[Congressional Record Volume 146, Number 81 (Friday, June 23, 2000)]
[Senate]
[Pages S5713-S5719]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS, 2001
The PRESIDING OFFICER. Under the previous order, the Senate will now
resume consideration of H.R. 4577, which the clerk will report.
The legislative clerk read as follows:
A bill (H.R. 4577) making appropriations for the
Departments of Labor, Health and Human Services, and
Education, and related agencies for the fiscal year ending
September 30, 2001, and for other purposes.
Pending:
McCain amendment No. 3610, to enhance protection of
children using the Internet.
Mr. SPECTER. Mr. President, the Labor, Health and Human Services, and
Education bill before the Senate today contains a program level of
$104.5 billion, an increase of $7.9 billion or 8.2 percent over the
fiscal year 2000 program level. This program level was achieved by
savings in the following areas: The temporary assistance to needy
families, supplemental security income, and the State children's health
insurance programs. Further, savings were also achieved by advance
funding an additional $2.3 billion of education dollars into fiscal
year 2002, while keeping the same overall level of advances as last
year. The actual budget authority in the bill is $97.35 billion, the
full amount of the subcommittee's allocation under section 302(b) of
the Budget Act.
Given the subcommittee's allocation there were inadequate resources
to sufficiently fund important health, education and training programs.
Therefore savings needed to be found in order to expand these high
priority discretionary programs. For example, savings were achieved by
shifting $1.9 billion in unspent fiscal year 1998 State Children's
Health Insurance Program (SCHIP) funds into fiscal year 2003. Currently
38 States and the District of Columbia have not spent their SCHIP funds
which are due to expire on September 30, 2000. By reappropriating
funds, these 38 States and the District of Columbia will have an
opportunity to spend these dollars in future years.
The recommendations made in the bill both keeps faith with the budget
agreement and addresses the health,
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education, employment and training priorities of the Senate.
While consistent with the budget agreement, many tough choices had to
be made. Senator Harkin and I received over 1,800 requests from Members
for expanded funding for programs within the subcommittee's
jurisdiction. In order to stay within the allocation and balance the
priorities established in the budget agreement and expressed in Member
requests, we had to take a critical look at all of the programs within
the bill. I want to take this opportunity to thank the distinguished
Senator from Iowa, Mr. Harkin, for his hard work and support in
bringing this bill through the committee and on to the floor for full
consideration by all Senators.
The programs funded within the subcommittee's jurisdiction provide
resources to improve the public health and strengthen biomedical
research, assure a quality education for America's children, and offer
opportunities for individuals seeking to improve job skills. I'd like
to mention several important accomplishments of this bill.
Nothing is more important than a persons health and few things are
feared more than ill health. Medical research into understanding,
preventing, and treating the disorders that afflict men and women in
our society is the best means we have for protecting our health and
combating disease.
Since January of 2000, the Labor-HHS Subcommittee has held nine
hearings on medical research issues.
We have heard testimony from NIH Institute Directors, medical experts
from across the United States, patients, family members, and advocates
asking for increased biomedical research funding to find the causes and
cures for diseases Alzheimer's and Parkinson's disease, ALS, AIDS,
cancer, diabetes, heart disease, and many other serious health
disorders. We have also heard from advocates on both sides of the stem
cell debate. The bill before the Senate contains $20.5 billion for the
National Institutes of Health, the crown jewel of the Federal
government. The $2.7 billion increase over the fiscal year 2000
appropriation will support medical research that is being conducted at
institutions throughout the country. This increase will continue the
effort to double NIH by fiscal year 2003. These funds will be critical
in catalyzing scientific discoveries that will lead to new treatments
and cures for a whole host of diseases.
Head Start: To enable all children to develop and function at their
highest potential, the bill includes $6.2 billion for the Head Start
program, an increase of $1 billion over last year's appropriation. This
increase will provide services to an additional 60,000 children
bringing the total amount of kids served in fiscal year 2001 to
936,000. This increase will put us on track to enroll one million
children in Head Start by the year 2002.
Community health centers: To help provide primary health care
services to the medically indigent and underserved populations in rural
and urban areas, the bill contains $1.1 billion for community health
centers. This amount represents an increase of $100 million over the
fiscal year 2000 appropriation. These centers will provide health care
to nearly 11 million low-income patients, 4.5 million of whom are
uninsured.
Youth Violence Initiative: The bill includes $1.2 billion for
programs to assist communities in preventing youth violence. This
initiative, begun in fiscal year 2000, will continue to address youth
violence in a comprehensive way by coordinating programs throughout the
Federal government to improve research, prevention, education and
treatment strategies to identify and combat youth violence.
Drug demand initiative: To curb the effects of drug abuse, the bill
includes $3.7 billion for programs to help reduce the demand for drugs
in this country. Funds have been increased for drug education in this
Nation's schools; youth offender drug counseling, education and
employment programs; and substance abuse research and prevention.
Women's health: Again this year, the committee has placed a very high
priority on women's health. The bill before the Senate provides $4.1
billion for programs specifically addressing the health needs of women.
Included in this amount is $27.4 million for the Public Health Service,
Office of Women's Health, an increase of $6.1 million over last year's
funding level to continue and expand programs to develop model health
care services for women, provide monies for a comprehensive review of
the impact of heart disease on women, and to launch an osteoporosis
public education campaign aimed at teenagers. Also included is $253.9
million for family planning programs; $169 million to support the
programs that provide assistance to women who have been victims of
abuse and to initiate and expand domestic violence prevention programs
to begin; $149.9 million for sexually transmitted diseases; $177.5
million for breast and cervical cancer screening; and $2.7 billion for
research directed at women at the National Institutes of Health.
Medical error reduction: The Labor-HHS Subcommittee held several
hearings to explore the factors leading to medical errors and received
testimony from family members and patients detailing their experiences
with medical mistakes. The Institute of Medicine also gave testimony
and outlined findings from their recent report which indicated that
98,000 deaths occur each year because of medical errors. The bill
before the Senate contains $50 million to determine ways to reduce
medical errors and also recommends that guidelines be developed to
collect data related to patient safety, best practices to reduce error
rates and ways to improve provider training.
LIHEAP: The bill maintains $1.1 billion for the Low Income Home
Energy Assistance Program (LIHEAP). The bill also provides an
additional $300 million in emergency appropriations. LIHEAP is a key
program for low income families in Pennsylvania and cold weather states
throughout the nation. Funding supports grants to states to deliver
critical assistance to low income households to help meet higher energy
costs.
Aging programs; For programs serving the elderly, the bill before the
Senate recommends $2.4 billion, an increase of $133 million over the
fiscal year 2000 appropriation. Included is: $440.2 million for the
community service employment program which provides part-time
employment opportunities for low-income elderly; $325.1 million for
supportive services and senior centers; $521.4 million for congregate
and home-delivered nutrition services; and $187.3 million for the
National Senior Volunteer Corps. Also, the bill provides increased
funds for research into the causes and cures of Alzheimer's disease and
other aging related disorders; funds to continue geriatric education
centers; and the Medicare insurance counseling program.
AIDS: The bill includes $2.5 billion for AIDS research, prevention
and services. Included in this amount is $1.6 billion for Ryan White
programs, an increase of $55.4 million; $762.1 million for AIDS
prevention programs at the Centers for Disease Control; $60 million for
global and minority AIDS activities within the Public Health and Social
Services Funds; and $85 million for benefit payments authorized by the
Ricky Ray Hemophilia Trust Fund Act.
Education: To enhance this Nation's investment in education, the bill
before the Senate contains $40.2 billion in discretionary education
funds, an increase of $4.6 billion over last year's funding level, and
$100 million more than the President's budget request.
Education for disadvantaged children: For programs to educate
disadvantaged children, the bill recommends $8.9 billion, an increase
of $177.8 million over last year's level. These funds will provide
services to approximately 13 million school children. The bill also
includes $185 million for the Even Start program, an increase of $35
million over the 2000 appropriation. Even Start provides education
services to low-income children and their families.
Title VI block grant: For the Innovative education program strategies
State grant program, the bill contains $3.1 billion, an increase of
$2.7 billion over fiscal year 2000. Within this amount, $2.7 billion is
to be used to assist local educational agencies, as part of their
locally developed strategies, to improve academic achievement of
students. Funds may be used to address the shortage of highly qualified
teachers, reduce class size, particularly in the early grades, or for
renovation and construction of school facilities. How the funds shall
be spent is at the sole discretion of the local educational agency.
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Impact aid: For impact aid programs, the bill includes $1.030
billion, an increase of $123.5 million over the 2000 appropriation.
Included in the recommendation is: $50 million for payments for
children with disabilities; $818 million for basic support payments, an
increase of $80.8 million; $82 million for heavily impacted districts;
$25 million for construction and $47 million for payments for Federal
property.
Bilingual education: The bill provides $443 million to assist in the
education of immigrant and limited-English proficient students. This
recommendation is an increase of $37 million over the 2000
appropriation and will provide instructional services to approximately
1.3 million children.
Special education: One of the largest increases recommended in this
bill is the $1.3 billion for special education programs. The $7.1
billion provided will help local educational agencies meet the
requirement that all children with disabilities have access to a free,
appropriate public education, and all infants and toddlers with
disabilities have access to early intervention services. These funds
will serve an estimated 6.4 million children age 3-21, at a cost of
$984 per child. While also supporting 580,500 preschoolers at a cost of
$672 per child.
TRIO: To improve post-secondary education opportunities for low-
income first-generation college students, the committee recommendation
provides $736.5 million for the TRIO program, a $91.5 million increase
over the 2000 appropriation. These additional funds will assist in more
intensive outreach and support services for low income youth.
Student aid: For student aid programs, the bill provides $10.6
billion, an increase of $1.3 billion over last year's amount. Pell
grants, the cornerstone of student financial aid, have been increased
by $350 for a maximum grant of $3,650. The supplemental educational
opportunity grants program has also been increased by $70 million, the
work study program was increased by $77 million and the Perkins loans
programs is increased by $30 million.
21st Century Community Learning Centers: For the 21st Century After
School program, the bill provides $600 million, an increase of $146.6
million over last year's level. This program supports rural and inner-
city public elementary and secondary schools that provide extended
learning opportunities and offer recreational, health, and other social
services programs. The bill also includes language to permit funds to
be provided to community-based organizations.
Job training: In this Nation, we know all too well that unemployment
wastes valuable human talent and potential, and ultimately weakens our
economy. The bill before us today provides $5.4 billion for job
training programs, $16.7 million over the 2000 level. Also included is
$652.4 million, an increase of $19.2 million for Job Corps operations;
$950 million for Adult training; and $1.6 billion for retraining
dislocated workers. Also includes is $20 million for a new program to
upgrade worker skills. These funds will help improve job skills and
readjustment services for disadvantaged youth and adults.
Workplace safety: The bill provides $1.3 billion for worker
protection programs, an increase of $90 million above the 2000
appropriation. While progress has been made in this area, there are
still far too many work-related injuries and illnesses. The funds
provided will continue the programs that inspect business and industry,
assist employers in weeding out occupational hazards and protect
workers' pay and pensions.
There are many other notable accomplishments in this bill, but for
the sake of time, I mentioned just several of the key highlights, so
that the Nation may grasp the scope and importance of this bill.
In closing, Mr. President, I again want to thank Senator Harkin and
his staff and the other Senators on the subcommittee for their
cooperation in a very tough budget year.
The PRESIDING OFFICER. Under the previous order, the Senator from
Missouri, Mr. Bond, is recognized to call up an amendment regarding
community health centers.
Mr. BOND. Mr. President, there is another pending amendment; is that
correct?
The PRESIDING OFFICER. The Senator is correct.
Mr. BOND. I ask unanimous consent that the amendment be set aside.
The PRESIDING OFFICER. Without objection, it is so ordered.
Amendment No. 3602
(Purpose: To increase funding for the consolidated health centers)
Mr. BOND. Mr. President, amendment No. 3602 is at the desk. I ask
that it be called up for immediate consideration.
The PRESIDING OFFICER. The clerk will report the amendment.
The legislative clerk read as follows:
The Senator from Missouri [Mr. Bond], for himself, Mr.
Hollings, Mr. Cochran, Mr. Daschle, Mr. Hutchinson, Mr.
Kennedy, Mr. DeWine, Mrs. Lincoln, Mr. Abraham, Mr. Akaka,
Mr. Ashcroft, Mr. Baucus, Mr. Bingaman, Mrs. Boxer, Mr.
Breaux, Mr. Bryan, Mr. Burns, Mr. Campbell, Mr. L. Chafee,
Mr. Cleland, Ms. Collins, Mr. Craig, Mr. Crapo, Mr. Dodd, Mr.
Dorgan, Mr. Durbin, Mr. Edwards, Mr. Enzi, Mr. Feingold, Mrs.
Feinstein, Mr. Frist, Mr. Grams, Mr. Inouye, Mr. Jeffords,
Mr. Johnson, Mr. Kerry, Mr. Kohl, Ms. Landrieu, Mr. Leahy,
Mr. Levin, Mr. Lugar, Mr. Murkowski, Mrs. Murray, Mr. Robb,
Mr. Rockefeller, Mr. Santorum, Mr. Smith of Oregon, Ms.
Snowe, Mr. Warner, Mr. Wellstone, Mr. Wyden, Mr. Schumer, Mr.
Lautenberg, Mr. Bayh, Mr. Grassley, Mr. Sarbanes, Mr. Roth,
Mr. Hatch, and Mr. Conrad, proposes an amendment numbered
3602.
Mr. BOND. Mr. President, I ask unanimous consent that further reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:
On page 23, line 23, strike ``4,522,424,000'' and replace
with ``4,572,424,000''.
On page 92, between lines 4 and 5, insert the following:
Sec. . Amounts made available under this Act for the
administrative and related expenses for departmental
management for the Department of Labor, the Department of
Health and Human Services, and the Department of Education
shall be reduced on a pro rata basis by $50,000,000.
Mr. BOND. Mr. President, I rise to offer what I think is a very
important amendment to increase the funding this bill provides for a
vital piece of our Nation's health care system--our community health
centers.
This amendment, which I am very pleased to offer in conjunction with
my colleague, Senator Hollings of South Carolina, who has been a long-
time supporter of community health centers--as was the late Senator
from Rhode Island, the father of the distinguished occupant of the
chair, who was a great champion of community health centers--along with
a total of 58 cosponsors, would increase funding for community health
centers by a total of $50 million for this coming year. That is a $50
million increase over that which is already included. The offset we use
to fund this health center increase is a reduction in the departmental
management fund for the Departments of Labor, Health and Human
Services, and Education.
The managers of this bill, Senators Specter and Harkin, clearly had a
very difficult task in crafting this bill. There is a lot of money in
it, but there are even more demands and requests for good things that
this bill does. And they have to compete for the funds that, although
they are significant, are still limited.
Despite the competing demands, the underlying bill has a $100 million
increase for community health centers. I sincerely commend the chairman
and the ranking member for their efforts to include this very needed
increase in the funding for the CHCs. At the same time, I believe very
strongly that adding an additional $50 million for health center
funding is crucial to ensure that these vital health care providers
have sufficient resources behind them to do everything they can to
provide for the uninsured and medically underserved Americans.
All of us who have talked about health care know that the lack of
access to care is perhaps the largest single health care problem that
faces our Nation today.
Part of this problem is a lack of health insurance. About 44 million
Americans are not covered by any type of health plan. But an equally
serious part of the problem is that many people are simply unable to
get access to a health care provider. Even if they have insurance, a
young couple with a sick child is out of luck if they can't get in to
see a pediatrician or other health care provider. In too many urban and
rural communities around
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the country, there just are not enough doctors to go around.
I urge my colleagues, if they have not done what I have done--and
that is, to visit community health centers in their States--that they
do so. You will be amazed and you will be very uplifted to see the work
that is going on each and every day in these community health centers.
Community health centers in a center city, in the poorest
neighborhoods, are reaching out and helping everyone--from the very
young to the teenage mother perhaps with a child, or a teenager who is
expecting a child, to the very elderly, who have difficulty getting
around.
We see the same thing in rural areas, in some of the communities that
are the hardest to access in our State. There are community health
centers with dedicated physicians and nurses and health care
professionals who are there to answer the health care needs of people
who would have no chance of getting service were it not for the health
centers.
These community health centers are truly the safety net of our health
care system. For all of my colleagues, I trust they do know about these
centers, but for other concerned citizens who may be watching, I
suggest they find out about the community health centers in their area.
What are they doing; are they serving people in need? I can tell my
colleagues, based on the experience in my State, they are delivering
the service to people who otherwise would not be served, were it not
for these CHCs.
We all know there are problems with access to health care. There are
many good ideas on additional steps we need to take. Some people want
nationalized health care. Other people want new tax credits, subsidized
health insurance. Others want to expand governmental health programs.
Some people want to enhance insurance pooling arrangements. All of
these have been proposed in an effort to make sure people have the
health coverage and can get the care they need. As different and as
diverse and as creative as many of these ideas are, they all have one
thing in common: They are not going to be passed into law this year.
All these wonderful ideas are going to come together. They are going to
clash. We will look at them and talk about them, and we are going to
refine them and argue about them and go down different roads. They are
not going to pass this year. The breadth of the disagreement over these
policy issues and the political complications of an election year make
it totally unlikely that Congress will bring any of these new ideas to
reality.
There is one thing we can still do this year, something we can pass
into law that will make a big difference for many people who lack
access to health care. What we can do is dramatically increase funding
for community health centers and help them reach out to even more
uninsured and underserved Americans.
Just for the technical background, health centers are private not-
for-profit clinics that provide primary care, preventive health care
services in thousands of medically underserved urban and rural
communities around the country. Partially with the help of Federal
grants, health care centers provide basic care for about 11 million
people every year, 4 million of whom are uninsured. Health centers
provide care for 7 million people who are minorities, 600,000 farm
workers, close to 1 out of every 20 Americans, 1 out of every 12 rural
residents, 1 out of every 6 low-income children, and 1 out of every 5
babies born to low-income families.
Despite this great work, there are millions of Americans who still
cannot get access to health care. The demand for the type of care these
centers provide simply exceeds the resources available. Today we can
help change this. There are as many as 44 million who are not covered
by a health plan. We are covering about 11 million. We need to do
something to make sure we serve those additional people. We are
building on a program that has proven itself to be effective.
This is probably the best health care bargain we can get because
these not-for-profit centers leverage the Federal dollars that go into
them. They collect insurance from those who are insured. They can
collect Medicare or Medicaid. They are a vehicle for providing the
service. The average cost per patient served by a community health
center in my State is something like $350 a year. That is how much it
costs them because of the other reimbursements and because of
the efficiencies and economies of scale. That is less than $1 a day.
Not too many plans can provide so much bang for the buck, so much
important delivery of health care service. This is probably the first
priority of all the health care problems we are facing, and there are
many. We can do something that will have a real impact on access to
care and the uninsured. It is the best thing we can do to expand that
safety net and pursue the search for better health care.
There are a couple of key reasons why community health centers are so
important. No. 1, these dollars build on an existing program that
produces results. Unlike many other health care proposals that suggest
radically new and untested ideas, health centers are known entities.
They do an outstanding job. They are known, respected, and trusted in
their communities.
Numerous independent studies, in addition to the observations of
those of us who have traveled around to visit them, confirm that
community health centers provide high quality care in an efficient and
cost-effective manner. Health centers truly target the health care
access problem. By definition, health centers must be located in
medically underserved communities, which means places where people have
serious problems getting access to health care. So health centers
attack the problem right at its source--in the communities where those
people live. Health centers are relatively cheap. Health centers can
provide primary and preventive care for one person for less than $1 a
day, $350 a year. That has to be one of the best health care bargains
around.
This proposal is not a Government takeover of health care.
Admittedly, this amendment calls for more Government spending, but
unlike most other health care proposals, this funding would not go to
create or expand a huge health care bureaucracy. This amendment would
invest additional funds into private organizations which have
consistently proven themselves to be efficient, high quality, cost-
effective health care providers.
If this amendment succeeds, it will mean an overall increase in
health center funding of $150 million. That level of increase will put
us on a path to double health center funding over 5 years. As my
colleagues know, this same goal, doubling funding over 5 years, is what
we challenge ourselves to provide to the National Institutes of Health.
Through these increased funds to health centers, we continue our
support for the good work that goes on in health centers. As in NIH, we
have increased funding for biomedical research that produces medical
innovations and develops ways to save, improve, and prolong people's
lives. I have supported those efforts. In fact, the underlying bill
contains funding increases for NIH that will keep us on the track for
doubling NIH funding over 5 years for this, the third straight year.
But as we expand the envelope for what is possible in the world of
health care, we must also ensure that more Americans have access to the
most basic level of primary care services, including regular checkups,
immunizations, and prenatal care. If we are not reaching some
Americans, it doesn't matter how much we put into health care research.
It doesn't matter how many innovations we come up with. It doesn't
matter how many new drugs or new procedures or new techniques we
develop. If they don't have access to the basic health care system, it
is not going to help them at all.
That is why I believe it is so important to set the same noble goal
we have set for research, doubling funding over 5 years, and adopt it
for community health centers as well. There is widespread bipartisan
support for both this 5-year plan as well as for the first-year
installment. Nineteen of my Senate colleagues cosponsored what I called
the REACH initiative--a resolution calling on Congress to double health
center funding over 5 years.
This resolution has since been made part of the congressional budget
resolution that establishes our tax and
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spending goals and priorities. Sixty-seven Senators joined in my
initial request for the 1-year funding increase of $150 million. This
amendment, which makes this 1-year increase a reality, has 57
cosponsors.
I am pleased to say that Gov. George W. Bush has publicly announced
his support for funding increases for community health centers
comparable to what this amendment would provide.
I thank my colleagues who have joined in these efforts for their
support. I urge all of my Senate colleagues to support this amendment.
A dramatic increase in community health center funding is one of the
first and most important things Congress can do this year to truly help
the uninsured and medically underserved Americans. Let us not waste the
opportunity to make it happen.
I express my thanks to the chairman and ranking member of the
committee.
The PRESIDING OFFICER (Mr. Gorton). The Senator from Pennsylvania is
recognized.
Mr. SPECTER. Mr. President, I compliment our distinguished colleague
from Missouri for offering this amendment and for his steadfast support
over the years. I compliment my distinguished colleague, Senator Bond,
for his continued support for community health centers. This has been a
matter he has taken a special interest in and he has organized enormous
support, with a letter having 67 signatories, 58 cosponsors, and
reflecting a very broad consensus as to the importance of this program.
The program would add in the current fiscal year $1.187 billion for
community health centers. The Appropriations Committee has increased
funding by $100 million over fiscal year 2000. Senator Bond now wants
an additional $50 million, with an offset from administrative expenses
pro rata among the three Departments.
We are prepared to accept Senator Bond's amendment. This is always a
matter of finding enough money and adjusting the priorities. There is
no one among the 100 Senators who knows that better than Senator Bond,
because he chairs the Appropriations Subcommittee on VA, HUD, and
Independent Agencies. I think his subcommittee and this subcommittee
have the toughest job in funding matters. But we agree there ought to
be more money in community health centers to serve people in both rural
and urban areas who are disadvantaged and do not have access to primary
health care.
There is nothing more important than health, so we are going to
accept the amendment. When we come to conference, we may have to modify
the offset as to the administrative cost, but we will do our very best
to maintain the funding in this important item.
One other comment. I commented yesterday that the President had
issued a veto threat after the subcommittee reported out a bill, and
Senator Harkin had some words for the President, which I thought came
better from the ranking member in the same party as the President. I
made the point yesterday--and I think it is worth repeating today--
about the priorities established by Members of Congress. We have
contacts that the President does not have. There are 535 of us who fan
out across America. Most of the Senators have fanned out already today,
going back to their States to assess local needs.
The Constitution gives the Senate the authority for appropriations.
Bills have to be signed by the President. But what Senator Bond has
done is a good illustration of getting a broad consensus. That makes an
impact upon the subcommittee when we look at our priorities. If 67
Senators sign a letter and 58 sign on as cosponsors, you wonder what
happened to the other 9 in the interim. That is a very strong showing,
and we intend to make that point when we do our best to honor the full
$150 million increase and as we move down to have an assessment of our
priorities versus the President's priorities.
Speaking for the majority, we are prepared to accept the amendment.
Mr. BOND. Mr. President, I thank my distinguished friend from
Pennsylvania, the chairman of the committee. If he really wants us to
get the rest of the 67, we will be happy to go about it. But I found
the chairman and the ranking member so responsive to my persuasive
arguments that I didn't think they needed any more weight on this. I
sincerely appreciate the willingness of the chairman to accept this.
Mr. DeWINE. Mr. President, I rise today to express my support for
increased funding for Community Health Centers. These health centers
offer much-needed primary and preventative health care services to
hundreds of medically underserved urban and rural communities across
our country.
Currently, the Labor, Health and Education Appropriations bill before
us would provide $100 million in Budget Year 2001 for these health
centers. The amendment I have cosponsored with Senator Bond and Senator
Hollings would provide an additional $50 million, bringing the total
investment to $150 million. This amendment, Mr. President, is very
important. It deserves the Senate's support. There are millions of
Americans who rely on Community Health Centers for their health care
needs. We have an obligation to ensure that those necessary services
are not interrupted due to a lack of sufficient federal funds.
The value of the services provided by these health centers becomes
quite apparent when you consider that right now there are at least 44
million uninsured people in our nation; and of those 44 million people,
Mr. President, 4 million of them receive health services from Community
Health Centers. When you combine the uninsured with the under-insured,
that total rises to 10 million--yes, Mr. President--10 million patients
who look to these centers for health care.
In my own home state of Ohio, the Third Street Community Clinic in
Mansfield and the Neighborhood Family Practice in Cleveland, for
example, are just two of the 69 Community Health Centers that serve
more than 200,000 Ohioans each year. In just the first three months of
this year, Ohio's Community Health Centers medically treated more than
29,000 uninsured people, of whom more than 31 percent--nearly one-
third--were children under 18 years of age.
These health centers provide critical health services to those who
would otherwise not have access to health care providers. The centers
offer prenatal care to uninsured or under-insured pregnant moms, and by
doing so, are working to prevent undue adverse risks to the health of
unborn babies. The health centers also provide immunizations so that
young children can continue to be healthy, even those that live in
medically underserved urban or rural areas.
And, in practical terms, by providing these and other types of
primary and preventive care, Community Health Centers save Medicare and
Medicaid dollars, because these services significantly reduce the need
for hospital stays and emergency room visits.
The value of Community Health Centers should not be underestimated--
nor should they be underfunded. The challenge we face today is that we
have to make sure funding keeps pace with the growing numbers of
Americans who will be in need of the health care services provided by
these centers. To keep pace with this rapid growth, the overall budget
for Community Health Centers will need to increase from $1 billion to
$2 billion by Fiscal Year 2005. This $1 billion increase would enable
the health centers to provide care to an additional six to ten million
people.
Because of the pressing need to increase funding, I am also a
cosponsor of Senator Bond's REACH Initiative, which is the ``Resolution
to Expand Access to Community Health Care.'' This important Initiative
would double the federal contribution for Community Health Centers over
the next five years. And, the Bond/Hollings amendment to the Labor,
Health, and Education Appropriations bill before us now would keep us
on track of meeting this five-year plan by increasing this year's $100
million allocation to $150 million.
I commend my colleagues from Missouri and South Carolina for their
amendment and for their tireless commitment to Community Health
Centers. I urge the rest of my colleagues to support this important
amendment.
Mr. HOLLINGS. Mr. President, It has been over 30 years since I set
off on my hunger tour of South Carolina, where I observed first-hand
the shocking condition of health care and nutritional habits in rural
parts of my state. The good news is, we have come a long way since
then. The bad news is, there is still much work to be done. Like the
``hunger myopia'' I described in my book
[[Page S5718]]
The Case Against Hunger, we suffer today from a sort of ``health care
myopia'', a condition in which a booming economy and low unemployment
rates mask a reality--that many Americans eke out a living in society's
margins, and most of them lack health insurance. Ironically, as the
stock market soars, so do the numbers of uninsured in our country, at a
rate of more than 100,000 each month; 53 million Americans are expected
to be uninsured by 2007.
The health care debate swirls around us, reaching fever pitch in
Congress, where I have faith that we will soon reach an agreement on
expanding coverage and other important issues. However, I see a need to
immediately address the health care concerns of these left-behind and
sometimes forgotten citizens. They cannot and should not have to wait
for Congress to hammer out health care reform in order to receive the
medical care so many of us take for granted. That's why I am
sponsoring, along with Senator Bond, this amendment to provide an
additional $50 million for health centers in this bill. Fifty-seven
cosponsors have joined us in working toward our objective. I would like
to thank subcommittee chairman Sen. Specter and ranking member Sen.
Harkin for their advocacy on behalf of community health centers. I look
forward to working with them as the bill moves to conference so that we
may ensure health centers across the nation receive the support they
deserve.
While ideas about health care have changed dramatically, community
health centers have remained steadfast in their mission, quietly
serving their communities and doing a tremendous job. Last year,
community health centers served 11 million Americans in decrepit inner-
city neighborhoods as well as remote rural areas, 4.5 million of which
were uninsured. It's no wonder these centers have won across-the-board,
bipartisan support. They have a proven track record of providing no-
nonsense, preventive and primary medical services at rock-bottom costs.
They're the value retailers of the health care industry, if you will,
treating a patient at a cost of less than $1.00 per day, or about $350
annually.
Let me emphasize that this measure is a cost-saving investment, not
an increase in spending. Not only are these centers providing care at
low costs, but they are saving precious health care dollars. An
increased investment in health centers will mean fewer uninsured
patients are forced to make costly emergency room visits to receive
basic care and fewer will utilize hospitals' specialty and inpatient
care resources. As a consequence, a major financial burden is lifted
from traditional hospitals and government and private health plans.
Every federal grant dollar invested in health centers saves $7 for
Medicare, Medicaid and private insurance: $6 from lower use of
specialty and inpatient care and $1 from reduced emergency room visits.
The value of community health centers can be measured in two other
significant ways. First of all, the centers' focus on wellness and
prevention, services largely unavailable to uninsured people, will lead
to savings in treatment down the road. And secondly, health centers
foster growth and development in their communities, shoring up the very
people they serve. They generate over $14 billion in annual economic
activity in some of the nation's most economically-depressed areas,
employing 50,000 people and training thousands of health professionals
and volunteers.
It should also be noted that community health centers are just that--
community-based. They are not cookie cutter programs spun from the
federal government wheel, but area-specific, locally-managed centers
tailored to the unique needs of a community. They are governed by
consumer boards composed of patients who utilize the center's services,
as well as local business, civic and community leaders. In fact, it is
stipulated that center clients make up at least 51% of board
membership. This set-up not only ensures accountability to the local
community and taxpayers, but keeps a constant check on each center's
effectiveness in addressing community needs.
In South Carolina, community health centers have a long history of
meeting the care requirements of the areas they serve. The Beaufort-
Jasper Comprehensive Health Center in Ridgeland, the Franklin C. Fetter
Family Health Center in Charleston, and Family Health Centers, Inc. in
Orangeburg were among the first community health centers established in
the nation. The Beaufort-Jasper Center was very innovative for its day,
in the late 1960s, tackling not only health care needs, but related
needs for clean water, indoor toilets and other sanitary services.
Today, the number of South Carolina health centers has grown to 15.
They currently provide more than 167,000 people, 38% of which are
uninsured, with a wide range of primary care services. Yet despite the
success story, a need to throw a wider net is obvious. Of the 3.8
million South Carolinians, nearly 600,000 have no form of health
insurance. That means roughly 15% of the state population is uninsured.
Another 600,000 residents are ``underinsured,'' meaning that they do
not receive comprehensive health care coverage from their insurance
plans and must pay out-of-pocket for a number of specialty services,
procedures, tests and medications.
South Carolina's statistics are mirrored nationwide. The swelling
ranks of the uninsured are outgrowing our present network of community
health centers. Adopting this amendment will ensure the reach of
community health centers expands to meet increasing demand. It is our
responsibility to continue providing our neediest citizens with a basic
health care safety net. What better way to do that than by building on
a program with a record of positive, fiscally responsible results?
Everyone can benefit and take pride in such a worthwhile investment.
Mr. KENNEDY. Mr. President, it is a privilege to be a sponsor of this
important amendment to increase funding for community health centers.
Each year, these centers provide quality health care to 11 million
Americans in 3,000 rural and inner-city communities in all 50 states,
including 4.5 million people who are uninsured. As the number of
uninsured Americans across the country continues to grow, the need for
the services is especially great.
Community health centers recently touched Juan Ramon Centeno's life
in Worcester, Massachusetts. Mr. Centeno was 54 years old when a
bilingual nurse working with Great Brook Valley Health Center arrived
at the public housing project where he lived to conduct health
screenings. Mr. Centeno felt ill, but because he did not have insurance
or resources for medical care, he had not sought care. The nurse found
that his blood pressure was high, he had risk factors for diabetes, and
had not received preventive health care for many years.
Health center physicians promptly examined Mr. Centeno and found him
at high risk for a cardiovascular accident. This timely intervention
enabled Mr. Centeno to receive good health care and to be placed on
medication through the health center pharmacy, which enables patients
to obtain prescription drugs at the reduced prices available under
Medicaid.
Day in and day out, community health centers are providing life-
saving services like these. Yet too often, the centers are struggling
to obtain the resources they need. In Massachusetts, over a dozen
community health centers currently face severe financial difficulties.
Congress cut Medicare reimbursement rates for the centers in 1997, in
spite of the fact that the number of people eligible for their services
continues to rise. The result for many health centers has been
bankruptcy, low morale among the health care professionals who are
dedicated to serving the poor, and great concern in the communities
that this needed access to health care will be lost. It is unacceptable
for Congress to permit health centers that have proved so effective for
so many years to suffer such severe financial difficulties,
particularly in this time of prosperity.
The Senate made a wise commitment to double the funding over the next
five years for medical research at the National Institutes of Health,
and it has kept that commitment. By making a similar commitment to
double the funding for community health centers--ten percent of the
cost of the commitment we made to medical research--we can ensure that
the benefits of modern medicine will remain available to millions of
low-income working families. The Senate is at its best when it approves
amendments like this one
[[Page S5719]]
on a bipartisan basis. I intend to do all I can to see that this year's
final appropriations bill, and future appropriations bills, maintain
our commitment to the extraordinary work of the nation's community
health centers.
The PRESIDING OFFICER. The Senator from Iowa is recognized.
Mr. HARKIN. Mr. President, this side has no objection to the
amendment. In fact, we wholeheartedly support the amendment. I
compliment the Senator from Missouri for his leadership, and I also
compliment Senator Hollings on this issue.
Community health centers are really the last sort of backstop for so
many people in this country who don't have health insurance--44 million
people in America don't have health insurance. Mainly, these are the
ones who, right now, for their health needs really need the community
health centers. We have about seven in our State of Iowa. We are
opening another one this summer. About 66,000 people are served per
year in the State of Iowa by our community health centers.
The really good thing--and the Senator from Missouri knows it--about
community health centers is they are engaged in preventive health care,
keeping people healthy in the first place, not just coming in when they
are sick. They do a lot of outreach work with low-income people. They
help with their diets, lifestyles, and with the medicines they need to
keep them healthy. That is one of the great services they provide.
We increased the funding for community health centers over last year
by $100 million. This would add another $50 million on to it. The need
is actually even more than that, but as the Senator from Missouri
knows, we have all these things we need to balance in the bill. This is
a welcome addition to our community health centers.
Again, I compliment the Senator from Missouri for his leadership. We
happily accept the amendment.
The PRESIDING OFFICER. Is there further debate on the amendment?
The question is on agreeing to the amendment.
The amendment (No. 3602) was agreed to.
Mr. BOND. Mr. President, I move to reconsider the vote.
Mr. HARKIN. I move to lay that motion on the table.
The motion to lay on the table was agreed to.
Mr. HARKIN. Mr. President, I will soon suggest the absence of a
quorum. I want Senators to know that we are open for business and for
taking amendments. Senator Specter and I are willing to sit here and
take amendments this morning. If Senators have amendments and they are
around, please come. As you can see, the floor is wide open. You won't
have a waiting line and you can speak for as long as you want. This is
the time to come and offer amendments on this bill.
With that, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. L. CHAFEE. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. L. CHAFEE. Mr. President, I ask unanimous consent to speak as in
morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
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