[Congressional Record Volume 144, Number 26 (Thursday, March 12, 1998)]
[Senate]
[Pages S1890-S1893]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST (for himself, Mr. Kennedy, Mr. Jeffords, Mr. 
        Bingaman, Mr. Cochran, and Mr. Inouye):
  S. 1754. A bill to amend the Public Health Service Act to consolidate 
and reauthorize health professions and minority and disadvantaged 
health professions and disadvantaged health education programs, and for 
other purposes; to the Committee on Labor and Human Resources.
  Mr. FRIST. Mr. President, I rise to introduce the Health Professions 
Reauthorization Act. First, I would like to tell you a story 
illustrating the importance of this legislation, which strives to 
increase the numbers of health practitioners in rural, underserved 
areas, to increase the number of underrepresented minorities and focus 
on primary care. My story is about a young man who dreamed of a career 
in medicine. Keith Junior, grew up in Nashville. During his high school 
years, he often visited the Meharry Medical College campus where he was 
warmly received and encouraged by the health care professionals and 
staff. Meharry's Health Careers Opportunity Program, (HCOP) helped him 
develop his academic skills and supplement his undergraduate 
experiences, in a supportive environment with a rich history and caring 
spirit.
  After completing college, Mr. Junior pursued an application to 
medical school. However, his undergraduate grades and MCAT scores were 
considered low. The HCOP program helped him to improve those scores. 
Because Meharry has a commitment to students who demonstrate a 
potential for success which might be otherwise overlooked by other 
institutions he applied there, was accepted and graduated.
  Dr. Junior recalls his experiences in the Meharry HCOP as invaluable 
in helping him to realize his dream of a career in medicine. He is now 
an internist and Interim Director of the Matthew Walker Health Center 
in Nashville, Tennessee. More important, he serves as a role model of 
success for younger generations to emulate.
  Mr. President, this story illustrates the many real life successes 
for individuals who benefit from the Title VII and Title VIII programs, 
of the Public Health Service Act. I rise today to introduce the Health 
Professions Reauthorization Act of 1998 which funds those programs. For 
many years this legislation has helped our nation's schools of health 
to serve the health needs of their communities better and to prepare 
the practitioners of the future.
  A critical component of the Title VII and VIII programs has been the 
goal to help students in need. These programs have often represented 
the assistance of last resort for many disadvantaged students seeking 
careers in health. I believe several schools in Tennessee tell this 
story well: in the East Tennessee State University Schools of Medicine, 
Nursing, Public and Allied Health approximately 89% of their students 
are deemed disadvantaged by the Free Application for Federal Student 
Aid. Both East Tennessee State University's College of Nursing and the 
James Quillen College of Medicine are featured in the ``1998 Best 
Graduate Schools,'' published by U.S. News and World Report. These 
schools were praised for their programs in rural medicine. I am 
extremely proud of these programs because they have been given national 
recognition for their mission which is to train primary health care 
professionals and to encourage an interest in serving rural areas.
  Equally important is this legislation's goal to fill the health care 
needs of many underserved communities, often in rural or inner city 
areas. With the assistance of Title VIII programs, the Vanderbilt 
School of Nursing reports that 72 percent of its 1997 graduating class 
is working in medically underserved areas. East Tennessee State 
University was also able to open the first nurse-managed primary care 
clinic in rural Appalachia with pretty impressive results: 7,663 
primary care visits, 25% of which were preventive services; 51% of the 
patients were covered by Tennessee's Medicaid Program (TennCare) and 
16% of the patients were uninsured; 54% of the visits were care for 
children under the age of 18.
  The examples from my medical colleagues in Tennessee are 
representative of the needs and results elsewhere in the nation due to 
the Health Professions Act, and I believe the revisions made in this 
bill continue to strengthen these programs and prepare us for the next 
century.
  This bill reauthorizes the programs funded through Titles VII and 
VIII of the Public Health Service Act. They are intended: to improve 
the distribution of health professions workers to underserved areas; to 
strengthen the infrastructures of organizations which facilitate their 
training and performance; to improve accountability for federal dollars 
used in these processes; and to improve the representation of 
minorities and disadvantaged individuals in the health professions, 
better reflecting the communities which they serve.
  However, more importantly, this bill represents an opportunity to 
improve the quality of, and access to, health care for millions of 
Americans. Why?
  It is the only measure to counter the maldistributions caused by 
current Graduate Medical Education programs and market forces. Patients 
in underserved areas depend on programs funded by this bill in order to 
receive their health care. Training providers in these areas greatly 
increases the likelihood they will work in these areas when they 
complete their education.
  It is an example of our government's ability to act as a catalyst. 
Too often we, as legislators, are forced to step in and micro manage 
such health care issues as hospital lengths of stay in order to 
preserve quality of care.
  I believe we are far better served to develop programs that stimulate 
the types of efforts which create innovative solutions for these 
problems, and give practitioners/clinicians the tools necessary to make 
needed changes.
  It fosters collaboration. Although foundations are still being laid, 
the many interest groups involved in this bill are learning to work 
together. They have discovered that they do have areas of common 
interest and they are learning to build on those incentives. Within 
many institutions new interdisciplinary programs are being developed 
and this legislation further stimulates those activities.
  Finally, over time, this bill will streamline care and improve cost-
effectiveness.
  Although its costs are quite small when compared to other health care 
measures, we still see it as an opportunity to set an example of 
efficient, high quality care.
  Over the years, there have been many successes among the more than 
300 programs funded through this legislation. Thus, clarification of 
the goals and objectives of these programs is a priority. We had to 
find ways to function within our budgetary constraints as well.
  In 1995, Senators Kassebaum, Kennedy and I attempted to take the 44 
programs involved and consolidate them into 6 groups or clusters. 
Performance outcomes were added. This approach was used to streamline 
the granting process, and to allow HHS to use budgetary factors: to 
leverage areas of development; and to align with community workforce 
needs.
  It also provided flexibility for strategic planning of the workforce 
supply, and insured a greater percentage of program dollars would go 
directly to grantees versus federal administration. Further, the FY98 
Appropriations bill passed by the Senate, also clustered these 
programs.
  After the Act passed in the Senate in 1996 but failed to pass in the 
House, I re-examined it to identify areas of disagreement. Over the 
past year, I made a concerted effort to overcome those obstacles. 
Another hearing was held on

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April 25, 1997 because I wanted to be sure that I listened to all 
parties and that all possibilities for compromise were addressed. My 
staff has worked very hard to maintain that level of input. We sought 
to involve the many constituency groups in the preparation of this 
legislation. The 1998 Health Professions Reauthorization Act 
accomplishes the goals passed by the Senate last year in several ways:
  It still uses only 7 clusters, but has 15 lines of authority as well. 
This approach, while more complex is also more reflective of both 
existing and potential alliances. It gives security about funding to 
groups within these clusters, and in turn, allows them to plan longer 
range.
  Flexibility is built into the bill over time. As funding lines 
change, the Secretary's authority to move funds across program lines 
increases. Thus, programs can grow into the cluster concept. This 
revision will better reflect the constantly changing healthcare needs 
of communities and more rapidly changing health care delivery system.
  Since so much of the Act's flexibility is based on the discretion of 
the Secretary, we have added advisory councils to insure that the view 
points of those on the front lines are heard. This will restore 
confidence among the grantees and encourage positive collaboration 
between agency officers and the programs they manage. In addition, 
these councils will report back to Congress to assure oversight of 
these programs.
  To encourage independence from federal funding, matching requirements 
for non-federal funds are required wherever appropriate. Federal 
dollars provide the seed money necessary for many health clinics to get 
on their feet, and in turn secure other financing mechanisms.
  Programs which attempt to resolve cultural barriers, especially those 
related to language, are restored.
  Community-based organizations are empowered so that the patient's 
voice can be heard.
  Geriatric initiatives have been strengthened and expanded to train 
health care personnel as we promote and integrate geriatrics into 
American medicine. Today there are 33 million older Americans, and by 
2030 it is expected that the elderly population will reach 66 million 
strong, when 1 of every 5 Americans will be 65 years of age or older.
  Mr. President, I am proud of our work. In fact, I would like to take 
this opportunity to specifically thank, Senators Kennedy, Jeffords, 
Bingaman, Representative Becerra, the Hispanic Caucus and all their 
staffs for their efforts to work with us on this bill. I would also 
like to thank the interest groups which gave so generously of their 
time and support to help us address the issues involved. In particular, 
I would like to mention several organizations which have sent me 
letters of support. I have heard from the Area Health Education 
Centers, American Psychological Association, American Mental Health 
Counselors, The Association of Minority Health Profession Schools, The 
Working Group on Hispanic Health-Education, American Nurse Association, 
American Organization of Nurse Executives, The American Geriatric 
Society, National Association of Geriatric Education Centers, and the 
National Association of Social Workers. Mr. President, I ask unanimous 
consent that a list of organizations supporting this legislation and 
their comments, be included in the Record. Mr. President, I especially 
thank Dr. Debra Nichols and Dr. Mary Moseley of my staff for their 
dedication and hard work toward the reauthorization of these programs.
  Mr. President, this bill encourages collaboration without forcing it. 
It creates new partnerships while supporting existing ones. It fosters 
new opportunities for change. It represents the best example of team 
work among interest groups, agencies and legislators. The 1998 Health 
Professions Reauthorization Act will prepare underserved areas to meet 
the future.
  Mr. President, I ask unanimous consent that the bill be printed in 
the Record.
  There being no objection, the items were ordered to be printed in the 
Record, as follows:
  (The bill was not available at time of printing.)

                           Letters of Support

       ``We are especially appreciative of having had the 
     opportunity in April 1997 to testify before your 
     subcommittee. Thus seeing the nation's 43 Geriatric Education 
     Centers (GECs) in this bill (as Sec. 753 within a grouping of 
     ``interdisciplinary, Community Based Linkages'') is indeed 
     gratifying, as this signifies your commitment to better 
     health care for older Americans.''--National Association of 
     Geriatric Education Centers.
       ``It is our pleasure to write in support of your 
     legislation reauthorizing federal health professions training 
     programs. We believe that our institutions, and our students 
     who become health professionals, will be able to help solve 
     the national crisis of disproportionately low health status 
     among minorities.''--The Association of Minority Health 
     Professions Schools.
       ``. . . the Working Group on Hispanic Health Education has 
     worked in partnership with your office on this Health 
     Professions Bill. Moreover, we have worked with the 
     Congressional Hispanic Caucus, the Association of Minority 
     Health Professions Schools, the Office of Minority Health, 
     and HRSA Bureau of Health Professions in development of the 
     Bill to amend the Public Health Service Act to consolidate 
     and reauthorize health professions and minority and 
     disadvantaged health education programs.''--Working Group on 
     Hispanic Health--Education.
       ``I certainly want to thank you for the careful work and 
     the relevant content of your draft Bill. Your staff carefully 
     considered each of the issues of importance to the Area 
     Health Education Centers across the nation, the 36 programs 
     supporting 157 community based centers.''--Kentucky Area 
     Health Education Center (AHEC) Program.
       ``Your bill, which proposes to continue support for HRSA's 
     health professions education and training programs, was 
     drafted in consultation with all concerned parties, and that, 
     Mr. Chairman, is appreciated.''--Association Of Schools Of 
     Public Health.
       ``We are pleased that Congress has continued to appropriate 
     adequate levels of funding for Title VII programs, but we 
     know that these programs are particularly vulnerable as long 
     as the health professions training programs remain 
     unauthorized. NASW believes the proposed legislation will 
     help increase access by minorities and disadvantaged people 
     to graduate programs in behavioral and mental health 
     practice, including social work.''--National Association Of 
     Social Workers.
       ``This legislation would make graduate students in mental 
     health counseling programs eligible to receive National 
     Institute of Mental Health (NIMH) training grants. The bill 
     allows for mental health counselors to serve in designated 
     underserved health professional areas.''--American Mental 
     Health Counselors Association.
       ``Your legislation will accomplish a much needed 
     streamlining and updating of current federal programs in this 
     area. Its enactment will reaffirm the importance of federal 
     health professional education and training support programs 
     in the effort to make sure that all Americans have access to 
     the health care services.''--American Counseling Association.
       ``The bill provides for a structure that will permit a 
     comprehensive, flexible, and effective approach to federal 
     support for nursing workforce development. It is a pleasure 
     to endorse this bill.''--American Nurses Association.
       ``This legislation is of critical importance in ensuring a 
     federal role in nursing education and this bill will foster 
     programs to prepare nurses to meet the healthcare system's 
     need for nursing professionals to: address sicker patients in 
     tertiary care sites; deal with life expectancy for people 
     with chronic conditions; and care for the complex health care 
     needs of an increasingly elderly population.''--American 
     Organization of Nurse Executives.

  Mr. KENNEDY. Mr. President, I commend Senator Frist, Senator 
Bingaman, and Senator Jeffords for their leadership on the bill we are 
introducing today to reauthorize the health professions and nursing 
training and education programs--Titles VII and VIII of the Public 
Health Service Act. This bill is a bipartisan effort to revise and 
strengthen these education and training programs and achieve a more 
effective workforce to meet the health needs of the nation.
  The ongoing national debate on health care has focused largely on the 
problems of access, cost and quality. These issues, however, cannot be 
addressed without also dealing with the need to train qualified health 
providers. No insurance policy can assure good health care without good 
doctors, nurses and other health professionals. No system of quality 
improvement, no matter how sophisticated, can assure good care for 
hospital patients if there are not good doctors and nurses at the 
bedside. Too often, inadequate priority is given to the workforce which 
staffs our health care system.
  As we know, that system is undergoing rapid and dramatic change. 
Today, nearly 60 percent of Americans receive their care through 
managed

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care arrangements. More and more, health care is moving out of 
hospitals and into out-patient or community-based settings. Fewer 
people are being admitted to hospitals and hospital stays are becoming 
shorter. It is essential for the health workforce to adapt to these 
changes. New graduates of health professions schools and practicing 
health providers need the right skills to provide effective patient 
care.
  In addition to these issues, the health care system continues to face 
by nationwide shortages of certain health personnel, serious 
georgraphical imbalances in the types of health professionals, and 
under-representation of providers from minority and disadvantaged 
backgrounds.
  Many types of health professionals are in short supply, including 
geriatricians, pediatric dentists, and allied health, public health, 
and behavioral and mental health professionals. Shortages of physicians 
persist in inner-city and rural areas, leaving many Americans unserved 
or underserved.
  Since 1986, the number of federally designated shortage areas for 
primary care health professionals has climbed by 40 percent--from 1,944 
to 2,597. The Health Resources and Services Administration estimates 
that over 26 million underserved persons live in these areas and that, 
at a minimum, 5,200 additional general practitioners are needed to 
eliminate these shortage areas.
  In addition, most experts agree that there is an imbalance between 
primary care physicians and specialists. In 1931, about 87 percent of 
U.S. physicians were practicing primary care, compared to 33 percent in 
1996. The Council on Graduate Medical Education recommends that the 
physician workforce should consist of 50 percent generalists and 50 
percent specialists. The persistent current imbalance contributes to 
problems of access and cost in our health care system. Primary care 
practitioners are more likely to locate in underserved areas and help 
underserved populations, and they tend to provide care in a more 
comprehensive, appropriate, and cost-effective manner than specialists.
  Across the nation, African Americans, Hispanic Americans, and Native 
Americans are seriously underrepresented in the health professions 
workforce. Their underrepresentation has reduced access to care among 
many of the nation's neediest citizens. African Americans represent 
approximately 12 percent of the U.S. population, but only 2-3 percent 
of the nation's health professions workforce. Hispanics make up nine 
percent of the population but represent only 5 percent of physicians, 
and 3 percent of dentists and pharmacists. This underrepresentation is 
of particular concern because studies show that minority health care 
providers are more likely to locate in underserved communities and 
provide health services to needy populations.
  The health professions and nursing training and education programs we 
seek to reauthorize in this legislation are designed to respond to each 
these concerns.
  The bill reauthorizes programs which provide educational 
opportunities in the health professions for individuals from minority 
and disadvantaged backgrounds. This strategy has been effective in 
increasing the availability and accessibility of health care providers 
to populations who have difficulty obtaining adeaquate health care, 
especially those from low-income and minority populations. Historically 
black colleges and universities have been particularly successful in 
this effort, training more than 50 percent of the nation's African 
American physicians, dentists, and pharmacists. Our bill will continue 
to support these basic efforts. It will also strengthen opportunities 
for Hispanic-serving institutions and institutions with high rates of 
enrollment of Native Americans.
  In addition, the bill will provide continued support for primary care 
practice through ambulatory care training, curriculum improvement, 
faculty development, data analysis and quality assurance. Among 
physicians, this support will address the continued imbalance between 
primary care physicians and specialists. It recognizes the unique gaps 
general internists, general pediatricians, and family physicians fill 
in meeting the needs of the underserved. In other instances, funding 
will be used to improve the supply of other disciplines suffering 
shortages, such as pediatric dentists.

  The bill reauthorizes model community-based, interdisciplinary 
programs to train individuals for practice in underserved settings, 
including remote and border areas. These programs encourage active 
partnerships between community-based programs and medical schools, 
nursing schools, and other health profession schools in their effort to 
provide greater educational opportunities to students, faculty, and 
practitioners in community-based settings to improve the delivery of 
health care.
  Doctors, nurses, and other health professionals can be trained 
together in teams in the community to address the needs of the 
medically underserved. In this way, their training is more in step with 
what they will encounter in the practice world while meeting critical 
needs in the community. These programs include the area health 
education centers, geriatric education centers, the rural 
interdisciplinary training, and allied health training.
  The bill also recognizes the increase in the elderly population and 
establishes a new junior geriatric faculty fellowship program. This 
program will help to address the large shortage in geriatric faculty 
members. Without an appropriate supply of teachers in geriatrics, we 
cannot seriously address the issue of the geriatrician shortage. I want 
to commend Senator Frist and the Administration for working closely 
with us and with the academic community on this issue.
  Finally, the legislation will provide new flexibility in targeting 
resources to meet the current and emerging needs of the nursing 
workforce. The emphasis is on meeting the needs of the underserved. 
Nurse anesthetists, clinical nurse specialists, nurse practitioners, 
and certified nurse midwives play a vital role in providing quality 
care to medically underserved and rural communities, and they deserve 
our support.
  As the health care system continues to change, so too must the 
federal programs intended to assure that America has an appropriate 
health care workforce to staff the health care delivery system. These 
programs are overdue for consolidation and better targeting. The bill 
we are introducing will consolidate more than 40 health professions 
programs into 7 broader authorities more directly focused on key goals. 
This greater flexibility will enable programs to respond more quickly 
to emerging workforce issues in our changing health care system. 
Specific workforce goals will be established and outcomes measured, in 
order to achieve accountability for the funds invested in these 
programs.
  The health professions and nursing education programs under the 
Public Health Service Act are the key mechanisms of the federal 
government has to meet national priorities for the nation's health care 
workforce. The bipartisan sponsors of this bill have worked closely 
with the Administration, the health professions education and practice 
community, and other groups to achieve these goals responsibly and to 
maintain adequate resources. We have worked to advance the central goal 
of these two important titles of the Public Health Service Act--to 
train a health care workforce that can meet the needs of the American 
people, and I look forward to the enactment of this necessary 
legislation.
  Mr. JEFFORDS. Mr. President, today, I am pleased to announce my co-
sponsorship of ``The Health Professions Education Partnerships Act of 
1998.'' My colleague Senator Frist, the Chair of the Labor and Human 
Resources Committee's Subcommittee on Public Health and Safety, has 
drafted this legislation reauthorizing the important programs contained 
in Titles VII and VIII of the Public Health Service Act. This 
legislation provides comprehensive, flexible, and effective authority 
for the support of health professions training programs and the related 
community-based educational partnerships. The enactment of this Act 
will improve health workforce quality, diversity, and the distribution 
of funds while requiring greater accountability of both the grant 
recipients of federal funds and the agency that administers them.
  Titles VII and VIII of the Public Health Service Act have provided 
programs of support to health professions schools and their students, 
for the past

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thirty-five years. As these programs have evolved, there has been a 
continuing need to address the specific concerns of rural and inner-
city communities that experience shortages of health professionals and 
a lack of primary care providers. This reauthorization will allow the 
Title VII and VIII programs to set improved goals and outcomes measures 
and it also provides them with greater flexibility in establishing 
priorities to target emerging workforce issues.
  In my own State of Vermont, the students of the University of 
Vermont's College of Medicine have benefited from a number of these 
programs and scholarships, including those relating to family medicine, 
professional nurse and nurse practitioner training.
  The newest Title VII program in Vermont is the Area Health Education 
Center (AHEC) which opened its first site in April 1997 in the 
Northeast Kingdom of Vermont. The AHEC will decentralize health 
professions education by having portions of the training provided in 
primary medical personnel shortage areas and by improving the 
coordination and use of existing health resources. Over the next two 
years, two additional sites are planned in other underserved areas of 
the state. These efforts have contributed to making Vermont a better 
place to obtain health care services and improved the quality of life 
for its residents.
  Again, I want to thank Senator Frist and his excellent staff for 
their dedication and hard work in drafting the ``Health Professions 
Education Partnership Act of 1998.'' Enactment of this legislation will 
improve health professions training programs across America and, as the 
Chair of the Labor and Human Resources Committee, I intend to make its 
passage one of our highest priorities.
  Mr. BINGAMAN. Mr. President, I rise today to join Senators Frist and 
Kennedy and Jeffords in the introduction of legislation to reauthorize 
Titles VII and VIII of the Public Health Service Act. I am pleased to 
be part of this bipartisan effort to reauthorize the programs that help 
shape the pool of qualified health care professionals for the United 
States.
  Titles VII and VIII were originally enacted to address a critical 
health manpower shortage and successfully served to increase the 
overall supply of providers. The mission of Title VII and VIII has 
evolved as the delivery system and needs of the population have 
shifted. Today, the focus of the various programs rests within three 
main areas. The programs are aimed to solve the shortages in rural and 
inner city communities. They strive to address the shortage of primary 
care providers and finally must correct the disparity in minority 
representation in the health professions. Indeed, the various programs 
in this legislation serve to provide a base for strengthening the 
health resources for this country.
  In my home state of New Mexico, 28 out of 33 counties are designated 
as health professional shortage areas by the federal government. I am 
acutely aware of how a maldistribution of health care providers can 
impact our citizens. Geographic access to the appropriate health care 
provider is an important factor in our debates on the health care 
system. Titles VII and VIII are noteworthy avenues to address the needs 
in this area. Studies have shown that if we recruit individuals from 
the shortage area, the likelihood is much greater that they will return 
to practice in the area. Additionally, if clinical training is 
community based in rural and underserved areas, the likelihood is also 
increased that upon graduation, the provider will serve in the locality 
in which they trained.
  Equally important for a state such as mine is the commitment to 
address the persistent and unmet health care need along the border 
between the United States and Mexico. The health education and training 
centers in the legislation address the community health needs and the 
training and educational needs of health professionals serving in these 
areas. The legislation also has the capacity to expand and improve the 
public health workforce which is a major component of addressing border 
health concerns.
  Mr. President, this legislation restructures the act to address the 
health workforce needs of our nation in a flexible, but more 
accountable manner. We have provided for data collection and analysis 
of the health workforce so that decision making for the future can be 
well founded and be an accurate reflection of societal needs. 
Additionally, this legislation affords us the opportunity to provide 
education and training that reflect changes in an evolving health care 
system. As managed care and other forces shift the delivery system from 
inpatient hospital care to outpatient facilities, it is necessary to 
respond to the shifts that this causes in the workforce. To this end, 
the legislation addresses the curriculum development in the areas of 
health promotion and disease prevention as well as long term care, home 
health and hospice.
  As the demographics of our population shift to an older population, 
we must ensure we have qualified individuals to treat the specific 
nature of chronic diseases associated with geriatrics. As we deal with 
an aging population, establishing interdisciplinary training programs 
that promote the role of nutritionists, physical therapists, 
occupational therapists and speech therapists in geriatrics are 
critical. The legislation provides an avenue to address these necessary 
components.
  Finally, the reauthorization provides a framework to better monitor 
the outcomes of our efforts. It continues to afford us the opportunity 
to assure an appropriate number and mix of health professionals for the 
health needs of the country. It strengthens our commitment to address 
the supply, distribution, and minority representation of health 
professionals through both Native American and Hispanic centers of 
excellence. I have been committed to seeing the needs of these two 
populations addressed. I commend Senators Frist and Kennedy for their 
hard work and the work of their staff to address the various concerns 
raised during our hearings on this important issue. I appreciate the 
work done by the Hispanic caucus in the House and by the minority 
health profession schools as well.
  Mr. President, in closing I want to thank Senators Frist and Kennedy 
and Jeffords for their determination to address the need to reauthorize 
Title VII and VIII of the Public Health Service Act. I appreciate that 
they have worked closely with our colleagues in the House to develop 
companion legislation. I am committed to working with my colleagues 
toward expeditious consideration and passage of this bill.

                          ____________________