[Congressional Record Volume 155, Number 81 (Tuesday, June 2, 2009)]
[Senate]
[Pages S5945-S5950]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. BINGAMAN (for himself and Mrs. Lincoln):
  S. 1161. A bill to amend the Public Health Service Act to authorize 
programs to increase the number of nurse faculty and to increase the 
domestic nursing and physical therapy workforce, and for other 
purposes; to the Committee on Health, Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, I rise today with my colleague Senator 
Lincoln to introduce the Nurse Faculty and Physical Therapist Education 
Act of 2009. This legislation will help to address the critical 
shortage of nurse faculty and physical therapists that is facing our 
Nation. The nationwide nursing shortage is growing rapidly, because the 
average age of the nursing workforce is near retirement and because the 
aging population has increased health care needs. The shortage is one 
that affects the entire Nation. A 2006 Health Resources and Services 
Administration, HRSA, report estimated that the national nursing 
shortage would more than triple, to more than one million nurses, by 
the year 2020. The report also predicts that all 50 States will 
experience nursing shortages by 2015. Quite simply, we need to educate 
more nurses, or we, as a Nation, will not have enough trained nurses to 
meet the needs of our aging society.
  One of the biggest constraints to educating more nurses is a shortage 
of nursing faculty. Almost three-quarters of nursing programs surveyed 
by the American Association of Colleges of Nursing cited faculty 
shortages as a reason for turning away qualified applicants. Although 
applications to nursing programs have surged 59 percent over the past 
decade, the National League for Nursing estimates that 147,000 
qualified applications were turned away in 2004. This represents a 27 
percent decrease in admissions over the previous year, indicating the 
need to scale up capacity in nursing programs is more critical than 
ever.
  I know that in my home State of New Mexico, nursing programs turned 
down almost half of qualified applicants, even though HRSA predicts 
that New Mexico will only be able to meet 64 percent of its demand for 
nurses by 2020. With a national nurse faculty workforce that averages 
53.5 years of age, and an average nurse faculty retirement age of 62.5 
years, we cannot and must not wait any longer to address nurse faculty 
shortages.
  Nursing faculty are not the only segment of the population that is 
aging. As the baby boom generation ages, there will be an increased 
need for nurses to care for the elderly. However, less than one percent 
of practicing nurses have a certification in geriatrics.
  The Nurse Faculty and Physical Therapist Education Act will amend the 
Public Health Service Act, to help alleviate the faculty shortage by 
providing funds to help nursing schools increase enrollment and 
graduation from nursing doctoral programs. The act will increase 
partnering opportunities between academic institutions and medical 
practices, enhance cooperative education, support marketing outreach, 
and strengthen mentoring programs. The bill will increase the number of 
nurses who complete nursing doctoral programs and seek employment as 
faculty members and nursing leaders in academic institutions. In 
addition, the bill authorizes awards to train nursing faculty in 
clinical geriatrics, so that more nursing students will be equipped for 
our aging population.
  By addressing the faculty shortage, we are addressing the nursing 
shortage.
  The aging population will also require additional health workers in 
other fields. Physical therapy was listed as one of the fastest growing 
occupations by the U.S. Department of Labor, with a projected job 
growth of greater than 36 percent between 2004 and 2014. The need for 
physical therapists is particularly acute in rural and urban 
underserved areas, which have three to four times fewer physical 
therapists per capita than suburban areas. To address this need, the 
bill also authorizes a distance education pilot program to improve 
access to educational opportunity for both nursing and physical therapy 
students. Finally, the bill calls for a study by the Institute of 
Medicine at the National Academy of Sciences which will recommend how 
to balance education, labor, and immigration policies to meet the 
demand for qualified nurses and physical therapists.
  The provisions of the Nurse Faculty and Physical Therapist Education 
Act are vital to overcoming workforce challenges. By addressing nurse 
faculty and physical therapist shortages, we will enhance both access 
to care and the quality of care.
  Mr. President, 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. 1161

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Nurse 
     Faculty and Physical Therapist Education Act of 2009''.
       (b) Findings.--Congress makes the following findings:
       (1) The Nurse Reinvestment Act (Public Law 107-205) has 
     helped to support students preparing to be nurse educators. 
     Yet, nursing schools nationwide are forced to deny admission 
     to individuals seeking to become nurses and nurse educators 
     due to the lack of qualified nurse faculty.
       (2) The American Association of Colleges of Nursing 
     reported that 42,866 qualified applicants were denied 
     admission to nursing baccalaureate and graduate programs in 
     2006, with faculty shortages identified as a major reason for 
     turning away students.
       (3) Seventy-one percent of schools have reported 
     insufficient faculty as the primary reason for not accepting 
     qualified applicants. The primary reasons for lack of faculty 
     are lack of funds to hire new faculty, inability to identify, 
     recruit and hire faculty in the competitive job market as of 
     May 2007, and lack of nursing faculty available in different 
     geographic areas.
       (4) Despite the fact that in 2006, 52.4 percent of 
     graduates of doctoral nursing programs enter education roles, 
     the 103 doctoral programs nationwide produced only 437 
     graduates, which is only an additional 6 graduates from 2005. 
     This annual graduation rate is insufficient to meet the needs 
     for nurse faculty. In keeping with other professional 
     academic disciplines, nurse faculty at colleges and 
     universities are typically doctorally prepared.
       (5) The nursing faculty workforce is aging and will be 
     retiring.
       (6) With the average retirement age of nurse faculty at 
     62.5 years of age, and the average age of doctorally prepared 
     faculty, as of May 2007, that hold the rank of professor, 
     associate professor, and assistant professor is 58.6, 55.8, 
     and 51.6 years, respectively, the health care system faces 
     unprecedented workforce and health access challenges with 
     current and future shortages of deans, nurse educators, and 
     nurses.
       (7) Research by the National League of Nursing indicates 
     that by 2019 approximately 75 percent of the nursing faculty 
     population (as of May 2007) is expected to retire.

[[Page S5946]]

       (8) A wave of nurses will be retiring from the profession 
     in the near future. As of May 2007, the average age of a 
     nurse in the United States is 46.8 years old. The Bureau of 
     Labor Statistics estimates that more than 1,200,000 new and 
     replacement registered nurses will be needed by 2014.
       (9) By 2030, the number of adults age 65 and older is 
     expected to double to 70,000,000, accounting for 20 percent 
     of the population. As the population ages, the demand for 
     nurses and nursing faculty will increase.
       (10) Despite the need for nurses to treat an aging 
     population, few registered nurses in the United States are 
     trained in geriatrics. Less than 1 percent of practicing 
     nurses have a certification in geriatrics and 3 percent of 
     advanced practice nurses specialize in geriatrics.
       (11) Specialized training in geriatrics is needed to treat 
     older adults with multiple health conditions and improve 
     health outcomes. Approximately 80 percent of Medicare 
     beneficiaries have 1 chronic condition, more than 60 percent 
     have 2 or more chronic conditions, and at least 10 percent 
     have coexisting Alzheimer's disease or other dementias that 
     complicate their care and worsen health outcomes. Two-thirds 
     of Medicare spending is attributed to 20 percent of 
     beneficiaries who have 5 or more chronic conditions. Research 
     indicates that older persons receiving care from nurses 
     trained in geriatrics are less frequently readmitted to 
     hospitals or transferred from nursing facilities to hospitals 
     than those who did not receive care from a nurse trained in 
     geriatrics.
       (12) The Department of Labor projected that the need for 
     physical therapists would increase by 36.7 percent between 
     2004 and 2014.
       (13) The need for physical therapists is particularly acute 
     rural and urban underserved areas, which have 3 to 4 times 
     fewer physical therapists per capita than suburban areas.

                 TITLE I--GRANTS FOR NURSING EDUCATION

     SEC. 101. NURSE FACULTY EDUCATION.

       Part D of title VIII of the Public Health Service Act (42 
     U.S.C. 296p et seq.) is amended by adding at the end the 
     following:

     ``SEC. 832. NURSE FACULTY EDUCATION.

       ``(a) Establishment.--The Secretary, acting through the 
     Health Resources and Services Administration, shall establish 
     a Nurse Faculty Education Program to ensure an adequate 
     supply of nurse faculty through the awarding of grants to 
     eligible entities to--
       ``(1) provide support for the hiring of new faculty, the 
     retaining of existing faculty, and the purchase of 
     educational resources;
       ``(2) provide for increasing enrollment and graduation 
     rates for students from doctoral programs; and
       ``(3) assist graduates from the entity in serving as nurse 
     faculty in schools of nursing;
       ``(b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       ``(1) be an accredited school of nursing that offers a 
     doctoral degree in nursing in a State or territory;
       ``(2) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       ``(3) develop and implement a plan in accordance with 
     subsection (c);
       ``(4) agree to submit an annual report to the Secretary 
     that includes updated information on the doctoral program 
     involved, including information with respect to--
       ``(A) student enrollment;
       ``(B) student retention;
       ``(C) graduation rates;
       ``(D) the number of graduates employed part-time or full-
     time in a nursing faculty position; and
       ``(E) retention in nursing faculty positions within 1 year 
     and 2 years of employment;
       ``(5) agree to permit the Secretary to make on-site 
     inspections, and to comply with the requests of the Secretary 
     for information, to determine the extent to which the school 
     is complying with the requirements of this section; and
       ``(6) meet such other requirements as determined 
     appropriate by the Secretary.
       ``(c) Use of Funds.--Not later than 1 year after the 
     receipt of a grant under this section, an entity shall 
     develop and implement a plan for using amounts received under 
     this grant in a manner that establishes not less than 2 of 
     the following:
       ``(1) Partnering opportunities with practice and academic 
     institutions to facilitate doctoral education and research 
     experiences that are mutually beneficial.
       ``(2) Partnering opportunities with educational 
     institutions to facilitate the hiring of graduates from the 
     entity into nurse faculty, prior to, and upon completion of 
     the program.
       ``(3) Partnering opportunities with nursing schools to 
     place students into internship programs which provide hands-
     on opportunity to learn about the nurse faculty role.
       ``(4) Cooperative education programs among schools of 
     nursing to share use of technological resources and distance 
     learning technologies that serve rural students and 
     underserved areas.
       ``(5) Opportunities for minority and diverse student 
     populations (including aging nurses in clinical roles) 
     interested in pursuing doctoral education.
       ``(6) Pre-entry preparation opportunities including 
     programs that assist returning students in standardized test 
     preparation, use of information technology, and the 
     statistical tools necessary for program enrollment.
       ``(7) A nurse faculty mentoring program.
       ``(8) A Registered Nurse baccalaureate to Ph.D. program to 
     expedite the completion of a doctoral degree and entry to 
     nurse faculty role.
       ``(9) Career path opportunities for 2nd degree students to 
     become nurse faculty.
       ``(10) Marketing outreach activities to attract students 
     committed to becoming nurse faculty.
       ``(d) Priority.--In awarding grants under this section, the 
     Secretary shall give priority to entities from States and 
     territories that have a lower number of employed nurses per 
     100,000 population.
       ``(e) Number and Amount of Grants.--Grants under this 
     section shall be awarded as follows:
       ``(1) In fiscal year 2010, the Secretary shall award 10 
     grants of $100,000 each.
       ``(2) In fiscal year 2011, the Secretary shall award an 
     additional 10 grants of $100,000 each and provide continued 
     funding for the existing grantees under paragraph (1) in the 
     amount of $100,000 each.
       ``(3) In fiscal year 2012, the Secretary shall award an 
     additional 10 grants of $100,000 each and provide continued 
     funding for the existing grantees under paragraphs (1) and 
     (2) in the amount of $100,000 each.
       ``(4) In fiscal year 2013, the Secretary shall provide 
     continued funding for each of the existing grantees under 
     paragraphs (1) through (3) in the amount of $100,000 each.
       ``(5) In fiscal year 2014, the Secretary shall provide 
     continued funding for each of the existing grantees under 
     paragraphs (1) through (3) in the amount of $100,000 each.
       ``(f) Limitations.--
       ``(1) Payment.--Payments to an entity under a grant under 
     this section shall be for a period of not to exceed 5 years.
       ``(2) Improper use of funds.--An entity that fails to use 
     amounts received under a grant under this section as provided 
     for in subsection (c) shall, at the discretion of the 
     Secretary, be required to remit to the Federal Government not 
     less than 80 percent of the amounts received under the grant.
       ``(g) Reports.--
       ``(1) Evaluation.--The Secretary shall conduct an 
     evaluation of the results of the activities carried out under 
     grants under this section.
       ``(2) Reports.--Not later than 3 years after the date of 
     the enactment of this section, the Secretary shall submit to 
     Congress an interim report on the results of the evaluation 
     conducted under paragraph (1). Not later than 6 months after 
     the end of the program under this section, the Secretary 
     shall submit to Congress a final report on the results of 
     such evaluation.
       ``(h) Study.--
       ``(1) In general.--Not later than 3 years after the date of 
     the enactment of this section, the Comptroller General of the 
     United States shall conduct a study and submit a report to 
     Congress concerning activities to increase participation in 
     the nurse educator program under the section.
       ``(2) Contents.--The report under paragraph (1) shall 
     include the following:
       ``(A) An examination of the capacity of nursing schools to 
     meet workforce needs on a nationwide basis.
       ``(B) An analysis and discussion of sustainability options 
     for continuing programs beyond the initial funding period.
       ``(C) An examination and understanding of the doctoral 
     degree programs that are successful in placing graduates as 
     faculty in schools of nursing.
       ``(D) An analysis of program design under this section and 
     the impact of such design on nurse faculty retention and 
     workforce shortages.
       ``(E) An analysis of compensation disparities between 
     nursing clinical practitioners and nurse faculty and between 
     higher education nurse faculty and higher education faculty 
     overall.
       ``(F) Recommendations to enhance faculty retention and the 
     nursing workforce.
       ``(i) Authorization of Appropriations.--
       ``(1) In general.--For the costs of carrying out this 
     section (except the costs described in paragraph (2), there 
     are authorized to be appropriated $1,000,000 for fiscal year 
     2010, $2,000,000 for fiscal year 2011, and $3,000,000 for 
     each of fiscal years 2012 through 2014.
       ``(2) Administrative costs.--For the costs of administering 
     this section, including the costs of evaluating the results 
     of grants and submitting reports to the Congress, there are 
     authorized to be appropriated such sums as may be necessary 
     for each of fiscal years 2010 through 2014.''.

     SEC. 102. GERIATRIC ACADEMIC CAREER AWARDS FOR NURSES.

       Part I of title VIII of the Public Health Service Act (42 
     U.S.C. 298 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 856. GERIATRIC FACULTY FELLOWSHIPS.

       ``(a) Establishment of Program.--The Secretary shall 
     establish a program to provide Geriatric Academic Career 
     Awards to eligible individuals to promote the career 
     development of such individuals as geriatric nurse faculty.
       ``(b) Eligible Individuals.--To be eligible to receive an 
     Award under subsection (a), an individual shall--
       ``(1) be a registered nurse with a doctorate degree in 
     nursing;

[[Page S5947]]

       ``(2)(A) have completed an approved advanced education 
     nursing program in geriatric nursing or geropsychiatric 
     nursing; or
       ``(B) have a State or professional nursing certification in 
     geriatric nursing or geropsychiatric nursing; and
       ``(3) have a faculty appointment at an accredited school of 
     nursing, school of public health, or school of medicine.
       ``(c) Application.--An eligible individual desiring to 
     receive an Award under this section shall submit to the 
     Secretary an application at such time, in such manner, and 
     containing such information as the Secretary may require, 
     which shall include an assurance that the individual will 
     meet the service requirement described in subsection (d).
       ``(d) Service Requirement.--An individual who receives an 
     Award under this section shall provide training in clinical 
     geriatrics, including the training of interdisciplinary teams 
     of health care professionals. The provision of such training 
     shall constitute at least 50 percent of the obligations of 
     such individual under the Award.
       ``(e) Amount and Number.--
       ``(1) Amount.--The amount of an Award under this section 
     shall equal $75,000 annually, adjusted for inflation on the 
     basis of the Consumer Price Index. The Secretary may increase 
     the amount of an Award by not more than 25 percent, taking 
     into account the fringe benefits and other research expenses, 
     at the recipient's institutional rate.
       ``(2) Number.--The Secretary shall award up to 125 Awards 
     under this section from 2008 through 2016.
       ``(3) Regional distribution.--
       ``(A) In general.--The Secretary shall provide Awards to 
     individuals from 5 regions in the United States, of which--
       ``(i) 2 regions shall be an urban area;
       ``(ii) 2 regions shall be a rural area; and
       ``(iii) 1 region shall include a State with--

       ``(I) a medical school that has a department of geriatrics 
     that manages rural outreach sites and is capable of managing 
     patients with multiple chronic conditions, 1 of which is 
     dementia; and
       ``(II) a college of nursing that has a required course in 
     geriatric nursing in the baccalaureate program.

       ``(B) Geographic diversity.--The Secretary shall ensure 
     that the 5 regions established under subparagraph (A) are 
     located in different geographic areas of the United States.
       ``(f) Term of Award.--The term of an Award made under this 
     section shall be 5 years.
       ``(g) Reports.--
       ``(1) Evaluation.--
       ``(A) In general.--The Secretary shall conduct an 
     evaluation of the results of the activities carried out under 
     the Awards established under this section.
       ``(B) Reports to congress.--Not later than 3 years after 
     the date of the enactment of this section, the Secretary 
     shall submit to Congress an interim report on the results of 
     the evaluation conducted under this paragraph. Not later than 
     180 days after the expiration of the program under this 
     section, the Secretary shall submit to Congress a final 
     report on the results of such evaluation.
       ``(2) Content.--The evaluation under paragraph (1) shall 
     examine--
       ``(A) the program design under this section and the impact 
     of the design on nurse faculty retention; and
       ``(B) options for continuing the program beyond fiscal year 
     2018.
       ``(h) Authorization of Appropriations.--
       ``(1) In general.--To fund Awards under subsection (e), 
     there are authorized to be appropriated $1,875,000 for each 
     of fiscal years 2010 through 2018.
       ``(2) Administrative costs.--To carry out this section 
     (except to fund Awards under subsection (e)), there are 
     authorized to be appropriated such sums as may be necessary 
     for each of fiscal years 2008 through 2016.
       ``(3) Separation of funds.--The Secretary shall ensure that 
     the amounts appropriated pursuant to paragraph (1) are held 
     in a separate account from the amounts appropriated pursuant 
     to paragraph (2).''.

  TITLE II--DISTANCE EDUCATION PILOT PROGRAM AND OTHER PROVISIONS TO 
          INCREASE THE NURSING AND PHYSICAL THERAPY WORKFORCE

     SEC. 201. INCREASING THE DOMESTIC SUPPLY OF NURSES AND 
                   PHYSICAL THERAPISTS.

       (a) Establishment of Nurse and Physical Therapists Distance 
     Education Pilot Program.--
       (1) In general.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary''), in 
     conjunction with the Secretary of Education, shall establish 
     a Nurse and Physical Therapist Distance Education Pilot 
     Program through which grants may be awarded for the conduct 
     of activities to increase accessibility to nursing and 
     physical therapy education.
       (2) Purpose.--The purpose of the Nurse and Physical 
     Therapist Distance Education Pilot Program established under 
     paragraph (1) shall be to increase accessibility to nursing 
     and physical therapy education to--
       (A) provide assistance to individuals in rural areas who 
     want to study nursing or physical therapy to enable such 
     individuals to receive appropriate nursing education and 
     physical therapy education;
       (B) promote the study of nursing and physical therapy at 
     all educational levels;
       (C) establish additional slots for nursing and physical 
     therapy students at existing accredited schools of nursing 
     and physical therapy education programs; and
       (D) establish new nursing and physical therapy education 
     programs at institutions of higher education.
       (3) Application.--To be eligible to receive a grant under 
     the Pilot Program under paragraph (1), an entity shall submit 
     to the Secretary an application at such time, in such manner, 
     and containing such information as the Secretary may require.
       (4) Authorization of appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this subsection.
       (b) Increasing the Domestic Supply of Nurses and Physical 
     Therapists.--
       (1) In general.--Not later than January 1, 2010, the 
     Secretary, in conjunction with the Secretary of Education, 
     shall--
       (A) submit to Congress a report concerning the country of 
     origin or professional school of origin of newly licensed 
     nurses and physical therapists in each State, that shall 
     include--
       (i) for the most recent 3-year period for which data is 
     available--

       (I) separate data relating to teachers at institutions of 
     higher education for each related occupation who have been 
     teaching for not more than 5 years; and
       (II) separate data relating to all teachers at institutions 
     of higher education for each related occupation regardless of 
     length of service;

       (ii) for the most recent 3-year period for which data is 
     available, separate data for each related occupation and for 
     each State;
       (iii) a separate identification of those individuals 
     receiving their initial professional license and those 
     individuals licensed by endorsement from another State;
       (iv) with respect to those individuals receiving their 
     initial professional license in each year, a description of 
     the number of individuals who received their professional 
     education in the United States and the number of individuals 
     who received such education outside the United States; and
       (v) to the extent practicable, a description, by State of 
     residence and country of education, of the number of nurses 
     and physical therapists who were educated in any of the 5 
     countries (other than the United States) from which the most 
     nurses and physical therapists arrived;
       (B) in consultation with the Department of Labor, enter 
     into a contract with the Institute of Medicine of the 
     National Academy of Sciences for the conduct of a study and 
     submission of a report that includes--
       (i) a description of how the United States can balance 
     health, education, labor, and immigration policies to meet 
     the respective policy goals and ensure an adequate and well-
     trained nursing and physical therapy workforce;
       (ii) a description of the barriers to increasing the supply 
     of nursing and physical therapy faculty, domestically trained 
     nurses, and domestically trained physical therapists;
       (iii) recommendations of strategies to be utilized by 
     Federal and State governments that would be effective in 
     removing the barriers described in clause (ii), including 
     strategies that address barriers to advancement to become 
     registered nurses for other health care workers, such as home 
     health aides and nurses assistants;
       (iv) recommendations for amendments to Federal laws that 
     would increase the supply of nursing faculty, domestically 
     trained nurses, and domestically trained physical therapists;
       (v) recommendations for Federal grants, loans, and other 
     incentives that would provide increases in nurse and physical 
     therapist educators and training facilities, and other 
     measures to increase the domestic education of new nurses and 
     physical therapists;
       (vi) an identification of the effects of nurse and physical 
     therapist emigration on the health care systems in their 
     countries of origin; and
       (vii) recommendations for amendments to Federal law that 
     would minimize the effects of health care shortages in the 
     countries of origin from which immigrant nurses arrived; and
       (C) collaborate with the heads of other Federal agencies, 
     as appropriate, in working with ministers of health or other 
     appropriate officials of the 5 countries from which the most 
     nurses and physical therapists arrived into the United 
     States, to--
       (i) address health worker shortages caused by emigration; 
     and
       (ii) ensure that there is sufficient human resource 
     planning or other technical assistance needed to reduce 
     further health worker shortages in such countries.
       (2) Access to data.--The Secretary shall grant the 
     Institute of Medicine access to the data described under 
     paragraph (1)(A), as such data becomes available to the 
     Secretary for use by the Institute in carrying out the 
     activities under paragraph (1)(B).
       (3) Authorization of appropriations.--There is authorized 
     to be appropriated $1,400,000 to carry out paragraph (1)(B).
                                 ______
                                 
      By Mr. FEINGOLD (for himself and Ms. Collins):
  S. 1164. A bill to amend the Public Health Service Act to reauthorize 
the Automated Defibrillation in Adam's Memory Act; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. FEINGOLD. Mr. President, today I am introducing the 
reauthorization of

[[Page S5948]]

the Automated Defibrillators in Adam's Memory Act, or the ADAM Act. 
This bill is modeled after the successful Project ADAM that originally 
began in Wisconsin, and will reauthorize a program to establish a 
national clearing house to provide schools with the ``how-to'' and 
technical advice to set up a public access defibrillation program.
  Every 2 minutes, someone in America falls into sudden cardiac arrest. 
By improving access to AEDs, we can improve the survival rates of 
cardiac arrest in our communities.
  In my home State of Wisconsin, as in many other states, heart disease 
is the number one killer. Nationwide, heart disease is the cause of one 
out of every 2.8 deaths. Overall, heart disease kills more Americans 
than breast cancer, lung cancer, and HIV/AIDS combined.
  Cardiac arrest can strike anyone. Cardiac victims are in a race 
against time, and unfortunately, for too many of those in rural areas, 
Emergency Medical Services are unable to reach people in need, and time 
runs out for victims of cardiac arrest. It's simply not possible to 
have EMS units next to every farm and small town across the nation.
  Fortunately, recent technological advances have made the newest 
generation of AEDs inexpensive and simple to operate. Because of these 
advancements in AED technology, it is now practical to train and equip 
police officers, teachers, and members of other community 
organizations.
  Over 163,000 Americans experience out-of-hospital sudden cardiac 
arrests each year. Immediate CPR and early defibrillation using an 
automated external defibrillator, AED, can more than double a victim's 
chance of survival. By taking some relatively simple steps, we can give 
victims of cardiac arrest a better chance of survival.
  Over the past 9 years, I have worked with Senator Susan Collins, a 
Republican from Maine, on a number of initiatives to empower 
communities to improve cardiac arrest survival rates. We have pushed 
Congress to support rural first responders--local police and fire and 
rescue services--in their efforts to provide early defibrillation. 
Congress heard our call, and responded by enacting two of our bills, 
the Rural Access to Emergency Devices Act and the ADAM Act.
  The Rural Access to Emergency Devices program allows community 
partnerships across the country to receive a grant enabling them to 
purchase defibrillators, and receive the training needed to use these 
devices. This program is entering its ninth year of helping rural 
communities purchase defibrillators and train first responders, and I 
am pleased to say that grants have already put defibrillators in rural 
communities all over the country, helping those communities be better 
prepared when cardiac arrest strikes.
  Approximately ninety-five percent of sudden cardiac arrest victims 
die before reaching the hospital. Every minute that passes before a 
cardiac arrest victim is defibrillated, the chance of survival falls by 
as much as 10 percent. After only eight minutes, the victim's survival 
rate drops by 60 percent. This is why early intervention is essential--
a combination of CPR and use of AEDs can save lives.
  Heart disease is not only a problem among adults. A few years ago I 
learned the story of Adam Lemel, a 17-year-old high school student and 
a star basketball and tennis player in Wisconsin. Tragically, during a 
timeout while playing basketball at a neighboring Milwaukee high 
school, Adam suffered sudden cardiac arrest, and died before the 
paramedics arrived.
  This story is incredibly tragic. Adam had his whole life ahead of 
him, and could quite possibly have been saved with appropriate early 
intervention. In fact, we have seen a number of examples in Wisconsin 
where early CPR and access to defibrillation have saved lives.
  Seventy miles away from Milwaukee, a 14-year-old boy collapsed while 
playing basketball. Within three minutes, the emergency team arrived 
and began CPR. Within five minutes of his collapse, the paramedics used 
an AED to jump start his heart. Not only has this young man survived, 
doctors have identified his father and brother as having the same heart 
condition and have begun preventative treatments.
  These stories help to underscore some important issues. First, 
although cardiac arrest is most common among adults, it can occur at 
any age--even in apparently healthy children and adolescents. Second, 
early intervention is essential--a combination of CPR and the use of 
AEDs can save lives. Third, some individuals who are at risk for sudden 
cardiac arrest can be identified.
  After Adam Lemel suffered his cardiac arrest, his friend David Ellis 
joined forces with Children's Hospital of Wisconsin to initiate Project 
ADAM to bring CPR training and public access defibrillation into 
schools, educate communities about preventing sudden cardiac deaths and 
save lives.
  Today, Project ADAM has introduced AEDs into several Wisconsin 
schools, and has been a model for programs in Washington, Florida, 
Michigan and elsewhere. Project ADAM provides a model for the nation, 
and now, with the enactment of this new law, more schools will have 
access to the information they seek to launch similar programs.
  The ADAM Act was passed into law in 2003, but has yet to be funded. I 
have been very proud to play a part in having this bill signed into 
law, and it is my hope that the reauthorization of the Act will quickly 
pass through the Congress and into law, and that funding will follow. 
It would not take much money to fund this program and save lives across 
the country.
  The ADAM Act is one way we can honor the life of children like Adam 
Lemel, and give tomorrow's pediatric cardiac arrest victims a fighting 
chance at life.
  This act exists because a family experienced the tragic loss of their 
son, but they were determined to spare other families that same loss. I 
thank Adam's parents, Joe and Patty, for their courageous efforts and I 
thank them for everything they have done to help the ADAM Act become 
law. Their actions take incredible bravery, and I commend them for 
their efforts.
  By making sure that AEDs are available in our nation's rural areas, 
schools and throughout our communities we can help those in a race 
against time have a fighting chance of survival when they fall victim 
to cardiac arrest. I urge Congress to pass this reauthorization, and to 
fund the ADAM Act and the Rural AED program at their full levels. We 
have the power to prevent death--all we must do is act.
  Mr. President, 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. 1164

       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 ``Automated Defibrillation in 
     Adam's Memory Reauthorization Act''.

     SEC. 2. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.

       Section 312 of the Public Health Service Act (42 U.S.C. 
     244) is amended--
       (1) in subsection (c)(6), after ``clearinghouse'' insert 
     ``, that shall be administered by an organization that has 
     substantial expertise in pediatric education, pediatric 
     medicine, and electrophysiology and sudden death,''; and
       (2) in the first sentence of subsection (e), by striking 
     ``fiscal year 2003'' and all that follows through ``2006'' 
     and inserting ``for each of fiscal years 2003 through 2014''.
                                 ______
                                 
      By Mr. FEINGOLD (for himself and Ms. Collins):
  S. 1165. A bill to promote the development of health care 
cooperatives that will help businesses to pool the health care 
purchasing power of employers, and for other purposes; to the Committee 
on Health, Education, Labor, and Pensions.
  Mr. FEINGOLD. Mr. President, today, along with my colleague Senator 
Collins from Maine, I am reintroducing legislation to help businesses 
form group-purchasing cooperatives to obtain enhanced benefits, to 
reduce health care rates, and to improve quality for their employees' 
health care.
  High health care costs are burdening businesses and employees across 
the nation. These costs are digging into profits and preventing access 
to affordable health care. Too many patients feel trapped by the 
system, with decisions about their health dictated by costs rather than 
by what they need.
  Nationally, the annual average cost to an employer for an individual 
employee's health care is $3,983. For a

[[Page S5949]]

family, the employer contribution is $9,325. We must curb these rapidly 
increasing health care costs. I strongly support initiatives to ensure 
that everyone has access to health care. It is crucial that we support 
successful local initiatives to reduce health care premiums and to 
improve the quality of employees' health care.
  By using group purchasing to obtain rate discounts, some employers 
have been able to reduce the cost of health care premiums for their 
employees. According to the National Business Coalition on Health, 
there are nearly 60 employer-led coalitions across the U.S. that 
collectively purchase health care. Through these pools, businesses are 
able to proactively challenge high costs and inefficient delivery of 
health care and share information on quality. These coalitions 
represent over 7,000 employers nationwide.
  Improving the quality of health care will also lower the cost of 
care. By investing in the delivery of high-quality health care, we will 
be able to lower long term health care costs. Effective care, such as 
high-quality preventive services, can reduce overall health care 
expenditures. Health purchasing coalitions help promote these services 
and act as an employer forum for networking and education on health 
care cost containment strategies. They can help foster a dialogue with 
health care providers, insurers, and local HMOs.
  Health care markets are local. Problems with cost, quality, and 
access to health care are felt most intensely in the local markets. 
Health care coalitions can function best when they are formed and 
implemented locally. Local employers of large and small businesses have 
formed health care coalitions to track health care trends, create a 
demand for quality and safety, and encourage group purchasing.
  In Wisconsin, there have been various successful initiatives that 
have formed health care purchasing cooperatives to improve quality of 
care and to reduce cost. For example, the Employer Health Care Alliance 
Cooperative, an employer-owned and employer-directed not-for-profit 
cooperative, has developed a network of health care providers in Dane 
County and 13 surrounding counties on behalf of more than 160 member 
employers. Through this pooling effort, employers are able to obtain 
affordable, high-quality health care for their more than 80,000 
employees and dependents.
  This legislation seeks to build on successful local initiatives, such 
as the Alliance, that help businesses to join together to increase 
access to affordable and high-quality health care.
  The Promoting Health Care Purchasing Cooperatives Act would authorize 
grants to groups of businesses so that they could form group-purchasing 
cooperatives to obtain enhanced benefits, reduce health care rates, and 
improve quality.
  This legislation offers two separate grant programs to help different 
types of businesses pool their resources and bargaining power. Both 
programs would aid businesses to form cooperatives. The first program 
would help large businesses that sponsor their own health plans, while 
the second program would help small businesses that purchase their 
health insurance.
  My bill would enable larger businesses to form cost-effective 
cooperatives that could offer high-quality health care through several 
ways. First, they could obtain health services through pooled 
purchasing from physicians, hospitals, home health agencies, and 
others. By pooling their experience and interests, employers involved 
in a coalition could better address essential issues, such as rising 
health insurance rates and the lack of comparable health care quality 
data. They would be able to share information regarding the quality of 
these services and to partner with these health care providers to meet 
the needs of their employees.
  For smaller businesses that purchase their health insurance, the 
formation of cooperatives would allow them to buy health insurance at 
lower prices through pooled purchasing. Also, the communication within 
these cooperatives would provide employees of small businesses with 
better information about the health care options that are available to 
them. Finally, coalitions would serve to promote quality improvements 
by facilitating partnerships between their group and the health care 
providers.
  By working together, the group could develop better insurance plans 
and negotiate better rates.
  This legislation also tries to alleviate the burden that our Nation's 
farmers face when trying to purchase health care for themselves, their 
families, and their employees. Because the health insurance industry 
looks upon farming as a high-risk profession, many farmers are priced 
out of, or simply not offered, health insurance. By helping farmers 
join cooperatives to purchase health insurance, we will help increase 
their health insurance options.
  Past health purchasing pool initiatives have focused only on cost and 
have tried to be all things for all people. My legislation creates an 
incentive to join the pools by giving grants to a group of similar 
businesses to form group-purchasing cooperatives. The pools are also 
given flexibility to find innovative ways to lower costs, such as 
enhancing benefits--for example, more preventive care--and improving 
quality. Finally, the cooperative structure is a proven model, which 
creates an incentive for businesses to remain in the pool because they 
will be invested in the organization.
  We must reform health care in America and give employers and 
employees more options. This legislation, by providing for the 
formation of cost-effective coalitions that will also improve the 
quality of care, contributes to this essential reform process. I urge 
my colleagues to join me in supporting this proposal to improve the 
quality and costs of health care.
  Mr. President, 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. 1165

       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 ``Promoting Health Care 
     Purchasing Cooperatives Act''.

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress makes the following findings:
       (1) Health care spending in the United States has reached 
     16.2 percent of the Gross Domestic Product of the United 
     States, yet over 46,000,000 people remain uninsured.
       (2) After nearly a decade of manageable increases in 
     commercial insurance premiums, many employers are now faced 
     with consecutive years of double digit premium increases.
       (3) Purchasing cooperatives owned by participating 
     businesses are a proven method of achieving the bargaining 
     power necessary to manage the cost and quality of employer-
     sponsored health plans and other employee benefits.
       (4) The Employer Health Care Alliance Cooperative has 
     provided its members with health care purchasing power 
     through provider contracting, data collection, activities to 
     enhance quality improvements in the health care community, 
     and activities to promote employee health care consumerism.
       (5) According to the National Business Coalition on Health, 
     there are nearly 60 employer-led coalitions across the United 
     States that collectively purchase health care, proactively 
     challenge high costs and the inefficient delivery of health 
     care, and share information on quality. These coalitions 
     represent more than 7,000 employers, and approximately 
     25,000,000 employees and their dependents.
       (b) Purpose.--It is the purpose of this Act to build off of 
     successful local employer-led health insurance initiatives by 
     improving the value of their employees' health care.

     SEC. 3. GRANTS TO SELF INSURED BUSINESSES TO FORM HEALTH CARE 
                   COOPERATIVES.

       (a) Authorization.--The Secretary of Health and Human 
     Services (in this Act referred to as the ``Secretary''), 
     acting through the Director of the Agency for Healthcare 
     Research and Quality, is authorized to award grants to 
     eligible groups that meet the criteria described in 
     subsection (d), for the development of health care purchasing 
     cooperatives. Such grants may be used to provide support for 
     the professional staff of such cooperatives, and to obtain 
     contracted services for planning, development, and 
     implementation activities for establishing such health care 
     purchasing cooperatives.
       (b) Eligible Group Defined.--
       (1) In general.--In this section, the term ``eligible 
     group'' means a consortium of 2 or more self-insured 
     employers, including agricultural producers, each of which 
     are responsible for their own health insurance risk pool with 
     respect to their employees.
       (2) No transfer of risk.--Individual employers who are 
     members of an eligible group may not transfer insurance risk 
     to such group.
       (c) Application.--To be eligible to receive a grant under 
     this section, an eligible group shall submit to the Secretary 
     an application

[[Page S5950]]

     at such time, in such manner, and accompanied by such 
     information as the Secretary may require.
       (d) Criteria.--
       (1) Feasibility study grants.--
       (A) In general.--An eligible group may submit an 
     application under subsection (c) for a grant to conduct a 
     feasibility study concerning the establishment of a health 
     insurance purchasing cooperative. The Secretary shall approve 
     applications submitted under the preceding sentence if the 
     study will consider the criteria described in paragraph (2).
       (B) Report.--After the completion of a feasibility study 
     under a grant under this section, an eligible group shall 
     submit to the Secretary a report describing the results of 
     such study.
       (2) Grant criteria.--The criteria described in this 
     paragraph include the following with respect to the eligible 
     group involved:
       (A) The ability of the group to effectively pool the health 
     care purchasing power of employers.
       (B) The ability of the group to provide data to employers 
     to enable such employers to make data-based decisions 
     regarding their health plans.
       (C) The ability of the group to drive quality improvement 
     in the health care community.
       (D) The ability of the group to promote health care 
     consumerism through employee education, self-care, and 
     comparative provider performance information.
       (E) The ability of the group to meet any other criteria 
     determined appropriate by the Secretary.
       (e) Cooperative Grants.--After the submission of a report 
     by an eligible group under subsection (d)(1)(B), the 
     Secretary shall determine whether to award the group a grant 
     for the establishment of a cooperative under subsection (a). 
     In making a determination under the preceding sentence, the 
     Secretary shall consider the criteria described in subsection 
     (d)(2) with respect to the group.
       (f) Cooperatives.--
       (1) In general.--An eligible group awarded a grant under 
     subsection (a) shall establish or expand a health insurance 
     purchasing cooperative that shall--
       (A) be a nonprofit organization;
       (B) be wholly owned, and democratically governed by its 
     member-employers;
       (C) exist solely to serve the membership base;
       (D) be governed by a board of directors that is 
     democratically elected by the cooperative membership using a 
     1-member, 1-vote standard; and
       (E) accept any new member in accordance with specific 
     criteria, including a limitation on the number of members, 
     determined by the Secretary.
       (2) Authorized cooperative activities.--A cooperative 
     established under paragraph (1) shall--
       (A) assist the members of the cooperative in pooling their 
     health care insurance purchasing power;
       (B) provide data to improve the ability of the members of 
     the cooperative to make data-based decisions regarding their 
     health plans;
       (C) conduct activities to enhance quality improvement in 
     the health care community;
       (D) work to promote health care consumerism through 
     employee education, self-care, and comparative provider 
     performance information; and
       (E) conduct any other activities determined appropriate by 
     the Secretary.
       (g) Review.--
       (1) In general.--Not later than 1 year after the date on 
     which grants are awarded under this section, and every 2 
     years thereafter, the Secretary shall study the programs 
     funded under the grants and submit to the appropriate 
     committees of Congress a report on the progress of such 
     programs in improving the access of employees to quality, 
     affordable health insurance.
       (2) Sliding scale funding.--The Secretary shall use the 
     information included in the report submitted under paragraph 
     (1) to establish a schedule for scaling back payments under 
     this section with the goal of ensuring that programs funded 
     with grants under this section are self sufficient within 10 
     years.

     SEC. 4. GRANTS TO SMALL BUSINESSES TO FORM HEALTH CARE 
                   COOPERATIVES.

       The Secretary shall carry out a grant program that is 
     identical to the grant program provided for in section 3, 
     except that an eligible group for purposes of a grant under 
     this section shall be a consortium of 2 or more employers, 
     including agricultural producers, each of which--
       (1) have 99 employees or less; and
       (2) are purchasers of health insurance (are not self-
     insured) for their employees.

     SEC. 5. AUTHORIZATION OF APPROPRIATIONS.

       From the administrative funds provided to the Secretary for 
     each fiscal year, the Secretary may use not to exceed a total 
     of $60,000,000 for fiscal years 2009 through 2018 to carry 
     out this Act.

                          ____________________