[Congressional Record Volume 157, Number 90 (Wednesday, June 22, 2011)]
[Senate]
[Pages S4030-S4032]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself and Mrs. Hutchison):
  S. 1257. A bill establish grant programs to improve the health of 
border area residents and for all hazards preparedness in the border 
area including bioterrorism and infectious disease, and for other 
purposes; to the Committee on Health, Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, I rise today to introduce the Border 
Health Security Act of 2011.
  This legislation is designed to make several important changes to 
current law to address pressing public health challenges along the 
U.S.-Mexico border.
  In 1993, along with Senators Hutchison and McCain, I introduced the 
original United States-Mexico Border Health Commission Act. With the 
support of Members from both chambers, and from both parties, we passed 
this landmark legislation, which was signed into law in 1994 by 
President Clinton. I was gratified when the bi-national agreement to 
establish the Commission was signed in 2000. And, I have monitored with 
interest the important work of the U.S.-Mexico Border Health Commission 
in the years since.
  As the Commission enters its second decade, the problems it seeks to 
deal with are no less pressing than those we originally set out to 
tackle with the Border Health Commission Act.
  Health disparities and chronic diseases for the over 14 million 
people who live in the border region, comprised of two sovereign 
nations, 25 Native American tribes, and four states in the United 
States and six states in Mexico, remain at unacceptable levels, far 
outpacing rates in most of the United States. Far too many border 
residents remain uninsured. Texas and New Mexico, for instance, rank 
first and fifth, respectively, in the percentage of residents who are 
uninsured. Many who live in the region still do not have access to 
adequate primary, preventive, and specialty care. If the border region 
were considered a state, it would rank at or near the bottom on many 
key health indicators, such as rates of tuberculosis, hepatitis, 
diabetes, and access to health professionals. Compounding all these 
problems are high rates of poverty; three of the ten poorest counties 
in the United States are located in the border area.
  In addition, communicable diseases that can easily travel across 
borders, such as tuberculosis and H1N1, strain our border's public 
health systems. Amplifying our public health surveillance efforts at 
our border can help mitigate the impact of such diseases, as well as 
other bio-security threats, in the rest of the nation.
  I believe, just as I did when I introduced the original legislation, 
that the public health problems the border region faces are truly bi-
national in nature. As such, they demand a truly bi-national public 
health architecture. Over the last 11 years, the U.S.-Mexico Border 
Health Commission has provided this structure as it worked to address 
these issues. It has had a number of successes, including notable 
conferences and reports on infectious disease surveillance, childhood 
obesity, and tuberculosis, developed jointly by both its U.S. and 
Mexican members. Its programs were particularly helpful as we 
coordinated our response to the H1N1 pandemic in 2009.
  Still, the public health challenges in the border remain great. As 
the Commission enters into its second decade, this bipartisan 
legislation will strengthen the capacity of the Commission and 
authorize appropriate federal resources for its important work.
  The legislation does this in several ways. First, through a new grant 
program, it authorizes additional funding to improve the 
infrastructure, access, and the delivery of health care services along 
the entire U.S.-Mexico border.
  These grants would be flexible and allow the individual communities 
to establish their own priorities with which to spend these funds for 
the following range of purposes: maternal and child health, primary 
care and preventative health, public health and public health 
infrastructure, health promotion, oral health, behavioral and mental 
health, substance abuse, health conditions that have a high prevalence 
in the border region, medical and health services research, community 
health workers or promotoras, health care infrastructure, including 
planning and construction grants, health disparities, environmental 
health, health education, and research.
  Second, it authorizes new, funding for the successful Early Warning 
Infectious Disease Surveillance, EWIDS, program in the U.S.-Mexico 
border region. EWIDS is designed to bolster preparedness for 
bioterrorism and infectious disease. The legislation also establishes a 
health alert network to identify and communicate information quickly to 
health providers about emerging health care threats. It requires the 
Department of Health and Human Services and the Department of Homeland 
Security to coordinate this system.
  Third, it strengthens the capacity of the U.S.-Mexico Border Health 
Commission by undertaking several key organizational reforms.
  Finally, the legislation encourages more coordination, 
recommendations, and study of these complex border health challenges. 
The bill affirms the need for integrated efforts across national, 
federal, state and local agencies to properly address border health 
issues. It specifies that recommendations and advice on how to improve 
border health will be communicated to Congress. Further, the 
legislation authorizes two key studies conducted by the Institute of 
Medicine: the first on bi-national health infrastructure and a second 
on health insurance coverage for border residents. A total of $31 
million is authorized to carry out the act.
  Without the changes and resources this legislation envisions, border 
residents will continue to lag behind the United States in many key 
indicators of good public health. Without this bill, both of our 
countries will be less prepared when the next bi-national health 
security threat hits.
  I would like to thank Senator Hutchison, who was an original 
cosponsor of the U.S.-Mexico Border Health Commission legislation, 
Public Law 103-400, that we passed in 1994 and is the lead cosponsor of 
this legislation today. She has also been the lead Senator in getting 
funding for the U.S.-

[[Page S4031]]

Mexico Border Health Commission since its inception.
  I urge the adoption of this bipartisan legislation by this Congress.
  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. 1257

       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 ``Border Health Security Act 
     of 2011''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) The United States-Mexico border is an interdependent 
     and dynamic region of 14,538,209 people with significant and 
     unique public health challenges.
       (2) These challenges include low rates of health insurance 
     coverage, poor access to health care services, and high rates 
     of dangerous diseases, such as tuberculosis, diabetes, and 
     obesity.
       (3) As the 2009 novel influenza A (H1N1) outbreak 
     illustrates, diseases do not respect international 
     boundaries, therefore, a strong public health effort at and 
     along the U.S.-Mexico border is crucial to not only protect 
     and improve the health of Americans but also to help secure 
     the country against biosecurity threats.
       (4) For 11 years, the United States-Mexico Border Health 
     Commission has served as a crucial bi-national institution to 
     address these unique and truly cross-border health issues.
       (5) Two initiatives resulting from the United States-Mexico 
     Border Health Commission's work speak to the importance of an 
     infrastructure that facilitates cross border communication at 
     the ground level. First, the Early Warning Infectious Disease 
     Surveillance (EWIDS), started in 2004, surveys infectious 
     diseases passing among border States allowing for early 
     detection and intervention. Second, the Ventanillas de Salud 
     program, allows Mexican consulates, in collaboration with 
     United States nonprofit health organizations, to provide 
     information and education to Mexican citizens living and 
     working in the United States through a combination of Mexican 
     state funds and private grants. This program reaches an 
     estimated 1,500,000 people in the United States.
       (6) As the United States-Mexico Border Health Commission 
     enters its second decade, and as these issues grow in number 
     and complexity, the Commission requires additional resources 
     and modifications which will allow it to provide stronger 
     leadership to optimize health and quality of life along the 
     United States-Mexico border.

     SEC. 3. UNITED STATES-MEXICO BORDER HEALTH COMMISSION ACT 
                   AMENDMENTS.

       The United States-Mexico Border Health Commission Act (22 
     U.S.C. 290n et seq.) is amended--
       (1) in section 3--
       (A) in paragraph (1), by striking ``and'' at the end;
       (B) in paragraph (2), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following:
       ``(3) to serve as an independent and objective body to both 
     recommend and implement initiatives that solve border health 
     issues'';
       (2) in section 5--
       (A) in subsection (b), by striking ``should be the leader'' 
     and inserting ``shall be the Chair''; and
       (B) by adding at the end the following:
       ``(d) Providing Advice and Recommendations to Congress.--A 
     member of the Commission may at any time provide advice or 
     recommendations to Congress concerning issues that are 
     considered by the Commission. Such advice or recommendations 
     may be provided whether or not a request for such is made by 
     a member of Congress and regardless of whether the member or 
     individual is authorized to provide such advice or 
     recommendations by the Commission or any other Federal 
     official.'';
       (3) by redesignating section 8 as section 13;
       (4) by striking section 7 and inserting the following:

     ``SEC. 7. BORDER HEALTH GRANTS.

       ``(a) Eligible Entity Defined.--In this section, the term 
     `eligible entity' means a State, public institution of higher 
     education, local government, Indian tribe, tribal 
     organization, urban Indian organization, nonprofit health 
     organization, trauma center, or community health center 
     receiving assistance under section 330 of the Public Health 
     Service Act (42 U.S.C. 254b), that is located in the border 
     area.
       ``(b) Authorization.--From amounts appropriated under 
     section 12, the Secretary, acting through the Commissioners, 
     shall award grants to eligible entities to address priorities 
     and recommendations outlined by the Commission's Strategic 
     and Operational Plans, as authorized under section 9, to 
     improve the health of border area residents.
       ``(c) Application.--An eligible entity that desires a grant 
     under subsection (b) shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(d) Use of Funds.--An eligible entity that receives a 
     grant under subsection (b) shall use the grant funds for--
       ``(1) programs relating to--
       ``(A) maternal and child health;
       ``(B) primary care and preventative health;
       ``(C) infectious disease testing and monitoring;
       ``(D) public health and public health infrastructure;
       ``(E) health promotion;
       ``(F) oral health;
       ``(G) behavioral and mental health;
       ``(H) substance abuse;
       ``(I) health conditions that have a high prevalence in the 
     border area;
       ``(J) medical and health services research;
       ``(K) workforce training and development;
       ``(L) community health workers or promotoras;
       ``(M) health care infrastructure problems in the border 
     area (including planning and construction grants);
       ``(N) health disparities in the border area;
       ``(O) environmental health;
       ``(P) health education;
       ``(Q) outreach and enrollment services with respect to 
     Federal programs (including programs authorized under titles 
     XIX and XXI of the Social Security Act (42 U.S.C. 1396 and 
     1397aa));
       ``(R) trauma care;
       ``(S) health research with an emphasis on infectious 
     disease;
       ``(T) epidemiology and health research;
       ``(U) cross-border health surveillance coordinated with 
     Mexican Health Authorities;
       ``(V) obesity, particularly childhood obesity;
       ``(W) crisis communication, domestic violence, substance 
     abuse, health literacy, and cancer; or
       ``(X) community-based participatory research on border 
     health issues; or
       ``(2) other programs determined appropriate by the 
     Secretary.
       ``(e) Supplement, Not Supplant.--Amounts provided to an 
     eligible entity awarded a grant under subsection (b) shall be 
     used to supplement and not supplant other funds available to 
     the eligible entity to carry out the activities described in 
     subsection (d).

     ``SEC. 8. GRANTS FOR EARLY WARNING INFECTIOUS DISEASE 
                   SURVEILLANCE (EWIDS) PROJECTS IN THE BORDER 
                   AREA.

       ``(a) Eligible Entity Defined.--In this section, the term 
     `eligible entity' means a State, local government, Indian 
     tribe, tribal organization, urban Indian organization, trauma 
     centers, regional trauma center coordinating entity, or 
     public health entity.
       ``(b) Authorization.--From funds appropriated under section 
     12, the Secretary shall award grants under the Early Warning 
     Infectious Disease Surveillance (EWIDS) project to eligible 
     entities for infectious disease surveillance activities in 
     the border area.
       ``(c) Application.--An eligible entity that desires a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may require.
       ``(d) Uses of Funds.--An eligible entity that receives a 
     grant under subsection (b) shall use the grant funds to, in 
     coordination with State and local all hazards programs--
       ``(1) develop and implement infectious disease surveillance 
     plans and readiness assessments and purchase items necessary 
     for such plans;
       ``(2) coordinate infectious disease surveillance planning 
     in the region with appropriate United States-based agencies 
     and organizations as well as appropriate authorities in 
     Mexico or Canada;
       ``(3) improve infrastructure, including surge capacity, 
     syndromic surveillance, laboratory capacity, and isolation/
     decontamination capacity;
       ``(4) create a health alert network, including risk 
     communication and information dissemination;
       ``(5) educate and train clinicians, epidemiologists, 
     laboratories, and emergency personnel;
       ``(6) implement electronic data systems to coordinate the 
     triage, transportation, and treatment of multi-casualty 
     incident victims;
       ``(7) provide infectious disease testing in the border 
     area; and
       ``(8) carry out such other activities identified by the 
     Secretary, the United States-Mexico Border Health Commission, 
     State and local public health offices, and border health 
     offices at the United States-Mexico or United States-Canada 
     borders.

     ``SEC. 9. PLANS, REPORTS, AUDITS, AND BY-LAWS.

       ``(a) Strategic Plan.--
       ``(1) In general.--Not later than 5 years after the date of 
     enactment of this section, and every 5 years thereafter, the 
     Commission (including the participation of members of both 
     the United States and Mexican sections) shall prepare a 
     binational strategic plan to guide the operations of the 
     Commission and submit such plan to the Secretary and Congress 
     (and the Mexican legislature).
       ``(2) Requirements.--The binational strategic plan under 
     paragraph (1) shall include--
       ``(A) health-related priority areas determined most 
     important by the full membership of the Commission;
       ``(B) recommendations for goals, objectives, strategies and 
     actions designed to address such priority areas; and
       ``(C) a proposed evaluation framework with output and 
     outcome indicators appropriate to gauge progress toward 
     meeting the objectives and priorities of the Commission.
       ``(b) Work Plan.--Not later than January 1, 2012 and every 
     other January 1 thereafter, the Commission shall develop and 
     approve an

[[Page S4032]]

     operational work plan and budget based on the strategic plan 
     under subsection (a). At the end of each such work plan 
     cycle, the Government Accountability Office shall conduct an 
     evaluation of the activities conducted by the Commission 
     based on output and outcome indicators included in the 
     strategic plan. The evaluation shall include a request for 
     written evaluations from the commissioners about barriers and 
     facilitators to executing successfully the Commission work 
     plan.
       ``(c) Biannual Reporting.--The Commission shall issue a 
     biannual report to the Secretary which provides independent 
     policy recommendations related to border health issues. Not 
     later than 3 months following receipt of each such biannual 
     report, the Secretary shall provide the report and any 
     studies or other material produced independently by the 
     Commission to Congress.
       ``(d) Audits.--The Secretary shall annually prepare an 
     audited financial report to account for all appropriated 
     assets expended by the Commission to address both the 
     strategic and operational work plans for the year involved.
       ``(e) By-laws.--Not less than 6 months after the date of 
     enactment of this section, the Commission shall develop and 
     approve bylaws to provide fully for compliance with the 
     requirements of this section.
       ``(f) Transmittal to Congress.--The Commission shall submit 
     copies of the work plan and by-laws to Congress. The 
     Government Accountability Office shall submit a copy of the 
     evaluation to Congress.

     ``SEC. 10. BINATIONAL HEALTH INFRASTRUCTURE AND HEALTH 
                   INSURANCE.

       ``(a) In General.--The Secretary shall enter into a 
     contract with the Institute of Medicine for the conduct of a 
     study concerning binational health infrastructure (including 
     trauma and emergency care) and health insurance efforts. In 
     conducting such study, the Institute shall solicit input from 
     border health experts and health insurance issuers.
       ``(b) Report.--Not later than 1 year after the date on 
     which the Secretary enters into the contract under subsection 
     (a), the Institute of Medicine shall submit to the Secretary 
     and the appropriate committees of Congress a report 
     concerning the study conducted under such contract. Such 
     report shall include the recommendations of the Institute on 
     ways to establish, expand, or improve binational health 
     infrastructure and health insurance efforts.

     ``SEC. 11. COORDINATION.

       ``(a) In General.--To the extent practicable and 
     appropriate, plans, systems and activities to be funded (or 
     supported) under this Act for all hazard preparedness, and 
     general border health, should be coordinated with Federal, 
     State, and local authorities in Mexico and the United States.
       ``(b) Coordination of Health Services and Surveillance.--
     The Secretary may coordinate with the Secretary of Homeland 
     Security in establishing a health alert system that--
       ``(1) alerts clinicians and public health officials of 
     emerging disease clusters and syndromes along the border 
     area; and
       ``(2) is alerted to signs of health threats, disasters of 
     mass scale, or bioterrorism along the border area.

     ``SEC. 12. AUTHORIZATION OF APPROPRIATIONS.

       ``There is authorized to be appropriated to carry out this 
     Act $31,000,000 for fiscal year 2012 and each succeeding year 
     subject to the availability of appropriations for such 
     purpose. Of the amount appropriated for each fiscal year, at 
     least $1,000,000 shall be made available to fund 
     operationally-feasible functions and activities with respect 
     to Mexico. The remaining funds shall be allocated for the 
     administration of United States activities under this Act, 
     border health activities under cooperative agreements with 
     the border health offices of the States of California, 
     Arizona, New Mexico, and Texas, the border health and EWIDS 
     grant programs, and the Institute of Medicine and Government 
     Accountability Office reports.''; and
       (5) in section 13 (as so redesignated)--
       (A) by redesignating paragraphs (3) and (4) as paragraphs 
     (4) and (5), respectively; and
       (B) by inserting after paragraph (2), the following:
       ``(3) Indians; indian tribe; tribal organization; urban 
     indian organization.--The terms `Indian', `Indian tribe', 
     `tribal organization', and `urban Indian organization' have 
     the meanings given such terms in section 4 of the Indian 
     Health Care Improvement Act (25 U.S.C. 1603).''.
                                 ______