[Congressional Record (Bound Edition), Volume 145 (1999), Part 16]
[House]
[Pages 23031-23063]
[From the U.S. Government Publishing Office, www.gpo.gov]



                HEALTH RESEARCH AND QUALITY ACT OF 1999

  Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call 
up House Resolution 299 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 299

       Resolved, That at any time after the adoption of this 
     resolution the Speaker may, pursuant to clause 2(b) of rule 
     XVIII, declare the House resolved into the Committee of the 
     Whole House on the state of the Union for consideration of 
     the bill (H.R. 2506) to amend title IX of the Public Health 
     Service Act to revise and extend the Agency for Health Care 
     Policy and Research. The first reading of the bill shall be 
     dispensed with. General debate shall be confined to the bill 
     and shall not exceed one hour equally divided and controlled 
     by the chairman and ranking minority member of the Committee 
     on Commerce. After general debate the bill shall be 
     considered for amendment under the five-minute rule. It shall 
     be in order to consider as an original bill for the purpose 
     of amendment under the five-minute rule the amendment in the 
     nature of a substitute recommended by the Committee on 
     Commerce now printed in the bill. Each section of the 
     committee amendment in the nature of a substitute shall be 
     considered as read. No amendment to the committee amendment 
     in the nature of a substitute shall be in order except those 
     printed in the portion of the Congressional Record designated 
     for that purpose in clause 8 of rule XVIII and except pro 
     forma amendments for the purpose of debate. Each amendment so 
     printed may be offered only by the Member who caused it to be 
     printed or his designee and shall be considered as read. The 
     Chairman of the Committee of the Whole may: (1) postpone 
     until a time during further consideration in the Committee of 
     the Whole a request for a recorded vote on any amendment; and 
     (2) reduce to five minutes the minimum time for electronic 
     voting on any postponed question that follows another 
     electronic vote without intervening business, provided that 
     the minimum time for electronic voting on the first in any 
     series of questions shall be 15 minutes. At the conclusion of 
     consideration of the bill for amendment the Committee shall 
     rise and report the bill to the House with such amendments as 
     may have been adopted. Any Member may demand a separate vote 
     in the House on any amendment adopted in the Committee of the 
     Whole to the bill or to the committee amendment in the nature 
     of a substitute. The previous question shall be considered as 
     ordered on the bill and amendments thereto to final passage 
     without intervening motion except one motion to recommit with 
     or without instructions.

                              {time}  1445

  The SPEAKER pro tempore (Mr. Pease). The gentleman from Florida (Mr. 
Goss) is recognized for 1 hour.
  Mr. GOSS. Mr. Speaker, for purposes of debate only, I yield the 
customary 30 minutes to the distinguished gentlewoman from Rochester, 
NY (Ms. Slaughter) pending which I yield myself such time as I may 
consume. During consideration of this resolution, Mr. Speaker, all time 
yielded is for the purpose of debate only.
  Mr. Speaker, this is a fair and appropriate rule for this particular 
legislation. In fact, had it not been for the amount of money H.R. 2506 
authorizes, doubling the current authorization level to $900 million, 
the bill would have been considered under the suspension process. The 
bill was voted out of the Committee on Commerce by a voice vote and the 
Committee on Rules reported a modified open rule to ensure that no 
extraneous amendments to the Public Health Service Act would be 
considered. The rule allows any Member who has preprinted an amendment 
in the Congressional Record to offer that amendment. This will ensure a 
full and open, yet targeted debate on the merits of this particular 
agency covered by this legislation.
  When the Agency for Health Care Policy and Research, AHCPR as it is 
known in its acronym, was created in 1989, the health care universe 
looked far different than it does today. Traditional fee for service 
plans still dominated the market and managed care was still very much 
in its infancy period. Utilization review, peer review, these were 
largely unknown concepts, at least fully tried or tested. H.R. 2506 
modernizes the agency to reflect these and other changes and provides 
resources to enable more effective collection of data.
  Many Americans sitting at home watching may be wondering why we need 
yet another Federal agency involved in health care quality. Well, 
health care quality is a critical issue these days. As someone who has 
always believed that Congress too often stands in the way of true 
health care quality, I share concern with the people at home who are 
worried about this. To the extent that this ``reformed'' agency can 
promote better research and encourage successful partnerships between 
the public and private sectors with limited Federal red tape, it can be 
a worthy investment. And, of course, that is the goal. But we must 
retain vigorous oversight and maintain high expectations to ensure that 
these precious taxpayer dollars are indeed put to good use. Again, we 
think that is the reason for this legislation and we congratulate its 
authors for this effort.
  As I stated before, this is an eminently fair rule that should 
engender no controversy as far as I know.
  Mr. Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Mr. Speaker, I thank my distinguished colleague from 
Florida for yielding me the 30 minutes, and I yield myself such time as 
I may consume.
  Mr. Speaker, this is an ``almost open'' rule, for the majority has 
again relied on a preprinting requirement for amendments which may 
affect some Members of the House. But I rise in support of the rule and 
in support of H.R. 2506, the Health Research and Quality Act of 1999. 
The bill is being brought to the floor by the gentleman

[[Page 23032]]

from Florida (Mr. Bilirakis) for the majority and the gentleman from 
Ohio (Mr. Brown) for the minority.
  This bipartisan legislation reauthorizes the Agency for Health Care 
Policy and Research and renames the agency as the Agency for Health 
Research and Quality, AHRQ, pronounced ``arc.'' This agency promotes 
health care quality through research, synthesizing and consolidating 
medical information, and disseminating scientific evidence. Building on 
its current initiatives, the agency will play a key role in partnering 
with the private sector to improve the quality of health care in the 
United States.
  As a longtime supporter of health care research, I believe this piece 
of legislation will benefit patients, care-givers and insurance 
providers with vital information and statistics on how to improve the 
Nation's health care system. The agency's research and information 
consolidation will play a key role in extending quality care and 
improving health service delivery throughout the country. This agency 
provides vital information and resources that foster improvement in 
health care systems from America's smallest rural townships to its most 
populous inner cities.
  The agency's mission includes fostering the extension of quality 
health care systems to those Americans left behind as our Nation 
continues its economic growth. The agency's work is especially 
important as health care delivery in our country evolves. When the 
AHCPR was established a little over 10 years ago, the health care 
system was vastly different from what we know today. More people now 
receive their care through managed plans and HMOs. The growing 
complexity of health plans bewilderers many patients and contributes to 
the growing tensions between patients and insurers.
  This legislation directs AHRQ to address the public's growing concern 
for the quality of patient care and the number of medical errors that 
continue to grow each day. Their research helps hospitals and clinics 
around the country to reduce the injuries arising from mismanagement of 
cases.
  A recent study examined the records of more than 30,000 hospital 
patients in my home State of New York. The study found that nearly 4 
percent of patients suffered serious injuries that were related to the 
management of their illnesses rather than the illnesses themselves. 
This is a vital area of research for the agency and another reason why 
the reauthorization of funding for this agency and the redirection of 
its mission is important.
  The legislation does more than merely change the name of the agency. 
It directs the agency to develop new public-private partnerships in the 
health care arena. This will bring new perspectives to improving the 
dissemination of health information and the development of health care 
systems that better serve our neighborhoods, towns and cities. These 
partnerships will also leverage greater private investment and 
commitment to creating improved health care service systems throughout 
the Nation. In the process, AHRQ will also support increased efficiency 
and quality of Federal program management.
  According to testimony provided to the committee during a recent 
hearing, nine out of 10 people surveyed supported health research as 
well as the amount of Federal money spent on our Nation's health care. 
Mr. Speaker, this agency costs just one one-hundredth of one percent of 
the total funds spent by the government on health care and is a sound 
investment in our Nation's future health.
  I support this initiative even though it is only a modest step toward 
guaranteeing that all our citizens have access to the finest medical 
care in the world. Citizens across the United States are crying out for 
more. We need comprehensive health care reform that includes a 
provision to ban genetic discrimination in insurance. We need a true 
Patients' Bill of Rights.
  Mr. Speaker, I yield back the balance of my time.
  Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I 
prove the previous question on the resolution.
  The previous question was ordered.
  The resolution was agreed to.
  A motion to reconsider was laid on the table.
  The SPEAKER pro tempore (Mr. Knollenberg). Pursuant to House 
Resolution 299 and rule XVIII, the Chair declares the House in the 
Committee of the Whole House on the State of the Union for the 
consideration of the bill, H.R. 2506.

                              {time}  1454


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the State of the Union for the consideration of the bill 
(H.R. 2506) to amend title IX of the Public Health Service Act to 
revise and extend the Agency for Health Care Policy and Research, with 
Mr. Pease in the chair.
  The Clerk read the title of the bill.
  The CHAIRMAN. Pursuant to the rule, the bill is considered as having 
been read the first time.
  Under the rule, the gentleman from Florida (Mr. Bilirakis) and the 
gentleman from Ohio (Mr. Brown) each will control 30 minutes.
  The Chair recognizes the gentleman from Florida (Mr. Bilirakis).
  Mr. BILIRAKIS. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, I am pleased to bring H.R. 2506, the Health Research 
and Quality Act of 1999, to the floor today. This widely supported 
bipartisan bill was approved by voice vote in the Committee on Commerce 
and the Subcommittee on Health and Environment. In April, experts from 
both the public and private sector testified about the critical 
function of this agency at a hearing before the subcommittee.
  I introduced this measure jointly with the gentleman from Ohio (Mr. 
Brown), the ranking member of the House Commerce Subcommittee on Health 
and Environment, to reauthorize the Agency for Health Care Policy and 
Research and redefine its mission. Our bill renames it as the Agency 
for Health Research and Quality, or, one of those famous Washington 
acronyms, AHRQ.
  The purpose of this new name, and the reauthorization, is to foster 
comprehensive improvements in our health care system. Our bill 
refocuses the efforts of this critical agency to support private sector 
initiatives. Building on its current activities, the new agency will 
become a key partner to the private sector in improving the quality of 
health care in America.
  The bill specifically prohibits the agency from mandating national 
standards of clinical practice or quality health care standards. 
Instead, it emphasizes the agency's nonregulatory role in building the 
science of health care quality.
  The bill also includes provisions to overcome barriers to access to 
preventive health care through a public-private partnership. It 
authorizes grants for the establishment of regional centers to improve 
and increase access to preventive health care services.
  By approving the legislation before us, we can ensure the continued 
availability of the objective, science-based information this agency 
provides.
  I urge Members to join us in supporting passage of H.R. 2506, the 
Health Research and Quality Act of 1999.
  Mr. Chairman, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Chairman, I yield myself such time as I may 
consume.
  I am pleased that the gentleman from Florida (Mr. Bilirakis) and I 
could work together to introduce the Health Research and Quality Act 
and pass it out of the Committee on Commerce. We hold similar views on 
why this issue is important. It is important because research is 
important.
  The U.S. health care system is far from transparent. In fact, in many 
ways it is not even a system. It is a complex set of relationships 
influenced by science, demographics, politics, money and cultural 
trends. Whether the focus is on health care financing or health care 
delivery, common sense alone rarely explains what is going on. In fact, 
it often throws policymakers off track. If we want to improve on the

[[Page 23033]]

status quo in health care, we have to get a realistic picture of what 
the status quo is. By conducting and supporting health services 
research, AHCPR helps paint that picture for us.
  If we want to improve on the status quo in health care, we have got 
to find out what improvement actually means. By conducting and 
supporting outcomes, effectiveness and cost effectiveness research, 
AHCPR helps us determine the best way to spend the limited health care 
dollars that we do have.
  And if we want to improve on the status quo in health care, we need 
to get the word out to the people in the institutions, in the agencies 
and the industries that somehow keep the whole thing running. By 
disseminating research and data broadly, AHCPR helps ensure that our 
investment in data collection, health services research and biomedical 
research pays off.
  This reauthorization makes research and broad dissemination of 
information AHCPR's main focus. We could definitely use more of both.
  I urge support of this important legislation.
  Mr. Chairman, I reserve the balance of my time.
  Mr. BILIRAKIS. Mr. Chairman, I yield 2 minutes to the gentleman from 
California (Mr. Gary Miller).
  Mr. GARY MILLER of California. Mr. Chairman, I rise today in support 
of H.R. 2506, the Health Research and Quality Act. First I want to 
thank the bill's author the gentleman from Florida (Mr. Bilirakis) and 
the cosponsors for all their hard work on this issue.
  H.R. 2506 is an important piece of legislation which will improve the 
quality of health care by directing the Agency for Health Care Policy 
and Research to emphasize medical research, synthesizing and 
disseminating scientific evidence, and advancing public and private 
efforts to improve health care quality.
  With the explosion of medical research and information being 
produced, medical practitioners face the increasingly difficult task of 
keeping current with medical literature and putting the latest 
scientific findings into perspective. As one study indicated, even if a 
doctor read two peer-reviewed journals each night for a year, he or she 
would still be 800 years behind in their reading.
  Access to up-to-date, quality research will improve the care that 
patients obtain from all levels of the health care system. H.R. 2506 
will provide a means whereby medical group practices can obtain and 
contribute to such a body of information. This legislation frees the 
Agency for Health Care Policy and Research from the difficult task of 
providing guidelines and standards of care and allows it to focus on 
providing unbiased, science-based research to the health care 
community. H.R. 2506 will help health care professionals and 
policymakers better understand the future demands on the Nation's 
health care system.
  Again, I lend my strong support to this measure and urge my 
colleagues to join me in voting in favor of the Health Research and 
Quality Act of 1999.

                              {time}  1500

  Mr. BILIRAKIS. Mr. Chairman, I yield such time as he may consume to 
another gentleman from California (Mr. Bilbray).
  Mr. BILBRAY. Mr. Chairman, I rise to strongly support H.R. 2506, and 
let me just say as someone who has the privilege of representing the 
49th District of California, one of the capitals of both public and 
private research, I want to commend the chairman and the ranking member 
for a cooperative effort here at really serving the American people.
  The concept of reform and change sometimes scares people in these 
chambers and they worry about what could go wrong, and I think we have 
to remind ourselves again and again that reform and change is also an 
essential step to improvement. And this bill will allow us to take that 
step towards an improvement of not only the cost effectiveness, the 
cost efficiency, but also the effectiveness of our total health care 
system through the information age.
  Mr. Chairman, 2506 will be that kind of step. And I hope that in the 
future we will be able to look back at H.R. 2506 and look back at the 
cooperative effort between the chairman of the subcommittee and the 
ranking member of this subcommittee and say this was the beginning of a 
very productive relationship between both sides of the aisle and a 
productive relationship with the American people and their health care 
system.
  Mr. Chairman, I would ask all of us to support this bill and support 
the attitude that is behind this bill and to support the entire concept 
that Democrats and Republicans can work together for the good of the 
safety and the health of the American people.
  Mr. BLILEY. Mr. Chairman, I commend the gentlemen from Florida and 
Ohio for bringing H.R. 2506, the Health Research and Quality Act of 
1999, to the floor. This legislation, introduced by Representatives 
Bilirakis and Brown, represents an important commitment to provide the 
science-based evidence that we need to improve health care quality.
  We need sound and reliable information to help patients make informed 
decisions, to help health care providers make sense of new discoveries, 
to help purchasers get value for their health care dollar, and to help 
avoid medical errors. Today's legislation builds on the progress the 
Agency for Health Care Policy and Research has already made. It will 
enable us to benefit from our investment in biomedical research, to 
improve the health care delivery programs under our jurisdiction, and 
to build the science of quality measurement and improvement.
  This emphasis on quality measurement and improvement is important. 
The focus on health outcomes is critical. If we are unable to determine 
the long-term effect of the care patients receive today, we will be 
unable to improve upon that care tomorrow. To address the full 
continuum of care and outcomes research, and to link research directly 
with clinical practice in geographically diverse locations throughout 
the United States, this bill stresses the importance of health care 
improvement research centers and provider-based research networks.
  Since the science of outcomes research is complex, this bill requires 
the agency to support research and evaluation to advance the use of 
information systems for the study of health care quality and outcomes. 
The importance of outcomes research and information dissemination in 
the continuous improvement of patient care cannot be overstated. For 
example, in the area of cancer care, the ability to chart patient 
outcomes from a variety of interventions and communicate these outcomes 
effectively among practitioners will allow significant improvement in 
the treatment of all types of cancer.
  In summary, Mr. Chairman, the Health Research and Quality Act of 1999 
is a sound investment in the future; it is legislation that both sides 
of the aisle can support. The Commerce Committee gave unanimous 
approval to this legislation and I hope it will enjoy similar support 
on the floor today.
  Mr. BALDACCI. Mr. Chairman, I commend the Chairman, Mr. Bilirakis, 
and the Ranking Member, Mr. Brown, for introducing this valuable 
legislation. I particularly want to thank the Members for the special 
attention given to rural health care in the bill.
  Access and quality of health care in rural America is of particular 
importance to me. I represent the largest geographic district east of 
the Mississippi. Recently, compounding changes in Medicare 
reimbursement and regulations have had a devastating impact on my 
district, and have endangered a very vulnerable population of my state. 
People in rural areas do not have the same choices available to those 
in urban areas. I am concerned that the rate of the uninsured in Maine 
continues to grow. Maine citizens rely heavily on community care, and 
we ought to promote research into enhancing quality of and access to 
health care in these areas. Careful studies of the delivery of health 
services in rural America will allow us to make better public policy, 
and I thank the Chairman and Ranking Member for their attention to this 
issue.
  I am also pleased to see the legislation address the critical issue 
of health insurance. Section 913 requires that there must be surveys 
on, among other factors, the types and costs of private health 
insurance. As we know, there is a growing trend to consolidation among 
health insurance companies, and I am particularly concerned about the 
ability of these large companies to direct costs and types of care 
offered when they buy out smaller local insurers. It is my hope that 
with this component of the bill, we will gain a better understanding of 
what effect the consolidation in the health insurance market is having 
on quality, access, and cost of insurance to rural Americans. Again, I 
thank the Chairman and Ranking Member for addressing this issue.

[[Page 23034]]


  Mr. BILIRAKIS. Mr. Chairman, we have no further requests for time.
  Mr. BROWN of Ohio. Mr. Chairman, I yield back the balance of my time.
  Mr. BILIRAKIS. Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN. All time for general debate has expired.
  Pursuant to the rule, the committee amendment in the nature of a 
substitute printed in the bill shall be considered by sections as an 
original bill for the purpose of amendment, and each section is 
considered read.
  No amendment to that amendment shall be in order except those printed 
in the portion of the Congressional Record designated for that purpose 
and pro forma amendments for the purpose of debate. Amendments printed 
in the Record may be offered only by the Member who caused it to be 
printed or his designee and shall be considered read.
  The Chairman of the Committee of the Whole may postpone a request for 
a recorded vote on any amendment and may reduce to a minimum of 5 
minutes the time for voting on any postponed question that immediately 
follows another vote, provided that the time for voting on the first 
question shall be a minimum of 15 minutes.
  The Clerk will designate section 1.
  The text of section 1 is as follows:

       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 ``Health Research and Quality 
     Act of 1999''.

  The CHAIRMAN. Are there any amendments to section 1?
  The Clerk will designate section 2.
  The text of section 2 is as follows:

     SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

       (a) In General.--Title IX of the Public Health Service Act 
     (42 U.S.C. 299 et seq.) is amended to read as follows:
           ``TITLE IX--AGENCY FOR HEALTH RESEARCH AND QUALITY

               ``PART A--ESTABLISHMENT AND GENERAL DUTIES

     ``SEC. 901. MISSION AND DUTIES.

       ``(a) In General.--There is established within the Public 
     Health Service an agency to be known as the Agency for Health 
     Research and Quality, which shall be headed by a director 
     appointed by the Secretary. The Secretary shall carry out 
     this title acting through the Director.
       ``(b) Mission.--The purpose of the Agency is to enhance the 
     quality, appropriateness, and effectiveness of health 
     services, and access to such services, through the 
     establishment of a broad base of scientific research and 
     through the promotion of improvements in clinical and health 
     system practices, including the prevention of diseases and 
     other health conditions. The Agency shall promote health care 
     quality improvement by--
       ``(1) conducting and supporting research that develops and 
     presents scientific evidence regarding all aspects of health, 
     including--
       ``(A) the development and assessment of methods for 
     enhancing patient participation in their own care and for 
     facilitating shared patient-physician decision-making;
       ``(B) the outcomes, effectiveness, and cost-effectiveness 
     of health care practices, including preventive measures and 
     long-term care;
       ``(C) existing and innovative technologies;
       ``(D) the costs and utilization of, and access to health 
     care;
       ``(E) the ways in which health care services are organized, 
     delivered, and financed and the interaction and impact of 
     these factors on the quality of patient care;
       ``(F) methods for measuring quality and strategies for 
     improving quality; and
       ``(G) ways in which patients, consumers, purchasers, and 
     practitioners acquire new information about best practices 
     and health benefits, the determinants and impact of their use 
     of this information;
       ``(2) synthesizing and disseminating available scientific 
     evidence for use by patients, consumers, practitioners, 
     providers, purchasers, policy makers, and educators; and
       ``(3) advancing private and public efforts to improve 
     health care quality.
       ``(c) Requirements With Respect to Rural Areas and Priority 
     Populations.--In carrying out subsection (b), the Director 
     shall undertake and support research, demonstration projects, 
     and evaluations with respect to--
       ``(1) the delivery of health services in rural areas 
     (including frontier areas);
       ``(2) health services for low-income groups, and minority 
     groups;
       ``(3) the health of children;
       ``(4) the elderly; and
       ``(5) people with special health care needs, including 
     disabilities, chronic care and end-of-life health care.

     ``SEC. 902. GENERAL AUTHORITIES.

       ``(a) In General.--In carrying out section 901(b), the 
     Director shall support demonstration projects, conduct and 
     support research, evaluations, training, research networks, 
     multi-disciplinary centers, technical assistance, and the 
     dissemination of information, on health care, and on systems 
     for the delivery of such care, including activities with 
     respect to--
       ``(1) the quality, effectiveness, efficiency, 
     appropriateness and value of health care services;
       ``(2) quality measurement and improvement;
       ``(3) the outcomes, cost, cost-effectiveness, and use of 
     health care services and access to such services;
       ``(4) clinical practice, including primary care and 
     practice-oriented research;
       ``(5) health care technologies, facilities, and equipment;
       ``(6) health care costs, productivity, organization, and 
     market forces;
       ``(7) health promotion and disease prevention, including 
     clinical preventive services;
       ``(8) health statistics, surveys, database development, and 
     epidemiology; and
       ``(9) medical liability.
       ``(b) Health Services Training Grants.--
       ``(1) In general.--The Director may provide training grants 
     in the field of health services research related to 
     activities authorized under subsection (a), to include pre- 
     and post-doctoral fellowships and training programs, young 
     investigator awards, and other programs and activities as 
     appropriate. In carrying out this subsection, the Director 
     shall make use of funds made available under section 487.
       ``(2) Requirements.--In developing priorities for the 
     allocation of training funds under this subsection, the 
     Director shall take into consideration shortages in the 
     number of trained researchers addressing the priority 
     populations.
       ``(c) Multidisciplinary Centers.--The Director may provide 
     financial assistance to assist in meeting the costs of 
     planning and establishing new centers, and operating existing 
     and new centers, for multidisciplinary health services 
     research, demonstration projects, evaluations, training, and 
     policy analysis with respect to the matters referred to in 
     subsection (a).
       ``(d) Relation to Certain Authorities Regarding Social 
     Security.--Activities authorized in this section shall be 
     appropriately coordinated with experiments, demonstration 
     projects, and other related activities authorized by the 
     Social Security Act and the Social Security Amendments of 
     1967. Activities under subsection (a)(2) of this section that 
     affect the programs under titles XVIII, XIX and XXI of the 
     Social Security Act shall be carried out consistent with 
     section 1142 of such Act.
       ``(e) Disclaimer.--The Agency shall not mandate national 
     standards of clinical practice or quality health care 
     standards. Recommendations resulting from projects funded and 
     published by the Agency shall include a corresponding 
     disclaimer.
       ``(f) Rule of Construction.--Nothing in this section shall 
     be construed to imply that the Agency's role is to mandate a 
     national standard or specific approach to quality measurement 
     and reporting. In research and quality improvement 
     activities, the Agency shall consider a wide range of 
     choices, providers, health care delivery systems, and 
     individual preferences.

               ``PART B--HEALTH CARE IMPROVEMENT RESEARCH

     ``SEC. 911. HEALTH CARE OUTCOME IMPROVEMENT RESEARCH.

       ``(a) Evidence Rating Systems.--In collaboration with 
     experts from the public and private sector, the Agency shall 
     identify and disseminate methods or systems that it uses to 
     assess health care research results, particularly methods or 
     systems that it uses to rate the strength of the scientific 
     evidence behind health care practice, recommendations in the 
     research literature, and technology assessments. The Agency 
     shall make methods or systems for evidence rating widely 
     available. Agency publications containing health care 
     recommendations shall indicate the level of substantiating 
     evidence using such methods or systems.
       ``(b) Health Care Improvement Research Centers and 
     Provider-Based Research Networks.--
       ``(1) In general.--In order to address the full continuum 
     of care and outcomes research, to link research to practice 
     improvement, and to speed the dissemination of research 
     findings to community practice settings, the Agency shall 
     employ research strategies and mechanisms that will link 
     research directly with clinical practice in geographically 
     diverse locations throughout the United States, including--
       ``(A) Health Care Improvement Research Centers that combine 
     demonstrated multidisciplinary expertise in outcomes or 
     quality improvement research with linkages to relevant sites 
     of care;
       ``(B) Provider-based Research Networks, including plan, 
     facility, or delivery system sites of care (especially 
     primary care), that can evaluate outcomes and promote quality 
     improvement; and
       ``(C) other innovative mechanisms or strategies to link 
     research with clinical practice.
       ``(2) Requirements.--The Director is authorized to 
     establish the requirements for entities applying for grants 
     under this subsection.

     ``SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE 
                   ORGANIZATION AND DELIVERY.

       ``(a) Support for Efforts To Develop Information on 
     Quality.--
       ``(1) Scientific and technical support.--In its role as the 
     principal agency for health research and quality, the Agency 
     may provide scientific and technical support for private and 
     public efforts to improve health care quality, including the 
     activities of accrediting organizations.

[[Page 23035]]

       ``(2) Role of the agency.--With respect to paragraph (1), 
     the role of the Agency shall include--
       ``(A) the identification and assessment of methods for the 
     evaluation of the health of--
       ``(i) enrollees in health plans by type of plan, provider, 
     and provider arrangements; and
       ``(ii) other populations, including those receiving long-
     term care services;
       ``(B) the ongoing development, testing, and dissemination 
     of quality measures, including measures of health and 
     functional outcomes;
       ``(C) the compilation and dissemination of health care 
     quality measures developed in the private and public sector;
       ``(D) assistance in the development of improved health care 
     information systems;
       ``(E) the development of survey tools for the purpose of 
     measuring participant and beneficiary assessments of their 
     health care; and
       ``(F) identifying and disseminating information on 
     mechanisms for the integration of information on quality into 
     purchaser and consumer decision-making processes.
       ``(b) Centers for Education and Research on Therapeutics.--
       ``(1) In general.--The Secretary, acting through the 
     Director and in consultation with the Commissioner of Food 
     and Drugs, shall establish a program for the purpose of 
     making one or more grants for the establishment and operation 
     of one or more centers to carry out the activities specified 
     in paragraph (2).
       ``(2) Required activities.--The activities referred to in 
     this paragraph are the following:
       ``(A) The conduct of state-of-the-art research for the 
     following purposes:
       ``(i) To increase awareness of--

       ``(I) new uses of drugs, biological products, and devices;
       ``(II) ways to improve the effective use of drugs, 
     biological products, and devices; and
       ``(III) risks of new uses and risks of combinations of 
     drugs and biological products.

       ``(ii) To provide objective clinical information to the 
     following individuals and entities:

       ``(I) Health care practitioners and other providers of 
     health care goods or services.

       ``(II) Pharmacists, pharmacy benefit managers and 
     purchasers.
       ``(III) Health maintenance organizations and other managed 
     health care organizations.
       ``(IV) Health care insurers and governmental agencies.
       ``(V) Patients and consumers.

       ``(iii) To improve the quality of health care while 
     reducing the cost of health care through--

       ``(I) an increase in the appropriate use of drugs, 
     biological products, or devices; and
       ``(II) the prevention of adverse effects of drugs, 
     biological products, and devices and the consequences of such 
     effects, such as unnecessary hospitalizations.

       ``(B) The conduct of research on the comparative 
     effectiveness, cost-effectiveness, and safety of drugs, 
     biological products, and devices.
       ``(C) Such other activities as the Secretary determines to 
     be appropriate, except that a grant may not be expended to 
     assist the Secretary in the review of new drugs.
       ``(c) Reducing Errors in Medicine.--The Director shall 
     conduct and support research and build private-public 
     partnerships to--
       ``(1) identify the causes of preventable health care errors 
     and patient injury in health care delivery;
       ``(2) develop, demonstrate, and evaluate strategies for 
     reducing errors and improving patient safety; and
       ``(3) promote the implementation of effective strategies 
     throughout the health care industry.

     ``SEC. 913. INFORMATION ON QUALITY AND COST OF CARE.

       ``(a) In General.--In carrying out 902(a), the Director 
     shall--
       ``(1) conduct a survey to collect data on a nationally 
     representative sample of the population on the cost, use and, 
     for fiscal year 2001 and subsequent fiscal years, quality of 
     health care, including the types of health care services 
     Americans use, their access to health care services, 
     frequency of use, how much is paid for the services used, the 
     source of those payments, the types and costs of private 
     health insurance, access, satisfaction, and quality of care 
     for the general population and also for populations 
     identified in section 901(c); and
       ``(2) develop databases and tools that provide information 
     to States on the quality, access, and use of health care 
     services provided to their residents.
       ``(b) Quality and Outcomes Information.--
       ``(1) In general.--Beginning in fiscal year 2001, the 
     Director shall ensure that the survey conducted under 
     subsection (a)(1) will--
       ``(A) identify determinants of health outcomes and 
     functional status, the needs of special populations in such 
     variables as well as an understanding of changes over time, 
     relationships to health care access and use, and monitor the 
     overall national impact of Federal and State policy changes 
     on health care;
       ``(B) provide information on the quality of care and 
     patient outcomes for frequently occurring clinical conditions 
     for a nationally representative sample of the population; and
       ``(C) provide reliable national estimates for children and 
     persons with special health care needs through the use of 
     supplements or periodic expansions of the survey.

     In expanding the Medical Expenditure Panel Survey, as in 
     existence on the date of enactment of this title in fiscal 
     year 2001 to collect information on the quality of care, the 
     Director shall take into account any outcomes measurements 
     generally collected by private sector accreditation 
     organizations.
       ``(2) Annual report.--Beginning in fiscal year 2003, the 
     Secretary, acting through the Director, shall submit to 
     Congress an annual report on national trends in the quality 
     of health care provided to the American people.

     ``SEC. 914. INFORMATION SYSTEMS FOR HEALTH CARE IMPROVEMENT.

       ``(a) In General.--In order to foster a range of innovative 
     approaches to the management and communication of health 
     information, the Agency shall support research, evaluations 
     and initiatives to advance--
       ``(1) the use of information systems for the study of 
     health care quality and outcomes, including the generation of 
     both individual provider and plan-level comparative 
     performance data;
       ``(2) training for health care practitioners and 
     researchers in the use of information systems;
       ``(3) the creation of effective linkages between various 
     sources of health information, including the development of 
     information networks;
       ``(4) the delivery and coordination of evidence-based 
     health care services, including the use of real-time health 
     care decision-support programs;
       ``(5) the structure, content, definition, and coding of 
     health information data and medical vocabularies in 
     consultation with appropriate Federal entities and shall seek 
     input from appropriate private entities;
       ``(6) the use of computer-based health records in 
     outpatient and inpatient settings as a personal health record 
     for individual health assessment and maintenance, and for 
     monitoring public health and outcomes of care within 
     populations; and
       ``(7) the protection of individually identifiable 
     information in health services research and health care 
     quality improvement.
       ``(b) Demonstration.--The Agency shall support 
     demonstrations into the use of new information tools aimed at 
     improving shared decision-making between patients and their 
     care-givers.

     ``SEC. 915. RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN 
                   UNDERSERVED AREAS.

       ``(a) Preventive Services Task Force.--
       ``(1) Purpose.--The Agency shall provide ongoing 
     administrative, research, and technical support for the 
     operation of the Preventive Services Task Force. The Agency 
     shall coordinate and support the dissemination of the 
     Preventive Services Task Force recommendations.
       ``(2) Operation.--The Preventive Services Task Force shall 
     review the scientific evidence related to the effectiveness, 
     appropriateness, and cost-effectiveness of clinical 
     preventive services for the purpose of developing 
     recommendations for the health care community, and updating 
     previous recommendations, regarding their usefulness in daily 
     clinical practice. In carrying out its responsibilities under 
     paragraph (1), the Task Force shall not be subject to the 
     provisions of Appendix 2 of title 5, United States Code.
       ``(b) Primary Care Research.--
       ``(1) In general.--There is established within the Agency a 
     Center for Primary Care Research (referred to in this 
     subsection as the `Center') that shall serve as the principal 
     source of funding for primary care practice research in the 
     Department of Health and Human Services. For purposes of this 
     paragraph, primary care research focuses on the first contact 
     when illness or health concerns arise, the diagnosis, 
     treatment or referral to specialty care, preventive care, and 
     the relationship between the clinician and the patient in the 
     context of the family and community.
       ``(2) Research.--In carrying out this section, the Center 
     shall conduct and support research concerning--
       ``(A) the nature and characteristics of primary care 
     practice;
       ``(B) the management of commonly occurring clinical 
     problems;
       ``(C) the management of undifferentiated clinical problems; 
     and
       ``(D) the continuity and coordination of health services.

     ``SEC. 916. CLINICAL PRACTICE AND TECHNOLOGY INNOVATION.

       ``(a) In General.--The Director shall promote innovation in 
     evidence-based clinical practice and health care technologies 
     by--
       ``(1) conducting and supporting research on the 
     development, diffusion, and use of health care technology;
       ``(2) developing, evaluating, and disseminating 
     methodologies for assessments of health care practices and 
     health care technologies;
       ``(3) conducting intramural and supporting extramural 
     assessments of existing and new health care practices and 
     technologies;
       ``(4) promoting education, training, and providing 
     technical assistance in the use of health care practice and 
     health care technology assessment methodologies and results; 
     and
       ``(5) working with the National Library of Medicine and the 
     public and private sector to develop an electronic 
     clearinghouse of currently available assessments and those in 
     progress.
       ``(b) Specification of Process.--
       ``(1) In general.--Not later than December 31, 2000, the 
     Director shall develop and publish a description of the 
     methods used by the Agency and its contractors for practice 
     and technology assessment.
       ``(2) Consultations.--In carrying out this subsection, the 
     Director shall cooperate and consult with the Assistant 
     Secretary for Health, the Administrator of the Health Care 
     Financing Administration, the Director of the National 
     Institutes of Health, the Commissioner of Food and Drugs, and 
     the heads of any other interested Federal department or 
     agency, and shall

[[Page 23036]]

     seek input, where appropriate, from professional societies 
     and other private and public entities.
       ``(3) Methodology.--The Director shall, in developing the 
     methods used under paragraph (1), consider--
       ``(A) safety, efficacy, and effectiveness;
       ``(B) legal, social, and ethical implications;
       ``(C) costs, benefits, and cost-effectiveness;
       ``(D) comparisons to alternate technologies and practices; 
     and
       ``(E) requirements of Food and Drug Administration approval 
     to avoid duplication.
       ``(c) Specific Assessments.--
       ``(1) In general.--The Director shall conduct or support 
     specific assessments of health care technologies and 
     practices.
       ``(2) Requests for assessments.--The Director is authorized 
     to conduct or support assessments, on a reimbursable basis, 
     for the Health Care Financing Administration, the Department 
     of Defense, the Department of Veterans Affairs, the Office of 
     Personnel Management, and other public or private entities.
       ``(3) Grants and contracts.--In addition to conducting 
     assessments, the Director may make grants to, or enter into 
     cooperative agreements or contracts with, entities described 
     in paragraph (4) for the purpose of conducting assessments of 
     experimental, emerging, existing, or potentially outmoded 
     health care technologies, and for related activities.
       ``(4) Eligible entities.--An entity described in this 
     paragraph is an entity that is determined to be appropriate 
     by the Director, including academic medical centers, research 
     institutions and organizations, professional organizations, 
     third party payers, governmental agencies, and consortia of 
     appropriate research entities established for the purpose of 
     conducting technology assessments.

     ``SEC. 917. COORDINATION OF FEDERAL GOVERNMENT QUALITY 
                   IMPROVEMENT EFFORTS.

       ``(a) Requirement.--
       ``(1) In general.--To avoid duplication and ensure that 
     Federal resources are used efficiently and effectively, the 
     Secretary, acting through the Director, shall coordinate all 
     research, evaluations, and demonstrations related to health 
     services research, quality measurement and quality 
     improvement activities undertaken and supported by the 
     Federal Government.
       ``(2) Specific activities.--The Director, in collaboration 
     with the appropriate Federal officials representing all 
     concerned executive agencies and departments, shall develop 
     and manage a process to--
       ``(A) improve interagency coordination, priority setting, 
     and the use and sharing of research findings and data 
     pertaining to Federal quality improvement programs, 
     technology assessment, and health services research;
       ``(B) strengthen the research information infrastructure, 
     including databases, pertaining to Federal health services 
     research and health care quality improvement initiatives;
       ``(C) set specific goals for participating agencies and 
     departments to further health services research and health 
     care quality improvement; and
       ``(D) strengthen the management of Federal health care 
     quality improvement programs.
       ``(b) Study by the Institute of Medicine.--
       ``(1) In general.--To provide Congress, the Department of 
     Health and Human Services, and other relevant departments 
     with an independent, external review of their quality 
     oversight, quality improvement and quality research programs, 
     the Secretary shall enter into a contract with the Institute 
     of Medicine--
       ``(A) to describe and evaluate current quality improvement, 
     quality research and quality monitoring processes through--
       ``(i) an overview of pertinent health services research 
     activities and quality improvement efforts conducted by all 
     Federal programs, with particular attention paid to those 
     under titles XVIII, XIX, and XXI of the Social Security Act; 
     and
       ``(ii) a summary of the partnerships that the Department of 
     Health and Human Services has pursued with private 
     accreditation, quality measurement and improvement 
     organizations; and
       ``(B) to identify options and make recommendations to 
     improve the efficiency and effectiveness of quality 
     improvement programs through--
       ``(i) the improved coordination of activities across the 
     medicare, medicaid and child health insurance programs under 
     titles XVIII, XIX and XXI of the Social Security Act and 
     health services research programs;
       ``(ii) the strengthening of patient choice and 
     participation by incorporating state-of-the-art quality 
     monitoring tools and making information on quality available; 
     and
       ``(iii) the enhancement of the most effective programs, 
     consolidation as appropriate, and elimination of duplicative 
     activities within various federal agencies.
       ``(2) Requirements.--
       ``(A) In general.--The Secretary shall enter into a 
     contract with the Institute of Medicine for the preparation--
       ``(i) not later than 12 months after the date of enactment 
     of this title, of a report providing an overview of the 
     quality improvement programs of the Department of Health and 
     Human Services for the medicare, medicaid, and CHIP programs 
     under titles XVIII, XIX, and XXI of the Social Security Act; 
     and
       ``(ii) not later than 24 months after the date of enactment 
     of this title, of a final report containing recommendations.
       ``(B) Reports.--The Secretary shall submit the reports 
     described in subparagraph (A) to the Committee on Finance and 
     the Committee on Health, Education, Labor, and Pensions of 
     the Senate and the Committee on Ways and Means and the 
     Committee on Commerce of the House of Representatives.

                      ``PART C--GENERAL PROVISIONS

     ``SEC. 921. ADVISORY COUNCIL FOR HEALTH CARE RESEARCH AND 
                   QUALITY.

       ``(a) Establishment.--There is established an advisory 
     council to be known as the Advisory Council for Health Care 
     Research and Quality.
       ``(b) Duties.--
       ``(1) In general.--The Advisory Council shall advise the 
     Secretary and the Director with respect to activities 
     proposed or undertaken to carry out the purpose of the Agency 
     under section 901(b).
       ``(2) Certain recommendations.--Activities of the Advisory 
     Council under paragraph (1) shall include making 
     recommendations to the Director regarding--
       ``(A) priorities regarding health care research, especially 
     studies related to quality, outcomes, cost and the 
     utilization of, and access to, health care services;
       ``(B) the field of health care research and related 
     disciplines, especially issues related to training needs, and 
     dissemination of information pertaining to health care 
     quality; and
       ``(C) the appropriate role of the Agency in each of these 
     areas in light of private sector activity and identification 
     of opportunities for public-private sector partnerships.
       ``(c) Membership.--
       ``(1) In general.--The Advisory Council shall, in 
     accordance with this subsection, be composed of appointed 
     members and ex officio members. All members of the Advisory 
     Council shall be voting members other than the individuals 
     designated under paragraph (3)(B) as ex officio members.
       ``(2) Appointed members.--The Secretary shall appoint to 
     the Advisory Council 18 appropriately qualified individuals. 
     At least 14 members of the Advisory Council shall be 
     representatives of the public who are not officers or 
     employees of the United States. The Secretary shall ensure 
     that the appointed members of the Council, as a group, are 
     representative of professions and entities concerned with, or 
     affected by, activities under this title and under section 
     1142 of the Social Security Act. Of such members--
       ``(A) 3 shall be individuals distinguished in the conduct 
     of research, demonstration projects, and evaluations with 
     respect to health care;
       ``(B) 3 shall be individuals distinguished in the practice 
     of medicine of which at least 1 shall be a primary care 
     practitioner;
       ``(C) 3 shall be individuals distinguished in the other 
     health professions;
       ``(D) 3 shall be individuals either representing the 
     private health care sector, including health plans, 
     providers, and purchasers or individuals distinguished as 
     administrators of health care delivery systems;
       ``(E) 3 shall be individuals distinguished in the fields of 
     health care quality improvement, economics, information 
     systems, law, ethics, business, or public policy; and
       ``(F) 3 shall be individuals representing the interests of 
     patients and consumers of health care.
       ``(3) Ex officio members.--The Secretary shall designate as 
     ex officio members of the Advisory Council--
       ``(A) the Assistant Secretary for Health, the Director of 
     the National Institutes of Health, the Director of the 
     Centers for Disease Control and Prevention, the Administrator 
     of the Health Care Financing Administration, the Assistant 
     Secretary of Defense (Health Affairs), and the Under 
     Secretary for Health of the Department of Veterans Affairs; 
     and
       ``(B) such other Federal officials as the Secretary may 
     consider appropriate.
       ``(d) Terms.--Members of the Advisory Council appointed 
     under subsection (c)(2) shall serve for a term of 3 years. A 
     member of the Council appointed under such subsection may 
     continue to serve after the expiration of the term of the 
     members until a successor is appointed.
       ``(e) Vacancies.--If a member of the Advisory Council 
     appointed under subsection (c)(2) does not serve the full 
     term applicable under subsection (d), the individual 
     appointed to fill the resulting vacancy shall be appointed 
     for the remainder of the term of the predecessor of the 
     individual.
       ``(f) Chair.--The Director shall, from among the members of 
     the Advisory Council appointed under subsection (c)(2), 
     designate an individual to serve as the chair of the Advisory 
     Council.
       ``(g) Meetings.--The Advisory Council shall meet not less 
     than once during each discrete 4-month period and shall 
     otherwise meet at the call of the Director or the chair.
       ``(h) Compensation and Reimbursement of Expenses.--
       ``(1) Appointed members.--Members of the Advisory Council 
     appointed under subsection (c)(2) shall receive compensation 
     for each day (including travel time) engaged in carrying out 
     the duties of the Advisory Council unless declined by the 
     member. Such compensation may not be in an amount in excess 
     of the maximum rate of basic pay payable for GS-18 of the 
     General Schedule.
       ``(2) Ex officio members.--Officials designated under 
     subsection (c)(3) as ex officio members of the Advisory 
     Council may not receive compensation for service on the 
     Advisory Council in addition to the compensation otherwise 
     received for duties carried out as officers of the United 
     States.
       ``(i) Staff.--The Director shall provide to the Advisory 
     Council such staff, information, and other assistance as may 
     be necessary to carry out the duties of the Council.

[[Page 23037]]



     ``SEC. 922. PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.

       ``(a) Requirement of Review.--
       ``(1) In general.--Appropriate technical and scientific 
     peer review shall be conducted with respect to each 
     application for a grant, cooperative agreement, or contract 
     under this title.
       ``(2) Reports to director.--Each peer review group to which 
     an application is submitted pursuant to paragraph (1) shall 
     report its finding and recommendations respecting the 
     application to the Director in such form and in such manner 
     as the Director shall require.
       ``(b) Approval as Precondition of Awards.--The Director may 
     not approve an application described in subsection (a)(1) 
     unless the application is recommended for approval by a peer 
     review group established under subsection (c).
       ``(c) Establishment of Peer Review Groups.--
       ``(1) In general.--The Director shall establish such 
     technical and scientific peer review groups as may be 
     necessary to carry out this section. Such groups shall be 
     established without regard to the provisions of title 5, 
     United States Code, that govern appointments in the 
     competitive service, and without regard to the provisions of 
     chapter 51, and subchapter III of chapter 53, of such title 
     that relate to classification and pay rates under the General 
     Schedule.
       ``(2) Membership.--The members of any peer review group 
     established under this section shall be appointed from among 
     individuals who by virtue of their training or experience are 
     eminently qualified to carry out the duties of such peer 
     review group. Officers and employees of the United States may 
     not constitute more than 25 percent of the membership of any 
     such group. Such officers and employees may not receive 
     compensation for service on such groups in addition to the 
     compensation otherwise received for these duties carried out 
     as such officers and employees.
       ``(3) Duration.--Notwithstanding section 14(a) of the 
     Federal Advisory Committee Act, peer review groups 
     established under this section may continue in existence 
     until otherwise provided by law.
       ``(4) Qualifications.--Members of any peer-review group 
     shall, at a minimum, meet the following requirements:
       ``(A) Such members shall agree in writing to treat 
     information received, pursuant to their work for the group, 
     as confidential information, except that this subparagraph 
     shall not apply to public records and public information.
       ``(B) Such members shall agree in writing to recuse 
     themselves from participation in the peer-review of specific 
     applications which present a potential personal conflict of 
     interest or appearance of such conflict, including employment 
     in a directly affected organization, stock ownership, or any 
     financial or other arrangement that might introduce bias in 
     the process of peer-review.
       ``(d) Authority for Procedural Adjustments in Certain 
     Cases.--In the case of applications for financial assistance 
     whose direct costs will not exceed $100,000, the Director may 
     make appropriate adjustments in the procedures otherwise 
     established by the Director for the conduct of peer review 
     under this section. Such adjustments may be made for the 
     purpose of encouraging the entry of individuals into the 
     field of research, for the purpose of encouraging clinical 
     practice-oriented or provider-based research, and for such 
     other purposes as the Director may determine to be 
     appropriate.
       ``(e) Regulations.--The Director shall issue regulations 
     for the conduct of peer review under this section.

     ``SEC. 923. CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT, 
                   COLLECTION, AND DISSEMINATION OF DATA.

       ``(a) Standards With Respect to Utility of Data.--
       ``(1) In general.--To ensure the utility, accuracy, and 
     sufficiency of data collected by or for the Agency for the 
     purpose described in section 901(b), the Director shall 
     establish standard methods for developing and collecting such 
     data, taking into consideration--
       ``(A) other Federal health data collection standards; and
       ``(B) the differences between types of health care plans, 
     delivery systems, health care providers, and provider 
     arrangements.
       ``(2) Relationship with other department programs.--In any 
     case where standards under paragraph (1) may affect the 
     administration of other programs carried out by the 
     Department of Health and Human Services, including the 
     programs under title XVIII, XIX or XXI of the Social Security 
     Act, or may affect health information that is subject to a 
     standard developed under part C of title XI of the Social 
     Security Act, they shall be in the form of recommendations to 
     the Secretary for such program.
       ``(b) Statistics and Analyses.--The Director shall--
       ``(1) take appropriate action to ensure that statistics and 
     analyses developed under this title are of high quality, 
     timely, and duly comprehensive, and that the statistics are 
     specific, standardized, and adequately analyzed and indexed; 
     and
       ``(2) publish, make available, and disseminate such 
     statistics and analyses on as wide a basis as is practicable.
       ``(c) Authority Regarding Certain Requests.--Upon request 
     of a public or private entity, the Director may conduct or 
     support research or analyses otherwise authorized by this 
     title pursuant to arrangements under which such entity will 
     pay the cost of the services provided. Amounts received by 
     the Director under such arrangements shall be available to 
     the Director for obligation until expended.

     ``SEC. 924. DISSEMINATION OF INFORMATION.

       ``(a) In General.--The Director shall--
       ``(1) without regard to section 501 of title 44, United 
     States Code, promptly publish, make available, and otherwise 
     disseminate, in a form understandable and on as broad a basis 
     as practicable so as to maximize its use, the results of 
     research, demonstration projects, and evaluations conducted 
     or supported under this title;
       ``(2) ensure that information disseminated by the Agency is 
     science-based and objective and undertakes consultation as 
     necessary to assess the appropriateness and usefulness of the 
     presentation of information that is targeted to specific 
     audiences;
       ``(3) promptly make available to the public data developed 
     in such research, demonstration projects, and evaluations;
       ``(4) provide, in collaboration with the National Library 
     of Medicine where appropriate, indexing, abstracting, 
     translating, publishing, and other services leading to a more 
     effective and timely dissemination of information on 
     research, demonstration projects, and evaluations with 
     respect to health care to public and private entities and 
     individuals engaged in the improvement of health care 
     delivery and the general public, and undertake programs to 
     develop new or improved methods for making such information 
     available; and
       ``(5) as appropriate, provide technical assistance to State 
     and local government and health agencies and conduct liaison 
     activities to such agencies to foster dissemination.
       ``(b) Prohibition Against Restrictions.--Except as provided 
     in subsection (c), the Director may not restrict the 
     publication or dissemination of data from, or the results of, 
     projects conducted or supported under this title.
       ``(c) Limitation on Use of Certain Information.--No 
     information, if an establishment or person supplying the 
     information or described in it is identifiable, obtained in 
     the course of activities undertaken or supported under this 
     title may be used for any purpose other than the purpose for 
     which it was supplied unless such establishment or person has 
     consented (as determined under regulations of the Director) 
     to its use for such other purpose. Such information may not 
     be published or released in other form if the person who 
     supplied the information or who is described in it is 
     identifiable unless such person has consented (as determined 
     under regulations of the Director) to its publication or 
     release in other form.
       ``(d) Penalty.--Any person who violates subsection (c) 
     shall be subject to a civil monetary penalty of not more than 
     $10,000 for each such violation involved. Such penalty shall 
     be imposed and collected in the same manner as civil money 
     penalties under subsection (a) of section 1128A of the Social 
     Security Act are imposed and collected.

     ``SEC. 925. ADDITIONAL PROVISIONS WITH RESPECT TO GRANTS AND 
                   CONTRACTS.

       ``(a) Financial Conflicts of Interest.--With respect to 
     projects for which awards of grants, cooperative agreements, 
     or contracts are authorized to be made under this title, the 
     Director shall by regulation define--
       ``(1) the specific circumstances that constitute financial 
     interests in such projects that will, or may be reasonably 
     expected to, create a bias in favor of obtaining results in 
     the projects that are consistent with such interests; and
       ``(2) the actions that will be taken by the Director in 
     response to any such interests identified by the Director.
       ``(b) Requirement of Application.--The Director may not, 
     with respect to any program under this title authorizing the 
     provision of grants, cooperative agreements, or contracts, 
     provide any such financial assistance unless an application 
     for the assistance is submitted to the Secretary and the 
     application is in such form, is made in such manner, and 
     contains such agreements, assurances, and information as the 
     Director determines to be necessary to carry out the program 
     involved.
       ``(c) Provision of Supplies and Services in Lieu of 
     Funds.--
       ``(1) In general.--Upon the request of an entity receiving 
     a grant, cooperative agreement, or contract under this title, 
     the Secretary may, subject to paragraph (2), provide 
     supplies, equipment, and services for the purpose of aiding 
     the entity in carrying out the project involved and, for such 
     purpose, may detail to the entity any officer or employee of 
     the Department of Health and Human Services.
       ``(2) Corresponding reduction in funds.--With respect to a 
     request described in paragraph (1), the Secretary shall 
     reduce the amount of the financial assistance involved by an 
     amount equal to the costs of detailing personnel and the fair 
     market value of any supplies, equipment, or services provided 
     by the Director. The Secretary shall, for the payment of 
     expenses incurred in complying with such request, expend the 
     amounts withheld.
       ``(d) Applicability of Certain Provisions With Respect to 
     Contracts.--Contracts may be entered into under this part 
     without regard to sections 3648 and 3709 of the Revised 
     Statutes (31 U.S.C. 529; 41 U.S.C. 5).

     ``SEC. 926. CERTAIN ADMINISTRATIVE AUTHORITIES.

       ``(a) Deputy Director and Other Officers and Employees.--
       ``(1) Deputy director.--The Director may appoint a deputy 
     director for the Agency.

[[Page 23038]]

       ``(2) Other officers and employees.--The Director may 
     appoint and fix the compensation of such officers and 
     employees as may be necessary to carry out this title. Except 
     as otherwise provided by law, such officers and employees 
     shall be appointed in accordance with the civil service laws 
     and their compensation fixed in accordance with title 5, 
     United States Code.
       ``(b) Facilities.--The Secretary, in carrying out this 
     title--
       ``(1) may acquire, without regard to the Act of March 3, 
     1877 (40 U.S.C. 34), by lease or otherwise through the 
     Director of General Services, buildings or portions of 
     buildings in the District of Columbia or communities located 
     adjacent to the District of Columbia for use for a period not 
     to exceed 10 years; and
       ``(2) may acquire, construct, improve, repair, operate, and 
     maintain laboratory, research, and other necessary facilities 
     and equipment, and such other real or personal property 
     (including patents) as the Secretary deems necessary.
       ``(c) Provision of Financial Assistance.--The Director, in 
     carrying out this title, may make grants to public and 
     nonprofit entities and individuals, and may enter into 
     cooperative agreements or contracts with public and private 
     entities and individuals.
       ``(d) Utilization of Certain Personnel and Resources.--
       ``(1) Department of health and human services.--The 
     Director, in carrying out this title, may utilize personnel 
     and equipment, facilities, and other physical resources of 
     the Department of Health and Human Services, permit 
     appropriate (as determined by the Secretary) entities and 
     individuals to utilize the physical resources of such 
     Department, and provide technical assistance and advice.
       ``(2) Other agencies.--The Director, in carrying out this 
     title, may use, with their consent, the services, equipment, 
     personnel, information, and facilities of other Federal, 
     State, or local public agencies, or of any foreign 
     government, with or without reimbursement of such agencies.
       ``(e) Consultants.--The Secretary, in carrying out this 
     title, may secure, from time to time and for such periods as 
     the Director deems advisable but in accordance with section 
     3109 of title 5, United States Code, the assistance and 
     advice of consultants from the United States or abroad.
       ``(f) Experts.--
       ``(1) In general.--The Secretary may, in carrying out this 
     title, obtain the services of not more than 50 experts or 
     consultants who have appropriate scientific or professional 
     qualifications. Such experts or consultants shall be obtained 
     in accordance with section 3109 of title 5, United States 
     Code, except that the limitation in such section on the 
     duration of service shall not apply.
       ``(2) Travel expenses.--
       ``(A) In general.--Experts and consultants whose services 
     are obtained under paragraph (1) shall be paid or reimbursed 
     for their expenses associated with traveling to and from 
     their assignment location in accordance with sections 5724, 
     5724a(a), 5724a(c), and 5726(C) of title 5, United States 
     Code.
       ``(B) Limitation.--Expenses specified in subparagraph (A) 
     may not be allowed in connection with the assignment of an 
     expert or consultant whose services are obtained under 
     paragraph (1) unless and until the expert agrees in writing 
     to complete the entire period of assignment, or 1 year, 
     whichever is shorter, unless separated or reassigned for 
     reasons that are beyond the control of the expert or 
     consultant and that are acceptable to the Secretary. If the 
     expert or consultant violates the agreement, the money spent 
     by the United States for the expenses specified in 
     subparagraph (A) is recoverable from the expert or consultant 
     as a statutory obligation owed to the United States. The 
     Secretary may waive in whole or in part a right of recovery 
     under this subparagraph.
       ``(g) Voluntary and Uncompensated Services.--The Director, 
     in carrying out this title, may accept voluntary and 
     uncompensated services.

     ``SEC. 927. FUNDING.

       ``(a) Intent.--To ensure that the United States investment 
     in biomedical research is rapidly translated into 
     improvements in the quality of patient care, there must be a 
     corresponding investment in research on the most effective 
     clinical and organizational strategies for use of these 
     findings in daily practice. The authorization levels in 
     subsections (b) and (c) provide for a proportionate increase 
     in health care research as the United States investment in 
     biomedical research increases.
       ``(b) Authorization of Appropriations.--For the purpose of 
     carrying out this title, there are authorized to be 
     appropriated $250,000,000 for fiscal year 2000, and such sums 
     as may be necessary for each of the fiscal years 2001 through 
     2004.
       ``(c) Evaluations.--In addition to amounts available 
     pursuant to subsection (b) for carrying out this title, there 
     shall be made available for such purpose, from the amounts 
     made available pursuant to section 241 (relating to 
     evaluations), an amount equal to 40 percent of the maximum 
     amount authorized in such section 241 to be made available 
     for a fiscal year.

     ``SEC. 928. DEFINITIONS.

       ``In this title:
       ``(1) Advisory council.--The term `Advisory Council' means 
     the Advisory Council on Health Care Research and Quality 
     established under section 921.
       ``(2) Agency.--The term `Agency' means the Agency for 
     Health Research and Quality.
       ``(3) Director.--The term `Director' means the Director of 
     the Agency for Health Research and Quality.''.
       (b) Rules of Construction.--
       (1) In general.--Section 901(a) of the Public Health 
     Service Act (as added by subsection (a) of this section) 
     applies as a redesignation of the agency that carried out 
     title IX of such Act on the day before the date of enactment 
     of this Act, and not as the termination of such agency and 
     the establishment of a different agency. The amendment made 
     by subsection (a) of this section does not affect 
     appointments of the personnel of such agency who were 
     employed at the agency on the day before such date.
       (2) References.--Any reference in law to the Agency for 
     Health Care Policy and Research is deemed to be a reference 
     to the Agency for Health Research and Quality, and any 
     reference in law to the Administrator for Health Care Policy 
     and Research Quality.


                Amendment No. 3 Offered by Mr. Bilirakis

  Mr. BILIRAKIS. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 3 offered by Mr. Bilirakis:
       Page 3, line 2, strike ``by'' and all that follows through 
     ``research'' on line 3 and insert the following: ``by 
     conducting and supporting--
       `` `(1) research''.
       Page 4, line 3, strike ``synthesizing and disseminating'' 
     and insert ``the synthesis and dissemination of''.
       Page 4, line 7, strike ``advancing'' and insert 
     ``initiatives to advance''.
       Page 4, beginning on line 11, strike ``shall undertake'' 
     and all that follows through ``evaluations'' on line 12 and 
     insert the following: ``shall conduct and support research 
     and evaluations, and support demonstration projects,''.
       Page 4, line 25, strike ``shall support'' and all that 
     follows through ``activities'' on page 5, line 4, and insert 
     the following: ``shall conduct and support research, 
     evaluations, and training, support demonstration projects, 
     research networks, and multi-disciplinary centers, provide 
     technical assistance, and disseminate information on health 
     care and on systems for the delivery of such care, including 
     activities''.
       Page 6, line 5, strike ``made available under section 487'' 
     and insert ``made available under section 487(d)(3) for the 
     Agency''.
       Page 7, beginning on line 21, strike ``that it uses''.
       Page 7, line 23, strike ``that it uses''.
       Page 7, line 24, strike ``behind health care practice'' and 
     insert ``underlying health care practice''.
       Page 8, beginning on line 15, strike ``Health Care 
     Improvement Research Centers'' and insert ``health care 
     improvement research centers''.
       Page 8, line 20, strike ``Provider-based Research 
     Networks'' and insert ``provider-based research networks''.
       Page 8, line 23, insert ``evaluate and'' before ``promote 
     quality improvement''.
       Page 13, beginning on line 7, strike ``In carrying out 
     902(a), the Director'' and insert ``The Director''.
       Page 14, beginning on line 5, strike ``, the needs'' and 
     all that follows through ``and monitor'' on line 8 and insert 
     the following: ``, including the health care needs of 
     populations identified in section 901(c), provide data to 
     study the relationships between health care quality, 
     outcomes, access, use, and cost, measure changes over time, 
     and monitor''.
       Page 15, beginning on line 10, strike ``shall support 
     research, evaluations and initiatives to advance'' and insert 
     ``shall conduct and support research, evaluations, and 
     initiatives to advance''.
       Page 18, beginning on line 15, strike ``clinical practice 
     and health care technologies'' and insert ``health care 
     practices and technologies''.
       Page 18, beginning on line 21, strike ``health care 
     practices and health care technologies'' and insert ``health 
     care practices and technologies''.
       Page 19, line 1, strike ``promoting education, training, 
     and providing'' and insert ``promoting education and training 
     and providing''.
       Page 19, beginning on line 2, strike ``health care practice 
     and health care technology assessment'' and insert ``health 
     care practice and technology assessment''.
       Page 20, line 4, insert ``health care'' before 
     ``technologies''.
       Page 25, line 5, insert ``National'' before ``Advisory 
     Council''.
       Page 29, beginning on line 4, strike ``the maximum rate of 
     basic pay payable for GS-18 of the General Schedule'' and 
     insert the following: ``the daily equivalent of the annual 
     rate of basic pay prescribed for level IV of the Executive 
     Schedule under section 5315 of title 5, United States Code, 
     for each day during which such member is engaged in the 
     performance of the duties of the Advisory Council''.
       Page 43, line 2, insert ``National'' before ``Advisory 
     Council''.

  Mr. BILIRAKIS. Mr. Chairman, this is an en bloc technical amendment 
to section 2 of the bill as reported by the Committee on Commerce. 
Section 2 of the bill is divided into three parts.

[[Page 23039]]

  Part A provides for the reauthorization of the agency for health care 
policy and research and renames it the Agency for Health Research and 
Quality and outlines the agency's mission and general authorities. Part 
A also establishes specific requirements that the agency must meet as 
well as limitations on the agency's authority and provides the agency 
with authority to support training programs.
  Part B outlines the specific programmatic authority of the agency in 
six broad areas and includes a seventh section to promote coordination 
and reduce unnecessary duplication of existing health services, 
research, quality research, and improvement activities. The six 
programmatic areas include outcomes research, organization and delivery 
research, quality and cost of care research, and data development 
information systems for health care improvement, primary care and 
access research, and practice and technology assessment.
  Part C governs the daily administration of the agency, establishes 
its national advisory counsel and sets the authorization levels for the 
agency. This section outlines the agency's authority to support grants 
and contracts and establishes requirements for scientific peer review 
of research funded by the agency and the dissemination of research 
findings.
  The committee was unable, Mr. Chairman, to make these technical 
corrections to the text of the bill before reporting it, however we 
have met with the minority and with the administration, and we are all 
in agreement that these amendments are technical in nature, improve the 
underlying text and do not make substantive changes in the bill as it 
was reported. For these reasons, I ask my colleagues for support of 
this en bloc amendment.
  Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
  Mr. BILIRAKIS. I yield to the gentleman from Ohio.
  Mr. BROWN of Ohio. Mr. Chairman, I agree. I concur with what the 
gentleman said. This is a by and large technical amendment that we 
worked on together as we worked on the bill together, and I ask my 
colleagues to support the Bilirakis amendment.
  Mr. BILIRAKIS. Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Florida (Mr. Bilirakis).
  The amendment was agreed to.


                Amendment No. 12 Offered by Mr. Andrews

  Mr. ANDREWS. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 12 offered by Mr. Andrews:
       Page 16, after line 15, insert the following subsection:
       (c) Certain Linkages Regarding Health Information.--
     Initiatives under subsection (a) shall include the 
     establishment, through a site maintained by the Director on 
     the telecommunications medium known as the World Wide Web, of 
     linkages that enable users of the site to obtain information 
     from consumer satisfaction agencies or other entities that 
     perform evaluations regarding the quality of health care, 
     including more than one link to entities that evaluate health 
     maintenance organizations, and including a link of the 
     National Committee for Quality Assurance.


        Modification to Amendment No. 12 Offered By Mr. Andrews

  Mr. ANDREWS. Mr. Chairman, I ask unanimous consent that slight 
technical modifications to the underlying amendment be considered in 
order.
  The CHAIRMAN. The Clerk will report the modification.
  The Clerk read as follows:

       Modification to Amendment No. 12 offered by Mr. Andrews:
       Page 16, after line 15, insert the following subsection:
       (c) Certain Linkages Regarding Health Information.--
     Initiatives under subsection (a) shall include the 
     establishment, through a site maintained by the Director on 
     the telecommunications medium known as the World Wide Web, of 
     linkages that enable users of the site to obtain information 
     from consumer satisfaction agencies or other entities that 
     perform evaluations regarding the quality of health care, 
     including more than one link to entities that evaluate health 
     maintenance organizations, and including a link of the 
     National Committee for Quality Assurance.

  Mr. ANDREWS (during the reading). Mr. Chairman, I ask unanimous 
consent that the modification be considered as read and printed in the 
Record.
  The CHAIRMAN. Is there objection to the request of the gentleman from 
New Jersey?
  There was no objection.
  The CHAIRMAN. Is there objection to the modification?
  There was no objection.
  Mr. ANDREWS. Mr. Chairman, I first wanted to thank and congratulate 
the gentleman from Florida (Mr. Bilirakis) and the gentleman from Ohio 
(Mr. Brown) for their leadership in bringing this legislation to the 
floor. It is worthy of unanimous support of the House, and I 
enthusiastically support the bill.
  My amendment speaks to a very traditional value and a new technology. 
The traditional value is enlightened consumer choice. When we buy a 
toaster or an automobile or a house, we have all kinds of information 
available to us about the quality of the product that we are buying. 
There are government and private for-profit and private nonprofit 
sources of such information readily available. So should such 
information be available with respect to health care plans; and that is 
where this traditional value is combined with a new technology, the 
World Wide Web.
  The purpose of my amendment is to call on the AHCPR to make available 
on a web site on the World Wide Web a collection of information offered 
by nonprofit and public groups that evaluate and give information about 
the quality of health care plans to consumers. If this amendment is 
included, consumers will be able to visit the web site and click on 
information from groups such as the National Committee for Quality 
Assurance and other institutions that provide independent, verifiable, 
valuable information to consumers about the quality of health insurance 
choices available to them. I believe that by bringing together the 
traditional concept of consumer empowerment and the relatively new 
technology of the World Wide Web that we help more American decision 
makers make better decisions about the health care choices before them.
  Mr. Chairman, I urge the adoption of the amendment.
  Mr. BILBRAY. Mr. Chairman, I rise in support of the amendment offered 
by the gentleman from New Jersey.
  The majority has had an opportunity to review the amendment which 
would require that, as the gentleman said, that the director maintain 
Internet linkages to appropriate sites and provide information on 
consumer satisfaction with health care and specifically health 
maintenance organizations, and we are prepared to accept the amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I move to strike the last word.
  I rise in support of the Andrews amendment and compliment him on his 
forward thinking on this issue. Transparency in the health care system 
is particularly important. I think this will contribute to that, and I 
ask Members on this side of the aisle and both sides of the aisle to 
support the Andrews amendment.
  The CHAIRMAN. The question is on the amendment, as modified, offered 
by the gentleman from New Jersey (Mr. Andrews).
  The amendment, as modified, was agreed to.


           Amendment No. 16 Offered by Mr. Davis of Illinois

  Mr. DAVIS of Illinois. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 16 offered by Mr. Davis of Illinois:
       Page 6, strike lines 6 through 10 and insert the following:
       ``(2) Requirements.--In developing priorities for the 
     allocation of training funds under this subsection, the 
     Director shall take into consideration shortages in the 
     number of trained researchers who are members of one of the 
     priority populations and the number of trained researchers 
     who are addressing the priority populations.

  Mr. DAVIS of Illinois. Mr. Chairman, let me first of all commend the 
gentleman from Florida (Mr. Bilirakis)

[[Page 23040]]

and the ranking member, the gentleman from Ohio (Mr. Brown), for the 
work that they have done on this particular bill.
  Mr. Chairman, the mission of this bill is to enhance the quality 
appropriateness and effectiveness of health services and access to 
those services. The amendment that I offer today is consistent with the 
underlying mission of the bill. This amendment seeks to address the 
issue of under-representation of individuals from the priority 
populations who receive training funds. This amendment merely suggests 
that the director take into consideration to the extent possible 
shortages in the number of trained researchers who are members of one 
of the priority populations and the number of trained researchers who 
are addressing the priority populations.
  Mr. Chairman, it is my position that trained individuals with the 
greatest levels of contact, experiences and interactions with priority 
populations have a better chance to have acquired keener insight into 
understanding the characteristics and behaviors of these population 
groups. That keener insight may help them better understand factors 
which impede individuals in priority populations from movement towards 
acquisition of equity in health care and health status. Their greater 
familiarity with low-income and minority groups may afford them the 
level of sensitivity that is needed to get them the results which are 
desired.
  Mr. Chairman, it is not easy to arrive at the desired results because 
when we look at the numbers of pre- and post-doctoral fellows, health 
researchers and medical doctors, the numbers from priority populations 
are very low and, in some instances, are in danger of even getting 
lower. According to Dr. Robert G. Petersdor, President of the 
Association of Medical Colleges, in 1992, he stated that not only have 
we not made any progress since the mid-1970s toward our goal of 
providing equitable access to medical school for students from all of 
society, we have been losing ground. For example, in 1996 there were 
reported to be 737,734 physicians in this country: 373,539 or 50.6 
percent were of the majority population, 13,759 or 1.8 percent were 
black, 21,841 or 3.0 percent were Hispanic, 48,913 or 6.6 percent were 
Asian Oriental, 225 or .0003 or three tenths of one thousandth percent 
were American Native Alaskan, 11,943 or 1.6 percent with others, and 
267,544 or 36.0 percent were unknown. Of course, the American Medical 
Association only had racial and ethnic data on about 64 percent of all 
the physicians in the United States.
  In 1996, there were 100 fewer under-represented minorities accepted 
into medical schools and only 10 percent of all medical school 
graduates were members of these under-represented minority groups who 
make up a total of approximately 28 percent of the total U.S. 
population.

                              {time}  1515

  We ought to make every effort to find individuals from these 
populations; and, in addition, we must make sure that these priority 
populations are adequately covered in terms of the number of trained 
researchers. It is my understanding that the Department of Health and 
Human Services supports this amendment and agrees that this effort must 
be made.
  Therefore, I would urge its immediate adoption.
  Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment.
  Mr. Chairman, the majority has had an opportunity to review the 
amendment which would require, as the gentleman said, that the director 
in allocating health services training grants under section 902 take 
into consideration shortages in the number of trained researchers who 
are one of a number of priority populations, as well as shortages in 
the number of trained researchers who are addressing the priority of 
populations. We are prepared to accept the amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, I rise in support of the Davis amendment and commend 
the gentleman on his work in promoting equal access for medical 
researchers and medical training. I think it is certainly an issue 
whose time has come. I thank the gentleman from Illinois for his work 
and ask the support of the House for the Davis amendment.
  The CHAIRMAN pro tempore (Mr. Quinn). The question is on the 
amendment offered by the gentleman from Illinois (Mr. Davis).
  The amendment was agreed to.


     Amendments No. 2 and No. 1 Offered by Ms. Jackson-Lee of Texas

  Ms. JACKSON-LEE of Texas. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 2 offered by Ms. Jackson-Lee of Texas:
       Page 4, line 14, insert ``In inner-city areas and'' after 
     ``health services''.

  Ms. JACKSON-LEE of Texas. Mr. Chairman, let me thank the ranking 
member and the chairman and their staff for the cooperation with my 
staff on an issue that I think we all can agree on. Let me also note my 
agreement with the amendments of the gentleman from Illinois (Mr. 
Davis), in talking about adding historically black colleges and 
Hispanic-serving colleges to the idea or the concept of research.
  This amendment adds the language ``inner-city'' to the provision of 
the bill which speaks to rural health care, and it does speak to 
minority groups; but this now makes it in particular an emphasis on 
some of our urban and inner-city areas.
  I come from one of the largest cities in the Nation, in fact the 
fourth largest city in the Nation, and am an avid supporter for the 
access of health care to be spread throughout our Nation, rural areas, 
urban areas, and our particular unique groups. But I think it is 
important to emphasize some of the special health care needs that we 
find in the inner city in populations that tend to be minority.
  For example, let me bring to the attention of my colleagues that, 
although we are talking about another matter, appropriations, I do not 
know if they are aware of the fact that last year we had 783 rural 
health clinics, and we are now down to 483 rural health clinics, 
particularly in my State, in the State of Texas.
  In addition, we have determined that a one-third decrease has 
occurred in inner-city health clinics. So we know for sure that we are 
declining in the access of health care. So this particular legislation, 
which focuses on the research and determination of access and better 
health care, is extremely important.
  If I might cite for you the issue of AIDS, it disproportionately 
affects the minority populations. Racial and ethnic minorities 
constitute approximately 25 percent of the total U.S. population, yet 
they account for nearly 54 percent of all AIDS cases. During 1995 and 
1996, AIDS death rates declined 23 percent for the total U.S. 
population, while declining only 13 percent for blacks and 20 percent 
for Hispanics. Contributing factors for these mortality disparities 
include late identification of disease and lack of health insurance to 
pay for drug therapies. So this bill's actual impact will be far 
reaching as we define minorities to include the inner cities.
  For men and women combined, blacks have a cancer death rate about 35 
percent higher than that for whites. The incidence rate for lung cancer 
in black men is about 50 percent higher than in white men. Native 
Hawaiian men, Alaskan native men and women, Vietnamese women and 
Hispanic women particularly suffer from elevated rates of cancer; and 
although these different groups are located throughout the United 
States, many times, because of job searches, they look for the inner 
city and find themselves in the inner city. In fact, Mr. Chairman, many 
new immigrant groups will find themselves in the inner city 
additionally.
  I would also like to note that, again, major disparities exist upon 
population groups, particularly for minority and low-income 
populations. The age-adjusted death rate for coronary heart disease for 
the total population declined by 20 percent from 1987 to 1995. For 
blacks, the overall decrease was

[[Page 23041]]

only 13 percent. So we can see the screening for cholesterol is 
extremely important.
  Diabetes is extremely important, which results in the complications 
such as end-stage renal disease, and amputations are much higher among 
black and American Indians when compared to the total population.
  I am very pleased that we have this legislation on the floor of the 
House, and I simply would like to add this language of the inner city 
in order to ensure that all of the resources that are brought to bear 
on this problem will get all of our populations, and particularly those 
who suffer the greatest lack of access to health care.
  I close by simply saying, Mr. Chairman, I have a very large public 
health system. It is overwhelmed. In fact, it suffers from lack of 
resources. I do know that the more knowledge we have about access of 
health care for minorities and inner-city residents, along with rural 
communities, will help our country in doing a better job of serving our 
constituencies. I would like my colleagues and solicit my colleagues' 
support for this amendment.
  Mr. Chairman, I rise to offer an amendment to H.R. 2506 that would 
include inner city areas as special populations that deserve priority. 
I commend my colleagues for introducing this legislation to improve the 
quality and effectiveness of health services. This amendment simply 
extends the reach of this measure to areas of society that desperately 
need our assistance.
  As written, this bill would provide innumerable benefits to 
Americans, but we must not be blind to the fact that many Americans 
cannot drink from this well. It is a sad fact that nowhere are 
divisions of race and ethnicity more sharply drawn than in the health 
of our people.
  For instance, AIDS disproportionately affects minority populations. 
Racial and ethnic minorities constitute approximately 25 percent of the 
total U.S. population, yet, they account for nearly 54 percent of all 
AIDS cases. During 1995 and 1996, AIDS death rates declined 23 percent 
for the total U.S. population while declining only 13 percent for 
blacks and 20 percent for Hispanics. Contributing factors for these 
mortality disparities include late identification of disease and lack 
of health insurance to pay for drug therapies.
  Cancer is also a leading cause of death in America. Many minority 
groups suffer disproportionately from cancer. Disparities exist in both 
mortality and incidence rates. For men and women combined, blacks have 
a cancer death rate about 35 percent higher than that for whites. The 
incidence rate for lung cancer in black men is about 50 percent higher 
than in white men. Native Hawaiian men, Alaskan native men and women, 
Vietnamese women, and Hispanic women particularly suffer from elevated 
rates of cancer. We must provide far greater screening opportunities 
for these members of society, and we can do so with this amendment.
  Cardiovascular disease is a leading killer and a leading cause of 
disability in the United States. Again, major disparities exist among 
population groups, particularly for minority and low-income 
populations. The age-adjusted death rate for coronary heart disease for 
the total population declined by 20 percent from 1987 to 1995; for 
blacks the overall decrease was only 13 percent. Rates of screening for 
cholesterol show disparities for racial and ethnic minorities, and 
without such screening, our citizens will continue to suffer from the 
debilitating effects of cardiovascular disease.
  Diabetes also affects more minorities than whites. The prevalence of 
diabetes is approximately 70 percent higher than whites and the 
prevalence in Hispanics is nearly double that of whites. Preventative 
interventions should target high-risk groups. Diabetes complications 
such as End-Stage Renal Disease and amputations are much higher among 
black and American Indians when compared to the total population. Early 
detection, improved care, and education can prevent this disease from 
incapacitating America's men and women. But we must provide these 
important health care services.
  Finally, infant mortality remains a threat to our children. Although 
the rate has declined to a record low of 7.2 per 1,000 live births in 
1996, infant mortality still greatly threatens certain racial and 
ethnic groups. Infant death rates among blacks, American Indians and 
Alaska natives, and Hispanics were all above the national average. 
Infant morality can be combated with timely prenatal care, but 84 
percent of white pregnant women received such care while only 71 
percent of black and Hispanic pregnant women received early pre-natal 
care. Eliminating these disparities requires the removal of financial, 
educational, social, and logistical barriers to health care services.
  This bill, as written, appropriately recognizes that rural areas are 
in particular need of health care. But as statistics clearly indicate, 
the inner city areas also need quality health care, and we can provide 
just that with this amendment. I strongly urge my colleagues to support 
this common-sense amendment.
  Mr. BILIRAKIS. Mr. Chairman, will the gentlewoman yield?
  Ms. JACKSON-LEE of Texas. I yield to the gentleman from Florida.
  Mr. BILIRAKIS. Mr. Chairman, I thank the gentlewoman for yielding, 
and I say to her that the majority has had an opportunity to review the 
amendment, which would add inner-city areas to rural and frontier areas 
among the geographic priority populations included in the submission.
  I commend the gentlewoman for formulating this amendment, and we are 
prepared to accept it.
  Mr. BROWN of Ohio. Mr. Chairman, will the gentlewoman yield?
  Ms. JACKSON-LEE of Texas. I yield to the gentleman from Ohio.
  Mr. BROWN of Ohio. Mr. Chairman, I thank the gentlewoman from Houston 
and rise in support of the amendment. It makes good sense with the 
HCPR's work in the past in rural areas that inner cities should be 
included, and ask for support of the amendment.
  Ms. JACKSON-LEE of Texas. Mr. Chairman, reclaiming my time, I thank 
the gentleman very much. Again, let me thank the chairman and the 
ranking member for their excellent leadership on this legislation.
  Mr. Chairman, I have another amendment. There are colleagues on the 
floor. I would be able to discuss that amendment very quickly within 
this time frame and have us all out of the way. I understand that we 
have mutual agreement on moving forward.
  Is that appropriate at this time, so that my other colleagues can go 
forward?
  The CHAIRMAN pro tempore. The gentlewoman controls the time.
  Ms. JACKSON-LEE of Texas. Mr. Chairman, I have an amendment at the 
desk.
  The CHAIRMAN pro tempore. Is the gentlewoman asking to offer her 
amendment at this time?
  Ms. JACKSON-LEE of Texas. I am.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 1 offered by Ms. Jackson-Lee of Texas:
       Page 4, line 9, strike ``(c)'' and all that follows through 
     ``the Director shall'' on line 11 and insert the following:
       ``(c) Requirements With Respect to Special Populations.--
     There is established within the Agency an office to be known 
     as the Office on Special Populations, which shall be headed 
     by an official appointed by the Director. The Director, 
     acting through such Office, shall''.

  The CHAIRMAN pro tempore. Is there objection to considering these 
amendments en bloc?
  There was no objection.
  The CHAIRMAN pro tempore. The gentlewoman from Texas is recognized 
for 5 minutes.
  Ms. JACKSON-LEE of Texas. Mr. Chairman, this amendment is dealing 
with creating an Office of Special Populations within the Agency for 
Health Research and Quality which will give us the opportunity to focus 
on the authority to conduct health care research, demonstration 
projects and evaluations with respect to low-income groups and minority 
groups.
  I would simply say that this complements the earlier amendment that I 
have and would be delighted to have these accepted en bloc.

[[Page 23042]]

  I rise to offer an amendment to H.R. 2506, the Health Research and 
Quality Act of 1999 that would create an office known as the Office on 
Special Populations, which shall be headed by an official appointed by 
the director.
  I commend my colleagues for introducing this legislation to provide 
higher quality and more effective health services to our citizens. This 
bill will improve health care services and will provide greater 
prevention of diseases and other health conditions through improvements 
in clinical and health system practices.
  Currently, the bill designates a Director of the Agency for Health 
Care Policy and Research to oversee this measure. While I agree that we 
must provide oversight to this plan, I feel that one position cannot 
possibly serve the needs of our citizens. My amendment would diminish 
the burden on the Director by providing an Office of Special 
Populations.
  This office also would help the Director pinpoint the dilemmas facing 
our special populations--those living in rural or inner city areas. It 
is clear that these areas suffer from disease and health-related 
problems to a far greater extent than other areas.
  A great disparity exists between whites and certain races and ethnic 
cultures. At this time, we do not know all of the reasons for this 
disturbing gap. Inadequate education, disproportionate poverty, 
discrimination in the delivery of health services, cultural differences 
likely contribute to the problem. This office could study these factors 
and pinpoint those that most affect the rural and inner city areas. 
Such research greatly would contribute to our ability to then find 
solutions to our current problems and would allow our health services 
to reach the people who need them the most.
  This office would work concurrently with the Director to study and 
determine appropriate measures that will improve our Nation's health 
care. This office clearly would provide a support system for the 
Director, and it is my hope that this office would increase the overall 
efficiency of the Agency for Health Care Policy and Research.
  The disparities that are detrimentally affecting our inner city and 
rural areas are unacceptable. We must provide a comprehensive 
initiative that will effectively eliminate this gap. This amendment 
would achieve such a goal by providing an office whose mission is to 
eliminate disparities in health care. I urge my colleagues to support 
this vital amendment.
  Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment.
  Mr. Chairman, again, to reiterate, we have had an opportunity to 
review the amendment, which would establish this Office of Special 
Populations within the agency to which the director would carry out the 
requirements specified in said section 901(c). We are prepared to 
accept the amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, I agree with the second part of the amendment too and 
support the en bloc amendment and commend the gentlewoman from Texas 
(Ms. Jackson-Lee) for her good work on this.
  The CHAIRMAN pro tempore. The question is on the amendments offered 
by the gentlewoman from Texas (Ms. Jackson-Lee).
  The amendments were agreed to.


           Amendment No. 17 Offered by Mr. Davis of Illinois

  Mr. DAVIS of Illinois. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 17 offered by Mr. Davis of Illinois:
       Page 7, after line 14, insert the following subsection:
       ``(g) Annual Report.--Beginning with fiscal year 2003, the 
     Director shall annually submit to the Congress a report 
     regarding prevailing disparities in health care delivery as 
     it relates to racial factors and socio-economic factors in 
     priority populations.''

  Mr. DAVIS of Illinois. Mr. Chairman, I once again would commend the 
chairman and ranking member of this committee for the manner in which 
they have been able to bring this bill before us.
  Mr. Chairman, this amendment seeks to make sure that Congress has the 
necessary information regarding prevailing health disparities by 
requiring an annual report to be submitted beginning with the fiscal 
year 2003 regarding prevailing disparities in health care delivery as 
it relates to racial factors and socioeconomic factors.
  Mr. Chairman, racial and ethnic minority populations are among the 
fastest growing of all communities in America. Unfortunately, as 
African Americans, Hispanic, American Indians, Asian Americans and 
other Pacific Islanders in many respects have continued to grow, so too 
have their disparities in health care. These groups have poorer health 
and remain chronically underserved by the health care system.
  Significant gaps in health data still exist, as we have not kept pace 
with growth of these population groups with health care infrastructure 
and personnel. Historically, participation in research and data 
gathering activities on the part of some minority groups has been 
modest, and especially among African Americans, who are wary of 
research and researchers, stemming in part from knowledge of the 
Tuskegee experiment, when the Federal Government withheld a syphilis 
cure from hundreds of male participants in a study that lasted 4 
decades. President Clinton apologized for that experiment last spring, 
although it occurred long before his watch.
  Fortunately, new approaches, techniques, guarantees and protective 
protocols are being put into place and used to make data gathering and 
research more appealing. These population groups are responding more 
positively, and we need to make sure that these focuses and activities 
continue.
  I am aware that the Secretary of Health and Human Services has 
announced a plan to end racial disparities in health care and require 
the collection of data relative to racial factors. However, in this 
robust economy we have witnessed a widening of the gap in health care 
disparities. One would hope that we would have been more effective in 
narrowing the gap between the have's and the have-not's and between 
minority and majority population groups. In many instances, that has 
not happened.
  Age-adjusted breast cancer mortality increased 3.9 percent for black 
women and declined 15.4 percent for white women between 1985 and 1996. 
While the number of tuberculosis cases among non-Hispanic whites 
actually decreased 42.9 percent between 1986 and 1997, the number of 
reported tuberculosis cases increased 51.1 percent for Asian Americans 
and Pacific Islanders and 30.3 percent for Hispanics, according to the 
Center for Disease Control.
  I could go on and on and cite statistics relative to the prevalence 
of prostate cancer in African American men and the increasing rates of 
HIV-AIDS infection for African American women.
  In short, we need an annual report to measure whether we are making 
progress in ending racial disparities in health care and improving the 
quality of life for all Americans.
  This report will also underscore where we need to direct our 
resources and research. In my congressional district, for example, we 
have 22 hospitals, some of the finest in the country. At the same time, 
we have 175,000 people living at or below the poverty level. We also 
have some of the most dire health status indicators in Western 
civilization.
  This amendment is designed to try and make sure that we have adequate 
and accurate information on which to base policy and budgetary 
decisions.

                              {time}  1530

  Therefore, I urge support of this amendment and urge its immediate 
adoption.
  Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, I just want to say that the majority has had an 
opportunity to review this amendment, which would require that the 
director of the agency submit an annual report to the Congress 
beginning with fiscal year 2003 regarding prevailing disparities in 
health care deliveries as related to racial and socioeconomic factors 
in priority populations.
  We are prepared to accept the amendment and also commend the 
gentleman from Illinois (Mr. Davis) for his insight and preparation of 
this and the other amendments.
  Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the Davis 
amendment.
  Mr. Chairman, I congratulate him and compliment him on his work on a

[[Page 23043]]

very important issue. I think that the disparity in health care 
delivery, especially as it relates to different racial groups, 
different socioeconomic groups, is one of the most serious problems our 
health care system faces.
  It is not something we have done especially well as a Nation or as a 
society in the past, and I think the Davis amendment is a major step 
forward in alleviating some of those discrepancies and variations.
  I thank the gentleman for his good work and ask for support of his 
amendment.
  The CHAIRMAN pro tempore (Mr. Quinn). The question is on the 
amendment offered by the gentleman from Illinois (Mr. Davis).
  The amendment was agreed to.


            Amendment No. 6 Offered by Mr. Davis of Illinois

  Mr. DAVIS of Illinois. Mr. Chairman, I offer amendment No. 6.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 6 Offered by Mr. Davis of Illinois:
       Page 21, line 6, insert after ``agencies,'' the following: 
     ``minority institutions of higher education (such as 
     Historically Black Colleges and Universities, and Hispanic 
     institutions),''.

  Mr. DAVIS of Illinois. Mr. Chairman, this amendment seeks to 
recognize the unique diversity of our Nation and take full advantage of 
minority institutions in clinical practice and technology innovation. 
This amendment simply urges the director to consider utilizing minority 
institutions such as historically black colleges and universities and 
Hispanic institutions when awarding such grants regarding health-care 
technology.
  Our historically black colleges and universities have produced some 
of the greatest pioneers in the medical profession, for example, 
Charles Richard Drew, who was the pioneer of blood plasma preservation, 
to Ernest Just, who formulated new concepts of cell life and metabolism 
and pioneered investigations of egg fertilization.
  Inclusion of minority institutions in medical research has been 
inadequate. The National Institutes of Health Office of Financial 
Management reported that in 1997 they spent $12.7 billion on medical 
research. Of that, $8.46 billion went to higher education institutions. 
Historically black colleges and universities received just $79.8 
million of these dollars, less than 1 percent of the National 
Institutes of Health higher-education pie.
  It is our diversity that strengthens us as a Nation. Someone remarked 
that we are a Nation of communities, of tens and thousands of ethnic, 
religious, social, business, labor union, neighborhood, regional and 
other organizations, all of them varied, voluntary and unique; a 
brilliant diversity spread like stars, like a thousand points of light 
in a broad and peaceful sky.
  This amendment merely seeks to capitalize on this Nation's great 
diversity by making minority institutions eligible and by urging them 
to seek these grants. I believe that this is an important amendment 
because it places valuable resources in the hands of institutions that 
are capable and able to help produce the needed researchers and 
professionals that this country relies so much upon. I urge adoption of 
this amendment.
  Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, the majority has had an opportunity to review the 
amendment, finds that it is consistent with the functions of the agency 
which would expand the eligible entities to receive grants and 
contracts for clinical practices and technology innovation, as 
determined by the director to include minority institutions of higher 
education. We are prepared to accept the amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the amendment.
  Mr. Chairman, the amendment underscores how all society benefits from 
the richness of diversity. I ask for support of the Davis amendment.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentleman from Illinois (Mr. Davis).
  The amendment was agreed to.


         Amendment No. 7 Offered by Mr. Thompson of California

  Mr. THOMPSON of California. Mr. Chairman, I offer an amendment.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 7 offered by Mr. Thompson of California:
       Page 21, after line 8, insert the following subsection:
       ``(d) Medical Examination of Certain Victims.--
       ``(1) In general.--In carrying out subsection (a), the 
     Director shall promote evidence-based clinical practices 
     for--
       ``(A) the examination and treatment by health professionals 
     of individuals who are victims of sexual assault (including 
     child molestation) or attempted sexual assault; and
       ``(B) the training of health professionals on performing 
     medical evidentiary examinations of individuals who are 
     victims of child abuse or neglect, sexual assault, elder 
     abuse, or domestic violence.
       ``(2) Certain considerations.--Evidence-based clinical 
     practices promoted under paragraph (1) shall take into 
     consideration the expertise and experience of Federal and 
     State law enforcement officials regarding the victims 
     referred to in such paragraph, and of other appropriate 
     public and private entities (including medical societies, 
     victim services organizations, sexual assault prevention 
     organizations, and social services organizations).''

  Mr. THOMPSON of California. Mr. Chairman, I would like to commend the 
Committee on Commerce and the bill's sponsors, the gentleman from 
Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. Brown), for 
bringing this important bill to the floor today for our consideration.
  Mr. Chairman, thousands of individuals are sexually assaulted or 
abused in our country every year. Over 300,000 individuals were the 
victim of rape or sexual assault in 1998 alone. Many are children and 
many are elderly. In fact, recent studies reveal that an increasingly 
high percentage of the victims of rape or sexual assault are likely to 
be children. Fifteen percent of rape victims are under the age of 12, 
and 44 percent are under the age of 18.
  These are the most awful of crimes, and Congress has responded with 
enactment of new Federal penalties in 1994, as well as the 
establishment of a number of grant programs under the landmark Violence 
Against Women Act. There remain gaps in our Nation's response to this 
type of violence, particularly in our ability to prosecute the 
perpetrators. The amendment I offer is intended to fill some of these 
gaps.
  The amendment adds an important provision related to the quality of 
the training of health professionals in several very sensitive areas of 
their work: the identifications, treatment, and examination of victims 
of sexual assault and the collection of forensic evidence for the use 
of possible criminal prosecutions.
  While services encountered in some metropolitan centers can be 
excellent, access to trained medical practitioners is restricted and 
unevenly distributed. Many rural, mid-sized counties, and 
geographically large urban areas lack health professionals trained in 
identifying and treating victims of sexual assault and in conducting 
evidentiary examinations, collecting and preserving evidence and in 
interpreting findings. Many are inexperienced in collaborating with law 
enforcement agencies and investigating social workers.
  As a result, many victims of child molestation, domestic violence, 
and elder abuse are underserved or ill-served in the medical treatment 
and counseling that they receive. At the same time, in instances where 
proper evidence collection procedures are not followed, district 
attorneys are forced to drop charges against dangerous perpetrators for 
lack of evidence. Rather than rely on bad testimony or testimony given 
by children who are emotionally wrought because of the crime that had 
been committed against them, the prosecutor is forced to allow the 
perpetrator to walk away; and this person is often free to do his crime 
or her crime again.
  Lack of proper training and lack of retraining appears to be a 
particular problem in acute cases and in areas where multidisciplinary 
teams are not readily available. Lack of experience

[[Page 23044]]

can have several deleterious consequences. First, professionals who 
lack experience with the delicate nature of such evaluations may 
psychologically traumatize children.
  Mr. Chairman, the amendment before this body requires the director of 
the Agency for Health, Research and Quality to set forth and promote 
evidence-based clinical practices for identifying, examining, and 
treating victims of sexual assault and training medical professionals 
on how to perform medical evidentiary exams in child physical and 
sexual abuse, domestic violence and elder abuse cases.
  The amendment is supported by a number of groups, including the 
International Association of Forensic Nurses, the National Association 
of Social Workers, the Pennsylvania Coalition Against Rape, and the 
administration. This amendment is a small but important step in 
addressing a serious national problem, and I urge its adoption.
  Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, the staff has, as they have in all of these amendments, 
reviewed this amendment, spent an awful lot of time in many cases with 
the proposers' staffs. We have had an opportunity to review this 
particular amendment along with the others, which would require the 
director to include among the evidence-based clinical practices and 
health-care technologies promoted by the agency, the examination and 
treatment of victims of sexual assault, the training of health 
professionals in performing medical evidentiary examinations of persons 
who are victims of sexual assault, and we are prepared to accept this 
very good amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the Thompson 
amendment.
  Mr. Chairman, I congratulate my friend from California (Mr. Thompson) 
for his leadership on issues of child abuse and abuse of the elderly. 
This amendment will lead to better training of health professionals to 
deal with those problems of sexual abuse and child abuse and abuse of 
the elderly, and I ask the House for support of the Thompson amendment.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentleman from California (Mr. Thompson).
  The amendment was agreed to.


                Amendment No. 20 Offered by Mr. Pascrell

  Mr. PASCRELL. Mr. Chairman, I offer an amendment.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 20 offered by Mr. Pascrell:
       Page 13, after line 5, insert the following subsection:
       ``(d) Cancer and Cardiovascular Diseases in Women.--The 
     Director shall conduct and support research and build 
     private-public partnerships to enhance the quality, 
     appropriateness, and effectiveness of and access to health 
     services regarding cancer and cardiovascular diseases in 
     women, including with respect to the comparative 
     effectiveness, cost-effectiveness, and safety of such 
     services.''

  Mr. PASCRELL. Mr. Chairman, I would like to congratulate the 
gentleman from Florida (Mr. Bilirakis) for this terrific piece of 
common sense legislation. The amendment that I bring to the floor does 
not seek to undo any of the positive aspects of the bill. Instead, it 
improves upon an already outstanding bill by addressing one of our 
Nation's silent killers.
  While there is a growing awareness of the devastating impact that 
breast cancer has on American women, there is still a misguided belief 
that cancer and cardiovascular disease are men's diseases. My amendment 
simply seeks to shine the light on this misinterpretation.
  These misconceptions have kept us from realizing that these 
debilitating and deadly diseases have been historically understudied 
when it comes to their effect on women. In fact, it was not until the 
last decade that we have pushed the scientific and medical communities 
to study how diseases specifically impact upon women.
  As we all know, cardiovascular disease is the leading killer in this 
country. Approximately 960,000 Americans die of cardiovascular disease 
each year. What is not well known is that more women die of this 
disease each year than men. Women have different heart attack symptoms 
than men. Therefore, they are frequently misdiagnosed. Where a man may 
have chest pain, left arm numbness, a woman may have a shortness of 
breath and stomach pain, symptoms that are seen in many other 
conditions, not just heart attacks.
  Although women live longer than men, they typically suffer from other 
chronic disease which mask heart attack symptoms. Women also die of 
heart attacks at greater rates than men do. The lack of research in 
women's health issues has also been seen in cancer research. Cancer is 
the second leading killer in women, with lung cancer as the leading 
cause of cancer death.
  Significantly, over the past 10 years, the death rate from lung 
cancer has declined in men, but has continued to rise in women. Women 
also suffer from breast, colorectal, cervical, and ovarian cancers at 
alarming rates. Although ovarian cancer has the lowest incidence of 
death, this is the deadliest of all cancers.
  Let me explain for a second what I mean.

                              {time}  1545

  One woman in 55, will develop ovarian cancer over her lifetime, one 
in 55; yet the 5-year survival rate for ovarian cancer is 35 to 47 
percent. In contrast, prostate cancer has a 5-year 87 percent survival 
rate.
  We all agree that we have reached a day where we must study these 
diseases further. We must also come to an understanding that diseases 
affect men very differently than they affect women.
  Gender-specific research is critical in the move toward better 
treatment. Just as we must focus on rural and urban and underserved 
populations, we must also focus on the studying and treating women in 
the most beneficial, cost-effective, and safe way.
  The Health Research and Quality Act gives such an opportunity when it 
comes to studying heart disease and cancers in woman. That will help us 
meet our shared goal of providing the best of all care.
  I urge my colleagues to support my amendment.
  Mr. BILIRAKIS. Mr. Chairman, will the gentleman yield?
  Mr. PASCRELL. Yes, I yield to the gentleman from Florida.
  Mr. BILIRAKIS. Mr. Chairman, I asked the gentleman to yield just to 
share with the House that the majority has had an opportunity to review 
his amendment which would require that the director bill private-public 
partnerships, enhance the quality of and access to health services 
regarding cancer and cardiovascular services for women.
  I would also report to the gentleman that we have a markup at my 
committee in a couple of days, a breast cancer markup, a very important 
piece of legislation.
  We are prepared, Mr. Chairman, to accept the amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, I thank the gentleman from New Jersey (Mr. Pascrell), 
my friend, on his leadership on this issue and ask the House for 
support on the Pascrell amendment.
  Two weeks ago, I sponsored a women's health fair in Brunswick, Ohio, 
in my district. Among other speakers was Dr. John Schaeffer, a 
prominent cardiologist from Elyria, Ohio, who talked about many of the 
things and emphasized many of the statements that the gentleman from 
New Jersey (Mr. Pascrell) mentioned, among them that the incidence of 
heart attacks in men is higher, but the mortality rates are higher for 
women.
  In other words, men are much more likely to recognize the symptoms of 
heart disease because we, too often, in this society have said that 
heart disease is a male disease more and not a female disease. But the 
fact is it is the largest killer among women. More women die of heart 
attacks than men. Women need to be aware of the symptoms that are 
present in heart attacks.

[[Page 23045]]

As we have instructed men in this society to be aware of the symptoms, 
we need to do the same with women.
  I think including the Pascrell amendment in this legislation will be 
a major step towards that. I ask the House support of the Pascrell 
amendment.
  The CHAIRMAN pro tempore (Mr. Quinn). The question is on the 
amendment offered by the gentleman from New Jersey (Mr. Pascrell).
  The amendment was agreed to.


                 Amendment No. 9 Offered by Mr. Tierney

  Mr. TIERNEY. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 9 offered by Mr. Tierney:
       Page 12, after line 14, insert the following subparagraph:
       ``(C) The conduct of research on methods to reduce the 
     costs to consumers of obtaining prescription drugs.
       Page 12, line 15, strike ``(C)'' and insert ``(D)''.

  Mr. TIERNEY. Mr. Chairman, my amendment is rather brief. What it does 
is it seeks to have this following subparagraph, ``the conduct of 
research on methods to reduce the costs to consumers of obtaining 
prescription drugs,'' be included in this bill.
  Mr. Chairman, prescription drugs can improve health care, and it can 
save lives. But these benefits cannot be realized unless patients can 
afford their medications.
  H.R. 2506 already requires research on ways that new and appropriate 
uses of drugs can improve health quality and costs. Our amendment would 
simply add support for research on ways of promoting prescription drug 
affordability as well.
  Pharmaceutical manufacturers may argue that reducing prescription 
drug costs to consumers will reduce the profit incentive that drives 
researchers to develop new drugs. But, Mr. Chairman, that is a myth.
  Currently, the drug companies enjoy such large profits that they have 
ample room to cut costs without sacrificing research. The largest 
pharmaceutical manufacturers spend less on research and development 
than they make in pure profit; and the size of that profit is, indeed, 
substantial. The drug industry is three times more profitable than the 
average profitability of all other Fortune 500 industries.
  Moreover, if individual U.S. purchasers paid less, the drug 
manufacturers would likely continue to maintain their high-profit 
levels. They would simply make up for the decreased revenue by 
spreading costs, for instance, to other countries that now consistently 
pay far lower prices for their prescription drugs than do citizens in 
this country. Currently, many Americans find prescription drugs 
unaffordable, particularly our seniors.
  A recent Standard and Poor's report on the pharmaceutical industry 
tells us that drugmakers have historically raised prices to private 
consumers to compensate for the discounts they grant to managed-care 
customers.
  Seniors in my district, Mr. Chairman, and in my colleagues' are 
victims of this price discrimination. When we studied this issue in my 
district, we found that seniors were being forced to pay, on average, 
more than twice as much as the large insurance companies' clients.
  Other countries are also benefiting from discounts. Other countries 
are benefiting from discounts far more than our country. A drug that 
would cost $100 in the United States costs only $76 in Canada, $67 in 
Britain, $47 in Sweden, and $32 in Australia. There certainly is room 
for equalizing prices.
  Let me add the human dimension to what we are talking about, Mr. 
Chairman. One of my constituents, Louise Duda of Newburyport, 
Massachusetts, recently had a letter published in the local newspaper, 
the Daily News of Newburyport. It was a tragically familiar tale, one 
that I am sure many of my colleagues can already account in their 
districts.
  Mrs. Duda begins her letter by saying: ``I am sitting at my desk, 
with an involuntary flow of tears streaming down my cheeks. My husband 
sits close by, silently. I am angry, distraught, and feeling extremely 
defenseless. Why is our Government heartless toward the most vulnerable 
segment of our society?''
  The letter goes on in which Mrs. Duda says: ``My husband just 
returned from the drugstore. When I read the receipt, I felt a sense of 
panic and my eyes welled up. $250? This has to be a mistake. No, it is 
$250. But how can that be? We just paid $400 2 weeks ago. We can't keep 
doing this. Our income tax return bailed us out the last time. Now 
what? I took a quick mental inventory of our financial status. Our one 
credit card is maxed. Our bankruptcy prevents us from obtaining a loan. 
We are living paycheck to paycheck. We have overdraft, but when that's 
exhausted, what do we do?'' She has no aces. She has no hope, just a 
prayer.
  Mr. Chairman, I urge our colleagues to vote on this amendment to find 
an answer to Louise Duda's question about what we do about lowering the 
cost of prescription drugs in this country. I ask that Members help 
support the prescription drug affordability by supporting this common 
sense amendment.
  Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, I commend the gentleman from Massachusetts (Mr. 
Tierney) for his amendment. We have spent the better part of today on a 
prescription drug hearing in my subcommittee and have another one 
scheduled for next week and one for shortly thereafter.
  As the gentleman from Ohio (Mr. Brown) knows, prescription drug 
problems is the forefront of what we are doing up here these days, and 
well it should be. Even though the agency, I think it is quite clear 
that their functions would include something like this, it is good that 
we sort of focus and highlight the need for many of these amendments, 
to basically instill in the agency the thought that, yes, they have got 
to spend some time on them.
  So anyhow, we have studied this amendment and are prepared to accept 
it. I thank the gentleman from Massachusetts for offering it.
  Mr. BROWN of Ohio. Mr. Chairman, I move to strike the requisite 
number of words.
  Mr. Chairman, I rise in support of the Tierney amendment and thank 
him for his efforts in a major step in dealing with the high price of 
prescription drugs that the gentleman from Maine (Mr. Allen) has worked 
on and the gentleman from California (Mr. Waxman) and the gentleman 
from Florida (Mr. Bilirakis) and the gentleman from Vermont (Mr. 
Sanders) and the gentleman from Texas (Mr. Turner) and many in this 
institution, the gentleman from Arkansas (Mr. Berry), and others.
  Some brief facts that I think that this agency will look at and need 
to look at about the price of prescription drugs: forty-three percent 
of the cost of research for new prescription drug products in this 
country are paid for by the National Institutes of Health; forty-three 
percent of the research dollars spent are spent by taxpayers through 
the National Institutes of Health.
  Drug companies themselves pay only about 50 percent of all their 
research costs in this country in developing new prescription drugs.
  In addition, this Congress has bestowed tax cuts on those drug 
companies for the dollars that they do spend on research and 
development. In turn, U.S. consumers are given the privilege of paying 
the highest drug prices in the world, two times, three times, four 
times the price that prescription drugs cost in countries like Britain 
and France and Germany and Japan and Israel and other countries that 
have a different pricing mechanism for their prescription drugs.
  Some allow something called parallel importing which brings sort of 
an international competition in the price of prescription drugs. Others 
allow something called product licensing which allows generics in the 
marketplace to compete so that prices are not monopoly priced and are 
not set so high unilaterally by the drug companies.

[[Page 23046]]

  The third point I would add, Mr. Chairman, is that one-half the drugs 
that are developed, the new prescription drugs developed in this 
country, are developed for the world market or developed outside the 
United States. That says when the drug companies threaten this 
institution, as they have repeatedly, by saying if we do anything to 
lower drug prices, the bill by the gentleman from Maine (Mr. Allen) or 
the bill by the gentleman from Arkansas (Mr. Berry) or my legislation 
or any other, if we do anything like that, they are going to cut back 
on research and development dollars.
  The fact is half the drugs developed around the world are developed 
in countries where governments have actually acted to lower 
prescription drug prices.
  I thank the gentleman from Florida (Mr. Bilirakis) for his hearing 
today. We are going to have another hearing next Monday, which will 
bring forward Members of this body who are supporting and sponsors of 
other prescription drug legislation.
  We all know the problem of high price of prescription drugs. I think 
the Tierney amendment will go a long way towards exploring solutions so 
we can in our committee move forward in dealing with the high cost of 
prescription drugs.
  I ask for support of the Tierney amendment.
  Mr. ALLEN. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, I want to begin by recognizing the work of the 
gentleman from Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. 
Brown) on this most important issue and to thank the gentleman from 
Massachusetts (Mr. Tierney) for bringing this amendment forward.
  The fact is that I believe this amendment is needed. The bill, as it 
stands, does allow research into the costs of health-care services and 
access to such services, and I agree with the chairman that conduct 
into the research of prescription drugs could be seen to be within that 
issue, but it is better to make it clear.
  Therefore, the Tierney amendment, which specifically mentions the 
conduct of research on methods to reduce the cost to consumers to 
obtain prescription drugs is the right sort of amendment.
  Whenever I talk to seniors in my district in Maine, the subject of 
prescription drugs comes up and particularly the high cost of 
prescription drugs. Seniors are not the only ones affected, however. 
The fact is that the most profitable industry in the country, which is 
the pharmaceutical industry, is charging the highest prices in the 
world to those people who can least afford it in this country; and 
those people are seniors and others without prescription drug coverage.
  Seniors make up 12 percent of the population, but they buy 33 percent 
of all prescription drugs. Spending on prescription drugs in this 
country is going up at the rate of 15 percent every single year.
  We are dealing with an issue that is of immediate importance to men 
and women all across this country who thought, when they retired, they 
would be able to figure out how to get by. But now they find that their 
next trip to the doctor may leave them unable to pay the electric light 
bill or the rent or to buy food.
  This is a burning issue for America's seniors, 37 percent of whom 
have no prescription drug coverage at all, and a significant additional 
portion do not have adequate, reliable coverage.
  In the midst of all of this, the pharmaceutical industry is running a 
national TV campaign to try to stop any reform, to try to prevent a 
benefit under Medicare and to stop the kind of discount that I and 
others here have been urging.
  This is an important issue. We need to do research. We need to figure 
out why prices in this country for people least able to afford it are 
the highest in the world. That is an appropriate area of research. 
Therefore, I rise to support the Tierney amendment.
  Mr. GREEN of Texas. Mr. Chairman, I move to strike the requisite 
number of words.
  Mr. Chairman, I rise in support of the Tierney amendment; but, first, 
I want to thank both the chairmen of our Subcommittee on Health and 
Environment and Committee on Commerce for the hearing today and also 
the commitment over the next few weeks to deal with this issue, at 
least through the committee process, and also the gentleman from Ohio 
(Mr. Brown), the ranking member.

                              {time}  1600

  This is one of the most important issues I think that Congress is 
facing, is how to provide prescription drugs at an affordable price to 
the people who need them most, our senior citizens.
  Several bills have been introduced to achieve this goal, but each has 
been met by critics who claim they are either inadequate, too costly, 
or unfair price controls. In fact, I am a cosponsor of the Allan-
Turner, et al. bill that we had that my colleague from Maine talked 
about.
  In fact, to follow up on his, I have seen the Flo advertisements on 
TV, and I have a little concern. I want to make sure people in our 
country realize who is paying for that multimillion dollar campaign on 
TV. It is the pharmaceutical and drug companies. Because, obviously, 
they do not pay for that ad on TV in Canada or Mexico, where 
constituents in my district may have to go, oftentimes, driving 6 hours 
to Mexico to get their drug prescriptions at a cost they can afford. 
The Tierney amendment may help provide some answers to the concerns on 
affordability and which method would truly meet the needs of seniors.
  The fact is our Nation's health care system has dramatically evolved 
over the past 10 to 20 years to the point that prescription drugs are 
not only a major component of the health care system, but they can be 
critical to an individual's survival. Everyone agrees we need to find a 
way to make prescription drugs more affordable to seniors, who are 
least able to afford them but who need them the most.
  Seniors are being forced to choose between buying food or their 
prescription medications or even postponing taking their prescription 
medications. Instead of taking them one a day, as prescribed, they may 
take them every other day just because they cannot afford them.
  Because Medicare does not cover prescription drugs, so many seniors, 
37 percent according to the GAO, but I think in my district it is much 
higher, do not have any prescription drug coverage and may incur these 
expenditures out-of-pocket. Worse yet, many of these beneficiaries have 
very limited coverage that do not even come close to meeting their 
medical needs.
  While I am sensitive to the need for drug manufacturers to make 
profits on their drugs, it is unacceptable that the bulk of these 
profits are made on sales to people who can least afford to pay those 
prices. Discounts are available to HMOs, to the U.S. Government, to 
hospitals, and even foreign countries, but seniors are forced to pay 
the full price. That is just not right, and something needs to be done 
to correct it.
  This amendment will give an important agency the opportunity to look 
at these issues and answer some of the questions surrounding them. 
Everyone knows this is a complex and difficult problem to solve. 
However, sitting back and doing nothing is not an acceptable option. 
Today, not only with this amendment, with this study, but also with 
what the Subcommittee on Health and Environment of the Committee on 
Commerce is doing, we are moving forward on it.
  As new drugs are developed and approved, the access gap to these 
potential life-saving treatments are only widened. This amendment is 
reasonable and sensible, and I am glad to be a co-sponsor of not only 
this bill but also the Turner-Allan bill that will provide a solution 
to this problem. Support for this amendment is important to research 
and study methods and practices.
  Mr. LUTHER. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, first of all, let me thank the gentleman from 
Massachusetts (Mr. Tierney) for bringing this

[[Page 23047]]

amendment forward. I think he does us a great service in this body.
  We have entered a remarkable period in our Nation's history. Never 
before have we had so many life-enhancing prescription drugs. Yet, let 
us face the facts. These remarkable achievements are today overshadowed 
by the exorbitantly high prices consumers in America are being required 
to pay for these prescription drugs.
  This is why I rise in support of the Tierney amendment. This 
amendment would expressly direct this agency, an important agency, to 
address this issue, an issue that is perhaps the most important issue 
we face in health care today. It would require that agency to recommend 
ways to make drugs more affordable for American consumers.
  Mr. Chairman, earlier this year, I requested a study on comparative 
drug prices in my home district in Minnesota. The report was issued in 
March of this year, and the results were astonishing. The report showed 
that the average retail prices for the five best selling drugs for 
older Americans in Minnesota are more than twice as high as the prices 
that drug companies charge their most favored customers. For one drug, 
Minnesotans actually paid a price 15 times higher than the price 
enjoyed by preferred customers. This does not just impact senior 
citizens, it affects all American consumers who do not have 
prescription drug coverage today.
  This type of unfairness needs to be addressed, and that is exactly 
what this amendment does. It does not dictate policy or set up a new 
layer of bureaucracy, it simply directs that we look at ways to create 
fairness and to help American consumers afford the cost of these wonder 
drugs that are available today. I urge Members to support this 
amendment.
  Mr. McGOVERN. Mr. Chairman, I rise today in support of the amendment 
offered by my good friend John Tierney instructing the Agency on Health 
Research and Quality to study methods of reducing the costs of 
prescription drugs to consumers. This is an important study in light of 
the focus on a Medicare prescription drug benefit, as well as the 
increase in pharmaceutical productions.
  Prescription drugs are an important means of providing healthcare in 
an outpatient setting. However, the costs of these drugs are too high. 
Earlier this summer, I commissioned a study to specifically examine the 
cost of prescription drugs in the Worcester/Attleboro/Fall River, 
Massachusetts area. This was the first and only study of its kind 
examining drug prices in Central Massachusetts. The results were 
alarming.
  On average, seniors get more than eighteen prescriptions filled each 
year. I was shocked to learn that uninsured seniors in my district--
those without any prescription drug benefit--pay 136% more for their 
prescription drugs than the drug companies most favored customers. This 
means that if a most favored customer pays ten dollars for a 
prescription, the uninsured senior in my district will pay twenty-three 
dollars and sixty cents for that same prescription. It is 
unconscionable that people who can least afford to pay these high costs 
are being gouged by the drug companies in the name of profits and I am 
sickened that seniors in my district, and across the country, are 
forced to choose between buying groceries and medicine.
  Our top priority must be a prescription drug benefit. However, this 
amendment is a first step in this Congress acknowledging that drug 
prices are too high for uninsured seniors. I support President 
Clinton's efforts to implement a prescription drug benefit. I also 
support Congressman Tom Allen's bill to end price discrimination by the 
drug companies. Together, these efforts will lower prescription drug 
prices and allow seniors to buy both food and medicine. We must 
continue to raise awareness of the need for affordable prescription 
drugs, at least until this Congress is able to pass a comprehensive 
prescription drug benefit. I urge the adoption of this important study.
  Mr. BERRY. Mr. Chairman, I rise today in support of the Tierney 
amendment and to talk, once again, about the affordability of 
prescription drugs.
  We have all gone back to our districts and have heard from our 
constituents, especially seniors, that they cannot afford the 
prescription drugs they need, often to stay alive.
  When I hold meetings in the 1st Congressional District of Arkansas, I 
hear about two issues and that's the agriculture crisis and the high 
cost of prescription drugs, especially for seniors.
  I also get letters from Arkansas seniors who tell me everyday they 
can't afford to pay for all their needs, specifically, all their 
medicine and their food.
  Seniors all over this country are not following their doctors' 
orders. Some of them have been given prescriptions which they cannot 
afford to fill. Others have filled prescriptions which they cannot 
afford to take as directed.
  Because they cannot pay the rent, pay the electrical bills, buy food 
and take very expensive prescription drugs, they either stop taking 
them, or they take less than what is prescribed by their doctor.
  They are doing things that in the long run are harmful to their 
health.
  I find it amazing that we tell our seniors they can live longer if 
they take this pill and that pill, but then if they can't afford their 
medication that keeps them alive, we don't do anything about it.
  Thousands of consumers, especially seniors have found themselves 
affected by the price of prescription drugs in this country.
  Seniors and other Americans go to Canada and Mexico because 
prescription drugs in these countries cost much less than in the United 
States.
  In my District in Arkansas, seniors paid 81% and 72% more, 
respectively, for the 10 prescription drugs they most commonly use than 
their elderly counterparts in Canada.
  I have introduced legislation, with Representatives Emerson and 
Sanders, the International Prescription Drug Parity Act, that amends 
the Food, Drug, and Cosmetic Act to allow American distributors and 
pharmacists to reimport prescription drugs into the U.S. as long as the 
drugs meet strict safety standards.
  This will allow American pharmacies and distributors to benefit by 
purchasing their drugs at lower prices, which they can pass along to 
American consumers.
  Mr. Chairman, the bottom line is, consumers should not have to choose 
between food and medicine.
   I urge all members of this body to vote for the Tierney amendment.
  The CHAIRMAN pro tempore (Mr. Quinn). The question is on the 
amendment offered by the gentleman from Massachusetts (Mr. Tierney).
  The amendment was agreed to.


                Amendment No. 11 Offered by Mr. Tierney

  Mr. TIERNEY. Mr. Chairman, I offer an amendment, amendment No. 11.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 11 offered by Mr. Tierney:
       Page 13, after line 5, insert the following subsection:
       ``(d) Studies of Methods to Improve Access to Health 
     Service.--The Director shall conduct, and shall provide 
     scientific and technical support for private and public 
     efforts to conduct, studies of the organization, delivery, 
     and financing of health services in order to determine the 
     cost and quality effects of various methods of substantially 
     increasing the number of individuals in the United States who 
     have access to health services. Such studies shall include a 
     study to determine the impact of a single payer insurance 
     coverage program on health expenditures in the United States 
     during the fiscal years 2000 through 2007 compared to the 
     projected impact of the current system on health expenditures 
     in the United States during such period.''

  Mr. TIERNEY. Mr. Chairman, this particular amendment is going to 
request that the director conduct and provide scientific and technical 
support for the private and public efforts to conduct studies of the 
organization, delivery and financing of health services in order to 
determine the cost and quality effects of various methods of 
substantially increasing the number of individuals in the United States 
who have access to health services.
  Mr. Chairman, those studies should include a study to determine the 
impact of a single-payer insurance coverage program on health 
expenditures in this country during the fiscal years 2000 to 2007 
compared to the projected impact of the current system on health 
expenditures in the United States during that period.
  Mr. Chairman, simply put, I bring this amendment forward for the 
gentleman from Washington (Mr. McDermott), the gentleman from Vermont 
(Mr. Sanders), the gentlewoman from Wisconsin (Ms. Baldwin), as well as 
myself. What we seek to do is to make more explicit one of the duties 
that the agency is already charged with, and that is the duty to study 
ways of increasing access to health services.

[[Page 23048]]

  We have a situation in this country where there are estimates of 43 
million Americans without health insurance coverage. Of those numbers, 
11 million are said to be children. The balance of those people are 
adults, the majority of whom are working adults. This is simply a 
situation that is intolerable, Mr. Chairman, and it is about time that 
we started to look at the reasons why that is so and what we can do 
about changing that dynamic and making sure that all Americans have 
access to affordable health care.
  As a former small business president of the Chamber of Commerce and 
someone who deals often with small businesses, I can tell my colleagues 
that there has been a change of mind amongst many people in the small 
business industry. They, at one time, were listening to the larger 
national organizations and international organizations about how 
terrible it would be if we had universal health care. Now they are 
seeing the alternative of what happens under the current system. They 
see the number of people that are uncovered, and they realize that the 
premiums they are paying to cover their employees and their own 
families are increased by virtue of the fact that those premiums are 
also covering the 43 million Americans who have no coverage.
  That has to be paid for somewhere. Those people do get health care. 
They unfortunately get it when it is later on in their situation, when 
the situation is more critical, when treatment is more expensive, and 
now we need to know why that is so. Now we need to know why we cannot 
cover everybody.
  I think it has come around to providers, whether they be doctors or 
nurses or others. It has come around to hospitals, to CEOs who I have 
talked to, as well as business people and consumer groups. We need to 
look at a more effective health care system in this country.
  It is more than enough to say that we have a problem. It is time to 
do something. And when we talk about some of the immediate solutions, 
and my colleagues have heard as well as I have that we need to put more 
money back into community hospitals, particularly teaching hospitals 
because of the cuts in the 1997 Balanced Budget Act, and that is so.
  The estimates were that we were going to cut $112 billion and that we 
were then going to be able to take care of fraud and abuse and get 
preventive services, and that was going to help it be more affordable. 
The fact of the matter is, that estimate was overshot. Some $200 
billion is estimated to have been squeezed, and those hospitals and 
home care providers and others do need some money to be put back in. 
But to just put money back in would be a temporary fix. The system is 
broken. It is not working. We are not covering everybody. And if we do 
not cover everybody, we cannot control the cost and cannot make sure 
that we provide good quality services to everyone.
  What this bill will do, Mr. Chairman, is to get this agency to do a 
study and to compare it to what we have now. What will improve the cost 
situation. More importantly, what will improve the accessibility and 
the affordability issues.
  Now, among those things we asked to be studied is the single-payer 
system. That is one option. In no way does my amendment say that that 
is all we should study or that we should predetermine that is exactly 
where we have to go. It is a proposal that I think has considerable 
merit. The Massachusetts Medical Association had two independent 
studies done, and not to the surprise of many, it came back saying the 
single-payer system would have been a better system if applied in 
Massachusetts over the next 8 years. It would save money, it would 
cover more people in that State, it would provide them better services.
  We should find out if that is so for all the States in this country. 
We should find out if we should have a single-payer system or some 
other form of universal health care. We should balance and measure 
those systems against each other and how they will do. And then we 
should measure it against the current system to find out what would be 
best.


        Modification to Amendment No. 11 Offered by Mr. Tierney

  Mr. TIERNEY. Mr. Chairman, some people are concerned about the 
language because they thought my amendment was simply saying that we 
would study only single-payer, but, in fact, we have looked at some 
language and I am more than happy to ask for unanimous consent that my 
amendment be modified in accordance with the modification that has been 
sent to the desk which says that the study shall include an examination 
of the financial impacts of a range of health care reform proposals to 
include, but not be limited to, a single-payer insurance program 
compared to the current system across an 8-year period beginning in 
fiscal year 2000.
  The CHAIRMAN pro tempore. The Clerk will report the modification.
  The Clerk read as follows:

       Modification to amendment No. 11 offered by Mr. Tierney:
       The second sentence of the amendment is modified to read as 
     follows: ``Such studies shall include an examination of the 
     financial impacts of a range of health reform proposals to 
     include, but not be limited to, a single payor insurance 
     program compared to the current system across an eight-year 
     period beginning in fiscal year 2000.''

  The CHAIRMAN pro tempore. Is there objection to the modification 
offered by the gentleman from Massachusetts?
  There was no objection.
  Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment, as 
modified.
  Mr. TIERNEY. Mr. Chairman, will the gentleman yield?
  Mr. BILIRAKIS. I yield to the gentleman from Massachusetts.
  Mr. TIERNEY. Mr. Chairman, I thank the gentleman very much for that 
courtesy. I simply wanted to reiterate the point that we must study all 
the available reforms on that, and this, of course, is one important 
one.
  Mr. BILIRAKIS. Mr. Chairman, reclaiming my time, we are not in 
disagreement, as far as that area is concerned. We have studied the 
amendment and have talked with the gentleman and talked with the 
gentleman's staff, and we accept the amendment, as modified, and do not 
object to it.
  Ms. LEE. Mr. Chairman, I move to strike the last word.
  I want to thank my colleague from Massachusetts for offering this 
amendment, and I rise in strong support of the Tierney amendment to 
authorize studies or methods to improve access to health services. 
While serving in the California legislature, I had the opportunity to 
work on similar legislation. I am proud to say that the bill was passed 
by the California legislature and is now before the governor for his 
signature.
  This Nation, as well as my home State of California, really needs the 
study, and also the California study, because of the profound failures 
of the present system. By now we have had 5 years of experience of 
depending on the private sector for the delivery of our health care, 5 
years of knowing intimately that a market-driven health care system 
leaves more and more people frustrated, angry, and sick.
  I also carried managed care bills while I was in the California 
legislature. I authored many of them. And I want to say that people are 
becoming increasingly more disappointed with the outcome of these 
managed care approaches. They are frustrated because medical decisions 
about operations, about how long to be hospitalized, about which 
illnesses are to be treated and by whom, crucial medical decisions are 
being made each and every day, each and every moment by accountants and 
executives of managed care companies who earn fortunes by denying 
medical care to their subscribers.
  The statistics on what CEOs are making are staggering and should make 
us really squirm in shame. These are profits at the expense of our 
right to live or our right to be as healthy as we can be. Now, 
simultaneously, we have had 5 years of a market-driven health care 
system which leaves more and more Americans uninsured. At last count we 
were at about 45 million, increasing at the rate of 1 million uninsured 
people a year.

[[Page 23049]]



                              {time}  1615

  Are these health care companies with their immense profits working to 
raise our knowledge and our standards of health care? Are they helping 
us to understand that an ounce of prevention is really worth a pound of 
cure? Sadly, it appears not.
  What has the industry done in these 5 years? Are they controlling 
health care costs? Sadly, again, it appears not. Health care premiums 
are once again rising.
  For example, the health care industry has spent millions successfully 
lobbying so far to defeat the Patients' Bill of Rights. Health 
insurance companies have had the gall recently to propose $60 billion 
in new Federal programs to subsidize insurance for 28 out of the 45 
million uninsured Americans.
  The current efforts to expand Medicare to cover prescription drugs, 
which, of course, I support, is now motivating, however, the health 
insurance industry to compete with the pharmaceutical companies by 
insisting that the uninsured should come before those needing 
prescription drugs.
  So to pit one group of Americans against those who need health care 
versus another group who needs health care to me is just basically 
wrong.
  Mr. Chairman, I am convinced that as long as profits provide the 
driving force in the health care industry, we will fall way short of 
providing health care, affordable and accessible health care, for all.
  For instance, recent studies show that for-profit hospitals drive up 
Medicare costs in general as a group. In another study, for-profit 
health plans perform worse than nonprofits in providing preventive 
health care. One study concluded that if all American women were 
enrolled in for-profit HMOs instead of nonprofits, over 5,900 more 
women would die from breast cancer each year due to lower rates of 
mammography.
  This Nation spends more money per person on health care than any 
other industrialized country. Yet, in 1997, Newsweek reported that 
current figures for longevity projections for the year 2050 for 
African-Americans will be less than the longevity of all other ethnic 
groups.
  Could that be because our health care dollars are not going for 
health care for all based on an equitable basis but going into the ever 
deeper and ever hungrier pockets of the top echelons of those health 
care insurance companies?
  Georgetown University Medical Center reported this February that 
their study together with Rand Corporation and the University of 
Pennsylvania indicated that African-Americans and women with chest pain 
would be referred for cardiac catheretization at 60 percent of those of 
whites and men. This disparity was most dramatic for black women, where 
odds of being referred were 40 percent of those of white men. This is 
really a shame.
  We need to get out of the competition by profit-making companies for 
our meager health dollars. We need to know that other ways are 
possible. For instance, we do need to know how much a single-payer 
system costs. We do need to know how much provision of universal health 
care without profits for insurance companies would cost. We need this 
information provided in the Tierney amendment.
  I urge my colleagues to support the amendment.
  Ms. BALDWIN. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, the Tierney amendment is a worthwhile step toward what 
must be a larger goal.
  As we approach the new millennium, Mr. Chairman, the United States is 
still the only country in the industrialized world that does not offer 
comprehensive affordable health care to all of its citizens. This, Mr. 
Chairman, is unconscionable, it is untenable, and it is wrong.
  As we reach the closing days of the 20th century, 43 million 
Americans have no health care coverage at all. In this wondrous 
century, we have put astronauts on the moon, we have created a global 
village united by computer technology, we have perfected travel from 
one end of the world to the other in mere hours, and yet 43 million of 
us cannot afford or cannot get health care insurance.
  Most of those people have jobs. But increasingly they work in small 
businesses or in the service sectors that either do not cover employees 
or require them to pay so much for health insurance that they simply 
cannot afford it.
  There are millions more Americans who are under-insured who have 
health insurance but would be at risk of having to spend more than 10 
percent of their income on health care bills in the event of a 
catastrophic illness. And there are tens of millions of Americans who 
have lost faith in the system, lost faith that comprehensive quality 
health care will be available to them without a struggle when they need 
it, where they need it, and from whom they want it. And these numbers 
continue to rise.
  The National Coalition on Health Care, a bipartisan group headed by 
former Presidents Bush, Carter, and Ford, put out its latest report on 
the erosion of health insurance coverage in the United States, which 
found that even if the rosy economic conditions prevalent since 1992 
prevail for another decade, one in five Americans will be uninsured in 
2009. Should a recession occur, that number is likely to jump as far as 
one in four.
  Mr. Chairman, it is time to put health care for all at the top of our 
national agenda. Many people have called for it. Many more believe it 
should happen.
  Mr. Chairman, universal health care will never happen until we create 
the national will to make it so. Let us begin.
  American medicine is the best in the world. Of that there is no 
doubt. And yet our nursing teams are understaffed, underpaid, and 
overworked. Our health care costs continue to rise at twice the rate of 
inflation. Today's one-trillion-dollar system will double in cost to $2 
trillion in the next decade. This will adversely affect our economy, 
the deficit, the Nation's small businesses, and the middle class's 
standard of living.
  Universal health care will actually lower health costs by providing 
less expensive preventative health care and treating illnesses before 
they become more complex and costly.
  It was just a year ago that I traveled around my district telling the 
voters of Wisconsin's second district that I wanted to go to Congress 
to re-ignite the national debate on health care. One reporter even 
called me from a prominent paper on the East Coast to talk about the 
campaign. I asked, Why are you interested in a race so far away? He 
said, Because you are one of the few candidates anywhere who is willing 
to talk about health care for all. It is a hot potato that no one wants 
to touch.
  Well, my constituents did not just touch it, Mr. Chairman. They 
embraced it. The voters in my district are tired of hearing, we cannot. 
The voters in my district reject the cynicism, the naysayers, the 
keepers of the status quo. The voters in my district posed the same 
question to this Congress that I posed during my campaign: If you are 
not for health care for all, then who would you leave behind? And if 
you agree that everyone should have access to affordable quality health 
care, then let us talk about the best way to achieve it.
  It is time to begin.
  Mr. FRANK of Massachusetts. Mr. Chairman, I move to strike the 
requisite number of words.
  Mr. Chairman, I congratulate the sponsors of this amendment for 
bringing it forward. The lack of an adequate universal health care 
system is one of the gravest defects in public policy in America.
  Now, there are many of us who are in favor of it on equitable 
grounds. I am going to take that segment for granted in my comments and 
talk to those on the more conservative side, the people in positions of 
responsibility, the financial community, and try to explain to them why 
I believe it is very much in their interest to get behind what we hope 
will be the first step in leading to the establishment of a universal 
health care system and would I say a single-payer health care system.
  By the way, for those who raise questions about the feasibility of a 
single-

[[Page 23050]]

payer health care system, let us talk about one which we have had in 
this country for over 30 years. It is called Medicare. Medicare is a 
universal single-payer health care system if they are over 65. And 
those who think it is a bad idea, go tell the recipients of Medicare 
that they are going to abolish it and let them go back to other ways 
and I think they will find a great deal of negative response.
  Indeed, one of the great mistakes this Congress made in 1997 was to 
cut Medicare. Exactly how it happened, I do not know. Because so many 
people who were for cutting Medicare in 1997 are so vehemently against 
it now that I think there was something in the air, that people were, 
like, absent but voting because they did not know what they did.
  But here is the argument for going further. In 1993, when the 
President put forward a health care plan, we were told, well, look, 
most people get health care and we are solving this problem through our 
current system. In fact, the opposite has been the case. People have 
been losing health care. They are losing it, in part, because of the 
international competitive situation. Holding down the costs to 
employers, particularly in manufacturing, has become a major factor 
worldwide.
  Alan Greenspan a couple of months ago gave a speech in which he 
lamented the fact that the former national consensus for free trade had 
eroded and he complained that so many people today are not for tree 
trade anymore. And he said, I understand how some people get hurt, that 
some people who do not have access to the skills in information 
technology will lose their job in the short-run, but we should not let 
our inability to help them keep us from going forward with 
globalization.
  Well, the fact is that we do not have an inability to help them, we 
have an unwillingness, because this very wealthy Nation clearly has the 
resources.
  One of the single best things that people should understand, and here 
is what I want to address, conservatives, people who believe in 
globalization, people who want China in the WTO, people who want to go 
forward with Fast Track authority, who want a new round in Seattle to 
lead to further trade reductions, we are not going to get that until we 
have satisfied working people in America that they will not be unfairly 
disadvantaged.
  And one of the biggest problems they have, I think the single biggest 
problem now is, when they lose their jobs, they lose their health care; 
and when they get new jobs, having lost their jobs, they may well get a 
job without health care. Because with the lower paying jobs, the 
service jobs, it is not simply a reduction in income that people face 
when they lose a manufacturing job and go into another industry, they 
may very well not have health care.
  The insecurities that people in this country feel because of our 
patchwork health care system and the absence of a reliable universal 
health care system, I think it should be single-payer, but the reliance 
of that, the knowledge that losing their job could mean losing their 
health care for them and their family, their children, their spouse, 
that is one of the biggest obstacles to the support these people are 
looking for for globalization.
  So Mr. Greenspan is right to acknowledge that many of us are 
unwilling to go forward with the process of globalization if it is 
going to hurt some of the people at the lower end economically, but he 
is wrong to say that the reason we are not helping them is that it is 
an inability.
  There used to be a problem, we thought, 10 years ago. We thought we 
were spending too much on health care. We said the American economy was 
stagnating because we were spending too much on health care. We now are 
clearly the best performing economy in the world. The fact that our 
health care expenditures per capita are higher than in some other 
places is obviously not an economic problem.
  We face a moral problem in condemning people to inadequate care. But 
they also, I have to say to the establishment and financial community, 
must understand that there is going to have to be a trade-off. And if 
people want to reverse the move away from support for globalization 
internationally, those who believe that is very much in our interest 
economically have to understand that social equity is going to have to 
be part of that deal. And they are not going to go forward with the 
kind of economic global integration they want to see until they do a 
number of things, and one of them is the provision of a universal 
health care system.
  So, as I said, I know we got some votes for equity. But fairness is 
not enough to win. We are in a trade-off situation. And if we look at 
the Congresses of the past few years, we have had increasing contention 
over American support for the international financial institutions, 
American support for reductions in tariffs. That will get worse rather 
than better as long as we get a refusal to recognize the legitimate 
claims of American workers for a universal health care system.
  Mr. TRAFICANT. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, we begin to talk about the economic principles that 
have probably caused the inability to provide it. I agree with the 
previous speaker that it is probably more willingness.
  Until we take the major costs off American corporations, they will 
continue to leave our country and we will continue to struggle and lose 
our manufacturing base.
  I think it is time, though, that while we are talking about the 
symptoms that we should start addressing the root causes and problems. 
It is time to take a look at the progressive income tax, the burdensome 
cost of compliance, and the negative economic competition globally that 
it places us in.
  We are now beginning to talk about the reasons why we cannot perform 
many of the deeds our constituents believe we should be addressing, and 
we will never do it with the complicated Tax Code that we have in 
place.

                              {time}  1630

  We reward companies for leaving. We reward imports. We kill exports. 
And then we talk about trade and then we talk about universal health 
care. Well, there will be no universal health care, there will be no 
improvement to the health care system until we change a tax code that 
rewards competitive imbalance overseas and negates America's 
opportunity to provide these programs. But it is interesting to see it. 
It is not an inability. It is not an unwillingness. It is a tax code 
that simply makes it almost impossible to provide this type of 
competitive program. We should get rid of it.
  Ms. SCHAKOWSKY. Mr. Chairman, I move to strike the requisite number 
of words.
  I want to thank the gentleman from Massachusetts for this amendment 
which I strongly support. Like my colleague from Wisconsin, in large 
part I wanted to come to this body to address the issue of health care, 
the crisis that so many families face, those that have insurance but 
find it inadequate, those that lose their jobs and lose their 
insurance, those that have no insurance and have no hope of affording 
it.
  I just wanted to read a letter from a constituent. This is typical. 
This is one of many. It is an e-mail I got the other day that says,

       The cost of health care is killing me. I'm self-employed 
     and the cost of medical insurance for my family of three is 
     about $9,000 a year. That's with high deductibles. That means 
     we also have to pay several thousands of dollars a year in 
     medical bills. These costs are getting out of control. I 
     don't believe that private insurance or even HMOs are the 
     answer anymore. I think it's time for a single-payer 
     insurance system backed by the Federal Government. I would 
     appreciate your working with others in Congress to start 
     moving in this direction.

  And so I rise to support an amendment that I think does move us at 
least in the direction of exploring how we can answer this gentleman 
who wrote on behalf of his family. Five years ago, we failed to pass 
comprehensive health reform and instead we left it to the for-profit 
health insurance industry to make critical decisions: whom to cover, 
what to cover and what

[[Page 23051]]

to charge. Today what do we have? More uninsured Americans, more 
underinsured Americans, more American families struggling to pay 
premiums and medical costs that are increasingly unaffordable.
  The gentleman's amendment is needed for four reasons. First, we must 
act now to provide health insurance to the uninsured. It is 
embarrassing, 44.3 million people now lacking any health coverage in 
this the wealthiest Nation in the world, a 1.7 million jump from the 
year before. Eleven million of these people are children. In my State 
nearly one of eight are uninsured and the numbers keep growing.
  According to an AFL-CIO study, 8 million fewer Americans in working 
families have employer-based coverage now than in 1989. If that erosion 
continues, the study concluded that 12.5 million more people would lose 
coverage over the next 5 years.
  And, second, we need to act to improve coverage for the poorly 
insured. Millions of insured Americans lack coverage for critical 
benefits. That includes 13 million senior citizens who lack 
prescription drug coverage as well as families who lack access to 
mental health services, rehab therapy, long-term care and other 
important services. Even if they have an insurance card, they are still 
effectively uninsured for services if their policies do not cover the 
services they need.
  Third, we must act to lower health care costs for individuals and 
families as well as for our Nation. High insurance premiums and out-of-
pocket costs present insurmountable barriers blocking access to needed 
care. A recent Commonwealth Foundation survey found that 40 million 
people went without needed medical care because they could not afford 
it and another 40 million said they did not have enough money to pay 
their medical bills.
  Finally, we pay a high price for not guaranteeing access to needed 
medical care. We pay a high price. Lack of insurance, inadequate 
insurance and high costs keep millions of Americans from getting the 
health care that they need. There is a cost to the individuals and 
families who cannot get care and as a result suffer from illnesses and 
conditions that could be prevented. There is the cost to society, to 
all of us, from lost wages and productivity from those who cannot work 
because of the preventable injuries or who cannot work because the job 
does not provide coverage. And there is the cost of paying for 
expensive illnesses and emergency care that could have been avoided 
through a more rational approach to health care.
  This amendment moves us in the right direction. I urge my colleagues 
to act now to pass it.
  Mr. STARK. Mr. Chairman, I rise in support of Representative 
Tierney's amendment to require the Agency for Health Research and 
Quality to conduct a study about the effect of universal health care 
and other access expansions on health quality and costs.
  The U.S. is the only industrialized nation that fails to provide 
universal health coverage for our citizens--and yet we continue to 
spend more on health than any of those nations.
  A key factor impacting our nation's health expenditures is that we 
have 43 million Americans left out of our system whom we are covering 
in the most expensive manner--through emergency rooms, late in their 
illnesses, and often without the benefit of appropriate prescription 
drugs since many of these people cannot afford them.
  It is time for Congress to return to the vitally important issue of 
expanding health insurance coverage. There are viable means to achieve 
that goal.
  The most direct routes to providing universal coverage would be to 
enact a single payer system or to expand Medicare coverage to everyone. 
There are other more incremental approaches which would also move us in 
the right direction:
  We could use a tax credit approach, like that I have authored in HR 
2185, the Health Insurance for Americans Act.
  We could expand Medicare coverage to persons aged 55-64 under HR 
2228, The Medicare Early Access Act, which is supported by many of my 
colleagues and the Administration.
  We could expand Medicare to children--creating a much more effective 
coverage policy than the State Children's Health Insurance Program, 
which continues to leave millions of our nation's children without 
coverage. That could become an avenue leading to Medicare for all.
  I urge support of the Tierney amendment which, if passed, would 
provide us with further evidence for moving forward to expand health 
insurance in our country. That is a debate to which Congress must 
return.
  The CHAIRMAN pro tempore (Mr. Quinn). The question is on the 
amendment, as modified, offered by the gentleman from Massachusetts 
(Mr. Tierney).
  The amendment, as modified, was agreed to.


                Amendment No. 21 Offered by Mr. Stearns

  Mr. STEARNS. Mr. Chairman, I offer an amendment.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 21 offered by Mr. Stearns:
       Page 21, after line 8, insert the following subsection:
       ``(d) Certain Technologies and Practices Regarding Survival 
     Rates for Cardiac Arrest.--In carrying out subsection (a) 
     with respect to innovations in health care technologies and 
     clinical practice, the Director shall, in consultation with 
     appropriate public and private entities, develop 
     recommendations regarding the placement of automatic external 
     defibrillators in Federal buildings as a means of improving 
     the survival rates of individuals who experience cardiac 
     arrest in such buildings, including recommendations on 
     training, maintenance, and medical oversight, and on 
     coordinating with the system for emergency medical 
     services.''

  Mr. STEARNS. Mr. Chairman, I would first like to say that I support 
H.R. 2506, to reauthorize the Agency for Health Care Policy and 
Research, I guess it is called the Health Care Quality Agency. This 
agency is an invaluable resource because the outcomes of research it 
provides improves the quality of health care for all of us.
  Under this reauthorization, the new agency would refocus and its 
responsibilities would be to promote quality by sharing information, 
building public-private partnerships, providing cost and quality care 
reports on an annual basis, supporting new technologies, and assisting 
in providing access to those in underserved areas.
  Mr. Chairman, the amendment I am offering adds a new section to 
section 916 entitled ``Certain Technologies and Practices Regarding 
Survival Rates for Cardiac Arrest.'' By adding this language, we are 
merely attempting to point out how valuable we believe automatic 
external defibrillators are, AEDs, to saving the lives of individuals 
who experience cardiac arrest. We are asking the Director to develop 
recommendations regarding the placement of AEDs in Federal buildings.
  Mr. Chairman, more than 1,000 Americans each and every day suffer 
from cardiac arrest. Of those, more than 95 percent die. That is 
unacceptable, because we have the means at our disposal to change those 
statistics. Studies show that 250 lives can be saved each and every day 
from cardiac arrest by using automatic external defibrillators, AEDs. 
Those are the kinds of statistics that nobody can argue with.
  The AEDs which are produced today are easier to use and require just 
absolutely minimal training to use and operate. They are also easier to 
maintain and they cost less. This affords a wider range of emergency 
personnel to be trained and equipped.
  One of the goals of this agency is to enhance the quality of health 
care. My amendment would help achieve this by directing the agency to 
develop recommendations for public access to defibrillation programs in 
Federal buildings in order to improve the survival rates of people who 
suffer cardiac arrest in Federal facilities. The programs should 
include training security personnel and other expected users in the use 
of AEDs, notifying local emergency medical services of the placement of 
the AED, and ensuring proper medical oversight and proper maintenance 
of the device.
  My reason for offering this amendment highlights that it is possible 
to prevent thousands of people suffering sudden cardiac arrest from 
dying by making the equipment and trained personnel available at the 
scene of such emergencies.
  I am hopeful that we can pass my bill in a larger sense which I have 
66 cosponsors, H.R. 2498, the Cardiac Arrest

[[Page 23052]]

Survival Act, in its entirety in the 106th Congress. My bill directs 
the Secretary of Health and Human Services to develop recommendations 
for public access to defibrillation programs in Federal buildings.
  The bill I introduced in this Congress differs from previous versions 
which primarily sought to encourage State action to promote public 
access to defibrillation. The States have responded to this call and 
many have passed legislation, over 40 States have since done it, to 
promote training and access to AEDs. So I think it is time for the 
Federal Government to catch up with the vast majority of our States and 
pass the legislation.
  Mr. Chairman, I hope the amendment I offered, which is fairly 
innocuous, will be passed and accepted by the gentleman from Florida.
  Mr. BILIRAKIS. Mr. Chairman, will the gentleman yield?
  Mr. STEARNS. I yield to the gentleman from Florida.
  Mr. BILIRAKIS. Mr. Chairman, I appreciate the gentleman yielding. I 
want to commend the gentleman. He has been very vocal on this, on the 
use of AEDs and of their great value to us on an everyday basis in 
committee. Of course his amendment is very helpful because again even 
though the general scope on functions of the agency would and could 
include these, it is another case of focusing attention, if you will, 
to it. We have had the opportunity to review the amendment and do 
accept it.
  Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the Stearns 
amendment. I believe his amendment will take a major step in saving the 
lives of people that have heart attacks in public buildings and in 
other places.
  I would also use this amendment briefly as an opportunity to talk for 
just one moment, Mr. Chairman, about cardiopulmonary resuscitation. 
Last week was National CPR Week. I have a resolution that I have 
introduced to encourage people around the country to get CPR training. 
Only 2 percent of Americans are trained in CPR. It would save literally 
tens if not hundreds of thousands of lives, both the recommendation 
that the gentleman from Florida (Mr. Stearns) has and CPR training.
  I urge my colleagues to think about taking that training and 
especially to talk about it at home when there are training sessions 
given by hospitals, by the Heart Association and by other 
organizations. I commend the gentleman from Florida (Mr. Stearns) for 
his interest in this issue broadly and specifically and ask for the 
House support for the Stearns amendment.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentleman from Florida (Mr. Stearns).
  The amendment was agreed to.
  Mr. VENTO. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, I rise to engage the distinguished subcommittee 
chairman from Florida and the ranking subcommittee member from Ohio in 
a colloquy.
  A recent series of articles in my hometown paper, the St. Paul 
Pioneer Press in Minnesota, highlighted a disturbing incidence 
nationwide of patient fatalities and injuries due to hospital errors 
which I will insert in the Record under General Leave.
  The most comprehensive study conducted by Harvard medical researchers 
found that the hospital mistakes caused the death of one of every 200 
patients admitted to hospitals. This provocative study also estimates 
that 1 million patients are injured by errors during hospital treatment 
each year. Alarmingly, some experts think official estimates of the 
medical errors may be understated as some cases go unreported. Most of 
us are very concerned about this new report.
  In section 912, part C, in my reading it is intended for the Agency 
for Health Research and Quality to include in its research a specific 
report on the number of hospital errors which result in patient injury 
and death.
  Two questions I have for my colleagues who are managing this measure: 
Is it intended that the agency will be reporting its findings to 
Congress? And is it possible that the report will include specific 
findings from State to State on the number of hospital errors which 
result in patient injury and death?
  Mr. BROWN of Ohio. Mr. Chairman, will the gentleman yield?
  Mr. VENTO. I yield to the gentleman from Ohio.
  Mr. BROWN of Ohio. I thank the gentleman from Minnesota for bringing 
this issue in front of the House. It is extraordinarily important. I 
think we all need to know more about it. That is something that perhaps 
our committee can consider. Certainly this Congress should. But 
specifically now clearly the agency should do that.
  In section 924 of the bill, it specifically says the information 
shall be promptly made available to the public, this data developed in 
such research demonstration projects and evaluations. They will do 
that. We have a great interest that they do.
  Mr. BILIRAKIS. Mr. Chairman, will the gentleman yield?
  Mr. VENTO. I yield to the gentleman from Florida. I appreciate the 
gentleman's guidance.
  Mr. BILIRAKIS. Mr. Chairman, I, too, commend the gentleman for 
bringing it to our attention. Obviously I think we would all agree that 
any intelligent reading would indicate that the scope and the general 
function of the agency would be to include something like this. Again 
it is important to focus some of these and to red-flag them, if you 
will, for the agency.
  The gentleman from Ohio mentioned section 924. Certainly section 
912(c), Reducing Errors in Medicine, and I will not repeat that, goes 
into that. Then you can go into Information on Quality and Cost of 
Care, section 913, subparagraph 2, I guess it is, Annual Report, and it 
refers to an annual report. I would say that it is intended the agency 
will report its findings to the Congress.
  And the second question when you talk about State to State, logically 
it would seem that that information would be accumulated by them on a 
State to State basis and thus reported from that standpoint. I honestly 
do not know why that would be a problem. So is it possible? I would say 
it is very possible.

                              {time}  1645

  Mr. VENTO. Mr. Chairman, I thank the subcommittee chairman and 
ranking member. Obviously this sort of study is of great concern. I am 
sure we want to know the accuracy of it and the circumstances that are 
arising out of it to build the type of quality and objectives that are 
broadly stated in this bill which I will revise and extend in support 
of under general leave and will put this article in the paper. I 
appreciate the chairman, the subcommittee chairman, and ranking 
member's interest and cooperation with regard to this measure.

         [From the Knight Ridder News Service, Sept. 24, 1999]

          Hospital Errors Kill Thousands of Patients Each Year

                           (By Andrea Gerlin)

       The Medical College of Pennsylvania Hospital is a typical 
     teaching hospital. It is known for cutting-edge research 
     programs, for training medical students and newly graduated 
     doctors, and for providing advanced medical care.
       It is also representative of modern American hospitals in 
     another respect: In the last decade alone, records show, 
     hundreds of MCP Hospital patients have been seriously 
     injured, and at least 66 have died after medical mistakes.
       The hospital's internal records cite 598 incidents reported 
     by medical professionals to the hospital administration in 
     the past decade. In some of those cases, patients or 
     survivors were never told the injuries were caused by medical 
     errors. None of the doctors involved in the incidents was 
     subjected to disciplinary action.
       For patients of all ages, serious injury and death caused 
     by medical errors are well-known facts of life in the medical 
     community. But they rarely are reported to the general 
     public.
       MCP Hospital's records came to light only because of 
     bankruptcy proceedings last year, when its new owner publicly 
     filed a detailed account of the 598 incidents reported at the 
     facility from January 1989 through June 1998.
       Those numbers mirror what is happening across the country. 
     Lucian Leape, a Harvard University professor who conducted 
     the most comprehensive study of medical errors in the

[[Page 23053]]

     United States, has estimated that one million patients 
     nationwide are injured by errors during hospital treatment 
     each year and that 120,000 die as a result.
       That number of deaths is the equivalent of what would occur 
     if a jumbo jet crashed every day; it is three times the 
     43,000 people killed each year in U.S. automobile accidents.
       ``It's by far the No. 1 problem'' in health care, said 
     Leape, an adjunct professor of health policy at the Harvard 
     School of Public Health.
       In their study, Leape and his colleagues examined patient 
     records at hospitals throughout the state of New York. Their 
     1991 report found that one of every 200 patients admitted to 
     a hospital died as a result of a hospital error.
       Researchers such as Leape say that not only are medical 
     errors not reported to the public, but those reported to 
     hospital authorities represent roughly 5 to 10 percent of the 
     number of actual medical mistakes at a typical hospital.
       ``The bottom line is we have a system that is terribly out 
     of control,'' said Robert Brook, a professor of medicine at 
     the University of California at Los Angeles. ``It's really a 
     joke to worry about the occasional plane that goes down when 
     we have thousands of people who are killed in hospitals every 
     year.''
       In bankruptcy proceedings last year, Tenet Healthcare 
     Corp.--which bought eight Philadelphia-area hospitals, 
     including MCP, from the bankrupt Allegheny health system--
     publicly filed an account of medical errors reported at MCP 
     from 1989 through 1998. Such documents, which are maintained 
     by hospitals for legal and insurance reasons, are routinely 
     kept confidential.
       The Philadelphia Inquirer sent written requests seeking 
     similar information from 34 other large hospitals in 
     Philadelphia. Of 25 that responded, all declined to provide 
     similar insurance reports, citing patient confidentiality. 
     Tenet declined to provide comparable data for MCP since it 
     acquired the hospital.
       Contained in the MCP records is a history of one hospital's 
     experience, providing an unprecedented glimpse into the 
     extent and natural of hospital mistakes.
       The cases run the gamut from benign to fatal, and involve 
     patients whose health status ranged from young and vital to 
     old and infirm.
       They include:
       Four patients who died after they received too much 
     medication, the wrong medication or no medication.
       Surgical ``misadventures'' during which patients' organs 
     were punctured or blood vessels were pierced.
       An epilepsy patient who died and another who was left 
     paralyzed on one side after suffering brain hemorrhages 
     during surgery by inexperienced and inadequately supervised 
     residents. In those two cases, four doctors at MCP later 
     signed a letter to a hospital administrator saying that 
     mistakes by unsupervised surgical residents ``resulted in the 
     unfortunate death of one of our patients.''
       Two middle-age patients who died following cardiac 
     emergencies--men who according to hospital records did not 
     receive proper or timely treatment from emergency room 
     residents. One man sat in the emergency room with dangerously 
     elevated blood pressure for more than seven hours before 
     dying of a heart attack.
       An 18-year-old man who received the wrong type of blood in 
     a transfusion after an automobile accident, and died after an 
     apparent hemolytic reaction to the blood.
       Eight surgical patients who required second operations to 
     retrieve sponges, cotton or metal instruments left inside 
     their bodies.
       Inadquate intensive-care monitoring, which delayed response 
     to a mother of two who had stopped breathing. She was left 
     permanently brain-damaged.
       The Allegheny Health, Education and Research Foundation, 
     which owned MCP until November, declined to comment. Tenet, 
     the hospital's current owner, declined to discuss specific 
     cases and events at the hospital preceding its ownership.
       A Tenet executive said the company is aggressive and 
     systematic in monitoring the quality of care at the 130 
     hospitals it owns across the country.
       As of June 30, 1998, the date of the MCP report, the 
     hospital's insurers had paid roughly $30 million--excluding 
     legal costs--in settlements or jury awards in 76 of the 266 
     cases that resulted in lawsuits. The figures include five 
     cases settled for more than $1 million each.
       Lawyers for MCP, a 400-bed hospital in East Falls, Pa., 
     have consistently denied the hospital's liability in lawsuits 
     arising from errors. The hospital's own records suggest that 
     its experience is no different from that of most hospitals in 
     America.
       ``I find nothing in there that's beyond the average,'' said 
     Donald Berwick, a pediatrician who is president and chief 
     executive officer of the Institute for Healthcare 
     Improvement, a nonprofit organization based in Boston.
       The MCP doctors who treated patients included in the report 
     had a wide range of expertise. Some were first-year doctors-
     in-training, or residents, working under the supervision of 
     attending doctors. Others were veteran faculty who had 
     graduated at the top of their medical school classes and are 
     regarded by their colleagues as among the most competent in 
     their specialties.
       None of the 40 doctors involved in some of the most serious 
     mistakes at MCP was ever subjected to disciplinary action by 
     the state Bureau of Professional and Occupational Affairs, 
     according to an agency spokeswoman.
       ``Most people in health care really try hard, but they're 
     human and they make mistakes,'' said Harvard's Leape, a co-
     author of the ``Harvard Medical Practice Study.'' Said Leape: 
     ``Physicians are not infallible.''
       Leape added: ``No nurse or doctor wants to hurt somebody 
     and every nurse and doctor has hurt somebody. They don't want 
     to do it again.''
       Because most medical mistakes do not go beyond hospital 
     walls, experts say, an estimated 2 to 10 percent of all cases 
     involving medical error result in lawsuits.
       ``Because of the surveillance climate in health care, the 
     tendency is not to report errors, but to conceal them or 
     explain them away,'' Berwick said.

  The CHAIRMAN pro tempore (Mr. Quinn). Are there any further 
amendments to section 2?
  If not, the Clerk will designate section 3.
  The text of section 3 is as follows:

     SEC. 3. GRANTS REGARDING UTILIZATION OF PREVENTIVE HEALTH 
                   SERVICES.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254b et seq.) is amended by adding at 
     the end the following section:

     ``SEC. 330D. CENTERS FOR STRATEGIES ON FACILITATING 
                   UTILIZATION OF PREVENTIVE HEALTH SERVICES AMONG 
                   VARIOUS POPULATIONS.

       ``(a) In General.--The Secretary, acting through the 
     appropriate agencies of the Public Health Service, shall make 
     grants to public or nonprofit private entities for the 
     establishment and operation of regional centers whose purpose 
     is to identify particular populations of patients and 
     facilitate the appropriate utilization of preventive health 
     services by patients in the populations through developing 
     and disseminating strategies to improve the methods used by 
     public and private health care programs and providers in 
     interacting with such patients.
       ``(b) Research and Training.--The activities carried out by 
     a center under subsection (a) may include establishing 
     programs of research and training with respect to the purpose 
     described in such subsection, including the development of 
     curricula for training individuals in implementing the 
     strategies developed under such subsection.
       ``(c) Quality Management.--A condition for the receipt of a 
     grant under subsection (a) is that the applicant involved 
     agree that, in order to ensure that the strategies developed 
     under such subsection take into account principles of quality 
     management with respect to consumer satisfaction, the 
     applicant will make arrangements with one or more private 
     entities that have experience in applying such principles.
       ``(d) Priority Regarding Infants and Children.--In carrying 
     out the purpose described in subsection (a), the Secretary 
     shall give priority to various populations of infants, young 
     children, and their mothers.
       ``(e) Evaluations.--The Secretary, acting through the 
     appropriate agencies of the Public Health Service, shall 
     (directly or through grants or contracts) provide for the 
     evaluation of strategies under subsection (a) in order to 
     determine the extent to which the strategies have been 
     effective in facilitating the appropriate utilization of 
     preventive health services in the populations with respect to 
     which the strategies were developed.
       ``(f) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated such sums as may be necessary for each of the 
     fiscal years 2000 through 2004.''.

  The CHAIRMAN pro tempore. Are there any amendments to section 3?
  If not, are there any further amendments to the bill?


        Amendment No. 18 Offered by Mrs. Johnson of Connecticut

  Mrs. JOHNSON of Connecticut. Mr. Chairman, I offer an amendment.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 18 offered by Mrs. Johnson of Connecticut:
       At the end of the bill, add the following new section:

     SEC. 4. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT 
                   OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

       Part D of title III of the Public Health Service Act (42 
     U.S.C. 254b et seq.) is amended by adding at the end the 
     following subpart:

[[Page 23054]]



    ``Subpart IX--Support of Graduate Medical Education Programs in 
                          Children's Hospitals

     ``SEC. 340E. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT 
                   OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

       ``(a) Payments.--The Secretary shall make two payments 
     under this section to each children's hospital for each of 
     fiscal years 2000 and 2001, one for the direct expenses and 
     the other for indirect expenses associated with operating 
     approved graduate medical residency training programs.
       ``(b) Amount of Payments.--
       ``(1) In general.--Subject to paragraph (2), the amounts 
     payable under this section to a children's hospital for an 
     approved graduate medical residency training program for a 
     fiscal year are each of the following amounts:
       ``(A) Direct expense amount.--The amount determined under 
     subsection (c) for direct expenses associated with operating 
     approved graduate medical residency training programs.
       ``(B) Indirect expense amount.--The amount determined under 
     subsection (d) for indirect expenses associated with the 
     treatment of more severely ill patients and the additional 
     costs relating to teaching residents in such programs.
       ``(2) Capped amount.--
       ``(A) In general.--The total of the payments made to 
     children's hospitals under paragraph (1)(A) or paragraph 
     (1)(B) in a fiscal year shall not exceed the funds 
     appropriated under paragraph (1) or (2), respectively, of 
     subsection (f) for such payments for that fiscal year.
       ``(B) Pro rata reductions of payments for direct 
     expenses.--If the Secretary determines that the amount of 
     funds appropriated under subsection (f)(1) for a fiscal year 
     is insufficient to provide the total amount of payments 
     otherwise due for such periods under paragraph (1)(A), the 
     Secretary shall reduce the amounts so payable on a pro rata 
     basis to reflect such shortfall.
       ``(c) Amount of Payment for Direct Graduate Medical 
     Education.--
       ``(1) In general.--The amount determined under this 
     subsection for payments to a children's hospital for direct 
     graduate expenses relating to approved graduate medical 
     residency training programs for a fiscal year is equal to the 
     product of--
       ``(A) the updated per resident amount for direct graduate 
     medical education, as determined under paragraph (2)); and
       ``(B) the average number of full-time equivalent residents 
     in the hospital's graduate approved medical residency 
     training programs (as determined under section 1886(h)(4) of 
     the Social Security Act during the fiscal year.
       ``(2) Updated per resident amount for direct graduate 
     medical education.--The updated per resident amount for 
     direct graduate medical education for a hospital for a fiscal 
     year is an amount determined as follows:
       ``(A) Determination of hospital single per resident 
     amount.--The Secretary shall compute for each hospital 
     operating an approved graduate medical education program 
     (regardless of whether or not it is a children's hospital) a 
     single per resident amount equal to the average (weighted by 
     number of full-time equivalent residents) of the primary care 
     per resident amount and the non-primary care per resident 
     amount computed under section 1886(h)(2) of the Social 
     Security Act for cost reporting periods ending during fiscal 
     year 1997.
       ``(B) Determination of wage and non-wage-related proportion 
     of the single per resident amount.--The Secretary shall 
     estimate the average proportion of the single per resident 
     amounts computed under subparagraph (A) that is attributable 
     to wages and wage-related costs.
       ``(C) Standardizing per resident amounts.--The Secretary 
     shall establish a standardized per resident amount for each 
     such hospital--
       ``(i) by dividing the single per resident amount computed 
     under subparagraph (A) into a wage-related portion and a non-
     wage-related portion by applying the proportion determined 
     under subparagraph (B);
       ``(ii) by dividing the wage-related portion by the factor 
     applied under section 1886(d)(3)(E) of the Social Security 
     Act for discharges occurring during fiscal year 1999 for the 
     hospital's area; and
       ``(iii) by adding the non-wage-related portion to the 
     amount computed under clause (ii).
       ``(D) Determination of national average.--The Secretary 
     shall compute a national average per resident amount equal to 
     the average of the standardized per resident amounts computed 
     under subparagraph (C) for such hospitals, with the amount 
     for each hospital weighted by the average number of full-time 
     equivalent residents at such hospital.
       ``(E) Application to individual hospitals.--The Secretary 
     shall compute for each such hospital that is a children's 
     hospital a per resident amount--
       ``(i) by dividing the national average per resident amount 
     computed under subparagraph (D) into a wage-related portion 
     and a non-wage-related portion by applying the proportion 
     determined under subparagraph (B);
       ``(ii) by multiplying the wage-related portion by the 
     factor described in subparagraph (C)(ii) for the hospital's 
     area; and
       ``(iii) by adding the non-wage-related portion to the 
     amount computed under clause (ii).
       ``(F) Updating rate.--The Secretary shall update such per 
     resident amount for each such children's hospital by the 
     estimated percentage increase in the consumer price index for 
     all urban consumers during the period beginning October 1997 
     and ending with the midpoint of the hospital's cost reporting 
     period that begins during fiscal year 2000.
       ``(d) Amount of Payment for Indirect Medical Education.--
       ``(1) In general.--The amount determined under this 
     subsection for payments to a children's hospital for indirect 
     expenses associated with the treatment of more severely ill 
     patients and the additional costs related to the teaching of 
     residents for a fiscal year is equal to an amount determined 
     appropriate by the Secretary.
       ``(2) Factors.--In determining the amount under paragraph 
     (1), the Secretary shall--
       ``(A) take into account variations in case mix among 
     children's hospitals and the number of full-time equivalent 
     residents in the hospitals' approved graduate medical 
     residency training programs; and
       ``(B) assure that the aggregate of the payments for 
     indirect expenses associated with the treatment of more 
     severely ill patients and the additional costs related to the 
     teaching of residents under this section in a fiscal year are 
     equal to the amount appropriated for such expenses for the 
     fiscal year involved under subsection (f)(2).
       ``(e) Making of Payments.--
       ``(1) Interim payments.--The Secretary shall determine, 
     before the beginning of each fiscal year involved for which 
     payments may be made for a hospital under this section, the 
     amounts of the payments for direct graduate medical education 
     and indirect medical education for such fiscal year and shall 
     (subject to paragraph (2)) make the payments of such amounts 
     in 26 equal interim installments during such period.
       ``(2) Withholding.--The Secretary shall withhold up to 25 
     percent from each interim installment for direct graduate 
     medical education paid under paragraph (1).
       ``(3) Reconciliation.--At the end of each fiscal year for 
     which payments may be made under this section, the hospital 
     shall submit to the Secretary such information as the 
     Secretary determines to be necessary to determine the percent 
     (if any) of the total amount withheld under paragraph (2) 
     that is due under this section for the hospital for the 
     fiscal year. Based on such determination, the Secretary shall 
     recoup any overpayments made, or pay any balance due. The 
     amount so determined shall be considered a final intermediary 
     determination for purposes of applying section 1878 of the 
     Social Security Act and shall be subject to review under that 
     section in the same manner as the amount of payment under 
     section 1886(d) of such Act is subject to review under such 
     section.
       ``(f) Authorization of Appropriations.--
       ``(1) Direct graduate medical education.--
       ``(A) In general.--There are hereby authorized to be 
     appropriated, out of any money in the Treasury not otherwise 
     appropriated, for payments under subsection (b)(1)(A) --
       ``(i) for fiscal year 2000, $90,000,000; and
       ``(ii) for fiscal year 2001, $95,000,000.
       ``(B) Carryover of excess.--The amounts appropriated under 
     subparagraph (A) for fiscal year 2000 shall remain available 
     for obligation through the end of fiscal year 2001.
       ``(2) Indirect medical education.--There are hereby 
     authorized to be appropriated, out of any money in the 
     Treasury not otherwise appropriated, for payments under 
     subsection (b)(1)(A) --
       ``(A) for fiscal year 2000, $190,000,000; and
       ``(B) for fiscal year 2001, $190,000,000.
       ``(g) Definitions.--In this section:
       ``(1) Approved graduate medical residency training 
     program.--The term `approved graduate medical residency 
     training program' has the meaning given the term `approved 
     medical residency training program' in section 1886(h)(5)(A) 
     of the Social Security Act.
       ``(2) Children's hospital.--The term `children's hospital' 
     means a hospital described in section 1886(d)(1)(B)(iii) of 
     the Social Security Act.
       ``(3) Direct graduate medical education costs.--The term 
     `direct graduate medical education costs' has the meaning 
     given such term in section 1886(h)(5)(C) of the Social 
     Security Act.''.

  Mrs. JOHNSON of Connecticut. Mr. Chairman, first I would like to 
commend the gentleman from Florida (Mr. Bilirakis) on the underlying 
bill, the Health Research and Quality Act which I consider to be a very 
progressive modernization of the mission of the Agency for Health Care 
Policy and Research, and I commend him on the thoughtful work done to 
enable that agency to serve us in the future in a focused and 
aggressive manner.
  I also would like to thank the subcommittee chairman, the gentleman

[[Page 23055]]

from Florida (Mr. Bilirakis), for his support of a solution to the 
problem that our children's centers faced. He has been a strong 
advocate of our children's centers, and a great help to me as we moved 
this matter forward. I would like to thank also the chairman, the 
gentleman from Virginia (Mr. Bliley) of the Committee on Commerce who 
also has been helpful in the support of the gentleman from California 
(Mr. Thomas) who is chairman of the Subcommittee on Health of the 
Committee on Ways and Means and for the help and assistance and 
guidance of the gentlewoman from Ohio (Ms. Pryce) who has been so very 
interested in the work of the children's hospital and is so conscious 
of the excellent opportunity they provide for children with complex, 
difficult illness.
  Mr. Chairman, I offer this amendment, and I ask the support of my 
colleagues because our children's medical centers are facing an 
unprecedented financial crisis that threatens future advances in 
children's health care. All our teaching hospitals are facing a 
terrible challenge in just maintaining the resources needed to treat 
medically complex patients, the uninsured and the poor, and in 
addition, to maintain their training and teaching capabilities. It is 
increasingly difficult to get Medicare, Medicaid, and private payers to 
reimburse at a rate that is adequate to cover the unique 
responsibilities of our medical centers including the additional added 
costs of training physicians and conducting health care research. In 
today's price-competitive health care market, private payers no longer 
are willing to cover the costs of the public mission of training our 
physician work force. Children's teaching hospitals face an additional 
and unique burden because they receive no significant Federal support 
for their graduate medical education programs.
  Mr. Chairman, GME is principally funded through the Medicare program. 
Teaching hospitals receive funding based on the number of Medicare 
patients that they treat. Because children's hospitals treat very few 
Medicare patients, they receive no significant support for their 
teaching programs from the Federal Government.
  Freestanding children's hospitals receive on average less than one-
half of 1 percent of what other teaching facilities receive in Federal 
GME funding. The grant program embodied in this amendment would provide 
GME support for children's hospitals. That is just commensurate with 
Federal GME support that other teaching facilities receive under 
Medicare. This amendment merely establishes interim assistance to our 
children's hospitals to maintain their teaching programs while Congress 
reforms the way we as a Nation fund medical education.
  Mr. Chairman, the grant program would provide $280 million in fiscal 
year 2000, $285 million in fiscal year 2001; that is, authorize that 
money. Since comprehensive GME reform will take more time to develop, 
this amendment would provide immediate financial assistance through a 
capped time limited authorization of appropriations.
  Mr. Chairman, freestanding children's hospitals are responsible for 
the pediatric training of almost 30 percent of the Nation's 
pediatricians and almost half of pediatric specialists. They also 
provide training to substantial numbers of residents of other 
institutions who require pediatric rotations. Even though they make up 
less than 1 percent of all hospitals, 59 facilities, freestanding 
teaching children's hospitals educate and train over 5 percent of all 
residents nationwide.
  Make no mistake about it, Mr. Chairman. Top notch training programs 
are critical to ensure quality health care for our children. Kids with 
unusual and medically complex diseases depend on the sophisticated 
resources of our children's medical centers. Quality pediatric care 
depends on high-quality training of pediatric specialists and sub-
specialists, and improvements in diagnosing and treating disease depend 
on sophisticated basic and clinical research carried out in our 
children's hospitals.
  This grant program has broad bipartisan support. It is co-authored by 
over 190 Members, including the chairs and ranking members of the 
critical committees, and I urge my colleagues' support of it here 
today.
  Mr. BILIRAKIS. Mr. Chairman, I rise in support of the amendment 
offered by the gentlewoman from Connecticut (Mrs. Johnson).
  Mr. Chairman, the majority had a chance to review the amendment. It 
would provide graduate medical education payments to the children's 
hospitals by creating a financing system for pediatric physical 
training. The amendment was introduced as the Children's Hospital 
Education and Research Act, H.R. 1579, with significant bipartisan 
support.
  Mr. Chairman, few contest the historic inequity in GME funding for 
children's hospitals. Because Medicare is the largest single payer of 
GME and since freestanding children's hospitals treat few Medicare 
patients, as the gentlewoman from Connecticut said, their GME funding 
is very low. This gap in Federal support jeopardizes highly successful 
pediatric training programs.
  Since comprehensive GME reform may take more time to develop, this 
amendment will provide immediate financial assistance through a capped, 
time-limited appropriation of $280 million in fiscal year 2000 and 285 
million in fiscal year 2001. This authorization would end after 2 years 
or with the enactment of GME reform, whichever occurs first.
  Although, Mr. Chairman, I am not going to make a motion to contest 
the germaneness of this amendment, I do wish to point out that the bill 
under consideration now which reauthorizes an agency with a primary 
research mission is a questionable vehicle for authorizing 
appropriations for funding GME and children's hospitals, and I am sure 
the gentlewoman understands that and would acknowledge that. Moreover, 
on process grounds I can make a strong argument for moving the 
children's GME bill through the normal committee process rather than as 
an amendment to H.R. 2506.
  But having said this, Mr. Chairman, of course I am a cosponsor of the 
Johnson GME bill, and I agree with my colleague from Connecticut that 
this authorization of appropriations will send an important message to 
the relevant appropriations committees that the Congress considers 
support of GME for doctors training in children's hospitals as a high, 
high priority, and therefore, Mr. Chairman, we are prepared to accept 
the amendment.
  Ms. PRYCE of Ohio. Mr. Chairman, I move to strike the requisite 
number of words.
  Mr. Chairman, I rise in strong support of the Johnson amendment, and 
I congratulate my friend for her work on this very and most important 
issue, and I appreciate the chairman's support. Very simply, this 
amendment makes an investment in children's health by authorizing funds 
for physician training. Currently the Medicare program provides the 
most reliable and significant support for graduate medical education, 
but children's hospitals do not treat Medicare patients who are largely 
senior citizens.
  Mr. Chairman, the current system leaves children's hospitals 
searching for compensation for the time-consuming and resource-
intensive training they provide to enhance our physician work force. 
While children's hospitals or while children's teaching hospitals 
represent only 1 percent of all hospitals, they train nearly 30 percent 
of all pediatricians, nearly half of all pediatric specialists and a 
significant number of general practitioners.
  Now I have spent the better part of the past year in and out of 
Children's Hospital in Columbus, Ohio, and I know firsthand the 
critical difference between medical care for adults and medical care 
for children and all the commensurate differences in training that go 
along with the treating of a sick child as opposed to a grown adult 
including very basically the size of medical equipment, the dosage of 
drugs, the size of prosthetics, the administration of anesthesia, the 
ongoing development, the physical development, of children, the 
communication barriers. The list goes on and on, and it is absolutely 
critical for the physicians who treat children to have the proper

[[Page 23056]]

training to meet the needs and challenges that are specific to 
children.
  It is this kind of training that our Nation's children's hospitals 
are uniquely qualified to provide. Our current system of financial 
support for medical training disadvantages children's teaching 
hospitals, and the Johnson amendment begins to address the inequities 
of our graduate medical education system by authorizing a grant program 
to advance pediatrician training and pediatric research. It is a small 
price to pay to ensure that our children's hospitals can continue their 
mission to care for the sickest and poorest children while training the 
next generation of caregivers. It makes sense to add this provision to 
legislation that is focused on promoting public-private partnership to 
ensure health care quality research and patient access to care.
  This interim solution to fix the inequities of our GME system has the 
support of 190 Members of the House and 38 Senators who have 
cosponsored similar legislation. I urge the rest of my colleagues to 
join us in support of the Johnson amendment and in recognition of the 
special work that children's doctors devote their lives and energies 
to.
  Mr. LARSON. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, I rise today in support of the amendment offered by my 
esteemed colleague from Connecticut (Mrs. Johnson). The amendment 
provides funding for grants to children's hospitals to train 
pediatricians. This amendment incorporates the provisions of H.R. 1579, 
the Children's Hospitals Education and Research Act of 1999. It was one 
of the first bills I cosponsored on becoming a Member of this body.
  This amendment greatly affects the 59 independent children's teaching 
hospitals across this Nation. Although these hospitals represent less 
than 1 percent of all hospitals in the Nation, they train over 5 
percent of all physicians, 29 percent of all pediatricians and most 
pediatric specialists.
  The Connecticut Children's Medical Center is located in the center of 
my district and is one of these hospitals that desperately needs this 
graduate medical funding for their education programs. I have heard 
from many of my constituents and work closely with the staff at the 
medical center, its president, Larry Gold, and Eva Bunnell who is a 
tireless advocate on behalf of the children of our great State of 
Connecticut.
  As a parent of three children, I understand the importance and 
necessity of this funding. This amendment would authorize annual 
funding for 2 years and provide a more equitable, competitive playing 
field for independent children's teaching hospitals.
  I wear this pin today, which is the Connecticut Children's Medical 
Center's logo. It represents an open-armed child made of colorful 
blocks. A 8-year-old from the hospital said the logo looks like a kid 
ready to give a hug.
  We cannot turn our backs on the Nation's children and the care they 
deserve, and aside from the hugs they richly deserve, they need 
funding. Without this funding, these independent hospitals, which care 
solely for children, will find it hard to operate to the best of their 
ability.
  I commend the gentlewoman from Connecticut (Mrs. Johnson) for her 
tireless work on behalf of children in the State of Connecticut and 
across this Nation. She has done so since she was a member of the 
Connecticut State Senate. I rise in support of this amendment today and 
urge our colleagues to join us.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, will the gentleman yield?
  Mr. LARSON. I yield to the gentlewoman from Connecticut.
  Mrs. JOHNSON of Connecticut. Mr. Chairman, it really is a pleasure to 
have the gentleman from Connecticut here and in support of the 
remarkable Children's Hospital in Hartford, Connecticut, but I think it 
gives us a good example of why this is so urgent and why my colleague, 
the gentleman from Florida (Mr. Bilirakis) has been so generous as to 
let us bring this on this bill.

                              {time}  1700

  Truly, in the environment in which our hospitals are operating, our 
remarkable little Children's Hospital is a good example of the terrible 
circumstances these children's centers face. They serve mostly 
children. Medicaid reimburses much worse than Medicare reimburses, to 
begin with, and then they are right in the middle of Hartford so they 
have many, many uninsured children, many very poor children, who need a 
lot of special care, and yet they get not one cent or hardly a cent of 
reimbursement for their teaching and research initiatives. We just 
cannot let this happen.
  In the interim, we need this money to help them survive this period 
of extraordinary change in reimbursements. I just appreciate the 
gentleman's long working relationship with them, the help he has been 
on this bill.
  I would also like to just take a moment to thank the ranking member, 
the gentleman from Ohio (Mr. Brown), who has been a long solid advocate 
of children's hospitals and worked hard on this amendment for the year 
and a half or 2 years we have been working on it.
  Mr. LARSON. Mr. Chairman, reclaiming my time, I can add no more to 
the gentlewoman's eloquence.
  Mr. WAXMAN. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, I rise in support of this amendment offered by our 
colleague, the gentlewoman from Connecticut (Mrs. Johnson). By 
providing adequate Graduate Medical Education funding to children's 
hospitals, this amendment will ensure that our Nation's premier 
pediatric health care institutions are capable of pursuing their 
research, training, and primary-care missions on a firm financial 
footing.
  For too long Congress has failed to remedy a clear inequity in the 
funding of Graduate Medical Education at children's hospitals. Because 
GME funding is contingent upon an institution's Medicare census, 
children's hospitals have not received adequate funding for the direct 
and indirect expenses of operating essential pediatric residency 
programs.
  This amendment has strong bipartisan support in both the House and 
the Senate. I urge my colleagues to cast a vote in favor of 
strengthening our children's health care by supporting this amendment.
  Let me conclude by saying how pleased I am that the House has 
reauthorized AHCPR, soon to be called the Agency for Health Research 
and Quality. I am proud to have been the one to have introduced this 
legislation creating the agency in 1989 with Senator Kennedy. Just 
three years ago, AHCPR underwent a near-death experience arising from 
partisan politics, so I am especially pleased this essential agency 
once again has the bipartisan support it deserves.
  Ms. McCARTHY of Missouri. Mr. Chairman, I move to strike the 
requisite number of words.
  Mr. Chairman, I want to thank the chairman of the subcommittee, the 
gentleman from Florida (Mr. Bilirakis) for accepting this amendment, to 
thank the gentlewoman from Connecticut (Mrs. Johnson) for her tireless 
efforts in championing it, and to thank my ranking member, the 
gentleman from Ohio (Mr. Brown), for his tireless work as well in 
support of our children.
  I am a cosponsor of similar legislation, and I am very pleased we are 
moving forward now on this key issue, which will authorize $565 million 
in appropriations for children's hospitals to maintain their graduate 
residency training programs.
  This is critical to the health of our children. Children's hospitals 
are responsible for the pediatric training of almost one-third of the 
Nation's pediatricians. A lack of Federal support jeopardizes all 
education and training programs in children's hospitals, thereby 
threatening not only the pediatric workforce, but future health-care 
research and our children's health. It would be penny-wise and pound-
foolish to continue down this path.
  In my district alone, this temporary funding will help train 70 
doctors at Children's Mercy Hospital, a freestanding regional facility 
in Kansas

[[Page 23057]]

City. The Johnson amendment supports the 59 children's teaching 
hospitals all across our country. I commend the sponsor and chairman 
and ranking member.
  Mr. BACHUS. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, first of all, I would like to commend the gentlewoman 
from Connecticut (Mrs. Johnson), the chairman of the subcommittee, the 
gentleman from Florida (Mr. Bilirakis), and the gentleman from Ohio 
(Mr. Brown) for offering this amendment.
  Let me tell you what it means to one hospital of the 59. Children's 
Hospital of Alabama is the only freestanding pediatric hospital in the 
State of Alabama. It not only receives patients from Alabama, it 
receives patients from Mississippi and from as far away as Chattanooga, 
Tennessee.
  Children's Hospital presently spends $4 million to $6 million 
annually for Graduate Medical Education. Unlike hospitals which treat 
Medicare patients, Children's Hospital receives no Medicare funds, and, 
therefore, no Medicare graduate medical expense reimbursement.
  As the gentlewoman from Connecticut has said, Medicaid reimbursements 
are less, commercial insurers are not offering reimbursement for these 
expenses, and, with the recent changes in Medicaid and Medicare, all 
our hospitals are operating under cost controls, but our children's 
hospitals are operating on the severest of restraints.
  Children's hospitals, we have heard various figures on how many of 
the pediatricians these hospitals train. Children's hospitals train 75 
percent of the pediatricians in Alabama; and, nationwide, although 
children's hospitals train 25 percent or one-fourth of pediatricians, 
they train almost all pediatric sub-specialists. These are the people 
that treat our little boys and girls with cancer, with epileptic 
seizures, those children who are injured in accidents. Our sickest 
children come to our children's hospitals. They need the best of care, 
and they need medical doctors who are trained and trained well.
  It is for this reason that I support enthusiastically the amendment 
of the gentlewoman from Connecticut (Mrs. Johnson), for, as we are fond 
of saying in this body, our children deserve the best, and that 
includes the best health care, and that includes the best trained 
health care pediatricians. This amendment will assure that.
  To the gentlewoman from Connecticut (Mrs. Johnson), I thank you for 
your hard work; and I commend the body for its consideration of this 
measure.
  Mr. BENTSEN. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, I rise in support of the amendment offered by the 
gentlewoman from Connecticut (Ms. Johnson) and commend her for offering 
this amendment. I also want to commend the ranking member, the 
gentleman from Ohio (Mr. Brown). Both the gentlewoman from Connecticut 
(Mrs. Johnson) and the gentleman from Ohio (Mr. Brown) have been the 
original sponsors, of which I am an original cosponsor, of the bill, 
H.R. 1579, the Children's Hospital Education Research Act, and I 
commend them for having the foresight to introduce this legislation.
  The Johnson amendment would provide critically important Federal 
funding for our Nation's 59 independent children's hospitals, including 
six such hospitals in Texas. I have the honor and distinction to 
represent two children's hospitals, Texas Children's Hospital, which is 
a qualified independent children's hospital, as well as Memorial 
Hermann Children's Hospital, which is part of a larger hospital system. 
In addition to that, I have the Shriner's Orthopedic Hospital in my 
district in the Texas Medical Center complex, which is in the 25th 
District. All of these are teaching hospitals aligned with the Baylor 
College of Medicine and the University of Texas.
  As has been pointed out by many Members today, there is a great 
disparity in the level of Federal funding for teaching hospitals for 
pediatrics versus other types of teaching hospitals. That is due in 
large part because of how we have structured our medical education 
program around the Medicare system.
  As the gentlewoman knows from the Committee on Ways and Means, this 
is a broader issue that we need to address. Some of us, the gentleman 
from Maryland (Mr. Cardin) and myself, have some ideas. Others have 
their ideas. The chairman of the Committee on Ways and Means, my next-
door neighbor in Houston, has his ideas. But, nonetheless, we should 
not wait until we come to a conclusion on that. We ought to act as the 
chairman of the subcommittee said. This is the right thing to do right 
now.
  As has been pointed out, these hospitals, while only being a small 
percentage, train a very large percentage of the pediatricians. As the 
gentlewoman from Connecticut (Mrs. Johnson) pointed out, these 
hospitals are under tremendous financial pressure. They are under 
financial pressure from the private sector in managed-care health 
plans. They are under pressure in the Medicaid program.
  In fact, back in 1997, as part of the Balanced Budget Act, we made 
pretty dramatic reductions in the disproportionate share program. 
Fortunately, we were able to ease those a little bit as it affected 
States like mine in Texas, Connecticut, and others. Those reductions 
were made, nonetheless. We know that the Nation's children's hospitals 
do carry a disproportionate share of both indigent and Medicaid 
patients, which just adds to the fiscal burden that they have to 
address.
  This bill would provide in a 2-year capped program some additional 
funding to address this situation. But, more importantly, in the long 
term it would underscore the Federal commitment to ensuring that we 
continue to have the world's best pediatric care and that we continue 
to have the world's best medical education program.
  I hope by passage of this amendment, and hopefully passage of this 
bill and funding of this bill, that we can go a step further, and when 
we look at the overall Graduate Medical Education program or the 
medical education program, we will look beyond just Medicare and 
understand that training doctors and training the other allied health 
positions is not just something that is benefited by the Medicare 
beneficiaries; but all of us, including our children, benefit from 
this; and, thus, we should take that into account in structuring the 
program.
  So I commend the gentlewoman from Connecticut, the gentleman from 
Ohio and the chairman of the subcommittee for accepting this amendment, 
and I ask my colleagues to support the amendment.
  Mr. COOK. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, I rise in support of the amendment being offered by the 
gentlewoman from Connecticut. Children's teaching hospitals play a 
vital and unique role in our health care system. They are the training 
ground for future pediatricians, and nurses and they do groundbreaking 
research into children's illnesses. Many of these hospitals are 
freestanding facilities without the resources of a university or a 
health care organization to subsidize the higher costs the teaching 
hospitals incur.
  Primary Children's Hospital in my State of Utah is one such hospital. 
It trains an average of 52 residents a year and has an outstanding 
reputation as one of the leading children's hospitals in the West. Most 
pediatricians in the 5-State Intermountain region have received at 
least some of their training at Primary Children's Hospital. But 
because children's hospitals treat few Medicare patients, they are at 
an economic disadvantage, since Graduate Medical Education is funded 
through the Medicare program. As a result, they receive less than one-
half of 1 percent of what other teaching facilities receive in Federal 
assistance. This is not right. Our children deserve the finest health 
care that we can provide.
  The $280 million grant funding proposed in the amendment offered by 
the gentlewoman from Connecticut (Mrs. Johnson) is a modest effort to 
provide

[[Page 23058]]

some equity and relief to these hospitals and enable them to continue 
their fine work. I was a cosponsor of H.R. 1579, and I am proud to 
support this amendment. I hope my colleagues will join me and stand up 
for children's health by voting for this amendment.
  Ms. LEE. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, I rise in strong support of the amendment offered by 
the gentlewoman from Connecticut (Mrs. Johnson) to authorize $280 
million in fiscal 2000 and $285 million in fiscal 2001 for a program 
that would provide grants to children's hospitals to train 
pediatricians.
  On behalf of the Children's Hospital in Oakland, California, my 
district, I want to thank the gentlewoman from Connecticut (Mrs. 
Johnson) and the gentleman from Ohio (Mr. Brown) for this amendment. 
This authorization is needed because freestanding children's hospitals 
are disadvantaged under the current Federal Graduate Medical Education 
funding for children's teaching hospitals.
  Freestanding children's hospitals receive an average of less than 
one-half percent of what other teaching facilities receive in Federal 
Graduate Medical Education funding.

                              {time}  1715

  Now, in Oakland, California, in my district, Children's Hospital, a 
freestanding hospital, has 205 licensed beds. It is a regional trauma 
center and is an independent teaching hospital. It is a hospital that 
when my children were children played a very important role in the 
healthy development of my kids. It continues to be an exemplary medical 
facility and a very supportive environment for children and their 
families.
  Now, because the hospital only treats children and not the elderly, 
it receives almost no graduate medical payments from Medicare, the one 
stable source of Graduate Medical Education support.
  At Children's Hospital in Oakland, California, senior clinicians and 
scientists work with young doctors in pediatrics and pediatric 
specialities. It is these interns and residents who will become the 
pediatricians and scientists of tomorrow and who will bring us the 
miracles of the 21st century, a cure for cancer, new therapies, and 
other great possibilities. We need an equitable playing field in the 
price competitive health-care marketplace.
  Medicare has become the only reliable source of significant support 
for Graduate Medical Education in teaching hospitals. Because 
children's teaching hospitals care for children, they receive less than 
.5 percent of the Medicare Graduate Medical Education support provided 
to other teaching hospitals. The current mechanism for Graduate Medical 
Education financing does not equitably recognize the contribution of 
these hospitals. So we must invest in children's health.
  Independent children's teaching hospitals are less than 1 percent of 
all hospitals but train nearly 30 percent of all pediatricians and 
nearly half of all pediatric specialists. A strong academic program is 
critical to all facets of children's hospitals' missions. They care for 
the sickest and the poorest children, training the next generation of 
caregivers for children and research in order to improve children's 
health care. They are in the community, responding to the health care 
needs of our children and supporting their families.
  So this amendment has broad bipartisan support. I urge my colleagues 
to support this amendment; and once again, I want to thank the 
gentlewoman from Connecticut (Mrs. Johnson) and the gentleman from Ohio 
(Mr. Brown) for their support and commitment to children in our 
country.
  Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the Johnson 
amendment.
  Mr. Chairman, I commend the gentlewoman for her work and also the 
gentlewoman from California (Ms. Lee) and others that have spoken 
before me. Before I introduced this legislation 2\1/2\ years ago, I 
visited the Akron Children's Hospital in Akron, Ohio, and saw the 
outstanding kind of work that medical personnel in that hospital did in 
pediatric medical advancement. As has been outlined by previous 
speakers, there is not a very good funding stream for medical education 
in children's hospitals and especially in freestanding children's 
hospitals.
  Ohio is the home, I believe, of more freestanding children's 
hospitals than any State in the country. With the squeeze of managed 
care, coupled with the peculiarity of the way that we fund Graduate 
Medical Education through Medicare, children's hospitals simply cannot 
produce the pediatric specialists or, for that matter, the pediatric 
general practitioners that this country needs to produce. This is a 
very good amendment. This is a very important part of this bill. I 
commend the sponsor of the bill and ask for support of the Johnson 
amendment.
  Mr. THOMAS. Mr. Chairman, I rise in support of Representative Nancy 
Johnson's amendment to the Health Research Quality Act (HR 2506). This 
amendment authorizes $280 million in FY 2000 and $285 million in FY 
2001 for graduate training programs at children's hospitals.
  Mr. Chairman, the way the government currently finances graduate 
medical education makes little objective sense. The system has unfairly 
penalized children's hospitals.
  The training of physicians, in what is known as Direct Graduate 
Medical Education, is financed through Medicare's Hospital Insurance 
Trust Fund. Thus, the funds a hospital receives depends on the number 
of Medicare patients it serves. Since children's hospitals treat very 
few Medicare patients (primarily those with End Stage Renal Disease), 
they receive almost no funding from the Medicare program. Medicare pays 
teaching hospitals $7 billion in Graduate Medical Education, or about 
$76,000 per resident. Yet children's hospitals receive only about $400 
per resident, despite training more than one-fourth of the nation's 
physicians and a majority of the pediatric specialties. In addition, 
free-standing children's hospitals constitute less than 1% of all 
hospitals but train more than 5% of all residents.
  This illustrates one more reason why the entire direct graduate 
medical education program is in need of fundamental reform. Why should 
the training of residents who go on to treat patients of all 
demographic profiles be financed out of a program designed for the 
elderly and disabled? Second, why should we pay certain hospitals 5 or 
6 times the amount per resident as we pay for the training of equally 
qualified residents at equally prestigious universities and teaching 
hospitals in other regions of the country?
  Senator Bill Frist, also a former physician, headed a task force 
within the Medicare Commission, which recommended that direct medical 
education be funded outside of the Medicare structure. I believe we can 
provide a more secure funding structure through a multi-year 
appropriations process because it provides a larger pool of resources: 
the General Fund. In addition, an appropriations process will provide 
needed oversight into the inequities that is lacking in the current 
entitlement structure.
  I am pleased that Representative Nancy Johnson and the children's 
hospitals support the Medicare Commission's recommendation that 
children hospital DME be funded through the appropriations process. I 
strongly endorse this amendment and hope we can finally start providing 
needed resources to children's hospitals so that they may secure the 
important missions they perform.
  Mr. SESSIONS. Mr. Chairman, freestanding children's hospitals are 
disadvantaged under the current federal GME (Graduate Medical 
Education) funding structure. GME is principally funded through the 
Medicare program. Teaching hospitals receive funding based on the 
number of patients that they treat. Because children's hospitals treat 
few Medicare patients, they receive no significant federal support for 
GME.
  Children's hospitals receive on average less than one-half of one 
percent (0.5%) of what other teaching facilities receive in federal GME 
funding. This grant program would provide GME support for children's 
hospitals that is commensurate with federal GME support that other 
teaching facilities receive under Medicare.
  Training programs are necessary to ensure quality health care for 
children. The education and training programs of these institutions are 
critical to the future of pediatric medicine and therefore to the 
future health of all children.
  In 1998, Children's Medical Center of Dallas served as the training 
site for 77 pediatric residents. Although hospitals like ``Children's 
Med. Center of Dallas'' represents less than 1% of all hospitals in the 
country, independent children's teaching hospitals are responsible for

[[Page 23059]]

training nearly 30% of all pediatricians, nearly half of all pediatric 
subspecialties and train over 5% of all residents nationwide.
  This amendment would establish interim assistance to children's 
hospitals to maintain their teaching program while Congress addresses 
the inequities in the current GME system through Medicare reform. The 
grant program would provide $280 million in FY2000 and $285 million in 
FY2001.
  Mr. PORTMAN. Mr. Chairman, I rise in strong support of Mrs. Johnson's 
amendment to establish interim funding assistance to children's 
hospitals. The amendment will enable children's hospitals in Ohio and 
across the nation to maintain their teaching programs while Congress 
addresses the inequities in the current graduate medical education 
(GME) system through Medicare reform.
  The nation's 59 freestanding children's hospitals, including 
Children's Hospital Medical Center in Cincinnati, train about 30 
percent of the nation's pediatricians and nearly half of all pediatric 
specialists. Many residents of other hospitals who require pediatric 
rotations are trained at these facilities as well. Although they make 
up less than 1 percent of all hospitals, freestanding children's 
hospitals educate and train over 5 percent of all residents nationwide.
  However, the current system of federal funding assistance is tilted 
against pediatric training. Graduate medical education is funded 
primarily through Medicare based on the number of patients that 
teaching hospitals treat. Since few Medicare patients receive care at 
children's hospitals, these facilities get less than one-half of one 
percent of what other teaching hospitals get in federal GME funding. 
This unfair situation threatens the future of our nation's pediatric 
workforce and also hinders the development of new treatments since 
teaching facilities perform the majority of health care research.
  Congress recognized this problem in the Balanced Budget Act of 1997 
by directing both the Medicare Payment Advisory Commission and the 
Bipartisan Commission on the Future of Medicare to address the 
financing of graduate medical education in children's hospitals as part 
of a comprehensive evaluation of GME. However, GME reform will take a 
while to develop. Therefore, the Johnson amendment will provide 
immediate financial assistance to children's hospitals comparable to 
the federal GME support that other teaching facilities receive under 
Medicare. It would do this through a capped, time-limited authorization 
of appropriations.
  The Johnson amendment is essentially the language of the Children's 
Hospital Education and Research Act, H.R. 1579. I am an original 
cosponsor of a bipartisan bill, which is supported by over 190 Members 
of the House, including the chairs, ranking members and other members 
of subcommittees and committees of jurisdiction--the Commerce, Ways and 
Means and Appropriations Committees.
  I urge my colleagues to support this important amendment to provide 
children's hospitals with a level playing field by addressing the 
federal funding GME gap they face, and, at the same time, give children 
a better shot at growing up healthy.
  Mr. HOBSON. Mr. Chairman, I rise in support of the amendment offered 
by the gentlelady from Connecticut. This issue is particularly 
important for children in Ohio, where thousands of sick children every 
year are treated at Ohio's six independent children's hospitals.
  Over the recent district work period, I visited the Children's 
Medical Center in Dayton, Ohio. Not only does the Center provide first 
rate care for children, it also provides a caring and attentive 
environment that allows parents and relatives to actively participate 
in their children's care. We all know how important it is to be near 
our children when they are sick, and the nation's children's hospitals 
provide the atmosphere and specialized care that is the best medicine 
for our children.
  At some hospital serving adult populations in Ohio, the federal 
reimbursement for resident training is about $50,000 per resident. This 
federal commitment to graduate medical education has helped ensure that 
our doctors and the quality of care they provide are the best in the 
world.
  However, due to the way the reimbursement formula has been set up, 
the federal commitment to graduate medical education at children's 
hospitals is much smaller. For example, Children's Hospital in 
Columbus, Ohio received about $230 per resident last year.
  This amendment restores some fairness to the reimbursement rates that 
children's hospitals receive and will help ensure that Ohio and other 
states with children's hospitals will continue to train qualified 
pediatricians. This is an issue of fairness, and an investment long-
overdue, and I urge my colleagues to support this amendment.
  Ms. DUNN. Mr. Chairman, I rise in support of Representative Johnson's 
amendment to provide grants to train medical residents at independent 
children's hospitals. I commend my friend for her leadership on this 
important issue and ask my colleagues to support her amendment.
  The problem is simple: the federal government provides funding for 
graduate medical education through Medicare. Independent children's 
hospitals throughout this nation treat children under the age of 21, 
which is primarily a Medicaid population. Consequently, these hospitals 
do not receive Medicare funding for the medical professionals they 
train.
  To rectify this discrepancy, this amendment will provide funding to 
children's hospitals that train medical doctors to be pediatricians. 
These hospitals are critical to serving sick children and providing 
important research to improve the quality of children's lives.
  Earlier this year, Speaker Hastert joined me in visiting the 
Children's Hospital and Regional Medical Center in Seattle, Washington. 
With 72 pediatric residents a year, Children's Hospital in Seattle is 
the dominant provider for training of pediatricians in the Pacific 
Northwest, covering the region of Washington, Wyoming, Alaska, Montana 
and Idaho.
  In 1997, Children's Hospital invested $8 million in its medical 
education program and was reimbursed only $160,000 from Medicare and 
$2.4 million from Medicaid. This hospital cannot meet the needs of our 
community if it is forced to reduce the number of residents it trains. 
This amendment will improve quality of care by continuing to provide 
doctors who specialize as pediatricians or other pediatric 
subspecialties.
  Independent children's teaching hospitals are less than 1% of all 
hospitals, but they train nearly 30% of all pediatricians. More 
importantly, we can continue our commitment to helping the sickest and 
poorest children in our communities.
  As a parent of two sons, I know the importance of good quality health 
care for our children, and we must be very careful to leave no child 
behind. I urge my colleagues to support this important amendment. It is 
an investment in our children's health.
  The CHAIRMAN pro tempore (Mr. Quinn). The question is on the 
amendment offered by the gentlewoman from Connecticut (Mrs. Johnson).
  The amendment was agreed to.


                Amendment No. 19 Offered by Mr. McGovern

  Mr. McGOVERN. Mr. Chairman, I offer amendment No. 19.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 19 offered by Mr. McGovern:
       Page 46, after line 2, insert the following section:

     SEC. 4. STUDY REGARDING SHORTAGES OF LICENSED PHARMACISTS.

       (a) In General.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary''), acting 
     through the appropriate agencies of the Public Health 
     Services, shall conduct a study to determine whether and to 
     what extent there is a shortage of licensed pharmacists. In 
     carrying out the study, the Secretary shall seek the comments 
     of appropriate public and private entities regarding any such 
     shortage.
       (b) Report to Congress.--Not later than one year after the 
     date of the enactment of this Act, the Secretary shall 
     complete the study under subsection (a) and submit to the 
     Congress a report that describes the findings made through 
     the study and that contains a summary of the comments 
     received by the Secretary pursuant to such subsection.

  Mr. McGOVERN. Mr. Chairman, my amendment calls attention to a very 
serious problem in this country, the potential shortage of pharmacists. 
As the population ages and prescription drug use continues to increase, 
we must examine whether there are enough qualified pharmacists to 
knowledgeably and safely distribute these medicines. My amendment would 
require that the Health Resources Services Administration study whether 
and to what extent there is a shortage of licensed pharmacists and to 
report back to Congress in 1 year on its findings. The report would 
include comments from private and public entities.
  Mr. Chairman, as we debate the specifics of a prescription drug plan, 
which is incredibly important, we must also examine the potential 
shortage of pharmacists serving our health-care community. Our health-
care system is changing from inpatient to outpatient treatment. 
Pharmaceutical manufacturing is on the rise; and even though there is 
debate about the specifics of such a plan, I think we all recognize the 
need for a Medicare prescription drug benefit.

[[Page 23060]]

  As these events continue to unfold, we must recognize the lag in the 
education and development of new, qualified pharmacists. Currently, 
pharmacy providers throughout northern New England and around the 
country are experiencing difficulty finding enough pharmacists to keep 
up with the demand for prescription drugs. Pharmacists often serve as a 
valuable link between patients and their doctors. They provide valuable 
information about side effects and drug interactions. They ensure that 
our prescriptions are filled correctly, and they provide important 
advice on a range of issues when one of us or a member of our family is 
not feeling well.
  I am concerned, Mr. Chairman, that in the near future people will not 
have access to the important community-based prescription services that 
are vital to maintaining their health. Unfortunately, this situation 
will only worsen. For example, the National Association of Chain Drug 
Stores estimates that the number of prescriptions will increase from 
2.8 billion per year today to 4 billion in the year 2005. The number of 
pharmacists, however, is not projected to keep up with this demand. 
Data from the National Association of Chain Drug Stores shows that 
while the number of prescriptions in Massachusetts, my State, will 
increase 39 percent between 1998 and 2005, the number of pharmacists 
will only increase 13 percent over that same amount of time.
  That is Massachusetts. The same problem exists all over the country. 
I believe Congress needs to take action. I have been working with the 
Massachusetts College of Pharmacy, which is opening a campus in 
Worcester, Massachusetts, in an attempt to deal with what potentially 
can be a major health crisis in this country.
  In my opinion, we need to support the creation of more pharmacy 
schools. We need to examine ways to help encourage more people to enter 
the field of pharmacy, and we need to make sure that the financial 
assistance is available for students who want to pursue a career in 
pharmacy. By voting for this amendment, Congress will take the first 
step in determining whether and to what extent there is a shortage of 
pharmacists in this country, and I believe this will lay the groundwork 
for us to take actions in the future to remedy this very significant 
problem.
  Mr. Chairman, I urge support of this amendment.
  Mr. Chairman, I insert the following letter for printing in the 
Record:

         Massachusetts College of Pharmacy and Allied Health 
           Sciences, Office of the President,
                                               September 24, 1999.
     Hon. James P. McGovern,
     416 Cannon House Office Building, Washington, District of 
         Columbia.
       Dear Congressman McGovern: I want to commend you for 
     addressing the current pharmacist shortage in America. I 
     support your amendment to the Health Research Quality Act, 
     H.R. 2506, which would study the impending crisis and report 
     potential solutions.
       The combination of new biomedical discoveries, and the 
     substantial graying of a large segment of the population, 
     will create demands for billions more prescriptions that will 
     be critical to maintaining the health of many Americans in 
     the 21st century. This increase will cause an equal demand on 
     human resources, and the need to supply trained personnel in 
     pharmacy and counseling. In their 1998 study, the National 
     Association of Chain Drug Stores found over 3500 vacant 
     positions among their members, concluding that the demand for 
     pharmacists could grow by as much as 30% over the next two 
     years.
       Like a great many of our colleagues throughout the nation, 
     the Massachusetts College of Pharmacy and Health Sciences has 
     been mindful of this burgeoning health care crisis from the 
     need for trained community pharmacists. The project that will 
     allow us to help to alleviate this crisis is the development 
     of a fully accredited MCPHS campus in the city of Worcester, 
     Massachusetts. Aided by the support of both the public and 
     the private sectors, our strategic planning outlines a growth 
     in academic resources that will facilitate an increase of 500 
     more pharmacy graduates, to bring out total to almost 2200 
     degrees in pharmacy studies, by the year 2003. I believe that 
     this project holds great potential as an effective public-
     private partnership that could truly serve as a national 
     model of creative response to this impending cataclysm to 
     national health care.
       We, at MCPHS, urge you and your colleagues to give serious 
     consideration in developing recommendations to address this 
     serious shortage of licensed pharmacists.
           Sincerely,
     Charles F. Monahan, Jr.
                                  ____

                                    NACDS, National Association of


                                            Chain Drug Stores,

                                               September 28, 1999.
     Hon. James P. McGovern,
     U.S. House of Representatives,
     Washington, DC.
       Dear Congressman McGovern: On behalf of the National 
     Association of Chain Drug Stores (NACDS), I am writing to 
     applaud your leadership in raising awareness about the 
     national shortage of licensed pharmacists. We are proud to be 
     working with you on this issue and look forward to continuing 
     our cooperative efforts to find solutions to this important 
     public health concern.
       Toward this end, NACDS supports your efforts to amend H.R. 
     2506, the Health Research and Quality Act, to direct the 
     Secretary of Health and Human Services to conduct a study on 
     the shortage of licensed pharmacists. As you are well aware, 
     NACDS had conducted research concluding that the pharmacist 
     shortage is an acute situation that will only get worse as 
     the national demand for prescription drug therapy continues 
     to grow. With your amendment, Congress can take an important 
     step towards developing solutions to ensure that an adequate 
     supply of pharmacists is available to provide medication and 
     pharmaceutical services to the public in the future.
       We also appreciate that you have included in the amendment 
     a definitive date for completion of the study, as this will 
     ensure that this issue receives the urgent consideration it 
     deserves. Given the potential consequences of prolonging the 
     pharmacist shortage, this research is too important to delay.
       Thank you for your ongoing efforts to ensure the Americans 
     consumers have access to the best health care services 
     available. If I may be of any assistance on this or other 
     issues, please do not hesitate to contact me.
           Sincerely,
                                                 Robert W. Hannan,
                            President and Chief Executive Officer.

  Mr. BILIRAKIS. Mr. Chairman, I move to strike the last word.
  Mr. Chairman, the majority has had an opportunity to review the 
amendment. I personally spoke with the gentleman regarding his 
amendment. I commend him for it, and I would agree with him. Certainly 
in Florida, where we have such a much bigger demand than most of the 
States in the country, we have a tremendous shortage of pharmacists. 
Most of the members of my family are pharmacists, and I am able to keep 
up with that.
  Mr. Chairman, we are prepared to accept the amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I rise in support of the McGovern 
amendment.
  Mr. Chairman, I want to thank the gentleman for his commitment, 
particularly in light of what Congress looks like it may do on 
prescription drugs, for his commitment to this issue. I think it is 
something we need to know more about to see if it is regional, if it is 
national, how acute the shortage is; and I think this amendment will 
help us learn to do that and deal with coverage of prescription drugs 
nationally also. I commend him and ask for support of the amendment.
  Mr. BERRY. Mr. Chairman, I rise today as a licensed pharmacist, in 
support of the McGovern amendment.
  I always say that I am proud to have served in two of the most 
respected professions: as a farmer and a pharmacist.
  I have stood here many times to talk about the affordability of 
prescription drugs. Today, I am here to ask that we pass this amendment 
for the sake of consumers.
  Why? Because our nation's consumers, especially seniors, rely on 
pharmacists for their livelihood.
  In the 1st Congressional District of Arkansas, these shortages are in 
the smaller towns.
  The demand for full-time pharmacists has increased more than 25 
percent in the past two years.
  We all know from traveling in our districts that one of the main 
concerns of seniors is the affordability of prescription drugs. But we 
also know that not enough pharmacists to fill those prescriptions, this 
is also a major problem.
  Let's pass the McGovern amendment.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentleman from Massachusetts (Mr. McGovern).
  The amendment was agreed to.


         Amendment No. 22 Offered by Mr. Thompson of California

  Mr. THOMPSON of California. Mr. Chairman, I offer amendment No. 22.
  The CHAIRMAN pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:


[[Page 23061]]

       Amendment No. 22 offered by Mr. Thompson of California:
       Page 46, after line 2, add the following section:

     SEC. 4. REPORT ON TELEMEDICINE.

       Not later than January 10, 2001, the Director of the Agency 
     for Health Research and Quality shall submit to the Congress 
     a report that--
       (1) identifies any factors that inhibit the expansion and 
     accessibility of telemedicine services, including factors 
     relating to telemedicine networks;
       (2) identifies any factors that, in addition to 
     geographical isolation, should be used to determine which 
     patients need or require access to telemedicine care;
       (3) determines the extent to which--
       (A) patients receiving telemedicine service have benefited 
     from the services, and are satisfied with the treatment 
     received pursuant to the services; and
       (B) the medical outcomes for such patients would have 
     differed if telemedicine services had not been available to 
     the patients;
       (4) determines the extent to which physicians involved with 
     telemedicine services have been satisfied with the medical 
     aspects of the services;
       (5) determines the extent to which primary care physicians 
     are enhancing their medical knowledge and experience through 
     the interaction with specialists provided by telemedicine 
     consultations; and
       (6) identifies legal and medical issues relating to State 
     licensing of health professionals that are presented by 
     telemedicine services, and provides any recommendations of 
     the Director for responding to such issues.

  Mr. THOMPSON of California. Mr. Chairman, telemedicine has been in 
existence for over 30 years but has only recently become one of the 
fastest growing areas of medicine. Telemedicine allows a consulting 
physician at one location to observe a patient or interpret data at 
another location via two-way audio or video links. Dermatology, 
oncology, cardiology, radiology, and surgery are just a few of the 
areas of medicine that have felt the positive impact of this 
technology.
  If someone represents a rural district, as I do, they have heard from 
constituents who often have to travel long distances to consult with 
medical specialists. Telemedicine allows these same individuals to 
consult with their primary-care physician and a specialist at the same 
time without the burdens of extraordinary travel, but telemedicine does 
not just help rural districts. This field of medicine has the potential 
to provide a wider range of services to all underserved communities, 
both rural and urban.
  The benefits of telemedicine are numerous; but in order to encourage 
its growth, we still need to research and answer a few critical 
questions.
  Are patients who have received telemedicine benefiting from it? What 
criteria should be used to determine which patients need these 
services? What factors are inhibiting the expansion of accessibility of 
telemedicine networks?
  Congress in the past has commissioned reports on telemedicine, 
including one under the Health Insurance Portability and Accountability 
Act of 1996 and another under the Balanced Budget Act of 1997. Although 
these reports address many important aspects of the field, there are 
still gaps that need to be filled in.
  In working with the National Institutes of Health and other medical 
professionals throughout the country, I have drafted this amendment. It 
requires the Agency for Health Research and Quality to research and 
respond to Congress by January of 2001 on issues relating to patient 
screening and interstate licensing of medical professionals.
  In addition, this amendment would require a review of the factors 
that may be inhibiting the expansion of telemedicine networks. It is 
necessary to identify the hurdles that still need to be overcome in 
this field in order to establish and promote successful systems of 
telemedicine.
  I want to thank the chairman and the ranking member for their great 
work on this measure, and I would urge a yes vote on this amendment.
  Mr. OSE. Mr. Chairman, I rise in support of the amendment by my good 
friend, the gentleman from California (Mr. Thompson).
  Mr. Chairman, I have this past week spent much time in my district 
visiting the various facilities that serve the medical needs of the 
people who live in the Third District, and I will say firsthand, up 
front and personal, that this system works. I have been in the hospital 
in Colusa, a small city of around 5,500 in my district, where we 
actually communicated as I was standing there with people at the 
University of California at Davis Medical Center talking about issues 
affecting a patient.
  Telemedicine works. It helps the people in my district, and the thing 
that is so critical here, the thing that actually makes a difference, 
that we should support here if for no other reason is that telemedicine 
is an effective, efficient, beneficial way to bring medical assistance 
to the people who live in our rural areas throughout this country.
  I have seen it work. I want to say that. I have seen it work in my 
district. There is a camera. There is a screen. There are people on the 
other end, and it is just like talking from here to the Chair.
  The amendment of the gentleman is well thought out. The fact that we 
can get some additional greater information to allow us to make 
reasoned, rational decisions regarding telemedicine merits our support. 
I thank the chairman for considering it.
  Mr. BILIRAKIS. Mr. Chairman, will the gentleman yield?
  Mr. OSE. I yield to the gentleman from Florida.
  Mr. BILIRAKIS. Mr. Chairman, I thank the gentleman from California 
(Mr. Ose) for yielding.
  Mr. Chairman, I really appreciate the gentleman sharing his story 
with us and commend the gentleman from California (Mr. Thompson) for 
offering this amendment. Back in the days when Ron Wyden from Oregon, 
who is now a U.S. senator, was here, he and I spent a lot of time on 
the issue of telemedicine. We ran into some roadblocks but it has been 
sort of a little bit of a cause of mine, a secondary cause of mine 
unfortunately, but I think it is an excellent resource.
  Frankly, my opinion is that it is not being used to its full 
potential and hopefully the gentleman's amendment will focus the agency 
on this particular issue, and hopefully we can improve upon that. So in 
any case, we are prepared to accept the amendment.

                              {time}  1730

  Mr. FALEOMAVAEGA. Mr. Chairman, I move to strike the requisite number 
of words.
  Mr. Chairman, I certainly want to commend the gentleman from Florida 
(Mr. Bilirakis), the chairman of the Subcommittee on Health and 
Environment, and the gentleman from Ohio (Mr. Brown), our ranking 
member, for allowing this amendment to be brought before the floor.
  Mr. Chairman, I rise today in full support of the proposed amendment 
of the gentleman from California (Mr. Thompson) to H.R. 2506 to require 
the Agency for Health Research and Quality to submit a report to 
Congress by January 2001 on telemedicine.
  Mr. Chairman, I represent a group of Americans living in a remote 
area, far from the modern hospitals or other major health facilities. 
The people of my district get sick and are injured just like anyone 
throughout the country.
  One big difference, Mr. Chairman, is that, if a person's serious 
injury or illness cannot be treated by a local physician, he may just 
have to wait awhile before he or she can be transferred to the nearest 
major hospital, which is about a 5-hour plane ride from Samoa to 
Honolulu. To make things more complicated, Mr. Chairman, there are only 
two flights per week between American Samoa and Honolulu.
  In addition to that, Mr. Chairman, the cost of transporting a patient 
in a gurney, along with an attending nurse or physician 2,300 miles to 
Hawaii and back is quite significant, which leads to the very reason 
why I fully support this amendment for telemedicine.
  Mr. Chairman, presently health and medical care needs in rural 
America and distant U.S. insular areas are simply overwhelming the 
available resources. Telemedicine can work to lessen the costs and, at 
the same time, can dramatically improve the quality of and access to 
needed health and medical care.
  Telemedicine can be a very valuable tool to medical facilities in 
rural areas.

[[Page 23062]]

We now have the technology to assist rural America, but the 
infrastructure is not always in place, and the costs are still somewhat 
of a concern.
  This amendment will require that we devote some of our resources to 
determining how best to move forward with this emergent technology to 
provide improved medical care for rural America.
  Again, I thank the gentleman from California (Mr. Thompson) for his 
initiative by introducing this necessary amendment, and my appreciation 
to the chairman and the ranking member for their leadership and 
assistance by allowing this amendment to be included in this 
legislation.
  I urge my colleagues to support this amendment.
  Ms. WOOLSEY. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, I, too, am in support of this amendment, an amendment 
to bring the delivery of health care into the 21st century.
  Telemedicine is an innovative and fast growing field that provides 
real access and necessary access to medical care, particularly to areas 
that are not close to major medical facilities.
  That is why this year the gentleman from California (Mr. Thompson) 
and I requested funding for a telemedicine network located in Santa 
Rosa at Santa Rosa Memorial Hospital to provide access to the children 
and families in northern California's remote and underserved 
population.
  Santa Rosa Memorial Hospital is in my district, and the majority of 
the families that it would serve are in the district of the gentleman 
from California (Mr. Thompson). Together, that was a partnership to 
take care of the children in our area in general.
  The U.S. Department of Health and Human Services has classified 
portions of our districts as medically underserved. Specialty and 
trauma care are often limited and episodic at best, making telemedicine 
the only viable answer to making care accessible to these families.
  The children who need state-of-the-art medicine, but do not have it 
in their rural communities, will be served greatly by this amendment.
  We have the technology to fix a problem. Now, let us have the 
courage. I hear on both sides of the aisle that the courage is there, 
and I appreciate it, to fix this problem permanently.
  Telemedicine has been in existence for over 30 years, and it is time 
to make it a priority so that it will work and so that it will work 
right.
  Again, I applaud the gentleman from California (Mr. Thompson) for his 
leadership on this issue. I urge my colleagues to support this 
amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I move to strike the requisite 
number of words.
  Mr. Chairman, I rise in support of the second Thompson amendment. I 
commend the gentleman from California for bringing attention to the 
potential of telemedicine and for outlining for us the success already 
of telemedicine. It is a terrific breakthrough in the last decade or so 
and in serving underserved remote areas, as the gentlewoman from 
California (Ms. Woolsey) said. I think this is a good amendment that 
will lead to more breakthroughs in telemedicine.
  I ask support of the House for the Thompson amendment.
  The CHAIRMAN pro tempore (Mr. Quinn). The question is on the 
amendment offered by the gentleman from California (Mr. Thompson).
  The amendment was agreed to.


               Amendment No. 23 Offered by Mr. Traficant

  Mr. TRAFICANT. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 23 offered by Mr. Traficant: Page 46, after 
     line 2, insert the following section:

     SEC. 4. BUY AMERICAN PROVISIONS.

       (a) Compliance With Buy American Act.--No funds authorized 
     pursuant to this Act may be expended by an entity unless the 
     entity agrees that in expending the assistance the entity 
     will comply with sections 2 through 4 of the Act of March 3, 
     1933 (41 U.S.C. 10a-10c, popularly known as the ``Buy 
     American Act'').
       (b) Sense of Congress; Requirement Regarding Notice.--
       (1) Purchase of american-made equipment and products.--In 
     the case of any equipment or products that may be authorized 
     to be purchased with financial assistance provided under this 
     Act, it is the sense of the Congress that entities receiving 
     such assistance should, in expending the assistance, purchase 
     only American-made equipment and products.
       (2) Notice to recipients of assistance.--In providing 
     financial assistance under this Act, the Secretary of Health 
     and Human Services shall provide to each recipient of the 
     assistance a notice describing the statement made in 
     paragraph (1) by the Congress.

  Mr. TRAFICANT. Mr. Chairman, I would like to start out by commending 
the gentleman from Florida (Mr. Bilirakis), a fellow graduate of the 
University of Pittsburgh and a dear friend, for his work on health 
care. I believe if the Congress would work with the gentleman from 
Florida (Mr. Bilirakis), we would continue to have improvements such as 
these that will incrementally improve the health-care system of 
America.
  I also want to commend the gentleman from Ohio (Mr. Brown), my 
neighbor, for working with our chairman and for aggressively working on 
problems of health-care needs for all the people of America. But I do 
want to encourage the Congress to continue to work carefully with the 
chairman. The health-care program that he is espousing makes a lot of 
sense.
  Mr. Chairman, this is a very simple amendment. It says people who get 
the money from this bill in the form of grants shall abide by the ``buy 
American'' law which many of them forget to do, and they have to be 
prosecuted for such evasion. At least we can remind them and encourage 
them when expending these funds, where at all possible and practicable, 
to expend those funds in the purchases of American-made goods and 
services.
  It makes sense. It is common sense. I would ask that it would be 
included in the bill.
  Mr. BILIRAKIS. Mr. Chairman, I move to strike the requisite number of 
words.
  Mr. Chairman, before I respond to the gentleman's amendment, I would 
like to take this opportunity to thank and commend the staffs, the 
people who really make all of this possible. We get the accolades, but 
they are really the ones who have done all the work: Jason Lee, a 
member of the committee staff; Tom Giles, another member of the 
majority staff; Ann Esposito from my personal staff; minority staff 
John Ford and Ellie Dahoney; and Pete Goodloe, legislative counsel. I 
really commend them and thank them. This has been a good piece of 
legislation. It has been very beneficial, I think.
  Mr. Chairman, the majority has had an opportunity to review the 
amendment by the Buy-American Congressman, the great Buy-American 
Congressman here in the Congress, and his amendment would require that 
the agency or any entity that expends funds authorized pursuant to this 
act comply with the Buy American Act. He is already very diligent in 
doing that.
  We are prepared to accept his amendment.
  Mr. BROWN of Ohio. Mr. Chairman, I move to strike the requisite 
number of words.
  Mr. Chairman, I rise in support of the Traficant amendment. I commend 
the gentleman from Ohio (Mr. Traficant), with whom I share a county, 
Trumbull County in eastern Ohio, and thank him for his work on this 
amendment. I thank the gentleman from Florida (Mr. Bilirakis) for his 
good work on this bill and so many other pieces of legislation in our 
committee. Also Mr. Ford, Mr. Schooler, and the majority staff, and 
Ellie Dahoney also in my office.
  This amendment, as the amendments of the gentleman from Ohio (Mr. 
Traficant) typically are on this, on several bills on buy America, 
makes sense. It will improve the bill. I commend him for his work. I 
ask for support of the amendment.
  The CHAIRMAN pro tempore. The question is on the amendment offered by 
the gentleman from Ohio (Mr. Traficant).
  The amendment was agreed to.
  Are there any further amendments on the bill?

[[Page 23063]]

  If not, the question is on the committee amendment in the nature of a 
substitute, as amended.
  The committee amendment in the nature of a substitute, as amended, 
was agreed to.
  The CHAIRMAN pro tempore. Under the rule, the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
McHugh) having assumed the chair, Mr. Quinn, Chairman pro tempore of 
the Committee of the Whole House on the State of the Union, reported 
that that Committee, having had under consideration the bill (H.R. 
2506) a bill to amend title IX of the Public Health Service Act to 
revise and extend the Agency for Health Care Policy and Research, 
pursuant to House Resolution 299, he reported the bill back to the 
House with an amendment adopted by the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any amendment to the committee 
amendment in the nature of a substitute adopted by the Committee of the 
Whole? If not, the question is on the amendment.
  The amendment was agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. BILIRAKIS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 417, 
nays 7, not voting 9, as follows:

                             [Roll No. 457]

                               YEAS--417

     Abercrombie
     Ackerman
     Aderholt
     Allen
     Andrews
     Armey
     Bachus
     Baird
     Baker
     Baldacci
     Baldwin
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Barrett (WI)
     Bartlett
     Barton
     Bass
     Bateman
     Becerra
     Bentsen
     Bereuter
     Berkley
     Berman
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bishop
     Blagojevich
     Bliley
     Blumenauer
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bonior
     Bono
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brady (TX)
     Brown (FL)
     Brown (OH)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Cannon
     Capps
     Capuano
     Cardin
     Carson
     Castle
     Chabot
     Chambliss
     Clay
     Clayton
     Clement
     Clyburn
     Coble
     Collins
     Combest
     Condit
     Conyers
     Cook
     Cooksey
     Costello
     Cox
     Coyne
     Cramer
     Crane
     Crowley
     Cubin
     Cummings
     Cunningham
     Danner
     Davis (FL)
     Davis (IL)
     Davis (VA)
     Deal
     DeFazio
     DeGette
     Delahunt
     DeLauro
     DeLay
     DeMint
     Deutsch
     Diaz-Balart
     Dickey
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doolittle
     Doyle
     Dreier
     Dunn
     Edwards
     Ehlers
     Ehrlich
     Emerson
     Engel
     English
     Eshoo
     Etheridge
     Evans
     Everett
     Ewing
     Farr
     Fattah
     Filner
     Fletcher
     Foley
     Forbes
     Ford
     Fossella
     Fowler
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Gallegly
     Ganske
     Gejdenson
     Gekas
     Gephardt
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gonzalez
     Goode
     Goodlatte
     Goodling
     Gordon
     Goss
     Graham
     Granger
     Green (TX)
     Green (WI)
     Greenwood
     Gutierrez
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastings (FL)
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (IN)
     Hill (MT)
     Hilleary
     Hilliard
     Hinchey
     Hinojosa
     Hobson
     Hoeffel
     Hoekstra
     Holden
     Holt
     Hooley
     Horn
     Houghton
     Hoyer
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Inslee
     Isakson
     Istook
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Jenkins
     John
     Johnson (CT)
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kasich
     Kelly
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     King (NY)
     Kingston
     Kleczka
     Klink
     Knollenberg
     Kolbe
     Kucinich
     Kuykendall
     LaFalce
     LaHood
     Lampson
     Lantos
     Largent
     Larson
     Latham
     LaTourette
     Lazio
     Leach
     Lee
     Levin
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Lucas (OK)
     Luther
     Maloney (CT)
     Maloney (NY)
     Manzullo
     Markey
     Martinez
     Mascara
     Matsui
     McCarthy (MO)
     McCollum
     McCrery
     McDermott
     McGovern
     McHugh
     McInnis
     McIntosh
     McIntyre
     McKeon
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Metcalf
     Mica
     Millender-McDonald
     Miller (FL)
     Miller, Gary
     Miller, George
     Minge
     Mink
     Moakley
     Mollohan
     Moore
     Moran (KS)
     Moran (VA)
     Morella
     Murtha
     Myrick
     Nadler
     Napolitano
     Neal
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Oberstar
     Obey
     Olver
     Ortiz
     Ose
     Owens
     Oxley
     Packard
     Pallone
     Pascrell
     Pastor
     Payne
     Pease
     Pelosi
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pickett
     Pitts
     Pombo
     Pomeroy
     Porter
     Portman
     Price (NC)
     Pryce (OH)
     Quinn
     Radanovich
     Rahall
     Ramstad
     Rangel
     Regula
     Reyes
     Reynolds
     Rivers
     Rodriguez
     Roemer
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Rothman
     Roukema
     Roybal-Allard
     Rush
     Ryan (WI)
     Ryun (KS)
     Sabo
     Salmon
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Saxton
     Schaffer
     Schakowsky
     Scott
     Sensenbrenner
     Serrano
     Shadegg
     Shaw
     Shays
     Sherman
     Sherwood
     Shimkus
     Shows
     Shuster
     Simpson
     Sisisky
     Skeen
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Souder
     Spence
     Spratt
     Stabenow
     Stark
     Stearns
     Stenholm
     Strickland
     Stump
     Stupak
     Sununu
     Sweeney
     Talent
     Tancredo
     Tanner
     Tauscher
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Terry
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Thune
     Thurman
     Tiahrt
     Tierney
     Toomey
     Towns
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Velazquez
     Vento
     Visclosky
     Vitter
     Walden
     Walsh
     Wamp
     Waters
     Watkins
     Watt (NC)
     Watts (OK)
     Waxman
     Weiner
     Weldon (FL)
     Weldon (PA)
     Weller
     Wexler
     Weygand
     Whitfield
     Wicker
     Wilson
     Wise
     Wolf
     Woolsey
     Wynn
     Young (AK)
     Young (FL)

                                NAYS--7

     Chenoweth
     Coburn
     Duncan
     Hostettler
     Johnson, Sam
     Paul
     Royce

                             NOT VOTING--9

     Archer
     McCarthy (NY)
     McKinney
     Riley
     Sanford
     Scarborough
     Sessions
     Thomas
     Wu

                              {time}  1804

  Mr. ROYCE changed his vote from ``yea'' to ``nay.''
  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. THOMAS. Mr. Speaker, on rollcall No. 457, had I been present, I 
would have voted ``yea.''

                          ____________________