form of FGM. While the CNN piece focused on FGM in 
Egypt, I have received reports that FGM is happening in the U.S.
  The Minority Health Improvement Act meets this damaging tradition 
head on. It requires the Office of women's Health and the Office of 
Minority Health to:
  First, collect data on the number of women and girls living in the 
United States who have experienced some form of FGM.
  Second, identify communities in the United States that traditionally 
practice FGM, and design and carry out outreach activities to educate 
individuals in the communities on the physical and psychological health 
effects of such practice.
  Third, develop recommendations for the education of students of 
schools of medicine and osteopathic medicine regarding female genital 
mutilation, and complications arising from such practices; and 
disseminate the recommendations.
  The Minority Health Improvement Act gives our doctors and social 
workers the information they need to treat the special health needs of 
women who have undergone FGM, and to start the education necessary to 
eradicate FGM in the United States.

                              {time}  1710

  Mr. BLILEY. Mr. Speaker, it gives me pleasure to yield as much time 
as he may consume to the gentleman from California [Mr. Moorhead], the 
ranking minority member of the full committee.
  Mr. MOORHEAD. Mr. Speaker, I rise in support of H.R. 3869. The 
conference report reauthorizes a number of expiring programs in the 
Public Health Service Act. The purpose of many of these programs is to 
improve the health of individuals who are members of minority groups 
through the provision of health care services and by increasing the 
number of minorities who enter the health professions. The bill: (1) 
reauthorizes the office of minority health; (2) consolidates three 
scholarship and loan programs for disadvantaged students and imposes a 
service requirement on students who receive scholarships; (3) 
reauthorizes the migrant and community health centers programs; (4) 
reauthorizes the health care for the homeless program; and (5) 
reauthorizes the state offices of rural health.
  Mr. Speaker, I am especially pleased that this bill reauthorizes the 
Community Health Centers Program. These centers provide comprehensive, 
high-quality, primary health care to populations living in medically 
underserved areas.
  Community health centers are located in areas throughout the country 
where there are financially, geographic, or cultural barriers to 
primary health care. In many communities, these centers are the sole 
providers of care. Currently, Community Health Centers (CHCs) serve 
large proportions of poor and minority people. Sixty percent of C-H-C 
users are below the poverty level, 29 percent are between 100 and 200 
percent of poverty and 11 percent are above 200 percent of poverty. In 
fiscal year 1992, 44 percent of individuals receiving services were 
children from newborn to 19 years of age.
  I also support the consolidation and modification of the existing 
health professions scholarship programs. The conference report 
specifies that scholarships are for the full tuition at a health 
professions school and in return for this money students are required 
to serve in a health professions shortage area upon graduation. In this 
manner this bill not only increases the number of disadvantaged 
minorities who can attend health professions school but improves the 
access to health care for underserved areas.
  Mr. Speaker, the Senate receded to the House language in Section 807 
of title VIII. The House amendment to section 340B creates narrow 
exemptions from current law eligibility requirements for purchases of 
covered outpatient drugs by certain entities identified pursuant to the 
amendments. It is my understanding that it is the intent of the 
conferees that eligibility for government-mandated price reductions 
under these amendments is available only to entities that fall within 
these categories as of the date of enactment of this provision. It is 
these entities, and only these entities, that have made the case to the 
Congress to qualify for the exemption.
  Any subsequent business arrangement or government actions that may 
make the terms of subparagraph (L) as modified or new subparagraph (M) 
appear to be applicable to entities in addition to those eligible as of 
the date of enactment, should not be construed as extending eligibility 
for government-mandated pharmaceutical prices under section 340B to 
such additional entities.
  For example, the conferees found that hospitals meeting the 
requirement of 340B(a)(4)(L)(i) and (ii) in Los Angeles County and 
currently purchasing through the Health Services Purchasing Group under 
the control of Los Angeles County warranted this narrow exemption. It 
is not the intent of the conferees to cover entities that may begin 
purchasing through the L.A. County purchasing group after date of 
enactment.
  Mr. Speaker, I urge my colleagues to join me in supporting the 
conference report on S. 1569
  Mr. WAXMAN. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Texas [Mr. Coleman].
  (Mr. COLEMAN asked and was given permission to revise and extend his 
remarks.)
  Mr. COLEMAN. Mr. Speaker, I rise in strong support of S. 1569.
  I rise in strong support of the conference report for S. 1569, the 
Minority Health Improvement Act of 1994. I applaud the leadership of 
Chairman Dingell and Congressman Waxman for bringing this vital 
initiative to the floor.
  This bill includes the authorization of a cooperative regional 
environmental laboratory to supplement the existing public health 
laboratories of the border States. A recent incidental discovery of 
highly toxic fish in the Rio Granda exemplished the need for additional 
laboratory capacity, because our current labs are stretched beyond 
capacity and are unable to detect a number of these potential health 
threats.
  This report includes the reauthorization of a host of important 
health initiatives, such as migrant and community health centers, as 
well as the creation of a new comprehensive scholarship program. These 
scholarships are aimed at minority and disadvantaged medical students 
choosing to go into primary care. This bill will also reserve one-third 
of medical scholarships for undecided students that may decide to go 
into specialty areas.
  These scholarships will provide stipends and fully fund students' 
medical education in exchange for service obligations in medically 
underserved communities. This will complement the existing National 
Health Service Corps Program, which has only been able to provide 
assistance to 2 out of every 10 applicants due to funding limitations. 
This change will result in scholarship recipients getting full funding 
for their education versus the current $200 to several thousand dollar 
range that had been awarded.
  This minority health bill also includes the reauthorization and 
improvements in the Health Careers Opportunity Program [H-COP], which 
provides grants to public, nonprofit entities, health profession, or 
training programs to promote science and math education in high schools 
to encourage students from disadvantaged background to go into health 
professions. This program has been redesigned to focus on making 
linkages between health profession programs and elementary and 
secondary schools, including border areas, rather than focusing on 
remedial math and science classes. The hope is to expose minority 
children to community-based health clinics via internships, in addition 
to the academic experience they will receive.
  These are only a few examples of the initiatives in this bill. These 
programs are very important for my district in El Paso, where we have a 
shortage of primary care providers and a great number individuals that 
stand to benefit from this bill.
  Mr. WAXMAN. Mr. Speaker, I yield 3 minutes to the gentleman form New 
York [Mr. Towns], a very important member of our subcommittee and one 
of the coauthors of the legislation.
  Mr. TOWNS. Mr. Speaker, let me begin by first congratulating and 
thanking Chairman Waxman, chairman of the subcommittee, and the ranking 
member of the committee, the gentleman from Virginia [Mr. Bliley], and 
of course the gentleman from Ohio [Mr. Stokes], who has been involved 
in this issue down through the years.
  Mr. Speaker, I rise in support of S. 1569, the Disadvantaged and 
Minority Health bill. This legislation is a compromise that reflects 
the concerns of all minority groups. The gross underrepresentation of 
minorities across all medical specialties dictates that scholarship 
opportunities be made available to all students. That is why I am 
particularly gratified that the scholarship provisions contain a 30 
percent setaside for students who do not elect a primary care 
specialty.
  The changes in the Office of Minority Health language will result in 
a more effective use of that office's resources as well as ensuring 
that all groups benefit from the programs. Finally, I am pleased that 
we upgraded the Office of Civil Rights at the Department of Health and 
Human Services. Unfortunately, the office has a backlog of complaints 
and lapses between the filing of a complaint and the final internal 
administrative resolution of a complaint. It is our hope that the 
elevation of the position of Director of Civil Rights to the rank of 
Assistant Secretary will assist in reducing the backlog and the 
processing time for complaints filed with the office.
  Mr. Speaker, in conclusion, we have crafted a bill that is fair to 
all parties. I would urge my colleagues to adopt the conference report.
  Again, I thank the ranking member, the gentleman from Virginia [Mr. 
Bliley], the chairman of the subcommittee, the gentleman from 
California [Mr. Waxman], and all of the staff on both sides of the 
aisle for the outstanding job they have done.
  Mr. WAXMAN. Mr. Speaker, I yield 3 minutes to the gentleman from Ohio 
[Mr. Stokes], the dean of the Black Caucus.
  (Mr. STOKES asked and was given permission to revise and extend his 
remarks.)
  Mr. STOKES. Mr. Speaker, I rise in support of the Minority Health 
Improvement Act, S. 1569. I want to begin by commending the 
distinguished chairman of the House Subcommittee on Health and the 
Environment [Mr. Waxman] for bringing this conference report to the 
floor. There have been a number of complicated issues related to this 
legislation. I want to especially note his work with both the 
congressional Hispanic Caucus and the Congressional Black Caucus in 
working out the concerns of both groups.
  I also want to express my appreciation to both Mr. Jose Serrano, 
chairman of the congressional Hispanic Caucus, and Mr. Luis Gutierrez, 
chairman of the congressional Hispanic Caucus health task force, for 
the excellent cooperation that I have had with them as chairman of the 
Congressional Black Caucus health braintrust.
  One of the stickiest areas of this bill involved the whole issue of 
primary health care. While the bill emphasizes primary care training, 
it does include some support to allow students to train in nonprimary 
care fields as well. The bill also includes support for the 
establishment of Offices of Minority Health at the Centers for Disease 
Control and other health related agencies.
  Mr. Speaker, the health crisis facing the minority population must be 
elevated on the Nation's health agenda. Until then, the minority health 
disparity gap will continue to widen. To effectively address this 
national crisis, the number of minority health professionals must be 
increased. Currently, African Americans constitute only 3.7 percent of 
the Nation's physicians, and Hispanics represent only 5.5 percent of 
the Nation's physicians. This low representation is reflective of the 
minority health crisis. Let me take a moment to share just a few of the 
startling statistics with regard to African Americans.

  The infant mortality rate for African Americans is more than twice 
the rate for whites.
  Both cancer incidence and mortality rates are higher for African 
Americans than for whites.
  The life expectancy for white males is 8.2 years longer than for 
African-American males.
  AIDS, HIV infection is now the 6th leading cause of death for African 
Americans while it is the 10th for whites.
  To begin to address the crisis, for the Office of Minority Health, 
the bill includes an authorization level of $25 million and $28 million 
for fiscal years 1996 and 1997 respectively. For the Centers of 
Excellence, the bill includes an authorization level of $28 million and 
$33 million respectively. For primary care scholarships, the bill 
includes an authorization level of $38 million and $48 million for 
fiscal years 1996 and 1997 respectively. These authorization levels 
will allow the Nation to begin to address the crisis in minority 
health.
  Mr. Speaker, as a nation and as a Congress, we must increase our 
commitment to resolving the crisis in minority health. S. 1569 is a 
beginning, however, much more needs to be done to reduce the drastic 
underrepresentation of minorities in all the health professions.
  Again, I commend Chairman Waxman for his efforts in bringing this 
important legislation to the floor. I look forward to working with him 
in the next Congress in implementing and improving this legislation. 
Minority health must be on the front burner as this Nation seeks to 
improve the quality of life for all Americans.

                              {time}  1720

  Mr. WAXMAN. Mr. Speaker, I yield 3 minutes to the gentleman from 
California [Mr. Mineta].
  (Mr. MINETA asked and was given permission to revise and extend his 
remarks.)
  Mr. MINETA. Mr. Speaker, I rise today in strong support of the 
conference report on S. 1569, the Disadvantaged Minority Health 
Improvement Act Reauthorization.
  I would first like to salute the gentleman from California, Mr. 
Waxman, the gentleman from New York, Mr. Serrano, the Chair of the 
Congressional Hispanic Caucus, and the gentleman from Ohio, Mr. Stokes, 
who has represented the Congressional Black Caucus in the negotiations 
which have brought this conference report to the floor.
  Each of these Members, and their staffs, have shown an extraordinary 
commitment to the goal of improving the work of the Department of 
Health and Human Services and its agencies in addressing the needs of 
this Nation's minority populations. I believe that we all owe them a 
debt of gratitude for their dedication.
  I would particularly like to acknowledge the work of Julia Fortier of 
the staff of the Subcommittee on Health and the Environment. Her 
commitment to, and understanding of, the issues facing Asian Pacific 
Americans around this country has been extraordinary and is deeply 
appreciated.
  I am proud to support this conference report, as I supported the 
earlier House passage of the bill. As Chair of the Congressional Asian 
Pacific American Caucus, I would like to draw particular attention to 
the provisions of S. 1569 which are of great concern to the Asian 
Pacific American communities.
  First, S. 1569 restates the commitment made by the Congress in 1990, 
that the necessity of linguistically and culturally appropriate care 
must be a priority within the Office of Minority Health at the 
Department of Health and Human Services.
  Unfortunately, OMH chose to ignore the directions of the Congress and 
the requirements of the law, and for 3 years refused to implement the 
bilingual grants program. With the restatement by the conference report 
before us today that clearly earmarks $3 million of the agency's budget 
for that purpose, they hopefully will not ignore it further.
  Second, the conference report reauthorizes the special research 
grants program at the National Center for Health Statistics. Since the 
passage of the Disadvantaged Minority Health Improvement Act in 1990, 
NCHS has been using this program as a means to measure the health 
status of ethnic minority groups too small to be picked up by their 
normal surveys. The resulting data are already providing important 
results for the smaller Asian and Pacific Islander communities--
particularly Southeast Asian refugees.
  The bill would also resolve a long-standing difficulty which the 
Asian Pacific American community has had with the operation of the 
Community and Migrant Health Centers Program. Current law is ambiguous 
about the ability of the Secretary of Health and Human Services to 
approve the funding of a community health center within the same 
geographic area as an existing center.
  This has had a devastating effect on efforts around the country by 
Asian Pacific American community organizations to establish community 
health centers responsive to our community's needs.
  Existing centers often have well-established patient caseloads, and 
are severely underfunded. Expansion of their existing programs to 
accommodate services in three, four, or five Asian languages is 
something which may not be in the reach of their current resources.
  Asian Pacific American health advocates have therefore been faced 
with an impossible choice: to fight existing centers doing outstanding 
work in the African-American and Latino communities, or simply do 
without access to the Community Health Centers Program. Neither one of 
those options is acceptable, and the language contained in this 
conference report will remove this ongoing difficulty.
  The conference agreement also accepts language adopted in the other 
body elevating the position of Director of the Office of Civil Rights 
at the Department of Health and Human Services to an Assistant 
Secretary of Civil Rights.
  Mr. Speaker, the problem of discrimination in our Nation's health 
care system is a major one. It seems to me that, in order to show the 
proper level of concern for this issue, and to give the occupant of 
this office the necessary clout to deal with this problem, the 
elevation of the Civil Rights Division at Health and Human Services to 
the Assistant Secretary level is crucial.
  The conference report would create a Minority Health Advisory 
Committee at the Department of Health and Human Services, in order to 
ensure that the Department no longer ignores the needs of racial and 
ethnic minority communities. It is my hope that this Advisory Committee 
can heal long-standing divisions between the Department of Health and 
Human Services and the communities the Department was intended to 
serve.
  The conference report will also extend and reauthorize two crucial 
programs: The Native Hawaiian Health Care Program and the Health 
Services for Pacific Islanders Program.
  Finally, the conference agreement accepts language adopted in the 
Senate requiring the Office of Civil Rights the Department of Health 
and Human Services to issue regulations establishing standards for 
linguistically appropriate care. While these regulations have 
technically been required since a Supreme Court decision in the late 
1970's, they have not yet been issued. This conference agreement 
clearly demonstrates that the Congress considers these regulations a 
priority, and would require their issuance within 180 days of the 
President signing this bill into law.
  In closing, Mr. Speaker, this conference agreement will restate this 
Congress' commitment to ensuring that health care programs within the 
Federal Government are fully responsive to the needs of racial and 
ethnic minority populations. I urge my colleagues to join me in 
approving it.
  Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
the District of Columbia [Ms. Norton].
  Ms. NORTON. Mr. Speaker, I rise to thank the chairman, the gentleman 
from California [Mr. Waxman], and the ranking member, the gentleman 
from Virginia [Mr. Bliley], for their hard work on the Minority Health 
Improvement Act. Their work assuages some of my disappointment that we 
were not able to enact full-fledged health care this year. With this 
act we at least continue to work to alleviate some of the problems of 
those who have the least access, as with people of color, and those who 
have been often overlooked, as with many women who have neglected 
health problems.
  The Office of Minority Health, I know, will reach to some of the 
places where health care simply does not exist, especially in rural 
areas and in public housing. The increase in scholarships to health 
professionals, in particular, means that the people most inclined to 
carry their skills back to where they are most needed will be favored 
with these scholarships.
  I am particularly delighted at the establishment of an Office of 
Women's Health now to match the Office of Minority Health. Only through 
such an office can we get to such troublesome issues as the study 
needed on female genital mutilation in the United States, a practice 
which we simply must not allow to grow here.
  The new office, of course, will yield some of the advocacy that came 
almost exclusively from our own Women's Caucus.
  I thank both gentlemen for their hard work on this very important 
bill.
  Mr. WAXMAN. Mr. Speaker, I yield 3 minutes to the gentleman from New 
York [Mr. Serrano].
  Mr. SERRANO. Mr. Speaker, as chairman of the Congressional Hispanic 
Caucus, I rise in strong support of the conference report accompanying 
S. 1569, the Minority Health Improvement Act of 1994. I strongly 
commend Chairman Waxman, the drafter of the House counterpart, H.R. 
3869, and Representative Bill Richardson, who was a conferee, for their 
continued leadership in moving this legislation forward.
  The legislation includes measures sponsored by the Hispanic Caucus in 
H.R. 3230. I introduced H.R. 3230 on behalf of the Hispanic Caucus last 
year to improve the health opportunities and outcomes of Latinos and 
other underserved communities. The enactment of the original Minority 
Health Improvement Act of 1990 was historic because it brought the 
health concerns of ethnic and racial minority communities to the 
forefront of Federal health policy. The bill before us today improves 
that bill and makes great strides toward assuring that Federal health 
programs better serve Latinos and other disadvantaged persons.
  Regardless of what some may say, there is a massive health care 
crisis. The Latino experience demonstrates that many hard working 
Americans are left behind by the current health insurance structure. 
Nearly half of Latinos at some point during the past year lacked health 
insurance. Yet 80 percent of uninsured Latinos are fully employed.
  Indeed, receiving timely and adequate health care is the exception 
rather than the rule for many underserved communities. Latinos in both 
urban and rural settings face severely limited health care options 
because there are too few providers and health care facilities are 
overcrowded. Studies of Latino communities in New York City, like the 
one I represent, reveal that existing health care providers can only 
meet 50 percent of the residents' needs for primary health care visits. 
Many Latino communities on the United States-Mexico border do not have 
a single doctor.
  Mr. Speaker, the bill before us today is an important step toward 
improving the health of underserved communities. However, in light of 
the great barriers faced by Latinos and other hard working Americans, 
broad changes are needed. We need universal health insurance.
  But, that is not the purpose of the bill before us now. The Minority 
Health Improvement Act is an excellent, let me repeat, excellent, step 
toward addressing the needs of Latinos and other underserved 
communities. I would like to detail for the record the numerous reforms 
proposed by this bill.
  Indeed, measures included in this bill will enhance the 
responsiveness of Federal programs in meeting the needs of Latino and 
other underserved communities. S. 1569, as worked out in Conference, 
places renewed emphasis on attempting to equitably balance the needs of 
all groups served. It improves and strengthens the health care capacity 
of community-based facilities, includes programs to help minority 
students enter in health professions, and improves research on the 
health status of ethnic minorities.
  This legislation reauthorizes the program of community and migrant 
health centers, which are badly needed in Latino communities. In 
addition, with the introduction of this legislation, the way community 
and migrant health center grants are allocated will now be more 
sensitive to the access needs of Latinos. I, and the Hispanic Caucus, 
strongly support the modifications made to the Medically Underserved 
Area [MUA] designation contained in the bill. The age and infant 
morbidity factors contained in existing MUA criteria, which target 
community and migrant health center grants, discriminate against 
Hispanics. S. 1569 modifies the criteria to include factors indicative 
of health status, availability of residents to pay, and other barriers 
to access. Report language specifies that lack of health insurance may 
be considered under the availability of residents to pay criteria. 
Latinos are the single group most likely to lack health insurance 
coverage.
  We are in strong support of provisions included in the bill to 
improve and increase services for limited-English-proficient persons so 
that care is provided in an appropriate language and cultural context.
  This legislation also improves programs that give access to Latino 
and other minority students to health professions schools. We welcome 
the renewed emphasis on attempting to equitably balance the needs of 
all groups served. Measures are included to improve the low 
participation rates of institutions who serve Latinos in the Health 
Careers Opportunities Program [H-COP]. H-COP is a pipeline program to 
increase the number of minority health professionals, will allow for 
more to participate in the program.
  Many Latino medical students who want to return to their underserved 
communities to practice complain that they are having problems choosing 
primary care as a health professional option because of the huge debt 
they must incur. This legislation includes scholarships for minority 
students interested in working in underserved communities, like those 
in New York City and along the U.S.-Mexico border, to choose a primary 
care specialty for career interest rather than not having it as an 
option because of economic reasons.
  I hope that Congress will return next year to finish the job begun by 
today's important legislation.
  I urge my colleagues to vote aye.


                             general leave

  Mr. WAXMAN. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks on 
the conference report on S. 1569, now under consideration.
  The SPEAKER pro tempore (Mr. Gonzalez). Is there objection to the 
request of the gentleman from California?
  There was no objection.
  Mrs. LOWEY. Mr. Speaker, I rise in strong support of the conference 
report on the Minority Health Improvement Act, S. 1569.
  The Minority Health Improvement Act contains important provisions to 
ensure equitable treatment of minorities and women under our health 
system.
  The provisions in the conference report on women's health, known as 
the Women's Health Equity Act, will improve the treatment and health of 
women across the Nation. My colleagues will describe many of the 
provisions in the women's health equity title--all of which will 
contribute to better treatment of women's health issues. But I will 
take just a moment to highlight provisions, which I sponsored, to 
improve the attention given to women's health needs in medical school 
curricula.
  Women have unique health needs. But traditional medical education 
uses men as the standard for research, surgical training, and diagnosis 
of disease. Traditional medical education, therefore, has failed 
American women by not adequately addressing their unique health needs. 
Inadequate focus by medical schools on the unique health issues women 
confront leads to misdiagnosis of women's health problems, increased 
costs associated with these problems, and degeneration of the health of 
many American women.
  It is time to ensure equity in the classroom and in the examining 
room. We must correct the lack of clinical training in women's health 
to ensure that women receive the appropriate primary and preventive 
care they need to improve their health and save health care dollars.
  The provisions included in the Minority Health Improvement Act will 
correct this inequity. This legislation directs the Department of 
Health and Human Services to study and detail the content of women's 
health curricula in medical schools, identify gaps and omissions, and 
make recommendations to correct inequities.
  These provisions are essential, Mr. Speaker, and this is a very 
important bill. I urge my colleagues to support the conference report.
  Mr. ORTIZ. Mr. Speaker, today I rise in support of the conference 
report on S. 1569, the Minority Health Improvement Act. This 
legislation seeks to improve the health status of racial and ethnic 
minorities along with reducing the disparities in the health status of 
minorities. While this legislation does address the needs of 
minorities, it also contains provisions that would affect the public 
health of our country. In particular, one invaluable provision 
addresses the incidence of birth defects, a national health problem 
that crosses all geographic areas and affects children of all races and 
economic classes.
  It is astonishing to note that every hour a baby dies due to a birth 
defect, and that birth defects are the leading cause of infant 
mortality in the United States. Our country lacks a coherent, 
comprehensive national strategy to address the birth defects problem. 
Because we lack such a strategy, there are inadequate State and local 
resources that work to combat the incidence of birth defects. As a 
result, most Americans have insufficient knowledge about birth defects, 
and remain unaware of the high rate of birth defects in our country.
  I became more aware of birth defects through a tragedy in Cameron 
County, TX, when it was noticed that there was a high rate of spinal 
and neural tube birth defects in infants born in the border region of 
south Texas. When the matter was first brought to my attention, I was 
astonished that there was no national monitoring system with which to 
track and investigate such birth defects.
  At that time, I introduced legislation, the Birth Defects Prevention 
Act, to establish a nationwide birth defects surveillance and 
prevention program. Such programs could identify clusters of birth 
defects, study patterns to determine causes, and ultimately lead to the 
development of prevention strategies.
  Legislation to collect and analyze data on birth defects could not 
have been possible without the drive of the March of Dimes. The 
allegiance of the March of Dimes and its staff on this effort has been 
remarkable. The March of Dimes' commitment and fervor for establishing 
a national program for birth defects prevention should be acknowledged 
by all Americans. For if this legislation can begin to identify causes 
of birth defects, then we can help prevent the occurrence of future 
ones.
  Ms. SNOWE. Mr. Speaker, I rise today in support of S. 1569, the 
Minority Health Improvement Act. This bill expands and reauthorizes 
health services, education, professional programs, and research for 
minorities. It also incorporates four provisions of the Women's Health 
Equity Act of 1993, of which I am a cosponsor as cochair of the 
Congressional Caucus for Women's Issues.
  Women's health has been overlooked for far too many years. It is only 
within the last decade that a governmental task force was formed to 
review and recommend a comprehensive women's health agenda. With the 
Congressional Caucus for Women's Issues leading the charge, the 
inadequacies and inequities in health care and medical research on 
women have begun to be addressed in legislation.
  The Minority Health Improvements Act authorizes $5 million for fiscal 
year 1995 for the establishment in law of the Office of Women's Health 
in the Public Health Service. I sponsored this bill as part of the 
Women's Health Equity Act. The Office will be administered by the 
Deputy Assistant Secretary for Women's Health, who has the authority to 
develop and support programs concerning women's health and advise heads 
of the PHS agencies and monitor activities that relate to women's 
health.
  I am pleased that the Office of Women's Health will have general 
authority to offer recommendations on all programs and activities 
conducted by the Public Health Service to assure that women's health 
care needs will be addressed through a comprehensive and coordinated 
policy. Codifying this Office in statute will ensure that women's 
health concerns are integrated into all programs and activities of the 
Public Health Service and that women are no longer a footnote in the 
annals of medical research and care.
  Ms. VELAZQUEZ. Mr. Speaker, I rise today in strong support of S. 
1569, the Minority Health Improvement Act. I would like to thank 
Chairman Waxman, Representative Luis Gutierrez, and the distinguished 
Hispanic Caucus Chairman Jose Serrano for their hard work on this bill.
  Comprehensive health care reform may be dead in Congress, but for 
millions of Americans, the health care crisis is very much alive. This 
is especially true for minorities. We lack access to health providers 
and information about our health options. For example, in New York's 
lower east side, a poor and minority area in my district, there are 
only 450 doctors per 100,000 people. Sixty blocks away, in the affluent 
upper east side, there are 1,700 doctors per 100,000 people. Even when 
health professionals are available, many people of color cannot access 
them because they do not accept Medicaid patients or provide 
linguistically and culturally appropriate care.
  The conference report on S. 1569 represents a strong response to the 
crisis. It will provide comprehensive data collection on the health 
status and needs of minorities, recruitment programs targeted at 
minority youth, scholarship opportunities for minorities entering 
medical school, and authorize funds for language services and disease 
prevention programs. S. 1569 reauthorizes the Community and Migrant 
Health Centers, the safety net providers who treat a large portion of 
the poor minority population. The bill also includes key provisions 
originally contained in H.R. 3230, the Minority Health Opportunity 
Enhancement Act [M-HOPE]. M-HOPE, which focused on enhancing the 
responsiveness of the Federal health programs in meeting the needs of 
Latinos, was unanimously supported by the Congressional Hispanic 
Caucus.
  I urge my colleagues to seize the day. The chance for comprehensive 
health reform in this Congress has passed, but we still have an 
opportunity to respond to a major component of the health care crisis. 
We must not let this moment pass--millions of lives depend upon it. 
Vote yes on the conference report on S. 1569.
  Mr. RICHARDSON. Mr. Speaker, I rise in support of the conference 
report on the minority health improvement Act of 1994. This conference 
report represents a huge leap in the right direction for all 
minorities.
  There have been some very contentious issues included in the 
conference on this bill and even though not all of them may have been 
worked out to the complete content of all parties, this conference 
report is far too important for minority health to be held up now.
  I joined by colleagues in the Hispanic caucus over a year ago to 
introduce H.R. 3230, the Minority Health Opportunity Enhancement Act of 
1993. Since that introduction, staff and members have been in very 
lengthy discussions and negotiations and the conference report contains 
many of the original goals of H.R. 3230.
  All of the programs in this conference report have great importance 
for minority health but I would like to take a moment to focus on just 
a few.
  Back when we first passed this act in 1990, I helped create the 
Center of Excellence Program in this act for both native Americans and 
Hispanics.
  I am happy to report that the conference report changes the 
distribution of funding for Centers of Excellence to make the 
allocations to Hispanic and Native American Centers more equitable in 
the future while protecting the funding all centers currently receive.
  The total authorization for all Centers of Excellence is increased 
and this is critical because many Hispanic and Native American Centers 
have had trouble meeting their goals with the money made available to 
them now.
  This conference report also contains specific funding that must be 
devoted to the collection of data on Hispanic Health at the agency for 
health care policy and research and the National Center for Health 
Statistics.
  There is an incredible lack of data available on the health of 
Hispanic citizens in this country. And within the Hispanic population, 
there are great differences in health indicators among various 
subgroups of the Hispanic population.
  This definitely promotes gross overgeneralizations on Hispanic 
health. All Hispanics are hurt by this narrow focus on certain health 
indicators.
  This conference report adds additional funding specifically for the 
gathering of more complete data on Hispanic health.
  Mr. Speaker, we had hoped that we would be able to pass a health care 
reform bill this year but that was not possible. However, this bill may 
be as important or more important for minorities in the immediate 
future.
  For that reason I want to express my thanks to Chairmen Waxman and 
Dingell for their continuing leadership on this issue as well as 
Senator Kennedy and Senator Kassebaum for their important work on this 
bill in the Senate.
  Mr. WAXMAN. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  Mr. BLILEY. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the conference report.
  There was no objection
  The SPEAKER pro tempore. The question is on the conference report.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. WAXMAN. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 394, 
nays 5, not voting 35, as follows:

                             [Roll No. 504]

                               YEAS--394

     Abercrombie
     Ackerman
     Allard
     Andrews (ME)
     Andrews (NJ)
     Andrews (TX)
     Archer
     Armey
     Bacchus (FL)
     Bachus (AL)
     Baesler
     Baker (CA)
     Baker (LA)
     Ballenger
     Barca
     Barcia
     Barlow
     Barrett (NE)
     Barrett (WI)
     Bartlett
     Becerra
     Beilenson
     Bereuter
     Berman
     Bevill
     Bilbray
     Bishop
     Blackwell
     Bliley
     Blute
     Boehlert
     Boehner
     Bonilla
     Bonior
     Borski
     Boucher
     Brooks
     Browder
     Brown (CA)
     Brown (FL)
     Brown (OH)
     Bryant
     Bunning
     Buyer
     Byrne
     Callahan
     Calvert
     Camp
     Canady
     Cantwell
     Cardin
     Carr
     Castle
     Chapman
     Clay
     Clayton
     Clement
     Clinger
     Clyburn
     Coble
     Coleman
     Collins (GA)
     Collins (IL)
     Collins (MI)
     Combest
     Condit
     Conyers
     Cooper
     Coppersmith
     Costello
     Cox
     Coyne
     Cramer
     Crane
     Crapo
     Cunningham
     Danner
     Darden
     de la Garza
     Deal
     DeFazio
     DeLauro
     Dellums
     Derrick
     Deutsch
     Diaz-Balart
     Dickey
     Dicks
     Dingell
     Dixon
     Dooley
     Doolittle
     Dornan
     Dreier
     Dunn
     Durbin
     Edwards (CA)
     Edwards (TX)
     Ehlers
     Emerson
     Engel
     English
     Eshoo
     Evans
     Everett
     Ewing
     Farr
     Fawell
     Fazio
     Fields (LA)
     Fields (TX)
     Filner
     Fingerhut
     Fish
     Flake
     Ford (MI)
     Fowler
     Frank (MA)
     Franks (CT)
     Franks (NJ)
     Frost
     Furse
     Gallegly
     Gejdenson
     Gekas
     Gephardt
     Geren
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gingrich
     Glickman
     Gonzalez
     Goodlatte
     Goodling
     Gordon
     Goss
     Grams
     Green
     Greenwood
     Gunderson
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hamburg
     Hamilton
     Hansen
     Harman
     Hastert
     Hastings
     Hayes
     Hefley
     Hefner
     Herger
     Hilliard
     Hinchey
     Hoagland
     Hobson
     Hochbrueckner
     Hoekstra
     Hoke
     Holden
     Horn
     Hoyer
     Huffington
     Hughes
     Hunter
     Hutchinson
     Hutto
     Hyde
     Inglis
     Inslee
     Jacobs
     Jefferson
     Johnson (CT)
     Johnson (GA)
     Johnson (SD)
     Johnson, E.B.
     Johnston
     Kanjorski
     Kaptur
     Kasich
     Kennedy
     Kennelly
     Kildee
     Kim
     King
     Kingston
     Kleczka
     Klein
     Klink
     Klug
     Knollenberg
     Kolbe
     Kopetski
     Kreidler
     Kyl
     LaFalce
     Lambert
     Lancaster
     Lantos
     LaRocco
     Lazio
     Leach
     Levin
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Lightfoot
     Linder
     Lipinski
     Livingston
     Lloyd
     Long
     Lowey
     Lucas
     Machtley
     Maloney
     Mann
     Manton
     Manzullo
     Margolies-Mezvinsky
     Markey
     Martinez
     Matsui
     Mazzoli
     McCandless
     McCloskey
     McCollum
     McCrery
     McDade
     McDermott
     McHale
     McHugh
     McInnis
     McKeon
     McKinney
     McNulty
     Meehan
     Meek
     Menendez
     Meyers
     Mfume
     Mica
     Michel
     Miller (CA)
     Miller (FL)
     Mineta
     Minge
     Mink
     Moakley
     Molinari
     Mollohan
     Montgomery
     Moorhead
     Moran
     Morella
     Murphy
     Murtha
     Myers
     Nadler
     Neal (MA)
     Neal (NC)
     Nussle
     Oberstar
     Obey
     Olver
     Ortiz
     Orton
     Owens
     Oxley
     Packard
     Pallone
     Parker
     Pastor
     Paxon
     Payne (NJ)
     Pelosi
     Penny
     Peterson (FL)
     Peterson (MN)
     Petri
     Pickett
     Pombo
     Pomeroy
     Portman
     Poshard
     Price (NC)
     Pryce (OH)
     Quillen
     Quinn
     Rahall
     Ramstad
     Rangel
     Reed
     Regula
     Reynolds
     Richardson
     Ridge
     Roberts
     Roemer
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Rose
     Rostenkowski
     Roth
     Rowland
     Roybal-Allard
     Royce
     Rush
     Sabo
     Sanders
     Sangmeister
     Santorum
     Sarpalius
     Sawyer
     Saxton
     Schaefer
     Schenk
     Schiff
     Schroeder
     Schumer
     Scott
     Sensenbrenner
     Serrano
     Sharp
     Shaw
     Shays
     Shepherd
     Shuster
     Sisisky
     Skaggs
     Skeen
     Skelton
     Smith (IA)
     Smith (MI)
     Smith (NJ)
     Smith (OR)
     Smith (TX)
     Snowe
     Solomon
     Spence
     Stark
     Stearns
     Stokes
     Strickland
     Stupak
     Swett
     Swift
     Synar
     Talent
     Tanner
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Tejeda
     Thomas (CA)
     Thomas (WY)
     Thompson
     Thornton
     Thurman
     Torkildsen
     Torres
     Towns
     Traficant
     Unsoeld
     Upton
     Valentine
     Velazquez
     Vento
     Visclosky
     Volkmer
     Vucanovich
     Walker
     Walsh
     Waters
     Watt
     Waxman
     Weldon
     Wheat
     Williams
     Wilson
     Wise
     Wolf
     Woolsey
     Wyden
     Wynn
     Yates
     Young (AK)
     Young (FL)
     Zeliff
     Zimmer

                                NAYS--5

     Burton
     Duncan
     Hancock
     Johnson, Sam
     Stump

                             NOT VOTING--35

     Applegate
     Barton
     Bateman
     Bentley
     Bilirakis
     Brewster
     DeLay
     Foglietta
     Ford (TN)
     Gallo
     Grandy
     Houghton
     Inhofe
     Istook
     Laughlin
     Lehman
     Levy
     Lewis (FL)
     McCurdy
     McMillan
     Payne (VA)
     Pickle
     Porter
     Ravenel
     Roukema
     Slattery
     Slaughter
     Spratt
     Stenholm
     Studds
     Sundquist
     Torricelli
     Tucker
     Washington
     Whitten

                              {time}  1749

  Mr. STUMP changed his vote from ``yea'' to ``nay.''
  Messrs. BONILLA, GILCHREST, and BARCIA of Michigan changed their vote 
from ``nay'' to ``yea.''
  So the conference report was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________