[Congressional Record Volume 147, Number 103 (Monday, July 23, 2001)]
[House]
[Pages H4423-H4426]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             BORDER HEALTH

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2001, the gentleman from Texas (Mr. Rodriguez) is recognized 
for 60 minutes.
  Mr. RODRIGUEZ. Mr. Speaker, I was just here talking about the 
Patients' Bill of Rights and how important that issue is. I want to 
take this opportunity tonight to begin to talk a little bit about 
border health.
  Mr. Speaker, I rise today to call attention to the poor state of 
health along the U.S.-Mexican border. The United States-Mexico border 
reaches approximately 2,000 miles, from the Pacific Ocean in the West 
to the Gulf of Mexico in the East.
  More than half of this border, over 1,248 miles, is shared with 
Texas. It is a vast region, and each of the four southwestern border 
States have a unique history and community dynamics.
  However, Texas, California, Arizona, and New Mexico's borders all 
share the plague of persistent socioeconomic problems largely ignored 
by the rest of the Nation.

                              {time}  2130

  If the United States border region of Texas were declared the 51st 
State, and we say this and we kind of talk in Texas about the fact that 
we are one of the few States that has a law that says we can divide our 
State into five States if we wanted to, but if we were to make the 51st 
State on the border of Texas, taking those counties into consideration, 
it would rank as one of the poorest in terms of access to health care, 
second in the death rate from hepatitis, and third in the death rate of 
diabetes. The rate of the uninsured is among the highest in the 
country, as are the poverty rates.
  In Texas and New Mexico, an estimated 30 percent of the border 
residents have no health insurance, and in Arizona it is estimated at 
28 percent, and the estimates in California are 19 percent. So that 
what we have throughout the border area is a very large lack of access 
to health care.
  I am relieved that there is finally a focus on health care and this 
has dominated both of the campaigns in the previous elections. There is 
some talk about the importance of border health now, although this 
focus had not been there before. Since the focus has started now and 
some dialogue has started, we are hoping to be able to get revenues to 
the border.
  I strongly support all the efforts that have been made to pass a 
comprehensive Patients' Bill of Rights, and we are going to continue to 
move forward on that, but I urge my colleagues to also look at the 
issues of access and especially in underserved communities such as the 
border.
  Oftentimes, the emergency rooms end up being the first line of care 
for residents in underserved areas like the border. It is also true 
that health disparities along the border are enormous. For those of my 
colleagues who have ever visited the border, any of the areas I 
represent, Starr and Zapata on the border are the two counties I have 
of which are in my district, both Starr County and Hidalgo County, not 
in my district, these two counties included are among the four poorest 
counties in the Nation. So we have a great deal of poverty associated 
with lack of access to health care.
  The district that I represent faces many health and environmental 
challenges. The poor state of infrastructure leads to real health and 
environmental problems, including hepatitis, diabetes and tuberculosis. 
Health problems are compounded by low per-capita income, lack of 
insurance, and lack of access to health care facilities.
  There is no question that the border region is crying out for 
increased resources in the face of so many challenges. Tuberculosis has 
emerged as a serious threat to public health along the border. One-
third of the new TB cases in the U.S. were from four southwest border 
States. Once again, one-third of all the cases in the United States 
come from the border.
  The ease with which an individual can contract the tuberculosis 
bacteria is often frightening. Often someone needs to do no more than 
breathe in the tuberculosis bacteria coughed into the air by the 
infected individual. Currently, 15 million Americans are infected with 
tuberculosis, which means we are all at risk. So this disease hits some 
communities more than others.
  Regions which have high levels of tourism, international business and 
immigration experience higher than average levels. For instance, Texas 
has one of the highest tuberculosis rates in the country now. My State 
ranks seventh nationwide in the incidence of tuberculosis, with TB 
rates of 8.2 percent per 100,000. Even more sad is that minorities 
suffer disproportionately. Latinos in the United States have a 
tuberculosis rate six times that of Anglos.
  Tuberculosis is not the only disease of which the border residents 
are hit disproportionately. They also suffer from diabetes.
  When we look at diabetes, the border has a higher mortality rate than 
the rest of the country. Again, I will use the Texas statistics. In 
1995, the Texas diabetes mortality rate was nearly 50 percent higher 
than the rest of the United States. Gestational diabetes and Type II 
diabetes hit the Spanish population in greater numbers than other 
populations, and it is the Hispanic population that makes up the larger 
percentage of border residents. It is unacceptable that such a high 
number of border diabetes patients die from disease that can be 
controlled and even prevented.
  When we consider the effect that environmental pollution has on 
health, it gets even worse. Last week we debated whether to let Mexican 
trucks into the United States. I cannot stress again how important it 
is that these trucks meet U.S. safety standards, especially when it 
comes to emissions. Our air quality along the border is threatened due 
to the increased truck traffic brought about through NAFTA. More 
children than ever are developing respiratory problems, such as asthma, 
causing them to miss school, extracurricular activities and, even 
worse, to be hospitalized.

  Water pollution poses a serious health hazard, including the spread 
of Hepatitis A and parasitic infections. Hepatitis A, spread mainly 
through unclean food and water, is two or three times more prevalent 
along the Mexican border than the U.S. as a whole. The presence of lead 
in water can cause damage to developing brains, the nervous system of 
children, and affects reproductive systems in adults.

[[Page H4424]]

  Residents in colonias are even more at risk from environmental 
health-related problems. Colonias are rural unincorporated communities 
characterized by the lack of certain basic public services, such as 
drinking water, sewage disposal, garbage pickup and paved roads. For 
instance, 86 percent of the individuals living in Texas colonias in the 
year 2000 had water but only 12 percent had sewage disposal.
  As my colleagues can see, what I am describing is not on the Mexican 
side, I am talking about the U.S. side, and we are talking about the 
boarders between Texas, New Mexico, Arizona and California. Mr. 
Speaker,the border regions between the U.S. and Mexico are an area of 
great potential and challenge, especially with respect to the health 
and environmental concerns that our two nations face.
  What is the cause of the border health disparities? The lack of 
health education, low reimbursement rates to our health care providers, 
the lack of access to health care facilities, and the chronic shortage 
of health care professionals. In addition, the poor data collection has 
left us in a situation where we do not have all the information needed 
to solve the problems that confront us. Disparities in the 
reimbursement rates for Medicaid and the SCHIPs, along with the 
consistent lack of health care professionals are some of the problems 
that have been confronted.
  I want to take this opportunity to also mention that we have had the 
opportunity to go through the border. We recently had a town hall 
meeting in El Paso with my colleague, the gentleman from Texas (Mr. 
Reyes), and one of the things, as we get the data that deals with the 
disproportionate disparities that exist on the border regarding health, 
is that despite the fact that we get resources from the Federal 
Government, such as Medicaid, for example, that we still find some 
disparities within the States.
  One of the great ironies was some testimony that was provided by a 
county judge from El Paso, Dolores Briones, and I want to read part of 
her testimony that she gave us. She talked about the ironies that have 
recently been discovered in our State, and I am going to read from her 
testimony.
  Our State, referring to Texas, Medicaid budget actually benefitted 
from the high poverty rates along the border when drawing down Federal 
dollars. That is, because of the poor people in south Texas, the State 
of Texas is able to leverage additional resources that they would not 
necessarily be able to.
  Right now, those funding formulas for the Texas Medicaid program 
allows the State to draw down $1.50 of every State general revenue 
dollar spent on Medicaid services. That is what we call the 60-40 
split. That is that for every 40 cents we put in, we get 60 cents. This 
split of funding responsibility is recalculated each year for each of 
the States, and it is based upon the State's per capita income.
  I mention this because it is real important that my colleagues stay 
with me and follow through. We get those monies based on per capita 
income when compared to the national average per income levels. The 
lower the State per capita income, the higher the Federal share. That 
means that Texas gets additional resources because of the poor people 
that live on the border.
  The testimony we received is that the State of Texas actually 
benefits from the high poverty based on per capita income and child 
poverty, El Paso and other border counties. Without the borders, the 
State of Texas would only be getting a statistic of 50 to 50 instead of 
40 to 60 percent, which is a minimum of Federal matching rate allowed 
under Medicaid.
  A separate calculation for the area, if we just took the lower region 
and if we took that calculation, the lower counties should get 83 cents 
for every 17 cents we put in. The bottom line is, when the money comes 
down and the formulas are distributed and the State gets that money, 
they reimburse Houston and some of the communities and Dallas in the 
north at a higher rate than they do San Antonio, than they do the rural 
area, than they do El Paso. So here they are leveraging that money 
based on per capita, based on the low-income population and, at the 
same time, as they receive those resources, they choose to distribute 
them on a formula that discriminates against those same poor that were 
able to leverage those resources for them.
  It was very startling information that was provided by the county 
judge. She talked about the fact that she was going to do everything 
she could to come to grips with that issue, to make sure that those 
monies followed those patients and that it go to those areas where 
those patients are in need. And the areas that are a little more 
affluent such as Dallas and Houston should not be leveraged at higher 
rates if they do not have the same formulas or the same per capita. The 
region and the border should be getting a higher rate, San Antonio 
included.

  So when we look at that disparity, we see some of the problems that 
exist and that we need to begin to clarify. And she indicated that she 
was looking at it and, if she had to, was going to go into litigation 
over the issue. My colleague, the gentleman from Texas (Mr. Reyes), and 
other Members of Congress from Texas asked the GAO to do an assessment 
of each of the States as to how this money was being handled. So it is 
something that needs to be looked at.
  It is something that is serious. It is something that we need to come 
to grips with in making sure that if those monies are going down there 
to help those people that are in need and if it is followed based on a 
formula that talks about how important it is because of the fact that 
they are poor and it is per capita, then one would think they would be 
receiving the money, yet they get disproportionate monies. What it does 
is it creates a real difficulty because of the reimbursement rate for 
our doctors on the border, which is much less, for our hospitals it is 
much less than it would be in Dallas or Houston or elsewhere.
  So that is unfortunate. But, hopefully, we will continue to work on 
that specific issue as we move forward.
  I also want to take this opportunity to just give a few statistics 
about the border. It is important to note that, in 1995, approximately 
10 million people lived along the border, with 55 percent in the United 
States and 45 percent in Mexico. A lot of times we do not take into 
consideration that these communities have sister cities right across 
and there are major populations. So it is important for us to remember 
that.
  When we look at the problems of tuberculosis, it is not just the 
population that we have in El Paso or the population that we have in 
Laredo. We have to consider the populations on the other side also that 
have a direct impact. So it becomes real important that we keep that in 
mind. So for health care, which is the issue that I am talking about, 
it is one of the areas that we also need to be very conscientious of.
  We talked about tuberculosis. As my colleagues may well know, 
tuberculosis can be spread by just talking in front of someone, as we 
breathe the air. It is very serious. Tuberculosis, a very infectious 
disease, up to six or seven prescriptions are needed. It has to be 
fought for over 6 months, and if it is not fought and the medication 
not taken during that period of time, we find a situation where those 
particular prescriptions will no longer work on that particular 
illness.

                              {time}  2145

  We find out now that in tuberculosis, we are finding that there are 
some strands that we are having difficulty with because we do not have 
medications to treat them.
  Mexico treats tuberculosis with less prescriptions, and a lot has to 
do with cost. We really need to battle tuberculosis on the border. We 
need to battle it wherever it is throughout the world because when it 
comes to infectious diseases, it is like preventing a war. If you can 
prevent something, it is better than having to send our troops to deal 
with it. The same thing with access to infectious diseases. We need to 
treat them because later on we will find other forms of the disease 
that you are unable to treat because people did not take the medication 
appropriately the way that they should.
  When we look at AIDS, the disparity in AIDS also exists. There is a 
tremendous amount of AIDS. We see the statistics of Hispanics based on 
their population figures. It is beginning to hit those populations that 
are poor. We know in the area of AIDS there is some new information 
that you can begin to test yourself, and you can identify

[[Page H4425]]

whether you have AIDS or not much earlier, which has a direct impact on 
being able to take care of yourself and taking care of those persons 
that are inflicted with that disease.
  It is important that we do that as quickly as possible. Once again, 
one of the problems that exists is with the poor. It is one thing to 
know that they have diabetes or AIDS, but it does not do any good 
unless patients have access to good care. It becomes more important 
with infectious diseases such as tuberculosis and AIDS that we provide 
that access. One might say why should I care about that, it is not in 
my area. We should all care because eventually if we do not take care 
of it, we are going to find some strands that we will not be able to 
defeat, such as the strands in tuberculosis that we need to come down 
on.
  Mr. Speaker, as we talk about the border States of Arizona, New 
Mexico, and Texas, we find the same problems in terms of the 
demographics, in terms of the lack of access to good quality care, the 
problems of not having access to insurance, and we do have Medicaid for 
our indigent, but one of the things that we find is if you are not 
indigent and you are working on the border, and a lot of times small 
companies do not have access to insurance. If you do not have access to 
insurance and you are trying to make ends meet, you find yourself in a 
situation if you get sick or your child gets sick, you find yourself in 
trouble. Thank God we were able to establish the CHIPs program which 
has helped a lot of youngsters of parents who are working and trying to 
make ends meet to get covered with insurance, but we need some 
additional efforts in that area. We do need to do the outreach. We need 
educational programs. We have done some good studies on diabetes. In 
fact, some initial studies on diabetes were on the border, Starr 
County, where we have been able to detect it earlier in life. The only 
way it is good information is if we do something about it. As we have 
found a way of being able to identify whether a person has diabetes or 
not, now we have to provide access to care and the possibility of being 
able to get rid of those problems that they encounter.
  I want to take this opportunity to mention the current border 
population is a little over 11 million. In the first 5 years up to July 
2000, the border area population has continued to increase by 25 
percent.
  If you look at the year 1986, 806 maquilladoras existed in the six 
border States. But a decade later, we have over 1,500 maquilladoras. 
1997 estimates show that over 2,000 plants employed more than 600,000 
Mexican workers on the borders. We have a good deal of growth on both 
sides.
  One of the larger metropolitan areas is the city of Laredo, and it 
continues to grow on the U.S. side. On the Mexican side we have similar 
growth throughout the border region. Although poverty is a common 
element shared with both United States and Mexico, the U.S. side of the 
border is more impoverished than the rest of the United States, with 
over 33 percent of the families living at or below poverty levels. In 
Texas the statistics are 35 percent of all of the families, and 40 to 
50 percent of the families in some of the border counties are living at 
or below that poverty level.
  Three of the U.S. border counties are among the 10 poorest counties 
in the United States. As I indicated, Starr County, that I represent, 
is one of the poorest. Tonight what I want to share is that there is a 
need for us to look at the border. We need to look at it from the 
perspective of also being part of this United States. We have to look 
at the colonias that are out there.
  There has been a great deal of efforts on the part of the States to 
stop that type of growth, and we do need to stop that growth from that 
perspective because it is growth that is not planned growth, is without 
good quality water, and we need to make every effort to make sure that 
those people, those individuals that still reside on the border, have 
access to good housing. It becomes important that we provide them with 
that access without the stumbling blocks of having those colonias that 
exist on the border.
  Mr. Speaker, I want to take this opportunity to give a little data on 
California's border. One the issues talks about the problem of diabetes 
all along the border, and the fact that people have gone blind. The sad 
thing is that it could have been prevented. Now we have gotten to the 
disease so we can prevent a great deal of blindness that occurs through 
diabetes. And amputation, people have lost their limbs as a result of 
diabetes. In a lot of those cases, it is preventable. Some it is not, 
but in most cases it is preventable. It could be worked on, and these 
are important things for us to remember.
  On the HIV-AIDS situation, as we all know, we can look at the data 
and say it is looking great. We have made some inroads, but the bottom 
line is the numbers are increasing for the socioeconomic areas of our 
country. Those increases are going to be more harshly hit because these 
are the people who do not have access to good quality care. These are 
people who do not have access to the resources needed to respond to 
issues such as AIDS. If you are wealthy and have insurance, you can 
almost survive AIDS. But if you do not, you are going to find yourself 
not being able to sustain life and also not even knowing about it until 
it is almost too late.

  As we look at the border, we look at our children's health and the 
importance of vaccinations in providing access to good quality health 
care, there have been some efforts with community mental health centers 
in assuring that we provide that care. I do want to take this 
opportunity to thank those centers for their efforts throughout the 
country, and especially on the border in providing access to health 
care. They have people working out there, people working in communities 
providing that access to that care, and making sure that those people 
have access. We still need a lot more resources.
  In addition to that, we have talked about the environment. We talked 
about water pollution. Remember that on both sides we still need sewage 
plants, not only on the United States side but the Mexican side also. 
We drink water from the Rio Grande. We find ourselves in a real bind in 
terms of the quality of that water. So every effort needs to be made to 
make sure we have good quality drinking water.
  When we look at air pollution, it is no coincidence that El Paso has 
not been able to meet EPA standards. No matter what El Paso does, they 
are going to have difficulty meeting those standards mainly because of 
colonias. So colonias needs to be considered when looking at the 
formulas. You cannot consider one side of the river without looking at 
the other side, and making sure that good quality care exists on both 
sides because we breathe the same air and drink the same water and we 
are affected as we communicate with each other.
  Mr. Speaker, the border has a lot of positives. It has a lot of 
enthusiasm. It has a lot of people moving forward. There are a lot of 
things happening that are great, but part of that is making sure that 
we have good quality care. I want to take this opportunity and maybe I 
will do it at a later date, to talk about the information regarding 
some of the other States. I know in New Mexico there are 167 miles 
along the Mexican border area comprised of five counties in that 
region. You will find some disparities that exist in the area of health 
care, and those disparities are evident not only in New Mexico but 
throughout. I want to mention a couple of other things.
  I know one of the main disparities that exist in New Mexico when you 
look at tuberculosis cases, they find that you have a large number of 
tuberculosis cases also all along the border, and New Mexico is no 
exception. As well as Arizona. Arizona finds itself in the same 
situation, as well as California. So the whole border region is an area 
that we need to continue to focus on.
  Mr. Speaker, I am very pleased if nothing else with the issue of 
NAFTA. For those who opposed NAFTA, you have to admit that at least 
NAFTA has allowed us an opportunity to focus. In Texas, very seldom did 
we talk about the border. The State of Texas never focused on it. It 
continued to neglect it, and because of the importance of trade, 
because they saw the value of our neighbor to the South, now there is a 
great deal of focus.
  Along with that focus once again should come the real concern of 
meeting the needs of the community in that area, and those needs are 
translated in

[[Page H4426]]

the form of resources for access to good quality care.
  I am hoping as we move forward, we will continue to look at getting 
resources for access to health care; and I am hoping as that county 
judge from El Paso testified, that we can start looking at those 
disparities and making sure that those resources when they come to 
Texas, and those States on the border, that they come to those regions 
where they are needed the most and allow them to be able to leverage 
those resources in order for them to be able to fight the diseases I 
have mentioned.

                              {time}  2200

  I want to thank everyone who has been here tonight. I know that we 
had some opportunities to be able to dialogue about the importance of 
these issues. I want to just indicate that there has been some 
discussion on the issue of medication. I just want to briefly indicate 
that along the border, there is a study that was done where nearly 40 
percent of a survey reported that someone in the immediate household, 
40 percent, received their medications on the border from Mexico. We 
find a population that is seeking out for access to health care, they 
are not finding it on this side, they are seeking it elsewhere in 
Mexico, and there are some pitfalls to that. There are some positives 
also, but there are some pitfalls. Some of the pitfalls that I have 
indicated are like the problems that we find with tuberculosis that in 
Mexico is not treated in the same way that we treat it. We provide it 
with a lot more medication than they do. That could create some serious 
problems for all of us if it is not treated appropriately. Secondly, as 
they go across, one of the main prescriptions that they get deals with 
uses for colds and some uses, 30 percent, were for blood pressure, 50 
percent were for heart disease, 20 percent for diabetes.
  As we move forward, I am hoping that Congress at the national level, 
that there is a responsibility to meet and that when people live on the 
border and people come across the border that we as a Nation have a 
responsibility to also provide access to good quality care for not only 
all the people on the border but also those people that get impacted by 
people from the other side of the border.

                          ____________________