[Congressional Record Volume 145, Number 128 (Tuesday, September 28, 1999)]
[House]
[Pages H8910-H8941]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH RESEARCH AND QUALITY ACT OF 1999
Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call
up House Resolution 299 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 299
Resolved, That at any time after the adoption of this
resolution the Speaker may, pursuant to clause 2(b) of rule
XVIII, declare the House resolved into the Committee of the
Whole House on the state of the Union for consideration of
the bill (H.R. 2506) to amend title IX of the Public Health
Service Act to revise and extend the Agency for Health Care
Policy and Research. The first reading of the bill shall be
dispensed with. General debate shall be confined to the bill
and shall not exceed one hour equally divided and controlled
by the chairman and ranking minority member of the Committee
on Commerce. After general debate the bill shall be
considered for amendment under the five-minute rule. It shall
be in order to consider as an original bill for the purpose
of amendment under the five-minute rule the amendment in the
nature of a substitute recommended by the Committee on
Commerce now printed in the bill. Each section of the
committee amendment in the nature of a substitute shall be
considered as read. No amendment to the committee amendment
in the nature of a substitute shall be in order except those
printed in the portion of the Congressional Record designated
for that purpose in clause 8 of rule XVIII and except pro
forma amendments for the purpose of debate. Each amendment so
printed may be offered only by the Member who caused it to be
printed or his designee and shall be considered as read. The
Chairman of the Committee of the Whole may: (1) postpone
until a time during further consideration in the Committee of
the Whole a request for a recorded vote on any amendment; and
(2) reduce to five minutes the minimum time for electronic
voting on any postponed question that follows another
electronic vote without intervening business, provided that
the minimum time for electronic voting on the first in any
series of questions shall be 15 minutes. At the conclusion of
consideration of the bill for amendment the Committee shall
rise and report the bill to the House with such amendments as
may have been adopted. Any Member may demand a separate vote
in the House on any amendment adopted in the Committee of the
Whole to the bill or to the committee amendment in the nature
of a substitute. The previous question shall be considered as
ordered on the bill and amendments thereto to final passage
without intervening motion except one motion to recommit with
or without instructions.
{time} 1445
The SPEAKER pro tempore (Mr. Pease). The gentleman from Florida (Mr.
Goss) is recognized for 1 hour.
Mr. GOSS. Mr. Speaker, for purposes of debate only, I yield the
customary 30 minutes to the distinguished gentlewoman from Rochester,
NY (Ms. Slaughter) pending which I yield myself such time as I may
consume. During consideration of this resolution, Mr. Speaker, all time
yielded is for the purpose of debate only.
Mr. Speaker, this is a fair and appropriate rule for this particular
legislation. In fact, had it not been for the amount of money H.R. 2506
authorizes, doubling the current authorization level to $900 million,
the bill would have been considered under the suspension process. The
bill was voted out of the Committee on Commerce by a voice vote and the
Committee on Rules reported a modified open rule to ensure that no
extraneous amendments to the Public Health Service Act would be
considered. The rule allows any Member who has preprinted an amendment
in the Congressional Record to offer that amendment. This will ensure a
full and open, yet targeted debate on the merits of this particular
agency covered by this legislation.
When the Agency for Health Care Policy and Research, AHCPR as it is
known in its acronym, was created in 1989, the health care universe
looked far different than it does today. Traditional fee for service
plans still dominated the market and managed care was still very much
in its infancy period. Utilization review, peer review, these were
largely unknown concepts, at least fully tried or tested. H.R. 2506
modernizes the agency to reflect these and other changes and provides
resources to enable more effective collection of data.
Many Americans sitting at home watching may be wondering why we need
yet another Federal agency involved in health care quality. Well,
health care quality is a critical issue these days. As someone who has
always believed that Congress too often stands in the way of true
health care quality, I share concern with the people at home who are
worried about this. To the extent that this ``reformed'' agency can
promote better research and encourage successful partnerships between
the public and private sectors with limited Federal red tape, it can be
a worthy investment. And, of course, that is the goal. But we must
retain vigorous oversight and maintain high expectations to ensure that
these precious taxpayer dollars are indeed put
[[Page H8911]]
to good use. Again, we think that is the reason for this legislation
and we congratulate its authors for this effort.
As I stated before, this is an eminently fair rule that should
engender no controversy as far as I know.
Mr. Speaker, I reserve the balance of my time.
Ms. SLAUGHTER. Mr. Speaker, I thank my distinguished colleague from
Florida for yielding me the 30 minutes, and I yield myself such time as
I may consume.
(Ms. SLAUGHTER asked and was given permission to revise and extend
her remarks.)
Ms. SLAUGHTER. Mr. Speaker, this is an ``almost open'' rule, for the
majority has again relied on a preprinting requirement for amendments
which may affect some Members of the House. But I rise in support of
the rule and in support of H.R. 2506, the Health Research and Quality
Act of 1999. The bill is being brought to the floor by the gentleman
from Florida (Mr. Bilirakis) for the majority and the gentleman from
Ohio (Mr. Brown) for the minority.
This bipartisan legislation reauthorizes the Agency for Health Care
Policy and Research and renames the agency as the Agency for Health
Research and Quality, AHRQ, pronounced ``arc.'' This agency promotes
health care quality through research, synthesizing and consolidating
medical information, and disseminating scientific evidence. Building on
its current initiatives, the agency will play a key role in partnering
with the private sector to improve the quality of health care in the
United States.
As a longtime supporter of health care research, I believe this piece
of legislation will benefit patients, care-givers and insurance
providers with vital information and statistics on how to improve the
Nation's health care system. The agency's research and information
consolidation will play a key role in extending quality care and
improving health service delivery throughout the country. This agency
provides vital information and resources that foster improvement in
health care systems from America's smallest rural townships to its most
populous inner cities.
The agency's mission includes fostering the extension of quality
health care systems to those Americans left behind as our Nation
continues its economic growth. The agency's work is especially
important as health care delivery in our country evolves. When the
AHCPR was established a little over 10 years ago, the health care
system was vastly different from what we know today. More people now
receive their care through managed plans and HMOs. The growing
complexity of health plans bewilderers many patients and contributes to
the growing tensions between patients and insurers.
This legislation directs AHRQ to address the public's growing concern
for the quality of patient care and the number of medical errors that
continue to grow each day. Their research helps hospitals and clinics
around the country to reduce the injuries arising from mismanagement of
cases.
A recent study examined the records of more than 30,000 hospital
patients in my home State of New York. The study found that nearly 4
percent of patients suffered serious injuries that were related to the
management of their illnesses rather than the illnesses themselves.
This is a vital area of research for the agency and another reason why
the reauthorization of funding for this agency and the redirection of
its mission is important.
The legislation does more than merely change the name of the agency.
It directs the agency to develop new public-private partnerships in the
health care arena. This will bring new perspectives to improving the
dissemination of health information and the development of health care
systems that better serve our neighborhoods, towns and cities. These
partnerships will also leverage greater private investment and
commitment to creating improved health care service systems throughout
the Nation. In the process, AHRQ will also support increased efficiency
and quality of Federal program management.
According to testimony provided to the committee during a recent
hearing, nine out of 10 people surveyed supported health research as
well as the amount of Federal money spent on our Nation's health care.
Mr. Speaker, this agency costs just one one-hundredth of one percent of
the total funds spent by the government on health care and is a sound
investment in our Nation's future health.
I support this initiative even though it is only a modest step toward
guaranteeing that all our citizens have access to the finest medical
care in the world. Citizens across the United States are crying out for
more. We need comprehensive health care reform that includes a
provision to ban genetic discrimination in insurance. We need a true
Patients' Bill of Rights.
Mr. Speaker, I yield back the balance of my time.
Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I
prove the previous question on the resolution.
The previous question was ordered.
The resolution was agreed to.
A motion to reconsider was laid on the table.
The SPEAKER pro tempore (Mr. Knollenberg). Pursuant to House
Resolution 299 and rule XVIII, the Chair declares the House in the
Committee of the Whole House on the State of the Union for the
consideration of the bill, H.R. 2506.
{time} 1454
In the Committee of the Whole
Accordingly, the House resolved itself into the Committee of the
Whole House on the State of the Union for the consideration of the bill
(H.R. 2506) to amend title IX of the Public Health Service Act to
revise and extend the Agency for Health Care Policy and Research, with
Mr. Pease in the chair.
The Clerk read the title of the bill.
The CHAIRMAN. Pursuant to the rule, the bill is considered as having
been read the first time.
Under the rule, the gentleman from Florida (Mr. Bilirakis) and the
gentleman from Ohio (Mr. Brown) each will control 30 minutes.
The Chair recognizes the gentleman from Florida (Mr. Bilirakis).
Mr. BILIRAKIS. Mr. Chairman, I yield myself such time as I may
consume.
Mr. Chairman, I am pleased to bring H.R. 2506, the Health Research
and Quality Act of 1999, to the floor today. This widely supported
bipartisan bill was approved by voice vote in the Committee on Commerce
and the Subcommittee on Health and Environment. In April, experts from
both the public and private sector testified about the critical
function of this agency at a hearing before the subcommittee.
I introduced this measure jointly with the gentleman from Ohio (Mr.
Brown), the ranking member of the House Commerce Subcommittee on Health
and Environment, to reauthorize the Agency for Health Care Policy and
Research and redefine its mission. Our bill renames it as the Agency
for Health Research and Quality, or, one of those famous Washington
acronyms, AHRQ.
The purpose of this new name, and the reauthorization, is to foster
comprehensive improvements in our health care system. Our bill
refocuses the efforts of this critical agency to support private sector
initiatives. Building on its current activities, the new agency will
become a key partner to the private sector in improving the quality of
health care in America.
The bill specifically prohibits the agency from mandating national
standards of clinical practice or quality health care standards.
Instead, it emphasizes the agency's nonregulatory role in building the
science of health care quality.
The bill also includes provisions to overcome barriers to access to
preventive health care through a public-private partnership. It
authorizes grants for the establishment of regional centers to improve
and increase access to preventive health care services.
By approving the legislation before us, we can ensure the continued
availability of the objective, science-based information this agency
provides.
I urge Members to join us in supporting passage of H.R. 2506, the
Health Research and Quality Act of 1999.
Mr. Chairman, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Chairman, I yield myself such time as I may
consume.
I am pleased that the gentleman from Florida (Mr. Bilirakis) and I
[[Page H8912]]
could work together to introduce the Health Research and Quality Act
and pass it out of the Committee on Commerce. We hold similar views on
why this issue is important. It is important because research is
important.
The U.S. health care system is far from transparent. In fact, in many
ways it is not even a system. It is a complex set of relationships
influenced by science, demographics, politics, money and cultural
trends. Whether the focus is on health care financing or health care
delivery, common sense alone rarely explains what is going on. In fact,
it often throws policymakers off track. If we want to improve on the
status quo in health care, we have to get a realistic picture of what
the status quo is. By conducting and supporting health services
research, AHCPR helps paint that picture for us.
If we want to improve on the status quo in health care, we have got
to find out what improvement actually means. By conducting and
supporting outcomes, effectiveness and cost effectiveness research,
AHCPR helps us determine the best way to spend the limited health care
dollars that we do have.
And if we want to improve on the status quo in health care, we need
to get the word out to the people in the institutions, in the agencies
and the industries that somehow keep the whole thing running. By
disseminating research and data broadly, AHCPR helps ensure that our
investment in data collection, health services research and biomedical
research pays off.
This reauthorization makes research and broad dissemination of
information AHCPR's main focus. We could definitely use more of both.
I urge support of this important legislation.
Mr. Chairman, I reserve the balance of my time.
Mr. BILIRAKIS. Mr. Chairman, I yield 2 minutes to the gentleman from
California (Mr. Gary Miller).
(Mr. GARY MILLER of California asked and was given permission to
revise and extend his remarks.)
Mr. GARY MILLER of California. Mr. Chairman, I rise today in support
of H.R. 2506, the Health Research and Quality Act. First I want to
thank the bill's author the gentleman from Florida (Mr. Bilirakis) and
the cosponsors for all their hard work on this issue.
H.R. 2506 is an important piece of legislation which will improve the
quality of health care by directing the Agency for Health Care Policy
and Research to emphasize medical research, synthesizing and
disseminating scientific evidence, and advancing public and private
efforts to improve health care quality.
With the explosion of medical research and information being
produced, medical practitioners face the increasingly difficult task of
keeping current with medical literature and putting the latest
scientific findings into perspective. As one study indicated, even if a
doctor read two peer-reviewed journals each night for a year, he or she
would still be 800 years behind in their reading.
Access to up-to-date, quality research will improve the care that
patients obtain from all levels of the health care system. H.R. 2506
will provide a means whereby medical group practices can obtain and
contribute to such a body of information. This legislation frees the
Agency for Health Care Policy and Research from the difficult task of
providing guidelines and standards of care and allows it to focus on
providing unbiased, science-based research to the health care
community. H.R. 2506 will help health care professionals and
policymakers better understand the future demands on the Nation's
health care system.
Again, I lend my strong support to this measure and urge my
colleagues to join me in voting in favor of the Health Research and
Quality Act of 1999.
{time} 1500
Mr. BILIRAKIS. Mr. Chairman, I yield such time as he may consume to
another gentleman from California (Mr. Bilbray).
Mr. BILBRAY. Mr. Chairman, I rise to strongly support H.R. 2506, and
let me just say as someone who has the privilege of representing the
49th District of California, one of the capitals of both public and
private research, I want to commend the chairman and the ranking member
for a cooperative effort here at really serving the American people.
The concept of reform and change sometimes scares people in these
chambers and they worry about what could go wrong, and I think we have
to remind ourselves again and again that reform and change is also an
essential step to improvement. And this bill will allow us to take that
step towards an improvement of not only the cost effectiveness, the
cost efficiency, but also the effectiveness of our total health care
system through the information age.
Mr. Chairman, 2506 will be that kind of step. And I hope that in the
future we will be able to look back at H.R. 2506 and look back at the
cooperative effort between the chairman of the subcommittee and the
ranking member of this subcommittee and say this was the beginning of a
very productive relationship between both sides of the aisle and a
productive relationship with the American people and their health care
system.
Mr. Chairman, I would ask all of us to support this bill and support
the attitude that is behind this bill and to support the entire concept
that Democrats and Republicans can work together for the good of the
safety and the health of the American people.
Mr. BLILEY. Mr. Chairman, I commend the gentlemen from Florida and
Ohio for bringing H.R. 2506, the Health Research and Quality Act of
1999, to the floor. This legislation, introduced by Representatives
Bilirakis and Brown, represents an important commitment to provide the
science-based evidence that we need to improve health care quality.
We need sound and reliable information to help patients make informed
decisions, to help health care providers make sense of new discoveries,
to help purchasers get value for their health care dollar, and to help
avoid medical errors. Today's legislation builds on the progress the
Agency for Health Care Policy and Research has already made. It will
enable us to benefit from our investment in biomedical research, to
improve the health care delivery programs under our jurisdiction, and
to build the science of quality measurement and improvement.
This emphasis on quality measurement and improvement is important.
The focus on health outcomes is critical. If we are unable to determine
the long-term effect of the care patients receive today, we will be
unable to improve upon that care tomorrow. To address the full
continuum of care and outcomes research, and to link research directly
with clinical practice in geographically diverse locations throughout
the United States, this bill stresses the importance of health care
improvement research centers and provider-based research networks.
Since the science of outcomes research is complex, this bill requires
the agency to support research and evaluation to advance the use of
information systems for the study of health care quality and outcomes.
The importance of outcomes research and information dissemination in
the continuous improvement of patient care cannot be overstated. For
example, in the area of cancer care, the ability to chart patient
outcomes from a variety of interventions and communicate these outcomes
effectively among practitioners will allow significant improvement in
the treatment of all types of cancer.
In summary, Mr. Chairman, the Health Research and Quality Act of 1999
is a sound investment in the future; it is legislation that both sides
of the aisle can support. The Commerce Committee gave unanimous
approval to this legislation and I hope it will enjoy similar support
on the floor today.
Mr. BALDACCI. Mr. Chairman, I commend the Chairman, Mr. Bilirakis,
and the Ranking Member, Mr. Brown, for introducing this valuable
legislation. I particularly want to thank the Members for the special
attention given to rural health care in the bill.
Access and quality of health care in rural America is of particular
importance to me. I represent the largest geographic district east of
the Mississippi. Recently, compounding changes in Medicare
reimbursement and regulations have had a devastating impact on my
district, and have endangered a very vulnerable population of my state.
People in rural areas do not have the same choices available to those
in urban areas. I am concerned that the rate of the uninsured in Maine
continues to grow. Maine citizens rely heavily on community care, and
we ought to promote research into enhancing quality of and access to
health care in these areas. Careful studies of the delivery of health
services in rural America will allow us to make better public policy,
and I thank the Chairman and Ranking Member for their attention to this
issue.
I am also pleased to see the legislation address the critical issue
of health insurance. Section 913 requires that there must be surveys
on, among other factors, the types and
[[Page H8913]]
costs of private health insurance. As we know, there is a growing trend
to consolidation among health insurance companies, and I am
particularly concerned about the ability of these large companies to
direct costs and types of care offered when they buy out smaller local
insurers. It is my hope that with this component of the bill, we will
gain a better understanding of what effect the consolidation in the
health insurance market is having on quality, access, and cost of
insurance to rural Americans. Again, I thank the Chairman and Ranking
Member for addressing this issue.
Mr. BILIRAKIS. Mr. Chairman, we have no further requests for time.
Mr. BROWN of Ohio. Mr. Chairman, I yield back the balance of my time.
Mr. BILIRAKIS. Mr. Chairman, I yield back the balance of my time.
The CHAIRMAN. All time for general debate has expired.
Pursuant to the rule, the committee amendment in the nature of a
substitute printed in the bill shall be considered by sections as an
original bill for the purpose of amendment, and each section is
considered read.
No amendment to that amendment shall be in order except those printed
in the portion of the Congressional Record designated for that purpose
and pro forma amendments for the purpose of debate. Amendments printed
in the Record may be offered only by the Member who caused it to be
printed or his designee and shall be considered read.
The Chairman of the Committee of the Whole may postpone a request for
a recorded vote on any amendment and may reduce to a minimum of 5
minutes the time for voting on any postponed question that immediately
follows another vote, provided that the time for voting on the first
question shall be a minimum of 15 minutes.
The Clerk will designate section 1.
The text of section 1 is as follows:
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 ``Health Research and Quality
Act of 1999''.
The CHAIRMAN. Are there any amendments to section 1?
The Clerk will designate section 2.
The text of section 2 is as follows:
SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
(a) In General.--Title IX of the Public Health Service Act
(42 U.S.C. 299 et seq.) is amended to read as follows:
``TITLE IX--AGENCY FOR HEALTH RESEARCH AND QUALITY
``PART A--ESTABLISHMENT AND GENERAL DUTIES
``SEC. 901. MISSION AND DUTIES.
``(a) In General.--There is established within the Public
Health Service an agency to be known as the Agency for Health
Research and Quality, which shall be headed by a director
appointed by the Secretary. The Secretary shall carry out
this title acting through the Director.
``(b) Mission.--The purpose of the Agency is to enhance the
quality, appropriateness, and effectiveness of health
services, and access to such services, through the
establishment of a broad base of scientific research and
through the promotion of improvements in clinical and health
system practices, including the prevention of diseases and
other health conditions. The Agency shall promote health care
quality improvement by--
``(1) conducting and supporting research that develops and
presents scientific evidence regarding all aspects of health,
including--
``(A) the development and assessment of methods for
enhancing patient participation in their own care and for
facilitating shared patient-physician decision-making;
``(B) the outcomes, effectiveness, and cost-effectiveness
of health care practices, including preventive measures and
long-term care;
``(C) existing and innovative technologies;
``(D) the costs and utilization of, and access to health
care;
``(E) the ways in which health care services are organized,
delivered, and financed and the interaction and impact of
these factors on the quality of patient care;
``(F) methods for measuring quality and strategies for
improving quality; and
``(G) ways in which patients, consumers, purchasers, and
practitioners acquire new information about best practices
and health benefits, the determinants and impact of their use
of this information;
``(2) synthesizing and disseminating available scientific
evidence for use by patients, consumers, practitioners,
providers, purchasers, policy makers, and educators; and
``(3) advancing private and public efforts to improve
health care quality.
``(c) Requirements With Respect to Rural Areas and Priority
Populations.--In carrying out subsection (b), the Director
shall undertake and support research, demonstration projects,
and evaluations with respect to--
``(1) the delivery of health services in rural areas
(including frontier areas);
``(2) health services for low-income groups, and minority
groups;
``(3) the health of children;
``(4) the elderly; and
``(5) people with special health care needs, including
disabilities, chronic care and end-of-life health care.
``SEC. 902. GENERAL AUTHORITIES.
``(a) In General.--In carrying out section 901(b), the
Director shall support demonstration projects, conduct and
support research, evaluations, training, research
networks, multi-disciplinary centers, technical
assistance, and the dissemination of information, on
health care, and on systems for the delivery of such care,
including activities with respect to--
``(1) the quality, effectiveness, efficiency,
appropriateness and value of health care services;
``(2) quality measurement and improvement;
``(3) the outcomes, cost, cost-effectiveness, and use of
health care services and access to such services;
``(4) clinical practice, including primary care and
practice-oriented research;
``(5) health care technologies, facilities, and equipment;
``(6) health care costs, productivity, organization, and
market forces;
``(7) health promotion and disease prevention, including
clinical preventive services;
``(8) health statistics, surveys, database development, and
epidemiology; and
``(9) medical liability.
``(b) Health Services Training Grants.--
``(1) In general.--The Director may provide training grants
in the field of health services research related to
activities authorized under subsection (a), to include pre-
and post-doctoral fellowships and training programs, young
investigator awards, and other programs and activities as
appropriate. In carrying out this subsection, the Director
shall make use of funds made available under section 487.
``(2) Requirements.--In developing priorities for the
allocation of training funds under this subsection, the
Director shall take into consideration shortages in the
number of trained researchers addressing the priority
populations.
``(c) Multidisciplinary Centers.--The Director may provide
financial assistance to assist in meeting the costs of
planning and establishing new centers, and operating existing
and new centers, for multidisciplinary health services
research, demonstration projects, evaluations, training, and
policy analysis with respect to the matters referred to in
subsection (a).
``(d) Relation to Certain Authorities Regarding Social
Security.--Activities authorized in this section shall be
appropriately coordinated with experiments, demonstration
projects, and other related activities authorized by the
Social Security Act and the Social Security Amendments of
1967. Activities under subsection (a)(2) of this section that
affect the programs under titles XVIII, XIX and XXI of the
Social Security Act shall be carried out consistent with
section 1142 of such Act.
``(e) Disclaimer.--The Agency shall not mandate national
standards of clinical practice or quality health care
standards. Recommendations resulting from projects funded and
published by the Agency shall include a corresponding
disclaimer.
``(f) Rule of Construction.--Nothing in this section shall
be construed to imply that the Agency's role is to mandate a
national standard or specific approach to quality measurement
and reporting. In research and quality improvement
activities, the Agency shall consider a wide range of
choices, providers, health care delivery systems, and
individual preferences.
``PART B--HEALTH CARE IMPROVEMENT RESEARCH
``SEC. 911. HEALTH CARE OUTCOME IMPROVEMENT RESEARCH.
``(a) Evidence Rating Systems.--In collaboration with
experts from the public and private sector, the Agency shall
identify and disseminate methods or systems that it uses to
assess health care research results, particularly methods or
systems that it uses to rate the strength of the scientific
evidence behind health care practice, recommendations in the
research literature, and technology assessments. The Agency
shall make methods or systems for evidence rating widely
available. Agency publications containing health care
recommendations shall indicate the level of substantiating
evidence using such methods or systems.
``(b) Health Care Improvement Research Centers and
Provider-Based Research Networks.--
``(1) In general.--In order to address the full continuum
of care and outcomes research, to link research to practice
improvement, and to speed the dissemination of research
findings to community practice settings, the Agency shall
employ research strategies and mechanisms that will link
research directly with clinical practice in geographically
diverse locations throughout the United States, including--
``(A) Health Care Improvement Research Centers that combine
demonstrated multidisciplinary expertise in outcomes or
quality improvement research with linkages to relevant sites
of care;
``(B) Provider-based Research Networks, including plan,
facility, or delivery system sites of care (especially
primary care), that can evaluate outcomes and promote quality
improvement; and
``(C) other innovative mechanisms or strategies to link
research with clinical practice.
``(2) Requirements.--The Director is authorized to
establish the requirements for entities applying for grants
under this subsection.
``SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE
ORGANIZATION AND DELIVERY.
``(a) Support for Efforts To Develop Information on
Quality.--
``(1) Scientific and technical support.--In its role as the
principal agency for health research and quality, the Agency
may provide scientific and technical support for private and
[[Page H8914]]
public efforts to improve health care quality, including the
activities of accrediting organizations.
``(2) Role of the agency.--With respect to paragraph (1),
the role of the Agency shall include--
``(A) the identification and assessment of methods for the
evaluation of the health of--
``(i) enrollees in health plans by type of plan, provider,
and provider arrangements; and
``(ii) other populations, including those receiving long-
term care services;
``(B) the ongoing development, testing, and dissemination
of quality measures, including measures of health and
functional outcomes;
``(C) the compilation and dissemination of health care
quality measures developed in the private and public sector;
``(D) assistance in the development of improved health care
information systems;
``(E) the development of survey tools for the purpose of
measuring participant and beneficiary assessments of their
health care; and
``(F) identifying and disseminating information on
mechanisms for the integration of information on quality into
purchaser and consumer decision-making processes.
``(b) Centers for Education and Research on Therapeutics.--
``(1) In general.--The Secretary, acting through the
Director and in consultation with the Commissioner of Food
and Drugs, shall establish a program for the purpose of
making one or more grants for the establishment and operation
of one or more centers to carry out the activities specified
in paragraph (2).
``(2) Required activities.--The activities referred to in
this paragraph are the following:
``(A) The conduct of state-of-the-art research for the
following purposes:
``(i) To increase awareness of--
``(I) new uses of drugs, biological products, and devices;
``(II) ways to improve the effective use of drugs,
biological products, and devices; and
``(III) risks of new uses and risks of combinations of
drugs and biological products.
``(ii) To provide objective clinical information to the
following individuals and entities:
``(I) Health care practitioners and other providers of
health care goods or services.
``(II) Pharmacists, pharmacy benefit managers and
purchasers.
``(III) Health maintenance organizations and other managed
health care organizations.
``(IV) Health care insurers and governmental agencies.
``(V) Patients and consumers.
``(iii) To improve the quality of health care while
reducing the cost of health care through--
``(I) an increase in the appropriate use of drugs,
biological products, or devices; and
``(II) the prevention of adverse effects of drugs,
biological products, and devices and the consequences of such
effects, such as unnecessary hospitalizations.
``(B) The conduct of research on the comparative
effectiveness, cost-effectiveness, and safety of drugs,
biological products, and devices.
``(C) Such other activities as the Secretary determines to
be appropriate, except that a grant may not be expended to
assist the Secretary in the review of new drugs.
``(c) Reducing Errors in Medicine.--The Director shall
conduct and support research and build private-public
partnerships to--
``(1) identify the causes of preventable health care errors
and patient injury in health care delivery;
``(2) develop, demonstrate, and evaluate strategies for
reducing errors and improving patient safety; and
``(3) promote the implementation of effective strategies
throughout the health care industry.
``SEC. 913. INFORMATION ON QUALITY AND COST OF CARE.
``(a) In General.--In carrying out 902(a), the Director
shall--
``(1) conduct a survey to collect data on a nationally
representative sample of the population on the cost, use and,
for fiscal year 2001 and subsequent fiscal years, quality of
health care, including the types of health care services
Americans use, their access to health care services,
frequency of use, how much is paid for the services used, the
source of those payments, the types and costs of private
health insurance, access, satisfaction, and quality of care
for the general population and also for populations
identified in section 901(c); and
``(2) develop databases and tools that provide information
to States on the quality, access, and use of health care
services provided to their residents.
``(b) Quality and Outcomes Information.--
``(1) In general.--Beginning in fiscal year 2001, the
Director shall ensure that the survey conducted under
subsection (a)(1) will--
``(A) identify determinants of health outcomes and
functional status, the needs of special populations in such
variables as well as an understanding of changes over time,
relationships to health care access and use, and monitor the
overall national impact of Federal and State policy changes
on health care;
``(B) provide information on the quality of care and
patient outcomes for frequently occurring clinical conditions
for a nationally representative sample of the population; and
``(C) provide reliable national estimates for children and
persons with special health care needs through the use of
supplements or periodic expansions of the survey.
In expanding the Medical Expenditure Panel Survey, as in
existence on the date of enactment of this title in fiscal
year 2001 to collect information on the quality of care, the
Director shall take into account any outcomes measurements
generally collected by private sector accreditation
organizations.
``(2) Annual report.--Beginning in fiscal year 2003, the
Secretary, acting through the Director, shall submit to
Congress an annual report on national trends in the quality
of health care provided to the American people.
``SEC. 914. INFORMATION SYSTEMS FOR HEALTH CARE IMPROVEMENT.
``(a) In General.--In order to foster a range of innovative
approaches to the management and communication of health
information, the Agency shall support research, evaluations
and initiatives to advance--
``(1) the use of information systems for the study of
health care quality and outcomes, including the generation of
both individual provider and plan-level comparative
performance data;
``(2) training for health care practitioners and
researchers in the use of information systems;
``(3) the creation of effective linkages between various
sources of health information, including the development of
information networks;
``(4) the delivery and coordination of evidence-based
health care services, including the use of real-time health
care decision-support programs;
``(5) the structure, content, definition, and coding of
health information data and medical vocabularies in
consultation with appropriate Federal entities and shall seek
input from appropriate private entities;
``(6) the use of computer-based health records in
outpatient and inpatient settings as a personal health record
for individual health assessment and maintenance, and for
monitoring public health and outcomes of care within
populations; and
``(7) the protection of individually identifiable
information in health services research and health care
quality improvement.
``(b) Demonstration.--The Agency shall support
demonstrations into the use of new information tools aimed at
improving shared decision-making between patients and their
care-givers.
``SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN
UNDERSERVED AREAS.
``(a) Preventive Services Task Force.--
``(1) Purpose.--The Agency shall provide ongoing
administrative, research, and technical support for the
operation of the Preventive Services Task Force. The Agency
shall coordinate and support the dissemination of the
Preventive Services Task Force recommendations.
``(2) Operation.--The Preventive Services Task Force shall
review the scientific evidence related to the effectiveness,
appropriateness, and cost-effectiveness of clinical
preventive services for the purpose of developing
recommendations for the health care community, and updating
previous recommendations, regarding their usefulness in daily
clinical practice. In carrying out its responsibilities under
paragraph (1), the Task Force shall not be subject to the
provisions of Appendix 2 of title 5, United States Code.
``(b) Primary Care Research.--
``(1) In general.--There is established within the Agency a
Center for Primary Care Research (referred to in this
subsection as the `Center') that shall serve as the principal
source of funding for primary care practice research in the
Department of Health and Human Services. For purposes of this
paragraph, primary care research focuses on the first contact
when illness or health concerns arise, the diagnosis,
treatment or referral to specialty care, preventive care, and
the relationship between the clinician and the patient in the
context of the family and community.
``(2) Research.--In carrying out this section, the Center
shall conduct and support research concerning--
``(A) the nature and characteristics of primary care
practice;
``(B) the management of commonly occurring clinical
problems;
``(C) the management of undifferentiated clinical problems;
and
``(D) the continuity and coordination of health services.
``SEC. 916. CLINICAL PRACTICE AND TECHNOLOGY INNOVATION.
``(a) In General.--The Director shall promote innovation in
evidence-based clinical practice and health care technologies
by--
``(1) conducting and supporting research on the
development, diffusion, and use of health care technology;
``(2) developing, evaluating, and disseminating
methodologies for assessments of health care practices and
health care technologies;
``(3) conducting intramural and supporting extramural
assessments of existing and new health care practices and
technologies;
``(4) promoting education, training, and providing
technical assistance in the use of health care practice and
health care technology assessment methodologies and results;
and
``(5) working with the National Library of Medicine and the
public and private sector to develop an electronic
clearinghouse of currently available assessments and those in
progress.
``(b) Specification of Process.--
``(1) In general.--Not later than December 31, 2000, the
Director shall develop and publish a description of the
methods used by the Agency and its contractors for practice
and technology assessment.
``(2) Consultations.--In carrying out this subsection, the
Director shall cooperate and consult with the Assistant
Secretary for Health, the Administrator of the Health Care
Financing Administration, the Director of the National
Institutes of Health, the Commissioner of Food and Drugs, and
the heads of any other interested Federal department or
agency, and shall seek input, where appropriate, from
professional societies and other private and public entities.
``(3) Methodology.--The Director shall, in developing the
methods used under paragraph (1), consider--
``(A) safety, efficacy, and effectiveness;
[[Page H8915]]
``(B) legal, social, and ethical implications;
``(C) costs, benefits, and cost-effectiveness;
``(D) comparisons to alternate technologies and practices;
and
``(E) requirements of Food and Drug Administration approval
to avoid duplication.
``(c) Specific Assessments.--
``(1) In general.--The Director shall conduct or support
specific assessments of health care technologies and
practices.
``(2) Requests for assessments.--The Director is authorized
to conduct or support assessments, on a reimbursable basis,
for the Health Care Financing Administration, the Department
of Defense, the Department of Veterans Affairs, the Office of
Personnel Management, and other public or private entities.
``(3) Grants and contracts.--In addition to conducting
assessments, the Director may make grants to, or enter into
cooperative agreements or contracts with, entities described
in paragraph (4) for the purpose of conducting assessments of
experimental, emerging, existing, or potentially outmoded
health care technologies, and for related activities.
``(4) Eligible entities.--An entity described in this
paragraph is an entity that is determined to be appropriate
by the Director, including academic medical centers, research
institutions and organizations, professional organizations,
third party payers, governmental agencies, and consortia of
appropriate research entities established for the purpose of
conducting technology assessments.
``SEC. 917. COORDINATION OF FEDERAL GOVERNMENT QUALITY
IMPROVEMENT EFFORTS.
``(a) Requirement.--
``(1) In general.--To avoid duplication and ensure that
Federal resources are used efficiently and effectively, the
Secretary, acting through the Director, shall coordinate all
research, evaluations, and demonstrations related to health
services research, quality measurement and quality
improvement activities undertaken and supported by the
Federal Government.
``(2) Specific activities.--The Director, in collaboration
with the appropriate Federal officials representing all
concerned executive agencies and departments, shall develop
and manage a process to--
``(A) improve interagency coordination, priority setting,
and the use and sharing of research findings and data
pertaining to Federal quality improvement programs,
technology assessment, and health services research;
``(B) strengthen the research information infrastructure,
including databases, pertaining to Federal health services
research and health care quality improvement initiatives;
``(C) set specific goals for participating agencies and
departments to further health services research and health
care quality improvement; and
``(D) strengthen the management of Federal health care
quality improvement programs.
``(b) Study by the Institute of Medicine.--
``(1) In general.--To provide Congress, the Department of
Health and Human Services, and other relevant departments
with an independent, external review of their quality
oversight, quality improvement and quality research programs,
the Secretary shall enter into a contract with the Institute
of Medicine--
``(A) to describe and evaluate current quality improvement,
quality research and quality monitoring processes through--
``(i) an overview of pertinent health services research
activities and quality improvement efforts conducted by all
Federal programs, with particular attention paid to those
under titles XVIII, XIX, and XXI of the Social Security Act;
and
``(ii) a summary of the partnerships that the Department of
Health and Human Services has pursued with private
accreditation, quality measurement and improvement
organizations; and
``(B) to identify options and make recommendations to
improve the efficiency and effectiveness of quality
improvement programs through--
``(i) the improved coordination of activities across the
medicare, medicaid and child health insurance programs under
titles XVIII, XIX and XXI of the Social Security Act and
health services research programs;
``(ii) the strengthening of patient choice and
participation by incorporating state-of-the-art quality
monitoring tools and making information on quality available;
and
``(iii) the enhancement of the most effective programs,
consolidation as appropriate, and elimination of duplicative
activities within various federal agencies.
``(2) Requirements.--
``(A) In general.--The Secretary shall enter into a
contract with the Institute of Medicine for the preparation--
``(i) not later than 12 months after the date of enactment
of this title, of a report providing an overview of the
quality improvement programs of the Department of Health and
Human Services for the medicare, medicaid, and CHIP programs
under titles XVIII, XIX, and XXI of the Social Security Act;
and
``(ii) not later than 24 months after the date of enactment
of this title, of a final report containing recommendations.
``(B) Reports.--The Secretary shall submit the reports
described in subparagraph (A) to the Committee on Finance and
the Committee on Health, Education, Labor, and Pensions of
the Senate and the Committee on Ways and Means and the
Committee on Commerce of the House of Representatives.
``PART C--GENERAL PROVISIONS
``SEC. 921. ADVISORY COUNCIL FOR HEALTH CARE RESEARCH AND
QUALITY.
``(a) Establishment.--There is established an advisory
council to be known as the Advisory Council for Health Care
Research and Quality.
``(b) Duties.--
``(1) In general.--The Advisory Council shall advise the
Secretary and the Director with respect to activities
proposed or undertaken to carry out the purpose of the Agency
under section 901(b).
``(2) Certain recommendations.--Activities of the Advisory
Council under paragraph (1) shall include making
recommendations to the Director regarding--
``(A) priorities regarding health care research, especially
studies related to quality, outcomes, cost and the
utilization of, and access to, health care services;
``(B) the field of health care research and related
disciplines, especially issues related to training needs, and
dissemination of information pertaining to health care
quality; and
``(C) the appropriate role of the Agency in each of these
areas in light of private sector activity and identification
of opportunities for public-private sector partnerships.
``(c) Membership.--
``(1) In general.--The Advisory Council shall, in
accordance with this subsection, be composed of appointed
members and ex officio members. All members of the Advisory
Council shall be voting members other than the individuals
designated under paragraph (3)(B) as ex officio members.
``(2) Appointed members.--The Secretary shall appoint to
the Advisory Council 18 appropriately qualified individuals.
At least 14 members of the Advisory Council shall be
representatives of the public who are not officers or
employees of the United States. The Secretary shall ensure
that the appointed members of the Council, as a group, are
representative of professions and entities concerned with, or
affected by, activities under this title and under section
1142 of the Social Security Act. Of such members--
``(A) 3 shall be individuals distinguished in the conduct
of research, demonstration projects, and evaluations with
respect to health care;
``(B) 3 shall be individuals distinguished in the practice
of medicine of which at least 1 shall be a primary care
practitioner;
``(C) 3 shall be individuals distinguished in the other
health professions;
``(D) 3 shall be individuals either representing the
private health care sector, including health plans,
providers, and purchasers or individuals distinguished as
administrators of health care delivery systems;
``(E) 3 shall be individuals distinguished in the fields of
health care quality improvement, economics, information
systems, law, ethics, business, or public policy; and
``(F) 3 shall be individuals representing the interests of
patients and consumers of health care.
``(3) Ex officio members.--The Secretary shall designate as
ex officio members of the Advisory Council--
``(A) the Assistant Secretary for Health, the Director of
the National Institutes of Health, the Director of the
Centers for Disease Control and Prevention, the Administrator
of the Health Care Financing Administration, the Assistant
Secretary of Defense (Health Affairs), and the Under
Secretary for Health of the Department of Veterans Affairs;
and
``(B) such other Federal officials as the Secretary may
consider appropriate.
``(d) Terms.--Members of the Advisory Council appointed
under subsection (c)(2) shall serve for a term of 3 years. A
member of the Council appointed under such subsection may
continue to serve after the expiration of the term of the
members until a successor is appointed.
``(e) Vacancies.--If a member of the Advisory Council
appointed under subsection (c)(2) does not serve the full
term applicable under subsection (d), the individual
appointed to fill the resulting vacancy shall be appointed
for the remainder of the term of the predecessor of the
individual.
``(f) Chair.--The Director shall, from among the members of
the Advisory Council appointed under subsection (c)(2),
designate an individual to serve as the chair of the Advisory
Council.
``(g) Meetings.--The Advisory Council shall meet not less
than once during each discrete 4-month period and shall
otherwise meet at the call of the Director or the chair.
``(h) Compensation and Reimbursement of Expenses.--
``(1) Appointed members.--Members of the Advisory Council
appointed under subsection (c)(2) shall receive compensation
for each day (including travel time) engaged in carrying out
the duties of the Advisory Council unless declined by the
member. Such compensation may not be in an amount in
excess of the maximum rate of basic pay payable for GS-18
of the General Schedule.
``(2) Ex officio members.--Officials designated under
subsection (c)(3) as ex officio members of the Advisory
Council may not receive compensation for service on the
Advisory Council in addition to the compensation otherwise
received for duties carried out as officers of the United
States.
``(i) Staff.--The Director shall provide to the Advisory
Council such staff, information, and other assistance as may
be necessary to carry out the duties of the Council.
``SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.
``(a) Requirement of Review.--
``(1) In general.--Appropriate technical and scientific
peer review shall be conducted with respect to each
application for a grant, cooperative agreement, or contract
under this title.
``(2) Reports to director.--Each peer review group to which
an application is submitted pursuant to paragraph (1) shall
report its finding and recommendations respecting the
application to the Director in such form and in such manner
as the Director shall require.
``(b) Approval as Precondition of Awards.--The Director may
not approve an application described in subsection (a)(1)
unless
[[Page H8916]]
the application is recommended for approval by a peer review
group established under subsection (c).
``(c) Establishment of Peer Review Groups.--
``(1) In general.--The Director shall establish such
technical and scientific peer review groups as may be
necessary to carry out this section. Such groups shall be
established without regard to the provisions of title 5,
United States Code, that govern appointments in the
competitive service, and without regard to the provisions of
chapter 51, and subchapter III of chapter 53, of such title
that relate to classification and pay rates under the General
Schedule.
``(2) Membership.--The members of any peer review group
established under this section shall be appointed from among
individuals who by virtue of their training or experience are
eminently qualified to carry out the duties of such peer
review group. Officers and employees of the United States may
not constitute more than 25 percent of the membership of any
such group. Such officers and employees may not receive
compensation for service on such groups in addition to the
compensation otherwise received for these duties carried out
as such officers and employees.
``(3) Duration.--Notwithstanding section 14(a) of the
Federal Advisory Committee Act, peer review groups
established under this section may continue in existence
until otherwise provided by law.
``(4) Qualifications.--Members of any peer-review group
shall, at a minimum, meet the following requirements:
``(A) Such members shall agree in writing to treat
information received, pursuant to their work for the group,
as confidential information, except that this subparagraph
shall not apply to public records and public information.
``(B) Such members shall agree in writing to recuse
themselves from participation in the peer-review of specific
applications which present a potential personal conflict of
interest or appearance of such conflict, including employment
in a directly affected organization, stock ownership, or any
financial or other arrangement that might introduce bias in
the process of peer-review.
``(d) Authority for Procedural Adjustments in Certain
Cases.--In the case of applications for financial assistance
whose direct costs will not exceed $100,000, the Director may
make appropriate adjustments in the procedures otherwise
established by the Director for the conduct of peer review
under this section. Such adjustments may be made for the
purpose of encouraging the entry of individuals into the
field of research, for the purpose of encouraging
clinical practice-oriented or provider-based research, and
for such other purposes as the Director may determine to
be appropriate.
``(e) Regulations.--The Director shall issue regulations
for the conduct of peer review under this section.
``SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT,
COLLECTION, AND DISSEMINATION OF DATA.
``(a) Standards With Respect to Utility of Data.--
``(1) In general.--To ensure the utility, accuracy, and
sufficiency of data collected by or for the Agency for the
purpose described in section 901(b), the Director shall
establish standard methods for developing and collecting such
data, taking into consideration--
``(A) other Federal health data collection standards; and
``(B) the differences between types of health care plans,
delivery systems, health care providers, and provider
arrangements.
``(2) Relationship with other department programs.--In any
case where standards under paragraph (1) may affect the
administration of other programs carried out by the
Department of Health and Human Services, including the
programs under title XVIII, XIX or XXI of the Social Security
Act, or may affect health information that is subject to a
standard developed under part C of title XI of the Social
Security Act, they shall be in the form of recommendations to
the Secretary for such program.
``(b) Statistics and Analyses.--The Director shall--
``(1) take appropriate action to ensure that statistics and
analyses developed under this title are of high quality,
timely, and duly comprehensive, and that the statistics are
specific, standardized, and adequately analyzed and indexed;
and
``(2) publish, make available, and disseminate such
statistics and analyses on as wide a basis as is practicable.
``(c) Authority Regarding Certain Requests.--Upon request
of a public or private entity, the Director may conduct or
support research or analyses otherwise authorized by this
title pursuant to arrangements under which such entity will
pay the cost of the services provided. Amounts received by
the Director under such arrangements shall be available to
the Director for obligation until expended.
``SEC. 924. DISSEMINATION OF INFORMATION.
``(a) In General.--The Director shall--
``(1) without regard to section 501 of title 44, United
States Code, promptly publish, make available, and otherwise
disseminate, in a form understandable and on as broad a basis
as practicable so as to maximize its use, the results of
research, demonstration projects, and evaluations conducted
or supported under this title;
``(2) ensure that information disseminated by the Agency is
science-based and objective and undertakes consultation as
necessary to assess the appropriateness and usefulness of the
presentation of information that is targeted to specific
audiences;
``(3) promptly make available to the public data developed
in such research, demonstration projects, and evaluations;
``(4) provide, in collaboration with the National Library
of Medicine where appropriate, indexing, abstracting,
translating, publishing, and other services leading to a more
effective and timely dissemination of information on
research, demonstration projects, and evaluations with
respect to health care to public and private entities and
individuals engaged in the improvement of health care
delivery and the general public, and undertake programs to
develop new or improved methods for making such information
available; and
``(5) as appropriate, provide technical assistance to State
and local government and health agencies and conduct liaison
activities to such agencies to foster dissemination.
``(b) Prohibition Against Restrictions.--Except as provided
in subsection (c), the Director may not restrict the
publication or dissemination of data from, or the results of,
projects conducted or supported under this title.
``(c) Limitation on Use of Certain Information.--No
information, if an establishment or person supplying the
information or described in it is identifiable, obtained in
the course of activities undertaken or supported under this
title may be used for any purpose other than the purpose for
which it was supplied unless such establishment or person has
consented (as determined under regulations of the Director)
to its use for such other purpose. Such information may not
be published or released in other form if the person who
supplied the information or who is described in it is
identifiable unless such person has consented (as determined
under regulations of the Director) to its publication or
release in other form.
``(d) Penalty.--Any person who violates subsection (c)
shall be subject to a civil monetary penalty of not more than
$10,000 for each such violation involved. Such penalty shall
be imposed and collected in the same manner as civil money
penalties under subsection (a) of section 1128A of the Social
Security Act are imposed and collected.
``SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND
CONTRACTS.
``(a) Financial Conflicts of Interest.--With respect to
projects for which awards of grants, cooperative agreements,
or contracts are authorized to be made under this title, the
Director shall by regulation define--
``(1) the specific circumstances that constitute financial
interests in such projects that will, or may be reasonably
expected to, create a bias in favor of obtaining results in
the projects that are consistent with such interests; and
``(2) the actions that will be taken by the Director in
response to any such interests identified by the Director.
``(b) Requirement of Application.--The Director may not,
with respect to any program under this title authorizing the
provision of grants, cooperative agreements, or contracts,
provide any such financial assistance unless an application
for the assistance is submitted to the Secretary and the
application is in such form, is made in such manner, and
contains such agreements, assurances, and information as the
Director determines to be necessary to carry out the program
involved.
``(c) Provision of Supplies and Services in Lieu of
Funds.--
``(1) In general.--Upon the request of an entity receiving
a grant, cooperative agreement, or contract under this title,
the Secretary may, subject to paragraph (2), provide
supplies, equipment, and services for the purpose of aiding
the entity in carrying out the project involved and, for such
purpose, may detail to the entity any officer or employee of
the Department of Health and Human Services.
``(2) Corresponding reduction in funds.--With respect to a
request described in paragraph (1), the Secretary shall
reduce the amount of the financial assistance involved by an
amount equal to the costs of detailing personnel and the fair
market value of any supplies, equipment, or services provided
by the Director. The Secretary shall, for the payment of
expenses incurred in complying with such request, expend the
amounts withheld.
``(d) Applicability of Certain Provisions With Respect to
Contracts.--Contracts may be entered into under this part
without regard to sections 3648 and 3709 of the Revised
Statutes (31 U.S.C. 529; 41 U.S.C. 5).
``SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES.
``(a) Deputy Director and Other Officers and Employees.--
``(1) Deputy director.--The Director may appoint a deputy
director for the Agency.
``(2) Other officers and employees.--The Director may
appoint and fix the compensation of such officers and
employees as may be necessary to carry out this title. Except
as otherwise provided by law, such officers and employees
shall be appointed in accordance with the civil service laws
and their compensation fixed in accordance with title 5,
United States Code.
``(b) Facilities.--The Secretary, in carrying out this
title--
``(1) may acquire, without regard to the Act of March 3,
1877 (40 U.S.C. 34), by lease or otherwise through the
Director of General Services, buildings or portions of
buildings in the District of Columbia or communities located
adjacent to the District of Columbia for use for a period not
to exceed 10 years; and
``(2) may acquire, construct, improve, repair, operate, and
maintain laboratory, research, and other necessary facilities
and equipment, and such other real or personal property
(including patents) as the Secretary deems necessary.
``(c) Provision of Financial Assistance.--The Director, in
carrying out this title, may make grants to public and
nonprofit entities and individuals, and may enter into
cooperative agreements or contracts with public and private
entities and individuals.
``(d) Utilization of Certain Personnel and Resources.--
[[Page H8917]]
``(1) Department of health and human services.--The
Director, in carrying out this title, may utilize personnel
and equipment, facilities, and other physical resources of
the Department of Health and Human Services, permit
appropriate (as determined by the Secretary) entities and
individuals to utilize the physical resources of such
Department, and provide technical assistance and advice.
``(2) Other agencies.--The Director, in carrying out this
title, may use, with their consent, the services, equipment,
personnel, information, and facilities of other Federal,
State, or local public agencies, or of any foreign
government, with or without reimbursement of such agencies.
``(e) Consultants.--The Secretary, in carrying out this
title, may secure, from time to time and for such periods as
the Director deems advisable but in accordance with section
3109 of title 5, United States Code, the assistance and
advice of consultants from the United States or abroad.
``(f) Experts.--
``(1) In general.--The Secretary may, in carrying out this
title, obtain the services of not more than 50 experts or
consultants who have appropriate scientific or professional
qualifications. Such experts or consultants shall be obtained
in accordance with section 3109 of title 5, United States
Code, except that the limitation in such section on the
duration of service shall not apply.
``(2) Travel expenses.--
``(A) In general.--Experts and consultants whose services
are obtained under paragraph (1) shall be paid or reimbursed
for their expenses associated with traveling to and from
their assignment location in accordance with sections 5724,
5724a(a), 5724a(c), and 5726(C) of title 5, United States
Code.
``(B) Limitation.--Expenses specified in subparagraph (A)
may not be allowed in connection with the assignment of an
expert or consultant whose services are obtained under
paragraph (1) unless and until the expert agrees in writing
to complete the entire period of assignment, or 1 year,
whichever is shorter, unless separated or reassigned for
reasons that are beyond the control of the expert or
consultant and that are acceptable to the Secretary. If the
expert or consultant violates the agreement, the money spent
by the United States for the expenses specified in
subparagraph (A) is recoverable from the expert or consultant
as a statutory obligation owed to the United States. The
Secretary may waive in whole or in part a right of recovery
under this subparagraph.
``(g) Voluntary and Uncompensated Services.--The Director,
in carrying out this title, may accept voluntary and
uncompensated services.
``SEC. 927. FUNDING.
``(a) Intent.--To ensure that the United States investment
in biomedical research is rapidly translated into
improvements in the quality of patient care, there must be a
corresponding investment in research on the most effective
clinical and organizational strategies for use of these
findings in daily practice. The authorization levels in
subsections (b) and (c) provide for a proportionate increase
in health care research as the United States investment in
biomedical research increases.
``(b) Authorization of Appropriations.--For the purpose of
carrying out this title, there are authorized to be
appropriated $250,000,000 for fiscal year 2000, and such sums
as may be necessary for each of the fiscal years 2001 through
2004.
``(c) Evaluations.--In addition to amounts available
pursuant to subsection (b) for carrying out this title, there
shall be made available for such purpose, from the amounts
made available pursuant to section 241 (relating to
evaluations), an amount equal to 40 percent of the maximum
amount authorized in such section 241 to be made available
for a fiscal year.
``SEC. 928. DEFINITIONS.
``In this title:
``(1) Advisory council.--The term `Advisory Council' means
the Advisory Council on Health Care Research and Quality
established under section 921.
``(2) Agency.--The term `Agency' means the Agency for
Health Research and Quality.
``(3) Director.--The term `Director' means the Director of
the Agency for Health Research and Quality.''.
(b) Rules of Construction.--
(1) In general.--Section 901(a) of the Public Health
Service Act (as added by subsection (a) of this section)
applies as a redesignation of the agency that carried out
title IX of such Act on the day before the date of enactment
of this Act, and not as the termination of such agency and
the establishment of a different agency. The amendment made
by subsection (a) of this section does not affect
appointments of the personnel of such agency who were
employed at the agency on the day before such date.
(2) References.--Any reference in law to the Agency for
Health Care Policy and Research is deemed to be a reference
to the Agency for Health Research and Quality, and any
reference in law to the Administrator for Health Care Policy
and Research Quality.
Amendment No. 3 Offered by Mr. Bilirakis
Mr. BILIRAKIS. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 3 offered by Mr. Bilirakis:
Page 3, line 2, strike ``by'' and all that follows through
``research'' on line 3 and insert the following: ``by
conducting and supporting--
`` `(1) research''.
Page 4, line 3, strike ``synthesizing and disseminating''
and insert ``the synthesis and dissemination of''.
Page 4, line 7, strike ``advancing'' and insert
``initiatives to advance''.
Page 4, beginning on line 11, strike ``shall undertake''
and all that follows through ``evaluations'' on line 12 and
insert the following: ``shall conduct and support research
and evaluations, and support demonstration projects,''.
Page 4, line 25, strike ``shall support'' and all that
follows through ``activities'' on page 5, line 4, and insert
the following: ``shall conduct and support research,
evaluations, and training, support demonstration projects,
research networks, and multi-disciplinary centers, provide
technical assistance, and disseminate information on health
care and on systems for the delivery of such care, including
activities''.
Page 6, line 5, strike ``made available under section 487''
and insert ``made available under section 487(d)(3) for the
Agency''.
Page 7, beginning on line 21, strike ``that it uses''.
Page 7, line 23, strike ``that it uses''.
Page 7, line 24, strike ``behind health care practice'' and
insert ``underlying health care practice''.
Page 8, beginning on line 15, strike ``Health Care
Improvement Research Centers'' and insert ``health care
improvement research centers''.
Page 8, line 20, strike ``Provider-based Research
Networks'' and insert ``provider-based research networks''.
Page 8, line 23, insert ``evaluate and'' before ``promote
quality improvement''.
Page 13, beginning on line 7, strike ``In carrying out
902(a), the Director'' and insert ``The Director''.
Page 14, beginning on line 5, strike ``, the needs'' and
all that follows through ``and monitor'' on line 8 and insert
the following: ``, including the health care needs of
populations identified in section 901(c), provide data to
study the relationships between health care quality,
outcomes, access, use, and cost, measure changes over time,
and monitor''.
Page 15, beginning on line 10, strike ``shall support
research, evaluations and initiatives to advance'' and insert
``shall conduct and support research, evaluations, and
initiatives to advance''.
Page 18, beginning on line 15, strike ``clinical practice
and health care technologies'' and insert ``health care
practices and technologies''.
Page 18, beginning on line 21, strike ``health care
practices and health care technologies'' and insert ``health
care practices and technologies''.
Page 19, line 1, strike ``promoting education, training,
and providing'' and insert ``promoting education and training
and providing''.
Page 19, beginning on line 2, strike ``health care practice
and health care technology assessment'' and insert ``health
care practice and technology assessment''.
Page 20, line 4, insert ``health care'' before
``technologies''.
Page 25, line 5, insert ``National'' before ``Advisory
Council''.
Page 29, beginning on line 4, strike ``the maximum rate of
basic pay payable for GS-18 of the General Schedule'' and
insert the following: ``the daily equivalent of the annual
rate of basic pay prescribed for level IV of the Executive
Schedule under section 5315 of title 5, United States Code,
for each day during which such member is engaged in the
performance of the duties of the Advisory Council''.
Page 43, line 2, insert ``National'' before ``Advisory
Council''.
Mr. BILIRAKIS. Mr. Chairman, this is an en bloc technical amendment
to section 2 of the bill as reported by the Committee on Commerce.
Section 2 of the bill is divided into three parts.
Part A provides for the reauthorization of the agency for health care
policy and research and renames it the Agency for Health Research and
Quality and outlines the agency's mission and general authorities. Part
A also establishes specific requirements that the agency must meet as
well as limitations on the agency's authority and provides the agency
with authority to support training programs.
Part B outlines the specific programmatic authority of the agency in
six broad areas and includes a seventh section to promote coordination
and reduce unnecessary duplication of existing health services,
research, quality research, and improvement activities. The six
programmatic areas include outcomes research, organization and delivery
research, quality and cost of care research, and data development
information systems for health care improvement, primary care and
access research, and practice and technology assessment.
Part C governs the daily administration of the agency, establishes
its national advisory counsel and sets the authorization levels for the
agency. This section outlines the agency's authority to support grants
and contracts and establishes requirements for scientific peer review
of research funded
[[Page H8918]]
by the agency and the dissemination of research findings.
The committee was unable, Mr. Chairman, to make these technical
corrections to the text of the bill before reporting it, however we
have met with the minority and with the administration, and we are all
in agreement that these amendments are technical in nature, improve the
underlying text and do not make substantive changes in the bill as it
was reported. For these reasons, I ask my colleagues for support of
this en bloc amendment.
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. BILIRAKIS. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, I agree. I concur with what the
gentleman said. This is a by and large technical amendment that we
worked on together as we worked on the bill together, and I ask my
colleagues to support the Bilirakis amendment.
Mr. BILIRAKIS. Mr. Chairman, I yield back the balance of my time.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from Florida (Mr. Bilirakis).
The amendment was agreed to.
Amendment No. 12 Offered by Mr. Andrews
Mr. ANDREWS. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 12 offered by Mr. Andrews:
Page 16, after line 15, insert the following subsection:
(c) Certain Linkages Regarding Health Information.--
Initiatives under subsection (a) shall include the
establishment, through a site maintained by the Director on
the telecommunications medium known as the World Wide Web, of
linkages that enable users of the site to obtain information
from consumer satisfaction agencies or other entities that
perform evaluations regarding the quality of health care,
including more than one link to entities that evaluate health
maintenance organizations, and including a link of the
National Committee for Quality Assurance.
Modification to Amendment No. 12 Offered By Mr. Andrews
Mr. ANDREWS. Mr. Chairman, I ask unanimous consent that slight
technical modifications to the underlying amendment be considered in
order.
The CHAIRMAN. The Clerk will report the modification.
The Clerk read as follows:
Modification to Amendment No. 12 offered by Mr. Andrews:
Page 16, after line 15, insert the following subsection:
(c) Certain Linkages Regarding Health Information.--
Initiatives under subsection (a) shall include the
establishment, through a site maintained by the Director on
the telecommunications medium known as the World Wide Web, of
linkages that enable users of the site to obtain information
from consumer satisfaction agencies or other entities that
perform evaluations regarding the quality of health care,
including more than one link to entities that evaluate health
maintenance organizations, and including a link of the
National Committee for Quality Assurance.
Mr. ANDREWS (during the reading). Mr. Chairman, I ask unanimous
consent that the modification be considered as read and printed in the
Record.
The CHAIRMAN. Is there objection to the request of the gentleman from
New Jersey?
There was no objection.
The CHAIRMAN. Is there objection to the modification?
There was no objection.
Mr. ANDREWS. Mr. Chairman, I first wanted to thank and congratulate
the gentleman from Florida (Mr. Bilirakis) and the gentleman from Ohio
(Mr. Brown) for their leadership in bringing this legislation to the
floor. It is worthy of unanimous support of the House, and I
enthusiastically support the bill.
My amendment speaks to a very traditional value and a new technology.
The traditional value is enlightened consumer choice. When we buy a
toaster or an automobile or a house, we have all kinds of information
available to us about the quality of the product that we are buying.
There are government and private for-profit and private nonprofit
sources of such information readily available. So should such
information be available with respect to health care plans; and that is
where this traditional value is combined with a new technology, the
World Wide Web.
The purpose of my amendment is to call on the AHCPR to make available
on a web site on the World Wide Web a collection of information offered
by nonprofit and public groups that evaluate and give information about
the quality of health care plans to consumers. If this amendment is
included, consumers will be able to visit the web site and click on
information from groups such as the National Committee for Quality
Assurance and other institutions that provide independent, verifiable,
valuable information to consumers about the quality of health insurance
choices available to them. I believe that by bringing together the
traditional concept of consumer empowerment and the relatively new
technology of the World Wide Web that we help more American decision
makers make better decisions about the health care choices before them.
Mr. Chairman, I urge the adoption of the amendment.
Mr. BILBRAY. Mr. Chairman, I rise in support of the amendment offered
by the gentleman from New Jersey.
The majority has had an opportunity to review the amendment which
would require that, as the gentleman said, that the director maintain
Internet linkages to appropriate sites and provide information on
consumer satisfaction with health care and specifically health
maintenance organizations, and we are prepared to accept the amendment.
Mr. BROWN of Ohio. Mr. Chairman, I move to strike the last word.
I rise in support of the Andrews amendment and compliment him on his
forward thinking on this issue. Transparency in the health care system
is particularly important. I think this will contribute to that, and I
ask Members on this side of the aisle and both sides of the aisle to
support the Andrews amendment.
The CHAIRMAN. The question is on the amendment, as modified, offered
by the gentleman from New Jersey (Mr. Andrews).
The amendment, as modified, was agreed to.
Amendment No. 16 Offered by Mr. Davis of Illinois
Mr. DAVIS of Illinois. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 16 offered by Mr. Davis of Illinois:
Page 6, strike lines 6 through 10 and insert the following:
``(2) Requirements.--In developing priorities for the
allocation of training funds under this subsection, the
Director shall take into consideration shortages in the
number of trained researchers who are members of one of the
priority populations and the number of trained researchers
who are addressing the priority populations.
Mr. DAVIS of Illinois. Mr. Chairman, let me first of all commend the
gentleman from Florida (Mr. Bilirakis) and the ranking member, the
gentleman from Ohio (Mr. Brown), for the work that they have done on
this particular bill.
Mr. Chairman, the mission of this bill is to enhance the quality
appropriateness and effectiveness of health services and access to
those services. The amendment that I offer today is consistent with the
underlying mission of the bill. This amendment seeks to address the
issue of under-representation of individuals from the priority
populations who receive training funds. This amendment merely suggests
that the director take into consideration to the extent possible
shortages in the number of trained researchers who are members of one
of the priority populations and the number of trained researchers who
are addressing the priority populations.
Mr. Chairman, it is my position that trained individuals with the
greatest levels of contact, experiences and interactions with priority
populations have a better chance to have acquired keener insight into
understanding the characteristics and behaviors of these population
groups. That keener insight may help them better understand factors
which impede individuals in priority populations from movement towards
acquisition of equity in health care and health status. Their greater
familiarity with low-income and minority groups may afford them the
level of sensitivity that is needed to get them the results which are
desired.
Mr. Chairman, it is not easy to arrive at the desired results because
when we look at the numbers of pre- and post-doctoral fellows, health
researchers
[[Page H8919]]
and medical doctors, the numbers from priority populations are very low
and, in some instances, are in danger of even getting lower. According
to Dr. Robert G. Petersdor, President of the Association of Medical
Colleges, in 1992, he stated that not only have we not made any
progress since the mid-1970s toward our goal of providing equitable
access to medical school for students from all of society, we have been
losing ground. For example, in 1996 there were reported to be 737,734
physicians in this country: 373,539 or 50.6 percent were of the
majority population, 13,759 or 1.8 percent were black, 21,841 or 3.0
percent were Hispanic, 48,913 or 6.6 percent were Asian Oriental, 225
or .0003 or three tenths of one thousandth percent were American Native
Alaskan, 11,943 or 1.6 percent with others, and 267,544 or 36.0 percent
were unknown. Of course, the American Medical Association only had
racial and ethnic data on about 64 percent of all the physicians in the
United States.
In 1996, there were 100 fewer under-represented minorities accepted
into medical schools and only 10 percent of all medical school
graduates were members of these under-represented minority groups who
make up a total of approximately 28 percent of the total U.S.
population.
{time} 1515
We ought to make every effort to find individuals from these
populations; and, in addition, we must make sure that these priority
populations are adequately covered in terms of the number of trained
researchers. It is my understanding that the Department of Health and
Human Services supports this amendment and agrees that this effort must
be made.
Therefore, I would urge its immediate adoption.
Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment.
Mr. Chairman, the majority has had an opportunity to review the
amendment which would require, as the gentleman said, that the director
in allocating health services training grants under section 902 take
into consideration shortages in the number of trained researchers who
are one of a number of priority populations, as well as shortages in
the number of trained researchers who are addressing the priority of
populations. We are prepared to accept the amendment.
Mr. BROWN of Ohio. Mr. Chairman, I move to strike the last word.
Mr. Chairman, I rise in support of the Davis amendment and commend
the gentleman on his work in promoting equal access for medical
researchers and medical training. I think it is certainly an issue
whose time has come. I thank the gentleman from Illinois for his work
and ask the support of the House for the Davis amendment.
The CHAIRMAN pro tempore (Mr. Quinn). The question is on the
amendment offered by the gentleman from Illinois (Mr. Davis).
The amendment was agreed to.
Amendments No. 2 and No. 1 Offered by Ms. Jackson-Lee of Texas
Ms. JACKSON-LEE of Texas. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 2 offered by Ms. Jackson-Lee of Texas:
Page 4, line 14, insert ``In inner-city areas and'' after
``health services''.
Ms. JACKSON-LEE of Texas. Mr. Chairman, let me thank the ranking
member and the chairman and their staff for the cooperation with my
staff on an issue that I think we all can agree on. Let me also note my
agreement with the amendments of the gentleman from Illinois (Mr.
Davis), in talking about adding historically black colleges and
Hispanic-serving colleges to the idea or the concept of research.
This amendment adds the language ``inner-city'' to the provision of
the bill which speaks to rural health care, and it does speak to
minority groups; but this now makes it in particular an emphasis on
some of our urban and inner-city areas.
I come from one of the largest cities in the Nation, in fact the
fourth largest city in the Nation, and am an avid supporter for the
access of health care to be spread throughout our Nation, rural areas,
urban areas, and our particular unique groups. But I think it is
important to emphasize some of the special health care needs that we
find in the inner city in populations that tend to be minority.
For example, let me bring to the attention of my colleagues that,
although we are talking about another matter, appropriations, I do not
know if they are aware of the fact that last year we had 783 rural
health clinics, and we are now down to 483 rural health clinics,
particularly in my State, in the State of Texas.
In addition, we have determined that a one-third decrease has
occurred in inner-city health clinics. So we know for sure that we are
declining in the access of health care. So this particular legislation,
which focuses on the research and determination of access and better
health care, is extremely important.
If I might cite for you the issue of AIDS, it disproportionately
affects the minority populations. Racial and ethnic minorities
constitute approximately 25 percent of the total U.S. population, yet
they account for nearly 54 percent of all AIDS cases. During 1995 and
1996, AIDS death rates declined 23 percent for the total U.S.
population, while declining only 13 percent for blacks and 20 percent
for Hispanics. Contributing factors for these mortality disparities
include late identification of disease and lack of health insurance to
pay for drug therapies. So this bill's actual impact will be far
reaching as we define minorities to include the inner cities.
For men and women combined, blacks have a cancer death rate about 35
percent higher than that for whites. The incidence rate for lung cancer
in black men is about 50 percent higher than in white men. Native
Hawaiian men, Alaskan native men and women, Vietnamese women and
Hispanic women particularly suffer from elevated rates of cancer; and
although these different groups are located throughout the United
States, many times, because of job searches, they look for the inner
city and find themselves in the inner city. In fact, Mr. Chairman, many
new immigrant groups will find themselves in the inner city
additionally.
I would also like to note that, again, major disparities exist upon
population groups, particularly for minority and low-income
populations. The age-adjusted death rate for coronary heart disease for
the total population declined by 20 percent from 1987 to 1995. For
blacks, the overall decrease was only 13 percent. So we can see the
screening for cholesterol is extremely important.
Diabetes is extremely important, which results in the complications
such as end-stage renal disease, and amputations are much higher among
black and American Indians when compared to the total population.
I am very pleased that we have this legislation on the floor of the
House, and I simply would like to add this language of the inner city
in order to ensure that all of the resources that are brought to bear
on this problem will get all of our populations, and particularly those
who suffer the greatest lack of access to health care.
I close by simply saying, Mr. Chairman, I have a very large public
health system. It is overwhelmed. In fact, it suffers from lack of
resources. I do know that the more knowledge we have about access of
health care for minorities and inner-city residents, along with rural
communities, will help our country in doing a better job of serving our
constituencies. I would like my colleagues and solicit my colleagues'
support for this amendment.
Mr. Chairman, I rise to offer an amendment to H.R. 2506 that would
include inner city areas as special populations that deserve priority.
I commend my colleagues for introducing this legislation to improve the
quality and effectiveness of health services. This amendment simply
extends the reach of this measure to areas of society that desperately
need our assistance.
As written, this bill would provide innumerable benefits to
Americans, but we must not be blind to the fact that many Americans
cannot drink from this well. It is a sad fact that nowhere are
divisions of race and ethnicity more sharply drawn than in the health
of our people.
For instance, AIDS disproportionately affects minority populations.
Racial and ethnic minorities constitute
[[Page H8920]]
approximately 25 percent of the total U.S. population, yet, they
account for nearly 54 percent of all AIDS cases. During 1995 and 1996,
AIDS death rates declined 23 percent for the total U.S. population
while declining only 13 percent for blacks and 20 percent for
Hispanics. Contributing factors for these mortality disparities include
late identification of disease and lack of health insurance to pay for
drug therapies.
Cancer is also a leading cause of death in America. Many minority
groups suffer disproportionately from cancer. Disparities exist in both
mortality and incidence rates. For men and women combined, blacks have
a cancer death rate about 35 percent higher than that for whites. The
incidence rate for lung cancer in black men is about 50 percent higher
than in white men. Native Hawaiian men, Alaskan native men and women,
Vietnamese women, and Hispanic women particularly suffer from elevated
rates of cancer. We must provide far greater screening opportunities
for these members of society, and we can do so with this amendment.
Cardiovascular disease is a leading killer and a leading cause of
disability in the United States. Again, major disparities exist among
population groups, particularly for minority and low-income
populations. The age-adjusted death rate for coronary heart disease for
the total population declined by 20 percent from 1987 to 1995; for
blacks the overall decrease was only 13 percent. Rates of screening for
cholesterol show disparities for racial and ethnic minorities, and
without such screening, our citizens will continue to suffer from the
debilitating effects of cardiovascular disease.
Diabetes also affects more minorities than whites. The prevalence of
diabetes is approximately 70 percent higher than whites and the
prevalence in Hispanics is nearly double that of whites. Preventative
interventions should target high-risk groups. Diabetes complications
such as End-Stage Renal Disease and amputations are much higher among
black and American Indians when compared to the total population. Early
detection, improved care, and education can prevent this disease from
incapacitating America's men and women. But we must provide these
important health care services.
Finally, infant mortality remains a threat to our children. Although
the rate has declined to a record low of 7.2 per 1,000 live births in
1996, infant mortality still greatly threatens certain racial and
ethnic groups. Infant death rates among blacks, American Indians and
Alaska natives, and Hispanics were all above the national average.
Infant morality can be combated with timely prenatal care, but 84
percent of white pregnant women received such care while only 71
percent of black and Hispanic pregnant women received early pre-natal
care. Eliminating these disparities requires the removal of financial,
educational, social, and logistical barriers to health care services.
This bill, as written, appropriately recognizes that rural areas are
in particular need of health care. But as statistics clearly indicate,
the inner city areas also need quality health care, and we can provide
just that with this amendment. I strongly urge my colleagues to support
this common-sense amendment.
Mr. BILIRAKIS. Mr. Chairman, will the gentlewoman yield?
Ms. JACKSON-LEE of Texas. I yield to the gentleman from Florida.
Mr. BILIRAKIS. Mr. Chairman, I thank the gentlewoman for yielding,
and I say to her that the majority has had an opportunity to review the
amendment, which would add inner-city areas to rural and frontier areas
among the geographic priority populations included in the submission.
I commend the gentlewoman for formulating this amendment, and we are
prepared to accept it.
Mr. BROWN of Ohio. Mr. Chairman, will the gentlewoman yield?
Ms. JACKSON-LEE of Texas. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. Mr. Chairman, I thank the gentlewoman from Houston
and rise in support of the amendment. It makes good sense with the
HCPR's work in the past in rural areas that inner cities should be
included, and ask for support of the amendment.
Ms. JACKSON-LEE of Texas. Mr. Chairman, reclaiming my time, I thank
the gentleman very much. Again, let me thank the chairman and the
ranking member for their excellent leadership on this legislation.
Mr. Chairman, I have another amendment. There are colleagues on the
floor. I would be able to discuss that amendment very quickly within
this time frame and have us all out of the way. I understand that we
have mutual agreement on moving forward.
Is that appropriate at this time, so that my other colleagues can go
forward?
The CHAIRMAN pro tempore. The gentlewoman controls the time.
Ms. JACKSON-LEE of Texas. Mr. Chairman, I have an amendment at the
desk.
The CHAIRMAN pro tempore. Is the gentlewoman asking to offer her
amendment at this time?
Ms. JACKSON-LEE of Texas. I am.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 1 offered by Ms. Jackson-Lee of Texas:
Page 4, line 9, strike ``(c)'' and all that follows through
``the Director shall'' on line 11 and insert the following:
``(c) Requirements With Respect to Special Populations.--
There is established within the Agency an office to be known
as the Office on Special Populations, which shall be headed
by an official appointed by the Director. The Director,
acting through such Office, shall''.
The CHAIRMAN pro tempore. Is there objection to considering these
amendments en bloc?
There was no objection.
The CHAIRMAN pro tempore. The gentlewoman from Texas is recognized
for 5 minutes.
Ms. JACKSON-LEE of Texas. Mr. Chairman, this amendment is dealing
with creating an Office of Special Populations within the Agency for
Health Research and Quality which will give us the opportunity to focus
on the authority to conduct health care research, demonstration
projects and evaluations with respect to low-income groups and minority
groups.
I would simply say that this complements the earlier amendment that I
have and would be delighted to have these accepted en bloc.
I rise to offer an amendment to H.R. 2506, the Health Research and
Quality Act of 1999 that would create an office known as the Office on
Special Populations, which shall be headed by an official appointed by
the director.
I commend my colleagues for introducing this legislation to provide
higher quality and more effective health services to our citizens. This
bill will improve health care services and will provide greater
prevention of diseases and other health conditions through improvements
in clinical and health system practices.
Currently, the bill designates a Director of the Agency for Health
Care Policy and Research to oversee this measure. While I agree that we
must provide oversight to this plan, I feel that one position cannot
possibly serve the needs of our citizens. My amendment would diminish
the burden on the Director by providing an Office of Special
Populations.
This office also would help the Director pinpoint the dilemmas facing
our special populations--those living in rural or inner city areas. It
is clear that these areas suffer from disease and health-related
problems to a far greater extent than other areas.
A great disparity exists between whites and certain races and ethnic
cultures. At this time, we do not know all of the reasons for this
disturbing gap. Inadequate education, disproportionate poverty,
discrimination in the delivery of health services, cultural differences
likely contribute to the problem. This office could study these factors
and pinpoint those that most affect the rural and inner city areas.
Such research greatly would contribute to our ability to then find
solutions to our current problems and would allow our health services
to reach the people who need them the most.
This office would work concurrently with the Director to study and
determine appropriate measures that will improve our Nation's health
care. This office clearly would provide a support system for the
Director, and it is my hope that this office would increase the overall
efficiency of the Agency for Health Care Policy and Research.
The disparities that are detrimentally affecting our inner city and
rural areas are unacceptable. We must provide a comprehensive
initiative that will effectively eliminate this gap. This amendment
would achieve such a goal by providing an office whose mission is to
eliminate disparities in health care. I urge my colleagues to support
this vital amendment.
Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment.
Mr. Chairman, again, to reiterate, we have had an opportunity to
review the
[[Page H8921]]
amendment, which would establish this Office of Special Populations
within the agency to which the director would carry out the
requirements specified in said section 901(c). We are prepared to
accept the amendment.
Mr. BROWN of Ohio. Mr. Chairman, I move to strike the last word.
Mr. Chairman, I agree with the second part of the amendment too and
support the en bloc amendment and commend the gentlewoman from Texas
(Ms. Jackson-Lee) for her good work on this.
The CHAIRMAN pro tempore. The question is on the amendments offered
by the gentlewoman from Texas (Ms. Jackson-Lee).
The amendments were agreed to.
Amendment No. 17 Offered by Mr. Davis of Illinois
Mr. DAVIS of Illinois. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 17 offered by Mr. Davis of Illinois:
Page 7, after line 14, insert the following subsection:
``(g) Annual Report.--Beginning with fiscal year 2003, the
Director shall annually submit to the Congress a report
regarding prevailing disparities in health care delivery as
it relates to racial factors and socio-economic factors in
priority populations.''
Mr. DAVIS of Illinois. Mr. Chairman, I once again would commend the
chairman and ranking member of this committee for the manner in which
they have been able to bring this bill before us.
Mr. Chairman, this amendment seeks to make sure that Congress has the
necessary information regarding prevailing health disparities by
requiring an annual report to be submitted beginning with the fiscal
year 2003 regarding prevailing disparities in health care delivery as
it relates to racial factors and socioeconomic factors.
Mr. Chairman, racial and ethnic minority populations are among the
fastest growing of all communities in America. Unfortunately, as
African Americans, Hispanic, American Indians, Asian Americans and
other Pacific Islanders in many respects have continued to grow, so too
have their disparities in health care. These groups have poorer health
and remain chronically underserved by the health care system.
Significant gaps in health data still exist, as we have not kept pace
with growth of these population groups with health care infrastructure
and personnel. Historically, participation in research and data
gathering activities on the part of some minority groups has been
modest, and especially among African Americans, who are wary of
research and researchers, stemming in part from knowledge of the
Tuskegee experiment, when the Federal Government withheld a syphilis
cure from hundreds of male participants in a study that lasted 4
decades. President Clinton apologized for that experiment last spring,
although it occurred long before his watch.
Fortunately, new approaches, techniques, guarantees and protective
protocols are being put into place and used to make data gathering and
research more appealing. These population groups are responding more
positively, and we need to make sure that these focuses and activities
continue.
I am aware that the Secretary of Health and Human Services has
announced a plan to end racial disparities in health care and require
the collection of data relative to racial factors. However, in this
robust economy we have witnessed a widening of the gap in health care
disparities. One would hope that we would have been more effective in
narrowing the gap between the have's and the have-not's and between
minority and majority population groups. In many instances, that has
not happened.
Age-adjusted breast cancer mortality increased 3.9 percent for black
women and declined 15.4 percent for white women between 1985 and 1996.
While the number of tuberculosis cases among non-Hispanic whites
actually decreased 42.9 percent between 1986 and 1997, the number of
reported tuberculosis cases increased 51.1 percent for Asian Americans
and Pacific Islanders and 30.3 percent for Hispanics, according to the
Center for Disease Control.
I could go on and on and cite statistics relative to the prevalence
of prostate cancer in African American men and the increasing rates of
HIV-AIDS infection for African American women.
In short, we need an annual report to measure whether we are making
progress in ending racial disparities in health care and improving the
quality of life for all Americans.
This report will also underscore where we need to direct our
resources and research. In my congressional district, for example, we
have 22 hospitals, some of the finest in the country. At the same time,
we have 175,000 people living at or below the poverty level. We also
have some of the most dire health status indicators in Western
civilization.
This amendment is designed to try and make sure that we have adequate
and accurate information on which to base policy and budgetary
decisions.
{time} 1530
Therefore, I urge support of this amendment and urge its immediate
adoption.
Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
Mr. Chairman, I just want to say that the majority has had an
opportunity to review this amendment, which would require that the
director of the agency submit an annual report to the Congress
beginning with fiscal year 2003 regarding prevailing disparities in
health care deliveries as related to racial and socioeconomic factors
in priority populations.
We are prepared to accept the amendment and also commend the
gentleman from Illinois (Mr. Davis) for his insight and preparation of
this and the other amendments.
Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the Davis
amendment.
Mr. Chairman, I congratulate him and compliment him on his work on a
very important issue. I think that the disparity in health care
delivery, especially as it relates to different racial groups,
different socioeconomic groups, is one of the most serious problems our
health care system faces.
It is not something we have done especially well as a Nation or as a
society in the past, and I think the Davis amendment is a major step
forward in alleviating some of those discrepancies and variations.
I thank the gentleman for his good work and ask for support of his
amendment.
The CHAIRMAN pro tempore (Mr. Quinn). The question is on the
amendment offered by the gentleman from Illinois (Mr. Davis).
The amendment was agreed to.
Amendment No. 6 Offered by Mr. Davis of Illinois
Mr. DAVIS of Illinois. Mr. Chairman, I offer amendment No. 6.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 6 Offered by Mr. Davis of Illinois:
Page 21, line 6, insert after ``agencies,'' the following:
``minority institutions of higher education (such as
Historically Black Colleges and Universities, and Hispanic
institutions),''.
Mr. DAVIS of Illinois. Mr. Chairman, this amendment seeks to
recognize the unique diversity of our Nation and take full advantage of
minority institutions in clinical practice and technology innovation.
This amendment simply urges the director to consider utilizing minority
institutions such as historically black colleges and universities and
Hispanic institutions when awarding such grants regarding health-care
technology.
Our historically black colleges and universities have produced some
of the greatest pioneers in the medical profession, for example,
Charles Richard Drew, who was the pioneer of blood plasma preservation,
to Ernest Just, who formulated new concepts of cell life and metabolism
and pioneered investigations of egg fertilization.
Inclusion of minority institutions in medical research has been
inadequate. The National Institutes of Health Office of Financial
Management reported that in 1997 they spent $12.7 billion on medical
research. Of that, $8.46 billion went to higher education institutions.
Historically black colleges and universities received just $79.8
million of these dollars, less than 1 percent of the National
Institutes of Health higher-education pie.
[[Page H8922]]
It is our diversity that strengthens us as a Nation. Someone remarked
that we are a Nation of communities, of tens and thousands of ethnic,
religious, social, business, labor union, neighborhood, regional and
other organizations, all of them varied, voluntary and unique; a
brilliant diversity spread like stars, like a thousand points of light
in a broad and peaceful sky.
This amendment merely seeks to capitalize on this Nation's great
diversity by making minority institutions eligible and by urging them
to seek these grants. I believe that this is an important amendment
because it places valuable resources in the hands of institutions that
are capable and able to help produce the needed researchers and
professionals that this country relies so much upon. I urge adoption of
this amendment.
Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
Mr. Chairman, the majority has had an opportunity to review the
amendment, finds that it is consistent with the functions of the agency
which would expand the eligible entities to receive grants and
contracts for clinical practices and technology innovation, as
determined by the director to include minority institutions of higher
education. We are prepared to accept the amendment.
Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the amendment.
Mr. Chairman, the amendment underscores how all society benefits from
the richness of diversity. I ask for support of the Davis amendment.
The CHAIRMAN pro tempore. The question is on the amendment offered by
the gentleman from Illinois (Mr. Davis).
The amendment was agreed to.
Amendment No. 7 Offered by Mr. Thompson of California
Mr. THOMPSON of California. Mr. Chairman, I offer an amendment.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 7 offered by Mr. Thompson of California:
Page 21, after line 8, insert the following subsection:
``(d) Medical Examination of Certain Victims.--
``(1) In general.--In carrying out subsection (a), the
Director shall promote evidence-based clinical practices
for--
``(A) the examination and treatment by health professionals
of individuals who are victims of sexual assault (including
child molestation) or attempted sexual assault; and
``(B) the training of health professionals on performing
medical evidentiary examinations of individuals who are
victims of child abuse or neglect, sexual assault, elder
abuse, or domestic violence.
``(2) Certain considerations.--Evidence-based clinical
practices promoted under paragraph (1) shall take into
consideration the expertise and experience of Federal and
State law enforcement officials regarding the victims
referred to in such paragraph, and of other appropriate
public and private entities (including medical societies,
victim services organizations, sexual assault prevention
organizations, and social services organizations).''
Mr. THOMPSON of California. Mr. Chairman, I would like to commend the
Committee on Commerce and the bill's sponsors, the gentleman from
Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. Brown), for
bringing this important bill to the floor today for our consideration.
Mr. Chairman, thousands of individuals are sexually assaulted or
abused in our country every year. Over 300,000 individuals were the
victim of rape or sexual assault in 1998 alone. Many are children and
many are elderly. In fact, recent studies reveal that an increasingly
high percentage of the victims of rape or sexual assault are likely to
be children. Fifteen percent of rape victims are under the age of 12,
and 44 percent are under the age of 18.
These are the most awful of crimes, and Congress has responded with
enactment of new Federal penalties in 1994, as well as the
establishment of a number of grant programs under the landmark Violence
Against Women Act. There remain gaps in our Nation's response to this
type of violence, particularly in our ability to prosecute the
perpetrators. The amendment I offer is intended to fill some of these
gaps.
The amendment adds an important provision related to the quality of
the training of health professionals in several very sensitive areas of
their work: the identifications, treatment, and examination of victims
of sexual assault and the collection of forensic evidence for the use
of possible criminal prosecutions.
While services encountered in some metropolitan centers can be
excellent, access to trained medical practitioners is restricted and
unevenly distributed. Many rural, mid-sized counties, and
geographically large urban areas lack health professionals trained in
identifying and treating victims of sexual assault and in conducting
evidentiary examinations, collecting and preserving evidence and in
interpreting findings. Many are inexperienced in collaborating with law
enforcement agencies and investigating social workers.
As a result, many victims of child molestation, domestic violence,
and elder abuse are underserved or ill-served in the medical treatment
and counseling that they receive. At the same time, in instances where
proper evidence collection procedures are not followed, district
attorneys are forced to drop charges against dangerous perpetrators for
lack of evidence. Rather than rely on bad testimony or testimony given
by children who are emotionally wrought because of the crime that had
been committed against them, the prosecutor is forced to allow the
perpetrator to walk away; and this person is often free to do his crime
or her crime again.
Lack of proper training and lack of retraining appears to be a
particular problem in acute cases and in areas where multidisciplinary
teams are not readily available. Lack of experience can have several
deleterious consequences. First, professionals who lack experience with
the delicate nature of such evaluations may psychologically traumatize
children.
Mr. Chairman, the amendment before this body requires the director of
the Agency for Health, Research and Quality to set forth and promote
evidence-based clinical practices for identifying, examining, and
treating victims of sexual assault and training medical professionals
on how to perform medical evidentiary exams in child physical and
sexual abuse, domestic violence and elder abuse cases.
The amendment is supported by a number of groups, including the
International Association of Forensic Nurses, the National Association
of Social Workers, the Pennsylvania Coalition Against Rape, and the
administration. This amendment is a small but important step in
addressing a serious national problem, and I urge its adoption.
Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
Mr. Chairman, the staff has, as they have in all of these amendments,
reviewed this amendment, spent an awful lot of time in many cases with
the proposers' staffs. We have had an opportunity to review this
particular amendment along with the others, which would require the
director to include among the evidence-based clinical practices and
health-care technologies promoted by the agency, the examination and
treatment of victims of sexual assault, the training of health
professionals in performing medical evidentiary examinations of persons
who are victims of sexual assault, and we are prepared to accept this
very good amendment.
Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the Thompson
amendment.
Mr. Chairman, I congratulate my friend from California (Mr. Thompson)
for his leadership on issues of child abuse and abuse of the elderly.
This amendment will lead to better training of health professionals to
deal with those problems of sexual abuse and child abuse and abuse of
the elderly, and I ask the House for support of the Thompson amendment.
The CHAIRMAN pro tempore. The question is on the amendment offered by
the gentleman from California (Mr. Thompson).
The amendment was agreed to.
Amendment No. 20 Offered by Mr. Pascrell
Mr. PASCRELL. Mr. Chairman, I offer an amendment.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 20 offered by Mr. Pascrell:
Page 13, after line 5, insert the following subsection:
``(d) Cancer and Cardiovascular Diseases in Women.--The
Director shall conduct and
[[Page H8923]]
support research and build private-public partnerships to
enhance the quality, appropriateness, and effectiveness of
and access to health services regarding cancer and
cardiovascular diseases in women, including with respect to
the comparative effectiveness, cost-effectiveness, and safety
of such services.''
Mr. PASCRELL. Mr. Chairman, I would like to congratulate the
gentleman from Florida (Mr. Bilirakis) for this terrific piece of
common sense legislation. The amendment that I bring to the floor does
not seek to undo any of the positive aspects of the bill. Instead, it
improves upon an already outstanding bill by addressing one of our
Nation's silent killers.
While there is a growing awareness of the devastating impact that
breast cancer has on American women, there is still a misguided belief
that cancer and cardiovascular disease are men's diseases. My amendment
simply seeks to shine the light on this misinterpretation.
These misconceptions have kept us from realizing that these
debilitating and deadly diseases have been historically understudied
when it comes to their effect on women. In fact, it was not until the
last decade that we have pushed the scientific and medical communities
to study how diseases specifically impact upon women.
As we all know, cardiovascular disease is the leading killer in this
country. Approximately 960,000 Americans die of cardiovascular disease
each year. What is not well known is that more women die of this
disease each year than men. Women have different heart attack symptoms
than men. Therefore, they are frequently misdiagnosed. Where a man may
have chest pain, left arm numbness, a woman may have a shortness of
breath and stomach pain, symptoms that are seen in many other
conditions, not just heart attacks.
Although women live longer than men, they typically suffer from other
chronic disease which mask heart attack symptoms. Women also die of
heart attacks at greater rates than men do. The lack of research in
women's health issues has also been seen in cancer research. Cancer is
the second leading killer in women, with lung cancer as the leading
cause of cancer death.
Significantly, over the past 10 years, the death rate from lung
cancer has declined in men, but has continued to rise in women. Women
also suffer from breast, colorectal, cervical, and ovarian cancers at
alarming rates. Although ovarian cancer has the lowest incidence of
death, this is the deadliest of all cancers.
Let me explain for a second what I mean.
{time} 1545
One woman in 55, will develop ovarian cancer over her lifetime, one
in 55; yet the 5-year survival rate for ovarian cancer is 35 to 47
percent. In contrast, prostate cancer has a 5-year 87 percent survival
rate.
We all agree that we have reached a day where we must study these
diseases further. We must also come to an understanding that diseases
affect men very differently than they affect women.
Gender-specific research is critical in the move toward better
treatment. Just as we must focus on rural and urban and underserved
populations, we must also focus on the studying and treating women in
the most beneficial, cost-effective, and safe way.
The Health Research and Quality Act gives such an opportunity when it
comes to studying heart disease and cancers in woman. That will help us
meet our shared goal of providing the best of all care.
I urge my colleagues to support my amendment.
Mr. BILIRAKIS. Mr. Chairman, will the gentleman yield?
Mr. PASCRELL. Yes, I yield to the gentleman from Florida.
Mr. BILIRAKIS. Mr. Chairman, I asked the gentleman to yield just to
share with the House that the majority has had an opportunity to review
his amendment which would require that the director bill private-public
partnerships, enhance the quality of and access to health services
regarding cancer and cardiovascular services for women.
I would also report to the gentleman that we have a markup at my
committee in a couple of days, a breast cancer markup, a very important
piece of legislation.
We are prepared, Mr. Chairman, to accept the amendment.
Mr. BROWN of Ohio. Mr. Chairman, I move to strike the last word.
Mr. Chairman, I thank the gentleman from New Jersey (Mr. Pascrell),
my friend, on his leadership on this issue and ask the House for
support on the Pascrell amendment.
Two weeks ago, I sponsored a women's health fair in Brunswick, Ohio,
in my district. Among other speakers was Dr. John Schaeffer, a
prominent cardiologist from Elyria, Ohio, who talked about many of the
things and emphasized many of the statements that the gentleman from
New Jersey (Mr. Pascrell) mentioned, among them that the incidence of
heart attacks in men is higher, but the mortality rates are higher for
women.
In other words, men are much more likely to recognize the symptoms of
heart disease because we, too often, in this society have said that
heart disease is a male disease more and not a female disease. But the
fact is it is the largest killer among women. More women die of heart
attacks than men. Women need to be aware of the symptoms that are
present in heart attacks. As we have instructed men in this society to
be aware of the symptoms, we need to do the same with women.
I think including the Pascrell amendment in this legislation will be
a major step towards that. I ask the House support of the Pascrell
amendment.
The CHAIRMAN pro tempore (Mr. Quinn). The question is on the
amendment offered by the gentleman from New Jersey (Mr. Pascrell).
The amendment was agreed to.
Amendment No. 9 Offered by Mr. Tierney
Mr. TIERNEY. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 9 offered by Mr. Tierney:
Page 12, after line 14, insert the following subparagraph:
``(C) The conduct of research on methods to reduce the
costs to consumers of obtaining prescription drugs.
Page 12, line 15, strike ``(C)'' and insert ``(D)''.
Mr. TIERNEY. Mr. Chairman, my amendment is rather brief. What it does
is it seeks to have this following subparagraph, ``the conduct of
research on methods to reduce the costs to consumers of obtaining
prescription drugs,'' be included in this bill.
Mr. Chairman, prescription drugs can improve health care, and it can
save lives. But these benefits cannot be realized unless patients can
afford their medications.
H.R. 2506 already requires research on ways that new and appropriate
uses of drugs can improve health quality and costs. Our amendment would
simply add support for research on ways of promoting prescription drug
affordability as well.
Pharmaceutical manufacturers may argue that reducing prescription
drug costs to consumers will reduce the profit incentive that drives
researchers to develop new drugs. But, Mr. Chairman, that is a myth.
Currently, the drug companies enjoy such large profits that they have
ample room to cut costs without sacrificing research. The largest
pharmaceutical manufacturers spend less on research and development
than they make in pure profit; and the size of that profit is, indeed,
substantial. The drug industry is three times more profitable than the
average profitability of all other Fortune 500 industries.
Moreover, if individual U.S. purchasers paid less, the drug
manufacturers would likely continue to maintain their high-profit
levels. They would simply make up for the decreased revenue by
spreading costs, for instance, to other countries that now consistently
pay far lower prices for their prescription drugs than do citizens in
this country. Currently, many Americans find prescription drugs
unaffordable, particularly our seniors.
A recent Standard and Poor's report on the pharmaceutical industry
tells us that drugmakers have historically raised prices to private
consumers to compensate for the discounts they grant to managed-care
customers.
Seniors in my district, Mr. Chairman, and in my colleagues' are
victims of this price discrimination. When we studied this issue in my
district, we
[[Page H8924]]
found that seniors were being forced to pay, on average, more than
twice as much as the large insurance companies' clients.
Other countries are also benefiting from discounts. Other countries
are benefiting from discounts far more than our country. A drug that
would cost $100 in the United States costs only $76 in Canada, $67 in
Britain, $47 in Sweden, and $32 in Australia. There certainly is room
for equalizing prices.
Let me add the human dimension to what we are talking about, Mr.
Chairman. One of my constituents, Louise Duda of Newburyport,
Massachusetts, recently had a letter published in the local newspaper,
the Daily News of Newburyport. It was a tragically familiar tale, one
that I am sure many of my colleagues can already account in their
districts.
Mrs. Duda begins her letter by saying: ``I am sitting at my desk,
with an involuntary flow of tears streaming down my cheeks. My husband
sits close by, silently. I am angry, distraught, and feeling extremely
defenseless. Why is our Government heartless toward the most vulnerable
segment of our society?''
The letter goes on in which Mrs. Duda says: ``My husband just
returned from the drugstore. When I read the receipt, I felt a sense of
panic and my eyes welled up. $250? This has to be a mistake. No, it is
$250. But how can that be? We just paid $400 2 weeks ago. We can't keep
doing this. Our income tax return bailed us out the last time. Now
what? I took a quick mental inventory of our financial status. Our one
credit card is maxed. Our bankruptcy prevents us from obtaining a loan.
We are living paycheck to paycheck. We have overdraft, but when that's
exhausted, what do we do?'' She has no aces. She has no hope, just a
prayer.
Mr. Chairman, I urge our colleagues to vote on this amendment to find
an answer to Louise Duda's question about what we do about lowering the
cost of prescription drugs in this country. I ask that Members help
support the prescription drug affordability by supporting this common
sense amendment.
Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
Mr. Chairman, I commend the gentleman from Massachusetts (Mr.
Tierney) for his amendment. We have spent the better part of today on a
prescription drug hearing in my subcommittee and have another one
scheduled for next week and one for shortly thereafter.
As the gentleman from Ohio (Mr. Brown) knows, prescription drug
problems is the forefront of what we are doing up here these days, and
well it should be. Even though the agency, I think it is quite clear
that their functions would include something like this, it is good that
we sort of focus and highlight the need for many of these amendments,
to basically instill in the agency the thought that, yes, they have got
to spend some time on them.
So anyhow, we have studied this amendment and are prepared to accept
it. I thank the gentleman from Massachusetts for offering it.
Mr. BROWN of Ohio. Mr. Chairman, I move to strike the requisite
number of words.
Mr. Chairman, I rise in support of the Tierney amendment and thank
him for his efforts in a major step in dealing with the high price of
prescription drugs that the gentleman from Maine (Mr. Allen) has worked
on and the gentleman from California (Mr. Waxman) and the gentleman
from Florida (Mr. Bilirakis) and the gentleman from Vermont (Mr.
Sanders) and the gentleman from Texas (Mr. Turner) and many in this
institution, the gentleman from Arkansas (Mr. Berry), and others.
Some brief facts that I think that this agency will look at and need
to look at about the price of prescription drugs: forty-three percent
of the cost of research for new prescription drug products in this
country are paid for by the National Institutes of Health; forty-three
percent of the research dollars spent are spent by taxpayers through
the National Institutes of Health.
Drug companies themselves pay only about 50 percent of all their
research costs in this country in developing new prescription drugs.
In addition, this Congress has bestowed tax cuts on those drug
companies for the dollars that they do spend on research and
development. In turn, U.S. consumers are given the privilege of paying
the highest drug prices in the world, two times, three times, four
times the price that prescription drugs cost in countries like Britain
and France and Germany and Japan and Israel and other countries that
have a different pricing mechanism for their prescription drugs.
Some allow something called parallel importing which brings sort of
an international competition in the price of prescription drugs. Others
allow something called product licensing which allows generics in the
marketplace to compete so that prices are not monopoly priced and are
not set so high unilaterally by the drug companies.
The third point I would add, Mr. Chairman, is that one-half the drugs
that are developed, the new prescription drugs developed in this
country, are developed for the world market or developed outside the
United States. That says when the drug companies threaten this
institution, as they have repeatedly, by saying if we do anything to
lower drug prices, the bill by the gentleman from Maine (Mr. Allen) or
the bill by the gentleman from Arkansas (Mr. Berry) or my legislation
or any other, if we do anything like that, they are going to cut back
on research and development dollars.
The fact is half the drugs developed around the world are developed
in countries where governments have actually acted to lower
prescription drug prices.
I thank the gentleman from Florida (Mr. Bilirakis) for his hearing
today. We are going to have another hearing next Monday, which will
bring forward Members of this body who are supporting and sponsors of
other prescription drug legislation.
We all know the problem of high price of prescription drugs. I think
the Tierney amendment will go a long way towards exploring solutions so
we can in our committee move forward in dealing with the high cost of
prescription drugs.
I ask for support of the Tierney amendment.
Mr. ALLEN. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, I want to begin by recognizing the work of the
gentleman from Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr.
Brown) on this most important issue and to thank the gentleman from
Massachusetts (Mr. Tierney) for bringing this amendment forward.
The fact is that I believe this amendment is needed. The bill, as it
stands, does allow research into the costs of health-care services and
access to such services, and I agree with the chairman that conduct
into the research of prescription drugs could be seen to be within that
issue, but it is better to make it clear.
Therefore, the Tierney amendment, which specifically mentions the
conduct of research on methods to reduce the cost to consumers to
obtain prescription drugs is the right sort of amendment.
Whenever I talk to seniors in my district in Maine, the subject of
prescription drugs comes up and particularly the high cost of
prescription drugs. Seniors are not the only ones affected, however.
The fact is that the most profitable industry in the country, which is
the pharmaceutical industry, is charging the highest prices in the
world to those people who can least afford it in this country; and
those people are seniors and others without prescription drug coverage.
Seniors make up 12 percent of the population, but they buy 33 percent
of all prescription drugs. Spending on prescription drugs in this
country is going up at the rate of 15 percent every single year.
We are dealing with an issue that is of immediate importance to men
and women all across this country who thought, when they retired, they
would be able to figure out how to get by. But now they find that their
next trip to the doctor may leave them unable to pay the electric light
bill or the rent or to buy food.
This is a burning issue for America's seniors, 37 percent of whom
have no prescription drug coverage at all, and a significant additional
portion do not have adequate, reliable coverage.
[[Page H8925]]
In the midst of all of this, the pharmaceutical industry is running a
national TV campaign to try to stop any reform, to try to prevent a
benefit under Medicare and to stop the kind of discount that I and
others here have been urging.
This is an important issue. We need to do research. We need to figure
out why prices in this country for people least able to afford it are
the highest in the world. That is an appropriate area of research.
Therefore, I rise to support the Tierney amendment.
Mr. GREEN of Texas. Mr. Chairman, I move to strike the requisite
number of words.
Mr. Chairman, I rise in support of the Tierney amendment; but, first,
I want to thank both the chairmen of our Subcommittee on Health and
Environment and Committee on Commerce for the hearing today and also
the commitment over the next few weeks to deal with this issue, at
least through the committee process, and also the gentleman from Ohio
(Mr. Brown), the ranking member.
{time} 1600
This is one of the most important issues I think that Congress is
facing, is how to provide prescription drugs at an affordable price to
the people who need them most, our senior citizens.
Several bills have been introduced to achieve this goal, but each has
been met by critics who claim they are either inadequate, too costly,
or unfair price controls. In fact, I am a cosponsor of the Allan-
Turner, et al. bill that we had that my colleague from Maine talked
about.
In fact, to follow up on his, I have seen the Flo advertisements on
TV, and I have a little concern. I want to make sure people in our
country realize who is paying for that multimillion dollar campaign on
TV. It is the pharmaceutical and drug companies. Because, obviously,
they do not pay for that ad on TV in Canada or Mexico, where
constituents in my district may have to go, oftentimes, driving 6 hours
to Mexico to get their drug prescriptions at a cost they can afford.
The Tierney amendment may help provide some answers to the concerns on
affordability and which method would truly meet the needs of seniors.
The fact is our Nation's health care system has dramatically evolved
over the past 10 to 20 years to the point that prescription drugs are
not only a major component of the health care system, but they can be
critical to an individual's survival. Everyone agrees we need to find a
way to make prescription drugs more affordable to seniors, who are
least able to afford them but who need them the most.
Seniors are being forced to choose between buying food or their
prescription medications or even postponing taking their prescription
medications. Instead of taking them one a day, as prescribed, they may
take them every other day just because they cannot afford them.
Because Medicare does not cover prescription drugs, so many seniors,
37 percent according to the GAO, but I think in my district it is much
higher, do not have any prescription drug coverage and may incur these
expenditures out-of-pocket. Worse yet, many of these beneficiaries have
very limited coverage that do not even come close to meeting their
medical needs.
While I am sensitive to the need for drug manufacturers to make
profits on their drugs, it is unacceptable that the bulk of these
profits are made on sales to people who can least afford to pay those
prices. Discounts are available to HMOs, to the U.S. Government, to
hospitals, and even foreign countries, but seniors are forced to pay
the full price. That is just not right, and something needs to be done
to correct it.
This amendment will give an important agency the opportunity to look
at these issues and answer some of the questions surrounding them.
Everyone knows this is a complex and difficult problem to solve.
However, sitting back and doing nothing is not an acceptable option.
Today, not only with this amendment, with this study, but also with
what the Subcommittee on Health and Environment of the Committee on
Commerce is doing, we are moving forward on it.
As new drugs are developed and approved, the access gap to these
potential life-saving treatments are only widened. This amendment is
reasonable and sensible, and I am glad to be a co-sponsor of not only
this bill but also the Turner-Allan bill that will provide a solution
to this problem. Support for this amendment is important to research
and study methods and practices.
Mr. LUTHER. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, first of all, let me thank the gentleman from
Massachusetts (Mr. Tierney) for bringing this amendment forward. I
think he does us a great service in this body.
We have entered a remarkable period in our Nation's history. Never
before have we had so many life-enhancing prescription drugs. Yet, let
us face the facts. These remarkable achievements are today overshadowed
by the exorbitantly high prices consumers in America are being required
to pay for these prescription drugs.
This is why I rise in support of the Tierney amendment. This
amendment would expressly direct this agency, an important agency, to
address this issue, an issue that is perhaps the most important issue
we face in health care today. It would require that agency to recommend
ways to make drugs more affordable for American consumers.
Mr. Chairman, earlier this year, I requested a study on comparative
drug prices in my home district in Minnesota. The report was issued in
March of this year, and the results were astonishing. The report showed
that the average retail prices for the five best selling drugs for
older Americans in Minnesota are more than twice as high as the prices
that drug companies charge their most favored customers. For one drug,
Minnesotans actually paid a price 15 times higher than the price
enjoyed by preferred customers. This does not just impact senior
citizens, it affects all American consumers who do not have
prescription drug coverage today.
This type of unfairness needs to be addressed, and that is exactly
what this amendment does. It does not dictate policy or set up a new
layer of bureaucracy, it simply directs that we look at ways to create
fairness and to help American consumers afford the cost of these wonder
drugs that are available today. I urge Members to support this
amendment.
Mr. McGOVERN. Mr. Chairman, I rise today in support of the amendment
offered by my good friend John Tierney instructing the Agency on Health
Research and Quality to study methods of reducing the costs of
prescription drugs to consumers. This is an important study in light of
the focus on a Medicare prescription drug benefit, as well as the
increase in pharmaceutical productions.
Prescription drugs are an important means of providing healthcare in
an outpatient setting. However, the costs of these drugs are too high.
Earlier this summer, I commissioned a study to specifically examine the
cost of prescription drugs in the Worcester/Attleboro/Fall River,
Massachusetts area. This was the first and only study of its kind
examining drug prices in Central Massachusetts. The results were
alarming.
On average, seniors get more than eighteen prescriptions filled each
year. I was shocked to learn that uninsured seniors in my district--
those without any prescription drug benefit--pay 136% more for their
prescription drugs than the drug companies most favored customers. This
means that if a most favored customer pays ten dollars for a
prescription, the uninsured senior in my district will pay twenty-three
dollars and sixty cents for that same prescription. It is
unconscionable that people who can least afford to pay these high costs
are being gouged by the drug companies in the name of profits and I am
sickened that seniors in my district, and across the country, are
forced to choose between buying groceries and medicine.
Our top priority must be a prescription drug benefit. However, this
amendment is a first step in this Congress acknowledging that drug
prices are too high for uninsured seniors. I support President
Clinton's efforts to implement a prescription drug benefit. I also
support Congressman Tom Allen's bill to end price discrimination by the
drug companies. Together, these efforts will lower prescription drug
prices and allow seniors to buy both food and medicine. We must
continue to raise awareness of the need for affordable prescription
drugs, at least until this Congress is able to pass a comprehensive
prescription drug benefit. I urge the adoption of this important study.
Mr. BERRY. Mr. Chairman, I rise today in support of the Tierney
amendment and to talk, once again, about the affordability of
prescription drugs.
We have all gone back to our districts and have heard from our
constituents, especially
[[Page H8926]]
seniors, that they cannot afford the prescription drugs they need,
often to stay alive.
When I hold meetings in the 1st Congressional District of Arkansas, I
hear about two issues and that's the agriculture crisis and the high
cost of prescription drugs, especially for seniors.
I also get letters from Arkansas seniors who tell me everyday they
can't afford to pay for all their needs, specifically, all their
medicine and their food.
Seniors all over this country are not following their doctors'
orders. Some of them have been given prescriptions which they cannot
afford to fill. Others have filled prescriptions which they cannot
afford to take as directed.
Because they cannot pay the rent, pay the electrical bills, buy food
and take very expensive prescription drugs, they either stop taking
them, or they take less than what is prescribed by their doctor.
They are doing things that in the long run are harmful to their
health.
I find it amazing that we tell our seniors they can live longer if
they take this pill and that pill, but then if they can't afford their
medication that keeps them alive, we don't do anything about it.
Thousands of consumers, especially seniors have found themselves
affected by the price of prescription drugs in this country.
Seniors and other Americans go to Canada and Mexico because
prescription drugs in these countries cost much less than in the United
States.
In my District in Arkansas, seniors paid 81% and 72% more,
respectively, for the 10 prescription drugs they most commonly use than
their elderly counterparts in Canada.
I have introduced legislation, with Representatives Emerson and
Sanders, the International Prescription Drug Parity Act, that amends
the Food, Drug, and Cosmetic Act to allow American distributors and
pharmacists to reimport prescription drugs into the U.S. as long as the
drugs meet strict safety standards.
This will allow American pharmacies and distributors to benefit by
purchasing their drugs at lower prices, which they can pass along to
American consumers.
Mr. Chairman, the bottom line is, consumers should not have to choose
between food and medicine.
I urge all members of this body to vote for the Tierney amendment.
The CHAIRMAN pro tempore (Mr. Quinn). The question is on the
amendment offered by the gentleman from Massachusetts (Mr. Tierney).
The amendment was agreed to.
Amendment No. 11 Offered by Mr. Tierney
Mr. TIERNEY. Mr. Chairman, I offer an amendment, amendment No. 11.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 11 offered by Mr. Tierney:
Page 13, after line 5, insert the following subsection:
``(d) Studies of Methods to Improve Access to Health
Service.--The Director shall conduct, and shall provide
scientific and technical support for private and public
efforts to conduct, studies of the organization, delivery,
and financing of health services in order to determine the
cost and quality effects of various methods of substantially
increasing the number of individuals in the United States who
have access to health services. Such studies shall include a
study to determine the impact of a single payer insurance
coverage program on health expenditures in the United States
during the fiscal years 2000 through 2007 compared to the
projected impact of the current system on health expenditures
in the United States during such period.''
Mr. TIERNEY. Mr. Chairman, this particular amendment is going to
request that the director conduct and provide scientific and technical
support for the private and public efforts to conduct studies of the
organization, delivery and financing of health services in order to
determine the cost and quality effects of various methods of
substantially increasing the number of individuals in the United States
who have access to health services.
Mr. Chairman, those studies should include a study to determine the
impact of a single-payer insurance coverage program on health
expenditures in this country during the fiscal years 2000 to 2007
compared to the projected impact of the current system on health
expenditures in the United States during that period.
Mr. Chairman, simply put, I bring this amendment forward for the
gentleman from Washington (Mr. McDermott), the gentleman from Vermont
(Mr. Sanders), the gentlewoman from Wisconsin (Ms. Baldwin), as well as
myself. What we seek to do is to make more explicit one of the duties
that the agency is already charged with, and that is the duty to study
ways of increasing access to health services.
We have a situation in this country where there are estimates of 43
million Americans without health insurance coverage. Of those numbers,
11 million are said to be children. The balance of those people are
adults, the majority of whom are working adults. This is simply a
situation that is intolerable, Mr. Chairman, and it is about time that
we started to look at the reasons why that is so and what we can do
about changing that dynamic and making sure that all Americans have
access to affordable health care.
As a former small business president of the Chamber of Commerce and
someone who deals often with small businesses, I can tell my colleagues
that there has been a change of mind amongst many people in the small
business industry. They, at one time, were listening to the larger
national organizations and international organizations about how
terrible it would be if we had universal health care. Now they are
seeing the alternative of what happens under the current system. They
see the number of people that are uncovered, and they realize that the
premiums they are paying to cover their employees and their own
families are increased by virtue of the fact that those premiums are
also covering the 43 million Americans who have no coverage.
That has to be paid for somewhere. Those people do get health care.
They unfortunately get it when it is later on in their situation, when
the situation is more critical, when treatment is more expensive, and
now we need to know why that is so. Now we need to know why we cannot
cover everybody.
I think it has come around to providers, whether they be doctors or
nurses or others. It has come around to hospitals, to CEOs who I have
talked to, as well as business people and consumer groups. We need to
look at a more effective health care system in this country.
It is more than enough to say that we have a problem. It is time to
do something. And when we talk about some of the immediate solutions,
and my colleagues have heard as well as I have that we need to put more
money back into community hospitals, particularly teaching hospitals
because of the cuts in the 1997 Balanced Budget Act, and that is so.
The estimates were that we were going to cut $112 billion and that we
were then going to be able to take care of fraud and abuse and get
preventive services, and that was going to help it be more affordable.
The fact of the matter is, that estimate was overshot. Some $200
billion is estimated to have been squeezed, and those hospitals and
home care providers and others do need some money to be put back in.
But to just put money back in would be a temporary fix. The system is
broken. It is not working. We are not covering everybody. And if we do
not cover everybody, we cannot control the cost and cannot make sure
that we provide good quality services to everyone.
What this bill will do, Mr. Chairman, is to get this agency to do a
study and to compare it to what we have now. What will improve the cost
situation. More importantly, what will improve the accessibility and
the affordability issues.
Now, among those things we asked to be studied is the single-payer
system. That is one option. In no way does my amendment say that that
is all we should study or that we should predetermine that is exactly
where we have to go. It is a proposal that I think has considerable
merit. The Massachusetts Medical Association had two independent
studies done, and not to the surprise of many, it came back saying the
single-payer system would have been a better system if applied in
Massachusetts over the next 8 years. It would save money, it would
cover more people in that State, it would provide them better services.
We should find out if that is so for all the States in this country.
We should find out if we should have a single-payer system or some
other form of universal health care. We should balance and measure
those systems against each other and how they will do. And then we
should measure it against the current system to find out what would be
best.
[[Page H8927]]
Modification to Amendment No. 11 Offered by Mr. Tierney
Mr. TIERNEY. Mr. Chairman, some people are concerned about the
language because they thought my amendment was simply saying that we
would study only single-payer, but, in fact, we have looked at some
language and I am more than happy to ask for unanimous consent that my
amendment be modified in accordance with the modification that has been
sent to the desk which says that the study shall include an examination
of the financial impacts of a range of health care reform proposals to
include, but not be limited to, a single-payer insurance program
compared to the current system across an 8-year period beginning in
fiscal year 2000.
The CHAIRMAN pro tempore. The Clerk will report the modification.
The Clerk read as follows:
Modification to amendment No. 11 offered by Mr. Tierney:
The second sentence of the amendment is modified to read as
follows: ``Such studies shall include an examination of the
financial impacts of a range of health reform proposals to
include, but not be limited to, a single payor insurance
program compared to the current system across an eight-year
period beginning in fiscal year 2000.''
The CHAIRMAN pro tempore. Is there objection to the modification
offered by the gentleman from Massachusetts?
There was no objection.
Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment, as
modified.
Mr. TIERNEY. Mr. Chairman, will the gentleman yield?
Mr. BILIRAKIS. I yield to the gentleman from Massachusetts.
Mr. TIERNEY. Mr. Chairman, I thank the gentleman very much for that
courtesy. I simply wanted to reiterate the point that we must study all
the available reforms on that, and this, of course, is one important
one.
Mr. BILIRAKIS. Mr. Chairman, reclaiming my time, we are not in
disagreement, as far as that area is concerned. We have studied the
amendment and have talked with the gentleman and talked with the
gentleman's staff, and we accept the amendment, as modified, and do not
object to it.
Ms. LEE. Mr. Chairman, I move to strike the last word.
I want to thank my colleague from Massachusetts for offering this
amendment, and I rise in strong support of the Tierney amendment to
authorize studies or methods to improve access to health services.
While serving in the California legislature, I had the opportunity to
work on similar legislation. I am proud to say that the bill was passed
by the California legislature and is now before the governor for his
signature.
This Nation, as well as my home State of California, really needs the
study, and also the California study, because of the profound failures
of the present system. By now we have had 5 years of experience of
depending on the private sector for the delivery of our health care, 5
years of knowing intimately that a market-driven health care system
leaves more and more people frustrated, angry, and sick.
I also carried managed care bills while I was in the California
legislature. I authored many of them. And I want to say that people are
becoming increasingly more disappointed with the outcome of these
managed care approaches. They are frustrated because medical decisions
about operations, about how long to be hospitalized, about which
illnesses are to be treated and by whom, crucial medical decisions are
being made each and every day, each and every moment by accountants and
executives of managed care companies who earn fortunes by denying
medical care to their subscribers.
The statistics on what CEOs are making are staggering and should make
us really squirm in shame. These are profits at the expense of our
right to live or our right to be as healthy as we can be. Now,
simultaneously, we have had 5 years of a market-driven health care
system which leaves more and more Americans uninsured. At last count we
were at about 45 million, increasing at the rate of 1 million uninsured
people a year.
{time} 1615
Are these health care companies with their immense profits working to
raise our knowledge and our standards of health care? Are they helping
us to understand that an ounce of prevention is really worth a pound of
cure? Sadly, it appears not.
What has the industry done in these 5 years? Are they controlling
health care costs? Sadly, again, it appears not. Health care premiums
are once again rising.
For example, the health care industry has spent millions successfully
lobbying so far to defeat the Patients' Bill of Rights. Health
insurance companies have had the gall recently to propose $60 billion
in new Federal programs to subsidize insurance for 28 out of the 45
million uninsured Americans.
The current efforts to expand Medicare to cover prescription drugs,
which, of course, I support, is now motivating, however, the health
insurance industry to compete with the pharmaceutical companies by
insisting that the uninsured should come before those needing
prescription drugs.
So to pit one group of Americans against those who need health care
versus another group who needs health care to me is just basically
wrong.
Mr. Chairman, I am convinced that as long as profits provide the
driving force in the health care industry, we will fall way short of
providing health care, affordable and accessible health care, for all.
For instance, recent studies show that for-profit hospitals drive up
Medicare costs in general as a group. In another study, for-profit
health plans perform worse than nonprofits in providing preventive
health care. One study concluded that if all American women were
enrolled in for-profit HMOs instead of nonprofits, over 5,900 more
women would die from breast cancer each year due to lower rates of
mammography.
This Nation spends more money per person on health care than any
other industrialized country. Yet, in 1997, Newsweek reported that
current figures for longevity projections for the year 2050 for
African-Americans will be less than the longevity of all other ethnic
groups.
Could that be because our health care dollars are not going for
health care for all based on an equitable basis but going into the ever
deeper and ever hungrier pockets of the top echelons of those health
care insurance companies?
Georgetown University Medical Center reported this February that
their study together with Rand Corporation and the University of
Pennsylvania indicated that African-Americans and women with chest pain
would be referred for cardiac catheretization at 60 percent of those of
whites and men. This disparity was most dramatic for black women, where
odds of being referred were 40 percent of those of white men. This is
really a shame.
We need to get out of the competition by profit-making companies for
our meager health dollars. We need to know that other ways are
possible. For instance, we do need to know how much a single-payer
system costs. We do need to know how much provision of universal health
care without profits for insurance companies would cost. We need this
information provided in the Tierney amendment.
I urge my colleagues to support the amendment.
Ms. BALDWIN. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, the Tierney amendment is a worthwhile step toward what
must be a larger goal.
As we approach the new millennium, Mr. Chairman, the United States is
still the only country in the industrialized world that does not offer
comprehensive affordable health care to all of its citizens. This, Mr.
Chairman, is unconscionable, it is untenable, and it is wrong.
As we reach the closing days of the 20th century, 43 million
Americans have no health care coverage at all. In this wondrous
century, we have put astronauts on the moon, we have created a global
village united by computer technology, we have perfected travel from
one end of the world to the other in mere hours, and yet 43 million of
us cannot afford or cannot get health care insurance.
Most of those people have jobs. But increasingly they work in small
businesses or in the service sectors that either do not cover employees
or require them to pay so much for health insurance that they simply
cannot afford it.
[[Page H8928]]
There are millions more Americans who are under-insured who have
health insurance but would be at risk of having to spend more than 10
percent of their income on health care bills in the event of a
catastrophic illness. And there are tens of millions of Americans who
have lost faith in the system, lost faith that comprehensive quality
health care will be available to them without a struggle when they need
it, where they need it, and from whom they want it. And these numbers
continue to rise.
The National Coalition on Health Care, a bipartisan group headed by
former Presidents Bush, Carter, and Ford, put out its latest report on
the erosion of health insurance coverage in the United States, which
found that even if the rosy economic conditions prevalent since 1992
prevail for another decade, one in five Americans will be uninsured in
2009. Should a recession occur, that number is likely to jump as far as
one in four.
Mr. Chairman, it is time to put health care for all at the top of our
national agenda. Many people have called for it. Many more believe it
should happen.
Mr. Chairman, universal health care will never happen until we create
the national will to make it so. Let us begin.
American medicine is the best in the world. Of that there is no
doubt. And yet our nursing teams are understaffed, underpaid, and
overworked. Our health care costs continue to rise at twice the rate of
inflation. Today's one-trillion-dollar system will double in cost to $2
trillion in the next decade. This will adversely affect our economy,
the deficit, the Nation's small businesses, and the middle class's
standard of living.
Universal health care will actually lower health costs by providing
less expensive preventative health care and treating illnesses before
they become more complex and costly.
It was just a year ago that I traveled around my district telling the
voters of Wisconsin's second district that I wanted to go to Congress
to re-ignite the national debate on health care. One reporter even
called me from a prominent paper on the East Coast to talk about the
campaign. I asked, Why are you interested in a race so far away? He
said, Because you are one of the few candidates anywhere who is willing
to talk about health care for all. It is a hot potato that no one wants
to touch.
Well, my constituents did not just touch it, Mr. Chairman. They
embraced it. The voters in my district are tired of hearing, we cannot.
The voters in my district reject the cynicism, the naysayers, the
keepers of the status quo. The voters in my district posed the same
question to this Congress that I posed during my campaign: If you are
not for health care for all, then who would you leave behind? And if
you agree that everyone should have access to affordable quality health
care, then let us talk about the best way to achieve it.
It is time to begin.
Mr. FRANK of Massachusetts. Mr. Chairman, I move to strike the
requisite number of words.
Mr. Chairman, I congratulate the sponsors of this amendment for
bringing it forward. The lack of an adequate universal health care
system is one of the gravest defects in public policy in America.
Now, there are many of us who are in favor of it on equitable
grounds. I am going to take that segment for granted in my comments and
talk to those on the more conservative side, the people in positions of
responsibility, the financial community, and try to explain to them why
I believe it is very much in their interest to get behind what we hope
will be the first step in leading to the establishment of a universal
health care system and would I say a single-payer health care system.
By the way, for those who raise questions about the feasibility of a
single-payer health care system, let us talk about one which we have
had in this country for over 30 years. It is called Medicare. Medicare
is a universal single-payer health care system if they are over 65. And
those who think it is a bad idea, go tell the recipients of Medicare
that they are going to abolish it and let them go back to other ways
and I think they will find a great deal of negative response.
Indeed, one of the great mistakes this Congress made in 1997 was to
cut Medicare. Exactly how it happened, I do not know. Because so many
people who were for cutting Medicare in 1997 are so vehemently against
it now that I think there was something in the air, that people were,
like, absent but voting because they did not know what they did.
But here is the argument for going further. In 1993, when the
President put forward a health care plan, we were told, well, look,
most people get health care and we are solving this problem through our
current system. In fact, the opposite has been the case. People have
been losing health care. They are losing it, in part, because of the
international competitive situation. Holding down the costs to
employers, particularly in manufacturing, has become a major factor
worldwide.
Alan Greenspan a couple of months ago gave a speech in which he
lamented the fact that the former national consensus for free trade had
eroded and he complained that so many people today are not for tree
trade anymore. And he said, I understand how some people get hurt, that
some people who do not have access to the skills in information
technology will lose their job in the short-run, but we should not let
our inability to help them keep us from going forward with
globalization.
Well, the fact is that we do not have an inability to help them, we
have an unwillingness, because this very wealthy Nation clearly has the
resources.
One of the single best things that people should understand, and here
is what I want to address, conservatives, people who believe in
globalization, people who want China in the WTO, people who want to go
forward with Fast Track authority, who want a new round in Seattle to
lead to further trade reductions, we are not going to get that until we
have satisfied working people in America that they will not be unfairly
disadvantaged.
And one of the biggest problems they have, I think the single biggest
problem now is, when they lose their jobs, they lose their health care;
and when they get new jobs, having lost their jobs, they may well get a
job without health care. Because with the lower paying jobs, the
service jobs, it is not simply a reduction in income that people face
when they lose a manufacturing job and go into another industry, they
may very well not have health care.
The insecurities that people in this country feel because of our
patchwork health care system and the absence of a reliable universal
health care system, I think it should be single-payer, but the reliance
of that, the knowledge that losing their job could mean losing their
health care for them and their family, their children, their spouse,
that is one of the biggest obstacles to the support these people are
looking for for globalization.
So Mr. Greenspan is right to acknowledge that many of us are
unwilling to go forward with the process of globalization if it is
going to hurt some of the people at the lower end economically, but he
is wrong to say that the reason we are not helping them is that it is
an inability.
There used to be a problem, we thought, 10 years ago. We thought we
were spending too much on health care. We said the American economy was
stagnating because we were spending too much on health care. We now are
clearly the best performing economy in the world. The fact that our
health care expenditures per capita are higher than in some other
places is obviously not an economic problem.
We face a moral problem in condemning people to inadequate care. But
they also, I have to say to the establishment and financial community,
must understand that there is going to have to be a trade-off. And if
people want to reverse the move away from support for globalization
internationally, those who believe that is very much in our interest
economically have to understand that social equity is going to have to
be part of that deal. And they are not going to go forward with the
kind of economic global integration they want to see until they do a
number of things, and one of them is the provision of a universal
health care system.
So, as I said, I know we got some votes for equity. But fairness is
not enough to win. We are in a trade-off situation. And if we look at
the Congresses of the past few years, we have
[[Page H8929]]
had increasing contention over American support for the international
financial institutions, American support for reductions in tariffs.
That will get worse rather than better as long as we get a refusal to
recognize the legitimate claims of American workers for a universal
health care system.
Mr. TRAFICANT. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, we begin to talk about the economic principles that
have probably caused the inability to provide it. I agree with the
previous speaker that it is probably more willingness.
Until we take the major costs off American corporations, they will
continue to leave our country and we will continue to struggle and lose
our manufacturing base.
I think it is time, though, that while we are talking about the
symptoms that we should start addressing the root causes and problems.
It is time to take a look at the progressive income tax, the burdensome
cost of compliance, and the negative economic competition globally that
it places us in.
We are now beginning to talk about the reasons why we cannot perform
many of the deeds our constituents believe we should be addressing, and
we will never do it with the complicated Tax Code that we have in
place.
{time} 1630
We reward companies for leaving. We reward imports. We kill exports.
And then we talk about trade and then we talk about universal health
care. Well, there will be no universal health care, there will be no
improvement to the health care system until we change a tax code that
rewards competitive imbalance overseas and negates America's
opportunity to provide these programs. But it is interesting to see it.
It is not an inability. It is not an unwillingness. It is a tax code
that simply makes it almost impossible to provide this type of
competitive program. We should get rid of it.
Ms. SCHAKOWSKY. Mr. Chairman, I move to strike the requisite number
of words.
I want to thank the gentleman from Massachusetts for this amendment
which I strongly support. Like my colleague from Wisconsin, in large
part I wanted to come to this body to address the issue of health care,
the crisis that so many families face, those that have insurance but
find it inadequate, those that lose their jobs and lose their
insurance, those that have no insurance and have no hope of affording
it.
I just wanted to read a letter from a constituent. This is typical.
This is one of many. It is an e-mail I got the other day that says,
The cost of health care is killing me. I'm self-employed
and the cost of medical insurance for my family of three is
about $9,000 a year. That's with high deductibles. That means
we also have to pay several thousands of dollars a year in
medical bills. These costs are getting out of control. I
don't believe that private insurance or even HMOs are the
answer anymore. I think it's time for a single-payer
insurance system backed by the Federal Government. I would
appreciate your working with others in Congress to start
moving in this direction.
And so I rise to support an amendment that I think does move us at
least in the direction of exploring how we can answer this gentleman
who wrote on behalf of his family. Five years ago, we failed to pass
comprehensive health reform and instead we left it to the for-profit
health insurance industry to make critical decisions: whom to cover,
what to cover and what to charge. Today what do we have? More uninsured
Americans, more underinsured Americans, more American families
struggling to pay premiums and medical costs that are increasingly
unaffordable.
The gentleman's amendment is needed for four reasons. First, we must
act now to provide health insurance to the uninsured. It is
embarrassing, 44.3 million people now lacking any health coverage in
this the wealthiest Nation in the world, a 1.7 million jump from the
year before. Eleven million of these people are children. In my State
nearly one of eight are uninsured and the numbers keep growing.
According to an AFL-CIO study, 8 million fewer Americans in working
families have employer-based coverage now than in 1989. If that erosion
continues, the study concluded that 12.5 million more people would lose
coverage over the next 5 years.
And, second, we need to act to improve coverage for the poorly
insured. Millions of insured Americans lack coverage for critical
benefits. That includes 13 million senior citizens who lack
prescription drug coverage as well as families who lack access to
mental health services, rehab therapy, long-term care and other
important services. Even if they have an insurance card, they are still
effectively uninsured for services if their policies do not cover the
services they need.
Third, we must act to lower health care costs for individuals and
families as well as for our Nation. High insurance premiums and out-of-
pocket costs present insurmountable barriers blocking access to needed
care. A recent Commonwealth Foundation survey found that 40 million
people went without needed medical care because they could not afford
it and another 40 million said they did not have enough money to pay
their medical bills.
Finally, we pay a high price for not guaranteeing access to needed
medical care. We pay a high price. Lack of insurance, inadequate
insurance and high costs keep millions of Americans from getting the
health care that they need. There is a cost to the individuals and
families who cannot get care and as a result suffer from illnesses and
conditions that could be prevented. There is the cost to society, to
all of us, from lost wages and productivity from those who cannot work
because of the preventable injuries or who cannot work because the job
does not provide coverage. And there is the cost of paying for
expensive illnesses and emergency care that could have been avoided
through a more rational approach to health care.
This amendment moves us in the right direction. I urge my colleagues
to act now to pass it.
Mr. STARK. Mr. Chairman, I rise in support of Representative
Tierney's amendment to require the Agency for Health Research and
Quality to conduct a study about the effect of universal health care
and other access expansions on health quality and costs.
The U.S. is the only industrialized nation that fails to provide
universal health coverage for our citizens--and yet we continue to
spend more on health than any of those nations.
A key factor impacting our nation's health expenditures is that we
have 43 million Americans left out of our system whom we are covering
in the most expensive manner--through emergency rooms, late in their
illnesses, and often without the benefit of appropriate prescription
drugs since many of these people cannot afford them.
It is time for Congress to return to the vitally important issue of
expanding health insurance coverage. There are viable means to achieve
that goal.
The most direct routes to providing universal coverage would be to
enact a single payer system or to expand Medicare coverage to everyone.
There are other more incremental approaches which would also move us in
the right direction:
We could use a tax credit approach, like that I have authored in HR
2185, the Health Insurance for Americans Act.
We could expand Medicare coverage to persons aged 55-64 under HR
2228, The Medicare Early Access Act, which is supported by many of my
colleagues and the Administration.
We could expand Medicare to children--creating a much more effective
coverage policy than the State Children's Health Insurance Program,
which continues to leave millions of our nation's children without
coverage. That could become an avenue leading to Medicare for all.
I urge support of the Tierney amendment which, if passed, would
provide us with further evidence for moving forward to expand health
insurance in our country. That is a debate to which Congress must
return.
The CHAIRMAN pro tempore (Mr. Quinn). The question is on the
amendment, as modified, offered by the gentleman from Massachusetts
(Mr. Tierney).
The amendment, as modified, was agreed to.
Amendment No. 21 Offered by Mr. Stearns
Mr. STEARNS. Mr. Chairman, I offer an amendment.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 21 offered by Mr. Stearns:
Page 21, after line 8, insert the following subsection:
``(d) Certain Technologies and Practices Regarding Survival
Rates for Cardiac Arrest.--In carrying out subsection (a)
with
[[Page H8930]]
respect to innovations in health care technologies and
clinical practice, the Director shall, in consultation with
appropriate public and private entities, develop
recommendations regarding the placement of automatic external
defibrillators in Federal buildings as a means of improving
the survival rates of individuals who experience cardiac
arrest in such buildings, including recommendations on
training, maintenance, and medical oversight, and on
coordinating with the system for emergency medical
services.''
Mr. STEARNS. Mr. Chairman, I would first like to say that I support
H.R. 2506, to reauthorize the Agency for Health Care Policy and
Research, I guess it is called the Health Care Quality Agency. This
agency is an invaluable resource because the outcomes of research it
provides improves the quality of health care for all of us.
Under this reauthorization, the new agency would refocus and its
responsibilities would be to promote quality by sharing information,
building public-private partnerships, providing cost and quality care
reports on an annual basis, supporting new technologies, and assisting
in providing access to those in underserved areas.
Mr. Chairman, the amendment I am offering adds a new section to
section 916 entitled ``Certain Technologies and Practices Regarding
Survival Rates for Cardiac Arrest.'' By adding this language, we are
merely attempting to point out how valuable we believe automatic
external defibrillators are, AEDs, to saving the lives of individuals
who experience cardiac arrest. We are asking the Director to develop
recommendations regarding the placement of AEDs in Federal buildings.
Mr. Chairman, more than 1,000 Americans each and every day suffer
from cardiac arrest. Of those, more than 95 percent die. That is
unacceptable, because we have the means at our disposal to change those
statistics. Studies show that 250 lives can be saved each and every day
from cardiac arrest by using automatic external defibrillators, AEDs.
Those are the kinds of statistics that nobody can argue with.
The AEDs which are produced today are easier to use and require just
absolutely minimal training to use and operate. They are also easier to
maintain and they cost less. This affords a wider range of emergency
personnel to be trained and equipped.
One of the goals of this agency is to enhance the quality of health
care. My amendment would help achieve this by directing the agency to
develop recommendations for public access to defibrillation programs in
Federal buildings in order to improve the survival rates of people who
suffer cardiac arrest in Federal facilities. The programs should
include training security personnel and other expected users in the use
of AEDs, notifying local emergency medical services of the placement of
the AED, and ensuring proper medical oversight and proper maintenance
of the device.
My reason for offering this amendment highlights that it is possible
to prevent thousands of people suffering sudden cardiac arrest from
dying by making the equipment and trained personnel available at the
scene of such emergencies.
I am hopeful that we can pass my bill in a larger sense which I have
66 cosponsors, H.R. 2498, the Cardiac Arrest Survival Act, in its
entirety in the 106th Congress. My bill directs the Secretary of Health
and Human Services to develop recommendations for public access to
defibrillation programs in Federal buildings.
The bill I introduced in this Congress differs from previous versions
which primarily sought to encourage State action to promote public
access to defibrillation. The States have responded to this call and
many have passed legislation, over 40 States have since done it, to
promote training and access to AEDs. So I think it is time for the
Federal Government to catch up with the vast majority of our States and
pass the legislation.
Mr. Chairman, I hope the amendment I offered, which is fairly
innocuous, will be passed and accepted by the gentleman from Florida.
Mr. BILIRAKIS. Mr. Chairman, will the gentleman yield?
Mr. STEARNS. I yield to the gentleman from Florida.
Mr. BILIRAKIS. Mr. Chairman, I appreciate the gentleman yielding. I
want to commend the gentleman. He has been very vocal on this, on the
use of AEDs and of their great value to us on an everyday basis in
committee. Of course his amendment is very helpful because again even
though the general scope on functions of the agency would and could
include these, it is another case of focusing attention, if you will,
to it. We have had the opportunity to review the amendment and do
accept it.
Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the Stearns
amendment. I believe his amendment will take a major step in saving the
lives of people that have heart attacks in public buildings and in
other places.
I would also use this amendment briefly as an opportunity to talk for
just one moment, Mr. Chairman, about cardiopulmonary resuscitation.
Last week was National CPR Week. I have a resolution that I have
introduced to encourage people around the country to get CPR training.
Only 2 percent of Americans are trained in CPR. It would save literally
tens if not hundreds of thousands of lives, both the recommendation
that the gentleman from Florida (Mr. Stearns) has and CPR training.
I urge my colleagues to think about taking that training and
especially to talk about it at home when there are training sessions
given by hospitals, by the Heart Association and by other
organizations. I commend the gentleman from Florida (Mr. Stearns) for
his interest in this issue broadly and specifically and ask for the
House support for the Stearns amendment.
The CHAIRMAN pro tempore. The question is on the amendment offered by
the gentleman from Florida (Mr. Stearns).
The amendment was agreed to.
Mr. VENTO. Mr. Chairman, I move to strike the last word.
(Mr. VENTO asked and was given permission to revise and extend his
remarks.)
Mr. VENTO. Mr. Chairman, I rise to engage the distinguished
subcommittee chairman from Florida and the ranking subcommittee member
from Ohio in a colloquy.
A recent series of articles in my hometown paper, the St. Paul
Pioneer Press in Minnesota, highlighted a disturbing incidence
nationwide of patient fatalities and injuries due to hospital errors
which I will insert in the Record under General Leave.
The most comprehensive study conducted by Harvard medical researchers
found that the hospital mistakes caused the death of one of every 200
patients admitted to hospitals. This provocative study also estimates
that 1 million patients are injured by errors during hospital treatment
each year. Alarmingly, some experts think official estimates of the
medical errors may be understated as some cases go unreported. Most of
us are very concerned about this new report.
In section 912, part C, in my reading it is intended for the Agency
for Health Research and Quality to include in its research a specific
report on the number of hospital errors which result in patient injury
and death.
Two questions I have for my colleagues who are managing this measure:
Is it intended that the agency will be reporting its findings to
Congress? And is it possible that the report will include specific
findings from State to State on the number of hospital errors which
result in patient injury and death?
Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
Mr. VENTO. I yield to the gentleman from Ohio.
Mr. BROWN of Ohio. I thank the gentleman from Minnesota for bringing
this issue in front of the House. It is extraordinarily important. I
think we all need to know more about it. That is something that perhaps
our committee can consider. Certainly this Congress should. But
specifically now clearly the agency should do that.
In section 924 of the bill, it specifically says the information
shall be promptly made available to the public, this data developed in
such research demonstration projects and evaluations. They will do
that. We have a great interest that they do.
Mr. BILIRAKIS. Mr. Chairman, will the gentleman yield?
Mr. VENTO. I yield to the gentleman from Florida. I appreciate the
gentleman's guidance.
Mr. BILIRAKIS. Mr. Chairman, I, too, commend the gentleman for
bringing it to our attention. Obviously I
[[Page H8931]]
think we would all agree that any intelligent reading would indicate
that the scope and the general function of the agency would be to
include something like this. Again it is important to focus some of
these and to red-flag them, if you will, for the agency.
The gentleman from Ohio mentioned section 924. Certainly section
912(c), Reducing Errors in Medicine, and I will not repeat that, goes
into that. Then you can go into Information on Quality and Cost of
Care, section 913, subparagraph 2, I guess it is, Annual Report, and it
refers to an annual report. I would say that it is intended the agency
will report its findings to the Congress.
And the second question when you talk about State to State, logically
it would seem that that information would be accumulated by them on a
State to State basis and thus reported from that standpoint. I honestly
do not know why that would be a problem. So is it possible? I would say
it is very possible.
{time} 1645
Mr. VENTO. Mr. Chairman, I thank the subcommittee chairman and
ranking member. Obviously this sort of study is of great concern. I am
sure we want to know the accuracy of it and the circumstances that are
arising out of it to build the type of quality and objectives that are
broadly stated in this bill which I will revise and extend in support
of under general leave and will put this article in the paper. I
appreciate the chairman, the subcommittee chairman, and ranking
member's interest and cooperation with regard to this measure.
[From the Knight Ridder News Service, Sept. 24, 1999]
Hospital Errors Kill Thousands of Patients Each Year
(By Andrea Gerlin)
The Medical College of Pennsylvania Hospital is a typical
teaching hospital. It is known for cutting-edge research
programs, for training medical students and newly graduated
doctors, and for providing advanced medical care.
It is also representative of modern American hospitals in
another respect: In the last decade alone, records show,
hundreds of MCP Hospital patients have been seriously
injured, and at least 66 have died after medical mistakes.
The hospital's internal records cite 598 incidents reported
by medical professionals to the hospital administration in
the past decade. In some of those cases, patients or
survivors were never told the injuries were caused by medical
errors. None of the doctors involved in the incidents was
subjected to disciplinary action.
For patients of all ages, serious injury and death caused
by medical errors are well-known facts of life in the medical
community. But they rarely are reported to the general
public.
MCP Hospital's records came to light only because of
bankruptcy proceedings last year, when its new owner publicly
filed a detailed account of the 598 incidents reported at the
facility from January 1989 through June 1998.
Those numbers mirror what is happening across the country.
Lucian Leape, a Harvard University professor who conducted
the most comprehensive study of medical errors in the United
States, has estimated that one million patients nationwide
are injured by errors during hospital treatment each year and
that 120,000 die as a result.
That number of deaths is the equivalent of what would occur
if a jumbo jet crashed every day; it is three times the
43,000 people killed each year in U.S. automobile accidents.
``It's by far the No. 1 problem'' in health care, said
Leape, an adjunct professor of health policy at the Harvard
School of Public Health.
In their study, Leape and his colleagues examined patient
records at hospitals throughout the state of New York. Their
1991 report found that one of every 200 patients admitted to
a hospital died as a result of a hospital error.
Researchers such as Leape say that not only are medical
errors not reported to the public, but those reported to
hospital authorities represent roughly 5 to 10 percent of the
number of actual medical mistakes at a typical hospital.
``The bottom line is we have a system that is terribly out
of control,'' said Robert Brook, a professor of medicine at
the University of California at Los Angeles. ``It's really a
joke to worry about the occasional plane that goes down when
we have thousands of people who are killed in hospitals every
year.''
In bankruptcy proceedings last year, Tenet Healthcare
Corp.--which bought eight Philadelphia-area hospitals,
including MCP, from the bankrupt Allegheny health system--
publicly filed an account of medical errors reported at MCP
from 1989 through 1998. Such documents, which are maintained
by hospitals for legal and insurance reasons, are routinely
kept confidential.
The Philadelphia Inquirer sent written requests seeking
similar information from 34 other large hospitals in
Philadelphia. Of 25 that responded, all declined to provide
similar insurance reports, citing patient confidentiality.
Tenet declined to provide comparable data for MCP since it
acquired the hospital.
Contained in the MCP records is a history of one hospital's
experience, providing an unprecedented glimpse into the
extent and natural of hospital mistakes.
The cases run the gamut from benign to fatal, and involve
patients whose health status ranged from young and vital to
old and infirm.
They include:
Four patients who died after they received too much
medication, the wrong medication or no medication.
Surgical ``misadventures'' during which patients' organs
were punctured or blood vessels were pierced.
An epilepsy patient who died and another who was left
paralyzed on one side after suffering brain hemorrhages
during surgery by inexperienced and inadequately supervised
residents. In those two cases, four doctors at MCP later
signed a letter to a hospital administrator saying that
mistakes by unsupervised surgical residents ``resulted in the
unfortunate death of one of our patients.''
Two middle-age patients who died following cardiac
emergencies--men who according to hospital records did not
receive proper or timely treatment from emergency room
residents. One man sat in the emergency room with dangerously
elevated blood pressure for more than seven hours before
dying of a heart attack.
An 18-year-old man who received the wrong type of blood in
a transfusion after an automobile accident, and died after an
apparent hemolytic reaction to the blood.
Eight surgical patients who required second operations to
retrieve sponges, cotton or metal instruments left inside
their bodies.
Inadquate intensive-care monitoring, which delayed response
to a mother of two who had stopped breathing. She was left
permanently brain-damaged.
The Allegheny Health, Education and Research Foundation,
which owned MCP until November, declined to comment. Tenet,
the hospital's current owner, declined to discuss specific
cases and events at the hospital preceding its ownership.
A Tenet executive said the company is aggressive and
systematic in monitoring the quality of care at the 130
hospitals it owns across the country.
As of June 30, 1998, the date of the MCP report, the
hospital's insurers had paid roughly $30 million--excluding
legal costs--in settlements or jury awards in 76 of the 266
cases that resulted in lawsuits. The figures include five
cases settled for more than $1 million each.
Lawyers for MCP, a 400-bed hospital in East Falls, Pa.,
have consistently denied the hospital's liability in lawsuits
arising from errors. The hospital's own records suggest that
its experience is no different from that of most hospitals in
America.
``I find nothing in there that's beyond the average,'' said
Donald Berwick, a pediatrician who is president and chief
executive officer of the Institute for Healthcare
Improvement, a nonprofit organization based in Boston.
The MCP doctors who treated patients included in the report
had a wide range of expertise. Some were first-year doctors-
in-training, or residents, working under the supervision of
attending doctors. Others were veteran faculty who had
graduated at the top of their medical school classes and are
regarded by their colleagues as among the most competent in
their specialties.
None of the 40 doctors involved in some of the most serious
mistakes at MCP was ever subjected to disciplinary action by
the state Bureau of Professional and Occupational Affairs,
according to an agency spokeswoman.
``Most people in health care really try hard, but they're
human and they make mistakes,'' said Harvard's Leape, a co-
author of the ``Harvard Medical Practice Study.'' Said Leape:
``Physicians are not infallible.''
Leape added: ``No nurse or doctor wants to hurt somebody
and every nurse and doctor has hurt somebody. They don't want
to do it again.''
Because most medical mistakes do not go beyond hospital
walls, experts say, an estimated 2 to 10 percent of all cases
involving medical error result in lawsuits.
``Because of the surveillance climate in health care, the
tendency is not to report errors, but to conceal them or
explain them away,'' Berwick said.
The CHAIRMAN pro tempore (Mr. Quinn). Are there any further
amendments to section 2?
If not, the Clerk will designate section 3.
The text of section 3 is as follows:
SEC. 3. GRANTS REGARDING UTILIZATION OF PREVENTIVE HEALTH
SERVICES.
Subpart I of part D of title III of the Public Health
Service Act (42 U.S.C. 254b et seq.) is amended by adding at
the end the following section:
``SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING
UTILIZATION OF PREVENTIVE HEALTH SERVICES AMONG
VARIOUS POPULATIONS.
``(a) In General.--The Secretary, acting through the
appropriate agencies of the Public Health Service, shall make
grants to public or nonprofit private entities for the
establishment
[[Page H8932]]
and operation of regional centers whose purpose is to
identify particular populations of patients and facilitate
the appropriate utilization of preventive health services by
patients in the populations through developing and
disseminating strategies to improve the methods used by
public and private health care programs and providers in
interacting with such patients.
``(b) Research and Training.--The activities carried out by
a center under subsection (a) may include establishing
programs of research and training with respect to the purpose
described in such subsection, including the development of
curricula for training individuals in implementing the
strategies developed under such subsection.
``(c) Quality Management.--A condition for the receipt of a
grant under subsection (a) is that the applicant involved
agree that, in order to ensure that the strategies developed
under such subsection take into account principles of quality
management with respect to consumer satisfaction, the
applicant will make arrangements with one or more private
entities that have experience in applying such principles.
``(d) Priority Regarding Infants and Children.--In carrying
out the purpose described in subsection (a), the Secretary
shall give priority to various populations of infants, young
children, and their mothers.
``(e) Evaluations.--The Secretary, acting through the
appropriate agencies of the Public Health Service, shall
(directly or through grants or contracts) provide for the
evaluation of strategies under subsection (a) in order to
determine the extent to which the strategies have been
effective in facilitating the appropriate utilization of
preventive health services in the populations with respect to
which the strategies were developed.
``(f) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2000 through 2004.''.
The CHAIRMAN pro tempore. Are there any amendments to section 3?
If not, are there any further amendments to the bill?
Amendment No. 18 Offered by Mrs. Johnson of Connecticut
Mrs. JOHNSON of Connecticut. Mr. Chairman, I offer an amendment.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 18 offered by Mrs. Johnson of Connecticut:
At the end of the bill, add the following new section:
SEC. 4. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT
OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.
Part D of title III of the Public Health Service Act (42
U.S.C. 254b et seq.) is amended by adding at the end the
following subpart:
``Subpart IX--Support of Graduate Medical Education Programs in
Children's Hospitals
``SEC. 340E. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT
OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.
``(a) Payments.--The Secretary shall make two payments
under this section to each children's hospital for each of
fiscal years 2000 and 2001, one for the direct expenses and
the other for indirect expenses associated with operating
approved graduate medical residency training programs.
``(b) Amount of Payments.--
``(1) In general.--Subject to paragraph (2), the amounts
payable under this section to a children's hospital for an
approved graduate medical residency training program for a
fiscal year are each of the following amounts:
``(A) Direct expense amount.--The amount determined under
subsection (c) for direct expenses associated with operating
approved graduate medical residency training programs.
``(B) Indirect expense amount.--The amount determined under
subsection (d) for indirect expenses associated with the
treatment of more severely ill patients and the additional
costs relating to teaching residents in such programs.
``(2) Capped amount.--
``(A) In general.--The total of the payments made to
children's hospitals under paragraph (1)(A) or paragraph
(1)(B) in a fiscal year shall not exceed the funds
appropriated under paragraph (1) or (2), respectively, of
subsection (f) for such payments for that fiscal year.
``(B) Pro rata reductions of payments for direct
expenses.--If the Secretary determines that the amount of
funds appropriated under subsection (f)(1) for a fiscal year
is insufficient to provide the total amount of payments
otherwise due for such periods under paragraph (1)(A), the
Secretary shall reduce the amounts so payable on a pro rata
basis to reflect such shortfall.
``(c) Amount of Payment for Direct Graduate Medical
Education.--
``(1) In general.--The amount determined under this
subsection for payments to a children's hospital for direct
graduate expenses relating to approved graduate medical
residency training programs for a fiscal year is equal to the
product of--
``(A) the updated per resident amount for direct graduate
medical education, as determined under paragraph (2)); and
``(B) the average number of full-time equivalent residents
in the hospital's graduate approved medical residency
training programs (as determined under section 1886(h)(4) of
the Social Security Act during the fiscal year.
``(2) Updated per resident amount for direct graduate
medical education.--The updated per resident amount for
direct graduate medical education for a hospital for a fiscal
year is an amount determined as follows:
``(A) Determination of hospital single per resident
amount.--The Secretary shall compute for each hospital
operating an approved graduate medical education program
(regardless of whether or not it is a children's hospital) a
single per resident amount equal to the average (weighted by
number of full-time equivalent residents) of the primary care
per resident amount and the non-primary care per resident
amount computed under section 1886(h)(2) of the Social
Security Act for cost reporting periods ending during fiscal
year 1997.
``(B) Determination of wage and non-wage-related proportion
of the single per resident amount.--The Secretary shall
estimate the average proportion of the single per resident
amounts computed under subparagraph (A) that is attributable
to wages and wage-related costs.
``(C) Standardizing per resident amounts.--The Secretary
shall establish a standardized per resident amount for each
such hospital--
``(i) by dividing the single per resident amount computed
under subparagraph (A) into a wage-related portion and a non-
wage-related portion by applying the proportion determined
under subparagraph (B);
``(ii) by dividing the wage-related portion by the factor
applied under section 1886(d)(3)(E) of the Social Security
Act for discharges occurring during fiscal year 1999 for the
hospital's area; and
``(iii) by adding the non-wage-related portion to the
amount computed under clause (ii).
``(D) Determination of national average.--The Secretary
shall compute a national average per resident amount equal to
the average of the standardized per resident amounts computed
under subparagraph (C) for such hospitals, with the amount
for each hospital weighted by the average number of full-time
equivalent residents at such hospital.
``(E) Application to individual hospitals.--The Secretary
shall compute for each such hospital that is a children's
hospital a per resident amount--
``(i) by dividing the national average per resident amount
computed under subparagraph (D) into a wage-related portion
and a non-wage-related portion by applying the proportion
determined under subparagraph (B);
``(ii) by multiplying the wage-related portion by the
factor described in subparagraph (C)(ii) for the hospital's
area; and
``(iii) by adding the non-wage-related portion to the
amount computed under clause (ii).
``(F) Updating rate.--The Secretary shall update such per
resident amount for each such children's hospital by the
estimated percentage increase in the consumer price index for
all urban consumers during the period beginning October 1997
and ending with the midpoint of the hospital's cost reporting
period that begins during fiscal year 2000.
``(d) Amount of Payment for Indirect Medical Education.--
``(1) In general.--The amount determined under this
subsection for payments to a children's hospital for indirect
expenses associated with the treatment of more severely ill
patients and the additional costs related to the teaching of
residents for a fiscal year is equal to an amount determined
appropriate by the Secretary.
``(2) Factors.--In determining the amount under paragraph
(1), the Secretary shall--
``(A) take into account variations in case mix among
children's hospitals and the number of full-time equivalent
residents in the hospitals' approved graduate medical
residency training programs; and
``(B) assure that the aggregate of the payments for
indirect expenses associated with the treatment of more
severely ill patients and the additional costs related to the
teaching of residents under this section in a fiscal year are
equal to the amount appropriated for such expenses for the
fiscal year involved under subsection (f)(2).
``(e) Making of Payments.--
``(1) Interim payments.--The Secretary shall determine,
before the beginning of each fiscal year involved for which
payments may be made for a hospital under this section, the
amounts of the payments for direct graduate medical education
and indirect medical education for such fiscal year and shall
(subject to paragraph (2)) make the payments of such amounts
in 26 equal interim installments during such period.
``(2) Withholding.--The Secretary shall withhold up to 25
percent from each interim installment for direct graduate
medical education paid under paragraph (1).
``(3) Reconciliation.--At the end of each fiscal year for
which payments may be made under this section, the hospital
shall submit to the Secretary such information as the
Secretary determines to be necessary to determine the percent
(if any) of the total amount withheld under paragraph (2)
that is due under this section for the hospital for the
fiscal year. Based on such determination, the Secretary shall
recoup any overpayments made, or pay any balance due. The
amount so determined shall be considered a
[[Page H8933]]
final intermediary determination for purposes of applying
section 1878 of the Social Security Act and shall be subject
to review under that section in the same manner as the amount
of payment under section 1886(d) of such Act is subject to
review under such section.
``(f) Authorization of Appropriations.--
``(1) Direct graduate medical education.--
``(A) In general.--There are hereby authorized to be
appropriated, out of any money in the Treasury not otherwise
appropriated, for payments under subsection (b)(1)(A) --
``(i) for fiscal year 2000, $90,000,000; and
``(ii) for fiscal year 2001, $95,000,000.
``(B) Carryover of excess.--The amounts appropriated under
subparagraph (A) for fiscal year 2000 shall remain available
for obligation through the end of fiscal year 2001.
``(2) Indirect medical education.--There are hereby
authorized to be appropriated, out of any money in the
Treasury not otherwise appropriated, for payments under
subsection (b)(1)(A) --
``(A) for fiscal year 2000, $190,000,000; and
``(B) for fiscal year 2001, $190,000,000.
``(g) Definitions.--In this section:
``(1) Approved graduate medical residency training
program.--The term `approved graduate medical residency
training program' has the meaning given the term `approved
medical residency training program' in section 1886(h)(5)(A)
of the Social Security Act.
``(2) Children's hospital.--The term `children's hospital'
means a hospital described in section 1886(d)(1)(B)(iii) of
the Social Security Act.
``(3) Direct graduate medical education costs.--The term
`direct graduate medical education costs' has the meaning
given such term in section 1886(h)(5)(C) of the Social
Security Act.''.
Mrs. JOHNSON of Connecticut. Mr. Chairman, first I would like to
commend the gentleman from Florida (Mr. Bilirakis) on the underlying
bill, the Health Research and Quality Act which I consider to be a very
progressive modernization of the mission of the Agency for Health Care
Policy and Research, and I commend him on the thoughtful work done to
enable that agency to serve us in the future in a focused and
aggressive manner.
I also would like to thank the subcommittee chairman, the gentleman
from Florida (Mr. Bilirakis), for his support of a solution to the
problem that our children's centers faced. He has been a strong
advocate of our children's centers, and a great help to me as we moved
this matter forward. I would like to thank also the chairman, the
gentleman from Virginia (Mr. Bliley) of the Committee on Commerce who
also has been helpful in the support of the gentleman from California
(Mr. Thomas) who is chairman of the Subcommittee on Health of the
Committee on Ways and Means and for the help and assistance and
guidance of the gentlewoman from Ohio (Ms. Pryce) who has been so very
interested in the work of the children's hospital and is so conscious
of the excellent opportunity they provide for children with complex,
difficult illness.
Mr. Chairman, I offer this amendment, and I ask the support of my
colleagues because our children's medical centers are facing an
unprecedented financial crisis that threatens future advances in
children's health care. All our teaching hospitals are facing a
terrible challenge in just maintaining the resources needed to treat
medically complex patients, the uninsured and the poor, and in
addition, to maintain their training and teaching capabilities. It is
increasingly difficult to get Medicare, Medicaid, and private payers to
reimburse at a rate that is adequate to cover the unique
responsibilities of our medical centers including the additional added
costs of training physicians and conducting health care research. In
today's price-competitive health care market, private payers no longer
are willing to cover the costs of the public mission of training our
physician work force. Children's teaching hospitals face an additional
and unique burden because they receive no significant Federal support
for their graduate medical education programs.
Mr. Chairman, GME is principally funded through the Medicare program.
Teaching hospitals receive funding based on the number of Medicare
patients that they treat. Because children's hospitals treat very few
Medicare patients, they receive no significant support for their
teaching programs from the Federal Government.
Freestanding children's hospitals receive on average less than one-
half of 1 percent of what other teaching facilities receive in Federal
GME funding. The grant program embodied in this amendment would provide
GME support for children's hospitals. That is just commensurate with
Federal GME support that other teaching facilities receive under
Medicare. This amendment merely establishes interim assistance to our
children's hospitals to maintain their teaching programs while Congress
reforms the way we as a Nation fund medical education.
Mr. Chairman, the grant program would provide $280 million in fiscal
year 2000, $285 million in fiscal year 2001; that is, authorize that
money. Since comprehensive GME reform will take more time to develop,
this amendment would provide immediate financial assistance through a
capped time limited authorization of appropriations.
Mr. Chairman, freestanding children's hospitals are responsible for
the pediatric training of almost 30 percent of the Nation's
pediatricians and almost half of pediatric specialists. They also
provide training to substantial numbers of residents of other
institutions who require pediatric rotations. Even though they make up
less than 1 percent of all hospitals, 59 facilities, freestanding
teaching children's hospitals educate and train over 5 percent of all
residents nationwide.
Make no mistake about it, Mr. Chairman. Top notch training programs
are critical to ensure quality health care for our children. Kids with
unusual and medically complex diseases depend on the sophisticated
resources of our children's medical centers. Quality pediatric care
depends on high-quality training of pediatric specialists and sub-
specialists, and improvements in diagnosing and treating disease depend
on sophisticated basic and clinical research carried out in our
children's hospitals.
This grant program has broad bipartisan support. It is co-authored by
over 190 Members, including the chairs and ranking members of the
critical committees, and I urge my colleagues' support of it here
today.
Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment
offered by the gentlewoman from Connecticut (Mrs. Johnson).
Mr. Chairman, the majority had a chance to review the amendment. It
would provide graduate medical education payments to the children's
hospitals by creating a financing system for pediatric physical
training. The amendment was introduced as the Children's Hospital
Education and Research Act, H.R. 1579, with significant bipartisan
support.
Mr. Chairman, few contest the historic inequity in GME funding for
children's hospitals. Because Medicare is the largest single payer of
GME and since freestanding children's hospitals treat few Medicare
patients, as the gentlewoman from Connecticut said, their GME funding
is very low. This gap in Federal support jeopardizes highly successful
pediatric training programs.
Since comprehensive GME reform may take more time to develop, this
amendment will provide immediate financial assistance through a capped,
time-limited appropriation of $280 million in fiscal year 2000 and 285
million in fiscal year 2001. This authorization would end after 2 years
or with the enactment of GME reform, whichever occurs first.
Although, Mr. Chairman, I am not going to make a motion to contest
the germaneness of this amendment, I do wish to point out that the bill
under consideration now which reauthorizes an agency with a primary
research mission is a questionable vehicle for authorizing
appropriations for funding GME and children's hospitals, and I am sure
the gentlewoman understands that and would acknowledge that. Moreover,
on process grounds I can make a strong argument for moving the
children's GME bill through the normal committee process rather than as
an amendment to H.R. 2506.
But having said this, Mr. Chairman, of course I am a cosponsor of the
Johnson GME bill, and I agree with my colleague from Connecticut that
this authorization of appropriations will send an important message to
the relevant appropriations committees that the Congress considers
support of GME for doctors training in children's hospitals as a high,
high priority, and therefore, Mr. Chairman, we are prepared to accept
the amendment.
[[Page H8934]]
Ms. PRYCE of Ohio. Mr. Chairman, I move to strike the requisite
number of words.
Mr. Chairman, I rise in strong support of the Johnson amendment, and
I congratulate my friend for her work on this very and most important
issue, and I appreciate the chairman's support. Very simply, this
amendment makes an investment in children's health by authorizing funds
for physician training. Currently the Medicare program provides the
most reliable and significant support for graduate medical education,
but children's hospitals do not treat Medicare patients who are largely
senior citizens.
Mr. Chairman, the current system leaves children's hospitals
searching for compensation for the time-consuming and resource-
intensive training they provide to enhance our physician work force.
While children's hospitals or while children's teaching hospitals
represent only 1 percent of all hospitals, they train nearly 30 percent
of all pediatricians, nearly half of all pediatric specialists and a
significant number of general practitioners.
Now I have spent the better part of the past year in and out of
Children's Hospital in Columbus, Ohio, and I know firsthand the
critical difference between medical care for adults and medical care
for children and all the commensurate differences in training that go
along with the treating of a sick child as opposed to a grown adult
including very basically the size of medical equipment, the dosage of
drugs, the size of prosthetics, the administration of anesthesia, the
ongoing development, the physical development, of children, the
communication barriers. The list goes on and on, and it is absolutely
critical for the physicians who treat children to have the proper
training to meet the needs and challenges that are specific to
children.
It is this kind of training that our Nation's children's hospitals
are uniquely qualified to provide. Our current system of financial
support for medical training disadvantages children's teaching
hospitals, and the Johnson amendment begins to address the inequities
of our graduate medical education system by authorizing a grant program
to advance pediatrician training and pediatric research. It is a small
price to pay to ensure that our children's hospitals can continue their
mission to care for the sickest and poorest children while training the
next generation of caregivers. It makes sense to add this provision to
legislation that is focused on promoting public-private partnership to
ensure health care quality research and patient access to care.
This interim solution to fix the inequities of our GME system has the
support of 190 Members of the House and 38 Senators who have
cosponsored similar legislation. I urge the rest of my colleagues to
join us in support of the Johnson amendment and in recognition of the
special work that children's doctors devote their lives and energies
to.
Mr. LARSON. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, I rise today in support of the amendment offered by my
esteemed colleague from Connecticut (Mrs. Johnson). The amendment
provides funding for grants to children's hospitals to train
pediatricians. This amendment incorporates the provisions of H.R. 1579,
the Children's Hospitals Education and Research Act of 1999. It was one
of the first bills I cosponsored on becoming a Member of this body.
This amendment greatly affects the 59 independent children's teaching
hospitals across this Nation. Although these hospitals represent less
than 1 percent of all hospitals in the Nation, they train over 5
percent of all physicians, 29 percent of all pediatricians and most
pediatric specialists.
The Connecticut Children's Medical Center is located in the center of
my district and is one of these hospitals that desperately needs this
graduate medical funding for their education programs. I have heard
from many of my constituents and work closely with the staff at the
medical center, its president, Larry Gold, and Eva Bunnell who is a
tireless advocate on behalf of the children of our great State of
Connecticut.
As a parent of three children, I understand the importance and
necessity of this funding. This amendment would authorize annual
funding for 2 years and provide a more equitable, competitive playing
field for independent children's teaching hospitals.
I wear this pin today, which is the Connecticut Children's Medical
Center's logo. It represents an open-armed child made of colorful
blocks. A 8-year-old from the hospital said the logo looks like a kid
ready to give a hug.
We cannot turn our backs on the Nation's children and the care they
deserve, and aside from the hugs they richly deserve, they need
funding. Without this funding, these independent hospitals, which care
solely for children, will find it hard to operate to the best of their
ability.
I commend the gentlewoman from Connecticut (Mrs. Johnson) for her
tireless work on behalf of children in the State of Connecticut and
across this Nation. She has done so since she was a member of the
Connecticut State Senate. I rise in support of this amendment today and
urge our colleagues to join us.
Mrs. JOHNSON of Connecticut. Mr. Chairman, will the gentleman yield?
Mr. LARSON. I yield to the gentlewoman from Connecticut.
Mrs. JOHNSON of Connecticut. Mr. Chairman, it really is a pleasure to
have the gentleman from Connecticut here and in support of the
remarkable Children's Hospital in Hartford, Connecticut, but I think it
gives us a good example of why this is so urgent and why my colleague,
the gentleman from Florida (Mr. Bilirakis) has been so generous as to
let us bring this on this bill.
{time} 1700
Truly, in the environment in which our hospitals are operating, our
remarkable little Children's Hospital is a good example of the terrible
circumstances these children's centers face. They serve mostly
children. Medicaid reimburses much worse than Medicare reimburses, to
begin with, and then they are right in the middle of Hartford so they
have many, many uninsured children, many very poor children, who need a
lot of special care, and yet they get not one cent or hardly a cent of
reimbursement for their teaching and research initiatives. We just
cannot let this happen.
In the interim, we need this money to help them survive this period
of extraordinary change in reimbursements. I just appreciate the
gentleman's long working relationship with them, the help he has been
on this bill.
I would also like to just take a moment to thank the ranking member,
the gentleman from Ohio (Mr. Brown), who has been a long solid advocate
of children's hospitals and worked hard on this amendment for the year
and a half or 2 years we have been working on it.
Mr. LARSON. Mr. Chairman, reclaiming my time, I can add no more to
the gentlewoman's eloquence.
Mr. WAXMAN. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, I rise in support of this amendment offered by our
colleague, the gentlewoman from Connecticut (Mrs. Johnson). By
providing adequate Graduate Medical Education funding to children's
hospitals, this amendment will ensure that our Nation's premier
pediatric health care institutions are capable of pursuing their
research, training, and primary-care missions on a firm financial
footing.
For too long Congress has failed to remedy a clear inequity in the
funding of Graduate Medical Education at children's hospitals. Because
GME funding is contingent upon an institution's Medicare census,
children's hospitals have not received adequate funding for the direct
and indirect expenses of operating essential pediatric residency
programs.
This amendment has strong bipartisan support in both the House and
the Senate. I urge my colleagues to cast a vote in favor of
strengthening our children's health care by supporting this amendment.
Let me conclude by saying how pleased I am that the House has
reauthorized AHCPR, soon to be called the Agency for Health Research
and Quality. I am proud to have been the one to have introduced this
legislation creating the agency in 1989 with Senator Kennedy. Just
three years ago, AHCPR underwent a near-death experience arising from
partisan politics, so I am
[[Page H8935]]
especially pleased this essential agency once again has the bipartisan
support it deserves.
Ms. McCARTHY of Missouri. Mr. Chairman, I move to strike the
requisite number of words.
Mr. Chairman, I want to thank the chairman of the subcommittee, the
gentleman from Florida (Mr. Bilirakis) for accepting this amendment, to
thank the gentlewoman from Connecticut (Mrs. Johnson) for her tireless
efforts in championing it, and to thank my ranking member, the
gentleman from Ohio (Mr. Brown), for his tireless work as well in
support of our children.
I am a cosponsor of similar legislation, and I am very pleased we are
moving forward now on this key issue, which will authorize $565 million
in appropriations for children's hospitals to maintain their graduate
residency training programs.
This is critical to the health of our children. Children's hospitals
are responsible for the pediatric training of almost one-third of the
Nation's pediatricians. A lack of Federal support jeopardizes all
education and training programs in children's hospitals, thereby
threatening not only the pediatric workforce, but future health-care
research and our children's health. It would be penny-wise and pound-
foolish to continue down this path.
In my district alone, this temporary funding will help train 70
doctors at Children's Mercy Hospital, a freestanding regional facility
in Kansas City. The Johnson amendment supports the 59 children's
teaching hospitals all across our country. I commend the sponsor and
chairman and ranking member.
Mr. BACHUS. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, first of all, I would like to commend the gentlewoman
from Connecticut (Mrs. Johnson), the chairman of the subcommittee, the
gentleman from Florida (Mr. Bilirakis), and the gentleman from Ohio
(Mr. Brown) for offering this amendment.
Let me tell you what it means to one hospital of the 59. Children's
Hospital of Alabama is the only freestanding pediatric hospital in the
State of Alabama. It not only receives patients from Alabama, it
receives patients from Mississippi and from as far away as Chattanooga,
Tennessee.
Children's Hospital presently spends $4 million to $6 million
annually for Graduate Medical Education. Unlike hospitals which treat
Medicare patients, Children's Hospital receives no Medicare funds, and,
therefore, no Medicare graduate medical expense reimbursement.
As the gentlewoman from Connecticut has said, Medicaid reimbursements
are less, commercial insurers are not offering reimbursement for these
expenses, and, with the recent changes in Medicaid and Medicare, all
our hospitals are operating under cost controls, but our children's
hospitals are operating on the severest of restraints.
Children's hospitals, we have heard various figures on how many of
the pediatricians these hospitals train. Children's hospitals train 75
percent of the pediatricians in Alabama; and, nationwide, although
children's hospitals train 25 percent or one-fourth of pediatricians,
they train almost all pediatric sub-specialists. These are the people
that treat our little boys and girls with cancer, with epileptic
seizures, those children who are injured in accidents. Our sickest
children come to our children's hospitals. They need the best of care,
and they need medical doctors who are trained and trained well.
It is for this reason that I support enthusiastically the amendment
of the gentlewoman from Connecticut (Mrs. Johnson), for, as we are fond
of saying in this body, our children deserve the best, and that
includes the best health care, and that includes the best trained
health care pediatricians. This amendment will assure that.
To the gentlewoman from Connecticut (Mrs. Johnson), I thank you for
your hard work; and I commend the body for its consideration of this
measure.
Mr. BENTSEN. Mr. Chairman, I move to strike the requisite number of
words.
(Mr. BENTSEN asked and was given permission to revise and extend his
remarks.)
Mr. BENTSEN. Mr. Chairman, I rise in support of the amendment offered
by the gentlewoman from Connecticut (Ms. Johnson) and commend her for
offering this amendment. I also want to commend the ranking member, the
gentleman from Ohio (Mr. Brown). Both the gentlewoman from Connecticut
(Mrs. Johnson) and the gentleman from Ohio (Mr. Brown) have been the
original sponsors, of which I am an original cosponsor, of the bill,
H.R. 1579, the Children's Hospital Education Research Act, and I
commend them for having the foresight to introduce this legislation.
The Johnson amendment would provide critically important Federal
funding for our Nation's 59 independent children's hospitals, including
six such hospitals in Texas. I have the honor and distinction to
represent two children's hospitals, Texas Children's Hospital, which is
a qualified independent children's hospital, as well as Memorial
Hermann Children's Hospital, which is part of a larger hospital system.
In addition to that, I have the Shriner's Orthopedic Hospital in my
district in the Texas Medical Center complex, which is in the 25th
District. All of these are teaching hospitals aligned with the Baylor
College of Medicine and the University of Texas.
As has been pointed out by many Members today, there is a great
disparity in the level of Federal funding for teaching hospitals for
pediatrics versus other types of teaching hospitals. That is due in
large part because of how we have structured our medical education
program around the Medicare system.
As the gentlewoman knows from the Committee on Ways and Means, this
is a broader issue that we need to address. Some of us, the gentleman
from Maryland (Mr. Cardin) and myself, have some ideas. Others have
their ideas. The chairman of the Committee on Ways and Means, my next-
door neighbor in Houston, has his ideas. But, nonetheless, we should
not wait until we come to a conclusion on that. We ought to act as the
chairman of the subcommittee said. This is the right thing to do right
now.
As has been pointed out, these hospitals, while only being a small
percentage, train a very large percentage of the pediatricians. As the
gentlewoman from Connecticut (Mrs. Johnson) pointed out, these
hospitals are under tremendous financial pressure. They are under
financial pressure from the private sector in managed-care health
plans. They are under pressure in the Medicaid program.
In fact, back in 1997, as part of the Balanced Budget Act, we made
pretty dramatic reductions in the disproportionate share program.
Fortunately, we were able to ease those a little bit as it affected
States like mine in Texas, Connecticut, and others. Those reductions
were made, nonetheless. We know that the Nation's children's hospitals
do carry a disproportionate share of both indigent and Medicaid
patients, which just adds to the fiscal burden that they have to
address.
This bill would provide in a 2-year capped program some additional
funding to address this situation. But, more importantly, in the long
term it would underscore the Federal commitment to ensuring that we
continue to have the world's best pediatric care and that we continue
to have the world's best medical education program.
I hope by passage of this amendment, and hopefully passage of this
bill and funding of this bill, that we can go a step further, and when
we look at the overall Graduate Medical Education program or the
medical education program, we will look beyond just Medicare and
understand that training doctors and training the other allied health
positions is not just something that is benefited by the Medicare
beneficiaries; but all of us, including our children, benefit from
this; and, thus, we should take that into account in structuring the
program.
So I commend the gentlewoman from Connecticut, the gentleman from
Ohio and the chairman of the subcommittee for accepting this amendment,
and I ask my colleagues to support the amendment.
Mr. COOK. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, I rise in support of the amendment being offered by the
gentlewoman from Connecticut. Children's teaching hospitals play a
vital and
[[Page H8936]]
unique role in our health care system. They are the training ground for
future pediatricians, and nurses and they do groundbreaking research
into children's illnesses. Many of these hospitals are freestanding
facilities without the resources of a university or a health care
organization to subsidize the higher costs the teaching hospitals
incur.
Primary Children's Hospital in my State of Utah is one such hospital.
It trains an average of 52 residents a year and has an outstanding
reputation as one of the leading children's hospitals in the West. Most
pediatricians in the 5-State Intermountain region have received at
least some of their training at Primary Children's Hospital. But
because children's hospitals treat few Medicare patients, they are at
an economic disadvantage, since Graduate Medical Education is funded
through the Medicare program. As a result, they receive less than one-
half of 1 percent of what other teaching facilities receive in Federal
assistance. This is not right. Our children deserve the finest health
care that we can provide.
The $280 million grant funding proposed in the amendment offered by
the gentlewoman from Connecticut (Mrs. Johnson) is a modest effort to
provide some equity and relief to these hospitals and enable them to
continue their fine work. I was a cosponsor of H.R. 1579, and I am
proud to support this amendment. I hope my colleagues will join me and
stand up for children's health by voting for this amendment.
Ms. LEE. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, I rise in strong support of the amendment offered by
the gentlewoman from Connecticut (Mrs. Johnson) to authorize $280
million in fiscal 2000 and $285 million in fiscal 2001 for a program
that would provide grants to children's hospitals to train
pediatricians.
On behalf of the Children's Hospital in Oakland, California, my
district, I want to thank the gentlewoman from Connecticut (Mrs.
Johnson) and the gentleman from Ohio (Mr. Brown) for this amendment.
This authorization is needed because freestanding children's hospitals
are disadvantaged under the current Federal Graduate Medical Education
funding for children's teaching hospitals.
Freestanding children's hospitals receive an average of less than
one-half percent of what other teaching facilities receive in Federal
Graduate Medical Education funding.
{time} 1715
Now, in Oakland, California, in my district, Children's Hospital, a
freestanding hospital, has 205 licensed beds. It is a regional trauma
center and is an independent teaching hospital. It is a hospital that
when my children were children played a very important role in the
healthy development of my kids. It continues to be an exemplary medical
facility and a very supportive environment for children and their
families.
Now, because the hospital only treats children and not the elderly,
it receives almost no graduate medical payments from Medicare, the one
stable source of Graduate Medical Education support.
At Children's Hospital in Oakland, California, senior clinicians and
scientists work with young doctors in pediatrics and pediatric
specialities. It is these interns and residents who will become the
pediatricians and scientists of tomorrow and who will bring us the
miracles of the 21st century, a cure for cancer, new therapies, and
other great possibilities. We need an equitable playing field in the
price competitive health-care marketplace.
Medicare has become the only reliable source of significant support
for Graduate Medical Education in teaching hospitals. Because
children's teaching hospitals care for children, they receive less than
.5 percent of the Medicare Graduate Medical Education support provided
to other teaching hospitals. The current mechanism for Graduate Medical
Education financing does not equitably recognize the contribution of
these hospitals. So we must invest in children's health.
Independent children's teaching hospitals are less than 1 percent of
all hospitals but train nearly 30 percent of all pediatricians and
nearly half of all pediatric specialists. A strong academic program is
critical to all facets of children's hospitals' missions. They care for
the sickest and the poorest children, training the next generation of
caregivers for children and research in order to improve children's
health care. They are in the community, responding to the health care
needs of our children and supporting their families.
So this amendment has broad bipartisan support. I urge my colleagues
to support this amendment; and once again, I want to thank the
gentlewoman from Connecticut (Mrs. Johnson) and the gentleman from Ohio
(Mr. Brown) for their support and commitment to children in our
country.
Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the Johnson
amendment.
Mr. Chairman, I commend the gentlewoman for her work and also the
gentlewoman from California (Ms. Lee) and others that have spoken
before me. Before I introduced this legislation 2\1/2\ years ago, I
visited the Akron Children's Hospital in Akron, Ohio, and saw the
outstanding kind of work that medical personnel in that hospital did in
pediatric medical advancement. As has been outlined by previous
speakers, there is not a very good funding stream for medical education
in children's hospitals and especially in freestanding children's
hospitals.
Ohio is the home, I believe, of more freestanding children's
hospitals than any State in the country. With the squeeze of managed
care, coupled with the peculiarity of the way that we fund Graduate
Medical Education through Medicare, children's hospitals simply cannot
produce the pediatric specialists or, for that matter, the pediatric
general practitioners that this country needs to produce. This is a
very good amendment. This is a very important part of this bill. I
commend the sponsor of the bill and ask for support of the Johnson
amendment.
Mr. THOMAS. Mr. Chairman, I rise in support of Representative Nancy
Johnson's amendment to the Health Research Quality Act (HR 2506). This
amendment authorizes $280 million in FY 2000 and $285 million in FY
2001 for graduate training programs at children's hospitals.
Mr. Chairman, the way the government currently finances graduate
medical education makes little objective sense. The system has unfairly
penalized children's hospitals.
The training of physicians, in what is known as Direct Graduate
Medical Education, is financed through Medicare's Hospital Insurance
Trust Fund. Thus, the funds a hospital receives depends on the number
of Medicare patients it serves. Since children's hospitals treat very
few Medicare patients (primarily those with End Stage Renal Disease),
they receive almost no funding from the Medicare program. Medicare pays
teaching hospitals $7 billion in Graduate Medical Education, or about
$76,000 per resident. Yet children's hospitals receive only about $400
per resident, despite training more than one-fourth of the nation's
physicians and a majority of the pediatric specialties. In addition,
free-standing children's hospitals constitute less than 1% of all
hospitals but train more than 5% of all residents.
This illustrates one more reason why the entire direct graduate
medical education program is in need of fundamental reform. Why should
the training of residents who go on to treat patients of all
demographic profiles be financed out of a program designed for the
elderly and disabled? Second, why should we pay certain hospitals 5 or
6 times the amount per resident as we pay for the training of equally
qualified residents at equally prestigious universities and teaching
hospitals in other regions of the country?
Senator Bill Frist, also a former physician, headed a task force
within the Medicare Commission, which recommended that direct medical
education be funded outside of the Medicare structure. I believe we can
provide a more secure funding structure through a multi-year
appropriations process because it provides a larger pool of resources:
the General Fund. In addition, an appropriations process will provide
needed oversight into the inequities that is lacking in the current
entitlement structure.
I am pleased that Representative Nancy Johnson and the children's
hospitals support the Medicare Commission's recommendation that
children hospital DME be funded through the appropriations process. I
strongly endorse this amendment and hope we can finally start providing
needed resources to children's hospitals so that they may secure the
important missions they perform.
Mr. SESSIONS. Mr. Chairman, freestanding children's hospitals are
disadvantaged under the current federal GME (Graduate Medical
Education) funding structure. GME is principally funded through the
Medicare program.
[[Page H8937]]
Teaching hospitals receive funding based on the number of patients that
they treat. Because children's hospitals treat few Medicare patients,
they receive no significant federal support for GME.
Children's hospitals receive on average less than one-half of one
percent (0.5%) of what other teaching facilities receive in federal GME
funding. This grant program would provide GME support for children's
hospitals that is commensurate with federal GME support that other
teaching facilities receive under Medicare.
Training programs are necessary to ensure quality health care for
children. The education and training programs of these institutions are
critical to the future of pediatric medicine and therefore to the
future health of all children.
In 1998, Children's Medical Center of Dallas served as the training
site for 77 pediatric residents. Although hospitals like ``Children's
Med. Center of Dallas'' represents less than 1% of all hospitals in the
country, independent children's teaching hospitals are responsible for
training nearly 30% of all pediatricians, nearly half of all pediatric
subspecialties and train over 5% of all residents nationwide.
This amendment would establish interim assistance to children's
hospitals to maintain their teaching program while Congress addresses
the inequities in the current GME system through Medicare reform. The
grant program would provide $280 million in FY2000 and $285 million in
FY2001.
Mr. PORTMAN. Mr. Chairman, I rise in strong support of Mrs. Johnson's
amendment to establish interim funding assistance to children's
hospitals. The amendment will enable children's hospitals in Ohio and
across the nation to maintain their teaching programs while Congress
addresses the inequities in the current graduate medical education
(GME) system through Medicare reform.
The nation's 59 freestanding children's hospitals, including
Children's Hospital Medical Center in Cincinnati, train about 30
percent of the nation's pediatricians and nearly half of all pediatric
specialists. Many residents of other hospitals who require pediatric
rotations are trained at these facilities as well. Although they make
up less than 1 percent of all hospitals, freestanding children's
hospitals educate and train over 5 percent of all residents nationwide.
However, the current system of federal funding assistance is tilted
against pediatric training. Graduate medical education is funded
primarily through Medicare based on the number of patients that
teaching hospitals treat. Since few Medicare patients receive care at
children's hospitals, these facilities get less than one-half of one
percent of what other teaching hospitals get in federal GME funding.
This unfair situation threatens the future of our nation's pediatric
workforce and also hinders the development of new treatments since
teaching facilities perform the majority of health care research.
Congress recognized this problem in the Balanced Budget Act of 1997
by directing both the Medicare Payment Advisory Commission and the
Bipartisan Commission on the Future of Medicare to address the
financing of graduate medical education in children's hospitals as part
of a comprehensive evaluation of GME. However, GME reform will take a
while to develop. Therefore, the Johnson amendment will provide
immediate financial assistance to children's hospitals comparable to
the federal GME support that other teaching facilities receive under
Medicare. It would do this through a capped, time-limited authorization
of appropriations.
The Johnson amendment is essentially the language of the Children's
Hospital Education and Research Act, H.R. 1579. I am an original
cosponsor of a bipartisan bill, which is supported by over 190 Members
of the House, including the chairs, ranking members and other members
of subcommittees and committees of jurisdiction--the Commerce, Ways and
Means and Appropriations Committees.
I urge my colleagues to support this important amendment to provide
children's hospitals with a level playing field by addressing the
federal funding GME gap they face, and, at the same time, give children
a better shot at growing up healthy.
Mr. HOBSON. Mr. Chairman, I rise in support of the amendment offered
by the gentlelady from Connecticut. This issue is particularly
important for children in Ohio, where thousands of sick children every
year are treated at Ohio's six independent children's hospitals.
Over the recent district work period, I visited the Children's
Medical Center in Dayton, Ohio. Not only does the Center provide first
rate care for children, it also provides a caring and attentive
environment that allows parents and relatives to actively participate
in their children's care. We all know how important it is to be near
our children when they are sick, and the nation's children's hospitals
provide the atmosphere and specialized care that is the best medicine
for our children.
At some hospital serving adult populations in Ohio, the federal
reimbursement for resident training is about $50,000 per resident. This
federal commitment to graduate medical education has helped ensure that
our doctors and the quality of care they provide are the best in the
world.
However, due to the way the reimbursement formula has been set up,
the federal commitment to graduate medical education at children's
hospitals is much smaller. For example, Children's Hospital in
Columbus, Ohio received about $230 per resident last year.
This amendment restores some fairness to the reimbursement rates that
children's hospitals receive and will help ensure that Ohio and other
states with children's hospitals will continue to train qualified
pediatricians. This is an issue of fairness, and an investment long-
overdue, and I urge my colleagues to support this amendment.
Ms. DUNN. Mr. Chairman, I rise in support of Representative Johnson's
amendment to provide grants to train medical residents at independent
children's hospitals. I commend my friend for her leadership on this
important issue and ask my colleagues to support her amendment.
The problem is simple: the federal government provides funding for
graduate medical education through Medicare. Independent children's
hospitals throughout this nation treat children under the age of 21,
which is primarily a Medicaid population. Consequently, these hospitals
do not receive Medicare funding for the medical professionals they
train.
To rectify this discrepancy, this amendment will provide funding to
children's hospitals that train medical doctors to be pediatricians.
These hospitals are critical to serving sick children and providing
important research to improve the quality of children's lives.
Earlier this year, Speaker Hastert joined me in visiting the
Children's Hospital and Regional Medical Center in Seattle, Washington.
With 72 pediatric residents a year, Children's Hospital in Seattle is
the dominant provider for training of pediatricians in the Pacific
Northwest, covering the region of Washington, Wyoming, Alaska, Montana
and Idaho.
In 1997, Children's Hospital invested $8 million in its medical
education program and was reimbursed only $160,000 from Medicare and
$2.4 million from Medicaid. This hospital cannot meet the needs of our
community if it is forced to reduce the number of residents it trains.
This amendment will improve quality of care by continuing to provide
doctors who specialize as pediatricians or other pediatric
subspecialties.
Independent children's teaching hospitals are less than 1% of all
hospitals, but they train nearly 30% of all pediatricians. More
importantly, we can continue our commitment to helping the sickest and
poorest children in our communities.
As a parent of two sons, I know the importance of good quality health
care for our children, and we must be very careful to leave no child
behind. I urge my colleagues to support this important amendment. It is
an investment in our children's health.
The CHAIRMAN pro tempore (Mr. Quinn). The question is on the
amendment offered by the gentlewoman from Connecticut (Mrs. Johnson).
The amendment was agreed to.
Amendment No. 19 Offered by Mr. McGovern
Mr. McGOVERN. Mr. Chairman, I offer amendment No. 19.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 19 offered by Mr. McGovern:
Page 46, after line 2, insert the following section:
SEC. 4. STUDY REGARDING SHORTAGES OF LICENSED PHARMACISTS.
(a) In General.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary''), acting
through the appropriate agencies of the Public Health
Services, shall conduct a study to determine whether and to
what extent there is a shortage of licensed pharmacists. In
carrying out the study, the Secretary shall seek the comments
of appropriate public and private entities regarding any such
shortage.
(b) Report to Congress.--Not later than one year after the
date of the enactment of this Act, the Secretary shall
complete the study under subsection (a) and submit to the
Congress a report that describes the findings made through
the study and that contains a summary of the comments
received by the Secretary pursuant to such subsection.
Mr. McGOVERN. Mr. Chairman, my amendment calls attention to a very
serious problem in this country, the potential shortage of pharmacists.
As the population ages and prescription drug use continues to increase,
we must examine whether there are enough qualified pharmacists to
knowledgeably and safely distribute these medicines. My amendment would
require that the Health Resources Services Administration study whether
and
[[Page H8938]]
to what extent there is a shortage of licensed pharmacists and to
report back to Congress in 1 year on its findings. The report would
include comments from private and public entities.
Mr. Chairman, as we debate the specifics of a prescription drug plan,
which is incredibly important, we must also examine the potential
shortage of pharmacists serving our health-care community. Our health-
care system is changing from inpatient to outpatient treatment.
Pharmaceutical manufacturing is on the rise; and even though there is
debate about the specifics of such a plan, I think we all recognize the
need for a Medicare prescription drug benefit.
As these events continue to unfold, we must recognize the lag in the
education and development of new, qualified pharmacists. Currently,
pharmacy providers throughout northern New England and around the
country are experiencing difficulty finding enough pharmacists to keep
up with the demand for prescription drugs. Pharmacists often serve as a
valuable link between patients and their doctors. They provide valuable
information about side effects and drug interactions. They ensure that
our prescriptions are filled correctly, and they provide important
advice on a range of issues when one of us or a member of our family is
not feeling well.
I am concerned, Mr. Chairman, that in the near future people will not
have access to the important community-based prescription services that
are vital to maintaining their health. Unfortunately, this situation
will only worsen. For example, the National Association of Chain Drug
Stores estimates that the number of prescriptions will increase from
2.8 billion per year today to 4 billion in the year 2005. The number of
pharmacists, however, is not projected to keep up with this demand.
Data from the National Association of Chain Drug Stores shows that
while the number of prescriptions in Massachusetts, my State, will
increase 39 percent between 1998 and 2005, the number of pharmacists
will only increase 13 percent over that same amount of time.
That is Massachusetts. The same problem exists all over the country.
I believe Congress needs to take action. I have been working with the
Massachusetts College of Pharmacy, which is opening a campus in
Worcester, Massachusetts, in an attempt to deal with what potentially
can be a major health crisis in this country.
In my opinion, we need to support the creation of more pharmacy
schools. We need to examine ways to help encourage more people to enter
the field of pharmacy, and we need to make sure that the financial
assistance is available for students who want to pursue a career in
pharmacy. By voting for this amendment, Congress will take the first
step in determining whether and to what extent there is a shortage of
pharmacists in this country, and I believe this will lay the groundwork
for us to take actions in the future to remedy this very significant
problem.
Mr. Chairman, I urge support of this amendment.
Mr. Chairman, I insert the following letter for printing in the
Record:
Massachusetts College of Pharmacy and Allied Health
Sciences, Office of the President,
September 24, 1999.
Hon. James P. McGovern,
416 Cannon House Office Building, Washington, District of
Columbia.
Dear Congressman McGovern: I want to commend you for
addressing the current pharmacist shortage in America. I
support your amendment to the Health Research Quality Act,
H.R. 2506, which would study the impending crisis and report
potential solutions.
The combination of new biomedical discoveries, and the
substantial graying of a large segment of the population,
will create demands for billions more prescriptions that will
be critical to maintaining the health of many Americans in
the 21st century. This increase will cause an equal demand on
human resources, and the need to supply trained personnel in
pharmacy and counseling. In their 1998 study, the National
Association of Chain Drug Stores found over 3500 vacant
positions among their members, concluding that the demand for
pharmacists could grow by as much as 30% over the next two
years.
Like a great many of our colleagues throughout the nation,
the Massachusetts College of Pharmacy and Health Sciences has
been mindful of this burgeoning health care crisis from the
need for trained community pharmacists. The project that will
allow us to help to alleviate this crisis is the development
of a fully accredited MCPHS campus in the city of Worcester,
Massachusetts. Aided by the support of both the public and
the private sectors, our strategic planning outlines a growth
in academic resources that will facilitate an increase of 500
more pharmacy graduates, to bring out total to almost 2200
degrees in pharmacy studies, by the year 2003. I believe that
this project holds great potential as an effective public-
private partnership that could truly serve as a national
model of creative response to this impending cataclysm to
national health care.
We, at MCPHS, urge you and your colleagues to give serious
consideration in developing recommendations to address this
serious shortage of licensed pharmacists.
Sincerely,
Charles F. Monahan, Jr.
____
NACDS, National Association of Chain Drug Stores,
September 28, 1999.
Hon. James P. McGovern,
U.S. House of Representatives,
Washington, DC.
Dear Congressman McGovern: On behalf of the National
Association of Chain Drug Stores (NACDS), I am writing to
applaud your leadership in raising awareness about the
national shortage of licensed pharmacists. We are proud to be
working with you on this issue and look forward to continuing
our cooperative efforts to find solutions to this important
public health concern.
Toward this end, NACDS supports your efforts to amend H.R.
2506, the Health Research and Quality Act, to direct the
Secretary of Health and Human Services to conduct a study on
the shortage of licensed pharmacists. As you are well aware,
NACDS had conducted research concluding that the pharmacist
shortage is an acute situation that will only get worse as
the national demand for prescription drug therapy continues
to grow. With your amendment, Congress can take an important
step towards developing solutions to ensure that an adequate
supply of pharmacists is available to provide medication and
pharmaceutical services to the public in the future.
We also appreciate that you have included in the amendment
a definitive date for completion of the study, as this will
ensure that this issue receives the urgent consideration it
deserves. Given the potential consequences of prolonging the
pharmacist shortage, this research is too important to delay.
Thank you for your ongoing efforts to ensure the Americans
consumers have access to the best health care services
available. If I may be of any assistance on this or other
issues, please do not hesitate to contact me.
Sincerely,
Robert W. Hannan,
President and Chief Executive Officer.
Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
Mr. Chairman, the majority has had an opportunity to review the
amendment. I personally spoke with the gentleman regarding his
amendment. I commend him for it, and I would agree with him. Certainly
in Florida, where we have such a much bigger demand than most of the
States in the country, we have a tremendous shortage of pharmacists.
Most of the members of my family are pharmacists, and I am able to keep
up with that.
Mr. Chairman, we are prepared to accept the amendment.
Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the McGovern
amendment.
Mr. Chairman, I want to thank the gentleman for his commitment,
particularly in light of what Congress looks like it may do on
prescription drugs, for his commitment to this issue. I think it is
something we need to know more about to see if it is regional, if it is
national, how acute the shortage is; and I think this amendment will
help us learn to do that and deal with coverage of prescription drugs
nationally also. I commend him and ask for support of the amendment.
Mr. BERRY. Mr. Chairman, I rise today as a licensed pharmacist, in
support of the McGovern amendment.
I always say that I am proud to have served in two of the most
respected professions: as a farmer and a pharmacist.
I have stood here many times to talk about the affordability of
prescription drugs. Today, I am here to ask that we pass this amendment
for the sake of consumers.
Why? Because our nation's consumers, especially seniors, rely on
pharmacists for their livelihood.
In the 1st Congressional District of Arkansas, these shortages are in
the smaller towns.
The demand for full-time pharmacists has increased more than 25
percent in the past two years.
We all know from traveling in our districts that one of the main
concerns of seniors is the affordability of prescription drugs. But we
also know that not enough pharmacists to fill those prescriptions, this
is also a major problem.
Let's pass the McGovern amendment.
The CHAIRMAN pro tempore. The question is on the amendment offered
[[Page H8939]]
by the gentleman from Massachusetts (Mr. McGovern).
The amendment was agreed to.
Amendment No. 22 Offered by Mr. Thompson of California
Mr. THOMPSON of California. Mr. Chairman, I offer amendment No. 22.
The CHAIRMAN pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 22 offered by Mr. Thompson of California:
Page 46, after line 2, add the following section:
SEC. 4. REPORT ON TELEMEDICINE.
Not later than January 10, 2001, the Director of the Agency
for Health Research and Quality shall submit to the Congress
a report that--
(1) identifies any factors that inhibit the expansion and
accessibility of telemedicine services, including factors
relating to telemedicine networks;
(2) identifies any factors that, in addition to
geographical isolation, should be used to determine which
patients need or require access to telemedicine care;
(3) determines the extent to which--
(A) patients receiving telemedicine service have benefited
from the services, and are satisfied with the treatment
received pursuant to the services; and
(B) the medical outcomes for such patients would have
differed if telemedicine services had not been available to
the patients;
(4) determines the extent to which physicians involved with
telemedicine services have been satisfied with the medical
aspects of the services;
(5) determines the extent to which primary care physicians
are enhancing their medical knowledge and experience through
the interaction with specialists provided by telemedicine
consultations; and
(6) identifies legal and medical issues relating to State
licensing of health professionals that are presented by
telemedicine services, and provides any recommendations of
the Director for responding to such issues.
Mr. THOMPSON of California. Mr. Chairman, telemedicine has been in
existence for over 30 years but has only recently become one of the
fastest growing areas of medicine. Telemedicine allows a consulting
physician at one location to observe a patient or interpret data at
another location via two-way audio or video links. Dermatology,
oncology, cardiology, radiology, and surgery are just a few of the
areas of medicine that have felt the positive impact of this
technology.
If someone represents a rural district, as I do, they have heard from
constituents who often have to travel long distances to consult with
medical specialists. Telemedicine allows these same individuals to
consult with their primary-care physician and a specialist at the same
time without the burdens of extraordinary travel, but telemedicine does
not just help rural districts. This field of medicine has the potential
to provide a wider range of services to all underserved communities,
both rural and urban.
The benefits of telemedicine are numerous; but in order to encourage
its growth, we still need to research and answer a few critical
questions.
Are patients who have received telemedicine benefiting from it? What
criteria should be used to determine which patients need these
services? What factors are inhibiting the expansion of accessibility of
telemedicine networks?
Congress in the past has commissioned reports on telemedicine,
including one under the Health Insurance Portability and Accountability
Act of 1996 and another under the Balanced Budget Act of 1997. Although
these reports address many important aspects of the field, there are
still gaps that need to be filled in.
In working with the National Institutes of Health and other medical
professionals throughout the country, I have drafted this amendment. It
requires the Agency for Health Research and Quality to research and
respond to Congress by January of 2001 on issues relating to patient
screening and interstate licensing of medical professionals.
In addition, this amendment would require a review of the factors
that may be inhibiting the expansion of telemedicine networks. It is
necessary to identify the hurdles that still need to be overcome in
this field in order to establish and promote successful systems of
telemedicine.
I want to thank the chairman and the ranking member for their great
work on this measure, and I would urge a yes vote on this amendment.
Mr. OSE. Mr. Chairman, I rise in support of the amendment by my good
friend, the gentleman from California (Mr. Thompson).
Mr. Chairman, I have this past week spent much time in my district
visiting the various facilities that serve the medical needs of the
people who live in the Third District, and I will say firsthand, up
front and personal, that this system works. I have been in the hospital
in Colusa, a small city of around 5,500 in my district, where we
actually communicated as I was standing there with people at the
University of California at Davis Medical Center talking about issues
affecting a patient.
Telemedicine works. It helps the people in my district, and the thing
that is so critical here, the thing that actually makes a difference,
that we should support here if for no other reason is that telemedicine
is an effective, efficient, beneficial way to bring medical assistance
to the people who live in our rural areas throughout this country.
I have seen it work. I want to say that. I have seen it work in my
district. There is a camera. There is a screen. There are people on the
other end, and it is just like talking from here to the Chair.
The amendment of the gentleman is well thought out. The fact that we
can get some additional greater information to allow us to make
reasoned, rational decisions regarding telemedicine merits our support.
I thank the chairman for considering it.
Mr. BILIRAKIS. Mr. Chairman, will the gentleman yield?
Mr. OSE. I yield to the gentleman from Florida.
Mr. BILIRAKIS. Mr. Chairman, I thank the gentleman from California
(Mr. Ose) for yielding.
Mr. Chairman, I really appreciate the gentleman sharing his story
with us and commend the gentleman from California (Mr. Thompson) for
offering this amendment. Back in the days when Ron Wyden from Oregon,
who is now a U.S. senator, was here, he and I spent a lot of time on
the issue of telemedicine. We ran into some roadblocks but it has been
sort of a little bit of a cause of mine, a secondary cause of mine
unfortunately, but I think it is an excellent resource.
Frankly, my opinion is that it is not being used to its full
potential and hopefully the gentleman's amendment will focus the agency
on this particular issue, and hopefully we can improve upon that. So in
any case, we are prepared to accept the amendment.
{time} 1730
Mr. FALEOMAVAEGA. Mr. Chairman, I move to strike the requisite number
of words.
Mr. Chairman, I certainly want to commend the gentleman from Florida
(Mr. Bilirakis), the chairman of the Subcommittee on Health and
Environment, and the gentleman from Ohio (Mr. Brown), our ranking
member, for allowing this amendment to be brought before the floor.
Mr. Chairman, I rise today in full support of the proposed amendment
of the gentleman from California (Mr. Thompson) to H.R. 2506 to require
the Agency for Health Research and Quality to submit a report to
Congress by January 2001 on telemedicine.
Mr. Chairman, I represent a group of Americans living in a remote
area, far from the modern hospitals or other major health facilities.
The people of my district get sick and are injured just like anyone
throughout the country.
One big difference, Mr. Chairman, is that, if a person's serious
injury or illness cannot be treated by a local physician, he may just
have to wait awhile before he or she can be transferred to the nearest
major hospital, which is about a 5-hour plane ride from Samoa to
Honolulu. To make things more complicated, Mr. Chairman, there are only
two flights per week between American Samoa and Honolulu.
In addition to that, Mr. Chairman, the cost of transporting a patient
in a gurney, along with an attending nurse or physician 2,300 miles to
Hawaii and back is quite significant, which leads to the very reason
why I fully support this amendment for telemedicine.
Mr. Chairman, presently health and medical care needs in rural
America and distant U.S. insular areas are simply overwhelming the
available resources. Telemedicine can work to lessen the costs and, at
the same time, can dramatically improve the quality of and access to
needed health and medical care.
Telemedicine can be a very valuable tool to medical facilities in
rural areas.
[[Page H8940]]
We now have the technology to assist rural America, but the
infrastructure is not always in place, and the costs are still somewhat
of a concern.
This amendment will require that we devote some of our resources to
determining how best to move forward with this emergent technology to
provide improved medical care for rural America.
Again, I thank the gentleman from California (Mr. Thompson) for his
initiative by introducing this necessary amendment, and my appreciation
to the chairman and the ranking member for their leadership and
assistance by allowing this amendment to be included in this
legislation.
I urge my colleagues to support this amendment.
Ms. WOOLSEY. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, I, too, am in support of this amendment, an amendment
to bring the delivery of health care into the 21st century.
Telemedicine is an innovative and fast growing field that provides
real access and necessary access to medical care, particularly to areas
that are not close to major medical facilities.
That is why this year the gentleman from California (Mr. Thompson)
and I requested funding for a telemedicine network located in Santa
Rosa at Santa Rosa Memorial Hospital to provide access to the children
and families in northern California's remote and underserved
population.
Santa Rosa Memorial Hospital is in my district, and the majority of
the families that it would serve are in the district of the gentleman
from California (Mr. Thompson). Together, that was a partnership to
take care of the children in our area in general.
The U.S. Department of Health and Human Services has classified
portions of our districts as medically underserved. Specialty and
trauma care are often limited and episodic at best, making telemedicine
the only viable answer to making care accessible to these families.
The children who need state-of-the-art medicine, but do not have it
in their rural communities, will be served greatly by this amendment.
We have the technology to fix a problem. Now, let us have the
courage. I hear on both sides of the aisle that the courage is there,
and I appreciate it, to fix this problem permanently.
Telemedicine has been in existence for over 30 years, and it is time
to make it a priority so that it will work and so that it will work
right.
Again, I applaud the gentleman from California (Mr. Thompson) for his
leadership on this issue. I urge my colleagues to support this
amendment.
Mr. BROWN of Ohio. Mr. Chairman, I move to strike the requisite
number of words.
Mr. Chairman, I rise in support of the second Thompson amendment. I
commend the gentleman from California for bringing attention to the
potential of telemedicine and for outlining for us the success already
of telemedicine. It is a terrific breakthrough in the last decade or so
and in serving underserved remote areas, as the gentlewoman from
California (Ms. Woolsey) said. I think this is a good amendment that
will lead to more breakthroughs in telemedicine.
I ask support of the House for the Thompson amendment.
The CHAIRMAN pro tempore (Mr. Quinn). The question is on the
amendment offered by the gentleman from California (Mr. Thompson).
The amendment was agreed to.
Amendment No. 23 Offered by Mr. Traficant
Mr. TRAFICANT. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 23 offered by Mr. Traficant: Page 46, after
line 2, insert the following section:
SEC. 4. BUY AMERICAN PROVISIONS.
(a) Compliance With Buy American Act.--No funds authorized
pursuant to this Act may be expended by an entity unless the
entity agrees that in expending the assistance the entity
will comply with sections 2 through 4 of the Act of March 3,
1933 (41 U.S.C. 10a-10c, popularly known as the ``Buy
American Act'').
(b) Sense of Congress; Requirement Regarding Notice.--
(1) Purchase of american-made equipment and products.--In
the case of any equipment or products that may be authorized
to be purchased with financial assistance provided under this
Act, it is the sense of the Congress that entities receiving
such assistance should, in expending the assistance, purchase
only American-made equipment and products.
(2) Notice to recipients of assistance.--In providing
financial assistance under this Act, the Secretary of Health
and Human Services shall provide to each recipient of the
assistance a notice describing the statement made in
paragraph (1) by the Congress.
Mr. TRAFICANT. Mr. Chairman, I would like to start out by commending
the gentleman from Florida (Mr. Bilirakis), a fellow graduate of the
University of Pittsburgh and a dear friend, for his work on health
care. I believe if the Congress would work with the gentleman from
Florida (Mr. Bilirakis), we would continue to have improvements such as
these that will incrementally improve the health-care system of
America.
I also want to commend the gentleman from Ohio (Mr. Brown), my
neighbor, for working with our chairman and for aggressively working on
problems of health-care needs for all the people of America. But I do
want to encourage the Congress to continue to work carefully with the
chairman. The health-care program that he is espousing makes a lot of
sense.
Mr. Chairman, this is a very simple amendment. It says people who get
the money from this bill in the form of grants shall abide by the ``buy
American'' law which many of them forget to do, and they have to be
prosecuted for such evasion. At least we can remind them and encourage
them when expending these funds, where at all possible and practicable,
to expend those funds in the purchases of American-made goods and
services.
It makes sense. It is common sense. I would ask that it would be
included in the bill.
Mr. BILIRAKIS. Mr. Chairman, I move to strike the requisite number of
words.
Mr. Chairman, before I respond to the gentleman's amendment, I would
like to take this opportunity to thank and commend the staffs, the
people who really make all of this possible. We get the accolades, but
they are really the ones who have done all the work: Jason Lee, a
member of the committee staff; Tom Giles, another member of the
majority staff; Ann Esposito from my personal staff; minority staff
John Ford and Ellie Dahoney; and Pete Goodloe, legislative counsel. I
really commend them and thank them. This has been a good piece of
legislation. It has been very beneficial, I think.
Mr. Chairman, the majority has had an opportunity to review the
amendment by the Buy-American Congressman, the great Buy-American
Congressman here in the Congress, and his amendment would require that
the agency or any entity that expends funds authorized pursuant to this
act comply with the Buy American Act. He is already very diligent in
doing that.
We are prepared to accept his amendment.
Mr. BROWN of Ohio. Mr. Chairman, I move to strike the requisite
number of words.
Mr. Chairman, I rise in support of the Traficant amendment. I commend
the gentleman from Ohio (Mr. Traficant), with whom I share a county,
Trumbull County in eastern Ohio, and thank him for his work on this
amendment. I thank the gentleman from Florida (Mr. Bilirakis) for his
good work on this bill and so many other pieces of legislation in our
committee. Also Mr. Ford, Mr. Schooler, and the majority staff, and
Ellie Dahoney also in my office.
This amendment, as the amendments of the gentleman from Ohio (Mr.
Traficant) typically are on this, on several bills on buy America,
makes sense. It will improve the bill. I commend him for his work. I
ask for support of the amendment.
The CHAIRMAN pro tempore. The question is on the amendment offered by
the gentleman from Ohio (Mr. Traficant).
The amendment was agreed to.
Are there any further amendments on the bill?
If not, the question is on the committee amendment in the nature of a
substitute, as amended.
The committee amendment in the nature of a substitute, as amended,
was agreed to.
The CHAIRMAN pro tempore. Under the rule, the Committee rises.
[[Page H8941]]
Accordingly, the Committee rose; and the Speaker pro tempore (Mr.
McHugh) having assumed the chair, Mr. Quinn, Chairman pro tempore of
the Committee of the Whole House on the State of the Union, reported
that that Committee, having had under consideration the bill (H.R.
2506) a bill to amend title IX of the Public Health Service Act to
revise and extend the Agency for Health Care Policy and Research,
pursuant to House Resolution 299, he reported the bill back to the
House with an amendment adopted by the Committee of the Whole.
The SPEAKER pro tempore. Under the rule, the previous question is
ordered.
Is a separate vote demanded on any amendments to the committee
amendment in the nature of a substitute adopted by the Committee of the
Whole? If not, the question is on the amendment.
The amendment was agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. BILIRAKIS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The vote was taken by electronic device, and there were--yeas 417,
nays 7, not voting 9, as follows:
[Roll No. 457]
YEAS--417
Abercrombie
Ackerman
Aderholt
Allen
Andrews
Armey
Bachus
Baird
Baker
Baldacci
Baldwin
Ballenger
Barcia
Barr
Barrett (NE)
Barrett (WI)
Bartlett
Barton
Bass
Bateman
Becerra
Bentsen
Bereuter
Berkley
Berman
Berry
Biggert
Bilbray
Bilirakis
Bishop
Blagojevich
Bliley
Blumenauer
Blunt
Boehlert
Boehner
Bonilla
Bonior
Bono
Borski
Boswell
Boucher
Boyd
Brady (PA)
Brady (TX)
Brown (FL)
Brown (OH)
Bryant
Burr
Burton
Buyer
Callahan
Calvert
Camp
Campbell
Canady
Cannon
Capps
Capuano
Cardin
Carson
Castle
Chabot
Chambliss
Clay
Clayton
Clement
Clyburn
Coble
Collins
Combest
Condit
Conyers
Cook
Cooksey
Costello
Cox
Coyne
Cramer
Crane
Crowley
Cubin
Cummings
Cunningham
Danner
Davis (FL)
Davis (IL)
Davis (VA)
Deal
DeFazio
DeGette
Delahunt
DeLauro
DeLay
DeMint
Deutsch
Diaz-Balart
Dickey
Dicks
Dingell
Dixon
Doggett
Dooley
Doolittle
Doyle
Dreier
Dunn
Edwards
Ehlers
Ehrlich
Emerson
Engel
English
Eshoo
Etheridge
Evans
Everett
Ewing
Farr
Fattah
Filner
Fletcher
Foley
Forbes
Ford
Fossella
Fowler
Frank (MA)
Franks (NJ)
Frelinghuysen
Frost
Gallegly
Ganske
Gejdenson
Gekas
Gephardt
Gibbons
Gilchrest
Gillmor
Gilman
Gonzalez
Goode
Goodlatte
Goodling
Gordon
Goss
Graham
Granger
Green (TX)
Green (WI)
Greenwood
Gutierrez
Gutknecht
Hall (OH)
Hall (TX)
Hansen
Hastings (FL)
Hastings (WA)
Hayes
Hayworth
Hefley
Herger
Hill (IN)
Hill (MT)
Hilleary
Hilliard
Hinchey
Hinojosa
Hobson
Hoeffel
Hoekstra
Holden
Holt
Hooley
Horn
Houghton
Hoyer
Hulshof
Hunter
Hutchinson
Hyde
Inslee
Isakson
Istook
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Jenkins
John
Johnson (CT)
Johnson, E. B.
Jones (NC)
Jones (OH)
Kanjorski
Kaptur
Kasich
Kelly
Kennedy
Kildee
Kilpatrick
Kind (WI)
King (NY)
Kingston
Kleczka
Klink
Knollenberg
Kolbe
Kucinich
Kuykendall
LaFalce
LaHood
Lampson
Lantos
Largent
Larson
Latham
LaTourette
Lazio
Leach
Lee
Levin
Lewis (CA)
Lewis (GA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lofgren
Lowey
Lucas (KY)
Lucas (OK)
Luther
Maloney (CT)
Maloney (NY)
Manzullo
Markey
Martinez
Mascara
Matsui
McCarthy (MO)
McCollum
McCrery
McDermott
McGovern
McHugh
McInnis
McIntosh
McIntyre
McKeon
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Metcalf
Mica
Millender-McDonald
Miller (FL)
Miller, Gary
Miller, George
Minge
Mink
Moakley
Mollohan
Moore
Moran (KS)
Moran (VA)
Morella
Murtha
Myrick
Nadler
Napolitano
Neal
Nethercutt
Ney
Northup
Norwood
Nussle
Oberstar
Obey
Olver
Ortiz
Ose
Owens
Oxley
Packard
Pallone
Pascrell
Pastor
Payne
Pease
Pelosi
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pickett
Pitts
Pombo
Pomeroy
Porter
Portman
Price (NC)
Pryce (OH)
Quinn
Radanovich
Rahall
Ramstad
Rangel
Regula
Reyes
Reynolds
Rivers
Rodriguez
Roemer
Rogan
Rogers
Rohrabacher
Ros-Lehtinen
Rothman
Roukema
Roybal-Allard
Rush
Ryan (WI)
Ryun (KS)
Sabo
Salmon
Sanchez
Sanders
Sandlin
Sawyer
Saxton
Schaffer
Schakowsky
Scott
Sensenbrenner
Serrano
Shadegg
Shaw
Shays
Sherman
Sherwood
Shimkus
Shows
Shuster
Simpson
Sisisky
Skeen
Skelton
Slaughter
Smith (MI)
Smith (NJ)
Smith (TX)
Smith (WA)
Snyder
Souder
Spence
Spratt
Stabenow
Stark
Stearns
Stenholm
Strickland
Stump
Stupak
Sununu
Sweeney
Talent
Tancredo
Tanner
Tauscher
Tauzin
Taylor (MS)
Taylor (NC)
Terry
Thompson (CA)
Thompson (MS)
Thornberry
Thune
Thurman
Tiahrt
Tierney
Toomey
Towns
Traficant
Turner
Udall (CO)
Udall (NM)
Upton
Velazquez
Vento
Visclosky
Vitter
Walden
Walsh
Wamp
Waters
Watkins
Watt (NC)
Watts (OK)
Waxman
Weiner
Weldon (FL)
Weldon (PA)
Weller
Wexler
Weygand
Whitfield
Wicker
Wilson
Wise
Wolf
Woolsey
Wynn
Young (AK)
Young (FL)
NAYS--7
Chenoweth
Coburn
Duncan
Hostettler
Johnson, Sam
Paul
Royce
NOT VOTING--9
Archer
McCarthy (NY)
McKinney
Riley
Sanford
Scarborough
Sessions
Thomas
Wu
{time} 1804
Mr. ROYCE changed his vote from ``yea'' to ``nay.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated for:
Mr. THOMAS. Mr. Speaker, on rollcall No. 457, had I been present, I
would have voted ``yea.''
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