[Congressional Record Volume 142, Number 58 (Wednesday, May 1, 1996)]
[House]
[Pages H4355-H4366]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CONFERENCE REPORT ON S. 641, RYAN WHITE CARE ACT AMENDMENTS OF 1996
Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that it now be in
order to proceed immediately to consider the conference report on the
Senate bill (S. 641), to reauthorize the Ryan White CARE Act of 1990,
and for other purposes, and that all points of order against the
conference report and against its consideration be waived, and that the
conference report be considered as read.
The Clerk read the title of the Senate bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Florida?
Mr. WAXMAN. Reserving the right to object, Mr. Speaker, I want to
clarify that this will allow us to move forward on the House floor to
consider the Ryan White reauthorization bill, allowing discussion of
that legislation and a vote.
Mr. BILIRAKIS. Mr. Speaker, if the gentleman will yield, I would say
to the gentleman, yes, by all means.
[[Page H4356]]
Mr. WAXMAN. I withdraw my reservation of objection, Mr. Speaker.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Florida?
There was no objection.
The SPEAKER pro tempore. Pursuant to the unanimous consent agreement,
the conference report is considered as having been read.
(For conference report and statement, see proceedings of the House of
Tuesday, April 30, 1996, at page H4287).
The SPEAKER pro tempore. The gentleman from Florida [Mr. Bilirakis]
and the gentleman from California [Mr. Waxman] will each be recognized
for 30 minutes.
The Chair recognizes the gentleman from Florida [Mr. Bilirakis].
{time} 1830
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may
consume.
(Mr. BILIRAKIS asked and was given permission to include extraneous
material.)
Mr. BILIRAKIS. Mr. Speaker, I rise in strong support of the
conference agreement on the Ryan White CARE Act Amendments of 1996.
This conference report represents a balanced compromise between the
House and Senate positions and updates and improves these important
programs.
I want to join my colleagues in saying how pleased I am that the
conference on the Ryan White program has finally been completed. It has
taken much longer than any of us would have liked. We are now at the
point where the remainder of the fiscal year 1996 funds are about to be
distributed to the States. Without the reauthorization and an
adjustment to the formula, approximately 20 States were expected to
lose a significant portion of their grants relative to fiscal year
1995. It is our expectation that those remaining funds will be
allocated based on the formulas contained in the conference agreement.
I want to briefly summarize some of the key provisions of the
conference agreement. The bill charges the criteria by which cities
become eligible for title I funds and modifies both the title I and
title II formulas. The allocations to cities under title I for
emergency relief grants will be based on the estimated number of living
cases of AIDS in the area over the most recent 10-year period.
The formula for the title II CARE grants to the States are based on
two distribution factors: The State factor and the non-EMA factor. The
minimum allotments to States with 90 or more cases is increased from
$100,000 to $250,000.
The conference agreement provides criteria for how members of title I
planning councils should be selected; these criteria include conflict
of interest standards. Additionally, it requires that the composition
of the planning council reflect the demographics of the epidemic in the
area. The conference agreement requires the Secretary to give priority
in awarding supplemental grants to cities that demonstrate a more
severe need based on the prevalence of: Sexually transmitted diseases,
substance abuse, tuberculosis, mental illness, and homelessness.
The bill also requires cities to allocate a percentage of its funds
for providing services to women, infants, and children, including
treatment measures to prevent the perinatal transmissions of HIV. It
also defines and places limits on administrative costs.
Other provisions of the bill provide that: States must spend a
portion of their grants on therapeutics to treat HIV disease including
measures for the prevention and treatment of opportunistic infections;
all four titles contribute 3 percent to the projects of National
Significance; clarification that the intent of title IV is to increase
the number of women and children in clinical research projects;
transfer of the dental reimbursement program from title 7 of the Public
Health Service Act; and reauthorization of all programs at such sums
through fiscal year 2000.
This is a conference report which represents compromise and hard work
by both the House and Senate. We are proud of our efforts and are
hopeful that by passing this conference report today, we can provide
much-needed services, education, and treatment to those afflicted with
this terrible disease.
I also want to take this opportunity to thank my staff, especially
Melody Harned, for their hard work on this legislation as well as Kay
Holcombe of the committee's minority staff.
I include a section-by-section summary of the bill in the Record at
this point.
Summary of Conference Agreement on S. 641, The Ryan White CARE Act
Amendments of 1996
Section 1. Short Title.
Section 2. References.
Section 3. General Amendments.
Part A--Emergency Relief for Areas With Substantial Need
for Services (Cities):
1. Eliminates the ability for an area to become eligible
based on per capita incidence of 0.0025. Changes the
timeframe of the cumulative AIDS case count from total
cumulative (from the beginning of the epidemic) to the total
for the 5-year period prior to the year for which the grant
is being made.
2. Limits eligibility for new grants to cities with
populations of 500,000 or more. (All cities currently
receiving funds and cities which will receive funds in FY
1996 are grandfathered).
3. Adds to the list of representatives to be included on
the planning councils: (a) federally qualified health
centers, (b) substance abuse treatment providers, (c)
individuals from historically underserved populations, (d)
the State Medicaid agency and the State agency administering
Title II, and (e) grantees under Part D.
4. Clarifies that in establishing priorities, planning
councils are to use the following factors: (a) documented
needs of the HIV-infected population, (b) cost and outcome
effectiveness data of proposed interventions, (c) priorities
of HIV-infected communities for whom services are intended,
and (d) availability of other resources.
5. Requires the planning council to participate in the
statewide coordinated statement of need.
6. Requires the composition of the planning council to
reflect the demographics of the epidemic in the area. Also
requires that nominations to the council be conducted through
an open process based on publicized criteria which includes a
conflict of interest standard. Prohibits the planning council
from being chaired solely by an employee of the grantee.
7. Prohibits the planning council from designating or
otherwise being directly involved in the selection of
specific service providers.
8. Requires planning councils to develop grievance
procedures. Requires the Secretary to develop model grievance
procedures.
Distribution of Grants
1. Formula Grant--Specifies that no city may receive a
reduction from the amount received in FY95 greater than 0
percent in FY96, 1 percent in FY97, 2 percent in FY98, 3.5%
in FY99 and 5% in FY 2000.
2. Supplemental Grant--Requires cities applications for
supplemental grants to demonstrate the inclusiveness of the
planning council membership and that proposed services are
consistent with local and statewide statements of need, and
that funds for the preceding year were spent in accordance
with the priorities developed by the planning council.
3. Supplemental Grant--Requires the Secretary to give
priority in awarding supplemental grants to cities that
demonstrate a more severe need based on the prevalence of:
sexually transmitted diseases, substance abuse, tuberculosis,
mental illness, and homelessness.
4. Prohibits the Secretary from awarding a grant unless
funds for the preceding fiscal year were expended in
accordance with the priorities established by the planning
council.
Use of Amounts
1. Clarifies that substance abuse and mental health
treatments and prophylactic treatment for opportunistic
infections are permissible uses of funds.
2. Clarifies that substance abuse treatment programs and
mental health programs are eligible to receive funds from
cities to provide services.
3. Requires the city to allocate a percentage of its funds
for providing services to women, infants, and children,
including treatment measures to prevent the perinatal
transmissions of HIV. The minimum for each city will be the
percentage of the HIV population constituted by women,
infants and children infected with HIV.
4. Specifies that administrative costs of all subgrantees
may not exceed an average of 10 percent. Defines
administrative activities.
Application
1. Authorizes the Secretary to phase-in the use of a single
application and a single grant for formula grants and
supplemental grants.
Technical Assistance; Planning Grants
1. Authorizes the Secretary to make grants of $75,000 to
cities who will become eligible for Part A grants (cities)
the following fiscal year. The purpose of the grant is to
assist the area in preparing for the responsibilities
associated with being a Part A grantee.
2. A maximum of 1 percent of Part A funds may be used for
planning grants. If a city receives a planning grant, the
amount it receives the subsequent fiscal year (under the Part
A formula) will be reduced by the amount of the planning
grant.
3. Permits current grantees to provide technical assistance
to new grantees.
[[Page H4357]]
Part B--Care Grant Program (States)
1. Specifies that an authorized use of funds is to provide
outpatient and ambulatory health and support services
(services authorized under Part A).
2. Amends the 15 percent set-aside for women and children
to require states to allocate a percentage of its funds for
providing services to women, infants, and children, including
treatment measures to prevent the perinatal transmissions of
HIV. The minimum for each state will be the percentage of the
HIV population constituted by women, infants and children
infected with HIV.
HIV Care Consortia
1. Specifies that private for profit entities are eligible
to receive funds to provide services, if they are the only
available provider of quality HIV care in the area.
2. Clarifies that substance abuse and mental health
treatment and prophylactic treatment for opportunistic
infections are permissible uses of funds.
3. Requires the consortium to consult with Part D grantees
in establishing a needs assessment.
4. Deletes the requirement that states with 1% or more of
the AIDS cases must spend 50% of their grant on consortia.
Provisions of Treatments
1. Requires States to spend a portion of its grant on
therapeutics to treat HIV disease including measures for the
prevention and treatment of opportunistic infections.
2. Requires states to document the progress made in making
therapeutics available to individuals eligible for
assistance.
3. Requires the Secretary to review State drug
reimbursement programs and assess barriers to expanded
availability.
state application
1. Requires the State in its application to provide a
description of how the allocation of resources is consistent
with the Statewide statement of need. Requires the State to
periodically convene a meeting of specified individuals to
develop the statement of need.
planning, evaluation, and administration
1. Prohibits States from using more than 10 percent of its
grant for planning and evaluation. Prohibits states from
using more than 10 percent of its grant for administration.
However, the total for planning, evaluation and
administration cannot exceed 15 percent. Requires states to
ensure that the average of administrative costs of entities
that receive funds from the states does not exceed 10
percent. Defines administrative activities.
technical assistance
1. Clarifies that the technical assistance which the
Secretary may provide includes technical assistance in
developing and implementing statewide statements of need.
coordination
1. Requires the Secretary to ensure that the Health
Resources and Services Administration, the Centers for
Disease Control and Prevention, and the Substance Abuse and
Mental Health Services Administration coordinate Federal HIV
programs. Requires the Secretary to report to Congress by
October 1, 1996 on such coordination efforts.
Part C--Early Intervention Services
1. Requires grantees to spend not less than 50 percent of
the grant, providing on-site or at sites where other primary
care services are rendered, the following four service
categories: (a) testing, (b) referrals for health services,
(c) clinical and diagnostic services, and (d) provision of
therapeutic measures.
2. Specifies that private for profit entities are eligible
to receive funds to provide services, if they are the only
available provider of quality HIV care in the area.
planning and development grants
1. Authorizes the Secretary to make grants to assist
entities in qualifying for a Title III(b) grant. The amount
of each grant is not to exceed $50,000. Preference is given
to entities that provide HIV primary care services in rural
or underserved areas. A maximum of 1 percent of the Title
III(b) appropriation is authorized to be used for such
grants.
required agreements
1. Adds planning and evaluation to activities considered
administration and increases the permissible percentage from
5% to 7.5%.
2. Requires applicants to submit evidence that the proposed
program is consistent with the statewide statement of need.
authorization of appropriations
1. Reauthorizes the program at such sums as necessary for
fiscal years 1996 through 2000.
Part D--Grants for Coordinated Services and Access to Research for
Women, Infants, Children, and Youth
1. Clarifies that the purpose of the grants is to (a)
provide opportunities for women and children to participate
as subjects in clinical research projects and (b) provide
health care to women and children on an outpatient basis.
2. Clarifies that the Secretary may not make a grant unless
the applicant agrees: (a) to make reasonable efforts to
identify women and children who would be appropriate
participants in research and offers the opportunity to
participate, (b) to use criteria provided by the research
project in such identification, (c) to offer other specified
services such as referrals for substance abuse and mental
health treatment and incidental services such as
transportation or child care, (d) to comply with accepted
standards of protection for human subjects.
3. In order for a grantee to continue receiving funds (in a
third or subsequent year), the Secretary must determine that
a significant number of women and children are participating
in projects of research. Permits the Secretary to take into
account circumstances in which a grantee is temporarily
unable to comply with this requirement for reasons beyond its
control (i.e., completion of the clinical trial). Authorizes
the Secretary to grant waivers of the significant number
requirement if the grantee is making reasonable progress
toward achieving this goal. This waiver authority expires
Oct. 1, 1998.
4. Clarifies that receipt of services is not dependent upon
a patient's consent to participate in research.
5. Clarifies that grant funds are not be to used to conduct
research, but to provide services which enable women and
children to participate in such research.
6. Requires the Secretary to establish a list of research
protocols to which the Secretary gives priority regarding the
prevention and treatment of HIV disease in women and
children.
7. Requires the coordination of the NIH with the activities
carried out under this title. Requires the Secretary to
develop a list of research protocols which are appropriate
for the purposes of this section. Requires the entity
actually conducting the research to be appropriately
qualified. Specifies that an entity is to be considered
qualified if any of its research protocols have been
recommended for funding by NIH.
8. Reauthorizes the program at such sums as necessary for
fiscal years 1996 through 2000.
evaluations and reports
1. Requires the Secretary to conduct an evaluation provided
for in current law by October 1, 1996.
special projects of national significance
1. Modifies the funding source for SPNS. Current law funds
SPNS through a 10 percent tap on Title II. The bill would
impose a 3 percent tap on all four titles.
2. Clarifies that special projects should include the
development and assessment of innovative service delivery
models designed to: address the needs of special populations
and ensure the ongoing availability of services for Native
Americans.
3. Requires the Secretary to make information concerning
successful models available.
transfer of the aids education and training centers (aetcs) and the
dental reimbursement program
1. Transfers to Title 26 from Title 7 of the Public Health
Service Act section 776, the AIDS Education and Training
Centers (AETCs) and the Dental Reimbursement Program.
2. Clarifies that training health care personnel in the
diagnosis, treatment, and prevention of HIV infection,
includes the prevention of perinatal transmission and
measures for the prevention and treatment of opportunistic
infections.
3. Reauthorizes both programs at such sums as necessary for
fiscal years 1996 through 2000.
Sec. 4 Amount of Emergency Relief Grants (Cities)
1. Modifies the Title I formula. Allocations to cities will
be based on the estimated number of living cases of AIDS in
the area. The number of living cases is determined through a
weighted average of cases over the most recent 10 year
period.
Sec. 5 Amount of Care Grants
1. Modifies the Title II formula. Distributes Part B funds
to states based on a formula that calculates two distribution
factors: the state factor, based on weighted AIDS case counts
for each state and the non-EMA factor based on weighted AIDS
case counts for areas within the state outside of Part A
eligible areas. The state factor is given a weight of 80% and
the non-EMA factor is given a weight of 20%. This formula
results in the transfer of funds among states. As a result
funding losses are capped at the following percentages
relative to FY95 funding levels: 0% in FY96, 1% in FY97, 2%
in FY98, 3.5% in FY99, and 5% in FY2000.
Minimum allotments to states with 90 or more cases is
increased from $100,000 to $250,000.
Funds appropriated specifically for the Drug Assistance
Program (an eligible use of funds under Part B) shall be
allocated based on states entire weighted case counts. ($52
million provided for FY96).
Sec. 6 Consolidation of Authorization of Appropriations
1. Reauthorizes Part A and Part B at such sums as necessary
for fiscal years 1996 through 2000.
2. Authorizes the Secretary to develop a methodology for
adjusting the amounts allocated to Part A and Part B.
Requires the Secretary to report on such methodology by July,
1996.
Sec. 7 Perinatal Transmission of HIV Disease
1. Requires all states to implement the CDC guidelines on
voluntary HIV testing and counseling for pregnant women.
2. Authorizes $10 million in grant funds to: (a) make
available to pregnant women counseling on HIV disease; (b)
make available outreach efforts to pregnant women at high
risk of HIV who are not currently receiving prenatal care;
(c) make available to such women voluntary HIV testing; (d)
implement mandatory newborn testing at an earlier date than
required. Only states that implement the CDC guidelines are
eligible for
[[Page H4358]]
these funds. Priority is given to states with high HIV
seroprevalence rates among childbearing women.
3. Requires the CDC, with 4 months of enactment, to develop
and implement a reporting system for states to use in
determining the rate of new AIDS cases resulting from
perinatal transmission and the possible causes of
transmission.
4. Requires the Secretary to contract with the Institute of
Medicine to conduct an evaluation of the extent to which
state efforts have been effective in reducing perinatal
transmission HIV and an analysis of the existing barriers to
further reduction in such transmission.
5. Within two years following the implementation of the CDC
reporting system, the Secretary will make a determination
whether mandatory HIV testing of all infants in the US whose
mothers have not undergone prenatal HIV testing has become a
routine practice. This determination will be made in
consultation with states and experts. If the Secretary
determines that such testing has become routine practice,
after an additional 18 months, a state will not receive Part
B funding unless it can demonstrate one of the following:
(a) A 50% reduction (or a comparable measure for states
with less than 10 cases) in the rate of new AIDS cases
resulting from perinatal transmission, comparing the most
recent data to 1993 data:
(b) At least 95% of women who have received at least two
perinatal visits have been tested for HIV; or
(c) A program for mandatory testing of all newborns whose
mothers have not undergone perinatal HIV testing.
6. Requires states which implement mandatory testing of
newborn infants to prohibit health insurance companies from
discontinuing coverage for a person solely on the basis that
the person is infected with HIV or that the individual has
been tested for HIV. Prohibition does not apply to persons
who knowingly misrepresent their HIV status.
Sec. 8 Spousal Notification
1. Prohibits the Secretary from making a grant to a State
unless the state takes such action to require that a good
faith effort be made to notify a spouse of a known HIV
infected person that such spouse may have been exposed to HIV
and should seek testing.
Sec. 9 Optional Participation of Federal Employees in AIDS
Training Programs
1. Provides that a Federal employee may not be required to
attend or participate in an AIDS or HIV training program if
such employee refuses, except for training necessary to
protect the health and safety of the employee (training in
universal precautions to prevent transmission of HIV).
Provides that an employer may not retaliate in any manner
against such employee.
Sec. 10 Prohibition on Promotion of Certain Activities
1. Prohibits funds being used to develop materials,
designed to promote or encourage, directly, intravenous drug
use or sexual activity, whether homosexual or heterosexual.
Sec. 11 Limitation on Appropriation
1. Provides that the total amounts of Federal funds
expended in any fiscal year for AIDS and HIV activities may
not exceed the total amounts expended in such fiscal year for
activities related to cancer.
Sec. 12 Additional Provisions
1. Adds funeral service practitioners to the definition of
emergency response employee.
2. Makes technical and conforming changes.
Sec. 13 Effective Date
1. The effective date is October 1, 1996 except for the
following provisions, for which the effective date is the
date of enactment: (a) eligibility of new cities under Part
A; (b) formula for Part A; (c) formula for Part B; (d)
provisions concerning perinatal transmission of HIV; (e)
consolidation of authorization for Part A and Part B; and (f)
the set-asides for Special Projects of National Significance.
Mr. Speaker, I urge my colleagues to join me in supporting this
important conference report.
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 am extremely pleased we have completed our work on the
House-Senate conference and we have reached an agreement to allow us to
reauthorize the Ryan White Act. This is an important program in dealing
with the AIDS epidemic throughout this country.
I think from the very beginning of this reauthorization everyone
wanted to continue the program, but we had some issues that we had to
resolve. One issue that took some discussion was the question of how to
direct our attention to deal with trying to prevent the transmission of
AIDS to newborns.
Appropriately, the conference said that we should put an emphasis on
encouraging pregnant women to be tested so that if they were HIV
positive and undertook therapy, they could in fact stop the
transmission of HIV to the newborn. But in the case where there has not
been a test with the mother, we wanted to establish a procedure for
having newborns tested. I think we came up with a good compromise
position that will move things in the right direction and deal
constructively with this problem.
The second area that we had to resolve were the funding formulas for
distribution of money under this act to cities and to States under
title I and title II. It makes sense to continue the two separate
authorizations for these two titles. Second, we agreed in changes in
the formulas which were designed in light of new information and the
changing nature of the AIDS epidemic. We did not want to allow large
shifts in funding that cities and States severely affected by the
epidemic would face, so we did have tight limits on any losses from
these areas.
In addition, we tailored the funding formulas appropriately to take
into account the continuing enormous need for funding in States and
cities like my own State of California and Los Angeles district, as
well as the State and city of New York, States of Florida and Texas,
and others where the AIDS epidemic began and where it will always
remain a significant problem.
On a personal note, I am pleased that the formulas we adopted do
result in significant increases of funds for Los Angeles and for the
State of California, where the need for services for people with HIV
and AIDS and for access to drug therapies for the very large number of
affected people remains to severe problem.
Mr. Speaker, in conclusion, and I am going to make a further
statement for the Record to reflect the views that I have on this
legislation, let me say I am extremely proud to have been the original
author of the Ryan White CARE Act and to have been a part of its
reauthorization. This is a law that has worked, and it will continue to
be an integral and essential part of this country's response to the
AIDS epidemic.
I want to express my appreciation to the chairman of the Committee on
Commerce, Mr. Bliley, and the chairman of the Subcommittee on Health
and the Environment, Mr. Bilirakis, for the cooperative and truly
bipartisan way in which this legislation has proceeded. I want to
acknowledge the hard work of the GAO staff who helped us with title I
and II formula calculations, and I want to thank the committee staff,
Melody Harned of the majority and Kay Holcombe of the minority, for
their significant contributions to this process.
Mr. Speaker, I am extremely pleased that we have completed our work
in the House-Senate conference and have reached agreement about the
reauthorization of the Ryan White CARE Act. Programs under this Act
provide health care services for people with HIV disease and AIDS
throughout this country, through public health departments in cities
and states; through community-based organizations; and through a
variety of primary care providers and social service organizations
dedicated to helping patients and families affected by this devastating
disease. One very important Ryan White program focuses on the need for
more research on AIDS and HIV disease in woman and children. Another
focuses on programs directed toward prevention of HIV infection and
AIDS. In total, this legislation represents a successful and very
important comprehensive approach to HIV and AIDS, and its
reauthorization is surely among the most significant legislative
accomplishments of this Congress.
I think from the very beginning of this reauthorization, Members on
both sides of the aisle and on both sides of the Capitol have
completely agreed on one point: that we should reauthorize these
important programs. We did, however, have several areas of difference
which needed to be resolved and have been resolved in the conference.
One of these related to the matter of HIV testing of women and
newborns. This is a difficult and contentious issue, and I am extremely
pleased that we were able to reach agreement.
Under this agreement, we have broadened the grant program included in
the House bill so that grants can be used to assist States to implement
the CDC guidelines relating to counseling and voluntary HIV testing of
pregnant women, as well as to determine the HIV status of newborns. I
am especially pleased with this change because I think it places
emphasis where we can do the most good--preventing the perinatal
transmission of HIV infection. The legislation then asks the Secretary
to make a determination, in consultation with appropriate medical
organizations, about whether it is the standard of practice in medicine
to test newborns for HIV. If the Secretary makes this determination,
then, in order to continue to receive Title II funding under Ryan
White,
[[Page H4359]]
States would need to meet one of two performance standards. The State
could demonstrate that, through voluntary counseling and testing
programs, it is determining the HIV status of 95 percent of women who
are in prenatal care. Alternatively, the State can demonstrate that it
has reduced pediatric AIDS, contracted through perinatal transmission,
by 50 percent, compared to the 1993 level. This date is important in
that it reflects the time at which we learned that treatment of HIV-
positive pregnant women with AT can prevent perinatal transmission.
Only if States cannot demonstrate the achievement of one of these
specified goals would they be required to put in place either
legislative or regulatory requirements relating to the mandatory HIV
testing of newborns, as a condition of their continuing to receive
title II funding under the Ryan White Act.
Further, any State that did choose this route would be required to
have in place important protections such as requirements that health
insurance could not be denied or canceled, based on the fact that an
individual has been tested or is HIV-positive. These provisions are
over and above the protections already provided in the Americans with
Disabilities Act and under applicable State law.
The ADA requires that all persons with disabilities--including those
with HIV or AIDS--be protected from arbitrary insurance discrimination.
In other words, under the ADA, an employer or insurance company cannot
treat people with HIV or AIDS differently from people with other
serious conditions that pose equal financial risk. That is clear.
Many State laws also provide a State remedy already for such
discrimination. That is also clear.
The Coburn-Waxman amendment as included in this bill would go further
and provide protection to people who have simply undergone testing for
HIV, whether or not they are perceived by the insurance company as
having HIV. The goal of this amendment is clear. We are all trying to
reduce any disincentives for anyone to be tested. The Coburn/Waxman
amendment also provides a different enforcement device to assure that
such discrimination is prohibited, that is, that States could lose
their Ryan White money.
With all three of these protections in place--ADA, State law, and
Ryan White, the conferees feel that we will make significant public
health strides in getting people who may be afraid of being tested less
afraid.
I am pleased with this result, because I think we have placed the
emphasis where it should be--not on testing as an end in itself, but on
reducing the number of babies born with HIV. Reaching pregnant women,
and educating them about the importance, both to them and to their
babies, of knowing their HIV status at a time when it will do the most
good and actually prevent perinatal HIV transmission, is what we should
be doing. After all, our goal here is to stop the transmission of HIV
to babies. I think this compromise emphasizes and also helps us achieve
that goal.
A second issue that has proven difficult to resolve is how funding
under this act is distributed to cities and States. The conference
report deals with these issues in three ways. First, the conferees
agreed that, particularly in light of the increases in funding for both
titles I and II under the fiscal year 1996 appropriations bill, it made
sense to continue authorizing two separate appropriations for these two
titles. Second, we agreed that although changes in the formulas were
designed were needed, in light of new information and the changing
nature of the AIDS epidemic, we did not want to allow such large shifts
in funding that cities and States severely affected by the epidemic
could not absorb them. Thus, while we have agreed to make significant
changes in the way funds are allocated to cities and States, we have
placed tight limits on losses.
In addition, we have tailored the funding formulas appropriately to
take account of the continuing enormous need for funding in States and
cities, like my home State of California, and my Los Angeles district,
as well as the State and city of New York, and the States of Florida
and Texas, and others where the AIDS epidemic began and where it always
will remain a significant problem.
On a personal note, I am pleased that the formulas we adopted do
result in significant increases of funds for Los Angeles, and for the
State of California, where the need for services for people with HIV
and AIDS and for access to drug therapies for the very large number of
affected people remains a severe problem.
Mr. Speaker, in conclusion let me say that I am extremely proud to
have been an original author of the Ryan White CARE Act and to have
been a part of its reauthorization. This is a law that has worked and
will continue to be an integral and essential part of this country's
response to the AIDS epidemic.
And finally, I want to express my appreciation to the chairman of the
Commerce Committee, Mr. Bliley, and the chairman of the Health
Subcommittee, Mr. Bilirakis, for the cooperative and truly bipartisan
way in which this legislation has proceeded. I want to acknowledge the
hard work of the GAO staff, who helped us with the title I and II
formula calculations. I particularly want to thank the committee
staff--Melody Harned of the majority and Kay Holcombe of the minority--
for their significant contributions to the process.
Mr. Speaker, I reserve the balance of my time.
Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Maryland [Mrs. Morella].
Mrs. MORELLA. I thank the gentleman for yielding me the time.
Mr. Speaker, I rise in support of the passage of the Ryan White CARE
Act, and I congratulate the conferees on their persistence in reaching
agreement on several difficult issues. A final agreement on this
reauthorization bill has been a long time in coming, and it is critical
that we pass this bill today.
The CARE Act provides medical care to more than 350,000 people living
with HIV/AIDS. Under the Act, local communities make the decisions as
to how funding should be allocated, in a manner consistent with this
Congress' efforts to give States and localities greater control.
In regard to the issue of HIV testing for infants and pregnant women,
I commend the conferees for choosing to focus on the voluntary testing
of pregnant women, instead of the mandatory testing of infants. This
approach is supported by the medical and public health community as the
most effective way of preventing perinatal transmission of HIV. The
final provisions include funding to assist States to implement the CDC
guidelines which call for voluntary HIV counseling, testing, and
treatment for pregnant women.
Mr. Speaker, every Member here agrees that we must do everything
possible to reduce perinatal transmission of HIV. The CDC guidelines
will provide access to early interventions that will actually prevent
perinatal transmission, and link them to HIV care and services.
Preserving a patient-provider relationship of trust is essential to
keeping women in the health care system. Many voluntary counseling and
testing programs exist, at Harlem Hospital and others; the physicians
who run these programs will tell you that it is because the testing is
voluntary that they are successful. In these programs, almost all
women, after talking with their provider, will choose testing and the
treatment recommended by their provider. We should devote our resources
to replicating these models, rather than to efforts that will do
nothing to prevent perinatal transmission.
Mr. Speaker, this bill is not perfect, but is the best agreement that
could be reached.
Mr. Speaker, I congratulate the chairman of the subcommittee, the
full committee, the ranking member of the full committee, the
subcommittee, and the conferees. We should all vote for this bill.
Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentleman from
Massachusetts [Mr. Studds], who played such a very important role in
the work on the Ryan White bill and our approach to the full AIDS
epidemic.
(Mr. STUDDS asked and was given permission to revise and extend his
remarks.)
Mr. STUDDS. Mr. Speaker, as an original cosponsor of this
legislation, I rise to express my strong support for the conference
report. This agreement is a welcome one which was far too long in
coming.
Nearly 6 years ago, I joined with colleagues on both sides of the
aisle in passing the Ryan White Care Act. Since then, this legislation
has been a lifeline for hundreds of thousands of people in States and
communities across the land.
We could not know then that AIDS would become the primary killer of
American men and women in the prime of their lives. Nearly half a
million cases have been reported to the Centers for Disease Control and
Prevention, and nearly half that number have died. Included in those
sobering statistics are two former Members of this House and many
members of our families and our official family.
As the AIDS epidemic has expanded, it has placed an enormous burden
on the public health system, including both the communities in which
the early cases were concentrated and
[[Page H4360]]
those in which significant case loads are a more recent development.
The public health burden has also increased with the emergence of
promising but costly new drugs for treating the disease. The conference
report attempts to reconcile these competing demands in a way that will
help ensure continuity of care for every person living with HIV/AIDS.
I would also like to say a word about one provision that has
attracted a good deal of attention and concern--the portion of the bill
dealing with the HIV testing of newborns. The compromise that has been
reached is precisely that--a compromise. On the one hand, it affirms
explicitly what I think we are believe: That every pregnant woman
should be tested for the AIDS virus, that those who test positive
should be offered the best treatments currently available, and that the
soundest and surest way of ensuring that both of these things will
happen is to provide the woman with counseling and voluntary testing.
On the other hand, a State that fails to meet specified targets
through these voluntary measures could conceivably find its title II
funding curtailed unless it agrees to institute mandatory testing of
newborn infants. While I respect the convictions of those who favor
such a result, the simple fact is that mandatory newborn testing cannot
prevent HIV transmission from mother to child and is not supported by
the responsible medical community.
Under the conference agreement, no State would be required to
institute mandatory testing of newborns unless the Secretary finds that
the medical community has changed its mind and such testing has become
routine practice. In essence, it could not be required unless it is
already taking place--a logic which Yogi Berra would surely appreciate.
Nevertheless, I think it would have been wiser to give State health
authorities the resources they need to implement voluntary testing
without holding a gun to their heads and threatening the very funds on
which so many vulnerable people depend.
Fortunately, the agreement we have reached virtually assures that no
State will ever be put in that position. I believe the provision will
allow every State to reduce its rate of perinatal transmission by
voluntary means to a level and within a time frame that is both
achievable and desirable, in a manner that is respectful of the
critical relationship between the woman and her physician.
The effort to reauthorize this legislation has been a long and
tortuous process. It has been, from first to last, a bipartisan effort.
This is as it should be, for the AIDS virus does not discriminate by
race or creed or sexual orientation--or even by party affiliation. This
is a crisis that compels us to put aside such differences, and I
commend Chairman Biliey, Mr. Bilirakis, Mr. Waxman, and our fellow
conferees for doing so.
I urge my colleagues to join together in that spirit to pass the
conference report without delay.
Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from
California [Mr. Bilbray], a member of the subcommittee.
Mr. BILBRAY. Mr. Speaker, I would like to commend Chairman Bilirakis
and the ranking member of our Health Subcommittee, Mr. Waxman, for the
cooperative effort that we see here today. I hate to say it is too bad,
that you watch, you will not see this on the front page of the papers
or you are not going to see this on national television, the
cooperative effort on something that is a major, health issue. I hope
we see more of this kind of cooperation and I hope that the American
people take notice of this success.
I am pleased to see the conference report, Mr. speaker, that
adequately funds the communities that are in desperate need of these
funds to be able to address the heavy impacts of AIDS and HIV. I am
also very pleased to see that this legislative piece actually directs
and corrects some of the mistakes that were made from the past.
Both Republicans and Democrats have worked together at developing a
formula that is fair and equitable and truly applies to the need. The
old formula actually had misconstrued numbers in it, Mr. Speaker, where
there were actually communities getting funds based on numbers of
people that had already passed away.
{time} 1845
I do not think anybody meant that to happen. What I am very proud of
is this body, bipartisanly, has been able to work together to
straighten out the mistakes of the past and make the Ryan White CARE
Act not only stronger and better, but also fairer.
I would like to take a moment to address one item, and that is an
item brought up, and that is the issue of testing. I have an AIDS
Advisory Committee member in my district that consists of health care
experts and also advocates in San Diego for the AIDS community. They
express major concerns about the mandatory testing component that was
originally included. But by trying to work together and find a good
compromise, this bill, through the conference process, has been able to
work it out and actually present an alternative.
I think the conference report addressed the concerns that allow the
time in the States of this Union to be able to work with the Centers
for Disease Control and their regulations to make a voluntary system
that will work out, to counsel pregnant women, make sure there is the
money, up to $10 million, to help not only to test, but also to counsel
in the case of high risk women who fall in this category.
With this compromise, we are able to get the job done. We are going
to be able to break new ground, enter into new territory, and try to be
more proactive in the first truly aggressive prevention strategy. I
think that we should be very proud of that, Mr. Chairman.
I understand that my advisory committee looked at this compromise,
and though they had major concerns about the original proposal, feel
that this is a very sound and humane way to approach this. I think it
is one of those issues that will show that we not only can be humane,
but we can also be smart and intelligent. With a crisis like the AIDS
crisis we are confronted with, this is going to be something we need to
do more of.
Again, I thank Chairman Bilirakis and also my colleague from
California for a job well done, and let us begin with this as an
example of what we need to do more of, and not allow it to end here.
Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentleman from New
York [Mr. Towns], a very important member of the subcommittee who
played an active role in the reauthorization of this legislation.
Mr. TOWNS. Mr. Speaker, I am very pleased that we finally have the
opportunity to vote on a conference concerning the reauthorization of
the Ryan White CARE Act. I want to particularly commend the Chairman of
the committee, the gentleman from Florida [Mr. Bilirakis], for his
tireless efforts to reauthorize this legislation. I want to also thank
the ranking minority member, the gentleman from California [Mr.
Waxman], for his work not only on this bill but also for the tremendous
role he has played in the past in working on the Ryan White Act. And, I
am certain the majority and minority staff are to be equally commended
for their efforts.
There is no more critical issue than funding for health care services
to combat the AIDS virus. Those of us from New York State continue to
have the unfortunate distinction of the highest number of AIDS and HIV
infection cases in the Nation. In fact, the Ft. Greene community in my
congressional district, has the highest incidence of new AIDS cases of
any area in New York City.
Mr. Speaker, Ryan White programs have been critical to New York's
ability to provide a continuum of care which has greatly improved the
quality of life for people with AIDS and HIV infection. For example, as
a result of Ryan White dollars, the HIV/AIDS dental program was able to
provide over $300,000 to Brooklyn Hospital in my district for oral
health services to AIDS patients who had little or no dental insurance.
The changing nature of the AIDS epidemic and its impact on minority
communities is recognized in this legislation. The average person would
assume that the leading cause of death for African-American men is
homicide. They would be wrong, however. AIDS now kills more black men
than gunshot wounds. Eighty-four percent of the
[[Page H4361]]
AIDS cases involving children, age 12 and under, can be found in the
Black community. And, AIDS has now become the second leading cause of
death for black women. I.V. drug use and T.B. have exacerbated these
mortality statistics in minority communities.
It is my hope, Mr. Speaker, that with today's action we can move
quickly to provide the funds that our cities and small towns so
desperately need to address the AIDS crisis in communities across this
Nation. I believe that this reauthorization of the Ryan White CARE Act
meets the needs of rural and suburban areas without devastating our
metropolitan areas, which still have the burden of treating the largest
number of AIDS and HIV infected patients.
This bill has been a long time coming, and I am happy we were able to
get through the conference process and where we are today. I would like
to encourage my colleagues to vote for the passage of this legislation.
There is a need for this legislation to pass and to pass very
quickly. I am not totally pleased with the formula, but I am happy that
some sensitivity was shown to those large areas, those metropolitan
areas, that have a severe crisis.
So I would like to again salute the leadership on both sides, the
minority and the majority, for taking these factors into consideration.
It is not perfect and a lot still needs to be done, but I am happy we
are moving in the right direction.
Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from
Wisconsin [Mr. Klug], a member of the subcommittee and full committee.
Mr. KLUG. Mr. Speaker, to my colleagues on the Health Subcommittee on
Commerce, this is a nice way to end the day after fairly contentious
hearings on trying to figure out a way to reform the Food and Drug
Administration, so that we can get pharmaceutical products and medical
devices to the market faster, but at the same time not compromising
public safety.
This is a fitting end for the day, because we end occasionally, as
this subcommittee can, and I hope will more often in the future, in a
strong spirit of bipartisan cooperation to move forward a very
important piece of legislation.
This is an interesting kind of coming together of the minds, not only
from both sides of the aisle, but, frankly, an interesting
collaboration from people who represent very different parts of the
country.
I represent Madison, WI, which, like most other smaller cities in the
United States, also has AIDS problems. But in the past we feel that we
have been shortchanged because so many of the resources were plowed
into New York and San Francisco, which obviously just based on current
numbers had a much more serious problem. But in the future communities
like Madison and Milwaukee will be just as dramatically impacted. I am
glad to see the gentleman from California [Mr. Waxman] and the
gentleman from Florida [Mr. Bilirakis], as well as the gentleman from
Michigan [Mr. Dingell] and the gentleman from Virginia [Mr. Bliley],
were able to move closer to Senate spending levels, which at the end of
the day frankly will take funding in Wisconsin that was just a little
bit over $1 million and, with the different kind of grant programs,
push it to nearly $2 million.
I think we have all learned over the last decades that AIDS affects
every part of the country, and, obviously, given the name of the bill
itself, affects very different demographic groups, whether it is a
young boy who has been victimized by the AIDS virus as a result of
being exposed to hemophilia in a blood transfusion, or somebody who
contracts AIDS from intravenous drug users, or whatever the case may
be. The bottom line is all of those people need compassion and at the
end all of those people need money.
Again, I congratulate the gentleman from Florida [Mr. Bilirakis] for
his leadership, and the gentleman from California [Mr. Waxman] for all
of his help on this bill as well.
Mr. WAXMAN. Mr. Speaker, I am pleased to yield 2 minutes to the
gentleman from New York [Mr. Ackerman].
(Mr. ACKERMAN asked and was given permission to revise and extend his
remarks.)
Mr. ACKERMAN. Mr. Speaker, I rise in full support of the conference
report and want to take a moment to thank the chairman and the ranking
member of the subcommittee and the full committee as well for the hard
work and dynamic leadership that they have exhibited in bringing all
parties and points of view together in this very, very important
legislation.
I want to especially take a moment to acknowledge the hard work and
important work that has been done in what has been called the AIDS baby
part of this legislation. This is a very, very important and creative
first step that we are taking, first emphasizing as strongly as we can
the voluntary aspects, to try to get as many pregnant women counseled
and tested for the HIV virus and then absent that, or after that, to
whatever extent that does or does not work, and we all hope that will
be as effective a method as possible, to then take those neonates whose
mothers' HIV status is unknown, and to mandatorily test them so as to
be able to save additional lives and to put off the onset of so much
tragedy and emotion in so many people's lives.
I want to thank the members of the conference committee and urge
everybody to support the report.
Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from
Wisconsin [Mr. Gunderson].
(Mr. GUNDERSON asked and was given permission to revise and extend
his remarks.)
Mr. GUNDERSON. Mr. Speaker, first I rise in support of the conference
report; to the commitment tonight continues. Second, I rise to extend
my deep and sincere appreciation to the gentleman from Florida [Mr.
Bilirakis], the chairman of the subcommittee, to the gentleman from
Virginia [Mr. Bliley], chairman of the full committee, certainly to the
gentleman from California [Mr. Waxman], to the gentleman from Oklahoma,
[Mr. Coburn], and others who have worked so hard to bring this day to
its reality.
The fact is that this is a difficult process and there were some
issues that were obviously very difficult, the infant testing issue,
the formula for title II. But both of those issues have been resolved
in, I think, a very positive and constructive way.
I can tell you from a Wisconsin perspective, because we now have some
reforms in the title II program, we can look toward an increase in our
funding in 1996 over 1995 of from $1 million to $1.5 million. In
addition, because we now have a drug assistance program, we can look at
the potential because it has been funded under the appropriation
process, of literally $254,000 in that regard.
I would hope that we would send a message tonight, a message that has
been developed over the last 2 weeks, that shows that this Congress on
a bipartisan basis, and, yes, that includes the Republican majority,
has sent the word that we understand and we care and we want to help.
We did it first and foremost last week when we repealed the DOD-HIV
provisions. We did it second last week when we included money for the
AIDS drug assistance program, because we recognize that the new
protocols are there but the funding is going to be one of the emerging
challenges in the next few years to deal with in this area. We did it,
third, because we increased the overall funding for Ryan White. Whoever
thought under a Republican-controlled Congress that we would stand here
tonight and tell you that Ryan White funding is up 17 percent over what
it was last year? And now, tonight, we bring you a reauthorization of
the Ryan White program.
It has been a good two weeks and it is important. Many of you recall,
certainly those of you who attended that hearing that began this
reauthorization process a few months ago when Mr. Bilirakis gave me the
honor of being the lead witness, I brought a former Republican staff
member who had retired November a year ago with AIDS with me to that
witness table and said ``Hear from one of our own on Capitol Hill who
has AIDS.''
Tonight as we pass this reauthorization, some 8 months later, his
partner died of AIDS in November, and he lies in Sibley Hospital
himself tonight as the ravage of this disease continues. I think it is
important as those among the 300,000-plus in this country who have lost
their life to AIDS, and the over 1 million who continue to battle the
fight continue, that they know as
[[Page H4362]]
their battle goes on they do it with the support of the U.S. Congress.
Mr. Speaker, I am happy to speak in favor of the Ryan White CARE
Reauthorization Act conference report. To say that this reauthorization
has been a long time in coming may be an understatement. Certainly, we
all had hoped that this reauthorization could have been completed
sooner, but the issues this conference committee grappled with were
delicate and complex. Importantly, their deliberations were careful and
fair, and I think that their final product is one of which they can be
proud and which we should all support. I congratulate the conference
committee on their work. I plan to vote in favor of this conference
report, in favor of reauthorization, and I urge my colleagues to do the
same.
HIV disease, including AIDS, is devastating and has already wreaked a
tremendous toll on this country and its citizens. The Centers for
Disease Control and Prevention [CDC] reports that over a half million
Americans have been diagnosed with AIDS, and that already over 300,000
have died. It is estimated that approximately 650,000 to 1 million more
Americans are infected with HIV, and that roughly 40,000 new infections
occur in the United States each year. The costs, financially,
emotionally, socially, and legally, that HIV has extracted from this
country have been great, but what these projections indicate is that
they will only increase in the years ahead. The Ryan White CARE Act
programs represent the most visible and significant response the
Federal Government has made to the HIV epidemic. It has provided
services and support for thousands of people affected by this disease,
and through this reauthorization, we can insure that such programs will
continue to be available for the next 5 years.
I would like to offer a few comments on some of the specific
successes that I see in the reauthorization conference report. I view
these as successes because workable and bipartisan compromises were
reached, compromises that will allow us to move forward in effectively
meeting the challenges HIV poses to this country.
First, funds for emergency assistance programs, those programs that
serve metropolitan areas hit hardest, and for comprehensive care
programs, will be linked and appropriated based on a plan devised by
the Health and Human Service Secretary. This linkage will help prevent
needless fighting for funds within the AIDS community and between
different organizations and advocates that all have the common goal of
improving the lives of people affected by HIV. In addition, the big
picture of the HIV epidemic will most likely determine the disbursement
of funds rather than narrowly circumscribed geographic regions or
special interests.
In addition, the formula that was adopted for the distribution of
title II, or part B, funds moves toward greater fairness. Previously,
all funds were distributed based on all AIDS cases in a State. AIDS
cases are not distributed equally across States, however, so there was
great disparity in the funding levels for different States. But, the
suffering caused by AIDS knows no State boundaries and is not limited
to the States with the highest case counts. The new formula recognizes
this important fact and disburses funds based on total AIDS case counts
in a State as well as AIDS case counts that occur outside of hard-hit
metropolitan areas.
My home State of Wisconsin, for example, has reported 3,239 cases for
AIDS through March 1996. This total may not sound like much to my
colleagues from New York, California, Florida, or Texas. But, the fact
remains that for each of these cases, there is an individual whose life
has been irrevocably changed, who faces new challenges everyday, and
whose family and friends have been affected. Many of us know firsthand
the pain of HIV and AIDS, including the pain of losing a loved one too
early, and this pain is not diminished simply because we live in a low
incidence area or State.
In addition, the CDC recently reported that the rate of proportionate
increases in AIDS cases was high in the Midwest, and higher than the
rates in the Northeast and West. In fact, during the period between
1993 and October 1995, higher proportions of cases among adolescent and
young adults occurred in small metropolitan and rural areas in the
Midwest and the South. Total case counts do not reveal the depth of
suffering inflicted by AIDS, nor do they reveal where changes in
transmission patterns are occurring. The new formulas for distributing
funds move us forward in being responsive to these changes and to
alleviating the suffering of all Americans affected by HIV.
Also in the name of fairness, this reauthorization stipulates that
money to support AIDS drug programs, appropriated at $52 million in
fiscal year 1996, will be based on total case counts. The committee has
adopted the simple and compelling logic that these drugs and drug
programs are intended to benefit anyone and everyone in a State with
HIV disease. As long as funds for drugs and treatments remain a
separate provision in appropriations, they will continue to be
distributed based on the numbers of people who are affected in a State.
Lastly, there is a provision in the reauthorization that insures that
cities that receive funds under title I will not lose money. For the
first 2 years, these cities are held harmless and the funds that could
be lost are capped at 5 percent in fiscal year 2000. Thus, there is
relative insulation from dramatic changes in funding levels, even if
there are substantial changes in AIDS case counts.
These formulas for distributing funds, complicated as they may be,
insure that there are no losers. The States with relatively large case
counts are protected from losing money, yet the new formulas benefit
States with relatively few cases, too. It is a delicate balance to
divide funds to combat a truly national epidemic; this conference
report has successfully accomplished this difficult task.
Another issue on which a delicate compromise has been crafted has to
do with perinatal testing for HIV. HIV testing, and whether it should
be anonymous or confidential, mandatory or voluntary, has long been a
controversial topic. I believe that testing today is a critical part of
good public health. Recent advances in the treatment of HIV disease
have been developed and are becoming increasingly available. To test
HIV positive is no longer the death sentence that many perceived it to
be previously. For individuals to access these new and effective
treatments, however, they must know that they are HIV positive. Testing
should be encouraged and should take place in a supportive and
sensitive context. With respect to pediatric HIV, scientific research
also has indicated that early treatment of a mother can reduce the
risks that her baby will be born with HIV.
An important piece of this reauthorization is the way in which
perinatal testing has been addressed. Rather than imposing a strict and
perhaps impossible testing standard on all States, the reauthorization
is flexible in its treatment of different States. In addition, critical
goals or guideposts are laid out by which States can gauge their
progress toward eliminating needless and tragic infant HIV infection.
The conference committee has succeeded in providing carrots and not
just sticks for implementing effective HIV testing programs as well as
evaluation criteria by which success can be judged.
To conclude, I urge a vote in favor of this conference report. Let
all of us demonstrate our compassion, concern, and commitment to
fighting the HIV epidemic in this country and to ensuring the high
quality of life of Americans affected by HIV disease.
Mr. WAXMAN. Mr. Speaker, I am pleased to yield 2 minutes to the
gentlewoman from Texas [Ms. Jackson-Lee].
(Ms. JACKSON-LEE of Texas asked and was given permission to revise
and extend her remarks.)
Ms. JACKSON-LEE of Texas. Mr. Speaker, may I take a moment of
personal privilege to offer my gratitude to the conference committee,
to the leadership, the Republican leadership, and chairman and ranking
member, and as well to the ranking member and subcommittee chairs that
have worked so actively. In particular, let me add my applause and
appreciation to the gentleman from California [Mr. Waxman] who has
visited the 18th Congressional District in Texas and noted in fact that
my district has one of the highest rates of HIV cases in this Nation.
So I humbly come to applaud the work, primarily because we should
recognize that HIV is not a respecter of sex or race. High numbers of
Hispanics and African-Americans in my community are now suffering from
HIV.
This effort, the Ryan White CARE Act, also brings groups together,
those who are in a different lifestyle, along with other members of the
community. It is important to know that this HIV, which results in
AIDS, affects people of all ages, genders, races, social and economic
status and sexual orientations.
In the years following the disease's discovery, nearly half a million
Americans have been diagnosed with AIDS and more than a quarter of a
million men and women and children have died of AIDS. In Texas, the
cumulative number of reported AIDS cases from the beginning of the
epidemic in 1981 through 1994 is 30,712. The cumulative number of
reported AIDS deaths for this time period is 18,435.
When I visited the Thomas Street Clinic that works not only with
adults between the ages of 25 to 44, but senior citizens and children,
I see the grip of AIDS. More importantly, I think it is important that
this conference committee has come together to allow for voluntary
testing of pregnant women
[[Page H4363]]
and as well counseling. That helps the unborn child, the innocent
child. That will help as we look toward the total elimination of the
HIV virus and its devastation.
Again let me add through the Ryan White program, over 300,000
Americans living with HIV receive community-based care and support that
allows them to live in their homes and neighborhoods. I join and hope
my colleagues will give this an enormous vote of confidence by voting
for the Ryan White CARE Act of 1996.
Mr. Speaker, let me again applaud my colleagues so that we can work
together to ensure that people will live and not die from HIV.
Mr. Speaker, I rise today in support of the conference report for the
Ryan White CARE Act Amendments of 1996. Next to the Medicaid Program,
the Ryan White CARE Act represents the single largest Federal
investment in the care and treatment of people living with HIV/AIDS in
the United States.
This act authorizes a set of Federal grant programs to provide
assistance to localities disproportionately affected by the HIV
epidemic. Grants are made to States, to certain metropolitan areas, and
to other public or private nonprofit entities both for the direct
delivery of treatment services and for the development, organization,
coordination, and operation of more effective service delivery systems
for individuals and families with the HIV disease. The CARE Act
supports a wide range of community based services, including primary
and home health care, case management, substance abuse treatment and
mental health services, nutritional and housing services. Through Ryan
White programs, over 300,000 Americans living with HIV/AIDS receive
community-based care and support that allows them to live in their
homes and neighborhoods and avoid costly in-hospital care, care that is
currently the most expensive kind of health care in America.
Particularly in the urban AIDS epicenters, Ryan White funds form a
safety net holding communities that have been devastated by the
epidemic together.
The CARE Act promotes cost effective systems of care for people
living with HIV/AIDS. The use of case management services and community
based alternatives ensures that the federal government is using its
resources most effectively. Similarly, antibody testing and early
intervention services provided through title III(B) allow individuals
to monitor their health status on a regular basis and receive early,
preventative care, rather than waiting until an acute episode requires
more costly hospitalization.
The CARE Act provides maximum flexibility to cities and States,
allowing them to develop local systems of care based on the specific
service needs of people living with HIV/AIDS in their area. Title I of
the CARE Act requires that each local HIV services planning council--
comprised of local public health, community-based service providers and
people living with HIV/AIDS assess local needs and make recommendations
as to which services are needed. Similarly, through title II, each
State is given maximum flexibility to craft a service mix that is
responsive to the specific service needs in that State.
One of the most important programs funded by the Care Act in Texas is
the AIDS Drug Assistance Program [ADAP]. Texas' ADAP is administered by
the HIV/STD Medication Program at the Texas Department of Health and it
provides free or low-cost HIV prescription drugs to individuals who
would otherwise have no access to basic HIV treatments. The program
currently has 4,775 clients enrolled and so far in fiscal year 1996
3,437 have been provided with medications they might not have otherwise
received. Approximately 35 to 40 percent of the clients are Medicaid
eligible at some time. Funds from the ADAP are only used to pay for
drugs the clients cannot receive with Medicaid benefits. All clients
have incomes below 200 percent of the poverty line.
Mr. Speaker, the AIDS epidemic is one that cries out for immediate
and forceful action. The human immunodeficiency virus [HIV], which
causes AIDS, does not discriminate. It affects people of all ages,
genders, races, socioeconomic statuses, and sexual orientations. In the
years following the disease's discovery, nearly half a million
Americans have been diagnosed with AIDS, and more than a quarter of a
million men, women, and children have died of AIDS. In Texas, the
cumulative number of reported AIDS cases from the beginning of the
epidemic in 1981 through 1994 is 30,712. The cumulative number of
reported AIDS deaths for this time period is 18,435.
Mr. Speaker, AIDS is the leading killer of Americans between the ages
25 and 44. AIDS is killing the youngest and most vital part of our
workforce and our whole Nation suffers as a result. The Centers for
Disease Control and Prevention estimated that in 1992 the indirect cost
of the AIDS epidemic to the U.S. economy was $23.3 billion, primarily
due to wages lost by workers. Clearly, we must invest in HIV
prevention, education and treatment. I support the conference report
and I urge my colleagues to do so as well.
Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from
Florida [Mr. Foley].
{time} 1900
Mr. FOLEY. Mr. Speaker, let me thank the gentlewoman from Texas for
her acknowledgment. That was very gracious and very kind, and I hope I
hear more of that tonight from the other side because this truly is a
bipartisan effort in helping people that have been stricken by a very
deadly and tragic disease.
With the passage of the conference report on the Ryan White CARE
amendment today we have a valuable opportunity to continue our
commitment in the fight against AIDS. This legislation secures vital
medical care and treatment for Americans suffering with this tragic
disease and gives States more flexibility to provide them with a wider
range of support services.
Since 1981, over 250,000 Americans have died from AIDS and more than
a million others are expected to be infected. Sadly, the number of
women, children, and teenagers infected with HIV continues to grow
dramatically.
In my home district in Florida, the city of West Palm Beach has the
single second highest rate of HIV infections in females. The
legislation recognizes these concerns and sets up special grants to
provide health services to women, infants, and children.
As more and more of our Nation's communities are affected by the AIDS
epidemic, preserving the partnerships we have developed between the
Federal, State and local governments to meet these health care needs is
critical.
I want to single out the gentleman from Florida [Mr. Bilirakis] for
his leadership on this important legislative initiative, but I also
want to take a moment to thank some people that are often derided by
both the media and the other side of the aisle as the radical extreme
of this party. I want to say, thank you, Mr. Newt Gingrich. He first
brought the Ryan White Act onto this House floor under a suspended
calendar to prevent it from being intruded on by harmful amendments.
Let me thank the gentleman from Louisiana, Bob Livingston, chairman
of the Committee on Appropriations, for working so closely with Mr.
Bilirakis to secure $105 million additional for the funding of the Ryan
White Act this year alone.
Let me thank my Republican colleagues for recognizing the severity of
AIDS; that it affects Republicans, that it affects Democrats, that it
affects Independents, that it affects men, it affects women, it affects
blacks, whites, and Hispanics, that it affects heterosexuals as well as
homosexuals. It affects America, our families, our children.
This legislation brings us to the point where we are fighting a
dreaded disease and we are fighting it in a bipartisan spirit, caring
for the soul of the human being rather than their ethnicity, their
race, their gender, their preference or their voting status.
I think we embark today on a day of bipartisan spirit, and I hope the
media genuinely reflects that it is a Republican majority that brings a
bill to this floor to show care and compassion for human beings; it is
a Republican majority, in concert with the gentleman from California
[Mr. Waxman], and the minority who brings a bill together that funds a
tragic, tragic thing in American life. It fights AIDS, it fights the
battle, and it provides for human suffering when they need help the
most.
Again my commendations to the gentleman from Florida [Mr. Bilirakis]
for his excellent leadership, and I urge the floor to vote solidly for
the reenactment of the Ryan White Act.
Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Connecticut [Mrs. Kennelly].
Mrs. KENNELLY. Mr. Speaker, I thank the gentleman from California
[Mr. Waxman] for yielding the time, and I rise in strong support of the
conference report for the Ryan White CARE Reauthorization Act.
My State knows all too well the pain and agony that HIV and AIDS
bring. Connecticut has the fifth highest number of AIDS cases per
capita in the Nation. In my district, the city of Hartford has been
particularly hard hit.
[[Page H4364]]
AIDS is clearly a health crisis we must address now.
Last fall, Hartford and two adjoining counties were, for the first
time, awarded title I Ryan White funding. This money will enable people
living with AIDS to receive services so important to those ill--from
housing to child care to respite care.
The formula under this conference report ensures that communities,
like Hartford, with growing caseloads get the emergency funds they need
to respond to this crisis. More importantly, it ensures the thousands
of men, women, and children affected by the disease get the support
they need to live their lives with dignity.
I urge a ``yes'' vote on this conference report.
Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from
California [Mr. Horn].
Mr. HORN. Mr. Speaker, I join others in commending the gentleman from
Florida, Chairman Bilirakis, for bringing the Ryan White Act to the
floor for reauthorization.
Mr. Speaker, I rise today in strong support of S. 641, the Ryan White
Comprehensive AIDS Resources Emergency Reauthorization Act of 1995.
Thousands of men and women and children with HIV and AIDS depend on the
continuation of these vital services and this vital program.
Ryan White services include outpatient health and medical services,
pharmaceuticals, funding for the continuation of private health
insurance and home care, which is essential. Without such assistance,
tens of thousands of people will be adversely affected. Without such
assistance increased suffering will ensue.
I have been an early active supporter of the Ryan White program since
coming to Congress in 1993, and in the 103d and the 104th Congresses
this bipartisan act and appropriate funds and increases have been
allocated by the Members with overwhelming majorities. Sufficient
funding for AIDS research, care, and prevention must be the consistent
goal of all future Congresses until this horror is eradicated from the
Earth.
Mr. WAXMAN. Mr. Speaker, I yield 1 minute to the gentleman from New
Jersey [Mr. Payne].
Mr. PAYNE of New Jersey. Mr. Speaker, I would like to commend my
colleagues for their work in the fight against AIDS in our community.
By producing this very important document, we here, in the spirit of
bipartisanship, have taken another step to deal with the devastation
and the threat that this disease poses to our society.
AIDS is growing fastest among women and children in our society. By
early 1993, 253,448 people in the United States had been diagnosed with
AIDS.
In my district in Newark, we have one of the highest reported
percentages of women with AIDS. In fact, I held the first congressional
hearing in my district on the AIDS issue.
Later, we held a hearing on the problem of abandoned infants, where
women infected with AIDS testified about the problems they encounter
and their personal plight.
As an original cosponsor of the Ryan White bill, I know the real
travesty of this disease and we can prevent it. If this document is any
indication, I believe there is some hope that we turn this tragedy into
a triumph.
I look forward to working very closely with my colleagues to
eliminate the threat to our community and our society.
Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from
Oklahoma [Mr. Coburn] who has added an awful lot of grassroots and
personal experience to the subcommittee and to the full committee and,
obviously, to this particular piece of legislation, and we are very
grateful for his work on Ryan White.
(Mr. COBURN asked and was given permission to revise and extend his
remarks.)
Mr. COBURN. Mr. Speaker, I thank the chairman of the committee. We
come here tonight happy that we have accomplished some things that are
new, some things that are important, but, most of all, to provide
support for those that need our support in terms of facing HIV
infection.
Some things have been added to this bill, which needed to be added a
long time ago, and the first of those is a prohibition on
discrimination based on either HIV status or the seeking of an HIV
test. It is long overdue and I am glad to see it included.
Spousal notification is something that is needed. It is right. It is
proper. It is a part of this bill as well.
And then, finally, putting in perspective where we have seen the best
AIDS research come forward; that in terms of treating newborn infants
and infants conceived to women who are HIV positive. The science is
great, the science is very promising, and, hopefully, this science will
lead to further discoveries and further breakthroughs that will treat
those that are so ravaged by this disease.
Mr. Speaker, I want to thank the gentleman from California [Mr.
Waxman] and those of the other side of the aisle who worked to help us
forge out a compromise. I believe we have forged out a good one and I
am hopeful we can get this money going straight away to help those who
need it.
Mr. WAXMAN. Mr. Speaker, I yield myself 2 minutes for the purpose of
engaging in a colloquy with the gentleman from Florida.
(Mr. WAXMAN asked and was given permission to revise and extend his
remarks.)
Mr. WAXMAN. Mr. Speaker, this bill provides that funds appropriated
solely for the drug assistance program be allocated based on statewide
case counts. I ask the gentleman from Florida; is that correct?
Mr. BILIRAKIS. Mr. Speaker, will the gentleman yield?
Mr. WAXMAN. I yield to the gentleman from Florida.
Mr. BILIRAKIS. Mr. Speaker, I would say to the gentleman that that is
correct.
Mr. WAXMAN. The bill also specifies that 3 percent of the
appropriations for each title of the Ryan White program be set aside
for the special projects of national significance; that 1 percent be
set aside for technical assistance; and 1 percent for the Public Health
Service evaluation funds.
It was my understanding that the $52 million for the drug assistance
program would not be subject to these set-asides nor would this sum be
included in calculating the set-aside taken from the formula grant. Was
that the gentleman's understanding as well?
Mr. BILIRAKIS. Mr. Speaker, if the gentleman will continue to yield,
yes, it was my understanding, Mr. Waxman, and I hope this colloquy and
conversations with the Health Resources and Services Administration
will help to clarify this point prior to funds being distributed to
States.
Mr. WAXMAN. Mr. Speaker, I thank the gentleman for entering into this
colloquy so we can clarify this.
Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentleman from
Connecticut [Mr. Shays].
Mr. SHAYS. Mr. Speaker, I just really want to express my gratitude to
the gentleman from Florida [Mr. Bilirakis] and the ranking member, the
gentleman from California [Mr. Waxman], for working so well together,
and the full chairman of the committee as well as the gentleman from
Oklahoma [Mr. Coburn], in particular, a new member who has helped bring
together and help forge some very important elements to this bill.
Mr. Speaker, I am grateful that we are seeing a 17 percent increase
in the Ryan White funding over last year. I am particularly grateful
that we are seeing for the first time the prohibiting of health
insurance discrimination against someone who suspects or in fact is HIV
positive.
We have a million people in our country who are HIV positive, we have
300,000 who have died of AIDS. This country needs to come together to
heal the wounds and to help them, and I am just extraordinarily
grateful for the leaders on both sides of the aisle who have
depoliticized this and made a significant step forward in helping the
people in our country who need the help the most.
Mr. GILMAN. Mr. Speaker, over 250,000 Americans have died from AIDS,
the dreaded equal opportunity killer which first became known to
Americans in 1981. It is a health crisis which must be addressed now.
This legislation accomplishes many of our most important goals--to
modify the eligibility requirements and allocation formulas for grants
to State and local governments; to give States increased flexibility to
provide a wider range of treatments and support services; to emphasize
the provision of services for women, infants, and children by
instituting special grant set-
[[Page H4365]]
asides; to cap administrative and evaluation expenses for grant
programs, and; to require states to implement center for disease
control guidelines regarding HIV testing and counseling for pregnant
women.
In short, this legislation not only demonstrates bipartisan
humanitarian spirit of this Congress, but by working together in areas
of mutual concern we can accomplish worthy goals. Accordingly, I am in
strong support of the Ryan White CARE Act amendments conference support
and urge its immediate passage.
Mr. BLILEY. Mr. Speaker, I am pleased that we are bringing to the
floor the reauthorization of the Ryan White CARE Act.
I am particularly pleased that we were able to work on a bipartisan
basis to develop this legislation. I believe that we have developed a
bill that responds to changes in the HIV and AIDS epidemic, addresses
some concerns with the current implementation of the Ryan White
program, includes provisions regarding the perinatal transmission of
HIV, and attempts to reach a compromise on funding formulas.
As is always the case, the funding formulas proved to be the most
difficult issue to resolve. It was further complicated by the fact that
States have not adopted the new definition of AIDS in a uniform
fashion, which without a reauthorization would have resulted in large
shifts of money this year. In addition, there have been some very
exciting therapeutic breakthroughs over the past several months. While
these breakthroughs represent tremendous hope in the treatment of HIV/
AIDS, they result in additional financial strains on States. For these
reasons, I believe it was very important, in agreeing on the title II
formula, that we kept in mind both the disruptions caused by large
shifts in money and the need to provide the non-EMA States with greater
funds.
We believe we have achieved a fair compromise between the original
House and Senate positions. We significantly increase funding for non-
EMA States while limiting the losses to large States with title I
cities. The formula we have agreed upon is a modified version of the
Senate formula. I do want to point out however, that in the fiscal year
1996 appropriations bill, which just passed, an additional $52 million
was provided solely for the drug assistance program. The conference
agreement provides that these funds will be allocated based on the
statewide case count rather than the Senate formula. I believe this is
important because the States provide drugs to all individuals with HIV/
AIDS regardless of where they live through the drug assistance program.
The other key issue was that of perinatal transmission of HIV. All
the conferees, and I am certain all Members of the House and Senate,
share the same goal--reducing the transmission of HIV to infants, and
in those cases where transmission is not prevented, identifying and
treating those babies as soon as possible. It is our sincere hope that
the provisions included in the conference agreement will achieve that
goal.
I also want to point out that we have received a letter from CBO
stating that the bill does not invoice the Unfunded mandates Reform Act
of 1995. And I ask that the letter from CBO follow my statement.
I want to thank all the conferees and their staffs for their
perseverance and hard work on this conference agreement. I also want to
thank the staff at the General Accounting Office who spent many long
hours running iterations of the formulas.
I urge my colleagues to join me in supporting the conference
agreement.
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 1, 1996.
Hon. Thomas J. Bliley, Jr.
Chairman, Committee on Commerce, House of Representatives,
Washington, DC.
Dear Mr. Chairman: At the request of your staff, the
Congressional Budget Office has reviewed the conference
committee's discussion draft of S. 641, the Ryan White CARE
Act Amendments of 1996, for intergovernmental and private
sector mandates. The bill contains two intergovernmental
mandates and no private sector mandates. The cost of the
intergovernmental mandates would not exceed the $50 million
threshold established in Public Law 104-4, the Unfunded
Mandates Reform Act of 1995.
S. 641 would require states to determine annually the
number of AIDS cases reported within their boundaries that
result from perinatal transmission. The cost associated with
this requirement would be insignificant because most states
are already gathering this type of information.
The bill would also require states to adopt the Center for
Disease Control's (CDC's) guidelines concerning HIV
counseling and voluntary testing for pregnant women. In order
to offset the costs associated with adopting these
guidelines, the bill would authorize the appropriation of $10
million in each of fiscal years 1996 through 2000. Any state
that does not adopt the guidelines would not be eligible for
this funding, but the bill does not clearly relieve states of
responsibility for adopting the CDC guidelines if they choose
not to take any of the grant money. While CBO does not expect
the costs of promulgating the CDC guidelines to be
significant, public hospitals and clinics could face
additional costs in implementing the guidelines. However,
many hospitals and clinics are already carrying out these
AIDS-related activities on their own or because their states
have already adopted the CDC guidelines. In the time
available, CBO has not been able to estimate the additional
costs with precision, but we believe that the costs to public
facilities would be well below the $50 million threshold.
Furthermore, the bill authorizes funds that would at least
partially offset these costs.
Finally, as a condition of receiving their Ryan White grant
money, states may have to require all newborns to be tested
for HIV. This requirement would not be a mandate as defined
by Public Law 104-4, because it is clearly a condition for
receiving federal financial assistance.
If you wish further details on this estimate, we will be
pleased to provide them. The analyst for intergovernmental
mandates is John Patterson, and the analyst for private
sector mandates is Linda Bilheimer.
Sincerely,
June E. O'Neill, Director.
Mr. LAZIO of New York. Mr. Speaker, I rise today to support S. 641,
the Ryan White CARE Act amendments conference Report. I am a cosponsor
of the House bill. It is long overdue and I am glad that Congress is
finally completing its work on this measure.
New York has been hit especially hard by the AIDS epidemic as close
to 20 percent of all AIDS cases are in my home State.
Since its enactment, the Ryan White CARE Act has provided a wider
range of services for people of all racial, ethnic, and social-economic
classes throughout the United States who are struggling with HIV
disease. These funds provide a coordinated continuum of care for these
individuals. Some of the services supported by the CARE Act include
outpatient health and medical serrices, pharmaceuticals, funding for
continuation of private health insurance, and some health care.
As a society we have a responsibility to provide for those who are
truly needy. Since its original enactment the Ryan White program has
helped tens of thousands of AIDS victims in my home State of New York
State as well as those throughout the country.
We need to reauthorize the Ryan CARE Act without any further delay
and I urge all my colleagues to vote for its passage.
Mrs. MINK of Hawaii. Mr. Speaker, I rise in strong support of the
conference report on the Ryan White CARE Reauthorization Act of 1995.
The importance of this act cannot be overstated; in the 6 years since
its enactment, it has been a lifeline of support to hundreds of
thousands of AIDS and HIV victims throughout the country.
The challenges of our fight against AIDS are not unfamiliar to us.
Since the onset of this epidemic over 15 years ago, we have struggled
to contain this virus via surveillance and prevention efforts, as
researchers worldwide scrambled for a cure. Meanwhile, numbers of
people affected with the AIDS has spiraled upward. According to the
Centers for Disease Control, more than 440,000 cases of AIDS have been
reported in this country, and over 1 million are HIV-infected. Over 100
Americans die each day from the disease. Health care costs for treating
the virus have risen astronomically, taking an unwieldy economical toll
on its victims. Discrimination rising out of fear and lack of awareness
about the AIDS and HIV has exacerbated the sense of emotional isolation
faced by its victims. This is all in addition to the physical agony the
disease wreaks on the body.
The scope of this crisis clearly commands the attention and resources
of the American people. The Ryan White CARE Act of 1990 made available
much needed Federal money to help ease the physical, emotional, and
economic toll of the disease on its victims. Our Nation was caught so
unprepared for the advent and explosion of AIDS and HIV in the last two
decades, that this legislation provided needed relief for our reeling
health services delivery system. In the 6 years since the law
authorized grants to States and cities for AIDS treatment and support
programs as alternatives to inpatient care, much of the burden that
urban and rural hospitals face has been alleviated and the quality of
life for those suffering with the virus has greatly improved. National
AIDS organizations and Federal, State, and local public health
officials have testified to the success of the program, while
underscoring that the urgency of the AIDS epidemic has not subsided and
that there exists a continued need for the CARE Act.
[[Page H4366]]
We are entering a new phase in our battle against the virus. A recent
article in the New York Times discussed the arrival of a new class of
drugs known as protease inhibitors, which, taken in combination with
standard older drugs, provide the most potent therapy against HIV to
date. These new treatments are unfortunately very expensive. Where
Medicare and private insurance defer some of the cost, many patients
are depending on the AIDS drug reimbursement program of the CARE Act as
a means of easing their suffering. I strongly believe that it is
especially critical as we are on the brink of medically treating this
disease, that we do not withdraw our funding support.
Fighting against this killer virus is the universal charge of all
Americans. AIDS is no longer a disease of a select few, but instead
touches the lives of more and more people in our society. The epidemic
has spread into suburban and rural areas in every State of this country
and entered the ranks of sports heroes and movie stars. AIDS is
currently the No. 1 killer of all Americans between the ages of 25 and
44. It does not discriminate between gender or sexual orientation. It
cuts across all races and socio-economic classes. As of July 1994,
5,000 children had received an AIDS diagnosis. It is our collective
social responsibility to provide for our most vulnerable citizens the
best that we can, and I urge my colleagues to support this conference
report.
Mr. WAXMAN. Mr. Speaker, I have no further requests for time, and I
yield back the balance of my time.
Mr. BILIRAKIS. Mr. Speaker, I yield back the balance of my time, and
I move the previous question on the conference report.
The previous question was ordered.
The SPEAKER pro tempore (Mr. Ewing). 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. GUNDERSON. Mr. Speaker, I object to the vote on the ground that a
quorum is not present and make the point of order that a quorum is not
present.
The SPEAKER pro tempore. Evidently a quorum is not present.
The Sergeant at Arms will notify absent Members.
The vote was taken by electronic device, and there were--yeas 402,
nays 4, not voting 27, as follows:
[Roll No. 145]
YEAS--402
Abercrombie
Ackerman
Allard
Andrews
Archer
Armey
Bachus
Baesler
Baker (CA)
Baker (LA)
Baldacci
Barcia
Barr
Barrett (NE)
Barrett (WI)
Bartlett
Bass
Bateman
Becerra
Bentsen
Bereuter
Bevill
Bilbray
Bilirakis
Bishop
Blute
Boehlert
Boehner
Bonior
Bono
Borski
Brewster
Browder
Brown (CA)
Brown (FL)
Brown (OH)
Brownback
Bryant (TN)
Bunn
Bunning
Burr
Burton
Buyer
Callahan
Calvert
Camp
Campbell
Canady
Cardin
Castle
Chabot
Chambliss
Chapman
Chenoweth
Christensen
Chrysler
Clayton
Clement
Clinger
Clyburn
Coble
Coburn
Coleman
Collins (GA)
Collins (IL)
Collins (MI)
Combest
Condit
Conyers
Cooley
Costello
Cox
Coyne
Cramer
Crane
Crapo
Cremeans
Cubin
Cummings
Cunningham
Danner
Davis
Deal
DeFazio
DeLauro
DeLay
Dellums
Deutsch
Diaz-Balart
Dickey
Dixon
Doggett
Dooley
Doolittle
Dornan
Doyle
Dreier
Duncan
Dunn
Durbin
Edwards
Ehlers
Ehrlich
Emerson
English
Ensign
Eshoo
Evans
Everett
Ewing
Farr
Fattah
Fawell
Fazio
Fields (LA)
Fields (TX)
Filner
Flake
Flanagan
Foglietta
Foley
Forbes
Ford
Fowler
Fox
Frank (MA)
Franks (CT)
Franks (NJ)
Frelinghuysen
Frisa
Frost
Furse
Gallegly
Ganske
Gejdenson
Gekas
Gephardt
Geren
Gilchrest
Gillmor
Gilman
Gonzalez
Goodlatte
Goodling
Gordon
Graham
Green (TX)
Greene (UT)
Greenwood
Gunderson
Gutierrez
Gutknecht
Hall (OH)
Hall (TX)
Hamilton
Hancock
Hansen
Harman
Hastert
Hastings (FL)
Hastings (WA)
Hayworth
Hefley
Hefner
Heineman
Herger
Hilleary
Hilliard
Hinchey
Hoekstra
Hoke
Holden
Horn
Hostettler
Hoyer
Hunter
Hutchinson
Hyde
Inglis
Jackson (IL)
Jackson-Lee (TX)
Jacobs
Jefferson
Johnson (CT)
Johnson (SD)
Johnson, E. B.
Johnson, Sam
Johnston
Jones
Kanjorski
Kasich
Kelly
Kennedy (MA)
Kennedy (RI)
Kennelly
Kildee
Kim
King
Kingston
Kleczka
Klink
Klug
Knollenberg
Kolbe
LaFalce
LaHood
Lantos
Largent
Latham
LaTourette
Laughlin
Lazio
Leach
Levin
Lewis (CA)
Lewis (GA)
Lewis (KY)
Lightfoot
Lincoln
Linder
Lipinski
LoBiondo
Lofgren
Longley
Lowey
Lucas
Luther
Maloney
Manton
Manzullo
Markey
Martinez
Martini
Mascara
Matsui
McCarthy
McCollum
McCrery
McDermott
McHale
McHugh
McInnis
McIntosh
McKeon
McKinney
McNulty
Meehan
Meek
Menendez
Metcalf
Meyers
Mica
Millender-McDonald
Miller (CA)
Minge
Mink
Moakley
Mollohan
Montgomery
Moorhead
Moran
Morella
Murtha
Myers
Myrick
Nadler
Neal
Nethercutt
Neumann
Ney
Norwood
Nussle
Oberstar
Obey
Olver
Ortiz
Orton
Owens
Oxley
Packard
Pallone
Parker
Pastor
Paxon
Payne (NJ)
Payne (VA)
Pelosi
Peterson (FL)
Peterson (MN)
Petri
Pickett
Pombo
Pomeroy
Porter
Portman
Poshard
Pryce
Quillen
Quinn
Radanovich
Rahall
Ramstad
Rangel
Reed
Regula
Richardson
Riggs
Rivers
Roberts
Roemer
Rogers
Rohrabacher
Ros-Lehtinen
Rose
Roth
Roukema
Roybal-Allard
Royce
Rush
Sabo
Salmon
Sanders
Sanford
Sawyer
Saxton
Schaefer
Schiff
Schroeder
Schumer
Scott
Seastrand
Sensenbrenner
Serrano
Shadegg
Shays
Shuster
Sisisky
Skaggs
Skeen
Skelton
Slaughter
Smith (MI)
Smith (NJ)
Smith (TX)
Smith (WA)
Solomon
Souder
Spence
Spratt
Stark
Stearns
Stenholm
Stockman
Stokes
Studds
Stupak
Talent
Tanner
Tate
Tauzin
Taylor (MS)
Taylor (NC)
Tejeda
Thomas
Thompson
Thornberry
Thornton
Thurman
Tiahrt
Torkildsen
Torres
Towns
Traficant
Upton
Velazquez
Vento
Visclosky
Volkmer
Vucanovich
Walker
Walsh
Wamp
Ward
Waters
Watt (NC)
Watts (OK)
Waxman
Weldon (PA)
Weller
White
Whitfield
Wicker
Williams
Wise
Wolf
Woolsey
Wynn
Yates
Young (AK)
Young (FL)
Zeliff
Zimmer
NAYS--4
Funderburk
Istook
Scarborough
Stump
NOT VOTING--27
Ballenger
Barton
Beilenson
Berman
Bliley
Bonilla
Boucher
Bryant (TX)
Clay
de la Garza
Dicks
Dingell
Engel
Gibbons
Goss
Hayes
Hobson
Houghton
Kaptur
Livingston
McDade
Miller (FL)
Molinari
Shaw
Torricelli
Weldon (FL)
Wilson
{time} 1933
Messrs. MARKEY, DIXON, and COBLE changed their votes 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.
____________________