[Congressional Record Volume 155, Number 76 (Monday, May 18, 2009)]
[House]
[Pages H5694-H5700]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        CBC FOCUS ON HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentlewoman from Ohio (Ms. Fudge) is recognized 
for 60

[[Page H5695]]

minutes as the designee of the majority leader.
  Ms. FUDGE. Thank you very much, Mr. Speaker. Good evening.
  Mr. Speaker, I am here this evening to anchor the hour for the CBC 
for our Special Order tonight, which will be health care.
  The Congressional Black Caucus, the CBC, is proud to anchor this 
hour. The CBC is chaired by the Honorable Barbara Lee from the Ninth 
Congressional District of California. My name is Congresswoman Marcia 
L. Fudge, and I represent the 11th Congressional District of Ohio.
  CBC members are advocates for families nationally, internationally, 
regionally, and locally. We continue to work diligently to be the 
conscience of the Congress. We stand firm as the voice of the people, 
and we provide dedicated, focused service to the citizens and to the 
congressional districts that elected us to Congress.
  The vision of the founding members of the Congressional Black Caucus 
is to promote the public welfare through legislation designed to meet 
the needs of millions of neglected citizens. It continues to be a 
beacon and focal point for the legislative work and political 
activities of the Congressional Black Caucus today.
  Tonight, the CBC will focus its attention on health care reform. 
Specifically, we must ensure access to quality health care for all 
Americans. We must control health care costs and eradicate health care 
disparities.
  At this time, Mr. Speaker, I yield to our Chair, the gentlelady from 
California, the Honorable Barbara Lee.

                              {time}  2000

  Ms. LEE of California. Thank you for yielding.
  Let me say once again as Chair of the Congressional Black Caucus how 
grateful I am to Congresswoman Marcia Fudge, the gentlelady from Ohio, 
for continuing to lead our Special Orders on Monday evening and for 
continuing to keep our caucus very focused on the key issues addressing 
and facing our Nation today. And also let me thank you for your 
sacrifices and everything you do each and every day to make sure that 
this hour is solidified so the rest of the country really understands 
the Congressional Black Caucus's agenda as the conscience of the 
Congress. Thank you, Congresswoman Fudge.
  Let me thank and acknowledge our colleague, Congresswoman Donna 
Christensen, who Chairs the Congressional Health Caucus Health Brain 
Trust and also serves as the second vice Chair of the Congressional 
Black Caucus. She has been such a phenomenal leader in leading the 
House of Representatives and, really, our country to address racial and 
ethnic disparities, health disparities in our country.
  Let me take a moment to thank Representative Danny Davis who co-
chairs the Congressional Black Caucus' Health and Wellness Taskforce 
along with Congresswoman Christensen. Together they have developed a 
very comprehensive set of principles with regard to health care reform, 
and I would like to insert, Mr. Speaker, a copy of those principles for 
the Record this evening.

Congressional Black Caucus Health and Wellness Taskforce Benchmarks for 
                           the 111th Congress

       1. Every measure must apply equitably to American Indian 
     tribes and the Territories.
       2. The elimination of health disparities of any population 
     group must be a central goal of any healthcare reform 
     process, and the process must be coordinated within HHS and 
     across all agencies at the state, local and community levels.
       3. Coverage and every other provision must extend to 
     everyone residing legally in this country.
       4. Communities must be engaged from the identification of 
     the challenges to the crafting of solutions and their 
     implementation. They must receive the funding, education and 
     technical assistance to fully carry out this role.
       5. In this process, health and health care must be 
     comprehensive and include mental and dental health services 
     fully and equitably with physical health.
       6. Creating and expanding a diverse workforce on all levels 
     must be a priority, and these efforts must begin in concert 
     with efforts to improve K through 12 education and with 
     outreach efforts beginning at least in junior high school 
     with underrepresented minorities including those with 
     disabilities.
       7. There must be increased focus and spending on 
     prevention, irrespective of any offset.
       8. Recognizing that the traditional ``medical home'' has 
     been the office of the family and other primary care 
     provider, efforts must be undertaken to increase their 
     numbers and their reimbursement and they must be an integral 
     part of the implementation of this program.
       9. Health information technology (HIT) must be an integral 
     part of any reform effort and access to it by all providers 
     must be supported where needed so that every provider and all 
     communities enjoy its benefits and savings. Additionally, all 
     HIT systems included and subsequently implemented must ensure 
     patient privacy, as well as robust penalties for any 
     violation of such privacy.
       10. There must be an increase in research that is community 
     based, looks at the causes of disparities and includes 
     minorities in clinical trials. Beneficial findings must be 
     fast tracked into practice.
       11. The collection of data by race, ethnicity, language, 
     geography and socioeconomic factors must be mandated and 
     uniform.
       12. Reform must be done within the context of and include 
     provisions that address the social, ambient and built 
     environmental issues affecting health.

  Also, let me thank and recognize Congresswoman Eddie Bernice Johnson 
who brings a wealth of knowledge and expertise to this health care 
debate. As a registered nurse, she has been very involved in health 
care reform for many, many years.
  First, let me just say as one who personally supports a single-payer 
form of universal health care, I also believe that health care must be 
and should be a fundamental human right. But I also know that whatever 
form health care reform takes, that we must have a public option very 
similar to that of Medicare.
  Forty-seven million people lack health insurance in America, and 
although racial and ethnic minorities account for about one-third of 
the American population, they account for about half of the uninsured. 
In my district alone in Alameda County--and also throughout the 
country--there are very profound inequities in health insurance 
coverage between various racial and ethnic groups. Among non-elderly 
adults 18-64 years of age, Latinos are five times as likely as whites 
to be uninsured; African Americans and Asian-Pacific Islanders are also 
more likely than whites to be uninsured.
  And because medical costs have been steadily rising, medical bills 
are the number one cause of bankruptcy in the United States. In today's 
economic climate with unemployment numbers--for instance, in my own 
State of California reaching over 11 percent--that means that millions 
more are falling into bankruptcy every day, and, of course, that means 
millions more are losing their health care coverage. And, of course, 
African Americans, Latinos, Native Americans and Asian-Pacific 
Islanders, unfortunately, are disproportionately affected.
  The statistics are irrefutable. African American women are nearly 
four times more likely to die during childbirth than white women from 
pregnancy complications. Nearly half of all those living with HIV and 
AIDS in the United States are African Americans, and the AIDS rates for 
African Americans are nearly 10 times that of whites. And a recent 
study by the CDC found that nearly one in two young African American 
girls is infected with one of the four more commonly sexually 
transmitted infections as opposed to one in four among the general 
population.
  African Americans are two times more likely to have diabetes than 
whites, and African Americans are nearly 3\1/2\ times more likely than 
whites to have an amputation as a result of the diabetes. African 
American men with colon cancer are more than 40 percent less likely 
than white men with the same condition to receive major diagnostic and 
treatment procedures. While medical science has made a lot of advances 
over the last 10 years, the gains made by the discovery of new drugs 
and treatments have not passed on to all segments of our population.
  For example, going back to my own district in Alameda County in 
California, from 2001-2003, we had an average rate of 2,033 people die 
of coronary heart disease, a mortality rate of about 160 per 100,000 
people. Across every category, African American men and women in my 
district had higher mortality rates than any other group: 286 per 
100,000 for African American men and 199 per 100,000 for African 
American women. While the overall mortality rate has declined in my 
district

[[Page H5696]]

by 7 percent since 1998, the gap, mind you, the gap between African 
Americans and the overall county rate has grown dramatically. In 1990-
1991, the African American rate was 16 percent higher than the county 
rate. In 2002-2003, it was 50 percent higher. Something is seriously 
wrong.
  The story is the same with cancer and with diabetes, and these 
statistics are not only in my district but they are reflected 
throughout the country and all of our Congressional Black Caucus, 
Congressional Hispanic Caucus, and Congressional Asian-Pacific American 
Caucus members' districts. It is a shame and a disgrace.
  This is a serious health care crisis that warrants a clarion call 
immediately. Our Nation has failed to guarantee what is often federally 
funded, health research, which fully benefits everyone across the 
Nation.
  So that is why we're here tonight, Mr. Speaker, to speak with 
clarity, with one voice, to demand health care reform now and to demand 
an end to the factors that perpetrate racial and ethnic health 
disparities in this country. We can't do one without the other.
  I'm sure that Congresswoman Dr. Christensen is going to review 
tonight the Health Equity and Accountability Act. Let me mention a 
couple of the provisions. It will bolster efforts to ensure culturally 
and linguistically appropriate health care and remove language and 
cultural barriers to health care; it will improve workforce diversity; 
it will strengthen and coordinate data collection; it will ensure 
accountability and improve evaluation, and it will improve health care 
services in general. This is the Health Equity and Accountability Act 
which Congresswoman Christensen has worked so hard on with our tri-
caucus for several years. It will help put our country back on track to 
eliminating health disparities in our country. So I must applaud again 
Congresswoman Christensen and her staff for spearheading the 
development of this initiative, and I look forward to its introduction 
in the next few weeks.
  Finally, let me just say we all know that the profit motive has 
driven the health care industry. It should not be an industry. It's an 
industry that has rewarded and provided profits for the wealthy and for 
the insurance industry; yet it's been, unfortunately, at the expense of 
the people it's intended to serve.
  And so as the conscience of the Congress, we are insisting that the 
public health option or a public health option similar to Medicare be 
part of any health care reform package and that closing health care 
disparities be part of any health care reform effort. These are central 
principles that we are making sure our perspective incorporates as it 
relates to whatever health care bill that comes out because, quite 
frankly, we can't have some of the same old business in the health care 
business.
  So thank you again, Congresswoman Fudge, for this evening. And let me 
just say we're sounding the alarm once again that members of the 
Congressional Black Caucus, we're not going to stand for any health 
care bill that doesn't include closing health care disparities which 
our community, unfortunately, has suffered under since our presence 
here in the United States of America.

  Thank you very much, Congresswoman Fudge.
  Ms. FUDGE. Thank you, Madam Chair, and thank you for your leadership 
and your vision as well as your focus.
  Mr. Speaker, I would now like to turn the podium to my colleague from 
the State of California, the gentlelady from California, Diane Watson.
  Ms. WATSON. Thank you, Ms. Fudge. And, Mr. Speaker, I'm here along 
with my colleagues to speak about health care.
  As we all know, the United States is the only industrialized Nation 
not to offer universal health care to its citizens. Currently, there 
are over 47 million people without health insurance, and as a Nation, 
we are facing a health care crisis.
  Also, due to the ailing economy, the number of uninsured is on the 
rise as many Americans have lost their access to employer-based health 
care. We are aware that all Americans need access to quality health 
care. Many of us for years have repeatedly called for a national 
solution to the health care crisis, especially those of us who are 
deeply concerned about health care disparities in minority communities. 
For years we have continually noted how minorities are less likely to 
have quality health care.
  For example, one-third of all African Americans lack comprehensive 
health care, but health care is not just a minority issue. Just this 
past weekend, thousands of students graduated from colleges and 
universities around the country. They walked across the stage to grasp 
their diplomas in return for their hard work, achievement, and their 
health insurance card. For those of us in California, we are blessed 
that children can remain on their parents' health insurance plan until 
they are 25 years old, but this is not the case in many States. Can you 
imagine overnight thousands of graduates who have not been able to find 
jobs in this struggling economy have now become uninsured? Yes, young 
people may be the healthiest portion of the population, but they, too, 
at some point will fall ill.
  This past weekend's graduations have made me realize how necessary it 
is to act quickly. That is why I support universal health care and H.R. 
676. We have twiddled our thumbs long enough, and now it's time to act 
as quickly as possible to give all Americans the right to quality 
health care.
  Now, I want to talk about another health issue that is very close to 
my heart, the issue of mercury amalgams. Dentists have been using 
silver dental fillings for over 150 years without informing consumers 
that these silver fillings are actually more than 50 percent mercury. A 
2006 poll showed that 78 percent of American people are not aware that 
mercury is the majority component in silver fillings. Congress has 
acted to remove mercury from public schools in the form of 
thermometers, the Environmental Protection Agency warns the public when 
mercury levels are high in certain fish. However, the Food and Drug 
Administration has done nothing to warn consumers of the risk of 
mercury in their mouth.
  Mercury is a known neurotoxin. It can harm the mental development of 
a fetus and children. Mercury vapors from dental fillings can enter the 
blood stream and cross the blood-brain, barrier. In an expecting 
mother, mercury can pass through the placenta into the fetus, 
potentially causing neurological damage. For example, autism in young 
children has been linked to mercury exposure. In adults, studies are 
beginning to show mercury as the root of neurological diseases such as 
Alzheimer's. I will admit that more studies are needed to strengthen 
the relationship between mercury and neurological illness. The studies 
that have been done thus far have been woefully shortsighted and have 
failed to look at the long-term effects of mercury fillings in children 
and adults. Rather, they have focused on only 2 or 3 years of an 
individual's life.
  I support more research on the subject. However, I do not support 
watching more Americans becoming ill without the knowledge of the 
potential health risk caused by mercury. The burden of proof is on the 
producers of mercury amalgam and on the dentist. If there is a chance 
that mercury is toxic to consumers' health, the consumer has the right 
to know.

                              {time}  2015

  In the coming months, I will be introducing a bill about the effects 
of mercury amalgam fillings and its potential health risks. I hope that 
you will support me in making consumers more aware of this critical 
issue.
  Ms. FUDGE. I thank the gentlelady from California. I would now, Mr. 
Speaker, like to yield to my colleague, the gentleman from Virginia 
(Mr. Scott).
  Mr. SCOTT of Virginia. I thank the gentlelady from Ohio for 
organizing this opportunity for us to discuss health care.
  Access to quality, affordable health care is critical to the well-
being of all Americans today and in the future. We are seeing millions 
of Americans suffering from illnesses that could have easily been 
prevented with basic preventive health care, but people did not seek 
that care because they didn't have health insurance. In fact, 46 
million Americans lack health insurance, and

[[Page H5697]]

tens of millions more lack health coverage during some part of the 
year.
  In these tough economic times, we must seek to provide universal 
health care and must seek to reduce the cost of health care insurance, 
especially for children and pregnant women. We also must address other 
health concerns, such as the health disparity that exists between 
racial and ethnic minorities and the need to fund cutting-edge research 
to find cures for diseases.
  We also need to strengthen the Medicaid and Medicare systems and give 
patients the tools needed to challenge the decisions of all health 
insurers. Only through action in these critical issues can we meet the 
pressing health care needs of our Nation.
  Providing health care for all and reducing the costs of health care 
will relieve the financial strain on all families and businesses. It 
will also go a long way to addressing the racial disparities in health 
indicators in this country because minorities, as it's already been 
said, are less likely to be covered by health insurance than others.
  On child health, one of the first actions of this Congress was the 
passage of the Children's Health Insurance Program, the SCHIP, where we 
were able to provide coverage for 7 million children already covered by 
SCHIP, plus an additional 4 million more. While this was a good step in 
the right direction, it is not enough, because 5 million children are 
still left without health insurance.
  That's why I introduced legislation that would provide health 
insurance for all children, the All Healthy Children Act, which was 
endorsed by the Children's Defense Fund as a logical, achievable, and 
incremental next step to closing the child health coverage gap. This 
proposal would ensure that all children and pregnant women are covered 
by expanding the coverage of both Medicaid and the SCHIP programs by 
eliminating the procedural red tape that currently prevents them from 
being covered by either program. This comprehensive program will 
include all basic health care coverage, as well as coverage for mental 
health, prenatal, and well-child care.
  Mr. Speaker, our health care system is unfortunately riddled with 
inefficiencies, excessive administrative expenses, inflated prices, 
poor management, and inappropriate care and waste. These problems 
significantly increase the cost of medical care and health insurance 
for employers and workers and affect the security of the financial 
security of our families. We all know that reforming health care is not 
going to be easy, but we have a good opportunity now to finally reform 
the health care system by cutting costs, protecting families from 
bankruptcy or debt because of medical costs, investing in prevention 
and wellness, and improving patient safety and quality of care.
  We have taken the first step in reforming our health care system by 
passing a Federal budget for fiscal year 2010 that includes more than 
$630 billion to establish a reserve fund to finance fundamental health 
care reform that will first bring down health care costs and then 
expand coverage.
  The budget does a number of things. It accelerates the adoption of 
health care information technology and expansion of electronic health 
records.
  The budget expands research comparing the effectiveness of medical 
treatments to give patients and physicians better information on what 
works best.
  It invests over $6 billion for cancer research at the National 
Institutes of Health as part of the administration's multiyear 
commitment to double cancer research funding.
  It strengthens the Indian health system, which sustained investments 
in health care services for American Indians and Alaska Natives to 
address persistent health disparities and foster healthy Indian 
communities.
  It invests $330 million to increase the number of physicians, nurses, 
and dentists practicing in areas of the country experiencing shortages 
of health professionals.

  It supports families by providing additional funding for affordable, 
high-quality child care, expanding Early Head Start and Head Start, and 
creating the Nurse Home Visitation program to support first-time 
mothers.
  It strengthens the Medicare program by encouraging high quality and 
efficient care and improving program integrity.
  And finally, it invests over $1 billion for Food and Drug 
Administration food safety efforts to increase and improve inspections, 
domestic surveillance, laboratory capacity, and initiatives to prevent 
and control food-borne illnesses.
  Mr. Speaker, for years we've been at a stalemate in Congress and 
haven't been able to enact real health care reform. As a Nation, we are 
already spending more on health care than any other Nation. We spend a 
higher percentage of our GDP. We spend a higher amount per capita, and 
yet by any measure, by any of the health indicators, we are still in 
poor health, and we still suffer from significant disparities in 
different parts of our population.
  So we're already paying for health care. What we need to do under the 
present administration and Congress is to finally do more than talk 
about health care reform and actually do something about it.
  Mr. Speaker, I'm delighted to have this opportunity and, again, want 
to thank the gentlelady from Ohio for organizing this Special Order.
  Ms. FUDGE. I would like to, Mr. Speaker, again thank Representative 
Scott for his vision. To put in place an act that really does address 
the needs of babies and children is very significant for this Congress, 
and I thank you as well.


                             General Leave

  Ms. FUDGE. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on health care reform.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Ohio?
  There was no objection.
  Ms. FUDGE. Mr. Speaker, I would now like to yield to my colleague, 
the gentleman from New Jersey (Mr. Payne).
  (Mr. PAYNE asked and was given permission to revise and extend his 
remarks.)
  Mr. PAYNE. Mr. Speaker, let me begin by thanking the gentlelady from 
Ohio, Congresswoman Marcia Fudge, for anchoring this evening's Special 
Order on health care. I want to say that her continued diligence in 
bringing issues that confront our Nation, in general, but African 
Americans, in particular, week after week has been a great addition to 
our Congressional Black Caucus, and let me commend you again for your 
diligence.
  Ms. FUDGE. Thank you.
  Mr. PAYNE. I want to also recognize our distinguished Chair of the 
CBC Health Brain Trust, Congresswoman Donna Christensen, for her 
leadership in health care debates and for introducing legislation which 
you will hear about tonight which will address the root causes of our 
Nation's health disparities and the crisis that we find ourselves in.
  You've heard from other Members, Congressman Scott, Congresswoman 
Barbara Lee, and you will hear from others tonight, because health care 
is one of the most important issues that confronts our Nation in 
general, as I mentioned before, but in particular, communities of 
minorities, whether they be black, Hispanic, Native American, foreign 
born.
  Mr. Speaker, I join and I am pleased to join the other Members 
tonight to talk about the costs, health care access, the lack of it, 
the need for quality care, and the eradication of health disparities 
which are so important to us.
  Our Nation's health care costs are increasing rapidly. In 2007, the 
United States spent $2.2 trillion on health care. We also spent twice 
as much on health care than any other developed countries.
  In 2006, the U.S. spent $6,714 per capita on health care, more than 
double that for any country in the Organization for Economic 
Cooperation and Development, OECD, with an average of $2,915, and these 
are developed nations in the world.
  Our health care quality system compares poorly to other developed 
nations. For example, the U.S. ranks 22nd out of 30 OECD countries on 
life expectancy. We have the third highest infant mortality rate in 
OECD countries, with 6.9 deaths per 1,000. Only Mexico and Turkey have 
worse infant mortality rates.
  As alarming as that is, though, if we take out the infant mortality 
rate for

[[Page H5698]]

African Americans, it's astounding. If you take the city of 
Minneapolis, 9.2 per 1,000; Seattle, 10.3; Los Angeles, 10.1; Phoenix, 
12.9--that's per 1,000 live births in the African American community--
Detroit, 17.3 deaths, when 6.9 deaths are in OECD countries. My own 
city, 15.5. It's an abomination. It's wrong. It should not be in a 
Nation, a developed Nation of this--13.6 in Philadelphia; and the 
Nation's capital, 14.4; Charlotte, 14.1; Orlando, 13.8; New Orleans, 
13.2; Miami, 11.8, when it's 6.9 in OECD countries.
  And so we really have to talk strongly about health care reform, and 
we have to go into the disparity of health care in our communities. The 
costs of health care are straining American families' pocketbooks. Half 
of all personal bankruptcies are at least partly the result of medical 
expenses. More than 80 percent of the 47 million Americans in this 
country are uninsured, and these are many working families.
  Mr. Speaker, there is strong support for comprehensive health care 
reform. In fact, a solid majority of the public, 59 percent, believes 
health care reform is more important than ever. Sixty-seven percent of 
all Americans favor a public health insurance option similar to 
Medicare to compete with the private health insurance plans, and I am a 
strong supporter of that public health insurance option.
  Mr. Speaker, I believe that our Nation's health is its most precious 
asset; however, health disparities plague this country and lead to 
deteriorating conditions for millions of Americans. Because of 
deficiencies in health insurance and health care access, minorities 
suffer at greater rates and greater levels of severity from health-
related issues than their like counterparts.
  Education and awareness alone cannot combat these issues. While 
vigilance and groundbreaking health research have reduced the incidence 
of death and illness among white Americans, health statistics on 
minorities remain staggering. Even though deaths caused by breast 
cancer have decreased among white women, African American women 
continue to have higher rates of mortality from breast and cervical 
cancer.
  While the national HIV and AIDS mortality rate lessens, this disease 
remains a leading cause of death among African American men. In 2002, 
more than 2.5 times more African American newborns died than white 
newborns at that time.
  Research shows that quality health care could eliminate some of these 
health-related issues and reduce the onset of others. Unfortunately, 
especially during the current state of the economy, health insurance 
and quality health care continues to be widely unavailable.

                              {time}  2030

  I represent one of the most expensive States for health care. In New 
Jersey, health care and health insurance remain out of reach for many 
low-income citizens--a large percentage of them living in my 
congressional district.
  Many of my constituents are aware of habits and actions that lead to 
health complications. Despite awareness efforts, non-Hispanic black 
males and females continue to have the highest prevalence of 
hypertension. Diabetes disproportionately affects the ethnic and racial 
minorities. Heart disease is the leading cause of death in the United 
States for African Americans. Its prevalence is double that of the 
broader community.
  Access to health care and the lack of health insurance prevents even 
some of the most knowledgeable from avoiding illness.
  In conclusion, on May 9, Congresswoman Christensen and the 
Congressional Black Caucus Foundation cosponsored a Health and Wellness 
Expo in my district. It began on Friday evening. We were fortunate 
enough to have Congressman Albio Sires and Congressman Ed Towns join 
Congresswoman Christensen in my district. That was on May 8th. The next 
afternoon, the next day, Congresswoman Clarke came to the district to 
the Health and Wellness Expo.
  We served over 400 people, with an overwhelmingly positive response 
to screenings and workshops, where people were told on the spot that 
they should immediately see a physician. I know that we saved the lives 
of many people because we had screenings of blood pressure and a bone 
marrow drive and bone density and cholesterol and depression. We had a 
screening for diabetes and glucose. We had a glaucoma screening. HIV/
AIDS screening was held, kidney disease, oral and dental, and on and 
on.
  I, again, would like to thank Donna Christensen, our Congresswoman 
who heads our Health Brain Trust, for her being there. This is the 
third time she's been to my district. We have a serious problem in my 
district, but I will continue to work to bring those statistics down. 
They should not be the way they are.
  So, Mr. Speaker, our society's institutions, from government to 
business to not-for-profits, must provide opportunities to bring 
affordable and quality health care to all Americans. More importantly, 
I believe that our society's leaders and major institutions must create 
incentives and lower barriers so that individuals and families can take 
steps to achieve healthier lifestyles. Finally, in order to reduce the 
cost of health care, there must be an increased focus on spending for 
prevention.
  Mr. Speaker, I look forward to working with my colleagues on both 
sides of the aisle to develop policies that will improve the delivery 
of our health system in the most effective and efficient way that we 
can.
  With that, thank you once again, Congresswoman Fudge, and thank you, 
Congresswoman Donna Christensen, for the outstanding work that you are 
both doing.
  I yield back the balance of my time.
  Ms. FUDGE. Thank you, Mr. Payne. Thank you for always continuing to 
fight for those who are most in need.
  Mr. Speaker, I would, at this time, yield to the gentleman from 
Illinois (Mr. Davis).
  (Mr. DAVIS of Illinois asked and was given permission to revise and 
extend his remarks.)
  Mr. DAVIS of Illinois. First of all, I want to commend Representative 
Marcia Fudge for the tremendous leadership that she continues to 
display each and every week by hosting, organizing, convening, and 
giving all of us the opportunity to discuss issues that are pertinent 
to all of America, but especially to the African American community.
  I also want to commend Representative Donna Christensen for the 
outstanding leadership that she has displayed for a number of years as 
chairperson of the Congressional Black Caucus Health Brain Trust, and 
all of the members who consistently try and protect, promote, and 
project the health care needs and opportunities that should exist for 
all of us in America.
  We are poised right now to do serious health reform. I want to 
commend President Obama for having the courage to tackle one of the 
most pernicious issues of our day, and that is the issue of trying to 
make sure that each and every American, that each and every one of our 
citizens have the opportunity to receive cost-effective, as 
comprehensively as we can provide it, quality health care that is 
culturally competent, provided by individuals who understand their 
needs and individuals that they can understand instructions and what is 
being given.
  We are about to do something that has been needed, and that is we're 
going to expand--and I'm confident that we will do it. No matter which 
option people look at, no matter what kind of coverage they suggest, 
that when we finish, we're going to have the best health care delivery 
system that this country has ever seen.
  In many instances, I don't think that we have to reinvent the wheel. 
Yes, there are large numbers of uninsured individuals in our country, 
probably about 50 million of them, and some of those individuals, no 
matter what plan we come up with, are going to be covered. But just as 
important as coverage--just as important are the delivery mechanisms 
and systems which are provided.
  I often say to people that as far as health care improvement, I don't 
think anything has done much more than Medicare, Medicaid, and the 
development of community health centers and community mental health 
centers. And so any plan or system that we come up with, I hope that we 
will expand community health centers, because as deliverers of primary 
care, I don't think that there's anything in America that has done a 
more effective job for low-income people than what these institutions 
have done.

[[Page H5699]]

  In addition to that, I would hope that we take a hard look at nursing 
home care. What happens to people once they begin to reach the 
``golden'' ages? What happens to them as they have given every measure 
of devotion that they could possibly provide for their country? We need 
to make sure that they don't languish in some place.
  One of the proudest things in my family is the fact that we decided, 
for example, that neither one of our parents would have to experience 
that kind of care. My mother was an invalid for about the last 10 or 12 
years of her life. But, of course, we decided that she would stay at 
somebody's house, in somebody's home, and that we could be assured. I 
think that every senior citizen should have the assurance of knowing 
that they're going to be cared for.
  I don't want us to forget those individuals with disabilities, those 
individuals who are sometimes shunned aside, who are not perceived as 
being a part of the mainstream population. And so in order to be 
effective, health care reform must be quite comprehensive.
  I know that our committees on Energy and Commerce, Ways and Means, 
Education, all of these committees are working jointly together to come 
up with the kind of plan that the President is going to be proud of.
  So, again, Representative Fudge, I want to commend and thank you for 
the opportunity to be here, and I want to thank, again, my classmate 
who has led the charge, and that's Representative Donna Christensen, 
who, for so many years, has been the caucus' point person on health 
care. And we're going to make health care in this country a right so 
people will understand that it does not have to be a privilege. I thank 
you all so much.
  Ms. FUDGE. Thank you, Mr. Davis. I just want to say that you have 
always talked of the need to make sure that we have community health 
clinics and how it probably does in many ways serve our communities 
better. I thank you for discussing that with us this evening.
  Mr. Speaker, I would now like to yield to the person that we have all 
talked about this evening, our go-to person, our expert, our Chair, and 
the person that we really do look to as we tackle health care, and that 
is my colleague from the Virgin Islands, Dr. Christensen.
  Mrs. CHRISTENSEN. Thank you, Congresswoman Fudge. I just want to add 
my word of thanks and commendation for the way that you bring us 
together every week on Monday evenings to discuss issues of importance, 
not just to the African American community or communities of color, but 
issues of importance to our entire country.
  I want to thank my colleagues for their kind words. I did have the 
opportunity to visit with Congressman Payne in his district. It was a 
wonderful event, very well attended, and the people who came, I know, 
really benefited from what he and his staff and others in the community 
came together to provide.
  And Congressman Scott, who's been working on SCHIP, but he also has 
worked tirelessly on another issue that's not always seen as a public 
health issue, but it is a public health issue, and that's the issue of 
juvenile violence among our young people, and working to prevent that. 
We look forward to continuing to work with him on the PROMISE Act and 
other legislation that he has introduced.
  Of course, Congressman Davis is my co-Chair on the Health Brain 
Trust, so I share all of the accolades with him, as he has long been 
working in the area of health care.
  This weekend I had the honor of giving the commencement address at 
LSU Health Sciences Center in New Orleans, Louisiana. I want to 
recognize and congratulate the 546 graduates. As we look to health care 
reform, we're wondering where the health care personnel are going to 
come from. The LSU Health Sciences Center made a great contribution in 
doctors, nurses, dentists, health researchers, and allied health.
  We commend them, and we commend them not just on graduating and 
completing their coursework, but I want to commend them especially 
because, for those who started about 4 years ago, as the medical 
students would have, and others, they started just before Katrina. 
Their school was devastated by Katrina. Some of them had to go to 
classes in other parts of our country to keep their coursework going.
  But the LSU administration, faculty, and staff really pulled together 
when they had very limited help and support to bring their students 
back together and to see to it that they did complete their coursework 
and do great research and be able to move on to very promising careers 
in all of the fields of health.
  So I want to congratulate them and commend them on that. It's good to 
see that they are now in the process of rebuilding some of the 
facilities there and continuing to grow and will be educating another 
cadre of young people and graduating another cadre next year.
  I want to thank our chairlady for our steadfast commitment to the 
issue of the elimination of health disparities as well, as we heard her 
speak to it a few minutes ago.
  I want to just highlight some of the key themes from a report that's 
often overlooked. It's the National Health Care Disparities Report 
that's done by the Department of Health and Human Services. They do it 
every year. It's done by the Agency for Health Research and Quality.
  This is the report for 2008. It's amazing because it really is very 
similar to the report that Surgeon General Heckler did 25 years ago 
when she found that persistent disparities remain and, as she said, was 
an affront to the ideals of this country and the quality of medicine 
that we have here.
  But three key themes emerge in the 2008 report: one, that disparities 
persist in health care quality and access; two, that the magnitude and 
pattern of disparities are different within subpopulations; three, that 
some disparities exist across multiple priority populations.
  As they look at some of these highlights, some of the trends that we 
still see today in communities of color, for blacks and Asians, 60 
percent of the core measures used to track access remained unchanged or 
got worse in that year. That's 60 percent for African Americans and for 
Asians.

                              {time}  2045

  For Hispanics, 80 percent of core access measures remained unchanged 
or got worse in 2008; and for poor populations, 57 percent of core 
access measures remained unchanged or got worse in that year.
  So as we move towards health care reform, the issue of access and 
insurance is very important. As we begin that work when we get back 
from our Memorial Day break, it will be critical that we work arduously 
to remove the 46 million Americans off of the rolls of the uninsured 
and an additional 20 million Americans out of the category of being 
underinsured.
  Studies confirm that more than 5 in 10 or 55 percent of Hispanics, 
and 4 in 10 African Americans were uninsured for all or part of 2007 
and 2008, compared to just 2 in 10 or 25 percent in whites. 
Additionally, in total, more than three in every four people of color, 
76 percent, were uninsured for 6 months or more in 2007-2008.
  I agree with Congressman Davis that we will enact universal coverage 
before the end of this year and bring insurance to every person living 
in this country. But while eliminating uninsurance is critical, it's 
also important that we remember that health and wellness is about more 
than just having an insurance card.
  Only about 20 percent of health disparities can be attributed to 
uninsurance. We have to ensure as well that health equity is an 
integral component of efforts not only to reform but to transform our 
Nation's health care system so that all Americans, regardless of race 
or ethnicity, regardless of whether you live in an urban or rural area, 
regardless of your gender or sexual orientation that you receive 
equitable and appropriate care every single time that it is needed.
  The time to eliminate the current inequities in health and in health 
care is long overdue, and the evidence detailing the impact that they 
have had and continue to have on the health and well-being of Americans 
is staggering.
  In fact, across every chronic condition and every acute disease, and 
across every measure of health care quality, racial and ethnic 
minorities, as you have heard this evening, are disproportionately more 
likely than

[[Page H5700]]

whites to be on the downside and to be detrimentally affected.
  In addition to eliminating uninsurance and achieving health equity 
with comprehensive health reform, we also have to ensure that we 
identify the health policy that exists in every policy, and this is 
something that I want to just focus on for a few minutes.
  We were reminded of this by a Dr. Ogilvie who spoke at our spring 
Braintrust a few weeks ago. From climate and urban planning policies to 
environmental and education policies, from housing and transportation 
policies, from employment and criminal justice policies, every week a 
new study is released that confirms that there is a health policy in 
every policy. So it's not a surprise then that by addressing the health 
repercussions of the policies that are not overtly health-related, we 
are more likely to champion policies that not only complement our 
health care reform efforts but that further improve the health and 
wellness of every person living in this country. And that's where we're 
also going to see some of those savings come about when we address 
health in a very holistic way, not just disease entities but the whole 
community creating cultures of wellness.
  For example, a March 2009 report from Public Health Law and Policy 
explains, the human health aspects of climate change policy by focusing 
on food systems and land use planning, that is, health policy in every 
policy. In their analyses and recommendations, they note that because 
both climate change policy and public health policy ultimately seek to 
improve the lives of people, it is critical that they work towards 
complementary goals and in a complementary manner to have the greatest 
potential to create healthy and sustainable communities and 
neighborhoods.
  You can take that into education if we don't have a strong 
educational system where every child has access to quality education. 
We know that poor education is also linked to poor health. We can never 
build the diverse workforce that we need if we don't have good K-12 
education.
  If you live in substandard housing, it's difficult to be healthy. If 
you don't have access to healthy foods, you cannot adopt those 
lifestyles that are necessary to improving and supporting good health.
  And so insurance for everyone. Universal coverage is important. I 
will work hard with my colleagues to ensure that we get that done, as 
the President has asked, before we go out for the August recess.
  But insurance is not enough. We have to reform the system. We have to 
improve the standard of living in our communities. And then with the 
insurance, with the improvements in the system, with the healthy 
communities, then we can ensure that every American will have access to 
quality health care, and our country will be a stronger and better 
country because of it.
  Ms. FUDGE. Thank you so much again to our expert, Representative 
Christensen.
  Mr. Speaker, I would like to close this session by saying a few 
things. Dr. Martin Luther King, Jr. said, ``Of all the forms of 
inequality, injustice in health care is the most shocking and 
inhumane.''
  Mr. Speaker, I come from the 11th District of Ohio, a place where 
arguably you can find the best health care providers in the world, but 
still people cannot see a doctor. There is something wrong with what is 
going on in America today.
  Anytime we have a health care system that is more reactive than 
proactive, something is wrong in America today. Anytime we look at a 
health care system whose cost is rising so rapidly that our paychecks 
can't keep up, something is wrong with what is going on in America 
today, Mr. Speaker. If your health is determined by where you are born 
or the neighborhood you live in, something is wrong with what is going 
on in America today.
  And I say to you that the members of this caucus are going to fight 
in every way we know how to ensure that every American, be they rich, 
be they poor, be they minority is going to have a right to have health 
care that is going to be not only affordable but is going to take care 
of their needs in a preventive way, in a cost-effective way and in a 
humane way.
  Because right now if you can get to see a doctor if you are poor, 
they may make you sit in an emergency room for 5 or 6 hours. They don't 
really take you seriously when you come in with serious problems, and 
that is why we have all of these hospitalizations that we really 
shouldn't have because these issues should have been treated early on 
in the process.
  So I say to you, Mr. Speaker, that as members of the Congressional 
Black Caucus, we are determined to make sure that by the time health 
care is approved in this country, every single person who wishes to 
have health care will have it. Every single person who has a job will 
be able to afford it. And for those who are not, we are going to take 
care of those people.
  Now they can call it anything they want to call it, but government's 
job is to take care of its people. That is what we intend to do, and 
that is what we intend to help our President do. We are going to 
continue to fight as hard as we can to make sure that every American in 
every district we serve has health care.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, health care in the 
United States has degraded in accessibility and quality, to the extent 
that we are a nation in crisis. Fundamental change is needed to truly 
make progress toward a healthier America.
  My experiences as a federal legislator--and as a nurse--have provided 
a unique vantage point from which to discuss this issue. During my 
years as chief psychiatric nurse at the Veterans' Administration 
Hospital in Dallas, I have seen, first-hand, the state of affairs of 
our health care system.
  When it comes to mental health, for example, our system is 
particularly weak. Insurers do not provide sufficient or consistent 
coverage of mental health care services. Individuals with mental 
illness must navigate a patchwork of community service providers. Those 
with severe illness often have limited options for care. They end up 
homeless and are victims of a system that does not work. Others may not 
have an employer who understands mental illness. Others may be 
unemployed, and uninsured; or they may work for minimum wage and earn 
``too much'' to qualify for Medicaid. People with mental illness are 
among those least served by our local and national care systems.
  We need relief from the harsh and unfair practices of the health 
insurance industry. We need a guarantee of quality, affordable health 
care for all of us. We need to set and enforce the rules so insurance 
companies put health care above profits. We must be able to keep the 
health care that we have, and in addition, we need the choice of a 
public plan, so we're not left at the mercy of the same private 
insurance companies that have gotten us into this mess.
  It is my belief that we need not re-invent the wheel. We can achieve 
savings and improve value in our current systems of Medicare, Medicaid 
and CHIP--and make them available to anyone who needs coverage. 
Legislation like H.R. 676 makes a strong case for this policy strategy. 
Tonight I would like to share some good suggestions for health care 
reform. A study by the Commonwealth Fund analyzed policy options and 
their economic impact on health care costs. Five major strategies 
emerged, and I think these should be priorities.
  First, we must extend affordable health insurance to all.
  Second, we should offer financial incentives to reward efficiency and 
quality in health care that is provided.
  The third strategy is to ensure that care is accessible, coordinated 
and patient-centered.
  A fourth strategy for a high performance health system is that we 
must set benchmarks for quality and efficiency.
  Last, a reformed health care system must hold national leadership 
accountable, and it must allow for public/private collaboration.
  We can take the best of current models, and lessons learned, and use 
that to reform our health care system. Only then will we begin to 
reduce the health disparities that plague African Americans and other 
minorities.
  Forty-six million uninsured Americans, including 5.7 million Texans, 
need health care coverage.
  The time to act is now.

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