[Congressional Record Volume 158, Number 61 (Thursday, April 26, 2012)]
[Senate]
[Pages S2830-S2831]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA (for himself and Mr. Inouye):
  S. 2474. A bill to improve the health of minority individuals, and 
for other purposes; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. AKAKA. Mr. President, I am proud to once again introduce 
legislation addressing the health care disparities in racial and ethnic 
minority communities, the Health Equity and Accountability Act of 2012. 
I would like to thank my cosponsor, Senator Inouye, along with a number 
of our colleagues in the House of Representatives, for all their 
support and contributions to this important legislation, and for 
raising awareness of this widespread problem.
  While there are glaring health disparities based on racial and ethnic 
identity alone, they are further exacerbated by factors such as 
socioeconomics, geography, and sexual orientation and identity. 
Although the exact causes for the current state of health disparities 
in our country may be debatable, it is undeniable that ethnic, racial, 
geographic, and other minorities across the United States are plagued 
by disproportionately high rates of disease and experience a diminished 
quality of health care. Statistics paint a disturbing picture of 
minority health, consistently showing higher rates of illness and death 
for members of minority and marginalized groups.
  For instance, HIV/AIDS has had a devastating impact on minorities in 
the U.S. In 2009, ethnic minorities accounted for over 70 percent of 
newly diagnosed cases of HIV. That year, nine out of ten babies born 
with HIV belonged to minority groups. The Office of Minority Health 
reported that, compared to Caucasians, Hispanic individuals are 3 times 
more likely to be diagnosed with AIDS; Native Americans are 1.4 times 
more likely; and Native Hawaiians and Pacific Islanders are 2.4 times 
more likely to be diagnosed with AIDS.
  Cancer is the number one killer of Asian American Pacific Islanders 
and the second leading cause of death for most other racial and ethnic 
minorities in the United States. Cancer also affects African Americans 
at particularly alarming rates and has a disproportionate prevalence in 
the population of Hispanic women, who are 1.6 times more likely to be 
diagnosed with cervical cancer than non-Hispanic women. In addition, 
Native Americans are twice as likely as non-Hispanic whites to develop 
stomach or liver cancer.
  The infant mortality rates for African Americans are one-and-a-half 
to 3 times higher than the rates for infants born to women of other 
races and ethnicities. Hispanic individuals are three times more likely 
to be diagnosed with AIDS than Caucasian individuals. As our nation 
continues to struggle with obesity, trends show increasingly high rates 
of obesity in minority groups, with young Mexican-American men under 
the age of 20 experiencing obesity at a rate of 25 percent of the 
population, while white men of the same age have a rate of just 15 
percent.
  Circulatory diseases are a growing problem in the Pacific region. 
These diseases not only lower patients' quality of life, but they are 
also very costly. Data from the Agency for Healthcare Research and 
Quality shows that eliminating preventable hospitalizations that are 
associated with lower incomes would save $6.7 billion in health care 
costs each year. However, the numbers alone do not capture the full 
extent of health disparities since there are additional issues with 
data collection and multiple factors often contribute to deaths.
  In 2005, I introduced a similar piece of legislation, S. 1580, 
because many of the indigenous and ethnic minority communities across 
the United States and its territories lacked essential access to health 
care and suffered from certain key diseases at disproportionately high 
rates. The bill I am introducing today addresses many of the same 
issues and also takes into account the strong advances made by the 
Patient Protection and Affordable Care Act. In 2008, the landmark 
health care reform legislation laid the foundation to start reducing 
some of those health disparities. Senator Inouye and I are introducing 
this legislation today to build on the work of the Affordable Care Act, 
and to advance the national discussion on how we can better achieve 
health equity.
  While the Affordable Care Act expanded care in diverse communities 
across the country, such as Asian Americans, Native Hawaiians, and 
Pacific Islanders, it is important that we take further steps to ensure 
that all Americans, regardless of racial, ethnic, socioeconomic, 
physical, and geographic circumstances, have affordable access to high-
quality health care. Because the causes of health care disparities are 
wide-ranging, the scope of this bill must be equally encompassing. 
Therefore, my bill focuses on two main strategies: first, encouraging 
research on diseases and conditions that disproportionately impact 
minority individuals; and second, improving access to effective care 
for minority communities.

  We must make it easier to identify existing disparities through 
comprehensive data collection, ensure workforce diversity, target 
diseases that disproportionately affect minorities, and make culturally 
and linguistically appropriate health care services available to all.
  We need more comprehensive data on the most significant health care 
problems experienced by minority individuals and the factors that play 
a role in how these diseases affect different communities. The more we 
know about the way populations are affected by disease, the better 
prepared health care professionals will be to create strategies to both 
treat and prevent each high-impact disease in specific communities. My 
bill will help to accomplish this by strengthening both data collection 
and the reporting of health data.
  To complement our efforts in data collection, we must also target 
disease awareness education and effective preventative services towards 
communities with large populations of ethnic and racial minorities at 
high risk for certain diseases. Community-based programs as well as 
comprehensive disease-specific programs already in place are helping to 
ensure that the health needs of minority communities are being met. My 
legislation would revitalize efforts in community health and preventive 
services, which are the most cost-effective ways of providing care.
  This bill builds upon the Affordable Care Act's historic investment 
in prevention and calls for resources to target communities striving to 
overcome negative social factors. This bill encourages these 
investments and focuses on preventing fatal diseases, which could save 
thousands of lives each year and lower health care costs.
  Although prevention plays a critical role in finding ways to close 
disparities, we also have to invest in research to develop better 
treatment plans for diseases that disproportionately affect indigenous, 
racial, and ethnic minorities, and to ensure that currently underserved 
communities have access to care. My bill proposes focused approaches to 
combat a variety of diseases and conditions, including heart disease, 
cancer, diabetes, and HIV/

[[Page S2831]]

AIDS, which have a disparate impact on racial and ethnic minorities. 
This legislation also helps to provide affordable and culturally 
appropriate access to care in several ways.
  My bill, the Health Equity and Accountability Act of 2012, includes 
proposals to remove significant barriers to health care coverage and 
access and maximize the positive impact of federal investments in 
health care in minority communities. For example, it would re-establish 
Medicaid eligibility for citizens of the Compact of Free Association 
nations living in the United States. This would greatly ease the 
financial burden on States like Hawaii and Arkansas, which have been 
forced to absorb the costs of providing health and social services, 
education, and public safety for Compact migrants in accordance with 
unfunded Federal mandates since 1996.
  My bill would also make health care more affordable and improve 
access by providing a 100 percent Federal Medicaid Assistance 
Percentage, FMAP, for Native Hawaiians who receive health care from 
Federally Qualified Health Centers or the Native Hawaiian Health Care 
System. The increased FMAP will ensure that Native Hawaiians have 
access to the essential health services provided by community health 
centers and the Native Hawaiian Health Care System. These provisions 
would provide treatment for Native Hawaiians that is similar to that 
already provided to Native Alaskans through the Indian Health Service 
or tribal organizations.
  This legislation will make it easier for minorities with cultural and 
language barriers to improve their health outcomes by enhancing 
language access services, making health literacy a priority in patient 
care, and making sure there is culturally competent care in the health 
care delivery system. My bill will support professionals who are well-
equipped to provide quality health care that is culturally and 
linguistically appropriate. As a part of this effort, this legislation 
creates training opportunities for willing and competent minority 
candidates to enter the health care workforce.
  The Health Equity and Accountability Act also seeks to ensure that 
communities of color benefit from the rapid advances in health 
information technology, or health IT. It also encourages new 
investments in health IT infrastructure, which will serve as the 
foundation for improving the quality, effectiveness, and efficiency for 
all Americans in our future health care system. Improvements in health 
IT and health IT infrastructure will also make it possible for rural 
communities to access mobile health services and other treatment and 
diagnostics that were previously unavailable.
  Another vital service that my bill seeks to make more accessible is 
mental health care. The Affordable Care Act fundamentally improved 
services for individuals with mental health and addiction disorders. 
Despite the improvements, mental health treatment remains 
underutilized, especially by minorities, due to social stigma and 
cultural resistance. To develop access and encourage treatment, my bill 
incorporates culturally competent strategies to address mental and 
behavioral health problems affecting minority communities and 
authorizes investment in researching and treating these serious 
conditions.
  However, we cannot simply put these provisions in place and believe 
that they will eliminate all health disparities. We must have 
accountability and regular evaluation of these programs to ensure they 
are being carried out as they were intended, and that they are meeting 
their goals. To that end, my bill strengthens oversight by the 
Department of Health and Human Services, requiring the Department to 
make regular scheduled reports to Congress on the impact of these 
initiatives to ensure that they are continuing to reduce health 
disparities.
  April is National Minority Health Month, and as we work diligently to 
transform health care in America, it is essential that we strive to 
eliminate the health disparities that affect our minority groups. This 
bill would significantly improve the quality of life for indigenous 
people, ethnic and racial minorities, as well as other marginalized 
groups. I encourage my colleagues to support this legislation, and 
begin an open dialogue on how we can close the gap in health care 
across the country.

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