[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.
                                 ______