[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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