[Congressional Record Volume 151, Number 106 (Friday, July 29, 2005)]
[Senate]
[Pages S9498-S9499]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA (for himself, Mr. Reid, Mr. Durbin, Mr. Bingaman, 
        Mr. Corzine, Mrs. Murray, Mr. Kennedy, Ms. Landrieu, Mr. 
        Lautenberg, Mr. Inouye, Mr. Pryor, Ms. Mikulski, Mr. Obama, Mr. 
        Dodd, Mr. Lieberman, and Mrs. Clinton):
  S. 1580. A bill to improve the health of minority individuals; to the 
Committee on Finance.
  Mr. AKAKA. Mr. President, I am proud to introduce the Healthcare 
Equality and Accountability Act, along with my colleagues Senators 
Reid, Durbin, Bingaman, Corzine, Murray, Kennedy, Landrieu, Lautenberg, 
Inouye, Pryor, Mikulski, Obama, Dodd, Lieberman, and Clinton. I want to 
thank them, as well as my colleagues in the other body, for all of 
their contributions to this important legislation.
  This bill will improve access to and the quality of health care for 
indigenous people and racial and ethnic minorities who often lack 
access and suffer disproportionately from certain diseases. It is 
essential that we expand and improve the health care safety net so that 
everyone can access the health care services that they need. This 
legislation will expand health coverage and includes provisions that 
will increase access to culturally-appropriate and relevant services 
for our communities.
  In addition to improving treatments for the diseases that 
disproportionately effect indigenous people and racial and ethnic 
minorities, we need to also focus on preventing these diseases in the 
first place. This legislation will help combat heart disease, asthma, 
HIV/AIDS, and diabetes. Diabetes is a disease that disproportionately 
affects Pacific Islanders, including Native Hawaiians. Among 
populations in Hawaii, Native Hawaiians had the highest age-adjusted 
mortality rates due to diabetes for the years 2000 to 2002.
  Statistics for U.S.-related Pacific Jurisdictions are difficult to 
obtain due to underdeveloped reporting and data collection systems. 
However, available data suggests that diabetes and its complications 
are growing problems that are creating a greater burden on the health 
care delivery systems of the Pacific Jurisdictions. For example, in the 
Republic of the Marshall Islands, mortality data for 1996-2000 reflects 
that complications from diabetes are the leading cause of death and 
accounted for 30 percent of all deaths during that period. In American 
Samoa, mortality data for 1998-2001 shows that diabetes is the third 
leading cause of death accounting for nine percent of all deaths for 
that period. In

[[Page S9499]]

Guam, diabetes has been identified as the fifth leading cause of death 
and the prevalence rate has been estimated to be seven times that of 
the United States. Local governments have had to focus on expensive 
off-island tertiary hospital care and curative services, resulting in 
the reduction of funds available for community-based primary preventive 
care and pnblic health services throughout the Pacific Jurisdictions.
  There is a need for more comprehensive diabetes awareness education 
efforts targeted at communities with Native Hawaiian and other Pacific 
Islander populations. Papa Ola Lokahi, a non-profit agency created in 
1988 that functions as a consortium with private and state agencies in 
Hawaii to improve the health status of Native Hawaiians and other 
Pacific Islanders, has established the Pacific Diabetes Today Resource 
Center. Pacific Diabetes Today is designed to provide community members 
with basic knowledge and skills to plan and implement community-based 
diabetes prevention and control activities. Since 1998, the Pacific 
Diabetes Today program has provided training and technical assistance 
to 11 communities in Hawaii and the Pacific Jurisdictions. However, 
more can be done to ensure that the diabetic health needs of Native 
Hawaiians and other Pacific Islanders are being met.
  Community-based diabetes programs need to be better integrated into 
the larger infrastructure of diabetes prevention and control. 
Comprehensive, specific programs are needed to mobilize Native Hawaiian 
and other Pacific Islander communities and develop appropriate 
interventions for diabetes complications prevention and improve 
diabetes care. My bill, therefore, includes a provision that would 
authorize a comprehensive program to prevent and better manage the 
overlapping health problems that are often related to diabetes such as 
obesity, hypertension, and cardiovascular disease.
  I am also pleased that a provision has been included in this bill 
that would restore Medicaid eligibility for Freely Associated States, 
FAS, citizens in the United States. The political relationship between 
the United States and the FAS is based on mutual support. In exchange 
for the United States having strategic denial and a defense veto over 
the FAS, the United States provides military and economic assistance to 
the Republic of Marshall Islands, Federated States of Micronesia and 
Palau with the goal of assisting these countries in achieving economic 
self-sufficiency following the termination of their status as U.N. 
Trust territories. Pursuant to the Compact, FAS citizens are allowed to 
freely enter the United States. They come to seek economic opportunity, 
education, and health care. Unfortunately, FAS citizens lost many of 
their public benefits as a result of the Personal Responsibility and 
Work Opportunity Act, PRWORA, of 1996, including Medicaid coverage. FAS 
citizens were previously eligible for Medicaid as aliens permanently 
residing under color of law in the United States.
  After the enactment of PRWORA, the State of Hawaii was informed that 
it could not claim Federal matching funds for services rendered to FAS 
citizens. Since then, the State of Hawaii, and the territories of Guam, 
American Samoa, and the Commonwealth of the Northern Mariana Islands, 
CNMI, have continued to incur substantial costs to meet the health care 
needs of FAS citizens that have immigrated to these areas.
  The Federal Government must provide Federal resources to help States 
meet the healthcare needs of the FAS citizens that have been brought 
about by a Federal commitment. It is inequitable for a state or 
territory to be responsible for all of the financial burden of 
providing necessary social services to individuals that are residing 
there due to a Federal commitment. Mr. President, FAS citizen 
eligibility must be restored. Furthermore, the State of Hawaii, and the 
territories of Guam, American Samoa, and the CNMI, should be reimbursed 
for all of the Medicaid expenses of FAS citizens, and must not be 
responsible for the costs of providing essential health care services 
for FAS citizens.
  Finally, there is another provision in this bill is of extreme 
importance to the State of Hawaii, taken from legislation that my 
colleague from Hawaii, Senator Inouye, has introduced. The provision 
would provide a 100 percent Federal Medicaid Assistance Percentage, 
FMAP, of health care costs of Native Hawaiians who receive health care 
from Federally Qualified Health Centers or the Native Hawaiian Health 
Care System. This would provide similar treatment for Native Hawaiians 
as already granted to Native Alaskans by the Indian Health Service or 
tribal organizations. The increased FMAP will ensure that Native 
Hawaiians have access to the essential health services provided by 
community health centers and the Native Hawaiian Health Care System.
  This bill would significantly improve the quality of life for 
indigenous people and ethnic and racial minorities, and I encourage all 
of my colleagues to support this legislation.
  Mr. KENNEDY. Mr. President, it is a privilege to join Senator Akaka 
and Senator Reid in introducing the Healthcare Equality and 
Accountability Act. Our goal is to eliminate racial and ethnic 
disparities in health care, so that all citizens, regardless of income 
or background, have the best possible health care our Nation can 
provide.
  The Institute of Medicine has documented the severity of ethnic and 
racial disparities in health care. People of color face unequal 
treatment and unequal outcomes in heart disease, infant mortality, HIV/
AIDS, diabetes, asthma, and other serious illnesses. The health care 
needs of communities of color are often more severe than those of white 
Americans. Minorities often face significant obstacles, including 
poverty and the lack of health insurance. We need to attack disparities 
in all their forms.
  A critical first step is to see that health insurance and decent 
health care are available and affordable for all Americans. This bill 
strengthens the health care safety net by expanding access to Medicaid 
and the Children's Health Insurance Program, and improving health care 
for Indian tribes, migrant workers, and farm workers.
  The bill also contains essential measures for removing cultural and 
linguistic barriers to good care. The United States is a Nation of 
immigrants, and all Americans deserve to understand what their doctor 
is telling them. Interpreter and translator services save money in the 
long run by avoiding harm when patients do not understand their 
diagnosis or the health advice they receive. Health care institutions 
deserve to be reimbursed for providing these critically needed 
services.
  Other important initiatives to reduce health disparities include 
diversifying the health care workforce. Minority providers are more 
likely to serve low-income communities of color, and this bill 
addresses the shortage of these providers.
  Federal agencies can do more in this battle too. The bill requires 
all Federal health agencies to develop specific plans to eliminate 
disparities. The bill expands the Office of Civil Rights and the Office 
of Minority Health at the Department of Health and Human Services, and 
creates minority health offices within the Food and Drug Administration 
and the Centers for Medicare and Medicaid Services.
  In addition, the bill strengthens investments in prevention and 
behavioral health and improves research and data collection. It 
strengthens health institutions that serve communities of color, 
provides grants for community initiatives, and funds programs on 
chronic disease. In each of these ways, we can reduce the gap in health 
care between people of color and whites, so that all Americans can 
benefit from the remarkable advances being made in modern health care.
  It's time for Congress, the administration, and the Nation to end the 
shameful inequality in health care that plagues the lives of so many 
people in our society. This bill contains numerous provisions intended 
to make that happen, and it can have a major impact on the lives of 
millions of Americans. I commend Senators Akaka and Reid for their 
leadership on this important health issue. We intend to do all we can 
in this Congress to see that effective legislation to combat health 
disparities is enacted into law and funded adequately to do the job.
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