[Congressional Record Volume 145, Number 52 (Thursday, April 15, 1999)]
[Senate]
[Pages S3777-S3779]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. DURBIN (for himself, Mr. DeWine, Mr. Kennedy, and Mr.
Schumer):
S. 805. A bill to amend title V of the Social Security Act to provide
for the establishment and operation of asthma treatment services for
children, and for other purposes; to the Committee on Finance.
THE CHILDREN'S ASTHMA RELIEF ACT OF 1999
Mr. DURBIN. Mr. President, I rise today to make a few remarks
concerning a bill that Senator DeWine and I are introducing today that
we hope will improve the lives of many of the nation's asthmatic
children.
Asthma is one of the most common chronic conditions in the U.S.,
affecting an estimated 14.9 million people, causing over 1.5 million
emergency department visits and over 5,500 deaths in 1995, and
estimated to cost over $14.5 billion by the year 2000. Asthma deaths
have tripled over the past two decades despite improvements in clinical
treatment.
Asthma is considered the worst chronic health problem affecting
children. Childhood asthma has dramatically increased by over 160
percent since 1980. Currently, 7 percent of the nation's children
suffer from asthma. It is particularly prevalent among the urban poor
because of the lack of accessible health care and the high number of
allergens in the environment. Research supported by the National
Institutes of Health demonstrated that the combination of cockroach
allergen, house dust mites, molds, tobacco smoke, and feathers are
important causes of asthma-related illness and hospitalization among
the children in inner-city areas of the United States.
To combat asthma, innovative community-based programs have been
developed in some areas to fight this growing public health problem.
For example, in Los Angeles the Asthma and Allergy Foundation has set
up two ``breathmobiles.'' The converted motor homes, staffed by doctors
and nurses, visit schools to test, treat, and educate at-risk children.
Since the program began two years ago, there has been a 17 percent
decline in the number of children visiting emergency rooms for asthma.
Today, I am introducing with Senator DeWine ``The Childhood Asthma
Initiative'' to help more communities create childhood asthma programs
tailored to meet their local needs. This bill funds grants for state
and community-based organizations to support a variety of treatment,
educational, or preventive programs. The funds are targeted to areas
where childhood asthma and asthma-associated mortality rates are high.
This will enable those areas with the most need to provide services
that reduce emergency room visits, create healthier environments,
reduce mortality rates from asthma, and provide overall improved
quality of life. The bill also helps enroll eligible asthmatic children
in Medicaid or State Children's Health Insurance Programs (S-CHIP).
Furthermore, the bill provides additional funding for S-CHIP to
incorporate asthma screening, treatment, and education in to their
programs.
The bill coordinates Federal asthma activities through the National
Asthma Education Prevention Program Coordinating Committee, and
increases data collection by the CDC on prevalence and mortality
associated with asthma. These efforts will help link patients to
effective treatments and disseminate new breakthroughs in asthma
treatment.
This bill has been endorsed by the National Association of Children's
Hospitals and Research Institutions, the American Lung Association, the
American Academy of Pediatrics, and the Association of Maternal and
Child Health Programs.
I hope that many of my colleagues will join me in supporting this
bill. Nobody should die from asthma. Treatments are available. Let us
make sure that every child in America that suffers from asthma has
access to those treatments.
I ask unanimous consent that a copy of the bill be inserted in the
Record.
There being no objection, the bill was ordered to be printed, in the
Record, as follows:
S. 805
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 ``Children's Asthma Relief Act
of 1999''.
SEC. 2. FINDINGS.
(a) Findings.--Congress makes the following findings:
(1) Asthma is one of the Nation's most common and costly
diseases. It affects an estimated 14,000,000 to 15,000,000
individuals in the United States, including almost 5,000,000
children.
(2) Asthma is often a chronic illness that is treatable
with ambulatory care, but over 43 percent of its economic
impact comes from use of emergency rooms, hospitalization,
and death.
(3) In Illinois, the mortality rate for blacks from asthma
is the highest in the nation with 60.8 deaths per every
1,000,000 population. In Ohio, the mortality rate for blacks
from asthma is 32.2 per 1,000,000 population and the
mortality rate for whites from asthma is 11.7 per 1,000,000.
(4) In 1995, there were more than 1,800,000 emergency room
visits made for asthma-related attacks and among these, the
rate for emergency room visits was 48.8 per 10,000 visits
among whites and 228.9 per 10,000 visits among blacks.
(5) Hospitalization rates were highest for individuals 4
years old and younger, and were 10.9 per 10,000 visits for
whites and 35.5 per 10,000 visits for blacks.
(6) From 1979 to 1992, the hospitalization rates among
children due to asthma increased 74 percent.
(7) It is estimated that more than 7 percent of children
now have asthma.
(8) Although asthma can occur at any age, about 80 percent
of the children who will develop asthma do so before starting
school.
(9) From 1980 to 1994, the most substantial prevalence rate
increase for asthma occurred among children aged 0-4 years
(160 percent) and persons aged 5-14 years (74 percent).
(10) Asthma is the most common chronic illness in
childhood, afflicting nearly 5,000,000 children under age 18,
and costing an estimated $1,900,000,000 to treat those
children. The death rate for children age 19 and younger
increased by 78 percent between 1980 and 1993.
(11) Children aged 0 to 5 years who are exposed to maternal
smoking are 201 times more likely to develop asthma compared
with those free from exposure.
(12) Morbidity and mortality related to childhood asthma
are disproportionately high in urban areas.
(13) Minority children living in urban areas are especially
vulnerable to asthma. In 1988, national prevalence rates were
26 percent higher for black children than for white children.
(14) Certain pests known to create public health problems
occur and proliferate at higher rates in urban areas. These
pests may spread infectious disease and contribute to the
worsening of chronic respiratory illnesses, including asthma.
(15) Research supported by the National Institutes of
Health demonstrated that the combination of cockroach
allergen, house dust mites, molds, tobacco smoke, and
feathers are important causes of asthma-related illness and
hospitalization among children in inner-city areas of the
United States.
(16) Cities outside the United States have developed and
implemented effective systems of cockroach management.
(17) Integrated pest management is a cost-effective
approach to pest control that emphasizes prevention and uses
a range of techniques, including property maintenance and
cleaning, and pesticides as a means of last resort.
(18) Reducing exposure to cockroach allergen, as part of an
integrated approach to asthma management, may be a cost-
effective way of reducing the social and economic costs of
the disease.
(19) No current Federal funding exists specifically to
assist cities in developing and implementing integrated
strategies to reduce cockroach infestation.
(20) Asthma is the most common cause of school absenteeism
due to chronic illness with 10,100,000 days missed from
school per year in the United States.
(21) According to a 1995 National Institute of Health
workshop report, missed school days accounted for an
estimated cost of lost productivity for parents of children
with asthma of almost $1,000,000,000 per year.
(22) According to data from the 1988 National Health
Interview Survey (NHIS), which surveyed children for their
health experiences over a 12-month period, 25 percent of
those children reported experiencing a great deal of pain or
discomfort due to asthma either often or all the time during
the previous 12 months.
(23) Managing asthma requires a long-term, multifaceted
approach, including patient education, behavior changes,
avoidance of asthma triggers, pharmacologic therapy, and
frequent medical follow-up.
[[Page S3778]]
(24) Enhancing the available prevention, educational,
research, and treatment resources with respect to asthma in
the United States will allow our Nation to address more
effectively the problems associated with this increasing
threat to the health and well-being of our citizens.
SEC. 3. CHILDREN'S ASTHMA RELIEF.
Title V of the Social Security Act (42 U.S.C. 701 et seq.)
is amended by adding at the end the following:
``SEC. 511. ASTHMA TREATMENT GRANTS PROGRAM.
``(a) Purposes.--The purposes of this section are as
follows:
``(1) To provide access to quality medical care for
children who live in areas that have a high prevalence of
asthma and who lack access to medical care.
``(2) To provide on-site education to parents, children,
health care providers, and medical teams to recognize the
signs and symptoms of asthma, and to train them in the use of
medications to prevent and treat asthma.
``(3) To decrease preventable trips to the emergency room
by making medication available to individuals who have not
previously had access to treatment or education in the
prevention of asthma.
``(4) To provide other services, such as smoking cessation
programs, home modification, and other direct and support
services that ameliorate conditions that exacerbate or induce
asthma.
``(b) Authority to Make Grants.--
``(1) In general.--In addition to any other payments made
under this title, the Secretary shall award grants to
eligible entities to carry out the purposes of this section,
including grants that are designed to develop and expand
projects to--
``(A) provide comprehensive asthma services to children,
including access to care and treatment for asthma in a
community-based setting;
``(B) fully equip mobile health care clinics that provide
preventive asthma care including diagnosis, physical
examinations, pharmacological therapy, skin testing, peak
flow meter testing, and other asthma-related health care
services;
``(C) conduct study validated asthma management education
programs for patients with asthma and their families,
including patient education regarding asthma management,
family education on asthma management, and the distribution
of materials, including displays and videos, to reinforce
concepts presented by medical teams; and
``(D) identify eligible children for the medicaid program
under title XIX, the State Children's Health Insurance
Program under title XXI, or other children's health programs.
``(2) Award of grants.--
``(A) Application.--
``(i) In general.--An eligible entity shall submit an
application to the Secretary for a grant under this section
in such form and manner as the Secretary may require.
``(ii) Required information.--An application submitted
under this subparagraph shall include a plan for the use of
funds awarded under the grant and such other information as
the Secretary may require.
``(B) Requirement.--In awarding grants under this section,
the Secretary shall give preference to eligible entities that
demonstrate that the activities to be carried out under this
section shall be in localities within areas of known high
prevalence of childhood asthma or high asthma-related
mortality (relative to the average asthma incidence rates and
associated mortality rates in the United States). Acceptable
data sets to demonstrate a high prevalence of childhood
asthma or high asthma-related mortality may include data from
Federal, State, or local vital statistics, title XIX or XXI
claims data, other public health statistics or surveys, or
other data that the Secretary, in consultation with the
Director of the Centers for Disease Control and Prevention,
deems appropriate.
``(3) Definition of eligible entity.--In this section, the
term `eligible entity' means a State agency or other entity
receiving funds under this title, a local community, a
nonprofit children's hospital or foundation, or a nonprofit
community-based organization.
``(c) Coordination With Other Children's Programs.--An
eligible entity shall identify in the plan submitted as part
of an application for a grant under this section how the
entity will coordinate operations and activities under the
grant with--
``(1) other programs operated in the State that serve
children with asthma, including any such programs operated
under this title, title XIX, and title XXI; and
``(2) one or more of the following--
``(A) the child welfare and foster care and adoption
assistance programs under parts B and E of title IV;
``(B) the head start program established under the Head
Start Act (42 U.S.C. 9831 et seq.);
``(C) the program of assistance under the special
supplemental nutrition program for women, infants and
children (WIC) under section 17 of the Child Nutrition Act of
1966 (42 U.S.C. 1786);
``(D) local public and private elementary or secondary
schools; or
``(E) public housing agencies, as defined in section 3 of
the United States Housing Act of 1937 (42 U.S.C. 1437a).
``(d) Evaluation.--An eligible entity that receives a grant
under this section shall submit to the Secretary an
evaluation of the operations and activities carried out under
the grant that includes--
``(1) a description of the health status outcomes of
children assisted under the grant;
``(2) an assessment of the utilization of asthma-related
health care services as a result of activities carried out
under the grant;
``(3) the collection, analysis, and reporting of asthma
data according to guidelines prescribed by the Director of
the Centers for Disease Control and Prevention; and
``(4) such other information as the Secretary may require.
``(e) Application of Other Provisions of Title.--
``(1) In general.--Except as provided in paragraph (2), the
other provisions of this title shall not apply to a grant
made under this section.
``(2) Exceptions.--The following provisions of this title
shall apply to a grant made under this section to the same
extent and in the same manner as such provisions apply to
allotments made under section 502(c):
``(A) Section 504(b)(4) (relating to expenditures of funds
as a condition of receipt of Federal funds).
``(B) Section 504(b)(6) (relating to prohibition on
payments to excluded individuals and entities).
``(C) Section 506 (relating to reports and audits, but only
to the extent determined by the Secretary to be appropriate
for grants made under this section).
``(D) Section 508 (relating to nondiscrimination).
``(f) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section
$50,000,000 for each of the fiscal years 2000 through
2004.''.
SEC. 4. INCORPORATION OF ASTHMA PREVENTION TREATMENT AND
SERVICES INTO STATE CHILDREN'S HEALTH INSURANCE
PROGRAMS.
(a) In General.--The Secretary of Health and Human Services
shall, in accordance with subsection (b), carry out a program
to encourage States to implement plans to carry out
activities to assist children with respect to asthma in
accordance with guidelines of the National Asthma Education
and Prevention Program (NAEPP) and the National Heart, Lung
and Blood Institute.
(b) Relation to Children's Health Insurance Program.--
(1) In general.--Subject to paragraph (2), if a State child
health plan under title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.) provides for activities described in
subsection (a) to an extent satisfactory to the Secretary,
the Secretary shall, with amounts appropriated under
subsection (c), make a grant to the State involved to assist
the State in carrying out such activities.
(2) Criteria regarding eligibility for grant.--The
Secretary shall publish in the Federal Register criteria
describing the circumstances in which the Secretary will
consider a State plan to be satisfactory for purposes of
paragraph (1).
(3) Requirement of matching funds.--
(A) In general.--With respect to the costs of the
activities to be carried out by a State pursuant to paragraph
(1), the Secretary may make a grant under such paragraph only
if the State agrees to make available (directly or through
donations from public or private entities) non-Federal
contributions toward such costs in an amount that is not less
than 15 percent of the costs.
(B) Determination of amount contributed.--Non-Federal
contributions required in subparagraph (A) may be in cash or
in kind, fairly evaluated, including equipment or services.
Amounts provided by the Federal Government, or services
assisted or subsidized to any significant extent by the
Federal Government, may not be included in determining the
amount of such non-Federal contributions.
(4) Technical assistance.--With respect to State child
health plans under title XXI of the Social Security Act (42
U.S.C. 1397aa et seq.), the Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
in consultation with the heads of other Federal agencies
involved in asthma treatment and prevention, shall make
available to the States technical assistance in developing
the provision of such plans that will provide for activities
pursuant to paragraph (1).
(c) Funding.--For the purpose of carrying out this section,
there is authorized to be appropriated $5,000,000 for each of
the fiscal years 2000 through 2004.
SEC. 5. PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT;
SYSTEMS FOR REDUCING ASTHMA AND ASTHMA-RELATED
ILLNESSES THROUGH URBAN COCKROACH MANAGEMENT.
Section 1904(a)(1) of the Public Health Service Act (42
U.S.C. 300w-3(a)(1)) is amended--
(1) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively;
(2) by adding a period at the end of subparagraph (G) (as
so redesignated);
(3) by inserting after subparagraph (D), the following:
``(E) The establishment, operation, and coordination of
effective and cost-efficient systems to reduce the prevalence
of asthma and asthma-related illnesses among urban
populations, especially children, by reducing the level of
exposure to cockroach allergen through the use of integrated
pest management, as applied to cockroaches. Amounts
[[Page S3779]]
expended for such systems may include the costs of structural
rehabilitation of housing, public schools, and other public
facilities to reduce cockroach infestation, the costs of
building maintenance, and the costs of programs to promote
community participation in the carrying out at such sites
integrated pest management, as applied to cockroaches. For
purposes of this subparagraph, the term `integrated pest
management' means an approach to the management of pests in
public facilities that minimizes or avoids the use of
pesticide chemicals through a combination of appropriate
practices regarding the maintenance, cleaning, and monitoring
of such sites.'';
(4) in subparagraph (F) (as so redesignated), by striking
``subparagraphs (A) through (D)'' and inserting
``subparagraphs (A) through (E)''; and
(5) in subparagraph (G) (as so redesignated), by striking
``subparagraphs (A) through (E)'' and inserting
``subparagraphs (A) through (F)''.
SEC. 6. COORDINATION OF FEDERAL ACTIVITIES TO ADDRESS ASTHMA-
RELATED HEALTH CARE NEEDS.
(a) In General.--The Director of the National Heart, Lung,
and Blood Institute shall, through the National Asthma
Education Prevention Program Coordinating Committee--
(1) identify all Federal programs that carry out asthma-
related activities;
(2) develop, in consultation with appropriate Federal
agencies and professional and voluntary health organizations,
a Federal plan for responding to asthma; and
(3) not later than 12 months after the date of enactment of
this Act, submit recommendations to Congress on ways to
strengthen and improve the coordination of asthma-related
activities of the Federal Government.
(b) Representation of the Department of Housing and Urban
Development.--A representative of the Department of Housing
and Urban Development shall be included on the National
Asthma Education Prevention Program Coordinating Committee
for the purpose of performing the tasks described in
subsection (a).
(c) Authorization of Appropriations.--Out of any funds
otherwise appropriated for the National Institutes of Health,
$5,000,000 shall be made available to the National Asthma
Education Prevention Program for the period of fiscal years
2000 through 2004 for the purpose of carrying out this
section. Funds made available under this subsection shall be
in addition to any other funds appropriated to the National
Asthma Education Prevention Program for any fiscal year
during such period.
SEC. 7. COMPILATION OF DATA BY THE CENTERS FOR DISEASE
CONTROL AND PREVENTION.
(a) In General.--The Director of the Centers for Disease
Control and Prevention, in consultation with the National
Asthma Education Prevention Program Coordinating Committee,
shall--
(1) conduct local asthma surveillance activities to collect
data on the prevalence and severity of asthma and the quality
of asthma management, including--
(A) telephone surveys to collect sample household data on
the local burden of asthma; and
(B) health care facility specific surveillance to collect
asthma data on the prevalence and severity of asthma, and on
the quality of asthma care; and
(2) compile and annually publish data on--
(A) the prevalence of children suffering from asthma in
each State; and
(B) the childhood mortality rate associated with asthma
nationally and in each State.
(b) Collaborative Efforts.--The activities described in
subsection (a)(1) may be conducted in collaboration with
eligible entities awarded a grant under section 511 of the
Social Security Act (as added by section 3).
Mr. DeWINE. Mr. President, today I join with my colleague, Senator
Durbin, in introducing the ``Children's Asthma Relief Act of 1999.''
This bill would authorize $50 million for each of 5 years for the
Secretary of Health and Human Services to award grants to eligible
entities to develop and expand projects to provide asthma services to
children. These grants may also be used to equip mobile health care
clinics that provide asthma diagnosis and asthma-related health care
services, educate families on asthma management, and identify and
enroll uninsured children who are eligible for but not receiving health
coverage under Medicaid or the State Children's Health Insurance
Program (SCHIP). The ability to identify and enroll children in these
programs will ensure that children with asthma receive the care they
need.
Research supported by the NIH has shown that the combination of
cockroach waste, house dust mites, molds, tobacco smoke, and feathers
(among other allergens) contribute to asthma-related illness and
hospitalization. Children living in urban areas are especially
susceptible.
Asthma is the most common chronic illness that forces children to
miss school. From 1979 to 1992, the hospitalization rates among
children due to asthma increased 74 percent. Estimates show that more
than 7% of children now suffer from asthma. Hospitalization rates were
highest for individuals 4 years old and younger. According to 1998 data
from the Center for Disease Control (CDC) my home state of Ohio ranks
about 17th in the estimated prevalence rates for asthma. Nationwide,
the most substantial prevalence rate increase for asthma occurred among
children aged 4 years old and younger.
I believe that an important component of this bill is that it
requires those receiving grants to coordinate with current children's
health programs such as the Maternal and Child Health Program,
Medicaid, the State Children's Health Insurance Program, supplemental
nutrition programs, and child welfare, foster care and adoption
assistance programs. This type of coordination with other children's
programs will help to ensure not just a better targeting of funding,
but also will help to identify children in these programs who are
asthmatic and may otherwise remain undetected and untreated.
This bill would authorize $5 million for each of 5 years for the
Secretary of HHS to award matching grants to states that develop plans
to carry out asthma-related programs for children according to NIH
guidelines through the state children's health insurance programs.
Since research shows that children living in urban areas suffer from
asthma at such alarming rates and that allergens such as cockroach
waste contribute to the onset of asthma, this bill adds urban cockroach
management to the current preventive health services block grant which
can currently be used for rodent control. To reduce roach allergens,
this block grant could be used to cover the costs of structural
rehabilitation of public housing, schools, and other public facilities
to control roach infestation, while minimizing or avoiding the use of
pesticides.
This bill would require that NIH give the National Asthma Education
Prevention Program (within NIH) an additional $5 million for each of 5
years to develop a federal plan for responding to asthma and to submit
recommendations to Congress on ways to strengthen and better coordinate
federal asthma-related activities.
To better monitor the prevalence and determine which areas have the
greatest incidences of children with asthma, this bill would require
CDC to conduct local asthma surveillance activities to collect data on
the prevalence and severity of asthma and to annually publish data on
the prevalence rates of asthma among children and on the childhood
mortality rate. This surveillance data will help us better detect
asthmatic conditions so that more children can be treated and we can
ensure that we are targeting our resources in an effective and
efficient way to reverse the disturbing trend in the hospitalization
and death rates of children who suffer from asthma.
Mr. President, I urge my colleagues to support this very important
initiative to help the nearly 5 million children who have been
diagnosed with asthma and to help those who suffer from asthma but who
remain untreated.
______