[Congressional Record Volume 146, Number 100 (Thursday, July 27, 2000)]
[Extensions of Remarks]
[Pages E1340-E1341]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 ON THE INTRODUCTION OF THE COMMUNITY ACCESS TO HEALTH CARE ACT OF 2000

                                 ______
                                 

                            HON. GENE GREEN

                                of texas

                    in the house of representatives

                        Wednesday, July 26, 2000

  Mr. GREEN of Texas. Mr. Speaker, I rise today in support of the 
Community Access to Health Care Act of 2000, legislation I am 
introducing to help our states and communities deal with the crisis of 
the uninsured.
  Over 44 million Americans do not have health insurance and this 
number is increasing by over a million persons a year. Most of the 
uninsured are working people and their children--nearly 74 percent are 
families with full-time workers. Ten percent of the uninsured are in 
families with at least one part-time worker. Low income Americans, 
those who earn less than 200% of the federal poverty level or $27,300 
for a family of three, are the most likely to be uninsured.
  Texas is a leader nationally in the number of uninsured, ranking 
second only to Arizona. About 4 million persons, or 26.8 percent of our 
non-elderly population, are without insurance.
  The uninsured and under-insured tend to be more expensive to care 
for. They fall through the health care cracks. They put off going to a 
doctor until it is too late--and then they go

[[Page E1341]]

to the emergency room. Instead of having available the wide variety of 
preventive measures and checkups that those of us with insurance take 
for granted, the uninsured often ignore the symptoms of what might be 
larger problems because they simply cannot afford to go to the doctor.
  According to research done by the Kaiser Family Foundation, nearly 
40% of uninsured adults skip a recommended medical test or treatment, 
and 20% say they have needed but not gotten care for a serious problem 
in the past year.
  Uninsured children are at least 70% less likely, Kaiser reports, to 
receive preventive care. Uninsured adults are over 30% less likely to 
have had a check-up in the past year, uninsured men 40% less likely to 
have had a prostate exam and uninsured women 60% less likely to have 
had a mammograrm than compared to the insured.
  The uninsured are at least 50% more likely than the insured to be 
hospitalized for conditions such as pneumonia and diabetes. 
Unfortunately, the uninsured are more likely to be diagnosed with fatal 
diseases at significantly later stages than are those with insurance. 
Death rates from breast cancer are higher for the uninsured than for 
those with insurance.
  In many American cities, towns and rural areas, there is general 
agreement that--something needs to be done to track, monitor and serve 
the uninsured. We all pick up the tab for the uninsured in the end--why 
not have communities join forces to attack this problem on a local 
level? Why not spend our tax dollars wisely and invest in prevention 
rather than spend them foolishly paying for emergency room visits or 
lengthy hospitalizations?
  The Community Access Program (CAP) embodies this idea; it stems from 
a very successful Robert Wood Johnson Foundation-funded project that 
showed that community collaboration increased access to quality, cost-
effective health care. Last year, the Clinton Administration proposed 
and Congress passed the Community Access Program as a $25 million 
demonstration effort. This year, over 200 applications were received 
for approximately 20 grants. Obviously, the need for and the interest 
in this program is great.
  The Community Access to Health Care Act of 2000 will authorize the 
Community Access Program for five years. It gives competitive grants to 
communities to help more uninsured people receive health care and to 
ensure that communities join forces to map a strategy for counting and 
dealing with the uninsured.
  Funding under CAP can be used to support a variety of projects to 
improve access for all levels of care for the uninsured and under-
insured. Each community designs a program that best addresses the needs 
of the uninsured and under insured and the providers in their 
community. Funding is intended to encourage safety net providers to 
develop coordinated care systems for the target population.
  The majority of the CAP funds will be used to support expenses for 
planning and developing an integrated health care delivery system. A 
small portion of the funds may be used for direct patient care if there 
are gaps to putting together an integrated delivery system.
  Applications for the CAP demonstration project were due this past 
June; 208 were submitted by groups from 46 states and the District of 
Columbia. Applications were evenly distributed between urban and rural 
areas, and six were submitted by tribal organizations. About three 
fourths of applications came from communities with rates of uninsured 
persons higher than the national average of 14%. Half of applications 
came from communities with rates of uninsured persons greater than 20%. 
Close to 90% of applications target all uninsured persons in an area.
  Perhaps the best way of explaining how CAP can improve a community's 
health care networking is to paraphrase from the application submitted 
from a group in Houston. The lead applicant, Harris County, is the 
third most populated county in the nation and the most populated county 
in Texas with about 3.2 million residents. Close to 50% of our 
residents are Anglo, about 18% are African American, about 27% are 
Hispanic and about 5% are Asian. The Asian population is the fastest 
growing, followed by Hispanics and African Americans.
  According to Harris County's proposal, ``population growth and an 
economic boom have enhanced the overall wealth and employment 
opportunities of the community. It has, however, also resulted in 
greater economic disparities between the privileged and the 
economically disadvantaged. The numbers of uninsured and under insured 
are on the rise.''
  The Texas Health and Human Services Commission estimated that in 
1999, 25.5% of the total population in Harris County--834,867--was 
uninsured. Of this total number, the applicants have targeted three 
populations: First, they will target those with incomes under 200% of 
the federal poverty level (428,369 persons). Second, they will target 
those with incomes over 200% of the federal poverty level (301,000 
persons). Third, they win target those who are under insured (328,183 
persons).
  According to Harris County, the primary focus of this project is to 
improve the interagency communication and referral infrastructure of 
major health care systems in the city. This will improve their ability 
to provide preventive, primary and emergency clinical health services 
in an integrated and coordinated manner for the uninsured and under 
insured population. Harris County will place particular emphasis on the 
development and/or enhancement of the existing local infrastructure and 
necessary information systems.
  In addition to expanding the number and type of providers who 
participate in collaborative care giving efforts, Harris County would 
establish a clearinghouse for local resources, care navigation and 
telephone triage to increase accessibility and reduce emergency room 
care. The clearinghouse will receive referrals of uninsured patients 
from health service providers and patient self-referrals. The consortia 
will give special attention to health disparities in minority groups. 
It will establish a database for monitoring, tracking, care navigation 
and evaluation. In Harris County, it is expected that this initial 
support from grant funds would become self-sustained through 
contributions from participating providers, especially smaller primary 
care providers who can rely on the centralized triage program for 
after-hours response.
  Harris County will also develop a plan to allow private and public 
safety-net providers to share eligibility information, medical and 
appointment records, and other information. The program will beef up 
efforts to make sure families and children enroll in programs for which 
they might be eligible, including Medicaid and the Childrens' Health 
Insurance Program (CHIP). In addition, Harris County would facilitate 
simplified enrollment procedures for childrens health programs.
  Among those participating in the Harris County group are the Asian 
American Health Coalition, the Baylor College of Medicine's Department 
of Family and Community Medicine, Communities Conquering Cancer, 
Community Education and Preventive Health, the Dental Health Task Force 
of the Greater Houston Area, the Gulf Coast CHIP Coalition, the Harris 
County Budget Office, the Harris County Hospital District, the Harris 
County Public Health and Environmental Services, the HIV Services 
Section, the Homeless Services Coordinating Council and the Houston 
Health and Human Services Department.
  Also part of this consortia are the Mental Health/Mental Retardation 
Authority of Harris County, the Ryan White Planning Council, The 
Assistance Fund, The Rose, and the University of Texas's Health Science 
Center's Department of Internal Medicine.
  What does this group hope to accomplish? It has four goals.
  1. Establish a county-wide communication and referral system 
accessible to Community Health Partners, Affiliates, Clients and 
Funding Resources.
  2. Document referrals from the Community Health Access Clearinghouse 
to Community Health Partners, Affiliates and Funding Resources.
  3. Decrease the rate of non-emergency use of emergency rooms.
  4. Increase the numbers of low-income persons with insurance 
coverage.
  This group's plan--and it's a great one--is just one of 208 that were 
submitted to HRSA this June. Unfortunately, since funds exist only for 
about 20 projects, Houston and other cities and rural areas may get 
turned away unless Congress acts to pass the Community Access to Health 
Care Act of 2000.
  Putting together the CAP application was the first step in building 
new collaborative efforts for many groups. I have heard of instances 
where providers serving the same populations in the same towns had 
never sat down at the same table together. Once they do, and once they 
begin to exchange information and ideas, great things can happen.
  We in Congress have argued for years about the federal government's 
role in ensuring access to affordable health care. I believe that some 
type of universal care should be a priority for the long term. For the 
short term, however, authorizing the CAP program will place much-needed 
funds in the hands of local consortia who, working together, can help 
to alleviate this crisis--town by town and patient by patient. I am 
pleased to note that this legislation has also been included as part of 
Rep. Dingell's FamilyCare Act of 2000, of which I am a cosoponsor.
  In closing, I would like to recognize a person whose dedication to 
this effort has led to the introduction of this legislation today. Dr. 
Mary Lou Anderson, from the Health Resources Services Administration, 
actually came out of her retirement to oversee the CAP demonstration 
project. Her dedication to this project, and to the health of America's 
families and children, is commendable.




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