[Congressional Record Volume 147, Number 17 (Wednesday, February 7, 2001)]
[Extensions of Remarks]
[Pages E129-E130]
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 2001

                                 ______
                                 

                            HON. GENE GREEN

                                of texas

                    in the house of representatives

                      Wednesday, February 7, 2001

  Mr. GREEN of Texas. Mr. Speaker, I rise today in support of the 
Community Access to Health Care Act of 2001, legislation I am 
introducing to help our states and communities deal with the crisis of 
the uninsured.
  More than 42 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. Low income Americans, those who earn 
less than 200 percent 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 insured, ranking second 
only to Arizona. About 4 million persons, or 26.8 percent of our non-
elderly population, are without health insurance.
  The uninsured and under-insured tend to be more expensive to treat 
because they fall through the cracks of our health care system. The 
uninsured and under-insured often can't afford to see the doctor for 
routine physicals and preventive medicine. Consequently, they arrive in 
the emergency room with costlier, often preventable, health problems.
  Research by the Kaiser Family Foundation underscores this problem. 
Nearly 40 percent of uninsured adults skip a recommended medical test 
or treatment, and 20 percent say they have needed but not received care 
for a serious problem in the past year. Kaiser also reports that 
uninsured children are at least 70 percent less likely to receive 
preventive care. Uninsured adults are more than 30 percent less likely 
to have had a check-up in the past year, uninsured men 40 percent less 
likely to have had a prostate exam and uninsured women 60 percent less 
likely to have had a mammogram than compared to the insured.
  This broken health care system yields dangerous, sometimes deadly 
results. The uninsured are at least 50 percent more likely than the 
insured to be hospitalized for conditions such as pneumonia and 
diabetes. Death rates from breast cancer are higher for the uninsured 
than for those with insurance.
  Our Nation's health care safety net is in dire need of repair. 
Communities across the country are identifying ways to better tend to 
the uninsured, to provide preventive, primary and emergency clinical 
health services in an integrated and coordinated manner. This kind of 
service can only be accomplished, however, if our safety net providers 
have the resources to improve communication to better reach this target 
population.
  The Community Access Program (CAP) promotes this kind of interagency 
coordination and communication. It stems from a very successful Robert 
Wood Johnson Foundation-funded project that demonstrated how community 
collaboration can increase access to quality, cost-effective health 
care. The Community Access to Health Care Act of 2001 provides 
competitive grants to assist communities in developing programs to 
better serve their uninsured population.
  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 its uninsured and under insured and its providers. Funding is 
intended to encourage safety net providers to develop coordinated care 
systems for the target population.
  The Clinton Administration created a $25 million CAP demonstration 
project in FY 2000. More than two hundred applications 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.
  Funding in FY 2000 provided grants to 23 communities. An increase to 
$125 million in FY 2001 will make grants available to an additional 55 
projects. While this increase has helped communities get their program 
off the ground, more can be done to ensure that future funding is 
available.
  I would like to highlight one program, the Harris County Public 
Health and Environmental Services Department, in my hometown of 
Houston, TX. This program is a good example of how CAP funds can 
improve a community's health care network. Harris County, Texas is the 
third most populated county in the nation and the most populated county 
in the state with approximately 3.2 million residents.
  The Texas Health and Human Services Commission estimated that in 
1999, 25.5 percent of the total population in Harris County--834,867--
was uninsured. Harris County's CAP project aims to assist three 
populations: Those with incomes under 200 percent of the Federal 
poverty level; those with incomes over 200 percent of the Federal 
poverty level; and those who are under insured.
  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

[[Page E130]]

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 Children's Health 
Insurance Program (CHIP). In addition, Harris County would facilitate 
simplified enrollment procedures for children's health programs.
  Fortunately for my constituents in Houston, Harris County's program 
is eligible for a grant through the FY 2001 demonstration project. They 
have completed their site visit, and are in the final stages of having 
their program approved. Unfortunately, communities who weren't 
fortunate enough to receive grants are still searching for ways to 
improve the health of their uninsured.
  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.

                          ____________________