[Congressional Record Volume 147, Number 12 (Tuesday, January 30, 2001)]
[Senate]
[Pages S712-S714]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST (for himself, Mr. Harkin, Mr. Jeffords, Mr. Kennedy, 
        Mr. Hutchinson, Ms. Mikulski, Mr. Bingaman, and Mrs. Murray):
  S. 208. A bill to reduce health care costs and promote improved 
health care by providing supplemental grants for additional preventive 
health services for women; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. FRIST. Mr. President, although we often think of cardiovascular 
disease as a men's health issue, the American Heart Association 
estimates that nearly one in two women will die of heart disease or 
stroke. However, because of its historically male stereotype, most 
women do not realize that they are at such high risk for cardiovascular 
disease even though cardiovascular diseases kills nearly 50,000 more 
women each year than men. Even more alarming is data reported by the 
Society for Women's Health Research which revealed that not all 
physicians know that cardiovascular diseases are the leading cause of 
death among American women.
  Each year nearly half a million women lose their lives as a result of 
heart disease and stroke. Fortunately, men have experienced a decline 
in deaths due to cardiovascular diseases since 1984; but women have 
not, and many of these tragic deaths could have been prevented had 
these women known they were at risk. For instance, they could have 
taken preventive measures by not smoking, lowering their cholesterol or 
blood pressure, or by eating more nutritiously, and perhaps avoided 
becoming a victim of heart disease or stroke. For many women, 
prevention is truly the only cure, since it has been reported that as 
many as two-thirds of women who die from heart attacks have no warning 
symptoms of any kind.
  Cardiovascular diseases kill more American females each year than the 
next 14 causes of death combined, including all forms of cancers. Over 
half of all cardiovascular deaths each year are women, and in 1997 
alone heart diseases claimed the lives of more than half a million 
women. My own home state of Tennessee has the second highest death rate 
from heart disease, stroke, and other cardiovascular diseases in the 
nation and the 13th highest ranking state in women's heart deaths. In 
1997, 10,884 Tennessee women died from these two cardiovascular 
diseases alone. Moreover, the Centers for Disease Control and 
Prevention (CDC) reports that women in the rural South are more likely 
to die of heart disease than those in other parts of the country.
  Fortunately, some preventive measures, such as physical activity and 
better nutrition, can be taken by women to reduce their risk for 
cardiovascular diseases, as well as other preventable diseases, such as 
osteoporosis--a disease that affects one out of every two women over 50 
and threatens roughly 28 million Americans, 80 percent of whom are 
women.
  To continue to draw greater awareness to health issues among American 
women, particularly cardiovascular diseases, I am very pleased to 
reintroduce legislation which I introduced last Congress, the 
``WISEWOMAN Expansion Act of 2001,'' with Senator Harkin. Our goal in 
expanding this program is to reduce the risk of cardiovascular 
diseases, and other preventable diseases, and to increase access to 
screening and other preventive measures for low-income and underinsured 
women. In addition to making cardiovascular diseases screening 
accessible to underserved women, this program will also educate them 
about their risk for cardiovascular diseases and how to make lifestyle 
changes--thereby giving them the power to prevent these diseases.
  The CDC's National Breast and Cervical Cancer Early Detection Program 
(NBCCEDP) is an example of a successful program that has provided 
critical services to help prevent major diseases affecting American 
women. The NBCCEDP has done an outstanding job of reaching out to low-
income underinsured women--women who are generally too young for 
Medicare and unable to qualify for Medicaid or other state programs--
and providing them with preventive screenings for breast and cervical 
cancers. These women would likely otherwise fall through the cracks in 
our health system.
  Our bill provides for the expansion of the WISEWOMAN (Well-Integrated 
Screening and Evaluation for Women in Massachusetts, Arizona, and North 
Carolina) demonstration project, which is run by the CDC in conjunction 
with the NBCCEDP, to additional states. The WISEWOMAN program 
capitalizes on the highly successful infrastructure of the NBCCEDP to 
offer ``one-stop shopping'' screening and preventive services for 
uninsured and low-income women. In addition to these very important 
breast and cervical cancer screenings, WISEWOMAN screens for 
cardiovascular disease risk factors and provides health counseling and 
lifestyle interventions to help women reduce behavioral risk factors. 
The program addresses risk factors such as elevated cholesterol, high 
blood pressure, obesity and smoking and provides important additional 
intervention and educational services to women who would not otherwise 
have access to cardiovascular disease screening or prevention. This 
bill also adds flexibility to the program language that would allow 
screenings and other preventive measures for diseases in addition to 
cardiovascular diseases, such as osteoporosis, as more preventive 
technology is developed.
  I would like to thank Judy Womack and Dr. Joy Cox of the Tennessee 
Department of Health for their counsel and assistance on this 
legislation and for their efforts in helping Tennesseans.
  I ask unanimous consent that three letters supporting the WISEWOMAN 
Expansion Act of 2001 be printed in the Record.

[[Page S713]]

  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                       American Heart Association,


                                    Office of Public Advocacy,

                                 Washington, DC, January 26, 2001.
     Hon. Bill Frist, M.D.,
     Hon. Tom Harkin,
     United States Senate,
     Washington, DC.
       Dear Senators Frist and Harkin: Heart attack, stroke and 
     other cardiovascular diseases remain the leading cause of 
     death of women in the United States. Heart disease, alone, is 
     the number one killer of American women and stroke is the 
     number three killer. In fact, low-income women are at an even 
     higher risk of heart disease and stroke than other women, and 
     they have a higher prevalence of risk factors contributing to 
     these diseases. The American Heart Association is very 
     grateful for the support you and other members of the United 
     States Congress have given to the WISEWOMAN demonstration 
     program which uses the National Breast and Cervical Cancer 
     Early Detection Program network to provide heart disease and 
     stroke screening services, as well as diet and physical 
     activity interventions and appropriate referrals.
       The American Heart Association applauds the WISEWOMAN 
     program and we are anticipating even greater results in the 
     battle against heart disease and stroke as the program 
     expands to serve more women throughout the United States. The 
     Frist-Harkin ``WISEWOMAN Expansion Act of 2001'' will expand 
     WISEWOMAN's heart disease and stroke screenings beyond its 
     current limit, which we believe will have a tremendous 
     positive impact to the cardiovascular health of women who 
     live in states served by the program.
       The American Heart Association recommends increased funding 
     and expansion of the WISEWOMAN program during fiscal year 
     2002. Also, because of the solid scientific evidence that 
     cardiovascular screenings can help prevent heart disease and 
     stroke in women, we believe cardiovascular screenings 
     provided by WISEWOMAN should be expanded before using the 
     demonstration program to provide screenings for other 
     diseases affecting women.
       We thank you for your commitment to fighting heart disease 
     and stroke, and look forward to your continued support in the 
     future.
           Sincerely,
                                       Rose Marie Robertson, M.D.,
     President.
                                  ____

                                                       Society for


                                      Women's Health Research,

                                 Washington, DC, January 25, 2001.
     Hon. Bill Frist,
     Chair, Subcommittee on Public Health, Committee on Health, 
         Education, Labor, and Pensions, Dirksen Senate Office 
         Building, Washington, DC.
     Hon. Tom Harkin,
     Ranking Member, Subcommittee on Public Health, Committee on 
         Health, Education, Labor, and Pensions, Dirksen Senate 
         Office Building, Washington, DC.
       Dear Senators Frist and Harkin: On behalf of the Society 
     for Women's Health Research, we express our appreciation for 
     your leadership on the introduction of the ``WISEWOMAN 
     Expansion Act of 2001.'' In addition to a strong national 
     research program, disease prevention is vital to our nation's 
     health. Chronic diseases, such as heart disease, cancer, 
     diabetes, and osteoporosis are among the most prevalent, 
     costly, and preventable of all health problems.
       As you know, women tend to live longer but not necessarily 
     better than men. They have more chronic health conditions and 
     are more economically insecure. Safety net programs often are 
     the difference between life and death. The WISEWOMAN 
     Expansion Act is building on a foundation that has provided 
     positive feedback and will allow additional states to provide 
     prevention services to those women in need. We applaud the 
     flexibility of the legislation. With the passage of time, as 
     new technologies develop, as disease burdens shift, and as 
     lifestyles change, the program can address women's most 
     critical health needs.
       We thank you for your commitment to improving the nation's 
     health through prevention. By focusing on the health of 
     women, you ultimately will be improving the health of the 
     nation's families.
           Sincerely,
     Phyliss Greenberger,
       President and CEO.
     Roberta Biegel,
       Director of Government Relations.
                                  ____



                             National Osteoporosis Foundation,

                                                 January 29, 2001.
     Hon. Tom Harkin,
     Hon. Bill Frist,
     U.S. Senate, Washington, DC.
       Dear Senators Harkin and Frist: On behalf of the National 
     Osteoporosis Foundation (NOF), I commend you on the 
     introduction of the bipartisan WISEWOMAN Expansion Act of 
     2001 that supports your effort to provide additional 
     preventive health services, including osteoporosis screening, 
     to low-income and uninsured women.
       As you know, osteoporosis is a major health threat for more 
     than 28 million Americans, 80 percent of whom are women. In 
     the United States today, 10 million individuals already have 
     the disease and 18 million more have low bone mass, placing 
     them at increased risk for osteoporosis. Also, one out of 
     every two women over 50 will have an osteoporosis-related 
     fracture in their lifetime. It is estimated that the direct 
     hospital and nursing home costs of osteoporosis are over 
     $13.8 billion annually, with much of that attributed to the 
     more than 1.5 million osteoporosis-related fractures that 
     occur annually.
       The health care services included in the WISEWOMAN program 
     have provided positive results for many women who have 
     participated and ultimately cost-savings for the states that 
     have participated. Expansion of the WISEWOMAN model to 
     additional states and for additional preventive services, 
     such as screening for osteoporosis, should enhance positive 
     results for both the women and states participating in the 
     program.
       The National Osteoporosis Foundation is most appreciative 
     of your efforts to promote improved both health and endorse 
     the WISEWOMAN Expansion Act of 2001.
           Sincerely,
                                                Sandra C. Raymond,
                                               Executive Director.

  Mr. HARKIN. Mr. President, I am pleased to join Senator Frist today 
to introduce the ``WISEWOMAN Expansion Act.'' This bill will help 
thousands of women have access to basic preventive health care they may 
otherwise not receive. The legislation builds on a successful 
demonstration program and expands screening services and preventive 
care for uninsured and low-income women across the nation.
  Beginning in 1990, I worked as Chairman of the Labor, Health and 
Human Services and Education Appropriation Subcommittee to provide the 
funding for the National Breast and Cervical Cancer Early Detection 
Program, NBCCEDP, run through the Centers for Disease Control and 
Prevention. In Iowa alone, the program has successfully served close to 
9000 women through 618 provider-based breast and cervical cancer 
screening sites.
  Today, the Centers for Disease Control and Prevention currently run 
the WISEWOMAN program through the NBCCEDP as a demonstration project. 
The program has successfully built upon the framework of the NBCCEDP to 
target other chronic diseases among women, including heart disease, the 
leading cause of death among women, and osteoporosis. The programs 
address risk factors such as elevated cholesterol, high blood pressure, 
obesity and smoking and provide important intervention services.
  This demonstration project has been successful. It is now time to 
expand the program to additional states, and eventually make it 
nationwide. As the brother of two sisters lost to breast cancer and the 
father of two daughters, I know first hand the importance of making 
women's health initiatives a top priority. The first step to fighting a 
chronic disease like cancer, heart disease or osteoporosis is early 
detection. All women deserve to benefit from the early detection and 
prevention made possible by the latest advances in medicine. This bill 
ensures a place for lower income woman at the health care table.
  The majority of Americans associate cardiovascular disease with men, 
but the American Heart Association estimates that nearly one in two 
women will die of heart disease or stroke. In fact, cardiovascular 
diseases kills nearly 50,000 more women each year than men. In my own 
state of Iowa, cardiovascular disease accounts for 44 percent of all 
deaths in Iowa. Close to 7,000 women die annually in Iowa from 
cardiovascular disease. Each year, nearly half a million women lose 
their lives as a result of heart disease and stroke. Sadly, with 
appropriate screening and interventions, many of these deaths could 
have been prevented.
  Osteoporosis is also a preventable disease and affects one out of 
every two women over the age of 50. Fortunately, some of the preventive 
measures women can take to reduce their risk for cardiovascular 
diseases, such as eating more nutritious foods and exercising, can also 
reduce their risk for osteoporosis.
  Our bill would do the following:
  Expand the current WISEWOMAN demonstration project to additional 
states;
  Add flexibility to program language that would allow screenings and 
other preventive measures for diseases in addition to cardiovascular 
diseases;
  Allow flexibility for the WISEWOMAN program to grow and adapt with 
the changing needs of individual states and our better understanding of 
new preventive strategies; and

[[Page S714]]

  Ensure continued full collaboration of the WISEWOMAN program with the 
NBCCEDP; Authorize the CDC to make competitive grants to states to 
carry out additional preventive health services to the breast and 
cervical cancer screenings at NBCCEDP programs, such as: screenings for 
blood pressure, cholesterol, and osteoporosis; health education and 
counseling; lifestyle interventions to change behavioral risk factors 
such as smoking, lack of exercise, poor nutrition, and sedentary 
lifestyle; and appropriate referrals for medical treatment and follow-
up services.
  In order to be eligible for this program, states are required to 
already participate in the NBCCEDP and to agree to operate their 
WISEWOMAN program in collaboration with the NBCCEDP.
  This bipartisan legislation has the support of the National 
Osteoporosis Foundation, the American Heart Association, the American 
Cancer Society and the Komen Foundation, among others. I urge my 
colleagues to join us in supporting this critical legislation.
                                 ______