[Congressional Record Volume 153, Number 127 (Friday, August 3, 2007)]
[Senate]
[Pages S10905-S10906]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER (for himself, Mr. Inouye, and Mr. Sanders):
  S. 1990. A bill to amend part D of title III of the Public Health 
Service Act to authorize grants and loan guarantees for health centers 
to enable the centers to fund capital needs projects, and for other 
purposes; to the Committee on Health, Education, Labor, and Pensions.
  Mr. ROCKEFELLER. Mr. President, today I rise with Senators Inouye and 
Sanders to introduce a very important bill--the Build, Update, Improve, 
Lift, and Design Health Centers Act of 2007. Also known as the BUILD 
Act, this legislation would provide building grants and loan guarantees 
to community health centers qualified under Section 330 of the Public 
Health Service Act. This widely-needed source of funding would be used 
for clinic renovation, replacement, modernization, and/or expansion in 
order to support community health centers in their on-going efforts to 
deliver high-quality health care in medically underserved areas.
  Research from the National Association of Community Health Centers 
and the Robert Graham Center indicates that there are 56 million 
Americans that do not have access to a primary care provider, 
regardless of insurance. Another 45 million Americans lack health 
insurance or the funds to pay out-of-pocket for their basic health care 
needs. This means that more than 100 million Americans do not get the 
medical treatment they need each year.
  Established over 40 years ago, community health centers are the 
backbone of America's health care safety net. Encompassing a network of 
over 1,000 centers, they provide much needed care to nearly 16 million 
people each year, including one in five children. 40 percent of health 
center patients are uninsured while Medicaid and CHIP cover 
approximately 36 percent. More than 70 percent of patients live in 
poverty. The average annual cost per patient is small, roughly $1.25 
per day. However, the benefits of community health centers are great. 
People in areas served by these clinics are less likely to use 
emergency room services and have unmet health care needs. Without these 
centers, many people, particularly those in rural areas, would have 
nowhere to turn.
  Clearly, our Nation's health centers bring health care to those in 
need, but these health centers are in need as well. Renovation and 
modernization are important to keep these buildings intact and up-to-
date. According to the National Association of Community Health 
Centers, 30 percent of the buildings are more than 30 years old and 12 
percent are more than 50 years old. Narrow operating margins, however, 
mean that most health centers do not have the resources necessary to 
pay for the capital improvements or new facilities needed to continue 
providing effective health care.
  In recent years, the President and the Senate have supported dramatic 
increases in funding to create a number of new community health 
centers. However, there has been no corresponding commitment to address 
the desperate need for renovation and modernization of the older 
centers.
  Currently, the Federal Government has no authority to provide grants 
or loan guarantees to address the building and capacity needs of 
existing community health centers. The BUILD Act provides such 
authority and, in doing so, supports the ability of these clinics to 
continue offering high quality, cost-effective care now and into the 
future.
  I urge my colleagues to join me in support of this critical 
legislation. I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1990

       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 ``Build, Update, Improve, 
     Lift, and Design Health Centers Act of 2007'' or the ``BUILD 
     Act''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Many health care experts believe that lack of access to 
     basic health services is our Nation's single most pressing 
     health care problem. There are 56,000,000 Americans that do 
     not have access to a primary care provider, whether they have 
     health insurance or not. In addition, more than 45,000,000 
     Americans lack health insurance and have difficulty accessing 
     care due to the inability to pay for such care.
       (2) Health centers, including community health centers, 
     migrant health centers, health centers for the homeless, and 
     public housing health centers, address the health care access 
     problem by providing primary care services in thousands of 
     rural and urban medically-underserved communities throughout 
     the United States.
       (3) Health centers provide basic health care services to 
     16,000,000 Americans each year, including nearly 9,500,000 
     minorities, 850,000 farmworkers, and 750,000 homeless 
     individuals. One in five children from low-income families 
     receives care through health centers.
       (4) Studies show that health centers provide high-quality 
     and cost-effective health care. The average yearly cost for a 
     health center patient is approximately $1.25 per day.
       (5) One of the most effective ways to address America's 
     health care access problem is by dramatically expanding 
     access to health centers, as both the Senate and the 
     President have proposed.
       (6) Many existing health centers operate in facilities that 
     desperately need renovation or modernization. Thirty percent 
     of health centers are located in buildings that are more than 
     30 years old, with 12 percent of such centers operating out 
     of facilities that are more than 50 years old. In a survey of 
     health centers in 11 States, 2/3 of those centers identified 
     a need to improve, expand, or replace their current facility. 
     An extrapolation based on this survey indicates there may be 
     as much as $2,200,000,000 in unmet capital needs in our 
     Nation's health centers.
       (7) Dramatically increasing access to health centers 
     requires building new facilities in communities that have 
     access problems and lack a health center.
       (8) Health centers often do not have the means to pay for 
     capital improvements or new facilities. While most health 
     centers raise some funds through private donations, it is 
     difficult to raise sufficient amounts for capital needs 
     without a middle-upper-class donor base similar to other 
     nonprofit organizations like universities and hospitals.
       (9) Health centers have a limited ability to support loan 
     payments. Due to an increasing number of uninsured patients 
     and the fact that many health care reimbursements are less 
     than the cost of care, health centers rarely have more than 
     minimal positive operating margins. Yet lenders are rarely 
     willing to take risks on nonprofit organizations without 
     these positive margins.
       (10) While the Federal Government currently provides grants 
     to health centers to assist with operational expenses used to 
     provide care to a medically underserved population, there is 
     no authority to provide grants to assist health centers to 
     meet capital needs, such as construction of new facilities or 
     modernization, expansion, or replacement of existing 
     buildings.
       (11) To assist health centers with their mission of 
     providing health care to the medically underserved, the 
     Federal Government should supplement local efforts to meet 
     the capital needs of health centers.

     SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

       (a) Health Care Facility Grants and Loan Guarantees.--
     Subpart I of part D of title III of the Public Health Service 
     Act (42 U.S.C. 254b et seq.) is amended by adding at the end 
     the following:

     ``SEC. 330R. HEALTH CARE FACILITY GRANTS AND LOAN GUARANTEES.

       ``(a) Eligible Health Center Defined.--In this section, the 
     term `eligible health center' means a health center that 
     receives--
       ``(1) a grant, on or after the date of enactment of this 
     section, under subsection

[[Page S10906]]

     (c)(1)(A), (e)(1)(A), (e)(1)(B), (f), (g), (h), or (i) of 
     section 330; or
       ``(2) a subgrant, on or after the date of enactment of this 
     section, from a grant awarded under such provision of law.
       ``(b) Grant Program Authorized.--
       ``(1) In general.--The Secretary may award grants to 
     eligible health centers to pay for the costs described in 
     paragraph (2).
       ``(2) Use of funds.--An eligible health center that 
     receives a grant under paragraph (1) may use the grant funds 
     to--
       ``(A) modernize, expand, and replace existing facilities at 
     such center; and
       ``(B) construct new facilities at such center.
       ``(3) Limitation.--
       ``(A) In general.--Subject to subparagraph (B), the Federal 
     share of a grant awarded under paragraph (1) to expand an 
     existing, or construct a new, facility shall not exceed 90 
     percent of the total cost of the project (including interest 
     payments) proposed by the eligible health center.
       ``(B) Exception.--The Federal share maximum under 
     subparagraph (A) shall not apply if--
       ``(i) the total cost of the project proposed by the 
     eligible health center is less than $750,000; or
       ``(ii) the Secretary waives such maximum upon a showing of 
     good cause.
       ``(c) Facility Loan Guarantees.--
       ``(1) In general.--
       ``(A) In general.--The Secretary shall establish a program 
     under which the Secretary may guarantee not less than 90 
     percent of the principal and interest on the total amount of 
     loans made to an eligible health center by non-Federal 
     lenders in order to pay for the costs associated with a 
     capital needs project described in subparagraph (B).
       ``(B) Projects.--Capital needs projects under this 
     subsection include--
       ``(i)(I) acquiring, leasing, modernizing, expanding, or 
     replacing existing facilities;
       ``(II) constructing new facilities; or
       ``(III) purchasing or leasing equipment; or
       ``(ii) the costs of refinancing loans made for any of the 
     projects described in clause (i).
       ``(C) Not a federal subsidy.--Any loan guarantee issued 
     pursuant to this subsection shall not be deemed a Federal 
     subsidy for any other purpose.
       ``(2) Authority for loan guarantee program.--With respect 
     to the program established under paragraph (1), the Secretary 
     shall assume such authority--
       ``(A) as the Secretary has under paragraphs (2) and (4) of 
     section 330; and
       ``(B) under section 1620 as the Secretary determines is 
     necessary and appropriate.
       ``(3) Health center project applications.--The Secretary 
     shall require that all applicants for grants and loans under 
     this section--
       ``(A) comply with the conditions set forth in section 1621, 
     as in effect on the date of enactment of this section, with 
     respect to activities authorized for assistance under 
     subsections (b)(2) and (c)(1)(B) in the same manner that 
     applicants for loans, loan guarantees, or grants for medical 
     facilities projects under such section are required to comply 
     with such conditions, unless such conditions are, by their 
     terms, otherwise inapplicable; and
       ``(B)(i) give priority to contractors that employ 
     substantial numbers of workers who reside in the area to be 
     served by the health center; and
       ``(ii) include in the construction contract involved a 
     requirement that the contractor will give priority in hiring 
     new employees to residents of such area.
       ``(4) Definitions.--In this subsection:
       ``(A) Facilities.--The term `facilities' means a building 
     or buildings used by a health center, in whole or in part, to 
     provide services permitted under section 330 and for such 
     other purposes as are not specifically prohibited under such 
     section as long as such use furthers the objectives of the 
     health center.
       ``(B) Non-federal lender.--The term `non-Federal lender' 
     means any entity other than an agency or instrumentality of 
     the Federal Government authorized by law to make loans, 
     including a federally-insured bank, a lending institution 
     authorized or licensed to make loans by the State in which it 
     is located, a community development finance institution or 
     community development entity (as designated by the Secretary 
     of the Treasury), any such lender as the Secretary may 
     designate, and a State or municipal bonding authority or such 
     authority's designee.
       ``(d) Evaluation.--Not later than 3 years after the date of 
     enactment of this section, the Secretary shall prepare a 
     report containing an evaluation of the programs authorized 
     under this section. Such report shall include recommendations 
     on how this section can be improved to better help health 
     centers meet such centers' capital needs in order to expand 
     access to health care in the United States.
       ``(e) Authorization.--For the purpose of carrying out this 
     section, the Secretary shall use not more than 5 percent of 
     any funds appropriated pursuant to section 330(s) (relating 
     to authorization of appropriations). In addition, funds 
     appropriated for fiscal years 1997 and 1998 under the 
     Departments of Labor, Health and Human Services, and 
     Education, and Related Agencies Appropriations Acts of 1997 
     and 1998, which were made available for loan guarantees for 
     loans made by non-Federal lenders for construction, 
     renovation, and modernization of medical facilities that are 
     owned and operated by health centers and which have not been 
     expended, shall be made available for loan guarantees under 
     this section.''.
       (b) Authorization of Appropriations.--Section 330(r)(1) of 
     the Public Health Service Act (42 U.S.C. 254b(r)(1)) 
     (relating to authorization of appropriations) is amended by 
     striking ``this section'' and inserting ``this section and 
     section 330R''.
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