[Congressional Record Volume 145, Number 156 (Monday, November 8, 1999)]
[Senate]
[Pages S14288-S14296]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KENNEDY (for himself, Mr. Akaka, Mr. Inouye, Mrs. Lincoln, 
        and Mr. Wellstone):
  S. 1880. A bill to amend the Public Health Service Act to improve the 
health of minority individuals; to the Committee on Health, Education, 
Labor, and Pensions.


                    health care fairness act of 1999

  Mr. KENNEDY. Mr. President, over the past few decades, we have made 
extraordinary advances as a nation in science and medicine. 
Unfortunately, those advances are not benefitting all of our citizens 
equally. Minority communities suffer disproportionately from many 
severe health problems.
  We know that poverty, lack of health insurance, and other barriers to 
care continue to undermine the health of minorities. Clearly we need to 
do more to give all Americans the fair chance for a healthy future that 
they deserve.
  The Administration has taken important steps to address this 
challenge. Last year, the President announced the Initiative to 
Eliminate Racial and Ethnic Disparities in Health. This initiative, led 
by the Department of Health and Human Services, has identified several 
areas where new commitments, new ideas, and new resources are 
necessary. The goal is to eliminate disparities in the areas of 
cardiovascular disease, cancer screening and management, diabetes, 
infant mortality, HIV/AIDS, and immunizations by 2010. This ambitious 
goal cannot be met without a major effort to improve research on the 
health of minorities and develop the steps needed to reduce these 
disparities.
  Today, Senators Akaka, Inouye, Lincoln, Wellstone, and I are 
introducing the Health Care Fairness Act of 1999, to secure the 
commitment and resources needed in each of these areas to ensure that 
minorities have a fair chance for improved health.
  Minority populations suffer disproportionately from cardiovascular 
disease. They have a greater risk of developing high blood pressure, 
and are less likely to receive treatment to manage the condition after 
it develops. As a result, African Americans are 40 percent more likely 
to die from coronary heart disease than whites.
  A Georgetown University study published in the New England Journal of 
Medicine last February found that bias in the decisions made by doctors 
is a factor in the treatment that African Americans receive when they 
suffer from heart disease. These findings are based on an experiment 
where physicians volunteered to view a video of actors posing as 
patients with significant symptoms of heart disease. The physicians 
were asked to prescribe further interventions for each ``patient,'' all 
of whom had identical medical histories, insurance coverage, and 
occupations. While 91 percent of the white males, white females, and 
African American males in the study were referred for cardiac 
catheterization, a more effective but more expensive diagnostic 
procedure, only 79 percent of the African American females in the study 
were referred for this test.
  A study published in the New England Journal of Medicine last month 
found similar disparities in the treatment of lung cancer. Patients 
whose tumors are discovered early are often able to be cured with 
surgery. This study found that African American patients with tumors 
small enough to be surgically removed were treated surgically in only 
64 percent of cases, compared with 77 percent of white patients treated 
surgically. As a result, African Americans have only a 26 percent 
chance of surviving lung cancer, compared with a 34 percent survival 
rate for whites.
  Other types of cancer also strike racial and ethnic minorities in 
disproportionate numbers. Vietnamese American women are five times more 
likely than white women to contract cervical cancer. Hispanic women are 
twice as likely to contract cervical cancer. Native Hawaiian men are 13 
percent more likely to contact lung cancer. Alaskan

[[Page S14289]]

Native women are 72 percent more likely to contract colon cancer and 
rectal cancer, when compared with whites. In addition, African 
Americans and Hispanic Americans are more likely to be diagnosed with 
cancer once the disease has reached an advanced stage. For African 
Americans, the result is a 35 percent higher death rate.
  The Institute of Medicine, issued a report last February concluding 
that federal efforts to research cancer in minority communities are 
insufficient. The report recommended an increase in resources and the 
development of a strategic plan to coordinate this research. The 
results of this study confirm that while NIH has been extremely 
successful in producing medical breakthroughs that improve health care, 
those breakthroughs do not always reach into racial and ethnic 
communities.
  The same troubling differences are found with HIV/AIDS. The powerful 
new drugs that have dramatically decreased AIDS deaths and prevented or 
delayed progression from HIV to AIDS for so many citizens are not 
reaching minorities in proportion to their need. Racial and ethnic 
minorities make up approximately 25 percent of the total population, 
but these groups account for over half of all AIDS cases. The disparity 
is even greater for African American and Hispanic women, who account 
for nearly 80 percent of the AIDS cases reported among women.
  In spite of recent bipartisan efforts to increase access to health 
care for all children, racial and ethnic disparities exist among young 
Americans as well. Minority children are less likely to receive 
prescription medications, and they have lower immunization rates than 
white children. Inadequate health care places a barrier in the path of 
healthy development for minority children, and that is an unfair 
disadvantage.
  The Health Care Fairness Act of 1999 addresses these racial and 
ethnic health disparities in many ways. It contains sections on 
research, data collection, medical education, and outreach. Each of 
these aspects has an important role to play in the reduction and 
eventual elimination of these unacceptable health disparities.
  Title I establishes a Center for Research on Minority Health at the 
National Institutes of Health. The Center will oversee the development 
of an NIH-wide strategic plan for minority health research. This step 
will enable those concerned with the advancement of research on 
minority health, both inside and outside NIH, to monitor the progress 
of NIH in this area. The Center will award Centers of Excellence grants 
to institutions across the country that serve under-represented 
populations. These funds will be used to conduct research into the 
nature, causes, and remedies for health disparties, to train minorities 
to become biomedical research professionals, to improve the 
infrastructure for conducting biomedical research on health disparties, 
and to provide long-term stability to these biomedical research 
programs.

  Changing attitudes about race and ethnic backgrounds are an ongoing 
challenge for all sectors of our society. The Georgetown study does not 
conclude that most doctors are racist. No such assumptions are drawn 
from its results. What is shown is that health care providers, like all 
members of our society, enter their profession with perceptions and 
biases related to race. Many industries have confronted racial 
sensitivity issues in their training programs. This study shows that 
such training must also be a part of medical education, for both new 
students and experienced practitioners alike.
  To help health care providers improve their ability to work with 
patients of different backgrounds, we must also develop educational 
techniques that are effective in improving this aspect of health care 
delivery. Title II of the Health Care Finance Act establishes 
demonstration projects to develop effective educational techniques such 
as courses that focus on reducing racial and ethnic disparties in 
health care.
  The close connection between race and poverty in this country has had 
a significant negative impact on the access of minority communities to 
quality health care. Reducing racial and ethnic health disparties will 
require a better understanding of issues beyond effective treatments 
and other questions of basic science. Barriers to care, poor quality 
health services, and the lack of useful outcome measures are all part 
of this complex problem. Title III of our bill strengthens the federal 
commitment to these social science aspects of health disparties. It 
directs the Agency for Health Care Policy and Research to conduct and 
support research in these areas, to promote effective interventions in 
minority communities, and to develop outcome measures to assess and 
improve health care for minority populations.
  Measuring our progress in reducing these racial and ethnic disparties 
will also require reliable and complete data on miniority health. In 
order to provide reliable information on the health status of minority 
communities, Title IV of our bill directs the National Academy of 
Sciences to conduct a study of the data collection and reporting 
systems at the Department of Health and Human Services that include 
race and ethnicity.
  This study will evaluate the effectiveness of data collection at HHS 
and recommend improvements for ensuring that reliable and complete 
information on racial and ethnic health disparties is available.
  The estimated cost of these provisions for fiscal year 2000 totals 
just under $350 million. The estimated cost in subsequent years is 
approximately $260 million. This is a small price when compared to the 
damage that racial and ethnic health disparties are causing in so many 
communities. We all know that in the long run better health is always 
less expensive than sickness and hospitalization.
  We know that many other structural, personal, and historical factors 
contribute to racial and ethnic disparties in health care. Our 
legislation asks that we make the elimination of these disparties a 
higher priority. It asks that we do all we can to develop the knowledge 
necessary to do better. The result will be a fairer chance for the 
healthy future that all Americans deserve, and I look forward to early 
action by Congress on this needed legislation.
  Mr. President, I ask unanimous consent that the full text of the bill 
and the accompanying letters and statement of support be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1880

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Health 
     Care Fairness Act of 1999''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.

 TITLE I--IMPROVING MINORITY HEALTH THROUGH THE NATIONAL INSTITUTES OF 
                                 HEALTH

Sec. 101. Research on minority health.

                 ``Part J--Research on Minority Health

``Sec. 499A. Establishment of Center.
``Sec. 499B. Advisory Council.
``Sec. 499C. Comprehensive plan and budget.
``Sec. 499D. Center funding.
``Sec. 499E. Centers of excellence for research on health disparities 
              and training.
``Sec. 499F. Loan repayment program for biomedical research.
``Sec. 499G. Additional authorities.
``Sec. 499H. General provisions regarding the Center.

                      TITLE II--MEDICAL EDUCATION

Sec. 201. Grants for health care education curricula development.
Sec. 202. National Conference on Continuing Health Professional 
              Education and Disparity in Health Outcomes.
Sec. 203. Advisory Committee.
Sec. 204. Cultural competency clearinghouse.

   TITLE III--MINORITY HEALTH RESEARCH BY THE AGENCY FOR HEALTH CARE 
                          POLICY AND RESEARCH.

Sec. 301. Minority health research by the Agency for Health Care Policy 
              and Research.

        TITLE IV--DATA COLLECTION RELATING TO RACE OR ETHNICITY

Sec. 401. Study and report by National Academy of Sciences.

                       TITLE V--PUBLIC AWARENESS

Sec. 501. Public awareness.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The United States ranks below most industrialized 
     nations in health status as

[[Page S14290]]

     measured by longevity, sickness, and mortality.
       (2) The United States ranks 24th among industrialized 
     nations in infant mortality.
       (3) This poor rank in health status is attributed in large 
     measure to the lower health status of America's minority 
     populations.
       (4) Many minority groups suffer disproportionately from 
     cancer. Disparities exist in both mortality and incidence 
     rates. For men and women combined, African Americans have a 
     cancer death rate about 35 percent higher than that for 
     whites. Paralleling the death rate, the incidence rate for 
     lung cancer in African American men is about 50 percent 
     higher than white men. Native Hawaiian men also have elevated 
     rates of lung cancer compared with white men. Alaskan Native 
     men and women suffer from higher rates of cancers of the 
     colon and rectum than do whites. Vietnamese women in the 
     United States have a cervical cancer incidence rate more than 
     5 times greater than white women. Hispanic women also suffer 
     elevated rates of cervical cancer.
       (5) Infant death rates among African American, Native 
     Americans and Alaskan Natives, and Hispanics were well above 
     the national average. The greatest disparity exists for 
     African Americans. The overall Native American rate does not 
     reflect the diversity among Indian communities, some of which 
     have infant mortality rates approaching twice the national 
     rate.
       (6) Sudden infant death syndrome (referred to in this 
     section as ``SIDS'') accounts for approximately 10 percent of 
     all infant deaths in the first year of life. Minority 
     populations are at greater risk for SIDS. In addition to the 
     greater risks among African Americans, the rates are 3 to 4 
     times as high for some Native American and Alaskan Native 
     populations.
       (7) Cardiovascular disease is the leading cause of death 
     for all racial and ethnic groups. Major disparities exist 
     among population groups, with a disproportionate burden of 
     death and disability from cardiovascular disease in minority 
     and low-income populations. Stroke is the only leading cause 
     of death for which mortality is higher for Asian-American 
     males than for white males.
       (8) Racial and ethnic minorities have higher rates of 
     hypertension, tend to develop hypertension at an earlier age, 
     and are less likely to undergo treatment to control their 
     high blood pressure.
       (9) Diabetes, the seventh leading cause of death in the 
     United States, is a serious public health problem affecting 
     racial and ethnic communities. The prevalence of diabetes in 
     African Americans is approximately 70 percent higher than 
     whites and the prevalence in Hispanics is nearly double that 
     of whites. The prevalence rate of diabetes among Native 
     Americans and Alaskan Natives is more than twice that for the 
     total population and at least 1 tribe, the Pimas of Arizona, 
     have the highest known prevalence of diabetes of any 
     population in the world.
       (10) The human immunodeficiency virus (referred to in this 
     section as ``HIV''), which causes acquired immune deficiency 
     syndrome (referred to in this section as ``AIDS''), results 
     in disproportionate suffering in minority populations. 
     Minority persons represent 25 percent of the total United 
     States population, but 54 percent of all cases of AIDS.
       (11) More than 75 percent of AIDS cases reported among 
     women and children occur in minority women and children.
       (12) Nearly 2 of 5 (38 percent) Hispanic adults, 1 of 4 (24 
     percent) African American adults, and 1 of 4 (24 percent) 
     Asian-American adults are uninsured, compared with 1 of 7 (14 
     percent) white adults.
       (13) Elderly minorities experience disparities in access to 
     care and health status, in part because medicare covers only 
     half the health care expenses of older Americans.
       (14) Two of 5 Hispanic and 2 of 5 African Americans age 65 
     and older rate their health status as fair or poor, compared 
     with less than 1 of 4 (23 percent) white Americans 65 and 
     over.
       (15) Nearly 2 of 5 (39 percent) African American adults and 
     almost half (46 percent) of Hispanic adults report that they 
     do not have a regular doctor, compared with 1 of 4 (26 
     percent) of white adults.
       (16) Minority Americans 65 and older are less likely to 
     have a regular doctor or to see a specialist.
       (17) Ninety percent of minority physicians produced by 
     Historically Black Medical Colleges live and serve in 
     minority communities.
       (18) Almost half (45 percent) of Hispanic adults, 2 of 5 
     (41 percent) Asian-American adults, and more than 1 of 3 (35 
     percent) African American adults report difficulty paying for 
     medical care, compared with 1 of 4 (26 percent) white adults.
       (19) Despite suffering disproportionate rates of illness, 
     death, and disability, minorities have not been 
     proportionately represented in many clinical research trials, 
     except in studies of behavioral risk factors associated with 
     negative stereotypes.
       (20) Culturally sensitive approaches to research are needed 
     to encourage minority participation in research studies.
       (21) There is a national need for minority scientists in 
     the field of biomedical, clinical, and health services 
     research.
       (22) In 1990, only 3.3 percent of all United States medical 
     school faculties were underrepresented minority persons.
       (23) Only 1 percent of full professors were 
     underrepresented minority persons in 1990.
       (24) The proportion of underrepresented minorities in high 
     academic ranks, such as professors and associated professors, 
     decreased from 1980 to 1990.
       (25) African Americans with identical complaints of chest 
     pain are less likely than white Americans to be referred by 
     physicians for sophisticated cardiac tests.
       (26) Cultural competency training in medical schools and 
     residency training programs has the potential to reduce 
     disparities in health care and health outcomes.
       (27) More detailed data on health disparities is needed 
     to--
       (A) evaluate the impact that race and ethnicity have on 
     health status, access to care, and quality of care; and
       (B) enforce existing protections for equal access to care.

 TITLE I--IMPROVING MINORITY HEALTH THROUGH THE NATIONAL INSTITUTES OF 
                                 HEALTH

     SEC. 101. RESEARCH ON MINORITY HEALTH.

       Title IV of the Public Health Service Act (42 U.S.C. 281 et 
     seq.) is amended by adding at the end the following:

                 ``PART J--RESEARCH ON MINORITY HEALTH

     ``SEC. 499A. ESTABLISHMENT OF CENTER.

       ``(a) In General.--There is established within the National 
     Institutes of Health an organization to be known as the 
     Center for Research on Minority Health and Health Disparities 
     (referred to in this part as the `Center'). The Center shall 
     be headed by a director, who shall be appointed by the 
     Secretary and shall report to the Director of the National 
     Institutes of Health.
       ``(b) Task Force.--The Director of the Center shall chair a 
     trans-NIH task force that is composed of Institute Directors, 
     NIH senior staff, and representatives of other public health 
     agencies, that will establish a comprehensive plan and budget 
     estimates under section 499C for minority health that should 
     be conducted or supported by the national research 
     institutes, and shall recommend an agenda for conducting and 
     supporting such research.
       ``(c) Duties.--
       ``(1) Interagency coordination of minority health 
     research.--With respect to minority health, the Director of 
     the Center shall facilitate the establishment of, and provide 
     administrative support to, the task force referred to in 
     subsection (b) to plan, coordinate, and evaluate all research 
     conducted at or funded by NIH.
       ``(2) Minority health research information system.--The 
     Director of the Center shall establish a minority health 
     research information system in order to track minority-
     related research, training, and construction. The system 
     shall capture, for each minority-related research, training, 
     or construction project year-end data.
       ``(3) Consultations.--The Director of the Center shall 
     carry out this part (including developing and revising the 
     plan required in section 499C) in consultation with the 
     Advisory Council established under section 499B, the heads of 
     the agencies of the National Institutes of Health, and the 
     advisory councils of such agencies.
       ``(4) Coordination.--The Director of the Center shall act 
     as the primary Federal official with responsibility for 
     monitoring all minority health research conducted or 
     supported by the National Institutes of Health, and--
       ``(A) shall serve to represent the National Institutes of 
     Health minority health research program at all relevant 
     Executive branch task forces, committees and planning 
     activities; and
       ``(B) shall maintain communications with all relevant 
     Public Health Service agencies and with various other 
     departments of the Federal Government, to ensure the timely 
     transmission of information concerning advances in minority 
     health research between these various agencies for 
     dissemination to affected communities and health care 
     providers.
       ``(d) Innovative Grants.--
       ``(1) In general.--The Director of the Center, in 
     consultation with the Advisory Council, shall identify areas 
     of insufficient minority health research at the Institutes 
     and Centers, and shall provide funds to the Institutes and 
     Centers for the awarding of peer-reviewed grants for 
     innovative projects that address high priority areas of 
     minority health research that are not adequately addressed by 
     other Institutes or Centers.
       ``(2) Exceptional circumstances.--
       ``(A) In general.--If the Director of the Center determines 
     that the Institutes or Centers are unwilling or unable to 
     award a grant under paragraph (1) for the conduct of a 
     research project identified under such paragraph, the 
     Director, in consultation with the Advisory Council, shall 
     award 1 or more peer reviewed grants to support such research 
     project.
       ``(B) Limitation.--The total amount of grants awarded under 
     subparagraph (A) for a fiscal year shall not exceed an amount 
     equal to 10 percent of the total final budget for the 
     minority health disparities comprehensive plan for the 
     National Institutes of Health for the fiscal year, or 
     $130,000,000, whichever is greater.
       ``(3) Administration of research proposals.--
       ``(A) Requests.--The Director of the Center may issue 
     requests for research proposals in areas identified under 
     paragraph (2)(A).
       ``(B) Delegation.--The Director of the Center may delegate 
     responsibility for the

[[Page S14291]]

     review and management of research proposals under this 
     subsection to another Institute or Center, or to the Center 
     for Scientific Review.
       ``(C) Final approval.--The Director of the Center may issue 
     a final approval of research awards under paragraph (1) so 
     long as such approval is provided within 30 days of the date 
     on which the award is approved by an Institute or Center.
       ``(e) Definitions.--In this part:
       ``(1) Minority health conditions.--The term `minority 
     health conditions', with respect to individuals who are 
     members of racial, ethnic, and indigenous (including Native 
     Americans, Alaskan Natives, and Native Hawaiians) minority 
     groups, means all diseases, disorders, and conditions 
     (including with respect to mental health)--
       ``(A) unique to, more serious, or more prevalent in such 
     individuals;
       ``(B) for which the factors of medical risk or types of 
     medical intervention are different for such individuals; or
       ``(C) which have been found to result in health disparities 
     but for which insufficient research has been conducted.
       ``(2) Minority health research.--The term `minority health 
     research' means basic and clinical research on minority 
     health conditions, including research on preventing such 
     conditions.

     ``SEC. 499B. ADVISORY COUNCIL.

       ``(a) In General.--The Secretary shall establish an 
     advisory council (referred to in this part as the `Advisory 
     Council'), pursuant to the Federal Advisory Committee Act, 
     for the purpose of providing advice to the Director of the 
     Center on carrying out this part.
       ``(b) Composition.--The Advisory Council shall be composed 
     of not less than 18, and not more than 24 individuals, who 
     are not officers or employees of the Federal Government, to 
     be appointed by the Secretary. A majority of the members of 
     the Advisory Council shall be individuals with demonstrated 
     expertise regarding minority health issues. The Advisory 
     Council shall include representatives of communities impacted 
     by racial and ethnic health disparities. The Director of the 
     Center shall serve as the chairperson of the Advisory 
     Council.

     ``SEC. 499C. COMPREHENSIVE PLAN AND BUDGET.

       ``(a) In General.--Subject to this section and other 
     applicable law, the Director of the Center (in consultation 
     with the Advisory Council) and the members of the Task Force 
     established under section 499A, in carrying out section 499A, 
     shall--
       ``(1) establish a comprehensive plan and budget for the 
     conduct and support of all minority health research 
     activities of the agencies of the National Institutes of 
     Health (which plan shall be first established under this 
     subsection not later than 12 months after the date of the 
     enactment of this part), which budget shall be submitted to 
     the Secretary, the Director of the Office of Management and 
     Budget and Congress and included in the annual budget 
     justification for the National Institutes of Health;
       ``(2) ensure that the plan and budget establishes 
     priorities, consistent with sound medical and scientific 
     judgment, among the minority health research activities that 
     such agencies are authorized to carry out;
       ``(3) ensure that the plan and budget establishes 
     objectives regarding such activities, describes the means for 
     achieving the objectives, and designates the date by which 
     the objectives are expected to be achieved;
       ``(4) ensure that all amounts appropriated for such 
     activities are expended in accordance with the plan and 
     budget;
       ``(5) review the plan and budget not less than annually, 
     and coordinate revisions to the plan as appropriate; and
       ``(6) ensure that the plan and budget serve as a broad, 
     binding statement of policies regarding minority health 
     research activities of the agencies, but does not remove the 
     responsibility of the heads of the agencies for the approval 
     of specific programs or projects, grant management, or for 
     other details of the daily administration of such activities, 
     in accordance with the plan and budget.
       ``(b) Certain Components.--With respect to minority health 
     research activities of the agencies of the National 
     Institutes of Health, the plan and budget shall--
       ``(1) provide for basic research;
       ``(2) provide for clinical research;
       ``(3) provide for research that is conducted by the 
     agencies;
       ``(4) provide for research that is supported by the 
     agencies;
       ``(5) provide for proposals developed pursuant to 
     solicitations by the agencies and for proposals developed 
     independently of such solicitations; and
       ``(6) provide for prevention research, behavioral research 
     and social sciences research.
       ``(c) Approval.--The plan and budget established under this 
     section are subject to the approval of the Director of the 
     Center and the Director of the National Institutes of Health.
       ``(d) Budget Items for Minority Health.--In the Budget of 
     the United States that is submitted to Congress by the 
     President, the President shall, with respect to each 
     Institute or agency of the National Institutes of Health, 
     include a separate line item account for the amount that each 
     such Institute or agency requests for minority health 
     activities.

     ``SEC. 499D. CENTER FUNDING.

       ``For the purpose of carrying out administrative functions 
     related to minority health research activities under the plan 
     under sections 499A, 499B, and 499C, there are authorized to 
     be appropriated $100,000,000 for fiscal year 2000, and such 
     sums as may be necessary for each of fiscal years 2001 
     through 2004.

     ``SEC. 499E. CENTERS OF EXCELLENCE FOR RESEARCH ON HEALTH 
                   DISPARITIES AND TRAINING.

       ``(a) In General.--The Secretary, acting through the 
     Director of the National Institutes of Health, shall make 
     grants to, and enter into contracts with, designated 
     biomedical research institutions described in subsection (c), 
     and other public and nonprofit health or educational 
     entities, for the purpose of assisting the institutions in 
     supporting programs of excellence in biomedical research 
     education for under-represented minority individuals.
       ``(b) Required Use of Funds.--
       ``(1) In general.--The Secretary may not make a grant under 
     subsection (a) unless the designated biomedical research 
     institution involved agrees, subject to subsection (c)(1)(B), 
     to expend the grant--
       ``(A) to conduct minority health research and research into 
     the nature of health disparities that affect racial, ethnic, 
     and indigenous minorities, the causes of such disparities, 
     and remedies for such disparities;
       ``(B) to train minorities as professionals in the area of 
     biomedical research;
       ``(C) to expand, remodel, renovate, or alter existing 
     research facilities or construct new research facilities for 
     the purpose of conducting biomedical research related to 
     health disparities; or
       ``(D) to establish or increase an endowment fund in 
     accordance with paragraph (2).
       ``(2) Endowment funds.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     an institution that meets the requirements of subparagraph 
     (B) may utilize not to exceed 35 percent of the amounts 
     received under a grant under subsection (a) to establish or 
     increase an endowment fund at the institution. Amounts used 
     under this subparagraph shall be dedicated exclusively to the 
     support of biomedical research and the associated costs of 
     such research.
       ``(B) Requirements.--To be eligible to use funds as 
     provided for under subparagraph (A), an institution shall not 
     have a endowment fund that is worth in excess of an amount 
     equal to 50 percent of the national average of all endowment 
     funds at all institutions that are of the same biomedical 
     research discipline.
       ``(c) Centers of Excellence.--
       ``(1) General conditions.--The conditions specified in this 
     paragraph are that a designated biomedical research 
     institution--
       ``(A) has a significant number of under-represented 
     minority individuals enrolled in the institution, including 
     individuals accepted for enrollment in the institution;
       ``(B) has been effective in assisting under-represented 
     minority students of the institution to complete the program 
     of education and receive the degree involved;
       ``(C) has been effective in recruiting under-represented 
     minority individuals to enroll in and graduate from the 
     institution, including providing scholarships and other 
     financial assistance to such individuals and encouraging 
     under-represented minority students from all levels of the 
     educational pipeline to pursue biomedical research careers; 
     and
       ``(D) has made significant recruitment efforts to increase 
     the number of under-represented minority individuals serving 
     in faculty or administrative positions at the institution.
       ``(2) Consortium.--Any designated biomedical research 
     institution involved may, with other biomedical institutions 
     (designated or otherwise) form a consortium to carry out the 
     purposes described in subsection (b) at the institutions of 
     the consortium.
       ``(3) Application of criteria to other programs.--In the 
     case of any criteria established by the Secretary for 
     purposes of determining whether institutions meet the 
     conditions described in paragraph (1), this section may not, 
     with respect to racial, ethnic, and indigenous minorities, be 
     construed to authorize, require, or prohibit the use of such 
     criteria in any program other than the program established in 
     this section.
       ``(d) Duration of Grant.--The period during which payments 
     are made under a grant under subsection (a) may not exceed 5 
     years. Such payments shall be subject to annual approval by 
     the Secretary and to the availability of appropriations for 
     the fiscal year involved to make the payments.
       ``(e) Definitions.--In this section:
       ``(1) Minority.--The term `minority' means an individual 
     from a racial or ethnic group that is under-represented in 
     health research.
       ``(2) Program of excellence.--The term `program of 
     excellence' means any program carried out by a designated 
     biomedical research institution with a grant made under 
     subsection (a), if the program is for purposes for which the 
     institution involved is authorized in subsection (b) or (c) 
     to expend the grant.
       ``(f) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     making grants under subsection (a), there are authorized to 
     be appropriated such sums as may be necessary for each of the 
     fiscal years 2000 through 2004.
       ``(2) No limitation.--Nothing in this subsection shall be 
     construed as limiting the centers of excellence referred to 
     in this section to the designated amount, or to preclude such 
     entities from competing for other grants under this section.
       ``(3) Maintenance of effort.--

[[Page S14292]]

       ``(A) In general.--With respect to activities for which a 
     grant made under this part are authorized to be expended, the 
     Secretary may not make such a grant to a center of excellence 
     for any fiscal year unless the center agrees to maintain 
     expenditures of non-Federal amounts for such activities at a 
     level that is not less than the level of such expenditures 
     maintained by the center for the fiscal year preceding the 
     fiscal year for which the institution receives such a grant.
       ``(B) Use of federal funds.--With respect to any Federal 
     amounts received by a center of excellence and available for 
     carrying out activities for which a grant under this part is 
     authorized to be expended, the Secretary may not make such a 
     grant to the center for any fiscal year unless the center 
     agrees that the center will, before expending the grant, 
     expend the Federal amounts obtained from sources other than 
     the grant.

     ``SEC. 499F. LOAN REPAYMENT PROGRAM FOR BIOMEDICAL RESEARCH.

       ``(a) In General.--The Secretary, acting through the 
     Director of the National Institutes of Health, shall 
     establish a program of entering into contracts with qualified 
     health professionals under which such health professionals 
     agree to engage in minority health research or research into 
     the nature of health disparities that affect racial, ethnic, 
     and indigenous populations, in consideration of the Federal 
     Government agreeing to repay, for each year of such service, 
     not more than $35,000 of the principal and interest of the 
     educational loans of such health professionals.
       ``(b) Service Provisions.--The provisions of sections 338B, 
     338C, and 338E shall, except as inconsistent with subsection 
     (a), apply to the program established in such subsection (a) 
     to the same extent and in the same manner as such provisions 
     apply to the National Health Service Corps Loan Repayment 
     Program established in subpart III of part D of title III.
       ``(c) Availability of Appropriations.--Amounts available 
     for carrying out this section shall remain available until 
     the expiration of the second fiscal year beginning after the 
     fiscal year for which the amounts were made available.
       ``(d) Health Disparities.--In carrying out this section, 
     the Secretary shall take steps sufficient to ensure the 
     active participation of appropriately qualified minority 
     heath professionals, including extensive outreach and 
     recruitment efforts. In complying with this subsection, the 
     Secretary shall waive the requirement that the recipients of 
     loan repayment assistance agree to engage in minority health 
     research or research into the nature of health disparities 
     that affect racial, ethnic and indigenous populations.
       ``(e) 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.

     ``SEC. 499G. ADDITIONAL AUTHORITIES.

       ``(a) In General.--In overseeing and supporting minority 
     health research, the Director of the Center--
       ``(1) shall assist the Director of the National Center for 
     Research Resources in carrying out section 481(c)(3) and in 
     committing resources for construction at Institutions of 
     Emerging Excellence;
       ``(2) shall assist in the administration of section 492B 
     with respect to the inclusion of members of minority groups 
     as subjects in clinical research; and
       ``(3) subject to section 405(b)(2) and without regard to 
     section 3324 of title 31, United States Code, and section 
     3709 of the Revised Statutes (41 U.S.C. 5), may enter into 
     such contracts and cooperative agreements with any public 
     agency, or with any person, firm, association, corporation, 
     or educational institution, as may be necessary to expedite 
     and coordinate minority health research.
       ``(b) Report to Congress and the Secretary.--The Director 
     of the Center shall each fiscal year prepare and submit to 
     the appropriate committees of Congress and the Secretary a 
     report--
       ``(1) describing and evaluating the progress made in such 
     fiscal year in minority health research conducted or 
     supported by the Institutes;
       ``(2) summarizing and analyzing expenditures made in such 
     fiscal year for activities with respect to minority health 
     research conducted or supported by the National Institutes of 
     Health; and
       ``(3) containing such recommendations as the Director 
     considers appropriate.
       ``(c) Projects for Cooperation Among Public and Private 
     Health Entities.--In carrying out subsection (a), the 
     Director of the Center shall establish projects to promote 
     cooperation among Federal agencies, State, local, and 
     regional public health agencies, and private entities, in 
     minority health research.

     ``SEC. 499H. GENERAL PROVISIONS REGARDING THE CENTER.

       ``(a) Administrative Support for Center.--The Secretary, 
     acting through the Director of the National Institutes of 
     Health, shall provide administrative support and support 
     services to the Director of the Center and shall ensure that 
     such support takes maximum advantage of existing 
     administrative structures at the agencies of the National 
     Institutes of Health.
       ``(b) Required Expertise.--The Director of the Center, in 
     consultation with the Advisory Council and the Center for 
     Scientific Review, shall ensure that scientists with 
     appropriate expertise in research on minority health are 
     incorporated into the review, oversight, and management 
     processes of all research projects in the National Institutes 
     of Health minority health research program and other 
     activities under such program.
       ``(c) Technical Assistance.--The Director of the Center, in 
     consultation with the directors of the national research 
     institutes and centers, shall ensure that appropriate 
     technical assistance is available to applicants for all 
     research projects and other activities supported by the 
     National Institutes of Health minority health research 
     program.
       ``(d) Evaluation and Report.--
       ``(1) Evaluation.--Not later than 5 years after the date of 
     the enactment of this part, the Secretary shall conduct an 
     evaluation to--
       ``(A) determine the effect of this section on the planning 
     and coordination of the minority health research programs at 
     the institutes, centers and divisions of the National 
     Institutes of Health;
       ``(B) evaluate the extent to which this part has eliminated 
     the duplication of administrative resources among such 
     Institutes, centers and divisions; and
       ``(C) provide recommendations concerning future alterations 
     with respect to this part.
       ``(2) Report.--Not later than 1 year after the date on 
     which the evaluation is commenced under paragraph (1), the 
     Secretary shall prepare and submit to the Committee on 
     Health, Education, Labor, and Pensions of the Senate, and the 
     Committee on Commerce of the House of Representatives, a 
     report concerning the results of such evaluation.''.

                      TITLE II--MEDICAL EDUCATION

     SEC. 201. GRANTS FOR HEALTH CARE EDUCATION CURRICULA 
                   DEVELOPMENT.

       Part F of title VII of the Public Health Service Act (42 
     U.S.C. 295j et seq.) is amended by inserting after section 
     791 the following:

     ``SEC. 791A. GRANTS FOR HEALTH PROFESSIONS EDUCATION 
                   CURRICULA DEVELOPMENT.

       ``(a) Grants for Graduate Education Curricula 
     Development.--
       ``(1) In general.--The Secretary, acting through the 
     Administrator for the Health Resources and Services 
     Administration and in collaboration with the Administrator 
     for Health Care Policy and Research and the Deputy Assistant 
     Secretary for Minority Health, may make awards of grants, 
     contracts, or cooperative agreements to public and nonprofit 
     private entities for the purpose of carrying out research 
     projects and demonstration projects to develop curricula to 
     reduce disparity in health care outcomes, including curricula 
     and faculty development for cultural competency in graduate 
     and undergraduate health professions education.
       ``(2) Eligibility.--To be eligible to receive a grant, 
     contract or cooperative agreements under paragraph (1), an 
     entity shall--
       ``(A) be a school of medicine, school of osteopathic 
     medicine, school of dentistry, school of public health, 
     school of nursing, school of pharmacy, school of allied 
     health, or other recognized health profession school; and
       ``(B) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(3) Use of funds.--An entity shall use amounts received 
     under a grant under paragraph (1) to carry out research 
     projects and demonstration projects to develop curricula to 
     reduce disparity in health care outcomes, including curricula 
     for cultural competency in graduate medical education. Such 
     curricula shall focus on the need to remove bias from health 
     care at a personal level as well as at a systematic level.
       ``(4) Number of grants and grant term.--The Secretary shall 
     award not to exceed 20 grants, contracts or cooperative 
     agreements (or combination thereof) under paragraph (1) in 
     each of the first and second fiscal years for which funds are 
     available under subsection (f). The term of each such grant, 
     contract or cooperative agreement shall be 3 years.
       ``(b) Grants for Continuing Health Professional Education 
     Curricula Development.--
       ``(1) In general.--The Secretary, acting through the Health 
     Resources and Services Administration and the Agency for 
     Health Care Policy and Research and in collaboration with the 
     Office of Minority Health, shall award grants, contracts or 
     cooperative agreements to eligible entities for the 
     establishment of demonstration projects to develop curricula 
     to reduce disparity in health care and health outcomes, 
     including curricula for cultural competency, in continuing 
     medical education.
       ``(2) Eligibility.--To be eligible to receive a grant, 
     contract, or cooperative agreement under paragraph (1) an 
     entity shall--
       ``(A) be a school of medicine, school of osteopathic 
     medicine, school of dentistry, school of public health, 
     school of nursing, school of pharmacy, school of allied 
     health, or other recognized health profession school; and
       ``(B) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(3) Use of funds.--An entity shall use amounts received 
     under a grant, contract, or cooperative agreement under 
     paragraph (1)

[[Page S14293]]

     to develop and evaluate the effect and impact of curricula 
     for continuing medical education courses or programs to 
     provide education concerning issues relating to disparity in 
     health care and health outcomes, including cultural 
     competency of health professionals. Such curricula shall 
     focus on the need to remove bias from health care at a 
     personal level as well as at a systemic level.
       ``(4) Number of grants and grant term.--The Secretary shall 
     award not to exceed 20 grants, contracts, or cooperative 
     under paragraph (1) in each of the first and second fiscal 
     years for which funds are available under subsection (f). The 
     term of each such grant shall be 3 years.
       ``(c) Distribution of Projects.--The Secretary shall ensure 
     that, to the extent practicable, projects under subsections 
     (a) and (b) are carried out in each of the principal 
     geographic regions of the United States and address issues 
     associated with different minority groups and health 
     professions.
       ``(d) Monitoring.--An entity that receives a grant, 
     contract or cooperative agreement under subsection (a) or (b) 
     shall ensure that procedures are in place to monitor 
     activities undertaken using grant, contract or cooperative 
     agreement funds. Such entity shall annually prepare and 
     submit to the Secretary a report concerning the effectiveness 
     of curricula developed under the grant contract or 
     cooperative agreement.
       ``(e) Report to Congress.--Not later than January 1, 2002, 
     the Secretary shall prepare and submit to the appropriate 
     committees of Congress, a report concerning the effectiveness 
     of programs funded under this section and a plan to encourage 
     the implementation and utilization of curricula to reduce 
     disparity in health care and health outcomes. A final report 
     shall be submitted by the Secretary not later than January 1, 
     2004.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $3,500,000 for 
     fiscal year 2000, $7,000,000 for fiscal year 2001, $7,000,000 
     for fiscal year 2002, and $3,500,000 for fiscal year 2003.''.

     SEC. 202. NATIONAL CONFERENCE ON CONTINUING HEALTH 
                   PROFESSIONAL EDUCATION AND DISPARITY IN HEALTH 
                   OUTCOMES.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall convene a national conference on continuing 
     health professions education as a method for reducing 
     disparity in health care and health outcomes, including 
     continuing medical education on cultural competency. The 
     conference shall include sessions to address measurements of 
     outcomes to assess the effectiveness of curricula in reducing 
     disparity.
       (b) Participants.--The Secretary of Health and Human 
     Services shall invite minority health advocacy groups, health 
     education entities described in section 741(b)(1) of the 
     Public Health Service Act (as added by section 201), and 
     other interested parties to attend the conference under 
     subsection (a).
       (c) Issues.--The national conference convened under 
     subsection (a) shall address issues relating to the role of 
     continuing medical education in the effort to reduce 
     disparity in health care and health outcomes, including the 
     role of continuing medical education in improving the 
     cultural competency of health professionals and health 
     professions faculty. The conference shall focus on methods to 
     achieve reductions in the disparities in health care and 
     health outcomes through continuing medical education courses 
     or programs and on strategies for measuring the effectiveness 
     of curricula to reduce disparities.
       (d) Publication of Findings.--Not later than 6 months after 
     the convening of the national conference under subsection 
     (a), the Secretary of Health and Human Services shall publish 
     in the Federal Register a summary of the proceedings and the 
     findings of the conference.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.

     SEC. 203. ADVISORY COMMITTEE.

       (a) Establishment.--The Secretary of Health and Human 
     Services shall establish an advisory committee to provide 
     advice to the Secretary on matters related to the 
     development, implementation, and evaluation of graduate and 
     continuing education curricula for health care professionals 
     to decrease the disparity in health care and health outcomes, 
     including curricula on cultural competency as a method of 
     eliminating health disparity.
       (b) Membership.--Not later than 3 months after the date on 
     which amounts are appropriated to carry out this section, the 
     Secretary of Health and Human Services shall appoint the 
     members of the advisory committee. Such members shall be 
     appointed from among individuals who--
       (1) unless otherwise specified, are not officers or 
     employees of the Federal Government;
       (2) are experienced in issues relating to health disparity; 
     and
       (3) meet such other requirements as the Secretary 
     determines appropriate;

     and shall include a representative of the Office of Minority 
     Health under section 1707 of the Public Health Service Act 
     (42 U.S.C. 300u-6) and such other representatives of offices 
     and agencies of the Public Health Service as the Secretary 
     determines to be appropriate. The Secretary shall ensure that 
     members of minority communities are well represented on the 
     advisory committee. Such representatives shall include 1 or 
     more individuals who serve on the advisory committee under 
     section 1707(c) of such Act.
       (c) Collaboration.--The advisory committee shall carry out 
     its duties under this section in collaboration with the 
     Office of Minority Health of the Department of Health and 
     Human Services, and other offices, centers, and institutes of 
     the Department of Health and Human Services, and other 
     Federal agencies.
       (d) Termination.--The advisory committee shall terminate on 
     the date that is 4 years after the date on which the first 
     member of the committee is appointed.
       (e) Existing Committee.--The Secretary may designate an 
     existing advisory committee operating under the authority of 
     the Office of Minority Health of the Department of Health and 
     Human Services to serve as the advisory committee under this 
     section.

     SEC. 204. CULTURAL COMPETENCY CLEARINGHOUSE.

       (a) Establishment.--The Director of the Office of Minority 
     Health of the Department of Health and Human Services shall 
     establish within the Resource Center of the Office of 
     Minority Health, or through the awarding of a contract 
     provide for the establishment of, an information 
     clearinghouse for curricula to reduce racial and ethnic 
     disparity in health care and health outcomes. The 
     clearinghouse shall facilitate and enhance, through the 
     effective dissemination of information, knowledge and 
     understanding of practices that lead to decreases in the 
     disparity of health across minority and ethnic groups, 
     including curricula for continuing medical education to 
     develop cultural competency in health care professionals.
       (b) Availability of Information.--Information contained in 
     the clearinghouse shall be made available to minority health 
     advocacy groups, health education entities described in 
     section 791A(b)(2)(A) of the Public Health Service Act (as 
     added by section 201), health maintenance organizations, and 
     other interested parties.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this section.

   TITLE III--MINORITY HEALTH RESEARCH BY THE AGENCY FOR HEALTH CARE 
                          POLICY AND RESEARCH.

     SEC. 301. MINORITY HEALTH RESEARCH BY THE AGENCY FOR HEALTH 
                   CARE POLICY AND RESEARCH.

       (a) In General.--Part A of title IX of the Public Health 
     Service Act (42 U.S.C. 299 et seq.) is amended by adding at 
     the end the following:

     ``SEC. 906. RESEARCH ON MINORITY HEALTH DISPARITIES.

       ``(a) In General.--The Administrator of the Agency for 
     Health Care Policy and Research shall--
       ``(1) conduct and support research to identify how to 
     improve the quality and outcomes of health care services for 
     minority populations and the causes of health disparities for 
     minority populations, including barriers to health care 
     access;
       ``(2) conduct and support research and support 
     demonstration projects to identify, test, and evaluate 
     strategies for eliminating the disparities described in 
     paragraph (1) and promoting effective interventions;
       ``(3) develop measures for the assessment and improvement 
     of the quality and appropriateness of health care services 
     provided to minority populations; and
       ``(4) in carrying out 902(c), provide support to increase 
     the number of minority health care researchers and the health 
     services research capacity of institutions that train 
     minority health care researchers.
       ``(b) Research and Demonstration Projects.--
       ``(1) in general.--In carrying out subsection (a), the 
     Administrator shall conduct and support research to--
       ``(A) identify the clinical, cultural, socioeconomic, and 
     organizational factors that contribute to health disparities 
     for minority populations (including examination of patterns 
     of clinical decisionmaking and of the availability of support 
     services);
       ``(B) identify and evaluate clinical and organizational 
     strategies to improve the quality, outcomes, and access to 
     care for minority populations;
       ``(C) support demonstrations to test such strategies; and
       ``(D) widely disseminate strategies for which there is 
     scientific evidence of effectiveness.
       ``(2) Use of certain strategies.--In carrying out this 
     section the Administrator shall implement research strategies 
     and mechanisms that will enhance the involvement of minority 
     health services researchers, institutions that train minority 
     researchers, and members of minority populations for whom the 
     Agency is attempting to improve the quality and outcomes of 
     care, including--
       ``(A) centers of excellence that can demonstrate, either 
     individually or through consortia, a combination of multi-
     disciplinary expertise in outcomes or quality improvement 
     research and a demonstrated capacity to engage minority 
     populations in the planning, conduct and translation of 
     research, with linkages to relevant sites of care;
       ``(B) provider-based research networks, including health 
     plans, facilities, or delivery system sites of care 
     (especially primary care), that make extensive use of 
     minority health care providers or serve minority patient 
     populations and have the capacity to

[[Page S14294]]

     evaluate and promote quality improvement; and
       ``(C) other innovative mechanisms or strategies that will 
     facilitate the translation of past research investments into 
     clinical practices that can reasonably be expected to benefit 
     these populations.
       ``(c) Quality Measurement Development.--
       ``(1) In general.--To ensure that minority populations 
     benefit from the progress made in the ability of individuals 
     to measure the quality of health care delivery, the 
     Administrator of the Agency for Health Care Policy and 
     Research shall support the development of quality of health 
     care measures that assess the experience of minority 
     populations with health care systems, such as measures that 
     assess the access of minority populations to health care, the 
     cultural competence of the care provided, the quality of the 
     care provided, the outcomes of care, or other aspects of 
     health care practice that the Administrator determines to be 
     important.
       ``(2) Report.--Not later than 24 months after the date of 
     enactment of this section, the Secretary, acting through the 
     Administrator, shall prepare and submit to the appropriate 
     committees of Congress a report describing the state-of-the-
     art of quality measurement for minority populations which 
     will identify critical unmet needs, the current activities of 
     the Department to address those needs, and a description of 
     related activities in the private sector.''.
       (b) Funding.--Section 926 of the Public Health Service Act 
     (42 U.S.C. 299c-5) is amended by adding at the end the 
     following:
       ``(f) Minority Health Disparities Research.--For the 
     purpose of carrying out the activities under section 906, 
     there are authorized to be appropriated such sums as may be 
     necessary for each of the fiscal years 2000 through 2004.''.

        TITLE IV--DATA COLLECTION RELATING TO RACE OR ETHNICITY

     SEC. 401. STUDY AND REPORT BY NATIONAL ACADEMY OF SCIENCES.

       (a) Study.--The Secretary of Health and Human Services 
     shall enter into a contract with the National Academy of 
     Sciences for the conduct of a comprehensive study of the 
     Department of Health and Human Services' data collection 
     systems and practices, and any data collection or reporting 
     systems required under any of the programs or activities of 
     the Department, relating to the collection of data on race or 
     ethnicity, including other Federal data collection systems 
     (such as the Social Security Administration) with which the 
     Department interacts to collect relevant data on race and 
     ethnicity.
       (b) Report.--Not later than 1 year after the date of 
     enactment of this Act, the National Academy of Sciences shall 
     prepare and submit to the Committee on Health, Education, 
     Labor, and Pensions of the Senate and the Committee on 
     Commerce of the House of Representatives, a report that--
       (1) identifies the data needed to support efforts to 
     evaluate the effects of race and ethnicity on access to and 
     quality of health care and other services and on disparity in 
     health and other social outcomes, the data needed to define 
     appropriate quality of care measures to assess the 
     equivalence of health care outcomes in health care payer 
     systems, and the data needed to enforce existing protections 
     for equal access to health care;
       (2) examines the effectiveness of the systems and practices 
     of the Department of Health and Human Services described in 
     subsection (a), including demonstration projects of the 
     Department, and the effectiveness of selected systems and 
     practices of other Federal and State agencies and the private 
     sector, in collecting and analyzing such data;
       (3) contains recommendations for ensuring that the 
     Department of Health and Human Services, in administering its 
     entire array of programs and activities, collects, or causes 
     to be collected, accurate and complete information relating 
     to race and ethnicity as may be necessary to monitor access 
     to and quality of health care and to ensure the capability to 
     monitor and enforce civil rights laws; and
       (4) includes projections about the costs associated with 
     the implementation of the recommendations described in 
     paragraph (3), and the possible effects of the costs on 
     program operations.
       (c) Authorization of Appropriations.--There are authorized 
     to be appropriated such sums as may be necessary for fiscal 
     year 2000 to carry out this section.

                       TITLE V--PUBLIC AWARENESS

     SEC. 501. PUBLIC AWARENESS.

       (a) Public Awareness Campaign.--The Secretary of Health and 
     Human Services, acting through the Surgeon General and the 
     Director of the Office for Civil Rights, shall conduct a 
     national media campaign for the purpose of informing the 
     public about racial and ethnic disparities in health care and 
     health outcomes.
       (b) Authorization of Appropriations.--For the purpose of 
     carrying out subsection (a), there are authorized to be 
     appropriated such sums as may be necessary for fiscal year 
     2000.
                                  ____


 Statement of Louis W. Sullivan, M.D., President, Morehouse School of 
   Medicine on the Health Care Fairness Act of 1999, November 5, 1999

       Thank you for the opportunity to speak in strong support of 
     the Health Care Fairness Act of 1999, which would elevate the 
     NIH's Office of Research on Minority Health to a National 
     Center for Research on Minority Health and Health 
     Disparities. Senator Kennedy and his colleagues are to be 
     commended for their initiative.
       For too many years, this country has witnessed one 
     disturbing report after another detailing the growing 
     disparities in health status between our minority and 
     majority populations. Unfortunately, while these reports 
     continue, not enough has been done to change this shocking 
     and unacceptable dynamic.
       Infant mortality is nearly twice the rate for minorities as 
     it is for non-minorities.
       African-Americans, Hispanics, and Native Americans 
     disproportionately suffer a variety of health care 
     disparities including cancer, diabetes, heart disease and 
     stroke.
       The HIV virus and AIDS cases result in disproportionate 
     suffering in minority populations. While minorities in the 
     United States represent about 28% of the population, 
     minorities account for 54% of all AIDS cases.
       The above mentioned are only a few of the health care 
     challenges faced by minorities and disadvantaged populations.
       If we as a nation are to solve these complex problems, we 
     must take an aggressive approach on all fronts. At the core 
     of improving the health status for all Americans is a strong 
     biomedical research effort to understand the factors which 
     contribute to health problems.
       During the time I was HHS Secretary, I was very pleased to 
     work with the Congress, particularly Congressman Louis Stokes 
     (D-OH) to establish the existing Office for Research on 
     Minority Health at NIH. Notwithstanding the success of this 
     office in highlighting and addressing health disparities, and 
     in supporting research focused on improving minority health, 
     the magnitude of the problem of health status disparities 
     warrants an even more aggressive effort.
       At the beginning of this year, we were very pleased to 
     begin working with Congressman Jesse Jackson, Jr. (D-IL), 
     Charlie Norwood (R-GA), J.C. Watts (R-OK), and Congresswoman 
     Donna Christensen (D-VI) to introduce H.R. 2391, the National 
     Center for Domestic Health Disparities Act of 1999. The 
     bipartisan Jackson bill, and the legislation that is being 
     introduced today, would elevate the existing NIH Office of 
     Research on Minority Health to a National Center for Research 
     on Minority Health and Health Disparities, and provide the 
     National Center with four new major mechanisms, which the 
     existing office does not have. They are:
       (1) The Director of the Center will participate with other 
     Institute and Center Directors to determine research policy 
     and initiatives at NIH.
       (2) The Center will serve as the catalyst for forward-
     thinking, strategic planning for the entire NIH, in order to 
     bring all of NIH's considerable resources to bear, to close 
     the health status gap.
       (3) The bill empowers the Center Director to make peer-
     reviewed grants in areas of promising research which are not 
     being addressed by the existing centers and institutes at 
     NIH.
       (4) There will be a new program of support for research 
     excellence at those academic health centers which have 
     demonstrated a historic commitment to studying and addressing 
     diseases which disproportionately affect minority Americans. 
     As a result of this legislation, minority investigations and 
     institutions like Morehouse School of Medicine, of which I am 
     President, Meharry Medical College, and others will have 
     access to the types of resources necessary to build and 
     enhance research infrastructure, and seek to compete on a 
     level playing field with other prominent institutions.
       I am grateful that both of the comprehensive bills which 
     are being introduced today in the Senate and the House embody 
     these four principles, and I am particularly pleased that 
     both bills enjoy strong bipartisan support.
       Today, I am urging members of Congress in both chambers, 
     and from both sides of the aisle to support and cosponsor 
     these important bills. We need to act as quickly as possible 
     to reverse the persistent health status gap, which affects 
     some 28% of our citizens.
                                  ____

                                           Association of Minority


                                   Health Professions Schools,

                                 Washington, DC, November 3, 1999.
     Hon. Edward M. Kennedy,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Senator Kennedy: Thank you for introducing the Health 
     Care Fairness Act of 1999. This important legislation would, 
     among other things, elevate the existing Office of Research 
     on Minority Health at the National Institutes of Health (NIH) 
     to a National Center for Research on Minority Health.
       The National Center would be better able to respond to the 
     health status disparity crisis facing minority Americans and 
     medically underserved populations through the establishment 
     of the following provisions:
       The Director of the new Center would actively participate 
     with Institute and Center Directors in planning major NIH 
     initiatives.
       This includes discussing how NIH's considerable resources 
     can be used to effectively address health status disparities.
       The Center Director would be able to make peer-reviewed 
     grants in areas of promising research not currently being 
     addressed by the NIH institutes and centers.

[[Page S14295]]

       The Center would establish a Centers of Excellence program 
     to support those academic health centers which have a 
     historic commitment to studying diseases which 
     disproportionately affect minority and disadvantaged 
     populations.
       On behalf of the Association of Minority Health Professions 
     Schools, I extend our enthusiastic support for this important 
     legislation. Please advise me as to how we can work with you 
     and other members of the Senate to pass this important 
     legislation.
       Thank you again for your leadership in this area.
           Sincerely,
                                               Ronny B. Lancaster,
     President.
                                  ____



                                 National Medical Association,

                                 Washington, DC, November 4, 1999.
     Hon. Edward Kennedy,
     Ranking Minority, Senate Committee on Health, Education, 
         Labor and Pensions, Hart Senate Office Building, 
         Washington, DC.
       Dear Senator Kennedy: The National Medical Association 
     (NMA) is pleased to support the ``Health Care Fairness Act of 
     1999.'' While the nation has experienced tremendous advances 
     in biomedical research, the benefits of these advances have 
     not fully transferred to the African American and other 
     minority communities, which are unduly plagued with 
     disproportionate rates of death and disease. As the changing 
     demographics of the United States yield growing racial and 
     ethnic minority populations, it is absolutely essential that 
     the nation become more proactive in addressing the critical 
     health and biomedical research needs of communities of color.
       Critical provisions of the ``Health Care Fairness Act of 
     1999'' include:
       The establishment of the Center for Research on Minority 
     Health and Health Disparities at the National Institutes of 
     Health (NIH);
       The provision of funds for peer-reviewed minority health-
     focused research grants, at the Institutes and Centers of the 
     NIH;
       The requirement to establish a comprehensive plan and 
     budget for the conduct and support of all minority research 
     activities of the NIH agencies; and
       The establishment of a grant program to support the 
     development of culturally competent curricula in health care 
     education.
       The NMA supports the ``Health Care Fairness Act of 1999'' 
     and believes that this legislation will create important 
     opportunities for the nation to make concrete advances in 
     it's effort to close the health disparity gap.
           Sincerely,
                                            Walter W. Shervington,
     President.
                                  ____

                                                    Association of


                                    Black Cardiologists, Inc.,

                                    Atlanta, GA, November 4, 1999.
     Hon. Edward M. Kennedy,
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Honorable Senator Kennedy: The Association of Black 
     Cardiologists, Inc. (ABC) would like to offer its full 
     support of The Health Care Fairness Act of 1999. Its premise 
     and objectives serve to meet the creativity and foresight 
     needed to eliminate the disparity in health care and the 
     mortality rate among African Americans versus White 
     Americans. We wholeheartedly endorse the efforts of this bill 
     to improve minority health, minority health research, data 
     collection relating to race or ethnicity, and the promotion 
     of medical education.
       A robust economy and years of government pressure have 
     helped move minority groups closer to the mainstream, but 
     when it comes to health, studies show a stubborn, daunting 
     and in some respects continuous disparity between Black and 
     White Americans. For decades, Blacks have suffered higher 
     death rates from nearly all-major causes including asthma, 
     diabetes, cancer, major infectious diseases and 
     cardiovascular diseases. The ABC recognizes that 
     cardiovascular diseases, the leading cause of deaths in the 
     United States, affect every family. CVD is the major cause of 
     death for the African American population. Contrary to 
     popular belief, the number one killer in the African American 
     community is not violence, cancer, or AIDS. Blacks are more 
     likely to die from cardiovascular disease than from any other 
     disease. We can reduce the cost of health care, improve 
     patient adherence to prescribed drug regimens, and improve 
     the cultural competence of medical professionals with the 
     passing of this bill.
       The ABC mission states: ``We believe that good health is 
     the cornerstone of progress for our people. We are firm in 
     our resolve to make exemplary health care accessible and 
     affordable to all in need, dedicated to lowering the high 
     rate of cardiovascular diseases in minority populations and 
     committed to advocacy and diversity. We are guided by high 
     ethics in all our transactions and strive for excellence in 
     our training and skills.''
       Our mission throughout our organization is to assure that 
     `African American Children know their Grandparents'. 
     Typically, African American men, with a life expectancy of 
     less than 65 years, die without the joy of nurturing and 
     guiding their grandchildren as only grandparents can.
       What we know from our past efforts to address this issue is 
     that it takes a focus effort to increase awareness, to 
     educate, and to eliminate the disparities in health care. We 
     are pleased that this bill will take this direction. Little 
     progress will be made without a strong partnership among 
     medical, public health and community organizations, and 
     government. Please let us know what else we can do to aid in 
     this effort. We applaud your commitment and stand ready to 
     work actively with you to accomplish these objectives.
           Sincerely,
                                                    B. Waine Kong,
     Chief Executive Officer.
                                  ____

                                                 Boston University


                                         School of Management,

                                     Boston, MA, October 14, 1999.
     Senator Edward M. Kennedy,
     Russell Senate Building,
     U.S. Senate, Washington, DC.
       Dear Senator Kennedy: I am writing to register my strong 
     and enthusiastic support for the Comprehensive Minority 
     Health Bill, that is currently under consideration by the 
     United States Senate. Considerable research has documented 
     the great disparities in minority health status and health 
     outcomes nationally. Racial and ethnic minorities are known 
     to suffer disproportionately high mortality and morbidity 
     rates, impaired access to health care, and lower quality 
     health care services. This bill includes a host of provisions 
     that would contribute importantly to the correction of this 
     imbalance. The Bill's proposals; to establish a NIH ``Center 
     for Health Disparities Research;'' to provide grants to 
     support programs of excellence in biomedical research 
     education for underrepresented minorities; to direct AHCPR to 
     study the causes of health disparities; to expand DHHS 
     collection/reporting of race/ethnicity data; to improve the 
     quality/outcomes of health care services to minority 
     populations; and to develop graduate/continuing medical 
     education curricula devoted to the reduction of disparity in 
     health care and health outcomes, all represent strong actions 
     intended to address the continuing health imbalance for 
     racial/ethnic minorities.
       I write as an academic researcher and educator, and as the 
     national director of the Robert Wood Johnson Foundation's 
     Scholarships in Health Policy Research Program, an initiative 
     that supports fellowships for talented young social 
     scientists who are interested in conducting research on 
     critical health and health policy issues facing the United 
     States, including racial/ethnic disparities in health status 
     and health outcomes. I write also as a citizen who is 
     concerned with the needless loss of human potential and 
     quality of life resulting from the continuing health 
     disparities in our society. I call upon you and your 
     colleagues in the U.S. Senate to support this Bill in all of 
     its elements.
           Respectfully submitted,
                                                    Alan B. Cohen,
         Professor of Health Policy and Management; Director, 
           Health Care Management; Director, RWJF Scholars in 
           Health Policy Research Program.
                                  ____



                                                         UCLA,

                                Los Angeles, CA, October 13, 1999.
     Senator Edward M. Kennedy,
     Russell Senate Building,
     U.S. Senate, Washington, DC.
       Dear Senator Kennedy: I write to register my strong and 
     enthusiastic support for the Comprehensive Minority Health 
     Bill currently under consideration by the United States 
     Senate. Considerable research has documented the great 
     disparities in minority health status and health outcomes 
     nationally. Race and ethnic minorities are known to suffer 
     disproportionate mortality and morbidity rates and lower 
     quality health care services. This bill includes a host of 
     provisions that will contribute to the correction of this 
     imbalance. The Bill's proposals: to establish a NIH ``Center 
     for Health Disparities Research''; to provide grants to 
     support programs of excellence in biomedical research 
     education for underrepresented minorities; to direct AHCPR to 
     study the causes of health disparities; to expand HHS 
     collection/reporting of race/ethnicity data and to improve 
     the quality/outcomes of health care services to minority 
     populations and to develop graduate/continuing medical 
     education curricula devoted to the reduction of disparity in 
     health care and health outcomes represent strong actions 
     intended to address the continuing health imbalance for 
     racial/ethnic minorities.
       I write as an academic researcher and citizen who is 
     concerned with the needless loss of human potential and 
     quality of life resulting from the continuing health 
     disparities in our society. I call upon you and your 
     colleagues in the U.S. Senate to support this Bill in all of 
     its elements.
           Respectfully submitted,
                                                  Walter R. Allen,
     Professor of Sociology.
                                  ____

     Attention: Ms. Stephanie Robinson

                                                 October 13, 1999.
     Senator Kennedy,
     Dirksen Senate Building,
     Washington, DC.
       Dear Senator Kennedy: I have read with interest your 
     proposed changes and budget recommendations for the Office of 
     Minority Health ``Improving Minority Health Through NIH. As a 
     scholar who does work and collaborations in the field of 
     minority health, and the Chair of a Sociology and 
     Anthropology Department with 62 young scholars in our 
     Graduate Programs, many of whom care about these issues, we 
     are collectively pleased to see this bill brought forward.
       Support for intervention and prevention research (of 
     significance) in our community

[[Page S14296]]

     is too long over overdue. I have held grants from the 
     National Cancer Institute and the National Science Foundation 
     and I know first hand about the obstacles of under funding 
     and a focus that is primarily on advocacy and community based 
     ``feel good'' projects rather than solid research. Research 
     that could possibly bring about some parity in health and 
     health care for people of color in our society. We in our 
     Medical Sociology Program and colleagues who work in the many 
     disciplines connected to health and qualify of life issues 
     applaud you and bring our support by way of many letters like 
     this one. Thank you.
           Joy,
                                               Florence B. Bonner,
                                                            Chair.
                                 ______