[Congressional Record Volume 159, Number 62 (Monday, May 6, 2013)]
[House]
[Pages H2416-H2424]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CBC HOUR: ELIMINATING HEALTH DISPARITIES
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 3, 2013, the gentleman from Nevada (Mr. Horsford) is recognized
for 60 minutes as the designee of the minority leader.
Mr. HORSFORD. Mr. Speaker, thank you.
We are pleased to come to this body at this time for this hour of
power with the Congressional Black Caucus. This evening, we'd like to
focus on eliminating health disparities in America.
Health is a cornerstone of equal opportunity, which is why access to
quality, affordable care is so important. Sickness not only decreases
individual and social productivity, but without access to health
resources, many get sick and never truly recover. Over this next hour,
members of the Congressional Black Caucus will discuss our priorities,
working together with the President, our colleagues on the other side
and throughout this body, and in the other Chamber, to address the
needs of health care for all Americans, and specifically to eliminate
the health disparities in the African-American communities.
I'd like to recognize the chair of the Congressional Black Caucus.
Under her leadership, the CBC is advancing a number of priorities
during this 113th Congress. I yield to the gentlelady from Ohio,
Chairwoman Fudge.
Ms. FUDGE. I thank the gentleman for yielding, and I want to thank my
colleagues, both Congressmen Horsford and Jeffries, again for leading
the Congressional Black Caucus Special Order hour. This hour is to
discuss health disparities. You both have done an incredible job
carrying the message of the CBC on the House floor each week, and I
thank you.
Mr. Speaker, the health disparities between African Americans and
other racial and ethnic populations are striking. When compared with
the country as a whole, African Americans are three times more likely
to die from diabetes. We account for about 44 percent of all new HIV
infections among adults and adolescents, despite representing only
about 13 percent of the U.S. population. African-American men can
expect to live approximately 6 years less than White men. African-
American women are twice as likely to give birth to low-weight infants,
and our children are almost five times more likely to be hospitalized
for asthma.
Though health disparities manifest in life-threatening ways, such as
lower life expectancy and higher disease rates, the root cause is
poverty. Where you live and how you live have a direct effect on how
long and how well you live. Until we address the persistent poverty
that plagues our communities, the debilitating cost of health
disparities will continue to rise.
According to the Joint Center for Political and Economic Studies,
health disparities collectively cost minorities more than $1.24
trillion from 2003 to 2006. We must create and maintain a path toward
greater health equity in America. We can't afford the status quo.
Thankfully, a path to equity has begun to take shape, a path that
reduces the rates of illness and premature death and increases access
to quality health care. The solution was and is the Affordable Care
Act--or, as it is known to many, ObamaCare. We are proud to call it
ObamaCare because it proves that the President and many in this
Congress really do care about the health of Americans.
ObamaCare has already begun to lower the cost of health care by
providing financial relief for consumers, increasing insurance options,
investing in preventative and primary care, and placing a focus on
minority health. The ACA helps decrease health disparities by
collecting data, strengthening cultural training, and
increasing diversity in the health care field. These investments are
critically important and will strengthen America's financial future.
Some on the other side of the aisle believe the status quo is
sufficient, that health disparities are not real. Some don't believe
that the impact of disparities on families is devastating. That's why a
number of Republicans are again calling for the repeal of the ACA. How
many times do we have to play this game?
The CBC will continue to stand up, speak out and defend the
Affordable Care Act against all of those who oppose it for political or
ideological reasons. Attaining health equity is to the benefit of all
Americans, and is not only consistent with the American promise of
opportunity, but it is critical to the future of Black America.
Mr. HORSFORD. At this time I would like to recognize the vice
chairman of the Congressional Black Caucus, a leader on a number of key
issues that the Congressional Black Caucus is facing this 113th
Congress, the gentleman from North Carolina (Mr. Butterfield).
Mr. BUTTERFIELD. Let me thank you, Mr. Horsford, for yielding time
this evening, and thank you for your leadership not only here in the
Congress but in the Congressional Black Caucus. You have come to this
Congress, and you've done so much in such a short period of time. Thank
you, Mr. Jeffries and Ms. Fudge as well, for your leadership.
But, Mr. Speaker, I want to start this conversation this evening by
talking about a 1985 report. President Ronald Reagan was President at
the time, and the U.S. Department of Health and
[[Page H2417]]
Human Services issued a statement. They called health disparities in
the United States of America ``an affront both to our ideals and to the
ongoing genius of American medicine.''
It's disgusting, Mr. Speaker, that in this year, 2013, health
disparities still exist in the richest and most powerful country in the
world. African Americans are disproportionately less healthy. Life-
threatening diseases like high blood pressure, diabetes, and heart
disease are ravaging our population.
Oftentimes African Americans that live in rural communities, like the
one that I represent in North Carolina, don't have insurance, and they
have difficulty finding a regular primary care doctor, and so they go
without an annual physical or regular checkups. Sometimes their only
interaction with a health care provider is when they call 911 because
their unchecked blood pressure resulted in a heart attack or stroke. By
then it's too late. If that same person suffering from a stroke would
have had access to care, their high blood pressure may have been
diagnosed early.
{time} 1940
They may have been put on medication meant to regulate their
condition, making a heart attack or stroke less likely.
Many African Americans do play an active role in their health care,
but the quality of the care they receive can be much worse than their
white counterparts, further widening the gulf of disparities.
A significant driver of these disparities is the lack of health
insurance, and that's what the gentlelady spoke about a moment ago.
African Americans make up 13 percent of the entire population, but
account for more than 50 percent of all people who are uninsured.
African Americans are also likely to have disproportionately lower
access to primary care and often receive poorer quality care and face
more barriers in seeking treatment for chronic-disease management.
The Affordable Care Act that we're all so proud of was designed to
put a premium on quality of care, increase access, and encourage and
reward good health care outcomes. I am a strong supporter of the
Affordable Care Act, and my constituents in North Carolina are as well.
Every person should have access to affordable quality health care,
regardless of who they are, where they come from, or how much money
they have in their bank accounts.
Before the Affordable Care Act was signed into law, 50 million people
lived without health insurance. An additional 38 million people had
insurance, but it was woefully inadequate and charged them exorbitant
coinsurance payments and huge copays and completely unmanageable out-
of-pocket expenses, essentially making them uninsured too. That means
nearly one-third of all Americans were without the very basic insurance
needed to see a health care professional and receive care at an
affordable price.
When President Barack Obama proposed, and Congressional Democrats
introduced, the Affordable Care Act, Republicans stirred up for a
battle. And they would scream in the town hall meetings all across the
country, and even right here on this House floor, about how the bill
would create death panels that would decide if a person was worthy of
receiving treatment for a particular disease. That was not correct.
They would insist that the bill would cut hundreds of millions of
dollars from Medicare. Not correct. In fact, the Affordable Care Act
specifically prohibits cuts to the guaranteed Medicare benefits.
They would bring out charts on this floor and graphs that showed how
the Affordable Care Act will be a ``job killer'' worse than we have
ever experienced before. That turned out to be a lie.
The cost of health care has risen each year, insurance coverage has
decreased each year, and the amount of uncompensated care has increased
every year.
Mr. Horsford, here's a statistic that really stands out with me: in
1970, the United States spent $75 billion on health care. That was 7.2
percent of GDP. In 2010, health care spending represented 17.9 percent
of GDP and, if not for the Affordable Care Act, was expected to reach
20 percent by the year 2020.
The U.S. spends more of its dollars for health care-related expenses
than any other country in the world, and the uncontrolled rise in the
cost of health care would have been completely unsustainable if not for
ObamaCare.
President Obama signed the Affordable Care Act into law and, with the
stroke of a pen, revolutionized health care in America. Insurance
companies can no longer deny coverage to people with preexisting
conditions or charge them more than anyone else. There is now no
lifetime dollar limit on what insurers will pay for claims.
Preventative visits to health care providers are now free, yes, free,
and even include some free vaccinations. Young adults can now stay on
their parents' policy until they're 26 years old. And all new group
health plans now have to cover all recommendations by the U.S.
Preventative Services Task Force.
Now, millions of people in our country, and in my congressional
district and, Mr. Horsford, in your congressional district, who were
living without the most basic health insurance can benefit from the
most advanced health care technology in the world.
My only disappointment, Mr. Speaker, is that some of our Republican
Governors and State legislatures across the country are refusing to
participate in the expansion of Medicaid. Shame on them.
Mr. Speaker, in closing, I am confident that because of the
Affordable Care Act the delta of health disparities in America will
begin to shrink. No matter the color of your skin or the amount of
money you have, each and every American deserves high-quality health
care so they can live long and prosperous lives.
Mr. Horsford, I thank you so very much for yielding time.
Mr. HORSFORD. Thank you, Mr. Vice Chairman, and thank you for your
leadership and commitment on these issues. And I know we will continue
to fight and advocate for the preservation of the Affordable Care Act
and, as you indicate, the proper implementation of that act with the
expansion of Medicaid and the other key provisions of the law which we
need our local and State partners to work with us in providing quality
health care for all Americans.
General Leave
Mr. HORSFORD. Mr. Speaker, I ask unanimous consent that all Members
have 5 legislative days to revise and extend their remarks on the
subject of this Special Order.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Nevada?
There was no objection.
Mr. HORSFORD. At this time I'd like to yield to the chair of the
Congressional Black Caucus' Health Brain Trust, the doctor in the
House, the person who knows more about health care than most, the
honorable gentlewoman from the Virgin Islands (Mrs. Christensen).
Mrs. CHRISTENSEN. Thank you, Mr. Horsford. Thank you and our other
colleague, Mr. Jeffries, for hosting these Special Orders every week.
It's been with great pride that we've watched our young new Members
come to the floor and present the case so forcefully and so effectively
to the American people and the disparities in all areas that African
Americans and other people of color and the poor are facing.
Before I start, Representative Barbara Lee of California could not be
with us this evening, but her work on HIV and AIDS, and other areas in
health care, but specifically in HIV and AIDS, both here in the United
States and across the globe, is worthy of recognition; and I know that
she'll be entering a statement for the Record on some of the issues
around HIV and AIDS.
I want to just go back a little bit and present a little bit of
historical context on just how long this battle to eliminate health
disparities has been going on. I'm going to go back--of course, it goes
back to slavery, but I want to go back to W.E.B. DuBois in 1899, when
he said, and I'm quoting:
There have been few other cases in the history of civilized
peoples where human suffering has been viewed with such
peculiar indifference.
And then 25 or so years later, and this was mentioned by Congressman
[[Page H2418]]
Butterfield, in 1985, the Heckler Report, where it was said, and I'm
quoting here:
There was a continuing disparity in the burden of dealt and
illness experienced by blacks and other minority Americans as
compared with our Nation's population as a whole.
And as he said:
The stubborn disparity remained. The stubborn disparity
remained an affront to both our ideals and the genius of
American medicine.
Surgeon General Heckler was very surprised by what that report found,
but when she asked her researchers, well, why is this, the only answer
that they could give her is, it's always been that way.
And so that stubborn indifference that W.E.B. DuBois mentioned in
1899 continued into as far as 25 years later.
Almost 20 years later, the IOM issued its unequal treatment report
which said:
In unassailable terms, the report found that even when
insurance and income are as the same as those of whites,
minorities often receive fewer tests, less sophisticated
treatment for a panoply of ailments, including heart disease,
cancer, diabetes and HIV/AIDS.
So even when you have insurance, even when your educational level,
even when your income is the same, you are still not getting the same
treatment. And so it's no wonder that African Americans and other
people of color have suffered from disparities for so long.
So in 2003, led then by Jesse Jackson, Jr., we insisted that there be
a report every year on health disparities, a national report. And the
very last one, so we're in our 11th year now, well, we're in our 10th
year now, and the very last report shows very little change.
{time} 1950
It showed that blacks received worse care--it talks about quality--
than whites for 41 percent of quality measures. Hispanics receive worse
care than non-Hispanic whites for 39 percent of measures. Asians and
American Indians and Alaskan Natives receive worse care than whites for
nearly 30 percent of quality measures. And in terms of access, blacks
had worse access to care for 32 percent of access measures, Asians for
17 percent, American Indians and Alaskan Natives for 62 percent, and
Hispanics 63 percent of the measures.
So as we look over the years from 1899 to 2011, which is what this
report is on, there has been very, very little change. Among the themes
that emerge from the report, health care quality and access are
suboptimal, especially for racial and ethnic minorities, and this is in
2011. I'm sure the report this year is not going to be any different.
Quality is improving, but disparities are not improving.
There are several areas where disparities are worsening over time
between minorities and whites. Those are maternal deaths in the black
population and breast cancer diagnosed at an advanced age for women in
the black population. Children zero to 40 pounds--their families are
not getting advice in the Asian population about seatbelts. Adults over
50 not receiving colonoscopy, sigmoidoscopy or anything in the American
Indian and Alaskan Native populations.
So when looking at these reports coming back the same way year after
year, the Tri-Caucus, the Black, Hispanic and Asian Caucus, when we
began to debate the Affordable Care Act and to write the Affordable
Care Act, we came together and said health equity had to be a major and
core goal of health care reform. We were able to insert into the bill
many of the provisions that we had worked on for many years to create
health equity and to begin to eliminate health disparities. So we call
on all people across the country to support us and make sure that all
of those attempts to repeal the Affordable Care Act, which would close
the door that we have been able to open for so many who have not had
access to quality health care for so long--that door would not be
closed again.
Mr. HORSFORD. Thank you again to the gentlelady from the Virgin
Islands and the chair of the Congressional Black Caucus' health brain
trust for laying out, again, the hard work that the Congressional Black
Caucus has been involved with for many years in getting to the point
with the Affordable Care Act now on the cusp of being fully implemented
in January of 2014. So when our colleagues on the other side spend time
bringing up legislation to repeal the Affordable Care Act now more than
30 times after this legislation has been approved by Congress, it has
been upheld by the courts, it has been signed by the President, and the
American public are desperate for quality health care--that is why we
are coming here today to say enough is enough. Thirty times to repeal
the Affordable Care Act--how many more times will we waste the
people's, House's and our time bringing these issues forward when we
need to be working together to implement the Affordable Care Act in the
way that it is intended?
At this time, I would like to yield to the second vice chair of the
Congressional Black Caucus. She is a strong leader for her
constituents, the gentlelady from New York (Ms. Clarke).
Ms. CLARKE. Thank you, very much, Congressman Horsford, and I thank
you for your leadership along with Congressman Jeffries in leading the
Special Order hour for the Congressional Black Caucus.
Mr. Speaker, I rise today to join my colleagues in the Congressional
Black Caucus to raise awareness about health disparities that continue
to affect racial and ethnic minorities in the United States of America.
Despite medical advances that save many lives in our country, there has
been very limited progress in ending the racial and ethnic disparities
in health. In a 1985 report, the United States Department of Health and
Human Services called health disparities in this country ``an affront
both to our ideals and to the ongoing genius of American medicine.''
Now, decades later, health disparities still exist between black and
white and rich and poor.
A primary reason for these disparities is, quite frankly, the lack of
health insurance that has been a problem for all these many years. For
instance, African Americans make up 13 percent of the entire population
but account for more than half of all people who are uninsured. Blacks
also have disproportionately lower access to primary care and face more
obstacles in seeking treatment.
Across our Nation, health disparities continue to persist and widen
in communities historically marginalized as a result of poverty and
other social, economic and environmental barriers. These communities
are experiencing a high burden of life-threatening diseases and poor
health outcomes.
Population-based approaches such as recent efforts to reduce
childhood obesity rates, while showing evidence of success, have been
primarily focused on white children in affluent communities. For
example, in a report released in 2012 by the CDC, New York showed an
overall decline of as much as 10 percent in obesity rates for
kindergartners. However, for poor black children, the decline was only
1.9 percent, and for Hispanic children it was 3.4 percent.
In my district in Brooklyn, New York, I represent a very large number
of immigrants. Close to 40 percent of the residents are first- and
second-generation Americans. Culturally significant and linguistically
tailored education is required to address health disparities. This
education is one of the building blocks upon which improvements in
early detection and screening in these communities have been built.
Health disparities are a serious matter. According to the National
Urban League's State of Urban Health report, in 2009, health
disparities cost the United States economy $82.2 billion. I firmly
believe in prevention and addressing health disparities, and that it
will go a long way in bringing these costs down. It is important that
we fully engage in a full implementation of the Affordable Care Act.
This will lead us to closing these disparities, this health disparity
gap.
I look forward to working with my colleagues in the Congressional
Black Caucus and, quite frankly, all Members of goodwill to find solid
solutions to addressing health disparities in communities of color
across this Nation.
Having said that, Mr. Speaker, I thank you for the time.
Mr. HORSFORD. Thank you to the gentlelady from New York, and I
appreciate, again, all of her hard work and her commitment on these
issues and her willingness to, again, reach across
[[Page H2419]]
the aisle as you said. We are here to work with anybody who wants to
work with us to find solutions to the health care crisis that exists in
America. But we need them to understand that voting to repeal the
Affordable Care Act is not that solution. There are many more things
that we can do together to provide access to health care than we can by
repealing this very important legislation.
At this time, I would like to recognize, Mr. Speaker, the gentleman
from Illinois (Mr. Davis).
Mr. DANNY K. DAVIS of Illinois. Mr. Speaker, I want to first of all
commend our colleagues for coming here every week raising issues and
promoting awareness. Tonight it is health care, health care
disparities.
I believe that the big problem with the eradication of the
disparities is the fact that we, as a nation, have not committed
ourselves to the concept that health care ought to be a right and not a
privilege. As the most technologically proficient nation on the face of
the Earth, as the wealthiest nation with a quality of life for large
numbers of people--that is commendable--we still have not reached the
point where we take the position that every person, no matter what
their status or circumstance, deserves the highest quality of health
care that our Nation can afford for them.
{time} 2000
So until we reach that point, we will continue to have studies and
reports and we will continue to look at disparities, and we'll keep
doing it and doing it and doing it and doing it again.
We will have legislation like the Affordable Care Act that is
designed to close some of the gaps. And it does, in fact, close some of
the gaps, and it's commendable that we have done that.
But I maintain that we have a health care system that really is a
sickness care system. We do a good job of treating illnesses and
sickness when people can get to the places where they get the
treatment.
I had a call yesterday from a person who suggested that they had gone
to the emergency room at the hospital and were given two Tylenol and
sat in a room for a good period of time. When they inquired of the
hospital why they had done that, they told them, Well, it's because of
the ObamaCare; that ObamaCare is causing this to happen to you.
Now, the person actually has been on Social Security disability for a
long time, before there was any ObamaCare and there was a way to pay
for their health care, and somebody took the opportunity to
misrepresent ObamaCare. I would hope that people would not, especially
people in the industry, people in the business, would not do that.
But I also urge individual citizens to take more responsibility for
our health. You know, there's still disparities in smoking, still
disparities in drinking too much alcohol, still disparities in not
having the appropriate diet or the exercise that is needed. So we've
got to tack on several fronts. We've never put enough resources into
the systems to make sure that they work properly and appropriately. We
need to put more money into health education, health promotion, health
awareness, so that individual citizens have a greater understanding of
what it is that they individually can do.
Of course, people who know me know that I promote community health
centers as the best way of providing ambulatory health care to large
numbers of low-income people more effectively than anything else we've
come up with, with the exception of Medicare and Medicaid, in a long
time. I still promote these institutions as being one of the best ways
in local communities of having health care delivery where people
themselves are involved. These centers provide jobs and work
opportunities and help keep the money in the neighborhood so that the
impact of poverty is not as great as it would be.
So, Mr. Horsford, again, I want to thank you; I want to thank Mr.
Jeffries; and I want to commend the caucus for raising the issues,
promoting awareness, and helping, hopefully, to develop a different
level of understanding. Health care ought to be a right and not a
privilege.
Mr. HORSFORD. I'd like to thank the gentleman from Illinois and,
again, just to highlight, as you indicated, the community health
centers as an important provision of support within the health care
delivery system.
Both rural and urban communities suffer from the disproportionate
distribution of health care resources and access to care. Community
health care centers play an important component in overcoming that
care, providing millions of health care services, particularly to
people of color, access to high-quality and affordable care in both
rural and urban areas.
I know in my own district, in Nevada's Fourth Congressional District,
we have 14 health centers throughout our region. From my rural parts to
the urban parts, these are very important areas. But unfortunately,
under the sequester, Mr. Speaker, these are still areas that are under
attack because cuts to these health care centers are still being
imposed because of the uncertainty of the sequester.
In my district, Nevada health centers, they're looking at over
$700,000 worth of reductions between now and September; elimination of
nursing positions and elimination of services for children and seniors
at a time when people are sick and they need it the most.
So I would hope that, again, we can work together with Members on the
other side to come up with solutions to replace the sequester and to
fully fund community health centers, who are providing such good care
to our citizens at this time.
I would like to yield now, Mr. Speaker, to the gentlelady from Texas,
Congresswoman Sheila Jackson Lee.
Ms. JACKSON LEE. I thank the conveners of this Special Order and
express my appreciation to Mr. Horsford and to Mr. Jeffries for
continuing to educate our colleagues on extremely important issues. And
I'm delighted to join the Congressional Black Caucus as it proceeds
continuously to ensure that we advocate for those who cannot speak for
themselves.
I want to take up an issue that has struck home and is being
confronted by many States, some of which are in the South and some are
in other places throughout the Nation. I was very pleased to stand with
my fellow Democrats and support the Affordable Care Act. I could go
through the journey of 2009 and 2010, when many of us spread out across
the country and confronted misinformation through town hall meetings,
controversy, and conflictedness.
I think that what should be continuously emphasized as the
President's leadership on one single point: that although health care
was not listed, per se, in the Constitution, it should be a
constitutional right. If you read the words or quote the words of the
Declaration of Independence, we hold these truths to be self-evident,
that we have certain unalienable rights of life, liberty, and the
pursuit of happiness, one might argue that education and health care
fall into those provisions of life, liberty, and the pursuit of
happiness.
It was in the context of that framework in the original words of the
Constitution that, as you open the book that has the provisions of the
Constitution, the opening phraseology indicates that we have come
together to create a more perfect Union. I think the Affordable Care
Act was intended to try and lift the boats of all people.
Interestingly enough, major hospitals across America were clamoring
for the passage of this legislation to really do what we're speaking
about, which is to cut into the health disparities, because our
hospitals across America were suffering from not being reimbursed on
uncompensated care for those people who came without insurance. Many of
them included African Americans, who suffered in larger numbers from
the difficulties with diabetes, for example.
Texas, which is now in the eye of the storm, is one of those States
that has rejected the expansion of Medicaid, which goes to the very
point of increasing opportunities for those who suffer disparities so
they can have access to health care. That is largely the problem in
Texas. Federal funding for the adult expansion far exceeds current
local expenses for unreimbursed health care costs, having 3 years
without any match whatsoever and then having the ability to have a very
small match later on.
It is estimated that Medicaid expansion would generate more than
231,000
[[Page H2420]]
jobs in 2016, a 1.8 percentage point reduction in the State's current
unemployment from 6.1 percent to 4.3 percent, and it would directly
address the disparities in diabetes, heart disease, and HIV/AIDS, in
partnership with our federally qualified health clinics, which many
States have seen expanded because of the Affordable Care Act. And now
in my home State, my city in particular, Central Care has now put more
community health clinics in areas where disparities were severe and
lives were being lost.
It benefits children as well. I'd like to cite some numbers here for
my colleagues to indicate what we would benefit from by the expansion
of Medicare.
{time} 2010
Unreimbursed health care costs for charity care in 2010, for an
estimated $4.4 billion in unreimbursed expenses. We would be covering
that.
We would also get off the number one list. Texas, number one, ranking
among States with the greatest share of uninsured residents at 23.8
percent in 2011, more than 6 million people, compared with the national
average of 15.7 percent.
And then, as I indicated, we would, again, eliminate the opportunity
for low-income adults to be able to secure care. When low-income adults
don't get care, the children don't get care.
So I am suggesting that the rejection by Governor Perry, along with
other Governors, to not accept expanded Medicaid has a direct impact on
the increase, not only of the uninsured, but the increase in the
numbers of those suffering from certain diseases who cannot get care
and, therefore, rather than have preventative care, which an expansion
of Medicaid would provide, allowing for doctor visits, then the only
time that we are able to secure health care for them is when they
arrive in the cities and the counties and the States' emergency rooms,
where we see a surge in emergency room costs, health care costs, and we
eliminate the good will and the good intentions of a very good bill
that answers the question, are we attempting to form a more perfect
union by establishing a framework of insurance for all Americans,
hardworking Americans, Americans of Asian descent and African descent
and Hispanic descent, who have different DNA and cultural indices that
would lead them to have certain diseases more than others.
Let me also take note of the fact that one of those particular
diseases that impacts the African American woman in a more devastating
manner than in others, and that is triple negative breast cancer that
impacts Hispanic women, African American women and Anglo women, but
more so in the African American community. That kind of diagnosis gives
in this current phrase of time a short and almost devastating
diagnosis, one that is difficult to recover from, one that sees an
increase in the loss of life.
So I would make the argument to Governor Perry and to Governors
across the Nation who have rejected the expanded Medicaid as a budget
issue, as a political issue, as a ``I'm going to stand up to the
President'' issue, you are wrong, you are absolutely wrong, because
this is not a political issue; this is a life and death question. And I
want to applaud Governors like those in Florida, who certainly,
obviously, may not welcome the applause. But I think it's important
when people stand on principle or what is good for others, that they
should be applauded.
So I applaud the Governor of Ohio and the Governor of Florida for
moving forward on Medicaid expansion. And I would say to my good
friend, who is leading this very important Special Order, that we need
to begin to work with the President to find ways to substitute the
rejection of the Medicaid expansion so that individuals that are in
these States who cannot speak for themselves, who in actuality have a
head of State Governor that is making a political decision, a simple
political decision, will not lose out on the benefits intended by the
Affordable Care Act, which is to give comfort and to give help and aid
to those who need health care.
I finish on this note. I want to thank Dr. Christensen, because when
we began to write this legislation with the Congressional Black Caucus
that, one, talked about the health care disparity, which was the
premise of the fact of expanding health care, it would be a shame if
after all this work and passage of this bill there would be innocent
persons in our respective States like Texas that could not benefit from
something that could save lives.
I thank the gentleman for yielding.
Why Texas Should Extend Medicaid Coverage to Low-Income Adults
local benefits
Local savings from the expansion would offset much if not
all of the state match in 2016 and 2017. According to reports
that cities, counties, hospital districts and local hospitals
submit to the state, unreimbursed local health care spending
in Texas that local property taxes largely support, totaled
$2.5 billion in 2011. In addition, Texas hospitals reported
at least $1.8 billion in conservatively estimated
unreimbursed health care costs for charity care in 2010, for
an estimated total of $4.4 billion in unreimbursed expenses
The math is simple--federal funding for the adult expansion
far exceeds current local expenses for unreimbursed health
care costs. Although the impact of the Medicaid expansion and
ACA subsidized insurance would not entirely offset total
local expenses, since not everyone currently receiving
charity care, such as undocumented immigrants, would be
eligible for these programs and since some services may not
be covered, much of it would.
If necessary, the state could use some portion of these
savings to fund the required match through an
intergovernmental transfer arrangement. Local governments and
hospitals would still realize a net gain over current costs
from the federal funds the match would generate.
It is estimated that the Medicaid expansion would generate
more than 231,000 jobs in 2016, equivalent to a 1.8
percentage point reduction in the state's current
unemployment rate--from 6.1 percent to 4.3 percent.
state benefits
In numerous programs, the state pays 100 percent for adult
health care that Medicaid would cover under an expansion. For
example, the Texas Department of Criminal Justice requested
$186.5 million in state appropriations for hospital inpatient
and clinical care for its inmates for 2014.
The federal federal government contributes nothing toward
this purpose now, but with a Medicaid expansion, the state
would spend nothing on in-patient hospital care for eligible
inmates from 2014 through 2016, and a maximum of just 10
percent of these costs by 2020. Similarly, the expansion
would cover eligible adults in state mental institutions and
juvenile facilities that need non-psychiatric hospital in-
patient care.
The state also spends unmatched general revenue for
community primary care services, mental and behavioral health
services and, soon, women's health care delivered to low-
income individuals who are not eligible for Medicaid. Other
programs include the breast and cervical cancer program, the
kidney health care program and the HIV Medication assistance
and STD program. Furthermore, the state supplements funding
for the County Indigent Health Care (CIHC) program, much of
which would be unnecessary under a Medicaid expansion. The
state also pays the regular state match for medically needy
adults that currently qualify for Medicaid. Under an
expansion, the state would be able to use the high federal
match rate for newly eligible individuals not covered by
Medicare.
The Comptroller's office estimates that larger caseloads
from a Medicaid expansion would net increased revenues from
the insurance premium tax due to the large number of persons
who will buy health insurance under the exchange, as well as
those covered in the expansion. The Comptroller estimates the
increased insurance premium tax revenue due to ACA
implementation and the Medicaid expansion at $1.3 billion
from 2015 through 2019, or an average of $250 million a year.
In addition to these savings and new revenue that could
offset the required state match, the expansion would generate
an additional $1.8 billion in new tax revenue from 2014
through 2017, assuming moderate enrollment--enough to offset
nearly half of the required state match from 2014 through
2017. These jobs, many of them in health care, would provide
substantial benefits and increased economic security to
families and local communities. As employees spend their
wages on taxable items, state and local governments benefit
from increased tax collections, and the increased economic
activity in turn creates other jobs.
benefits to children
According to the Census Bureau, in 2011 Texas had about
900,000 or 16.7 percent of the nation's 5 million uninsured
children, and nearly 600,000 of the nation's 3.5 million
uninsured children with family incomes below 200 percent FPL,
again a 16.7 percent share. About 13.2 percent of all Texas
children are uninsured, compared to a national average of 7.5
percent.
Bringing Texas up to the national average would require the
state to insure an additional 393,000 children, less than the
550,000 expected to enroll in Medicaid under a Moderate
scenario. After 2014, the national average will increase
significantly since most states will expand Medicaid, which
means that, without the expansion, the disparity between
Texas and other states will grow.
[[Page H2421]]
Studies conducted in the 1980s found that expanding
Medicaid to children reduced child mortality by 5.1 percent
and infant mortality by 8.5 percent. Assuming the lower 5.1
percent rate, the expansion would save the lives of 2,700
Texas children every year after full implementation.
benefits to adults
Our children also need healthy parents to provide for their
care. Many low-income individuals and families simply cannot
afford basic living expenses, health insurance and out-of-
pocket health care expenses, making a Medicaid expansion
imperative.
The Kaiser Family Foundation estimates that about 41
percent of adults covered under the expansion would be
parents. Many of them work, but lack health insurance.
According to the Census Bureau, 59.9 percent of uninsured
adults in Texas work, a higher labor force participation rate
than the total population's. According to Kaiser, about 1.2
million adults who would be covered under the expansion in
Texas are working, about 60 percent of them in agriculture or
service industries that tend toward smaller firms and are
less likely to offer insurance to employees.
Only 28.4 percent of the 320,334 Texas private firms with
fewer than 50 employees insured their employees in 2011,
versus 92.3 percent of the 132,109 larger private firms. And
besides working for low wages in firms that do not offer
health insurance, many low-income individuals find work only
on a part-time or seasonal basis, resulting in poverty-level
incomes.
The Medicaid expansion would cover a person employed in a
full-time, minimum-wage job paying $7.25 per hour, which
equates to $15,080 per year, just below the 138 percent FPL
cutoff. It also would cover a single parent earning $10 per
hour (annual wages of $20,800). These wages are generally
insufficient to cover basic living and working expenses as
well as health insurance.
The high cost of health insurance affects both employers
and workers, but high premiums as well as out-of-pocket
medical expenses make it impossible for most low-income
workers to afford health care. The 2012 average cost of
single coverage was $5,615, and family coverage was $15,745,
a 30 percent increase since 2007, according to a recent study
by the Kaiser Family Foundation and the Health Research and
Educational Trust. Employees paid an average of $951 for
single coverage and $4,316 for and $11,429 for family
coverage per employee, it is unsurprising that most small
employers find it difficult to provide insurance.
Although the ACA provides subsidized health insurance for
individuals above 100 percent of FPL, about 1.4 million
uninsured Texas adults aged 18 to 64 who are below 100
percent of FPL will not be eligible. Covering most of these
adults through Medicaid would mean a healthier workforce and
would reduce absenteeism, job loss and unemployment insurance
costs to employers. It also would increase income for
families with children, thus reducing stress and providing
more opportunities.
And, it would save lives. The Harvard School of Public
Health recently compared three states (New York, Arizona and
Maine) that expanded Medicaid to childless adults aged 20 to
64 between 2000 and 2005 with neighboring states that did not
(New Hampshire, Pennsylvania, Nevada and New Mexico). They
found not only a higher insured rate in the expansion states,
but a 6.1 percent drop in the death rate for adults under age
65, or about 2,840 deaths prevented each year for every
500,000 persons newly insured. This translates into one life
saved per year in the five-year follow-up period for every
176 newly insured. In Texas, that would amount to about 5,700
lives saved per year under the Moderate enrollment scenario
once fully implemented.
benefits to employers
Only 36 percent of U.S. workers in firms with fewer than 25
workers have insurance.36 In a Kaiser Family Foundation
survey, 48 percent of small employers indicated that the cost
of insurance was too high for them to offer it to employees.
On the other hand, when their uninsured employees become
sick, they are more likely to be absent from work longer,
creating a burden to their employer and fellow employees.
Frequent or prolonged absences for common untreated
conditions such as asthma, diabetes, heart disease, allergies
and flu can lead to terminations and the costs of recruiting,
hiring and training new employees. Expanding Medicaid to
adults aged 18 through 64 who are making marginal wages or
working in part-time or seasonal positions is an effective
way to assist small businesses and their employees alike.
Finally, we estimate that the Medicaid expansion would
generate nearly 71,500 jobs in Texas in 2014, rising to
231,100 jobs in 2016, the first year of full implementation.
Many of these jobs would be in health care, an industry that
pays well and provides good job security and benefits,
including health insurance, and wages would average $50,818
during the 2014-2017 period--the same as the statewide
average for all industries.
Texas already has the highest rate of uninsured for adults
aged 18 to 64 of any state--31 percent compared to a national
average of 21 percent in 2011.45 If Texas does not expand
Medicaid, and Wal-Mart and other companies implement their
intended policies, the number of uninsured in Texas will grow
as it shrinks in states that acted, leaving Texas still at
the bottom and digging a deeper hole.
findings in other states
Recent studies in other states have also found that states
can finance their share of the expansion using funds already
spent on state and locally funded health care for adults and
new revenues generated from the expansion. After further
study and considering revised trends, several states besides
Texas have also substantially reduced their estimates of the
state funds required for the expansion.
Some governors that previously expressed opposition to the
expansion have changed their minds. In particular, Arizona's
governor, Jan Brewer, initially in opposition, has recently
announced that she will support it as long as Arizona
includes an automatic trigger reducing Medicaid optional
coverage should the federal government reduce its match rate
in the future, a concern expressed by several state
governors.46 After reviewing a new study that identified
sufficient existing revenue sources, New Mexico's governor,
Susana Martinez, also announced her support for the
expansion.
California. A recent study by the University of California
at Berkeley and the University of California at Los Angeles
on the California expansion found that increased state tax
revenues and savings would largely offset additional
spending. It also found that savings in other areas of the
budget, including other state health programs, mental health
services and state prisons due to the expansion ``would
likely be more than enough to offset the $46 to $381 million
in annual state General Fund spending for the newly eligible
population through 2019.''
Florida. Florida has recently reduced its estimate of state
costs from $26 billion to $5.066 billion over 10 years from
2013-14 to 2022-23, including costs for newly eligible adults
($1.767 billion), children who are currently eligible but not
enrolled ($3.012 billion) and the cost of shifting, called
``crowd out,'' of currently insured individuals to Medicaid
($0.287 billion). The state now estimates that the expansion
would generate $37 billion in federal funds over the ten-year
period, of which about $30 billion is for newly eligible
adults.
Ohio. Estimates just published by Ohio State University
compare the state's match requirements with the net savings
the state would receive from moving adults from state-funded
programs to Medicaid over a nine-year period from 2014
through 2019, concluding that savings in these programs would
provide 41.2 percent of the state match necessary for the
expansion. The study estimated that the state would receive
net savings of about $1 billion on:
Better match rate for medically needy adults of $709
million.
Breast and Cervical Cancer Program costs of $48 million.
Inpatient prison health care costs of $273 million.
In addition, the study pointed out that there would also be
savings on non-Medicaid substance abuse treatment, family
planning, pregnant women and other state health care programs
for uninsured adults. The study identified other areas of
savings as well, including reduced criminal justice costs due
to better access to substance abuse treatment.
The study also found net increases in state revenue from
taxes of $2,898 million on: managed care plans ($1.823
billion), general revenue ($857 million) from increased
economic activity and increased drug rebates to the state
from pharmaceutical companies ($218 million). The study
estimates that the state will need about $2.5 billion for
state match, which would leave a net state fiscal gain of
$1.4 billion.
Wyoming. The Wyoming Department of Health issued a report
in November 2012 that also looked for offsets to pay for the
Medicaid expansion. The department found that ``participating
in the optional expansion of the Medicaid program would
result in a projected cost savings for the State General Fund
throughout the first 6 years of the ACA implementation
(fiscal years 2014-2020).''
objections to medicaid expansion
The ACA and the Medicaid expansion have raised concerns in
Texas and some other states about its long-term costs for
state and local budgets, as well as other concerns.
Objections to expansion in Texas primarily revolve around
three arguments:
Medicaid is ``socialized medicine'' like that practiced in
western Europe and expanding it would spread it further;
The federal government should abandon Medicaid and move to
a system of block grants to states, to provide them with more
``flexibility'' in meeting their citizens' health care needs;
and
The added cost burden of expansion, despite extremely
favorable federal matching rates, is too much for a program
that has already overburdened the state financially.
Socialized medicine: Medicaid is not socialized medicine.
Socialized medicine as practiced in Western Europe, and
specifically Great Britain, is a system under which the
government not only funds but also operates hospitals, hires
health care providers and controls every aspect of health
care. Medicaid does not do these things; patients and their
health care providers make health care decisions. Medicaid in
no way meets the definition of ``socialized medicine.''
Medicaid is a federal insurance program that matches state
funding to provide health care to eligible, low-income
citizens who cannot afford private health insurance. States
receive federal matching funds and
[[Page H2422]]
administer the program under federal rules that limit
eligibility to certain groups and services and that provide
states with flexibility within certain eligibility and
service requirements. Texas participates in many similar
federal programs that require state matching funds, including
transportation, historic preservation and homeland security
programs, among others.
Block grants: Some Texas lawmakers suggest that Medicaid is
a ``one-size-fits-all'' program that fails to meet the
state's unique demographic and industry needs. They are
petitioning the federal government to convert federal
Medicaid funding to a block grant, with each state receiving
a fixed amount to establish its own state-specific program
that might or might not include all the features of the
current program. Even for lawmakers who favor a block-grant
approach, however, this argument should not affect the
decision to extend Medicaid coverage under the ACA. In fact,
lawmakers who favor a Medicaid block grant in particular
should support extending Medicaid to low-income adults: the
government typically bases block grants on historical funding
levels, so maximizing federal funding now would better
position Texas in the event of any future conversion to block
grants.
Cost burdens: As noted above, state and local governments
currently fund all of our expenditures for indigent care and
in-patient hospital costs for eligible incarcerated
individuals, while the state supplies 100 percent of funding
for some adults served in state health care programs that
would be eligible for Medicaid. These, combined with hospital
charity costs, far exceed the amount Texas would be required
to contribute to expand Medicaid. New revenue from insurance
premium taxes and economic growth from the infusion of $100
billion in federal funds would provide additional revenue
sources. Furthermore, opting out of the expansion will not
reduce Texans' federal tax burden, nor will expanding
Medicaid increase it.
Concerns that the federal government will not be able to
maintain high match rates in the future are unlikely to
become reality given that Congressional representatives and
senators represent their states. To ensure against this
event, however, Texas could build in an automatic
``trigger,'' such as Arizona is doing, to reduce Medicaid
optional populations and services should Congress reduce the
match rate in the future.
Governor Rick Perry has described extending Medicaid to
low-income adults as ``adding more passengers to the
Titanic.'' It would be closer to the case to say that failing
to cover adults will doom them like those hapless travelers.
Experience in other states indicates that the death rate
would fall by 6.1 percent for adults under age 65 if the
state expands Medicaid, preventing premature deaths of 5,700
Texas adults in each of the five years following the
implementation year, or 28,500 Texans over five years.
Previous studies also have found reductions of 5.1 percent in
the child mortality rate and 8.5 percent in the infant
mortality rate attributable to Medicaid coverage.
Such studies led one author from the Harvard study, Arnold
M. Epstein, to conclude: Sometimes the political rhetoric is
at odds with the evidence, such as claims that Medicaid is a
`broken program' or worse than no insurance at all; our
findings suggest precisely the opposite.
Conclusion
Extending Medicaid to low-income adults will save tens of
thousands of lives and improve millions more over the next
decade and beyond. The jobs created will support hundreds of
thousands of people and boost the economy. The additional tax
revenue will benefit state and local governments and
important public purposes such as education, infrastructure
and public safety. Businesses will benefit from healthier
employees and lower employer insurance costs.
State and local government and the state's hospitals
collectively spend far more on piecemeal health care for low-
income Texans than the state's expected match for the
expansion. Expanding Medicaid would move thousands of people
into managed care from these programs and significantly
reduce the use of expensive emergency room treatment for
routine care.
Without expanding Medicaid to adults, Texas will still have
to find additional state match for many of the eligible but
unenrolled children identified in this report--but without
the benefit of the additional state funds that an expansion
would free up and without the new revenues that the
additional federal funding would generate.
The decision to expand Medicaid--or not--will affect the
lives of millions of Texans for years into the future and is
arguably one of the most important decisions that the
Legislature has had to make in decades. If politics are set
aside, the right decision is obvious.
Mr. HORSFORD. I thank the gentlelady from Texas. We stand with you
and your colleagues here on the floor to continue to put pressure on
leaders, not only in Texas but throughout the country, who do not see
the value of expanding Medicaid.
I'm fortunate in Nevada--we have a Republican Governor, but he has
agreed to provide the expansion for Medicaid, because he understands
that in Nevada a third of our population is currently uninsured, and
with the expansion of Medicaid that's going to make sure that fewer
people turn up in the emergency rooms through uncompensated care, which
all of us as taxpayers end up paying for.
So this is an issue where Republicans who understand the bottom line
in terms of health care and cost can work together with us to implement
good policy for the American people. We'll continue to work with
Governors that have not seen the light, but we believe that this is a
plan that will work very effectively.
Mr. Speaker, can I ask how much time we have remaining?
The SPEAKER pro tempore. The gentleman has 18 minutes.
Mr. HORSFORD. Thank you, Mr. Speaker.
At this time, I would like to turn to several of our new Members of
the 113th Congress. I'm very pleased and honored to be serving with
them. I've learned so much from all the Members here, but particularly
have enjoyed getting to know the new Members of the Congressional Black
Caucus. There are five new Members.
I would now like to recognize my good friend, the gentleman from New
Jersey, the man with the great legacy, who's carrying on the legacy of
the late Congressman Payne, Representative Payne, Jr., at this time.
Mr. PAYNE. Mr. Speaker, I thank the gentleman.
Let me first thank my colleagues, Congressman Horsford from Nevada
and Congressman Jeffries of New York, for anchoring tonight's CBC's
Special Order on eliminating health disparities.
I would also be remiss if I did not acknowledge our leader on health
issues in the Congressional Black Caucus, Dr. Christensen.
Mr. Speaker, I would also like to take the opportunity to acknowledge
a young person on the floor, the gentlelady from Nevada, the young Miss
Horsford, who is here tonight. This is truly unique quality time to
spend with your daughter.
There are numerous factors that contribute to the growing health
disparities in New Jersey's 10th District--poverty, environmental
threats, inadequate access to health care, and educational inequities.
These issues are so interconnected that a piecemeal approach to fixing
them just will not work. A comprehensive approach that focuses on
providing access to quality care to all, creating good jobs that
provide a decent living and increasing educational opportunities for
low-income communities, is the only way to eliminate health disparities
once and for all.
Even in the 21st century, health disparities are stark, especially in
the African American community, in which life expectancies are lower
and infant mortality rates are higher. Children of color who live at or
below the poverty line are much more likely to have asthma, develop
ADHD and contract diseases because they cannot afford vaccinations.
So we have a moral obligation to eliminate health disparities. Our
children and our future generations are depending on us. But narrowing
the health disparities that exist is not only good for our Nation's
health, it's good for our Nation's pocketbook.
Research tells us that access to quality health care could eliminate
or reduce the onset of many chronic illnesses and disproportionate
health outcomes that add to astronomical health care costs every year.
Yet many of my colleagues won't rest until they repeal ObamaCare. The
fact is, the Affordable Care Act will now provide health care to 9
million African Americans who are uninsured or underinsured. ObamaCare
ensures that everyone has access to lifesaving care such as
preventative cancer screenings, as well as coverage for children with
preexisting conditions.
{time} 2020
We know that ObamaCare's preventative services will help save lives
and save money. So why are my Republican colleagues so set on repealing
it? We have to protect ObamaCare just like we have to protect Medicare
and Medicaid.
Sequestration is a direct attack on these already limited health
resources. Sequestration is an irresponsible, across-the-board cut
approach that will only contribute to the widening health disparity
gap. Because of sequestration, Medicare has been cut by $11 billion;
cancer patients are being turned
[[Page H2423]]
away from clinics, and they cannot get access to the life-saving
treatments they need to live; millions in funding have been cut from
community health centers.
Furthermore, the effects are very real for the people in New Jersey.
In my State, nearly 4,000 fewer children will receive vaccines for
diseases such as measles, mumps, rubella, tetanus, whooping cough,
influenza, and hepatitis B. There will be millions in cuts to grants
that would help prevent and treat substance abuse. New Jersey will lose
nearly $4.9 million in environmental funding that ensures clean air and
clean water.
We live in a first world country, and you want me to go back home and
tell my constituents that we cannot provide them with clean water and
clean air? This is absolute insanity.
And to make matters worse, the New Jersey State Department of Health
and Senior Services will be forced to provide 19,000 fewer HIV tests to
low-income communities. Sequestration is directly contributing to the
spread of this fatal disease. In essence, it is providing a death
sentence to those who are poor and who can't afford the testing.
So I say to my colleagues tonight: addressing health disparities in
this country is both a moral obligation and a financial imperative. If
we are going to truly eliminate disparities, we must start by
eliminating sequestration, which does nothing but further the burden of
our distressed citizens. Finally, we must maintain and strengthen our
investments in health care access and resources for the disadvantaged
populations that we serve.
In closing, just as Medicaid and Medicare and Social Security have
become common threads and fibers of this great Nation, one day
ObamaCare will be looked at in the same manner.
Mr. HORSFORD. Thank you very much to the gentleman from New Jersey.
I would like to now turn to the gentlelady from Ohio. She has come to
Congress, providing great perspective as a member of the Financial
Services Committee specifically, but also in her background of higher
education and in her working on a number of these issues, one of which
being the need to create a workforce that's trained and ready,
particularly in the health care sector. I would like to yield to the
gentlelady from Ohio, Congresswoman Beatty.
Mrs. BEATTY. First, let me join my other colleagues in thanking my
freshman class members, Mr. Horsford and Mr. Jeffries, for leading the
Congressional Black Caucus' important discussion tonight on eliminating
health disparities in America.
Tonight, you are hearing a lot of statistics because it is so
important for us to let America know that low-income Americans, racial
and ethnic minorities and other underserved populations often have a
higher rate of disease and fewer treatment options and reduced access
to health care. So you will hear facts tonight.
The facts are that African Americans have the highest rate of high
blood pressure of all population groups and tend to develop it earlier
in life; African Americans are twice as likely to have diabetes than
Whites; African Americans are twice as likely to die from stroke than
Whites; African Americans are more than twice as likely to die from
prostate cancer than White men; and African American women younger than
40 years of age are more likely to develop breast cancer than White
women; infants born to Black women are 1.5 to 3 times more likely to
die than those born to women of other races or ethnicities; African
Americans are estimated to be 44 percent of all new HIV infections
despite representing only 13 percent of the U.S. population.
These disparities are shocking, and the Congressional Black Caucus
will not let us ignore them. In 2009, health disparities cost the
United States economy $82.2 billion. We have to continue to bring
awareness to this issue within our communities and develop strategies
to eliminate these disparities in a cost-effective way.
On March 23, 2010, President Obama signed the Affordable Care Act,
which is a monumental step that helps us address these overwhelming
statistics in health disparities within our communities. We now have in
place comprehensive health care reform that improves access
to affordable care and guarantees that millions of our most at-risk
citizens will finally be able to receive care. By improving access to
quality health care for all Americans, the Affordable Care Act actually
reduces health disparities.
We share this information so citizens will know that this law invests
in prevention and wellness, that it gives individuals and families more
control over their own care, that it expands initiatives to increase
racial and ethnic diversity in health care professionals by
strengthening cultural competency training for all health providers,
and that it improves communications between providers and patients.
As a lifelong health care advocate and as a stroke survivor and as an
African American woman, I know the importance of protecting access to
affordable health care coverage for all Americans, particularly for
those who are most in need. We need to continue to move forward with
this legislation and with initiatives that eliminate health disparities
in America, and I look forward to continuing to work with all of my
colleagues to improve our health care system. In order to have a
successful Nation, we must have a healthy Nation. So this is my clarion
call to all my colleagues--Democrats and Republicans--to help us make
progress on this critical issue.
Mr. HORSFORD. I thank the gentlelady from Ohio.
At this time, I would like to turn to the gentleman from Texas,
Congressman Veasey, and I would like to thank him again for his hard
work and contributions to this new 113th Congress.
Mr. VEASEY. Thank you.
I would also like to thank the gentleman from the Sagebrush State,
Steven Horsford, and from the Empire State, Hakeem Jeffries, for all of
their work on this very important issue and also in talking about the
importance of the Affordable Care Act and everything that it's going to
bring to our country. I also want to talk about the health care crisis
that is ongoing in America today.
Unfortunately, obesity and the long-term effects associated with this
condition are all too prevalent in our country. When you look at the
health statistics, it's quite astounding to say the least. Today in
America, nearly two-thirds of adults and one in three children are
overweight. In my own home State of Texas, we have one of the highest
obesity rates in the country. According to the Centers for Disease
Control and Prevention, 30 percent or more of Texans are obese.
The high obesity rate has contributed to the pervasiveness of
diabetes, heart disease, and other chronic diseases that drain
resources from our health care system. Increases in food intake, a lack
of physical activity, and environments that make nutritious choices
more difficult have all played a role in this obesity epidemic.
Many children and adults do not have much control over the choices of
foods they are able to get. Across this country, we are laden with food
deserts or places where residents may not be able to get to a
nutritious food option because they do not own a car or have access to
public transportation, or maybe they don't live along walkable roads.
This forces families to outsource their daily eating to more accessible
and sometimes cheaper alternatives, such as fast food, to get their
daily nutrients. A steady diet with high fat, salt- and sugar-based
products has led to unhealthy lifestyles.
Diabetes is one of the more commonly known effects of being
overweight or obese.
{time} 2030
The disease affects 25.8 million Americans, roughly 8 percent of our
population. The effects and complications of diabetes can include
stroke, high blood pressure, blindness, kidney disease, and
amputations.
Studies have shown that people with prediabetes who lose weight or
increase their physical activity can prevent or delay type 2 diabetes
and in some cases even return their blood glucose levels to normal.
Each of these statistics is more exacerbated when you look
specifically at the minority population in our country such as Latinos
and African Americans and our special-needs population.
When you break down obesity by race, African Americans have the
highest rates of obesity at roughly over 35
[[Page H2424]]
percent; Latinos, a little over 28 percent as compared to the non-
Hispanic White population of 23.7 percent. Individuals with
disabilities also have higher rates of obesity at 31.2 percent. This is
why I introduced House Resolution 195 designating May as Health and
Fitness Month.
We need to correct our course as a country and get on the path to
healthier lifestyles. The numbers are clear. We cannot sustain this
unhealthy path we are on. Not only is it cutting the lives of too many
Americans short, but it's also costing our country. In 2008, medical
costs associated with diabetes were estimated to be at $147 billion.
The medical costs for people who were obese were over $1,400 higher
than those of normal weight.
We need to show our children that we can make healthy, nutritious
choices and increase our physical activity. We must also not forget
that this must be spread throughout all aspects of our population.
While tremendous resources have been employed to help combat the
growing obesity epidemic amongst children, markedly fewer have been
used to address specific issues regarding how to best help obese
children with disabilities.
So, today, let's declare a more nutritious and healthy lifestyle with
better food choices and more active lives.
Mr. Horsford, thank you very much.
Mr. HORSFORD. I thank the gentleman from Texas.
I know we are wrapping up on our hour, Mr. Speaker.
I'd like to recognize the co-anchor for this hour, my good friend and
colleague from New York (Mr. Jeffries), who will provide a bit of a
synopsis.
Mr. JEFFRIES. Thank you, Mr. Horsford, for once again co-anchoring
this Special Order and for your tremendous leadership, and also thanks
to Dr. Christensen. We are thankful for all that you have done in
chairing the CBC Brain Trust on Health Care.
The Affordable Care Act is the law of the land; the President has
been elected and reelected; the Supreme Court has ruled it
constitutional. Let's move forward and address the health care
disparities that have been set forth so eloquently here today, come
together and deal with the ailments that are facing the American
people.
With that, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. DeSantis). Members are reminded not to
refer to persons on the floor as guests of the House.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today to
recognize the contributions of the Affordable Care Act to eliminating
health disparities. Health disparities refer to the unequal health
outcomes, ability to access health care, and rates of disease that
impact certain Americans based on their income, race, ethnicity, or
other identities. These disparities not only have devastating impacts
on communities of color in my district, but they undermine health in
historically marginalized communities across the Nation.
The disparities are staggering. For instance, in 2006, the infants of
African American women had death rates over twice as high as infants of
white American women. In 2009, the average American could expect to
live 78.5 years, but the average African American could only expect to
live to 74.5 years. African Americans also have significantly higher
rates of hypertension and HIV than white Americans.
The impacts are financial as well as human. Eliminating health
disparities would prevent approximately one million hospital stays per
year, saving $6.7 billion in health care costs alone. Even more
stunning, from 2003 to 2006, the direct and indirect costs of racial
and ethnic health disparities totaled $1.24 trillion in the United
States.
Insurance coverage is strongly related to better health outcomes, and
African Americans have substantially higher uninsured rates than white
Americans. Beginning in 2014, the Affordable Care Act will expand
health insurance coverage to millions of Americans who are currently
uninsured, and will provide subsidies to make coverage affordable for
low-income Americans. The Affordable Care Act will mandate that
Medicare and some private insurance plans cover essential preventive
services at no additional cost, so that more people will be able to
prevent illness and stay healthy.
The Affordable Care Act invests in community health centers, which
offer primary health care to patients regardless of income, and in
coordinated care measures, such as providing care teams to help
patients manage chronic diseases and funding home visits for pregnant
mothers and infants. Patients may be more likely to visit the doctor
and receive quality care if physicians are able to understand their
cultural background, so the Affordable Care Act also devotes resources
to increasing the racial and ethnic diversity of health care providers
and improving cultural competency training for all providers.
These are just some of the important ways in which the Affordable
Care Act is working to eliminate health disparities. I look forward to
collaborating with my colleagues to support the successful
implementation of the Affordable Care Act and eliminate health
disparities for future generations.
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