[Congressional Record Volume 143, Number 155 (Friday, November 7, 1997)]
[Senate]
[Pages S11977-S11978]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. MURKOWSKI:
  S. 1402. A bill to amend the Social Security Act to establish a 
community health aide program for Alaskan communities that do not 
qualify for the Community Health Aide Program for Alaska operated 
through the Indian Health Service; to the Committee on Finance.


    the alaskan community health aide program expansion act of 1997

  Mr. MURKOWSKI. Mr. President, I am pleased to rise to introduce 
legislation relative to the benefits of community health aides. This 
particular legislation would be titled the Alaskan Community Health 
Aide Program Expansion Act of 1997. The purpose of the act would be to 
provide a link to health care for rural communities, primarily in my 
State.
  The Alaskan Community Health Aide Program Expansion Act would enable 
the health aides to have access to rural, non-Native communities 
throughout Alaska. The act will authorize training and continuing 
education of Alaskans as community health aides to small communities 
that do not currently qualify for the Indian Health Services' Community 
Health Aide Program.
  Mr. President, some 50 years ago, this unique system of community 
health aides was formed in my State. In the early 1940's, due to an 
extreme outbreak of tuberculosis across Alaska, volunteers were 
selected by local communities and trained as community health aides. 
These communities, of course, suffered from distance, extreme 
isolation. They were often located hundreds of miles from the nearest 
physician. And the community health aides, through radio contact to a 
distant hospital in the region, became the eyes, the ears and hands of 
a physician and administered life-saving medications to remote patients 
throughout the State.
  Today, through the Indian Health Services, the aides reside in 176 
Alaskan-Native communities, small isolated communities throughout our 
State--which if you spread Alaska across the United States, in a 
proportional map it would run from Canada to Mexico, from California to 
Florida. So we are talking about a big piece of real estate, Mr. 
President.
  These aides, today, through telecommunications capability with 
physicians in Anchorage, Fairbanks, and other urban areas, provide 
health care, provide disease prevention throughout our State. The 
health aides are broadly acknowledged as the backbone of rural health 
delivery for Alaska's Native people.
  However, Mr. President, there is a large void in Alaska's Community 
Health Aide Program. Approximately 50 of our local Alaskan communities 
do not have community health aides because the people who live there 
are non-Native, and thus they do not qualify for the service under 
current law.
  In these 50, 51 communities, there is no physician, there is no other 
health care provider of any kind. Instead, these communities are served 
by public health care nurses who come and go on an itinerant basis. In 
other words, Mr. President, health care access in these communities is 
infrequent at best.
  Often these non-Native communities are characterized by geographic 
isolation and cultural isolation, especially in areas such as the 
Russian communities of Nikolaevsk, Vosnesenda, Katchmaksel, and 
Rassdonla.
  Most of these communities are completely unconnected by roads. Access 
is only available by airplane, boat, and sometimes snowmachine or 
dogsled. The needs of these communities is a daunting task.

[[Page S11978]]

  The Community Health Aide Program Expansion Act would remedy this 
dilemma. For the first time in the history of our State, all 
communities and villages will have the opportunity to have health care 
available within a village. This legislation will enable the trained 
health aide to live within a community, teach basic disease prevention 
and health promotion, in other words, the basic skills for good health.
  Mr. President, this legislation will enable affordable and consistent 
access to health care to all Alaskan communities.
  I ask my colleagues to join in support of this legislation.
  I ask unanimous consent that the text of this legislation be printed 
in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1402

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Alaskan Community Health 
     Aide Program Expansion Act of 1997''.

     SEC. 2. FINDINGS.

       Congress finds the following:
       (1) Numerous communities in Alaska have no physicians or 
     health care providers of any kind.
       (2) While those communities are served by Alaskan public 
     health nurses on an itinerant basis, Alaskan law prohibits 
     those nurses from treating patients for individual health 
     concerns.
       (3) Physical and cultural isolation is so severe in those 
     communities that private health care providers often opt not 
     to serve those communities.
       (4) Not enough Native Alaskans reside in such communities 
     to warrant placement of a community health aide pursuant to 
     the Community Health Aide Program for Alaska operated through 
     the Indian Health Service.

     SEC. 3. EXPANSION OF THE COMMUNITY HEALTH AIDE PROGRAM FOR 
                   ALASKA.

       Part A of title XI of the Social Security Act (42 U.S.C. 
     1301-1320b-16), as amended by section 4321(c) of the Balanced 
     Budget Act of 1997 (42 U.S.C. 1320b-16), is amended by adding 
     at the end the following:


                ``alaskan community health aide program

       ``Sec. 1147. Not later than October 1, 1998, the Secretary 
     shall establish an Alaskan Community Health Aide Program (in 
     this section referred to as the `Program') under which the 
     Secretary shall--
       ``(1) provide for the training of Alaskans as community 
     health aides or community health practitioners;
       ``(2) use such aides or practitioners in the provision of 
     health care, health promotion, and disease prevention 
     services to Alaskans living in communities that do not 
     qualify for the Community Health Aide Program for Alaska 
     operated through the Indian Health Service and established 
     under section 119 of the Indian Health Care Improvement Act 
     (25 U.S.C. 1616l);
       ``(3) provide for the establishment of teleconferencing 
     capacity in health clinics located in or near such 
     communities for use by community health aides or community 
     health practitioners;
       ``(4) using trainers accredited under the Program, provide 
     a high standard of training to community health aides and 
     community health practitioners to ensure that such aides and 
     practitioners provide quality health care, health promotion, 
     and disease prevention services to the Alaskan communities 
     served by the Program;
       ``(5) develop a curriculum for the training of such aides 
     and practitioners that--
       ``(A) combines education in the theory of health care with 
     supervised practical experience in the provision of health 
     care; and
       ``(B) provides instruction and practical experience in the 
     provision of acute care, emergency care, health promotion, 
     disease prevention, and the efficient and effective 
     management of clinic pharmacies, supplies, equipment, and 
     facilities;
       ``(6) establish and maintain a Community Health Aide 
     Certification Board to certify as community health aides or 
     community health practitioners individuals who have 
     successfully completed the training described in paragraphs 
     (4) and (5), or can demonstrate equivalent experience;
       ``(7) develop and maintain a system which identifies the 
     needs of community health aides and community health 
     practitioners for continuing education in the provision of 
     health care, including the areas described in paragraph 
     (5)(B), and develop programs that meet the needs for such 
     continuing education;
       ``(8) develop and maintain a system that provides close 
     supervision of community health aides and community health 
     practitioners; and
       ``(9) develop a system under which the work of community 
     health aides and community health practitioners is reviewed 
     and evaluated to ensure the provision of quality health care, 
     health promotion, and disease prevention services in 
     accordance with this section.''.
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