[Congressional Record Volume 141, Number 197 (Tuesday, December 12, 1995)]
[House]
[Pages H14273-H14277]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       FEDERALLY SUPPORTED HEALTH CENTERS ASSISTANCE ACT OF 1995

  Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1747) to amend the Public Health Service Act to permanently 
extend and clarify malpractice coverage for health centers, and for 
other purposes, as amended.
  The Clerk read as follows:

                               H.R. 1747

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; REFERENCES.

       (a) Short Title.--This Act may be cited as the ``Federally 
     Supported Health Centers Assistance Act of 1995''.
       (b) References.--Except as otherwise expressly provided, 
     whenever in this Act an amendment or repeal is expressed in 
     terms of an amendment to, or repeal of, a section or other 
     provision, the reference shall be considered to be made to a 
     section or other provision of the Public Health Service Act.

     SEC. 2. PERMANENT EXTENSION OF PROGRAM.

       (a) In General.--Section 224(g)(3) (42 U.S.C. 233(g)(3)) is 
     amended by striking the last sentence.
       (b) Conforming Amendments.--Section 224(k) (42 U.S.C. 
     233(k)) is amended--
       (1) in paragraph (1)(A)-- 
       
[[Page H14274]]

       (A) by striking ``For each of the fiscal years 1993, 1994, 
     and 1995'' and inserting ``For each fiscal year''; and
       (B) by striking ``(except'' and all that follows through 
     ``thereafter)''; and
       (2) in paragraph (2), by striking ``for each of the fiscal 
     years 1993, 1994, and 1995'' and inserting ``for each fiscal 
     year''.

     SEC. 3. CLARIFICATION OF COVERAGE.

       Section 224 (42 U.S.C. 233) is amended--
       (1) in subsection (g)(1), by striking ``an entity described 
     in paragraph (4)'' in the first sentence and all that follows 
     through ``contractor'' in the second sentence and inserting 
     the following: ``an entity described in paragraph (4), and 
     any officer, governing board member, or employee of such an 
     entity, and any contractor of such an entity who is a 
     physician or other licensed or certified health care 
     practitioner (subject to paragraph (5)), shall be deemed to 
     be an employee of the Public Health Service for a calendar 
     year that begins during a fiscal year for which a transfer 
     was made under subsection (k)(3) (subject to paragraph (3)). 
     The remedy against the United States for an entity described 
     in paragraph (4) and any officer, governing board member, 
     employee, or contractor''; and
       (2) in subsection (k)(3), by inserting ``governing board 
     member,'' after ``officer,''.

     SEC. 4. COVERAGE FOR SERVICES FURNISHED TO INDIVIDUALS OTHER 
                   THAN CENTER PATIENTS.

       Section 224(g)(1) (42 U.S.C. 233(g)) is amended--
       (1) by redesignating paragraph (1) as paragraph (1)(A); and
       (2) by adding at the end thereof the following:
       ``(B) The deeming of any entity or officer, governing board 
     member, employee, or contractor of the entity to be an 
     employee of the Public Health Service for purposes of this 
     section shall apply with respect to services provided--
       ``(i) to all patients of the entity, and
       ``(ii) subject to subparagraph (C), to individuals who are 
     not patients of the entity.
       ``(C) Subparagraph (B)(ii) applies to services provided to 
     individuals who are not patients of an entity if the 
     Secretary determines, after reviewing an application 
     submitted under subparagraph (D), that the provision of the 
     services to such individuals--
       ``(i) benefits patients of the entity and general 
     populations that could be served by the entity through 
     community-wide intervention efforts within the communities 
     served by such entity;
       ``(ii) facilitates the provision of services to patients of 
     the entity; or
       ``(iii) are otherwise required under an employment contract 
     (or similar arrangement) between the entity and an officer, 
     governing board member, employee, or contractor of the 
     entity.''.

     SEC. 5. APPLICATION PROCESS.

       (a) Application Requirement.--Section 224(g)(1) (42 U.S.C. 
     233(g)(1)) (as amended by section 4) is further amended--
       (1) in subparagraph (A), by inserting after ``For purposes 
     of this section'' the following: ``and subject to the 
     approval by the Secretary of an application under 
     subparagraph (D)''; and
       (2) by adding at the end thereof the following:
       ``(D) The Secretary may not under subparagraph (A) deem an 
     entity or an officer, governing board member, employee, or 
     contractor of the entity to be an employee of the Public 
     Health Service for purposes of this section, and may not 
     apply such deeming to services described in subparagraph 
     (B)(ii), unless the entity has submitted an application for 
     such deeming to the Secretary in such form and such manner as 
     the Secretary shall prescribe. The application shall contain 
     detailed information, along with supporting documentation, to 
     verify that the entity, and the officer, governing board 
     member, employee, or contractor of the entity, as the case 
     may be, meets the requirements of subparagraphs (B) and (C) 
     of this paragraph and that the entity meets the requirements 
     of paragraphs (1) through (4) of subsection (h).
       ``E) The Secretary shall make a determination of whether an 
     entity or an officer, governing board member, employee, or 
     contractor of the entity is deemed to be an employee of the 
     Public Health Service for purposes of this section within 30 
     days after the receipt of an application under subparagraph 
     (D). The determination of the Secretary that an entity or an 
     officer, governing board member, employee, or contractor of 
     the entity is deemed to be an employee of the Public Health 
     Service for purposes of this section shall apply for the 
     period specified by the Secretary under subparagraph (A).
       ``(F) Once the Secretary makes a determination that an 
     entity or an officer, governing board member, employee, or 
     contractor of an entity is deemed to be an employee of the 
     Public Health Service for purposes of this section, the 
     determination shall be final and binding upon the Secretary 
     and the Attorney General and other parties to any civil 
     action or proceeding. Except as provided in subsection (i), 
     the Secretary and the Attorney General may not determine that 
     the provision of services which are the subject of such a 
     determination are not covered under this section.
       ``(G) In the case of an entity described in paragraph (4) 
     that has not submitted an application under subparagraph (D):
       ``(i) The Secretary may not consider the entity in making 
     estimates under subsection (k)(1).
       ``(ii) This section does not affect any authority of the 
     entity to purchase medical malpractice liability insurance 
     coverage with Federal funds provided to the entity under 
     section 329, 330, 340, or 340A.
       ``(H) In the case of an entity described in paragraph (4) 
     for which an application under subparagraph (D) is in effect, 
     the entity may, through notifying the Secretary in writing, 
     elect to terminate the applicability of this subsection to 
     the entity. With respect to such election by the entity:
       ``(i) The election is effective upon the expiration of the 
     30-day period beginning on the date on which the entity 
     submits such notification.
       ``(ii) Upon taking effect, the election terminates the 
     applicability of this subsection to the entity and each 
     officer, governing board member, employee, and contractor of 
     the entity.
       ``(iii) Upon the effective date for the election, clauses 
     (i) and (ii) of subparagraph (G) apply to the entity to the 
     same extent and in the same manner as such clauses apply to 
     an entity that has not submitted an application under 
     subparagraph (D).
       ``(iv) If after making the election the entity submits an 
     application under subparagraph (D), the election does not 
     preclude the Secretary from approving the application (and 
     thereby restoring the applicability of this subsection to 
     the entity and each officer, governing board member, 
     employee, and contractor of the entity, subject to the 
     provisions of this subsection and the subsequent 
     provisions of this section.''.
       (b) Approval Process.--Section 224(h) (42 U.S.C. 233(h)) is 
     amended--
       (1) in the matter preceding paragraph (1), by striking 
     ``Notwithstanding'' and all that follows through ``entity--'' 
     and inserting the following: ``The Secretary may not approve 
     an application under subsection (g)(1)(D) unless the 
     Secretary determines that the entity--''; and
       (2) by striking ``has fully cooperated'' in paragraph (4) 
     and inserting ``will fully cooperate''.
       (c) Delayed Applicability for Current Participants.--If, on 
     the day before the date of the enactment of this Act, an 
     entity was deemed to be an employee of the Public Health 
     Service for purpose of section 224(g) of the Public Health 
     Service Act, the condition under paragraph (1)(D) of such 
     section (as added by subsection (a) of this section) that an 
     application be approved with respect to the entity does not 
     apply until the expiration of the 180-day period beginning on 
     such date.

     SEC. 6. TIMELY RESPONSE TO FILING OF ACTION OR PROCEEDING.

       Section 224 (42 U.S.C. 233) is amended by adding at the end 
     thereof the following subsection:
       ``(l)(1) If a civil action or proceeding is filed in a 
     State court against any entity described in subsection (g)(4) 
     or any officer, governing board member, employee, or any 
     contractor of such an entity for damages described in 
     subsection (a), the Attorney General, within 15 days after 
     being notified of such filing, shall make an appearance in 
     such court and advise such court as to whether the Secretary 
     has determined under subsections (g) and (h), that such 
     entity, officer, governing board member, employee, or 
     contractor of the entity in deemed to be an employee of the 
     Public Health Service for purposes of this section with 
     respect to the actions or omissions that are the subject of 
     such civil action or proceeding. Such advice shall be deemed 
     to satisfy the provisions of subsection (c) that the Attorney 
     General certify that an entity, officer, governing board 
     member, employee, or contractor of the entity was acting 
     within the scope of their employment or responsibility.
       ``(2) If the Attorney General fails to appear in State 
     court within the time period prescribed under paragraph (1), 
     upon petition of any entity or officer, governing board 
     member, employee, or contractor of the entity named, the 
     civil action or proceeding shall be removed to the 
     appropriate United States district court. The civil action or 
     proceeding shall be stayed in such court until such court 
     conducts a hearing, and makes a determination, as to the 
     appropriate forum or procedure for the assertion of the claim 
     for damages described in subsection (a) and issues an order 
     consistent with such determination.''.

     SEC. 7. APPLICATION OF COVERAGE TO MANAGED CARE PLANS.

       Section 224 (42 U.S.C. 223) (as amended by section 6) is 
     amended by adding at the end thereof the following 
     subsection:
       ``(m)(1) An entity or officer, governing board member, 
     employee, or contractor of an entity described in subsection 
     (g)(1) shall, for purposes of this section, be deemed to be 
     an employee of the Public Health Service with respect to 
     services provided to individuals who are enrollees of a 
     managed care plan if the entity contracts with such managed 
     care plan for the provision of services.
       ``(2) Each managed care plan which enters into a contract 
     with an entity described in subsection (g)(4) shall deem the 
     entity and any officer, governing board member, employee, or 
     contractor of the entity as meeting whatever malpractice 
     coverage requirements such plan may require of contracting 
     providers for a calendar year if such entity or officer, 
     governing board member, employee, or contractor of the 
     entity has been deemed to be an employee of the Public 
     Health Service for purposes of this section for such 
     calendar year. Any plan which is 

[[Page H14275]]
     found by the Secretary on the record, after notice and an opportunity 
     for a full and fair hearing, to have violated this 
     subsection shall upon such finding cease, for a period to 
     be determined by the Secretary, to receive and to be 
     eligible to receive any Federal funds under title XVIII or 
     XIX of the Social Security Act.
       ``(3) For purposes of this subsection, the term `managed 
     care plan' shall mean health maintenance organizations and 
     similar entities that contract at-risk with payors for the 
     provision of health services or plan enrollees and which 
     contract with providers (such as entities described in 
     subsection (g)(4)) for the delivery of such services to plan 
     enrollees.''.

     SEC. 8. COVERAGE FOR PART-TIME PROVIDERS UNDER CONTRACTS.

       Section 224(g)(5)(B) (42 U.S.C. 223(g)(5)(B)) is amended to 
     read as follows:
       ``(B) in the case of an individual who normally performs an 
     average of less than 32\1/2\ hours of services per week for 
     the entity for the period of the contract, the individual is 
     a licensed or certified provider of services in the fields of 
     family practice, general internal medicine, general 
     pediatrics, or obstetrics and gynecology.''.

     SEC. 9. DUE PROCESS FOR LOSS OF COVERAGE.

       Section 224(i)(1) (42 U.S.C. 233(i)(1)) is amended by 
     striking ``may determine, after notice and opportunity for a 
     hearing'' and inserting ``may on the record determine, after 
     notice and opportunity for a full and fair hearing''.

     SEC. 10. AMOUNT OF RESERVE FUND.

       Section 224(k)(2) (42 U.S.C. 223(k)(2)) is amended by 
     striking ``$30,000,000'' and inserting ``$10,000,000''.

     SEC. 11. REPORT ON RISK EXPOSURE OF COVERED ENTITIES.

       Section 224 (as amended by section 7) is amended by adding 
     at the end thereof the following subsection:
       ``(n)(1) Not later than one year after the date of the 
     enactment of the Federally Supported Health Centers 
     Assistance Act of 1995, the Comptroller General of the United 
     States shall submit to the Congress a report on the 
     following:
       ``(A) The medical malpractice liability claims experience 
     of entities that have been deemed to be employees for 
     purposes of this section.
       ``(B) The risk exposure of such entities.
       ``(C) The value of private sector risk-management services, 
     and the value of risk-management services and procedures 
     required as a condition of receiving a grant under section 
     329, 330, 340, or 340A.
       ``(D) A comparison of the costs and the benefits to 
     taxpayers of maintaining medical malpractice liability 
     coverage for such entities pursuant to this section, taking 
     into account--
       ``(i) a comparison of the costs of premiums paid by such 
     entities for private medical malpractice liability insurance 
     with the cost of coverage pursuant to this section; and
       ``(ii) an analysis of whether the cost of premiums for 
     private medical malpractice liability insurance coverage is 
     consistent with the liability claims experience of such 
     entities.
       ``(2) The report under paragraph (1) shall include the 
     following:
       ``(A) A comparison of--
       ``(i) an estimate of the aggregate amounts that such 
     entities (together with the officers, governing board 
     members, employees, and contractors of such entities who have 
     been deemed to be employees for purposes of this 
     section) would have directly or indirectly paid in 
     premiums to obtain medical malpractice liability insurance 
     coverage if this section were not in effect; with
       ``(ii) the aggregate amounts by which the grants received 
     by such entities under this Act were reduced pursuant to 
     subsection (k)(2).
       ``(B) A comparison of--
       ``(i) an estimate of the amount of privately offered such 
     insurance that such entities (together with the officers, 
     governing board members, employees, and contractors of such 
     entities who have been deemed to be employees for purposes of 
     this section) purchased during the three-year period 
     beginning on January 1, 1993; with
       ``(ii) an estimate of the amount of such insurance that 
     such entities (together with the officers, governing board 
     members, employees, and contractors of such entities who have 
     been deemed to be employees for purposes of this section) 
     will purchase after the date of the enactment of the 
     Federally Supported Health Centers Assistance Act of 1995.
       ``(C) An estimate of the medical malpractice liability loss 
     history of such entities for the 10-year period preceding 
     October 1, 1996, including but not limited to the following:
       ``(i) Claims that have been paid and that are estimated to 
     be paid, and legal expenses to handle such claims that have 
     been paid and that are estimated to be paid, by the Federal 
     Government pursuant to deeming entities as employees for 
     purposes of this section.
       ``(ii) Claims that have been paid and that are estimated to 
     be paid, and legal expenses to handle such claims that have 
     been paid and that are estimated to be paid, by private 
     medical malpractice liability insurance.
       ``(D) An analysis of whether the cost of premiums for 
     private medical malpractice liability insurance coverage is 
     consistent with the liability claims experience of entities 
     that have been deemed as employees for purposes of this 
     section.
       ``(3) In preparing the report under paragraph (1), the 
     Comptroller General of the United States shall consult with 
     public and private entities with expertise on the matters 
     with which the report is concerned.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida [Mr. Bilirakis] will be recognized for 20 minutes, and the 
gentleman from California [Mr. Waxman] will be recognized for 20 
minutes.
  The Chair recognizes the gentleman from Florida [Mr. Bilirakis].
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  (Mr. BILIRAKIS asked and was given permission to revise and extend 
his remarks.)
  Mr. BILIRAKIS. Mr. Speaker, the intent of the original Federally 
Supported Health Centers Assistance Act passed in 1993 was to relieve 
health centers of the burdensome costs of private malpractice insurance 
by extending Federal Tort Claims Act coverage to health center 
employees. The funds saved on these premiums could then be used to 
provide health care to additional individuals. H.R. 1747 extends 
current law and enables these health centers to maximize their Federal 
dollars and provide health care service to more people.
  Based upon the current statute, 542 health centers have been approved 
for FTCA coverage. However, because final regulations were not issued 
until May 8, 1995 the program has not been fully implemented. This 
lengthy period of uncertainty regarding the law's scope has made it 
necessary for many health centers to continue their private malpractice 
coverage. Despite this delay, 119 health centers have reportedly saved 
$14.3 million because they have been able to drop private malpractice 
coverage for one or more of their clinicians.
  The amendment before us would make the FTCA coverage permanent. The 
amendment also clarifies that participation in the FTCA is at the 
option of the health center and is not mandatory. It also modifies a 
study of the program so that a true cost-benefit analysis of the 
program will be done. This amendment was crafted with input from a 
bipartisan group of Members, the community health centers, and 
insurance agents who sell private malpractice insurance. I believe this 
amendment satisfies everyone's objectives for this legislation.
  I urge my colleagues to join me in supporting H.R. 1747.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WAXMAN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of this legislation that would extend 
the law that allows the community health centers to take advantage of 
the Federal Tort Claims Act coverage. That will mean and has meant for 
a number of these community health centers that they will not have to 
use their scarce resources to go out and buy a private medical 
malpractice insurance policy, since they will be covered by the Federal 
law, the same as any other Federal agency would under the 
circumstances.
  This legislation was authored originally by the gentleman from 
Oregon, Mr. Wyden, and coauthored by the gentlewoman from Connecticut, 
Mrs. Nancy Johnson. It has worked well, and the bill before us would be 
to extend the legislation to be able to work in the future.
  Mr. Speaker, I support the legislation and urge all our colleagues to 
support it as well.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I thank the gentleman again for his 
cooperation regarding this legislation, and I yield such time as she 
may consume to the gentlewoman from Connecticut [Mrs. Johnson].
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank my colleague, the 
gentleman from Florida [Mr. Bilirakis], for his leadership on this 
issue and for his help in working out the amendment that has made it 
possible for this bill to offer this program on a permanent basis. He 
has always been a strong supporter and advocate of community health 
centers, and I appreciate the gentleman's good help.
  I also appreciate the support of my colleague, the gentleman from 
California, Mr. Waxman, his longtime support and hard work on the 
legislation governing our community health centers, and want to 
acknowledge the work of my colleague, the gentleman from Oregon, Mr. 
Ron Wyden, on this issue. He 

[[Page H14276]]
and I introduced the original legislation 3 years ago, which was heavy 
lifting, as we say in this body, and we are very pleased that this is 
before us today to make this program permanent. While he cannot be with 
us at this time, I want to commend the hard work and the real 
dedication of the gentleman from Oregon [Mr. Wyden] to ensuring that 
the important health services that these centers provide are there for 
people in America.
  Mr. Speaker, H.R. 1747, the federally supported Health Centers 
Assistance Act of 1995, makes permanent, at no additional cost to 
taxpayers, a highly successful demonstration project offering 
malpractice coverage for the Nation's community, migrant, and homeless 
citizens under the Federal Tort Claims Act.

  H.R. 1747 will ensure that the maximum amount of the limited Federal 
funds supporting health centers are spent to provide quality patient 
care and services, rather than to pay for malpractice insurance 
premiums. The limited demonstration project saved health centers 
millions of dollars on malpractice insurance expenses over the past 2 
years, allowing health centers to offer their services to an additional 
75,000 patients. Federally supported health centers are nonprofit 
providers of health care to America's medically underserved. They serve 
the working poor, the uninsured, Medicare and Medicaid recipients, as 
well as high-risk and vulnerable populations.
  Today health centers provide cost-effective primary and preventive 
care to over 8.8 million people nationwide. Health centers are public-
private partnerships, funded in part by grants under the Public Health 
Service Act, which enable health centers to employ health care 
professionals and operate over 2,200 health service delivery sites 
throughout our cities and towns.
  Private malpractice insurance has been a significant expense for 
these nonprofit centers. Prior to the FDCA coverage bill, health 
centers spent $40 billion annually of their grant funds for private 
malpractice insurance, yet they had very few claims. By permanently 
extending coverage for health centers under the FDCA, Congress will 
enable health centers to use more of their scarce Federal dollars for 
patient care instead of for malpractice premiums. For each $10 million 
saved in funds, health centers can serve an additional 100,000 patients 
with quality care.
  Mr. speaker, I am proud to have supported legislation ensuring that 
standards for health centers ranked among the highest in terms of 
certification, quality care, and accountability.

                              {time}  1545

  These health centers have a remarkably low incidence of malpractice 
claims.
  Since the fall of 1993, only 30 claims have been filed against the 
545 health centers approved for FTCA coverage, a rate consistent with 
the low rate of claims filed against health centers under private 
insurance.
  More than ever, America's health centers have growing 
responsibilities for the provision of health care to medically 
underserved populations and communities, yet your support for the 
permanent extension of FTCA malpractice coverage for health centers 
will enable health centers to make cost-effective use of limited 
Federal grant funds, and I urge the support of my colleagues for this 
legislation.
  Mr. YOUNG of Alaska. Mr. Speaker, I thank the gentlewoman for her 
terrific leadership in this regard.


                             general leave

  Mr. YOUNG of Alaska. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks on H.R. 1747.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Alaska?
  There was no objection.
  Mr. WYDEN. Mr. Speaker, I wish to express my strong support for H.R. 
1747, the Federally Supported Health Centers Assistance Act of 1995. I 
would like to thank members on both sides of the aisle, including 
Representative Bilirakis, Representative Waxman, and Representative 
Frank for their unflagging support and assistance in moving this 
important piece of legislation through the House. In particular, I wish 
to thank Representative Nancy Johnson of Connecticut for her years of 
work and commitment on this bill. She is a true friend of community 
health centers and has been an outstanding partner in our fight for 
smarter Government. As always, it was a joy to work with her.
  I think we all realize that the Federal Government has to work harder 
to squeeze every last ounce of service out of each taxpayer dollar 
allocated to health care. That's exactly what this program 
accomplishes.
  This legislation will be a shot in the arm to struggling community 
health centers [CHC's]. The bill allows CHC's to reallocate desperately 
needed health care dollars from the coffers of private medical 
malpractice insurance companies to direct services for hundreds 
thousands more poor and rural Americans. Additionally, it will ensure 
that American taxpayers get the biggest bang for their buck.
  When Representative Johnson and I first introduced this legislation 
in 1991, community health centers were paying $58 million a year, most 
of which came out of their Federal grant fund for medical malpractice 
insurance--while they only generated about $4 million a year in claims.
  Roughly $54 million dollars, allocated by the Federal Government for 
health care services for poor and rural Americans, was not going for 
services, but was going as pure profit to large insurance corporations. 
It seemed to myself and Mrs. Johnson that there had to be a better way.
  What we discovered was that Federal employees, including health care 
providers at the Veterans Administration, Department of Defense, and 
Indian Health Service, are covered by the Federal Tort Claims Act 
[FTCA] instead of by private insurers. It seemed only natural that 
community health centers, which receive a substantial sum of their 
operating budget from the Federal Government and which are strictly 
regulated by the Department of Health and Human Services, should also 
be included under this program.
  The original Federally Supported Health Centers Assistance Act set up 
a fund, under the FTCA, to which a portion of the grants for community 
health centers would be allocated. To date, only 15 claims have been 
filed against health centers under the FTCA and none of the $11 million 
set-aside to be expended for coverage of such has been expended.
  In fact, since the enactment of this bill in late 1992, coverage 
under the FTCA has saved community health centers an estimated $14.3 
million, allowing about 75,000 more patients to be served.
  H.R. 1747 reauthorizes the Federally Supported Health Centers 
Assistance Act permanently and clarifies portions of the original 
legislation. In particular, it ensures that doctors who have to do 
shared call are covered. These are doctors in rural or poor urban 
communities who all have to share duties at the local hospital.
  The legislation also ensures that part-time doctors who work for 
health centers are covered under the FTCA, and it clarifies that FTCA 
coverage may apply in managed care arrangements with health centers.
  Time is of the essence with this reauthorization. Since the final 
regulations for this program were not issued until May of this, many 
community health centers are waiting before they drop their private 
malpractice coverage to see if this act is reauthorized.
  For those 119 health centers that are now covered under the FTCA, the 
situation is more urgent. If this bill is not reauthorized, they will 
have to start purchasing expensive private malpractice insurance in the 
next couple weeks to ensure that they are not left without coverage 
next year.
  In Oregon, the passage of H.R. 1747 will mean a number of health 
centers will finally feel comfortable dropping their private 
malpractice insurance. At La Clinica Del Valle in Phoenix, OR, the 
health center will have as much as $20,000 more to spend on patients--
meaning they can serve at least 250 patients. Next year, when they move 
to a new facility, they will save $40,000 or the equivalent of a part-
time doctor--and be able to serve 500 more patients. At the Salud 
Medical Center in Woodburn, OR, reauthorizing this program will mean 
that the center will have at a minimum $10,000 more to spend on serving 
patients.
  At the West Salem Clinic in Salem, OR, with the savings from this 
program, they will be able to hire a part-time nurse practitioner, and 
the head of the center estimates that this will mean they will be able 
to take 2,100 more visits from people in the area--or serve about 700 
more patients. At the Southeastern Rural Health Network in Chiloquin, 
OR, the savings will mean the center can repair a leaking roof and 
build a wheelchair ramp so that handicapped people can enter the clinic 
to visit the doctor.
  It seems to me that this legislation is a prime example of how we can 
work together, on a bipartisan basis, to come up with creative, cost-
effective solutions, to provide people with more medical assistance and 
to effectively use American's hard-earned tax dollars. Again, I thank 
the Members who have helped 

[[Page H14277]]
with this important piece of legislation, and urge its speedy approval.
  Mr. YOUNG of Alaska. Mr. Speaker, I have no further requests for 
time, and I yield back the balance of my time.
  Mr. WAXMAN. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Ewing). The question is on the motion 
offered by the gentleman from Florida [Mr. Bilirakis] that the House 
suspend the rules and pass the bill, H.R. 1747, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________