[Congressional Record Volume 149, Number 110 (Wednesday, July 23, 2003)]
[Senate]
[Pages S9795-S9798]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. BINGAMAN (for himself, Mr. McCain, Mrs. Feinstein, and Mr.
Cornyn):
S. 1447. A bill to establish grant programs to improve the health of
border area residents and for bioterrorism preparedness in the border
area, and for other purposes; to the Committee on Health, Education,
Labor, and Pensions.
Mr. BINGAMAN. Mr. President, today I am introducing a bill with
Senators McCain, Feinstein, and Cornyn entitled the Border Health
Security Act of 2003. This bill addresses the tremendous health
problems confronting our Nation's southwestern border.
The United States-Mexico border region is defined in the U.S.-Mexico
Border Health Commission authorizing legislation as the area of land
100 kilometers, or 62.5 miles, north and south of the international
boundary. It stretches 2,000 miles from California, through Arizona and
New Mexico to the southern tip of Texas and is estimated to have a
population of 12 million residents.
The border region comprises two sovereign nations, 25 Native American
tribes, and four States in the United States and six States in Mexico.
Why should we provide some focus to this geographic region? The
situation along the border is among the most dire in the country. In
the past, we have recognized problems with other regions, through the
Denali, Delta, and Appalachian commissions, and have provided targeted
funding to those areas. The U.S.-Mexico Border Health Commission,
legislation I sponsored with Senators McCain, Simon and Hutchison, was
created for the same reasons and annually receives about $4 million in
funding that is matched by $1 million from the Mexican government for
administrative purposes to improve international cooperation and
agreements to tackle health problems in the region. However, we need to
take the next step and provide resources to address the problems.
In the border region, three of the ten poorest counties in the United
States are located in the border area, 21 of the counties have been
designated as economically distressed, approximately 430,000 people
live in 1,200 colonias in Texas and New Mexico, which are
unincorporated communities that are characterized by substandard
housing, unsafe public drinking water, and wastewater systems, very
high unemployment, and the lower per capita income as a region in the
Nation.
The result is a health system that confronts tremendous health
problems with little or no resources. Although it is difficult to
access the health needs along the border since data is more often
collected on a statewide basis, we do know that diabetes, cancer,
infectious disease such as tuberculosis, and health disease rates are
far greater than the national average but the residents in the area
have the highest uninsured rates in the country.
In fact, the States of Texas, New Mexico, and California rank as the
States with the three worst uninsured rates in the country to begin
with. Arizona is not much better and ranks 46th in the Nation, just
ahead of Louisiana and Oklahoma. The uninsured rates of these States
are: 23.5 percent in Texas, 20.7 percent in New Mexico, 19.5 percent in
California, and 18.3 percent in Arizona.
However, the figures along the border are even worse, as the rates of
uninsured are higher still than that in the four States overall.
Uninsured rates in many border counties are estimated to be above 30
percent and as high as 50 percent in certain communities.
As the U.S.-Mexico Border Commission notes, ``The border is
characterized by weaknesses in the border health
[[Page S9796]]
systems and infrastructure, lack of public financial resources, poor
distribution of physicians and other health professionals and
hospitals. Moreover, the low rates of health insurance coverage and low
incomes puts access to health services out of reach for many border
residents and thus keeps the border communities at risk.''
The U.S.-Mexico Border Commission has identified and approved of an
agenda through its ``Health Border 2010'' initiative, which seeks to,
among other things: reduce by 25 percent the population lacking access
to a primary provider; reduce the female breast cancer death rate by 20
percent; reduce the cervical cancer death rate by 30 percent; reduce
deaths due to diabetes by 10 percent; reduce hospitalizations due to
diabetes by 25 percent; reduce the incidence of HIV cases by 50
percent; reduce the incidence of tuberculosis cases by 50 percent;
reduce the incidence of hepatitis A and B cases by 50 percent; reduce
the infant mortality rate by 15 percent; and increase initiation of
prenatal care in the first trimester by 85 percent.
However, the U.S.-Mexico Border Commission lacks the resources that
are needed to address those important goals. The bipartisan legislation
I am introducing today with Senators McCain, Feinstein, and Cornyn
would address that problem by reauthorizing the U.S.-Mexico Border
Health Commission at $10 million and authorizing another $200 million
in funding to improve the infrastructure, access, and the delivery of
health care services along the entire U.S.-Mexico border.
These grants would be flexible and allow the individual communities
to establish their own priorities with which to spend these funds for
the following range of purposes: maternal and child health, primary
care and preventative health, public health and public health
infrastructure, health promotion, oral health, behavioral and mental
health, substance abuse, health conditions that have a high prevalence
in the border region, medical and health services research, community
health worker or promotoras, health care infrastructure, including
planning and construction grants, health disparities, environmental
health, health education, and outreach and enrollment services with
respect to Medicaid and the State Children's Health Insurance Program,
CHIP.
We would certainly expect those grants would be used for the purpose
of striving to achieve the measurable goals established by the ``Health
Border 2010'' initiative.
In addition, the bill contains authorization for $25 million for
funding to border communities to improve the infrastructure,
preparedness, and education of health professionals along the U.S.-
Mexico border with respect to bioterrorism. This includes the
establishment of a health alert network to identify and communicate
information quickly to health providers about emerging health care
threats.
On October 15, 2001, just one month after the September 11, 2001,
attack on our Nation, Secretary Thompson spoke to the U.S.-Mexico
Border Health Commission and urged them to put together an application
for $25 million for bioterrorism and preparedness. The Commission has
done so but has not seen targeted funding despite the vulnerability
that border communities have with respect to a bioterrorism attack. Our
legislation addresses the vulnerability of communities along the border
and targets funding to those communities specifically to improve
infrastructure, training, and preparedness.
I ask unanimous consent to include articles from the El Paso Times
and the Los Angeles Times from October 2001 with respect to those
meetings and hope the Secretary will be an advocate with us in the
passage of this legislation.
There being no objection, the articles were ordered to be printed in
the Record, as follows:
[From the El Paso Times, Oct. 16, 2001]
Health Secretary To Fight for Border Funds
(By Tammy Fonce-Olivas)
U.S. Health and Human Services Secretary Tommy Thompson
wants to arm the border with $25 million to combat illnesses.
``Diseases don't stop at the border,'' said Thompson, who
was in El Paso on Monday. ``We need to work in a
collaborative fashion to improve the health of the border
neighborhood. It's our neighborhood.''
He talked about the additional funds he is seeking for
border health initiatives while chairing the fourth
binational meeting of the U.S.-Mexico Border Health
Commission.
Thompson was joined by Julio Frenk Mora, Mexico's Secretary
of Health.
Thompson said he didn't know if he would get the $25
million from Congress but vowed to make a strong effort to
get more funding for programs to improve access to public
health for those living along the border and bolstering
border health research.
Frenk Mora also said he will be fighting for more money to
support border health programs. Frenk is a co-chairman of the
commission.
The group is composed of 26 public-health leaders from both
sides of the U.S.-Mexico border, who are devoted to fighting
health problems, such as tuberculosis, AIDS and diabetes.
Dr. Laurence Nickey, El Paso's former city-county health
director and member of the commission, said he wants to see
more funding concentrated on diabetes.
He said diabetes is diagnosed in one of five Hispanics on
the border by the age of 45. He expects this statistic to
become worse unless more work is done in this area.
Frenk Mora said Mexico understands the importance of public
health and will do its share to improve the health and
wellness of people residing along the border.
Mayor Ray Caballero, who attended the meeting, said one of
El Paso's biggest problem is a lack of health-care providers.
``We are not able to attract or retain enough physicians,''
he said.
Thompson announced after the meeting that the University of
Texas Health Sciences Center in San Antonio has been awarded
a $250,000 grant to establish a Regional Center for Health
Workforce Studies.
workshop
Today will be the final session of the U.S.-Mexico
Binational Tuberculosis Workshop at the Hilton Camino Real.
Among today's discussions will be a binational information
system, as well as talks on consensus building.
____
[From the Los Angeles Times, Oct. 17, 2001]
U.S., Mexico Team Up on Health Care
(By James F. Smith)
The United States and Mexico took some imaginative steps
this week to combat health problems that plague border
communities and migrant workers, including tuberculosis,
diabetes and AIDS.
Meeting in El Paso and neighboring Ciudad Juarez, Mexico,
health experts from the two nations agreed on a 10-year
agenda for improving care for the 11.5 million people living
along the nearly 2,000-mile border.
Mexico also launched a program that promises a new approach
to treating migrants' health problems. Formally unveiled in
Ciudad Juarez on Sunday, the ``Go Healthy, Return Healthy''
initiative seeks to help Mexico migrants in their hometowns,
along the routes they travel and during their stays in the
United States.
Elsewhere, California and Mexico kicked off the program by
staging their first joint ``health week.'' California is
conducting a flurry of activities through Friday for migrants
in the state, including vaccinations, checkups and
information campaigns. The California Endowment is devoting
part of a $50-million agricultural health grant to the
initiative.
The mere fact that U.S. Health and Human Services Secretary
Tommy G. Thompson showed up for the U.S.-Mexico Border health
Commission meeting here Monday--despite an international
anthrax scare--delighted the Mexicans, who have worried that
U.S. relations with their nation would become a low priority
for the Bush administration following the Sept. 11 terrorist
attacks.
Officials from both nations emphasized that the border
health problems are real and immediate threats, killing many
thousands of people each year.
``We should not let the anthrax scare kidnap our entire
health agenda,'' said Mexican Health Secretary Julio Frenk.
``There are a lot of other very important issues of much
higher risk to our populations.''
Thompson, meanwhile, offered a challenge to the U.S.
delegation to the year-old Border Health Commission: He'll
try to come up with an additional $25 million for health
projects along the frontier if they can come up with
specific, effective ways to spend the money.
A commission study issued Monday detailed the serious
health challenges on the border, compounded by population
growth of 28% on the U.S. side and 39% on the Mexican side
during the 1990s, about twice the national growth rate in
each country.
The study found that rates of communicable diseases such as
tuberculosis, HIV/AIDS and hepatitis A are higher in the
border region than nationally for both countries. Cancer,
asthma and diabetes rates also are higher along the border.
``The high level of border crossings between the U.S. and
Mexico complicates the development of strategies to address
the spread of infectious diseases,'' the report says,
heightening the need for coordinated policies.
While the commission debated overall strategies, a workshop
of about 100 experts on tuberculosis met to map out
innovative cross-border approaches to tracking and caring for
patients. The interruption of tuberculosis treatment is
highly dangerous for patients because it can lead to
resistance to
[[Page S9797]]
medication. Yet such breaks in treatment occur frequently
when ailing migrants cross illegally into the United States.
The workshop focused on development of a binational
tuberculosis card that would allow patients to continue
treatment on either side of the border with confidentiality.
The cared would not only ensure continuity in treatment but
allow both countries to improve their database of
tuberculosis cases.
Dr. Lincoln Chen, a public health expert from the
Rockefeller Foundation, said such initiatives make the border
region ``the cutting edge of health in the 21st century . . .
This is the front line of global health.''
Thompson and Frenk visited sites that symbolize the
emerging cooperation, from the La Fe health clinic in south
El Paso, which treats many Latino AIDS patients, to a U.S.
Food and Drug Administration inspection operation. In
September, the two governments agreed to expand efforts to
ensure the safety of meat, poultry and egg products that are
shipped across the border in immense volumes.
In California, meanwhile, seven counties that are home to
large numbers of migrant workers took part in the health week
with Mexico. Jose Ignacio Santos, head of child health in
Mexico and director of the ``Go Health, Return Healthy''
program, said the initiative brings to the U.S. some of the
techniques that have made Mexico's public health system
highly regarded. Those included very public community
outreach activities, which have helped achieve a 98%
immunization rate.
In Mexico, the thrice-yearly National Public Health Weeks--
such as one that began Sunday--bring vaccinations to the
homes of millions of people. More than 11 million injections
will be given in Mexico this week for childhood diseases, in
programs supported by nearly 180,000 volunteers.
Similar efforts are being carried out this week in the
seven California counties, with a focus on messages about
cervical and breast cancer, immunizations and diabetes. The
goal is to reach some of the more than 3 million Mexicans
living and working in the state, especially the 1 million
agricultural laborers.
Frenk, the health secretary, said that in the past, Mexico
did not clearly understand the differences between treating
stable and migrant populations. The new program acknowledges
that migrants carry health problems with them as they leave
home--and bring back ailments such as AIDS when they return
from the United States.
Now officials are developing preventive programs in 502
towns in the 10 Mexican states that produce the most
migrants, including Jalisco and Guanajuato.
The effort will also respond to the seasonal moves of the
workers. For example, it calls for information and
immunization campaigns in August and September, when migrants
often leave home to work during the harvest season. It
prepares for treating the workers when they return home at
year's end or Easter.
Frenk said the new model demands a high level of
coordination with U.S. authorities. And it will require new
levels of trust from illegal migrants that the health
information won't be used against them, he said.
``The ideal would be a well-coordinated system in which we
could say to the U.S. authorities: `There goes a migrant who
has tuberculosis. Care for him,''' he said. ``Some day not
too far in the future, there will be electronic clinical
histories on a card with an intelligent chip, and the person
will carry it. But this will require much trust on the part
of illegal migrants.''
Mr. BINGAMAN. Mr. President, our relationship with Mexico, like that
with Canada, is a special one. Those countries are our closest
neighbors, and yet, we often and wrongly neglect our neighbor to the
South and the much needed economic development needed in the region.
Mexico is the United States' second largest trading partner and the
border is recognized as one of the busiest ports of entry in the world.
And yet, the region is often neglected.
As the U.S.-Mexico Border Health Commission points out, ``Without
increases and sustained federal, state and local governmental and
private funding for health programs, infrastructure and education, the
border populations will continue to lag behind the United States in
these areas.'' If the border were its own state, according to data from
the Heath Resources and Services Administration, it would: rank last in
access to health care; second in death rates due to hepatitis; third in
deaths related to diabetes; last in per capita income; first in the
number of school children living in poverty; and, first in the numbers
of the uninsured.
I would like to thank Senator McCain, who was the original cosponsor
of the U.S.-Mexico Border Health Commission legislation, Public Law
103-400, that we passed in 1994 and is the lead cosponsor of this
legislation as well, for his outstanding leadership on border issues
throughout his career. I would also thank Senators Feinstein and Cornyn
for working with us on this important legislation and Senator Hutchison
for her constant support for the appropriations of the U.S.-Mexico
Border Commission upon the signed agreement between the United States
and Mexico, which was signed by President Clinton on July 14, 2000.
I urge the adoption of this bipartisan legislation by this Congress.
I ask unanimous consent that a fact sheet and the text of the bill be
printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Fact Sheet--Border Health Security Act of 2003
Senators Jeff Bingaman, D-NM, John McCain, R-AZ, Dianne
Feinstein, D-CA, and John Cornyn, R-TX, are preparing to
introduce the ``Border Health Security Act of 2003.'' The
legislation seeks to improve the infrastructure, access, and
delivery of health care services to residents along the U.S.-
Mexico border.
The legislation would achieve these goals by:
Improving Border Health Services: Provides for $200 million
in funding to States, local governments, tribal governments,
institutions of higher education, nonprofit health
organizations, or community health centers along the U.S.-
Mexico border to improve infrastructure, access, and the
delivery of health care services.
These grants are flexible and would allow the community to
establish its own priorities with which to spend these funds
for the following range of purposes: maternal and child
health, primary care and preventative health, public health
and public health infrastructure, health promotion, oral
health, behavioral and mental health, substance abuse, health
conditions that have a high prevalence in the border region,
medical and health services research, community health
workers or promotoras, health care infrastructure, including
planning and construction grants, health disparities,
environmental health, health education, and outreach and
enrollment services with respect to Medicaid and the State
Children's Health Insurance Program, CHIP.
Providing Border Bioterrorism Preparedness Grants: Provides
for $25 million in funding to States and local governments or
public health departments to improve the infrastructure,
preparedness, and education of health professionals along the
U.S.-Mexico border with respect to bioterrorism. This
includes the establishment of a health alert network to
identify and communicate information quickly to health
providers about emerging health care threats.
Reauthorizing the U.S.-Mexico Border Health Commission:
Provides for the reauthorization of the U.S.-Mexico Border
Health Commission at $10 million annually.
S. 1447
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Border Health Security Act
of 2003''.
SEC. 2. DEFINITIONS.
In this Act:
(1) Border area.--The term ``border area'' has the meaning
given the term ``United States-Mexico Border Area'' in
section 8 of the United States-Mexico Border Health
Commission Act (22 U.S.C. 290n-6).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
SEC. 3. BORDER HEALTH GRANTS.
(a) Eligible Entity Defined.--In this section, the term
``eligible entity'' means a State, public institution of
higher education, local government, tribal government,
nonprofit health organization, or community health center
receiving assistance under section 330 of the Public Health
Service Act (42 U.S.C. 254b), that is located in the border
area.
(b) Authorization.--From funds appropriated under
subsection (f), the Secretary, acting through the United
States members of the United States-Mexico Border Health
Commission, shall award grants to eligible entities to
address priorities and recommendations to improve the health
of border area residents that are established by--
(1) the United States members of the United States-Mexico
Border Health Commission;
(2) the State border health offices; and
(3) the Secretary.
(c) Application.--An eligible entity that desires a grant
under subsection (b) shall submit an application to the
Secretary at such time, in such manner, and containing such
information as the Secretary may require.
(d) Use of Funds.--An eligible entity that receives a grant
under subsection (b) shall use the grant funds for--
(1) programs relating to--
(A) maternal and child health;
(B) primary care and preventative health;
(C) public health and public health infrastructure;
(D) health promotion;
(E) oral health;
(F) behavioral and mental health;
(G) substance abuse;
(H) health conditions that have a high prevalence in the
border area;
(I) medical and health services research;
[[Page S9798]]
(J) workforce training and development;
(K) community health workers or promotoras;
(L) health care infrastructure problems in the border area
(including planning and construction grants);
(M) health disparities in the border area;
(N) environmental health;
(O) health education; and
(P) outreach and enrollment services with respect to
Federal programs (including programs authorized under titles
XIX and XXI of the Social Security Act (42 U.S.C. 1396 and
1397aa)); and
(2) other programs determined appropriate by the Secretary.
(e) Supplement, Not Supplant.--Amounts provided to an
eligible entity awarded a grant under subsection (b) shall be
used to supplement and not supplant other funds available to
the eligible entity to carry out the activities described in
subsection (d).
(f) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $200,000,000
for fiscal year 2004, and such sums as may be necessary for
each succeeding fiscal year.
SEC. 4. BORDER BIOTERRORISM PREPAREDNESS GRANTS.
(a) Eligible Entity Defined.--In this section, the term
``eligible entity'' means a State, local government, tribal
government, or public health entity.
(b) Authorization.--From funds appropriated under
subsection (e), the Secretary shall award grants to eligible
entities for bioterrorism preparedness in the border area.
(c) Application.--An eligible entity that desires a grant
under this section shall submit an application to the
Secretary at such time, in such manner, and containing such
information as the Secretary may require.
(d) Uses of Funds.--An eligible entity that receives a
grant under subsection (b) shall use the grant funds to--
(1) develop and implement bioterror preparedness plans and
readiness assessments and purchase items necessary for such
plans;
(2) coordinate bioterrorism and emergency preparedness
planning in the region;
(3) improve infrastructure, including syndrome surveillance
and laboratory capacity;
(4) create a health alert network, including risk
communication and information dissemination;
(5) educate and train clinicians, epidemiologists,
laboratories, and emergency personnel; and
(6) carry out such other activities identified by the
Secretary, the United States-Mexico Border Health Commission,
State and local public health offices, and border health
offices.
(e) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $25,000,000 for
fiscal year 2004 and such sums as may be necessary for each
succeeding fiscal year.
SEC. 5. UNITED STATES-MEXICO BORDER HEALTH COMMISSION ACT
AMENDMENTS.
The United States-Mexico Border Health Commission Act (22
U.S.C. 290n et seq.) is amended by adding at the end the
following:
``SEC. 9. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated to carry out this
Act $10,000,000 for fiscal year 2004 and such sums as may be
necessary for each succeeding fiscal year.''.
SEC. 6. COORDINATION OF HEALTH SERVICES AND SURVEILLANCE.
The Secretary may coordinate with the Secretary of Homeland
Security in establishing a health alert system that--
(1) alerts clinicians and public health officials of
emerging disease clusters and syndromes along the border
area; and
(2) is alerted to signs of health threats or bioterrorism
along the border area.
Mr. McCAIN. Mr. President, recognizing that the communities along our
Nation's border are literally our front line of defense, it is in the
interest of our national security to ensure that these areas are well
equipped to respond to health emergencies and potential bioterror
attacks. To address the critical needs of this vulnerable region, I am
pleased to once again join my good friends from New Mexico, Senator
Bingaman, along with Senator Feinstein and Senator Cornyn, in
introducing the Border Health Security Act of 2003.
Ten years ago, Senator Bingaman and I introduced a bill which we
believed represented a first step toward addressing the many health
challenges confronting the U.S.-Mexico border region as it faced
growing population and an expanding industrial base. The United States-
Mexico Border Health Commission Act authorized the President to enter
into a bilateral agreement with Mexico and establish a binational
commission on border health, and was signed into law in the fall of
1994.
Six years later the U.S. Secretary of Health and Human Services and
the Secretary of Health of Mexico signed an agreement creating the
United States-Mexico Border Health Commission. Although still in its
infancy, the Commission serves to draw attention to the unique needs of
the border region, while improving and protecting the health and well-
being of the residents on both sides of the border.
The bill we are introducing today builds upon the effort we began 10
years ago. This legislation authorizes two new grant programs targeting
health care and bioterror preparedness in the border area in addition
to funding for the Commission.
The first grant program we establish, the Border Health Grants, will
be competitively awarded to programs that improve health care
infrastructure or address the unique health care needs of the border
region. Eligible programs could address health disparities, public
health, maternal and child health, and conditions with a high
prevalence in the border area. Acknowledging our national vulnerability
in the wake of September 11 attacks and the need to ensure that
bioterror efforts are specifically focused on the border region, our
bill establishes bioterror preparedness grants for activities including
coordination of bioterror and emergency preparedness, improvements in
infrastructure, and education and training.
The communities along our Nation's southern border typically have
high rates of uninsured and underinsured individuals, unemployment, and
poverty. This region also has higher rates of infections and chronic
diseases, often exacerbated by migrant populations. Compounding these
problems is the lack of health care facilities and qualified health
care professionals. According to the U.S.-Mexico Border Health
Commission, if the border area were a state, it would rank last in
access in health care, second in death rates due to hepatitis, third in
deaths related to diabetes, first in number of TB cases and last in per
capita income.
I have long supported legislative initiatives aimed at improving the
security and quality of life in our border area. This bill is a part of
that ongoing effort. As our Nation enters a new era of heightened
national alert, it is incumbent upon us to ensure our border area--our
front line of defense--is strenghtened and protected.
______