[Congressional Record Volume 154, Number 121 (Wednesday, July 23, 2008)]
[Senate]
[Pages S7153-S7156]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Mr. Bingaman, and Mr. Feingold):
  S. 3312. A bill amend the Public Health Service Act to ensure that 
victims of public health emergencies have meaningful and immediate 
access to medically necessary health care services; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. DURBIN. Today I am introducing the Public Health Emergency 
Response Act. This bill authorizes a temporary health benefit during a 
public emergency for people in that area who don't have health 
insurance. The program makes it more likely that people who need 
healthcare services will get them and ensures that the doctors and 
nurses who treat them will be compensated.
  Since 2000, the Secretary of Health and Human Services has had the 
authority to declare public health emergencies so that government can 
provide resources quickly to communities in need. That authority has 
been exercised very rarely--for 9-11; Hurricanes Wilma, Katrina, and 
Rita; and the recent flooding in the Midwest. These public health 
emergencies--both man-made and natural disasters--ruined neighborhoods, 
divided families, and weakened many spirits. But for every tragic 
emergency witnessed, we saw acts of remarkable selflessness and 
kindness.
  One of the greatest examples of this generosity is in the efforts of 
local health care providers to meet the increased need for services. 
Whether it was the hurricanes that hit the Gulf Coast, the debris in 
downtown New York, or the waters in the Midwest, the need for medical 
services was immediate and in some cases dramatic. The demand for 
mental health services also rose in response to the psychological 
stress and trauma caused by the destruction of homes, the loss of jobs, 
the separation of families, and the death and devastation surrounding 
those in the areas hit by these tragic events.
  Despite the trauma of a disaster or the pain from an injury incurred 
during a disaster, people who don't seek care not only leave themselves 
vulnerable to worsening health conditions, but they exacerbate the 
situation on the ground. For those uninsured people who do access 
medical care, the providers--typically those in areas immediately 
surrounding the disaster area--are often left without any compensation.
  During Hurricane Katrina, the Harris County hospital district in 
Houston assumed responsibility for the health care of 23,000 evacuees 
living in the Reliant Astrodome. In Baton Rouge, hospitals struggled to 
meet the health care needs of a population that doubled in size after 
absorbing half a million evacuees. Health facilities and other public 
infrastructure were stretched beyond their capacity as they faced the 
multiple challenges of addressing the public health needs in the 
counties or parishes directly affected; delivering needed health care 
to the displaced; and ensuring the continued delivery of health care 
services to residents of the other areas.
  Victims of public health emergencies should know that the government 
will assist them in their time of need. This is why I am introducing 
the Public Health Emergency Response Act.
  The Public Health Emergency Response Act would make it easier for 
uninsured victims to seek treatment and would provide coverage to the 
health care professionals who are treating them. The bill would 
establish a temporary emergency health benefit for people who are 
uninsured. The benefit could be triggered only when the Secretary of 
Health and Human Services declared a public health emergency and chose 
to activate the benefit. The benefit would last for up to 90 days, and 
the Secretary could extend it once for another 90 days. Rather than put 
additional stress on our public health programs like Medicare, Medicaid 
or SCHIP, the funding mechanism for the benefit is the Public Health 
Emergency Fund, a no-year fund established in 1983. Funds for emergency 
victims' health coverage would be determined by Congressional 
appropriations. The bill will help save lives and ensure a functioning 
health care system for whatever lies ahead.
  Most recently, we saw the entire Midwest reeling from weeks of 
flooding and tornadoes--from Minnesota to Kansas and everywhere in 
between--Wisconsin, Iowa, Missouri, and, of course, Illinois. The 
damage has been heartbreaking. We know from the great flood that 
devastated the Midwest in 1993 and from Hurricanes Katrina and Rita 
that the losses from this chain of weather-related disasters will be 
more than our states and citizens alone can bare. We also know that, in 
times of crisis, Americans have always come together to help those in 
need.
  The Public Health Emergency Response Act carries on this tradition. 
The bill allows Federal government to prepare for the next emergency. 
We do not know what the next public health emergency will look like. It 
may be a bioterrorist attack, a hurricane, or pandemic flu. We should 
act now to create the framework for emergency health coverage and 
reimbursement.
  Mr. President, I ask unanimous consent that the text of the bill and 
a letter of support be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 3312

       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 ``Public Health Emergency 
     Response Act of 2008''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress finds the following:
       (1) Since 2000, the Secretary of Health and Human Services 
     has declared that a public health emergency existed 
     nationwide in response to the attacks of September 11th and 
     in response to Hurricanes Katrina and Rita.
       (2) In the event of a public health emergency, compliance 
     with recommendations to seek immediate care may be critical 
     to containing the spread of an infectious disease outbreak or 
     responding to a bioterror attack.
       (3) Nearly sixteen percent of Americans lack health 
     insurance coverage.
       (4) Fears of out-of-pocket expenses may cause individuals 
     to delay seeking medical attention during a public health 
     emergency.
       (5) A public health emergency may disrupt health care 
     assistance programs for individuals with chronic conditions, 
     exacerbating the costs and risks to their health.
       (6) The uninsured could place great financial strain on 
     healthcare providers during a public health emergency.
       (7) The Department of Health and Human Services Pandemic 
     Influenza Plan projects that a pandemic influenza outbreak 
     could result in 45 million additional outpatient visits, with 
     865,000 to 9,900,000 individuals requiring hospitalization, 
     depending upon the severity of the pandemic.
       (8) Hospitals in the United States could lose as much as 
     $3.9 billion in uncompensated care and cash flow losses in 
     the event of a severe pandemic.
       (9) Under current statute, no dedicated mechanism exists to 
     reimburse providers for uncompensated care during a public 
     health emergency.
       (b) Purposes.--The purposes of this Act are--
       (1) to provide temporary emergency healthcare coverage for 
     uninsured and certain otherwise qualified individuals in the 
     event of a public health emergency declared by the Secretary 
     of Health and Human Services;
       (2) to ensure that healthcare providers remain fiscally 
     solvent and are not overburdened by the cost of uncompensated 
     care during a public health emergency;
       (3) to eliminate a primary disincentive for uninsured and 
     certain otherwise qualified individuals to promptly seek 
     medical care during a public health emergency; and
       (4) to minimize delays in the provision of emergency 
     healthcare coverage by clarifying eligibility requirements 
     and the scope of such coverage and identifying the funding 
     mechanisms for emergency healthcare services.

     SEC. 3. EMERGENCY HEALTHCARE COVERAGE.

       (a) In General.--Title III of the Public Health Service Act 
     is amended by inserting after section 319K the following new 
     section:

     ``SEC. 319K-1. EMERGENCY HEALTHCARE COVERAGE.

       ``(a) Activation and Termination of Emergency Healthcare 
     Coverage.--

[[Page S7154]]

       ``(1) Based on public health emergency.--
       ``(A) In general.--The Secretary may activate the coverage 
     of emergency healthcare services under this section only if 
     the Secretary determines that there is a public health 
     emergency.
       ``(B) Determination of public health emergency.--For 
     purposes of this section, there is a `public health 
     emergency' only if a public health emergency exists under 
     section 319.
       ``(2) Considerations.--In making a determination under 
     paragraph (1), the Secretary shall consider a range of 
     factors including the following:
       ``(A) The degree to which the emergency is likely to 
     overwhelm healthcare providers in the region.
       ``(B) The opportunity to minimize morbidity and mortality 
     through intervention under this section.
       ``(C) The estimated number of direct casualties of the 
     emergency.
       ``(D) The potential number of casualties in the absence of 
     intervention under this section (such as in the case of 
     infectious disease).
       ``(E) The potential adverse financial impacts on local 
     healthcare providers in the absence of activation of this 
     section.
       ``(F) The need for healthcare services is of sufficient 
     severity and magnitude to warrant major assistance under this 
     section above and beyond the emergency services otherwise 
     available from the Federal Government.
       ``(G) Such other factors as the Secretary may deem 
     appropriate.
       ``(3) Termination and extension.--
       ``(A) In general.--Coverage of emergency healthcare 
     services under this section shall terminate, subject to 
     subsection (c)(2), upon the earlier of the following:
       ``(i) The Secretary's determination that a public health 
     emergency no longer exists.
       ``(ii) Subject to subparagraph (B), 90 days after the 
     initiation of coverage of emergency healthcare services.
       ``(B) Extension authority.--The Secretary may extend a 
     public health emergency for a second 90-day period, but only 
     if a report to Congress is made under paragraph (4) in 
     conjunction with making such extension.
       ``(4) Report.--
       ``(A) In general.--Prior to making an extension under 
     paragraph (3)(B), the Secretary shall transmit a report to 
     Congress that includes information on the nature of the 
     public health emergency and the expected duration of the 
     emergency. The Secretary shall include in such report 
     recommendations, if deemed appropriate, regarding requesting 
     Congress to provide a further extension of the public health 
     emergency period beyond the second 90-day period.
       ``(B) Report contents.--A report under subparagraph (A) 
     shall include a discussion of the healthcare needs of 
     emergency victims and affected individuals including the 
     likely need for follow-up care over a two-year period.
       ``(5) Coordination.--The Secretary shall ensure that the 
     activation, implementation, and termination of emergency 
     healthcare services under this section in response to a 
     public health emergency is coordinated with all functions, 
     personnel, and assets of the Federal, State, local, and 
     tribal responses to the emergency.
       ``(6) Medical monitoring program.--The Secretary shall 
     establish a medical monitoring program for monitoring and 
     reporting on healthcare needs of the affected population over 
     time. At least annually during the 5-year period following 
     the date of a public health emergency, the Secretary shall 
     report to Congress on any continuing healthcare needs of the 
     affected population related to the public health emergency. 
     Such reports shall include recommendations on how to ensure 
     that emergency victims and affected individuals have access 
     to needed healthcare services.
       ``(b) Eligibility for Coverage of Emergency Healthcare 
     Services.--
       ``(1) Limited eligibility.--
       ``(A) In general.--Eligibility for coverage of emergency 
     healthcare services under this section for a public health 
     emergency is limited to individuals who--
       ``(i) are emergency victims who are uninsured or otherwise 
     qualified; or
       ``(ii) are affected individuals who are uninsured.
       ``(B) Definitions.--For purposes of this section with 
     respect to a public health emergency:
       ``(i) Insured.--An individual is `insured' if the 
     individual has group or individual health insurance coverage 
     or publicly financed health insurance (as defined by the 
     Secretary).
       ``(ii) Otherwise qualified.--An individual is ``otherwise 
     qualified'' if the individual is insured but the Secretary 
     determines that the individual's healthcare insurance 
     coverage is not at least actuarially-equivalent to benchmark 
     coverage. In establishing such benchmark coverage, the 
     Secretary shall consider the standard Blue Cross/Blue Shield 
     preferred provider option service benefit plan described in 
     and offered under section 8903(1) of title 5, United States 
     Code.
       ``(iii) Uninsured.--An individual is `uninsured' if the 
     individual is not insured.
       ``(iv) Emergency victim.--An individual is an `emergency 
     victim' with respect to a public health emergency if the 
     individual needs healthcare services due to injuries or 
     disease resulting from the public health emergency.
       ``(v) Affected individual.--An individual is an `affected 
     individual' with respect to a public health emergency if--

       ``(I) the individual resides in an assistance area 
     designated for the emergency (or whose residence was 
     displaced by the emergency) or, in the case of such an 
     emergency constituting a pandemic flu or other infectious 
     disease outbreak, who resides in the area affected by the 
     outbreak (or whose residence was displaced by the emergency); 
     and
       ``(II) the individual's ability to access care or medicine 
     is disrupted as a result of the emergency.

       ``(2) Process.--The Secretary shall establish a streamlined 
     process for determining eligibility for emergency healthcare 
     services under this section. In establishing such process--
       ``(A) the Secretary shall recognize that in the context of 
     a public health emergency, individuals may be unable to 
     provide identification cards, healthcare insurance 
     information, or other documentation; and
       ``(B) the primary method for determining eligibility for 
     such services shall be an attestation provided to the 
     healthcare provider by the recipient of the services that the 
     recipient meets the eligibility criteria established under 
     paragraph (1)(A), with a standard alternative for unattended 
     minors and adults without the capacity to sign such an 
     attestation form.
       ``(3) Service delivery.--Providers may commence provision 
     of emergency healthcare services for an individual in the 
     absence of any centralized enrollment process, if the 
     provider has collected basic information, specified by the 
     Secretary, including the individual's name, address, social 
     security number, and existing health insurance coverage (if 
     any), that establishes a prima facie basis for eligibility, 
     except that such information shall not be required in cases 
     where the individual is unable to provide the information due 
     to disability or incapacitation.
       ``(c) Emergency Healthcare Services.--
       ``(1) In general.--For purposes of this section, the term 
     `emergency healthcare services'--
       ``(A) means items and services for which payment may be 
     made under parts A and B of the Medicare program;
       ``(B) includes prescription drugs (not covered under such 
     part B) specified by the Secretary under subsection (g), 
     based on the formularies of the two or more prescription drug 
     plans under part D of the Medicare program with the largest 
     enrollment;
       ``(C) may include drugs, devices, biologics, and other 
     healthcare products, if such products are authorized for use 
     by the Food and Drug Administration pursuant to an alternate 
     authority, including the emergency use authority under 
     section 564 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 360bbb-3); and
       ``(D) for an affected individual, is limited to those items 
     and services described under subparagraphs (A), (B) or (C) 
     that a third-party payor, such as a government program or 
     charitable organization, reimbursed or otherwise provided to 
     an affected individual during the three months prior to the 
     declaration of the public health emergency.
       ``(2) Not medicare, medicaid, or schip benefits.--The 
     emergency healthcare services provided under this section are 
     not benefits under Medicare, Medicaid or SCHIP. Nothing in 
     this section shall be interpreted as altering or otherwise 
     conflicting with titles XVIII, XIX, or XXI of the Social 
     Security Act.
       ``(3) Completion of treatment for emergency victims.--
     Notwithstanding termination of the coverage of emergency 
     healthcare services pursuant to subsection (a)(4), the 
     Secretary may identify a subgroup of emergency victims on a 
     case-by-case basis or otherwise to continue receiving 
     coverage of emergency healthcare services for up to an 
     additional 60 days. Such emergency healthcare services 
     provided after the termination date shall be limited to 
     services and items that are medically necessary to treat an 
     injury or disease resulting directly from the public health 
     emergency involved.
       ``(d) Covered Providers.--
       ``(1) In general.--Subject to paragraph (2), healthcare 
     services are not covered under this section unless they are 
     furnished by a healthcare provider that--
       ``(A) has a valid provider number under the Medicare 
     program, the Medicaid program, or SCHIP;
       ``(B) is in good standing with such program; and
       ``(C) is not excluded from participation in a Federal 
     health care program (as defined in section 1128B(f) of the 
     Social Security Act, 42 U.S.C. 1320a-7b(f)).
       ``(2) Waiver authority.--
       ``(A) In general.--The Secretary may by regulation waive 
     certain requirements for provider enrollment that otherwise 
     apply under the Medicare or Medicaid program or under SCHIP 
     to ensure an adequate supply of healthcare providers (such as 
     nurses and other health care providers who do not typically 
     participate in the Medicare or Medicaid program or SCHIP) and 
     services in the case of a public health emergency. Such 
     requirements may include the requirement that a licensed 
     physician or other health care professional holds a license 
     in the State in which the professional provides services or 
     is otherwise authorized under State law to provide the 
     services involved.
       ``(B) Report on emergency system for advance registration 
     of volunteer health professionals (esar-vhp).--Not later than 
     180 days after the date of the enactment of

[[Page S7155]]

     this section, the Secretary shall submit to Congress a report 
     on the number of volunteers, by profession and credential 
     level, enrolled in the Emergency System for Advance 
     Registration of Volunteer Health Professionals (ESAR-VHP) 
     that will be available to each State in the event of a public 
     health emergency. The Secretary shall determine if the number 
     of such volunteers is adequate for interstate deployment in 
     response to regional requests for volunteers and, if not, 
     shall include in the report recommendations for actions to 
     ensure an adequate surge capacity for public health 
     emergencies in defined geographic areas.
       ``(3) Medicare and medicaid programs and schip defined.--
     For purposes of this section:
       ``(A) The term `Medicare program' means the program under 
     parts A, B, and D of title XVIII of the Social Security.
       ``(B) The term `Medicaid program' means the program of 
     medical assistance under title XIX of such Act.
       ``(C) The term `SCHIP' means the State children's health 
     insurance program under title XXI of such Act.
       ``(e) Payments and Claims Administration.--
       ``(1) Payment amount.--The amount of payment under this 
     section to a provider for emergency healthcare services shall 
     be equal to 100 percent of the payment rate for the 
     corresponding service under part A or B of the Medicare 
     program, or, in the case of prescription drugs and other 
     items and services not covered under either such part, such 
     amount as the Secretary may specify by rule. Such a provider 
     shall not be permitted to impose any cost-sharing or to 
     balance bill for services furnished under this section.
       ``(2) Use of medicare contractors.--The Secretary shall 
     enter into arrangements with Medicare administrative 
     contractors under which they process claims for emergency 
     healthcare services under this section using the claim forms, 
     codes, and nomenclature in effect under the Medicare program.
       ``(3) Application of secondary payer rules.--In the case of 
     payment under this section for emergency healthcare services 
     for otherwise qualified individuals who have some health 
     insurance coverage with respect to such services, the 
     administrative contractors under paragraph (2) shall submit a 
     claim to the entity offering such coverage to recoup all or 
     some of such payment, reflecting whatever amount the entity 
     would normally reimburse for each covered service. The 
     provisions of section 1862(b) of the Social Security Act (42 
     U.S.C. 1395y(b)) shall apply to benefits provided under this 
     section in the same manner as they apply to benefits provided 
     under the Medicare program.
       ``(4) Payments for emergency healthcare services and 
     related costs.--Payments to provide, and costs to administer, 
     emergency healthcare services under this section shall be 
     made from the Public Health Emergency Fund, as provided under 
     subsection (f)(1).
       ``(5) Attestation requirement.--No payment shall be made 
     under this section to a provider for emergency healthcare 
     services unless the provider has executed an attestation 
     that--
       ``(A) the provider has notified the administrative 
     contractor of any third-party payment received or claims 
     pending for such services;
       ``(B) the recipient of the services has executed an 
     attestation or otherwise satisfies the eligibility criteria 
     established under subsection (b); and
       ``(C) the services were medically necessary.
       ``(f) Public Health Emergency Fund; Fraud and Abuse 
     Provisions.--
       ``(1) The public health emergency fund.--There is 
     authorized to be appropriated to the Public Health Emergency 
     Fund (established under section 319(b)) such sums as may be 
     necessary under this section for payments to provide 
     emergency healthcare services and costs to administer the 
     services during a public health emergency.
       ``(2) No use of medicare funds.--No funds under the 
     Medicare program shall be available or used to make payments 
     under this section.
       ``(3) Fraud and abuse provisions.--Providers and recipients 
     of emergency healthcare services under this section shall be 
     subject to the federal fraud and abuse protections that apply 
     to Federal health care programs as defined in section 
     1128B(f) of the Social Security Act.
       ``(g) Rulemaking.--The Secretary may issue regulations to 
     carry out this section and shall use a negotiated rulemaking 
     process to advise the Secretary on key issues regarding the 
     implementation of this section.
       ``(h) Public Health Emergency Planning and the Education of 
     Healthcare Providers and the General Population.--
       ``(1) Planning for coverage of emergency healthcare 
     services in public health emergencies.--The Secretary shall, 
     within 90 days after the date of the enactment of this 
     section, initiate planning to carry out this section, 
     including planning relating to implementation of the 
     subsection (e) in the event of activation of emergency 
     healthcare coverage.
       ``(2) Outreach and public education campaign.--The 
     Secretary shall conduct an outreach and public education 
     campaign to inform healthcare providers and the general 
     public about the availability of emergency healthcare 
     coverage under this section during the period of the 
     emergency. Such campaign shall include--
       ``(A) an explanation of the emergency healthcare coverage 
     program under this section;
       ``(B) claim forms and instructions for healthcare providers 
     to use when providing covered services during the emergency 
     period; and
       ``(C) special outreach initiatives to vulnerable and hard-
     to-reach populations.
       ``(3) Authorization of appropriations.--There is authorized 
     to be appropriated for each fiscal year (beginning with 
     fiscal year 2009) $7,000,000 to carry out paragraphs (1) and 
     (2) during the fiscal year.
       ``(i) Application of Policies Under Other Federal Health 
     Care Programs.--As specified in subsections (c) through (e), 
     the Secretary may adopt in whole or in part the coverage, 
     reimbursement, provider enrollment, and other policies used 
     under the Medicare program and other Federal health care 
     programs in administering emergency healthcare services under 
     this section to the extent consistent with this section.''.
       (b) Application of Public Health Emergency Fund.--Section 
     319(b)(1) of such Act (42 U.S.C. 247d(b)(1)) is amended--
       (1) by inserting ``and section 319K-1'' after ``subsection 
     (a)''; and
       (2) by striking ``such subsection'' and inserting 
     ``subsection (a)''.
                                  ____



                                               Washington, DC,

                                                    July 22, 2008.
     Hon. Richard Durbin,
     U.S. Senate,
     Washington, DC.
     Hon. Lois Capps,
     House of Representatives,
     Washington, DC.
       Dear Senator Durbin and Representative Capps: The 
     undersigned organizations join in supporting your 
     introduction of the Public Health Emergency Response Act 
     (PHERA), legislation that would put a turn-key process into 
     place which would ensure that victims of a public health 
     emergency have immediate access to medically necessary 
     healthcare services and help ensure that we have a 
     functioning health care system.
       A public health emergency, such as a natural disaster, 
     biologic attack or infectious disease outbreak, could strike 
     at any time. The September 11th attacks and Hurricanes 
     Katrina and Rita have underscored the need for rapid access 
     to healthcare services during and immediately following a 
     public health emergency. Following Hurricane Katrina, 
     Congress ultimately approved $2.1 billion for grants to 
     certain states to cover the Medicaid and SCHIP matching 
     requirements for individuals enrolled in these programs, and 
     the cost of uncompensated care for the uninsured. However, it 
     took six months for Congress to pass the Deficit Reduction 
     Act, which provided for these funds. This unnecessary delay 
     could have been prevented. PHERA would put into place ahead 
     of time a framework for providing reimbursement for 
     uncompensated care in the event of a major public health 
     emergency.
       The temporary benefit established through this bill would 
     help remove a disincentive for uninsured individuals to 
     promptly seek medical care. Any delay in seeking care could 
     result in lives lost, particularly during an infectious 
     disease outbreak when immediate identification and isolation 
     are very important, and delay in seeking care could render 
     treatment ineffective. At a time when our health care system 
     could be overwhelmed with patients, it is vital that 
     reimbursement issues not dissuade providers from offering 
     care. A study by the Center for Biosecurity estimated that 
     U.S. hospitals could lose as much as $3.9 billion in 
     uncompensated care and cash flow losses in the event of a 
     severe pandemic. By helping to reduce the burden of 
     uncompensated care, PHERA would help ensure the solvency and 
     continuity and our health care system during a catastrophic 
     emergency.
       Specifically, PHERA would provide a temporary emergency 
     health benefit for uninsured individuals and individuals 
     whose health insurance coverage is not actuarially equivalent 
     to benchmark coverage, in the event that the Secretary of 
     Health and Human Services (HHS) declares that a public health 
     emergency exists and chooses to activate the benefit. It 
     would clarify who is eligible for this benefit, including 
     individuals displaced by a public health emergency, limit the 
     amount of time for which the benefit would last, and 
     stipulate what providers would be covered under this Act. It 
     would not use Medicare, Medicaid or SCHIP funding. The 
     funding mechanism would be the Public Health Emergency Fund, 
     a no-year fund available to the Secretary. The bill 
     authorizes funding for the administration of the fund, 
     together with a public education campaign on the availability 
     of the benefit, but further funding would not be necessary 
     until Congress appropriated funds in the event of a declared 
     public health emergency.
       Past experiences have shown that Congress will step in to 
     help defray the costs of uncompensated care resulting from a 
     catastrophic emergency. Determining the scope of such 
     coverage ahead of time will help ensure the solvency of our 
     health care system and help eliminate a disincentive for 
     individuals to promptly seek care. PHERA would help ensure 
     that when tragedy strikes, time and lives are not lost as 
     Congress debates a course of action. It would create the 
     turn-key process ahead of time, thereby allowing for timely 
     care to individuals affected by a crisis.
       We appreciate your leadership in introducing this 
     legislation and look forward to working with you on this and 
     other public health initiatives in the future.
           Sincerely,
       American Red Cross.
       Center for Biosecurity, University of Pittsburgh Medical 
     Center.
       Center for Infectious Disease Research and Policy.

[[Page S7156]]

       Council of State and Territorial Epidemiologists.
       Infectious Diseases Society of America.
       National Association of Community Health Centers.
       Society for Healthcare Epidemiology of America.
       Trust for America's Health.
                                 ______