[Congressional Record Volume 157, Number 142 (Thursday, September 22, 2011)]
[Senate]
[Pages S5906-S5908]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN (for himself, Mr. Leahy, and Mr. Inouye):
  S. 1609. A bill to require the Secretary of Health and Human Services 
to establish a demonstration program to award grants to, and enter into 
contracts with, medical-legal partnerships to assist patients and their 
families to navigate health-related programs and activities; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. HARKIN. Mr. President, today I join Senators Leahy and Inouye to 
introduce the Medical-Legal Partnership for Health Act. This 
legislation will reduce our Nation's health care costs and improve the 
health of vulnerable patients by building upon the great work that 
medical-legal partnerships are doing every day, all across the United 
States.
  Medical-legal partnerships bring legal aid services into medical 
settings, such as hospitals and community health centers, to help 
patients overcome problems that create and perpetuate poor health. In 
today's difficult economy, many Americans are struggling to meet the 
basic health needs of themselves and their children. This may mean 
struggling to pay the high costs of medical care or prescription drugs, 
or putting off an annual check-up until next year.
  But some health care needs are non-medical in nature, like making 
sure your home is properly heated in the winter; that it is not 
infested by insects or rodents; and that it is free of domestic 
violence. These needs may require more than just medical care; they may 
require legal assistance.
  Unfortunately, most health care providers are not equipped to deal 
with the non-medical issues that lead some patients to seek medical 
care repeatedly or on an ongoing basis. Despite the perception that 
legal issues frequently affect their patients, a survey of physicians 
at Boston Medical Center revealed that fewer than 20 percent of doctors 
knew how to refer patients to legal resources. As a result, many 
patients never address the root cause of their health problems, leading 
to costly visits to the emergency room and lengthy hospital stays.
  Medical-legal partnerships connect patients with the legal assistance 
they need to address these root causes. Rather than just applying a 
temporary fix to a health issue, they help patients get healthy and 
stay healthy.
  In the process, medical-legal partnerships generate substantial cost 
savings for families and the entire health care system. One study found 
a 50 percent reduction in emergency room visits following the 
intervention of medical-legal partnerships, saving families hundreds of 
dollars per visit. Another study showed that medical-legal partnerships 
reduced the cost per pediatric asthma patient from $735 to $181 through 
fewer emergency room visits, while also resulting in decreased 
frequency and duration of asthma attacks following an intervention. 
These cost savings not only help keep families out of potentially 
crippling debt, but they also help reduce emergency room overcrowding 
and decrease health care expenditures on preventable health conditions.
  Unfortunately, many patients are unlikely to seek legal services on 
their own. Eighty-five percent of patients who sought legal assistance 
from one medical-legal partnership in California had not used legal 
resources before and more than 78 percent were not previously aware of 
legal services at all. By embedding legal services in health care 
settings, medical-legal partnerships raise awareness of legal services 
so that patients are more likely to address problems before they turn 
into crises.
  In an article about medical-legal partnerships last year, the Los 
Angeles Times told the story of Maria Perez. Maria had a fever of 103, 
her body ached and she had trouble breathing. After being told in the 
emergency room that she had pneumonia, she went to a clinic in South 
Los Angeles for a follow-up appointment. The doctor asked Perez about 
her housing situation. Her apartment had cockroaches and mice, and rain 
fell through a broken window and filled the walls with mold. The doctor 
wrote prescriptions to treat the pneumonia and an asthma flare-up and 
then sent her down the hall to talk to a lawyer.
  After the attorney contacted both the landlord and the Los Angeles 
Housing Department, Maria's living conditions improved, and so did her 
health. She told the Times: ``The medicine wasn't what cured me. It was 
[my lawyer] and what he did.''
  Medical-legal partnerships also offer a critical lifeline to victims 
of domestic violence. In my home state of Iowa, a young woman named 
Brenda sought help to escape an abusive marriage. Her husband was a 
gang member and threatened to kill her or have members of his gang kill 
her. One night, while attempting to flee an attack, Brenda's husband 
pulled her back into the house and beat and choked her until she lost 
consciousness. When Brenda sought medical care the next day, her care 
providers referred her to Iowa Legal Aid's Health and Law Project for 
help.

[[Page S5907]]

Iowa Legal Aid helped Brenda obtain a protective order, which included 
custody of the couple's daughter. Iowa Legal Aid is currently helping 
Brenda with a divorce so that she and her daughter will have protection 
and long-term autonomy from her abuser; thereby reducing the need for 
ongoing health care.
  The success of these programs is catching on. The first medical-legal 
partnership was created nearly two decades ago at Boston Medical 
Center. By 2009, there were 60 such partnerships across the country. 
Today there are 90 medical-legal partnerships working with more than 
240 health services providers.
  Medical-legal partnerships have attracted the attention of corporate 
America, too. In July, Walmart became the first corporation to take a 
lead role in a medical-legal partnership, and I commend them for 
recognizing the valuable role these programs can play in our 
communities.
  After graduating from law school, I served as a Legal Services 
attorney in Iowa. I learned first-hand how crucial this assistance is 
to struggling families and individuals who have no place else to turn 
when they are taken advantage of or abused. I know the invaluable legal 
help provided to battered women trying to leave abusive relationships 
while fearing for their safety and the safety of their children. I know 
that, without access to the legal system, the poor are often powerless 
against the injustices they suffer.
  I am particularly proud of the success of a medical-legal partnership 
in my home state of Iowa. The Iowa Legal Aid Health and Law Project 
harnesses the talents of Iowa physicians and attorneys to improve the 
lives of vulnerable Iowans. By partnering with 17 hospitals and health 
centers across my state, the Iowa Legal Aid Health and Law Project is 
able to extend services from Sioux City to Dubuque, and from Council 
Bluffs to Fort Dodge. In 2009, the program served 880 Iowans, and 94 
percent of their cases had a positive outcome. The Iowa Legal Aid 
Health and Law Project does a remarkable job. They are just one example 
of the great work going on across the country.
  You may be surprised to learn that when it comes to medical-legal 
partnerships, a little money can go a long way. Iowa's program was 
started with a federal investment of less than $300,000. The program 
prevents hospital admissions and emergency room visits that cost 
hospitals and patients many thousands of dollars in health care costs 
and insurance premiums. A modest investment in these community programs 
can help people achieve healthier, safer lives and prevent future 
hospitalizations and health care costs. That sounds like common sense 
to me. And that's why, today, I am proud to introduce the Medical-Legal 
Partnership for Health Act: to give health care providers and lawyers 
across the country the opportunity to start such programs.
  The Act creates a federal demonstration program to help create, 
strengthen, and evaluate medical-legal partnerships. Overall, this 
legislation will support 60 partnership sites in community health 
centers, the Veterans Administration, hospitals, and other health care 
settings.
  I was proud to have the support of former Senator Kit Bond of 
Missouri when I introduced this legislation during the previous 
Congress. I know there are many Americans who think that the two 
political parties in Washington can't agree on anything these days, but 
this is an issue that has attracted bipartisan support in the past and 
it is my strong hope that it will do so again. In the spirit of 
compromise and bipartisanship, I have taken contentious issues off the 
table: the bill excludes federal money from being used toward class 
action law suits, medical malpractice cases, representation of 
undocumented individuals, and abortion or abortion-counseling services.
  Medical-legal partnerships also have broad support from prominent 
organizations representing physicians and attorneys. They've received 
the endorsement of the American Medical Association, the American Bar 
Association, the American Academy of Pediatrics, the American Hospital 
Association, and the Accreditation Council of Graduate Medical 
Education, to name just a few.
  Through this community-based, common-sense investment, we will be 
able to help some of our most vulnerable citizens avoid illness and 
hospitalization, while reducing costs across the entire health care 
system.
  I urge my colleagues to join me in supporting this investment in 
medical-legal partnerships.
  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. 1609

       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 ``Medical-Legal Partnership 
     for Health Act''.

     SEC. 2. FINDINGS; PURPOSE.

       (a) Findings.--Congress finds the following:
       (1) Numerous studies and reports, including the annual 
     National Healthcare Disparities Report and Unequal Treatment, 
     the 2002 Institute of Medicine Report, document the 
     extensiveness to which vulnerable populations suffer from 
     health disparities across the country.
       (2) These studies have found that, on average, racial and 
     ethnic minorities and low-income populations are 
     disproportionately afflicted with chronic and acute 
     conditions such as asthma, cancer, diabetes, and hypertension 
     and suffer worse health outcomes, worse health status, and 
     higher mortality rates.
       (3) Several recent studies also show that health and 
     healthcare quality are a function of not only access to 
     healthcare, but also the social determinants of health, 
     including the environment, the physical structure of 
     communities, socio-economic status, nutrition, educational 
     attainment, employment, race, ethnicity, geography, and 
     language preference, that directly and indirectly affect the 
     health, healthcare, and wellness of individuals and 
     communities.
       (4) Formally integrating medical and legal professionals in 
     the health setting can more effectively address the health 
     needs of vulnerable populations and ultimately reduce health 
     disparities.
       (5) All over the United States, healthcare providers who 
     take care of low-income individuals and families are 
     partnering with legal professionals to assist them in 
     providing better quality of healthcare.
       (6) Medical-legal partnerships integrate lawyers in a 
     health setting to help patients navigate the complex 
     government, legal, and service systems in addressing social 
     determinants of health, such as income supports for food 
     insecure families and mold removal from the home of 
     asthmatics.
       (b) Purposes.--The purposes of this Act are to--
       (1) support and advance opportunity for medical-legal 
     partnerships to be more fully integrated in healthcare 
     settings nationwide;
       (2) to improve the quality of care for vulnerable 
     populations by reducing health disparities among health 
     disparities populations and addressing the social 
     determinants of health; and
       (3) identify and develop cost-effective strategies that 
     will improve patient outcomes and realize savings for 
     healthcare systems.

     SEC. 3. MEDICAL-LEGAL PARTNERSHIPS.

       (a) In General.--The Secretary of Health and Human Services 
     shall establish a nationwide demonstration project consisting 
     of--
       (1) awarding grants to, and entering into contracts with, 
     medical-legal partnerships to assist patients and their 
     families to navigate programs and activities; and
       (2) evaluating the effectiveness of such partnerships.
       (b) Technical Assistance.--The Secretary may, directly or 
     through grants or contracts, provide technical assistance to 
     grantees under subsection (a)(1) to support the establishment 
     and sustainability of medical-legal partnerships. Not to 
     exceed 5 percent of the amount appropriated to carry out this 
     section in a fiscal year may be used for purposes of this 
     subsection.
       (c) Funding.--
       (1) Use of funds.--Amounts received as a grant or pursuant 
     to a contract under this section shall be used to assist 
     patients and their families to navigate health-related 
     programs and activities for purposes of achieving one or more 
     of the following goals:
       (A) Enhancing access to healthcare services.
       (B) Improving health outcomes for low-income individuals, 
     as defined in subsection (g).
       (C) Reducing health disparities among health disparities 
     populations.
       (D) Enhancing wellness and prevention of chronic conditions 
     and other health problems.
       (E) Reducing cost of care to the healthcare system.
       (F) Addressing the social determinants of health.
       (G) Addressing situational contributing factors.
       (2) Authorization of appropriations.--There are authorized 
     to be appropriated to carry out this section such sums as may 
     be necessary, but not to exceed $10,000,000, for each of the 
     fiscal years 2012 through 2016.
       (3) Matching requirement.--For each fiscal year, the 
     Secretary may not award a

[[Page S5908]]

     grant or contract under this section to a entity unless the 
     entity agrees to make available non-Federal contributions 
     (which may include in-kind contributions) toward the costs of 
     a grant or contract awarded under this section in an amount 
     that is not less than $1 for each $10 of Federal funds 
     provided under the grant or contract.
       (4) Allocation.--Of the amounts appropriated pursuant to 
     paragraph (2) for a fiscal year, the Secretary may obligate 
     not more than 5 percent for the administrative expenses of 
     the Secretary in carrying out this section.
       (d) Eligible Entities.--To be eligible to receive a grant 
     or contract under this section, an entity shall--
       (1) be an organization experienced in bridging the medical 
     and legal professions on behalf of vulnerable populations 
     nationally; and
       (2) submit to the Secretary an application at such time, in 
     such manner, and containing such information as the Secretary 
     may require, including information demonstrating that the 
     applicant has experience in bridging the medical and legal 
     professions or a strategy or plan for cultivating and 
     building medical-legal partnerships.
       (e) Prohibitions.--No funds under this section may be 
     used--
       (1) for any medical malpractice action or proceeding;
       (2) to provide any support to an alien who is not--
       (A) a qualified alien (as defined in section 431 of the 
     Immigration and Nationality Act);
       (B) a nonimmigrant under the Immigration and Nationality 
     Act; or
       (C) an alien who is paroled into the United States under 
     section 212(d)(5) of such Act for less than one year;
       (3) to provide legal assistance with respect to any 
     proceeding or litigation which seeks to procure an abortion 
     or to compel any individual or institution to perform an 
     abortion, or assist in the performance of an abortion; or
       (4) to initiate or participate in a class action lawsuit.
       (f) Reports.--
       (1) Final report by secretary.--Not later than 6 months 
     after the date of the completion of the demonstration program 
     under this section, the Secretary shall conduct a study of 
     the results of the program and submit to the Congress a 
     report on such results that includes the following:
       (A) An evaluation of the program outcomes, including--
       (i) a description of the extent to which medical-legal 
     partnerships funded through this section achieved the goals 
     described in subsection (b);
       (ii) quantitative and qualitative analysis of baseline and 
     benchmark measures; and
       (iii) aggregate information about the individuals served 
     and program activities.
       (B) Recommendations on whether the programs funded under 
     this section could be used to improve patient outcomes in 
     other public health areas.
       (2) Interim reports by secretary.--The Secretary may 
     provide interim reports to the Congress on the demonstration 
     program under this section at such intervals as the Secretary 
     determines to be appropriate.
       (3) Reports by grantees.--The Secretary may require each 
     recipient of a grant under this section to submit interim and 
     final reports on the programs carried out by such recipient 
     with such grant.
       (g) Definitions.--In this section:
       (1) The term ``health disparities populations'' has the 
     meaning given such term in section 485E(d) of the Public 
     Health Service Act.
       (2) The term ``low-income individuals'' refers to the 
     population of individuals and families who earn up to 200 
     percent of the Federal poverty level.
       (3) The term ``medical-legal partnership'' means an 
     entity--
       (A) that is a partnership between--
       (i) a community health center, public hospital, children's 
     hospital, or other provider of healthcare services to a 
     significant number of low-income beneficiaries; and
       (ii) one or more legal professionals; and
       (B) whose primary mission is to assist patients and their 
     families navigate health-related programs, activities, and 
     services through the provision of relevant civil legal 
     assistance on-site in the healthcare setting involved, in 
     conjunction with regular training for healthcare staff and 
     providers regarding the connections between legal 
     interventions, social determinants, and health of low-income 
     individuals.
       (4) The term ``Secretary'' means the Secretary of Health 
     and Human Services.
                                 ______