[Congressional Record (Bound Edition), Volume 146 (2000), Part 15]
[House]
[Pages 22378-22386]
[From the U.S. Government Publishing Office, www.gpo.gov]



CONCURRING IN SENATE AMENDMENT TO H.R. 4386, BREAST AND CERVICAL CANCER 
                  PREVENTION AND TREATMENT ACT OF 2000

  Mrs. MYRICK. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 628 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 628

       Resolved, That upon adoption of this resolution it shall be 
     in order to take from the Speaker's table the bill (H.R. 
     4386) to amend title XIX of the Social Security Act to 
     provide medical assistance for certain women screened and 
     found to have breast or cervical cancer under a federally 
     funded screening program, to amend the Public Health Service 
     Act and the Federal Food, Drug, and Cosmetic Act with respect 
     to surveillance and information concerning the relationship 
     between cervical cancer and the human papillomavirus (HPV), 
     and for other purposes, with the Senate amendment thereto, 
     and to consider in the House, without intervention of any 
     point of order, a motion offered by the chairman of the 
     Committee on Commerce or his designee that the House concur 
     in the Senate amendment with the amendment printed in the 
     report of the Committee on Rules accompanying this 
     resolution. The Senate amendment and the motion shall be 
     considered as read. The motion shall be debatable for one 
     hour equally divided and controlled by the chairman and 
     ranking minority member of the Committee on Commerce. The 
     previous question shall be considered as ordered on the 
     motion to final adoption without intervening motion or demand 
     for division of the question.

  The SPEAKER pro tempore. The gentlewoman from North Carolina (Mrs. 
Myrick) is recognized for 1 hour.
  Mrs. MYRICK. Mr. Speaker, for the purpose of debate only, I yield the 
customary 30 minutes to the gentlewoman from New York (Ms. Slaughter) 
pending which I yield myself such time as I may consume. During 
consideration of this rule, all time yielded is for the purpose of 
debate only.
  Mr. Speaker, yesterday the Committee on Rules met and granted a rule 
waiving all points of order against a motion to concur in the Senate 
amendment to H.R. 4386, the Breast and Cervical Cancer Prevention and 
Treatment Act of 2000 with an amendment.
  Mr. Speaker, the rule provides for 1 hour of debate in the House on 
the motion equally divided and controlled by the chairman and ranking 
minority member of the Committee on Commerce.
  The rule also waives all points of order against the amendment 
printed in the Committee on Rules report.
  Mr. Speaker, this rule allows us to finally pass a very, very 
important bill. The Breast Cancer Treatment Act will allow low-income, 
uninsured women to get treatment for their breast and cervical cancer.
  Right now, uninsured women can receive free Federal mammograms and 
pap smears; but if they find out they have cancer, they are on their 
own.
  There is nothing worse than being diagnosed with breast cancer or 
cervical cancer and then being told, sorry, there is nothing we can do 
to help. That is ridiculous. It is very, very expensive to get 
chemotherapy and radiation, which are the treatment options we have 
available today. I know this because I just finished that treatment 
through my own battle with cancer.
  It is also a very emotional battle when one is told they have this 
disease and just diagnosed with it and somebody should not have to 
worry that they are not going to be able to get the treatment they 
need. Because they naturally would think, I am going to die. What is 
going to happen to me?
  I was very lucky because I was able to afford health insurance. This 
bill is for working women who have no insurance, and it is crucial that 
we do our part to help them with the tough time in their lives.
  In my own State of North Carolina, 20,000 women have been screened 
for breast cancer through the government's free mammogram program. And 
up until now, many of these women have been left out in the cold.
  Now, as soon as we get this bill to the President, these women will 
have health. And there is another issue in this bill which we are going 
to be addressing and we both have speakers on both sides of the aisle, 
and that is the human papilloma virus. We are going to be talking about 
that. And then, as we go through the process, I am going to move at the 
end of the rule to make an amendment to the bill. And I want to make 
that clear.
  So we need to pass this rule and, more importantly, let us get this 
bill to the President.
  Mr. Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I thank my colleague from North Carolina for yielding me 
the customary half hour.
  Mr. Speaker, first and foremost, I want to express my very strong 
support for the underlying bill. I am proud to be an original cosponsor 
of H.R. 1070, on which the legislation is based.
  Our consideration of this measure is long overdue. I want to commend 
the gentlewoman from California (Ms. Eshoo), the gentlewoman from North 
Carolina (Mrs. Myrick) and the gentlewoman from Missouri (Ms. Danner) 
as well as all the members of the Women's Caucus for persevering and 
advancing the issue and bringing it before the House today.
  Now, according to our colleagues in the other body, the other body 
will not, I repeat, will not consider the measure in the final days of 
Congress if we allow the Coburn amendment to go forward. And with this 
in mind, my colleague the gentlewoman from North Carolina (Mrs. Myrick) 
has secured a mechanism to remove the additional language to provide 
for consideration of a clean bill. She has my strong support in this 
effort. I urge the support of my colleagues, as well.
  I would like to say a word about the serious nature of the human 
papilloma virus to both men and women as one of the leading causes of 
both cervical and prostate cancer, and I would also like to have some 
more work done on the importance of surveillance and research on that 
virus. I think it is an

[[Page 22379]]

important step, and I look forward to seeing the provision that the 
gentleman from Oklahoma (Mr. Coburn) has in his amendment included on a 
bill this year, but just not this one. We cannot afford to let this 
year about to go by while women wait.
  The Breast and Cervical Cancer Treatment Act is much too important to 
be caught up in the procedural confusion. This bill provides an 
opportunity to extend care and treatment to low-income women diagnosed 
with cancer under the CDC breast and cervical cancer screening program. 
For many of these women, such a bill will ensure that they have access 
to affordable care.
  Low-income women screened and diagnosed with breast cancer through 
the Centers for Disease Control and Prevention of Breast and Cervical 
Cancer Control Program should not have to hold bake sales to obtain 
treatment for breast cancer. The underlying bill will give States the 
option of providing Medicaid coverage for the treatment of these women.
  Mr. Speaker, the bill has the strong support of the National Breast 
Cancer Coalition, a 500 member organization representing hundreds of 
thousands of individual members. And we also have letters of support 
from numerous health care organizations urging that the Senate version 
of the bill be considered so that we can pass this and send it to the 
President this year.
  Mr. Speaker, I reserve the balance of my time.
  Mrs. MYRICK. Mr. Speaker, I yield 6 minutes to the gentleman from 
Oklahoma (Mr. Coburn) my friend.
  Mr. COBURN. Mr. Speaker, I want to thank the gentlewoman from North 
Carolina, who is a very dear friend of mine, and want to say this: 
There is no question I have lost the battle on this bill to have women 
have the knowledge about what the risks are from this virus. And that 
has been my goal all along.
  Every Friday and every Monday that we are not here, I treat women. I 
hate this virus. I hate it worse than HIV. Because what it does is it 
takes the self-esteem away from a woman. A woman feels dirty when she 
finds out that she has got this virus.
  Unfortunately, we as a body have condoned the message in this country 
that says to our young children and young adults that they can have 
safe sex. That is a lie.
  A condom offers no protection from this virus. The NIH has stated so. 
As a matter of fact, NIH Dr. Richard Cosner has stated that no 
additional research should be done on the efficacy of condoms as 
related to this virus because the studies are irrefutable that a condom 
will not protect them.
  I understand the concerns of the gentlewoman from New York and the 
Women's Caucus in this. I want a breast and cervical cancer bill. I 
have three close family members with breast cancer. I want this. I want 
this for the women in my practice who have trouble getting treatment 
when they are working and do not have health insurance. I do not mean 
to be an impediment. But if we take the same track on cervical cancer, 
on prostate cancer, and now 20 percent of the gay men in this country 
have rectal dysplasia, which means they are going to have rectal cancer 
if we take the same track we did initially on HIV and offer treatment 
only, without education and information for prevention, what we have 
done is a very great disservice to the country.

                              {time}  1445

  We have abrogated our responsibility. The fact is that we can prevent 
cervical cancer. Yes, we have set up a great screening system to find 
this. That is why we find it early. That is why we have such wonderful 
cure rates on cervical cancer. But we should not have as many women 
with cervical cancer as we do in this country: 3,800 women will die 
this year from cervical cancer; 30,000 will be diagnosed with cervical 
cancer in this country. Those are preventable diseases.
  As we discuss the health care dollars and the health care crisis in 
this country, to be spending money on treatments when we could have 
prevented it is very, very foolish. I would like to engage the 
gentlewoman from New York in a colloquy, if I might. I would like to 
just ask again, I heard her opening statement and I am very 
appreciative of it. Can I have a commitment from the Women's Caucus 
that before this session of Congress is over, that we in fact will have 
in some language somewhere a study and a prevention message for the 
young people in this country as relating to human papilloma virus?
  Ms. SLAUGHTER. If the gentleman will yield, if I could give him that 
assurance, I would. Unfortunately, I do not determine what goes on what 
bills. However, I made it as clear as I could in my statement that we 
recognize that what he is doing is important, that we want to see it 
this year. However, there is no mistaking the fact that if his 
amendment is on this bill, the Senate will not take it up this year. 
That means that another year, maybe two, would pass before the poor 
women in the United States would have access to treatment. We would be 
more than happy, and I will give the gentleman my commitment that we 
would vote for that, be happy to do it; but certainly I am not the 
person he wants to talk to about putting that on another bill.
  Mr. COBURN. I have the assurance of our leadership. What I want is 
the assurance of the Women's Caucus that they want women in this 
country to be informed about this risk.
  Ms. SLAUGHTER. I think we have made that very clear. I do not know 
anything I could say to make it clearer. We want all the information we 
can get. We do not believe there is any such thing as too much. But we 
want to save this bill because women are waiting.
  Mr. COBURN. I thank the gentlewoman, and I reclaim my time.
  I would just say the following thing: information is powerful. Women 
in our country are smart. They make good medical decisions. They can 
and must be informed of the risk of this virus. Seven million women 
this year will become infected with this virus. Not all of them will 
develop cervical cancer. But if one does, we have not done our job.
  Mrs. MALONEY of New York. Mr. Speaker, will the gentleman yield?
  Mr. COBURN. I yield to the gentlewoman from New York.
  Mrs. MALONEY of New York. Mr. Speaker, I just first of all want to 
commend the gentleman from Oklahoma for his efforts, his really sincere 
and hard efforts to alert the public on the danger of HPV, which is a 
very widespread sexually transmitted disease. As cochair of the Women's 
Caucus along with my dear friend and colleague from the great State of 
New York (Mrs. Kelly), he has my absolute commitment to work this year 
to find some vehicle to have this study and the important work that he 
is supporting in a package this year. But as the gentlewoman from New 
York (Ms. Slaughter) pointed out, the Senate has said they want a clean 
bill. That is what we want to give them. But we applaud his efforts, 
his work and we want to work with him.
  Mr. COBURN. I thank the gentlewoman for that assurance.
  Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Mrs. Capps).
  Mrs. CAPPS. I thank my colleague from New York for yielding me this 
time.
  Mr. Speaker, I have spent many months working with my colleagues in 
the Committee on Commerce on helping to support the Breast and Cervical 
Treatment Act. I want to pay particular tribute to the gentlewoman from 
California (Ms. Eshoo), who is not able to be here today for her 
leadership in that effort in the committee and throughout the House.
  I want to pay a special tribute today to the gentlewoman from North 
Carolina (Mrs. Myrick) for her leadership to move this legislation 
along. As a nurse, I fully understand the importance of human papilloma 
virus as a public health issue. I commend the gentleman from Oklahoma 
(Mr. Coburn) for his interest in this topic, and I hope that the House 
will address this issue very soon.
  But today we must be voting on a clean bill so that we can ensure 
that

[[Page 22380]]

low-income women who have been screened positive for breast and 
cervical cancer can get the treatment that they so desperately need. As 
the gentlewoman from North Carolina said, early diagnosis is 
meaningless without the opportunity for treatment. That is what this 
bill, the Breast and Cervical Cancer Treatment Act, addresses. Adding 
the HPV provision to this bill which is extraneous to its underlying 
purpose of treatment jeopardizes its passage. Think of the disservice 
this does, the critical lifesaving treatment that could be denied to 
millions of women in this country today if this happens.
  Today, instead, we have the chance to pass this strongly bipartisan 
bill out of the House and send it directly to the President's desk for 
a signature. We cannot let that opportunity pass by.
  Mrs. MYRICK. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
New York (Mrs. Kelly).
  Mrs. KELLY. Mr. Speaker, I rise today in support of the rule for H.R. 
4386, the Breast and Cervical Cancer Prevention and Treatment Act. Back 
in May, the House passed this legislation under the suspension of the 
rules. Today, we have the opportunity to again support this important 
legislation which would provide treatment for low-income women with 
breast and cervical cancer by closing the gap in an existing Federal 
program that screens low-income women for breast and cervical cancer 
but does not provide treatment once diagnosed.
  The rule we are now considering will allow the House to consider the 
same bill which the Senate passed this week, and by the end of today we 
will have a bill to send to the President to close this gap and provide 
treatment for the hundreds of thousands of women across this country 
who need this treatment.
  The rule removes the amendment offered by the gentleman from Oklahoma 
(Mr. Coburn). His amendment addresses a serious disease, the human 
papilloma virus. But unfortunately this language may have slowed this 
bill's passage in the other body. I support the efforts of my 
colleague, and I look forward to joining him in the future to have 
these concerns considered. I join my colleague, the gentlewoman from 
New York (Mrs. Maloney), the cochair of the House Women's Caucus, in 
committing to work within the Women's Caucus for the inclusion of his 
bill in any vehicle possible this year so we can address this dangerous 
virus.
  Presently, I urge all of my colleagues to support this rule, however, 
and the underlying bill. This legislation is a critical step in 
ensuring women have access to the treatment that they need for these 
terrible diseases. I thank the gentlewoman from California (Ms. Eshoo) 
and the gentleman from New York (Mr. Lazio) for their work on this 
issue.
  Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, I came to the floor originally to speak 
against the rule, but now I understand that the rule will be amended 
and the language that was added to the Senate bill will not be included 
so that this legislation will go directly from the House to the 
President. We hear he is anxiously awaiting the opportunity to sign it.
  I was the author of the legislation originally to provide the breast 
and cervical cancer screening. That was during the Bush-Quayle 
administration. We had their support for that legislation, but we could 
not get them to agree to help fund the treatment for women if they 
found that they had cancer. It is now 8 years later and in a bipartisan 
and maybe unanimous move we are finally going to allow low- and 
moderate-income women who are screened for breast and cervical cancer 
under the existing program to have assured treatment under this 
legislation.
  This bill would provide them the hope by allowing States to cover 
them under Medicaid to get the care that they need. It makes sense. It 
is in fact a cruel hoax to say to a woman, ``Go get screened but if it 
turns out you have cancer, if you don't have insurance, you're on your 
own.''
  Unfortunately, in these last 8 years, the number of people who are 
uninsured has grown 1 million each year. So we have more and more 
people uninsured. At least for those women who have breast and cervical 
cancer, once they are screened under the existing program, we will now 
provide medical services, lifesaving medical services for them. It 
would be a travesty to do otherwise.
  I am pleased now to support the rule when it is amended and to 
support the legislation. It is long overdue. I look forward to having 
the President sign this legislation into law.
  Mrs. MYRICK. Mr. Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Cunningham).
  Mr. CUNNINGHAM. Mr. Speaker, this should be a guy thing, and I want 
to tell my colleagues why. I joined the Labor-HHS committee because it 
focuses primarily on two issues: one is education, the other is medical 
research. This century is going to be, I think, not for technology but 
the most important century for medical research in the history of 
mankind, from the genome program to cell division where we can take 
pancreatic cells and inject into maybe a child that has juvenile 
diabetes.
  I would like my colleagues to remember that we lost Herb Bateman this 
year. Congressman Vento, we go to his funeral tomorrow. Cancer is a 
brutal thing. I know many of our colleagues on this floor have 
contracted it. I have talked to the gentlewoman from Connecticut (Ms. 
DeLauro). She is a cancer survivor. My mom is a cancer survivor. There 
is no better woman in this country than my little mom. But can you 
imagine, and I know when the doctor looked me in the face and said, 
``Duke, you've got cancer,'' that is pretty tough. And I try and put 
myself in the position that what if I did not have care for my medical 
retirement from my military retirement, what if someone says, ``Duke, 
you've got prostate cancer, but you've got no hope. You're going to 
die.'' How terrible is that in a country as powerful as ours? I look at 
the things in my own personal life. I am pro-life. My colleagues know 
that. And I disagree with areas like Planned Parenthood on their 
abortion issue. But I went to Planned Parenthood, and I saw many women 
receive mammograms, pap smears, care that indigent women would not have 
received. At least we need to come together in those areas to make sure 
that many of our unfortunate that do not have health care can come 
together and get that. That is why I think this is so important, and I 
rise in strong support. I want to thank my colleagues on both sides of 
the aisle for this legislation.
  Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Eddie Bernice Johnson).
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise to support 
this measure and to pay tribute to the gentlewoman from California (Ms. 
Eshoo) and the gentlewoman from North Carolina (Mrs. Myrick) for taking 
the lead and for the rest of the women in the bipartisan Women's 
Caucus. Many taxpayers' dollars went into the discovery and the 
security of having diagnostic and treatment modalities for cervical and 
breast cancer. Yet we have seen a number of working women, low-income 
women without health insurance coverage not be able to get treatment 
simply because they cannot afford it. Yet some of their tax dollars 
went into the real arrival of these answers that we have today.
  I stand here as a cancer survivor because of these diagnostic and 
treatment modalities.

                              {time}  1500

  My grandmother was a victim. So I do know what it is like to be told 
not only of a family member but be told myself that I have cancer, and 
to have access to getting treatment.
  I would hope that the gentleman from Oklahoma (Mr. Coburn) would 
understand that we do not want to delay this measure any longer in 
going to get the President's signature so that women can have access to 
this treatment. I do not believe that he would want to do that.
  I understand the seriousness of that virus. I too am a health 
professional. I

[[Page 22381]]

am a registered nurse and understand the real importance of early 
diagnosis and treatment. Far too long we have waited for this to become 
law, and I hope we will wait no longer.
  Mrs. MYRICK. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Florida (Ms. Ros-Lehtinen).
  Ms. ROS-LEHTINEN. Mr. Speaker, I thank my good friend, the 
gentlewoman from North Carolina (Mrs. Myrick), for yielding me this 
time.
  Mr. Speaker, breast and cervical cancers have continued to increase 
in exponential numbers. Just today approximately 480 women across our 
Nation will be diagnosed with breast cancer and approximately 120 will 
die from this affliction. Women's cancers are sweeping the families of 
our Nation at high speeds, and while researchers continue to look for 
cures and effective treatments, many women will never be able to see 
the benefits of such research because they simply will not be able to 
afford it.
  Today, by passing this legislation, we will be on our way to ensuring 
that low-income women without health insurance have access to 
lifesaving treatment.
  Cancer eats away at the spirits of women battling with this disease. 
These women should not have to waste their energy scrambling for an ad 
hoc patchwork of providers, volunteers and charity care programs that 
will only result in unpredictable, delayed, or incomplete treatment. 
For the women and families fighting cancer, every minute counts. They 
simply cannot and should not have to wait any longer for this 
treatment. Their lives may depend on the outcome of today's vote. I 
urge my colleagues to vote for the passage of this bill so that low-
income women can have a fighting chance at beating breast or cervical 
cancer.
  I would like to thank my dear constituent, Jane Torres, president of 
the Florida Breast Cancer Coalition, for her selfless devotion to this 
very worthy cause; and to Fran Visco, president of the National Breast 
Cancer Coalition, for her tireless efforts to eradicate breast cancer; 
and to my dear colleague, the gentleman from New York (Mr. Lazio), the 
leader of this legislation, who continues to show through his actions 
that the welfare and the health of women and families remain his 
priorities; and lastly, to my colleague, the gentlewoman from North 
Carolina (Mrs. Myrick), a breast cancer survivor and a fighter to whom 
this legislation is dedicated and a fearless advocate for all women 
living with breast cancer.
  Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
New York (Mrs. Maloney).
  Mrs. MALONEY of New York. Mr. Speaker, I thank the gentlewoman from 
New York (Ms. Slaughter) for yielding me this time, and for her 
leadership.
  Mr. Speaker, I rise in strong support of this rule and the underlying 
bill. This is an extremely important bill, and it will literally save 
thousands of women's lives. Mr. Speaker, I ask everyone to stop for a 
moment and think about what they might do if they were diagnosed with 
cancer but were told that no treatment options were available under 
their insurance and that they could not afford treatment because they 
could barely afford to feed their family and pay their rent.
  Mr. Speaker, for thousands of women in this country, this is an 
unfortunate reality. There is an outstanding program under the CDC 
called the National Breast and Cervical Cancer Early Detection program. 
It provides screening for low-income women who have little or no health 
insurance, but for women who find that they have cancer from this 
important screening program there is no guarantee of any treatment. It 
is clear that this situation must change. This bill will do that.
  The Women's Caucus has made it a top priority. I want to thank the 
gentlewoman from California (Ms. Eshoo) and the gentlewoman from 
California (Mrs. Capps), the gentlewoman from North Carolina (Mrs. 
Myrick), the gentlewoman from Missouri (Ms. Danner), and my Women's 
Caucus cochair, the gentlewoman from New York (Mrs. Kelly), for their 
tireless work to get this bill passed. I also want to thank all the 
members of the Women's Caucus who signed a letter to Speaker Hastert 
this week urging swift passage of the bill.
  This bill gives States the option to provide Medicaid coverage to 
uninsured or underinsured women who have been diagnosed through the 
CDC's screening program. It passed overwhelmingly in the House and 
Senate, and every day this bill is delayed we have women dying from 
treatable breast and cervical cancer. Today is a great and important 
day for women facing breast and cervical cancer. I commend the 
leadership for bringing it to the floor today, and I also want to 
commend the gentleman from Oklahoma (Mr. Coburn) for his efforts and 
pledge my support to continue working with him on the dangers of HPV.
  I urge total support and passage and to the President's desk.
  Mrs. MYRICK. Mr. Speaker, I reserve the balance of my time.
  Ms. SLAUGHTER. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise simply to thank all of 
those who have been engaged in this battle both personally and as well 
publicly. I do acknowledge the importance of this legislation and 
particularly the fight against this virus HPV. I think it is very 
important to acknowledge the number of women who have died suffering 
from both breast and cervical cancer. Just a week ago, many of us, or 
this past month, saw the Susan B. Coleman Race for the Cure all over 
the Nation. Thousands of women stood up to be counted for a cure for 
breast cancer. In my own community 20,000 walked, and I am particularly 
proud of the Sisters Network, a group of African American women who 
have gone into the community to fight against the stigma of 
acknowledging the importance of getting a mammogram or the importance 
of early detection.
  This legislation, however, comports with the mission of many women in 
the United States Congress and that is there can be no real research if 
we do not use clinics and reach out to women to be tested and further 
research in the National Institutes of Health. I am glad that this 
legislation will help low-income women, inner city women, rural women, 
Asian, Hispanic, African American women, white women, all women who 
face these devastating diseases; and we will learn more by this 
legislation. I hope that my colleagues will support this legislation 
enthusiastically, but I also ask that we continue to fetter out some of 
the perceived uncurable diseases that have plagued American citizens, 
and particularly in this instance women. I also want to salute the very 
brave women who are survivors and ask that there be many more as we 
seek a cure for these diseases.
  Ms. SLAUGHTER. Mr. Speaker, I yield back the balance of my time.
  Mrs. MYRICK. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, as I stated earlier, the amendment of the gentleman from 
Oklahoma (Mr. Coburn) is not going to be included on this bill, just 
for clarity; but I do want to say that I will do everything in my power 
to make sure that the very important issue is included in a bill this 
year. I want to thank the Women's Caucus for coming forward and saying 
that they are willing to work on this as well because we all understand 
how important it is to women that we get this done, and men, too, 
relative to prostate cancer.
  I also want to thank everyone on both sides of the aisle for their 
cooperation on this and making it possible to see this bill come to 
fruition this year, and also thank the Breast Cancer Coalition for 
their support and other groups on the outside, and especially the 
gentleman from New York (Mr. Lazio), who has been a real champion of 
this and spent a lot of hard work on this issue over the past year.


     Amendment in the Nature of a Substitute Offered by Mrs. Myrick

  Mrs. MYRICK. Mr. Speaker, I offer an amendment in the nature of a 
substitute.
  The SPEAKER pro tempore (Mr. Barrett of Nebraska). The Clerk will 
report the amendment in the nature of a substitute.

[[Page 22382]]

  The Clerk read as follows:

       Amendment in the nature of a substitute offered by Mrs. 
     Myrick:
       Strike all after the resolved clause and insert:
       That upon adoption of this resolution it shall be in order 
     to take from the Speaker's table the bill (H.R. 4386) to 
     amend title XIX of the Social Security Act to provide medical 
     assistance for certain women screened and found to have 
     breast or cervical cancer under a federally funded screening 
     program, to amend the Public Health Service Act and the 
     Federal Food, Drug, and Cosmetic Act with respect to 
     surveillance and information concerning the relationship 
     between cervical cancer and the human papillomavirus (HPV), 
     and for other purposes, with the Senate amendment thereto, 
     and to consider in the House, without intervention of any 
     point of order, a motion offered by the chairman of the 
     Committee on Commerce or his designee that the House concur 
     in the Senate amendment. The Senate amendment and the motion 
     shall be considered as read. The motion shall be debatable 
     for one hour equally divided and controlled by the chairman 
     and ranking minority member of the Committee on Commerce. The 
     previous question shall be considered as ordered on the 
     motion to final adoption without intervening motion.

  Mrs. MYRICK. Mr. Speaker, I do want to reiterate that this means this 
bill will go straight to the President for signature.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the amendment in the nature of a substitute and on the 
resolution.
  There was no objection.
  The SPEAKER pro tempore. The question is on the amendment in the 
nature of a substitute offered by the gentlewoman from North Carolina 
(Mrs. Myrick).
  The amendment in the nature of a substitute was agreed to.
  The SPEAKER pro tempore. The question is on the resolution, as 
amended.
  The resolution, as amended, was agreed to.
  A motion to reconsider was laid on the table.
  Mr. BILIRAKIS. Mr. Speaker, pursuant to House Resolution 628, I call 
up the bill (H.R. 4386) to amend title XIX of the Social Security Act 
to provide medical assistance for certain women screened and found to 
have breast or cervical cancer under a federally funded screening 
program, to amend the Public Health Service Act and the Federal Food, 
Drug and Cosmetic Act with respect to surveillance and information 
concerning the relationship between cervical cancer and the human 
papillomavirus, and for other purposes.
  The Clerk read the title of the bill.


                    Motion Offered by Mr. Bilirakis

  Mr. BILIRAKIS. Mr. Speaker, I offer a motion.
  The SPEAKER pro tempore. The Clerk will designate the motion.
  The text of the motion is as follows:
  Mr. Bilirakis of Florida moves that the House concur in the Senate 
amendment to H.R. 4386.
  The text of the Senate amendment is as follows:

       Senate Amendment:
       Strike out all after the enacting clause and insert:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Breast and Cervical Cancer 
     Prevention and Treatment Act of 2000''.

     SEC. 2. OPTIONAL MEDICAID COVERAGE OF CERTAIN BREAST OR 
                   CERVICAL CANCER PATIENTS.

       (a) Coverage as Optional Categorically Needy Group.--
       (1) In general.--Section 1902(a)(10)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
       (A) in subclause (XVI), by striking ``or'' at the end;
       (B) in subclause (XVII), by adding ``or'' at the end; and
       (C) by adding at the end the following:

       ``(XVIII) who are described in subsection (aa) (relating to 
     certain breast or cervical cancer patients);''.

       (2) Group described.--Section 1902 of the Social Security 
     Act (42 U.S.C. 1396a) is amended by adding at the end the 
     following:
       ``(aa) Individuals described in this subsection are 
     individuals who--
       ``(1) are not described in subsection (a)(10)(A)(i);
       ``(2) have not attained age 65;
       ``(3) have been screened for breast and cervical cancer 
     under the Centers for Disease Control and Prevention breast 
     and cervical cancer early detection program established under 
     title XV of the Public Health Service Act (42 U.S.C. 300k et 
     seq.) in accordance with the requirements of section 1504 of 
     that Act (42 U.S.C. 300n) and need treatment for breast or 
     cervical cancer; and
       ``(4) are not otherwise covered under creditable coverage, 
     as defined in section 2701(c) of the Public Health Service 
     Act (42 U.S.C. 300gg(c)).''.
       (3) Limitation on benefits.--Section 1902(a)(10) of the 
     Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in 
     the matter following subparagraph (G)--
       (A) by striking ``and (XIII)'' and inserting ``(XIII)''; 
     and
       (B) by inserting ``, and (XIV) the medical assistance made 
     available to an individual described in subsection (aa) who 
     is eligible for medical assistance only because of 
     subparagraph (A)(10)(ii)(XVIII) shall be limited to medical 
     assistance provided during the period in which such an 
     individual requires treatment for breast or cervical cancer'' 
     before the semicolon.
       (4) Conforming amendments.--Section 1905(a) of the Social 
     Security Act (42 U.S.C. 1396d(a)) is amended in the matter 
     preceding paragraph (1)--
       (A) in clause (xi), by striking ``or'' at the end;
       (B) in clause (xii), by adding ``or'' at the end; and
       (C) by inserting after clause (xii) the following:
       ``(xiii) individuals described in section 1902(aa),''.
       (b) Presumptive Eligibility.--
       (1) In general.--Title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) is amended by inserting after section 
     1920A the following:


    ``presumptive eligibility for certain breast or cervical cancer 
                                patients

       ``Sec. 1920B. (a) State Option.--A State plan approved 
     under section 1902 may provide for making medical assistance 
     available to an individual described in section 1902(aa) 
     (relating to certain breast or cervical cancer patients) 
     during a presumptive eligibility period.
       ``(b) Definitions.--For purposes of this section:
       ``(1) Presumptive eligibility period.--The term 
     `presumptive eligibility period' means, with respect to an 
     individual described in subsection (a), the period that--
       ``(A) begins with the date on which a qualified entity 
     determines, on the basis of preliminary information, that the 
     individual is described in section 1902(aa); and
       ``(B) ends with (and includes) the earlier of--
       ``(i) the day on which a determination is made with respect 
     to the eligibility of such individual for services under the 
     State plan; or
       ``(ii) in the case of such an individual who does not file 
     an application by the last day of the month following the 
     month during which the entity makes the determination 
     referred to in subparagraph (A), such last day.
       ``(2) Qualified entity.--
       ``(A) In general.--Subject to subparagraph (B), the term 
     `qualified entity' means any entity that--
       ``(i) is eligible for payments under a State plan approved 
     under this title; and
       ``(ii) is determined by the State agency to be capable of 
     making determinations of the type described in paragraph 
     (1)(A).
       ``(B) Regulations.--The Secretary may issue regulations 
     further limiting those entities that may become qualified 
     entities in order to prevent fraud and abuse and for other 
     reasons.
       ``(C) Rule of construction.--Nothing in this paragraph 
     shall be construed as preventing a State from limiting the 
     classes of entities that may become qualified entities, 
     consistent with any limitations imposed under subparagraph 
     (B).
       ``(c) Administration.--
       ``(1) In general.--The State agency shall provide qualified 
     entities with--
       ``(A) such forms as are necessary for an application to be 
     made by an individual described in subsection (a) for medical 
     assistance under the State plan; and
       ``(B) information on how to assist such individuals in 
     completing and filing such forms.
       ``(2) Notification requirements.--A qualified entity that 
     determines under subsection (b)(1)(A) that an individual 
     described in subsection (a) is presumptively eligible for 
     medical assistance under a State plan shall--
       ``(A) notify the State agency of the determination within 5 
     working days after the date on which determination is made; 
     and
       ``(B) inform such individual at the time the determination 
     is made that an application for medical assistance under the 
     State plan is required to be made by not later than the last 
     day of the month following the month during which the 
     determination is made.
       ``(3) Application for medical assistance.--In the case of 
     an individual described in subsection (a) who is determined 
     by a qualified entity to be presumptively eligible for 
     medical assistance under a State plan, the individual shall 
     apply for medical assistance under such plan by not later 
     than the last day of the month following the month during 
     which the determination is made.
       ``(d) Payment.--Notwithstanding any other provision of this 
     title, medical assistance that--
       ``(1) is furnished to an individual described in subsection 
     (a)--
       ``(A) during a presumptive eligibility period;
       ``(B) by a entity that is eligible for payments under the 
     State plan; and
       ``(2) is included in the care and services covered by the 
     State plan,
     shall be treated as medical assistance provided by such plan 
     for purposes of clause (4) of the first sentence of section 
     1905(b).''.
       (2) Conforming amendments.--

[[Page 22383]]

       (A) Section 1902(a)(47) of the Social Security Act (42 
     U.S.C. 1396a(a)(47)) is amended by inserting before the 
     semicolon at the end the following: ``and provide for making 
     medical assistance available to individuals described in 
     subsection (a) of section 1920B during a presumptive 
     eligibility period in accordance with such section''.
       (B) Section 1903(u)(1)(D)(v) of such Act (42 U.S.C. 
     1396b(u)(1)(D)(v)) is amended--
       (i) by striking ``or for'' and inserting ``, for''; and
       (ii) by inserting before the period the following: ``, or 
     for medical assistance provided to an individual described in 
     subsection (a) of section 1920B during a presumptive 
     eligibility period under such section''.
       (c) Enhanced Match.--The first sentence of section 1905(b) 
     of the Social Security Act (42 U.S.C. 1396d(b)) is amended--
       (1) by striking ``and'' before ``(3)''; and
       (2) by inserting before the period at the end the 
     following: ``, and (4) the Federal medical assistance 
     percentage shall be equal to the enhanced FMAP described in 
     section 2105(b) with respect to medical assistance provided 
     to individuals who are eligible for such assistance only on 
     the basis of section 1902(a)(10)(A)(ii)(XVIII)''.
       (d) Effective Date.--The amendments made by this section 
     apply to medical assistance for items and services furnished 
     on or after October 1, 2000, without regard to whether final 
     regulations to carry out such amendments have been 
     promulgated by such date.

  The SPEAKER pro tempore. Pursuant to House Resolution 628, 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).


                             General Leave

  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and insert extraneous material on H.R. 4386.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in support of H.R. 4386, the Breast and Cervical 
Cancer Prevention and Treatment Act of 2000. I commend the gentlewoman 
from North Carolina (Mrs. Myrick) for her personal courage in the face 
of breast cancer and for her work in persuading the House leadership to 
bring this important bill to the floor today.
  I also wish to recognize one of the original cosponsors of H.R. 4386, 
the gentleman from New York (Mr. Lazio), for his many months of hard 
work on the Committee on Commerce persuading Members and forging 
alliances with the American Cancer Society, the National Women's Health 
Network, the National Cervical Cancer Coalition, the National Breast 
Cancer Coalition, the Cancer Research Foundation of America, and so 
many others, to make this day possible. His diligent work on H.R. 1070 
laid the groundwork for this legislation. Mr. Speaker, I was joined on 
our Committee on Commerce by the gentlewoman from California (Ms. 
Eshoo), who persistently fought for progress on this bill.
  Like so many women I have met over the last few years advocating for 
this legislation, I understand the fears that families face when they 
first hear that word. I have worked in Congress to help find ways to 
help more women from falling victim to cancer. In the closing days of 
the last session, the Committee on Commerce reported out H.R. 1070, the 
Lazio-Eshoo Breast and Cervical Cancer Prevention and Treatment Act of 
1999. I am very pleased that we are now on the floor debating a bill 
based on the committee's work, which addresses both breast cancer, the 
leading cause of cancer deaths among women, and cervical cancer, cancer 
caused by the HPV viral infection that kills more women in America than 
HIV, the cause of AIDS.
  I am deeply disappointed, as has been stated by others, that the 
other body stripped the House-passed amendments that would do so much 
to prevent cervical cancer. Perhaps this is a consequence of the 
outside lobbying groups that have been formed around breast cancer, 
leaving in the dust their sister organizations concerned about cervical 
cancer, and that is a shame.
  Mr. Speaker, we need to do more about cervical cancer than pass 
resolutions increasing awareness about it. We need to take positive 
steps to prevent its occurrence in the first place through our public 
health agencies. Cervical cancer is 100 percent preventable, and I fear 
that if the House is not successful in addressing prevention, the 
families of the 5,000 women who will die of this disease this year will 
judge us for not taking action when we had the opportunity.
  So, Mr. Speaker, while I am disappointed that the bill we consider 
today does not address prevention of cervical cancer, and I am not 
really sure why in the world we have refused to do that, but in any 
case I do believe that we should move forward on the underlying bill 
and address cervical cancer prevention in another piece of legislation.

                              {time}  1515

  H.R. 4386 will close a gap left open when the screening program was 
first created, and it represents an important step forward in the 
battle against breast and cervical cancer.
  I urge my colleagues to support passage of this critical measure, 
which will give new hope to breast and cervical cancer patients in need 
as we continue the fight to find a cure for these terrible diseases.
  Again, I thank the gentlewoman from North Carolina (Mrs. Myrick), the 
gentlewoman from Missouri (Ms. Danner), the gentleman from New York 
(Mr. Lazio), the gentlewoman from California (Ms. Eshoo), my Committee 
on Commerce colleagues, and many others who have contributed to bring 
this legislation to the floor today.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I would like to commend the gentlewoman from California 
(Ms. Eshoo) and the gentlewoman from North Carolina (Mrs. Myrick) for 
their hard work on behalf of women screened under the CDC Breast and 
Cervical Cancer Screening Program.
  H.R. 4386 has garnered tremendous support with some 318 cosponsors. 
In 1990, Congress passed the Breast and Cervical Cancer Mortality 
Prevention Act. That bill authorized funding for a national breast and 
cervical cancer screening program focusing on uninsured and 
underinsured women.
  The program is federally-funded and locally operated. Simply put, it 
works.
  My home State of Ohio set up 12 local screening sites, providing 
coverage for all of Ohio's 88 counties. Since the Ohio program's 
inception, 16,000 women have been screened for breast and cervical 
cancer. Cancer has been detected in more than 200 women.
  Early detection alters the odds of successful treatment dramatically, 
restoring precious years otherwise lost to these devastating cancers. 
But, unfortunately, there is there is a catch. Early detection is a 
futile and ultimately cruel exercise if a cancer diagnosis does not 
trigger appropriate treatment. The two obviously go hand-in-hand.
  The 1990 bill authorized funding for screening, but not for 
treatment. Instead, it calls on States to secure treatment for women 
diagnosed with cancer under the Federal screening program.
  As it turns out, the onus of responsibility has fallen on the local 
screening programs. Staff at the screening programs and at the 
screening sites typically do two jobs. They arrange screenings. Then, 
when tragically necessary, they try to convince hospitals and doctors 
to provide free cancer care to patients, cobbling together any program, 
any services, any assistance, any help they can.
  This is a labor-intensive hit or miss effort that places an immense 
burden on the screening programs, with no guarantee that women will 
receive care on a timely or a consistent basis. In a health care system 
shaped all too often now by the managed care industry, providers 
inevitably have less flexibility to offer their time and their services 
for free.
  The Federal government invested $158 million to the breast and 
cervical cancer screening program in fiscal year 1999, yet we are only 
reaching 12 to 15 percent of the target population. When

[[Page 22384]]

the women we have invested in are diagnosed with cancer, our commitment 
to them, unbelievably, ends.
  CDC cancer screening resources should be used to provide cancer 
screening. Health care resources should be used for health care. That 
is where Medicaid comes in.
  The title of the original authorization is the Breast and Cervical 
Cancer Mortality Prevention Act, but mortality prevention requires not 
just screening, but also treatment. H.R. 4386 fills that gap. It 
establishes a modest optional Medicaid benefit enabling the Federal 
government to contribute to the costs of providing proper care for 
these women.
  By freeing up screening program resources, by eliminating the 
uncertainty around treatment for women screened under the CDC program, 
H.R. 4386 permits our Nation to achieve the full health potential 
promised in the Breast and Cervical Cancer Screening Program.
  We need to fight breast and cervical cancer with every weapon 
available. Early detection, proper health care, are the strongest 
weapons we have. Because the Republicans changed a bad rule to a good 
rule, this bill will go straight to the President, not back to the 
Senate.
  On this side of the aisle, we enthusiastically support this bill, as 
the gentlewoman from California (Ms. Eshoo) when she began the process 
did, and as all of us have joined her.
  I urge my colleagues to support this very good legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I yield 3 minutes to the gentleman from 
New Jersey (Mr. Smith).
  Mr. SMITH of New Jersey. Mr. Speaker, I thank the gentleman for 
yielding time to me, and I want to thank the gentleman for his great 
work on this, and also commend the gentlewoman from North Carolina 
(Mrs. Myrick) for her sponsorship of H.R. 4386, the Breast Cancer 
Prevention and Treatment Act.
  Passage of H.R. 4386 would guarantee low-income uninsured women in 
this country treatment if they are diagnosed with breast or cervical 
cancer in the Federal screening program. Currently, as we know, many 
low-income and uninsured women are not receiving the treatment and 
medication they urgently need because they simply cannot afford it.
  It is crucial that we pass this legislation and that we pass it today 
so that women across the country receive the lifesaving treatment that 
they so desperately deserve and need. Mr. Speaker, breast cancer is the 
most common cancer among women, other than skin cancer. It is the 
second leading cause of cancer death in women after lung cancer.
  I would point out to my colleagues that my own cousin Sue, who was 
very, very close to me, fell victim to this disease several years ago. 
She was misdiagnosed. She went to her own doctor, who missed the signs. 
It was a matter of providential help that she walked into one of those 
mobile screening clinics and found out that that lump that she was so 
concerned about turned out to be cancer. Because of that, she got 
several years because she was able to at least get it treated. Had she 
known about it sooner, I do believe that my cousin Sue would be here 
today.
  In like manner, my wife's mother died of breast cancer. That was more 
than 25 years ago. But she, too, went to a doctor, and had it missed 
because he missed the signs of what was taking place in her body. She 
passed prematurely while my wife was still in high school.
  We all have cases. Every single one of us have a loved one who has 
been lost to this devastating disease. Hopefully, this kind of 
initiative will at least spare some the agony of this terrible cancer.
  As my colleagues know, the American Cancer Society reports that there 
will be approximately 182,000 new cases of invasive breast cancer in 
the year 2000 among women in this country, resulting in about 40,800 
deaths from this horrible disease.
  It is imperative, Mr. Speaker, that Congress continues to expand 
research opportunities focusing on finding a cure, increasing early 
detection, and speeding access to treatment for breast cancer.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 4 minutes to the gentleman 
from Michigan (Mr. Dingell), who played a role in 1990 in writing the 
original Breast and Cervical Cancer Treatment Act.
  Mr. DINGELL. Mr. Speaker, I support this legislation. I want to 
commend my colleagues who have had a part in bringing this legislation 
to the floor today.
  I want to pay tribute to my friend, the gentleman from Oklahoma (Mr. 
Coburn) for having withdrawn his amendment. That is going to make it 
possible for us to send it to the President for signature.
  I want to commend my colleagues on the other side of the aisle. I 
commend the chairman of the subcommittee, the gentleman from Florida 
(Mr. Bilirakis), the gentleman from Ohio (Mr. Brown), the gentlewoman 
from California (Ms. Eshoo), the gentlewoman from North Carolina (Mrs. 
Myrick), and the gentleman from New York (Mr. Lazio), for their 
leadership on it. We owe them a great debt.
  More importantly, the people in the country owe gratitude to these 
Members and all of the others, some 318 of them, who worked to bring 
this legislation to the floor.
  This is good legislation. Hardly a Member of this body, or indeed, a 
citizen walking down the street in this country, has not had his or her 
life touched by cancer, and hardly a citizen has not had a loved one 
who has had to confront this terrible disease.
  Like most other, I can tell stories of people in my family that I 
have lost to this disease. It has left permanent scars on the family. 
It has left permanent scars on me and on a lot of others.
  Having said that, this legislation is not only good, humane, 
important, but it is needed. Some years ago I was at a hospital in 
Michigan, a major hospital. And they say, Mr. Dingell, ``There is good 
news.'' I said, ``I am glad to hear it. What is it?'' They said, ``We 
now are able to examine women under Medicaid to find out if they are at 
risk from cancer of the breast and of other parts of the body.'' They 
said, ``But there is bad news.'' I said, ``What is that?'' They said, 
``We can screen them for cancer, but we cannot provide the necessary 
treatment under Medicaid to remove the cancer.''
  I said ``That is like telling a woman that she has cancer, that is 
the good news, and the bad news is, she is going to die.'' I think that 
was intolerable then, and I am happy to note that the legislation 
before us addresses that problem. Women are now able to know when this 
bill is signed by the President, as it will be, that there will be 
treatment for those women who are in the low- and moderate-income 
groups so that they will not know that when they get a government 
analysis of their health and are tested for cancer, they are going to 
know they have cancer, but they also will know they are going to die.
  The wonderful thing about this legislation is it is going to give 
lots of hope to Americans who have no other hope in the time when they 
have the greatest need, when they have cancer.
  I applaud the legislation. It meets a tremendous need in our society. 
These women will now know that they can expect to have at least a 
fighting chance to have decent treatment, and know that they have a 
chance to live for themselves and for their families and for those who 
love them.
  It is a humane, a necessary, a good piece of legislation. Mr. 
Speaker, I rejoice that the House is considering this legislation 
today. I support it, and I am delighted that the matter will now go to 
the President for signature, because it is an important and needed 
piece of legislation, and should go so as speedily and as rapidly and 
as efficiently as we can possibly get it there for the signature of the 
President, so the money can begin to be spent on a terrible need of 
women who have no other hope for surviving a terrible disease.
  Mr. BILIRAKIS. Mr. Speaker, I yield 2 minutes to the gentlewoman from

[[Page 22385]]

Maryland (Mrs. Morella), who is probably the largest proponent of 
women's issues in this House.
  Mrs. MORELLA. Mr. Speaker, I thank the distinguished chairman of the 
subcommittee, who has been a great advocate for issues that affect 
women, children, and families, and this is certainly a case in point.
  Mr. Speaker, October is Breast Cancer Awareness Month. Congress has 
an opportunity to do something now to help turn awareness into action 
by passing H.R. 4386, the Breast and Cervical Cancer Prevention and 
Treatment Act.
  One out of every nine women will be diagnosed for having breast 
cancer. Just last Saturday I was in Boston, where the eldest child of 
my late brother was buried, having had breast cancer.
  So we know that awareness is important as well as treatment being 
important, diagnosis, mammograms, personal checking by oneself, and 
certainly through the Centers for Disease Control and the prevention 
and early detection program.
  The Senate passed the bill we are considering today unanimously last 
week. Women and their families across the country are really looking 
forward to this legislation finally being signed into law. Indeed, I 
want to applaud the many groups that have diligently worked very hard 
for this bill.
  I also want to applaud the gentlewoman from North Carolina (Mrs. 
Myrick), the gentlewoman from California (Ms. Eshoo), the gentleman 
from New York (Mr. Lazio). I want to applaud the chairman, the 
gentleman from Florida (Mr. Bilirakis), the ranking member, and the 
gentleman from Ohio (Mr. Brown) for the hard work they have put into 
this legislation.
  The legislation is lifesaving. It has strong bipartisan support, a 
groundswell of support from the grass roots level. With passage of the 
Senate version of the bill, we will take the final step in a long 
process to guarantee low-income, uninsured women in this country the 
treatment they need when they are diagnosed with breast or cervical 
cancer through the Centers for Disease Control and Prevention's early 
detection program.
  I cannot imagine diagnosing and then not treating. This bill will do 
that. It will allow us treatment. Many of us have worked hard to get 
this bill passed. Let today be the day. We are going to pass this bill 
through the House, with the gentleman's leadership.

                              {time}  1530

  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from the District of Columbia (Ms. Norton).
  Ms. NORTON. Mr. Speaker, I thank the gentleman for yielding me the 
time and for his hard work on this bill.
  This is a great bipartisan moment in the House. The gentleman from 
Oklahoma (Mr. Coburn) and the bipartisan Women's Caucus have worked 
together to make sure that this bill gets done this year.
  Mr. Speaker, it is harder to get low-income women to take preventive 
steps. We know resources is one of the reasons; but the fact is we have 
to fight against advice, for example, on whether or not mammograms are 
harmful. We have to fight against the lack of education that middle-
income women do not suffer from. But there is no greater deterrent than 
knowing that the information I find may be information I have to not 
only live with, but ultimately die with, because there is no treatment, 
no matter what we learn.
  Mr. Speaker, this really raises moral and ethical issues, because if 
we detect but do not treat, what are we as a society doing and saying? 
We have made real progress on early detection in recent years. It is 
quite amazing progress.
  For example, the majority of women in the District of Columbia 
probably now get a mammogram. D.C. offers free screening at 26 
different sites, a program called WISH, Women Interested in Staying 
Healthy, that is pennywise and healthwise, because it saves money and 
saves lives, but not if there is no treatment. We are then defeating 
our own purpose.
  Let me give you a painful example. The incidence of breast cancer 
among black women is significantly less than among white women, but the 
mortality rate among black women is much greater: 19.8 per 100,000 for 
white women, 26.5 for black women. Why? Of course, it is a combination 
of early diagnosis and no treatment, no early diagnosis and no 
treatment.
  It is almost cruel to offer one without the other. If we continue to 
do this, it will throw us back on early detection, because we would be 
sending the message, don't come forward and scare yourself to death 
because we cannot do anything for you afterwards.
  Mr. Speaker, we have made enormous progress on early diagnosis of 
cervical cancer and breast cancer. Now we are making great progress on 
curing them.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman 
from Texas (Mr. Bentsen), who has been very, very involved in this 
issue in his 6 years in the House.
  Mr. BENTSEN. Mr. Speaker, I thank the gentleman for yielding the time 
to me.
  Mr. Speaker, I want to commend the gentleman from Florida (Mr. 
Bilirakis), the chairman, and the gentleman from Ohio (Mr. Brown), the 
ranking member of the Subcommittee on Health and Environment, for 
getting this bill brought to the floor, and, in particular, in moving 
to concur in the action by the other body so this bill can be sent 
directly to the President and be enacted this month, which is in fact 
Breast Cancer Awareness Month.
  Mr. Speaker, this measure would provide critical Medicare for low- 
and moderate-income working women who have been diagnosed with breast 
and cervical cancer.
  Under a 1990 law, low- and moderate-income women are eligible for 
screening for both breast cancer and cervical cancer through the 
Centers for Disease Control and Early Prevention early detection 
program. This has served more than a million women and diagnosed more 
than 30,000 women with cancer or precancerous conditions. However, it 
is unconscionable that we would help these women get the screenings 
they need to discover these cancers, but not provide any ability for 
follow-up care.
  The diagnosis of breast or cervical cancer should not be a notice of 
a death sentence to a working woman who has no insurance.
  Mr. Speaker, under current law, treatment is available only for a 
small percentage of these diagnosed women, those who are eligible under 
the TANF programs or under the supplemental security income program for 
disability. As a result, many of these 30,000 low- and moderate-income 
women who have been diagnosed simply delay treatment because they 
cannot afford it or because they make too much money to qualify for 
Medicaid.
  This bill would correct this inequity by giving States the option to 
expand Medicaid coverage for these women who have no health insurance.
  Mr. Speaker, I am also pleased that the bill is structured to 
encourage the States to immediately expand their Medicaid coverage 
program for women. Under the bill, States would receive an average of 
68 percent of the cost share by the Federal Government and they would 
be responsible for 32 percent. This is much higher than the basic 
Medicaid rate for many States, including my State of Texas, where the 
average rate of the Federal Government is 61 percent. And I hope it 
would encourage the State to move quickly.
  Earlier this year, I met a young women, Ms. Barbara Marsh, who is 
receiving treatment in a clinic, the Rose, which is located in my 
district and who would benefit from this program. Ms. Marsh of Humble, 
Texas, was diagnosed with breast cancer and is a self-employed dance 
instructor. At the age of 32, Barbara discovered a lump in her breast 
and was treated for breast cancer through the public health system. 
However, because she owns her own dance studio, which is considered to 
be an asset, she was required to pay the $26,000 for her medical 
treatments.
  Mr. Speaker, unable to afford these high bills, Ms. Marsh did not 
seek any additional follow-up treatment until

[[Page 22386]]

August of 1999 when her breast cancer had advanced to Stage 3. If 
Barbara had health insurance, she would have had access to follow-up 
care and treatment and may have discovered this disease in a much 
earlier stage. But because she is self-employed and does not have any 
health insurance, she suffered.
  This legislation would ensure that Ms. Marsh and thousands of women 
like her across America will have access to cutting-edge treatments 
that can save their lives. In a Nation with the greatest health and 
research assets and facilities in the world, no one should suffer the 
risk of death due to cancer for lack of access to such assets.
  I congratulate the sponsors of this bill. I am proud to be a 
cosponsor of the initial House bill, and I look forward to its passage 
and its enactment into law.
  Mrs. FOWLER. Mr. Speaker, I rise today in strong support of the 
Breast and Cervical Cancer Treatment Act.
  Nearly 40,000 low-income women have been diagnosed with breast or 
cervical cancer or pre-cancerous lesions since the National Breast and 
Cervical Cancer Early Detection Program was established one decade ago. 
For many of them, the pain of learning they have a devastating illness 
is exacerbated by the fact that they cannot afford the treatment they 
know they need.
  I do not want this Congress to have to tell another woman that yes, 
you have this disease, but no, there is nothing we can do to help you 
fight it.
  This bill allows us to help these women by providing coverage for the 
treatment they need. It is common-sense legislation, and the 
overwhelming consensus with which it passed in the House and in the 
Senate is proof of that fact. Today, we have an opportunity to again 
show our overwhelming support for the Breast and Cervical Cancer 
Treatment Act.
  I would like to take a moment to thank the Speaker of the House for 
his commitment to moving this bill through all the procedural hurdles 
it has faced. He promised women that the House would pass this bill 
before Mother's Day, and he did. He promised them we would take it up 
again before adjourning, and we are.
  Mr. Speaker, I am hopeful that this bill will move swiftly from our 
halls to the President's desk and become law. The women who will be 
diagnosed through this program deserve nothing less than prompt action 
by the President. I urge my colleagues to vote yes on this critical 
bill.
  Mr. HOLT. Mr. Speaker, I rise today in support of H.R. 4386 and urge 
my colleagues to pass this important legislation.
  I am grateful for the strong bipartisan support this legislation has 
received and I am proud to support this bill again so it can be 
forwarded to the President for signing and passage.
  Mr. Speaker, passing this bill is critical for all Americans, but it 
is especially critical for families in my home State of New Jersey 
where breast cancer death rates are the highest in the nation. The 
program served women with incomes that are low but above the 
eligibility of Medicaid.
  Ten years ago this Congress established a screening program to 
prevent and detect breast and cervical cancer to be administered under 
the auspices of the Centers for Disease Control (CDC).
  In my home State of New Jersey, 20,000 women have been screened for 
breast cancer under the CDC program since 1996, and 16,000 have been 
screened for cervical cancer. Nationwide, over 200,000 women received 
mammograms under the CDC program in 1997 alone.
  But until now, the program has not assured those women unfortunate 
enough to be diagnosed with either of these diseases that they would 
receive coverage and treatment, because, while they were uninsured, 
they had income above the limit set by State Medicaid programs. Too 
many of these women were left without hope. This was a great travesty.
  Mr. Speaker, we must do more than just diagnose the problem. We must 
take the next step to ensure treatment for those without health 
insurance and pass this important legislation.
  Thanks to this bill these women will now be eligible for Medicaid 
coverage should they be diagnosed with either of these diseases. This 
bill will save lives.
  I know that many here in this Congress have been working hard to see 
this discrepancy addressed. I applaud their efforts and I am glad that 
we are finally having a chance to pass this much-needed legislation 
this year.
  Ms. PELOSI. Mr. Speaker, I rise in strong support of the Breast and 
Cervical Cancer Prevention and Treatment Act. I first want to commend 
my colleague Representative Anna Eshoo for her hard work on this 
important bill. She has been a great leader in this effort for many 
years. In addition, I also commend Representative Slaughter and my 
colleagues in the women's caucus for their work to ensure that we have 
the opportunity to vote on a clean bill that will make it to the 
President's desk.
  We all agree that Americans should be educated and informed about 
HPV, and all other sexually transmitted diseases. However, passage of 
this important legislation to help uninsured women beat back the 
ravages of breast and cervical cancer is vital, and it would have been 
a tragedy to jeopardize its success by including language unacceptable 
to the Senate.
  Every year, Cervical cancer kills 4,400 women and breast cancer, the 
leading cause of death among women between 40 and 45, kills over 46,000 
women. This bill builds on the CDC's National Breast and Cervical 
Cancer Early Detection Program which covers screening services, but 
does not cover treatment for women who are detected with cancer. The 
Breast and Cervical Cancer Protection and Treatment Act takes the vital 
next step to offer lifesaving treatment to cancer victims.
  Early detection of breast and cervical cancer saves lives. According 
to the CDC, approximately 15 to 30 percent of all deaths from breast 
cancer among women over the age of 40 and virtually all deaths from 
cervical cancer could have been prevented with early screening and 
treatment.
  Unfortunately, many of the women diagnosed through the CDC screening 
program do not receive the care they need because they lack adequate 
health insurance. Uninsured women with breast and cervical cancer face 
significant barriers to receiving lifesaving treatment. Women who are 
uninsured are 40 percent more likely to die from breast cancer than 
those with insurance. Not only are these women likely to be screened, 
but the scope of treatment they receive is often limited by their 
ability to pay.
  The Breast and Cervical Cancer Treatment and Prevention Act would 
provide states with the option to provide the full Medicaid benefit 
package without delay to uninsured women diagnosed with breast or 
cervical cancer through the CDC screening program. As a result, 
thousands of low-income women would have access to consistent, reliable 
treatment.
  I urge my colleagues to vote yes on this bill.
  Mr. CROWLEY. Mr. Speaker, I am honored today to join my colleagues in 
support of H.R. 4386, The Breast and Cervical Cancer Treatment Act. I 
am pleased that the Republican leadership has withdrawn the Coburn 
Amendment, which will allow this bill to pass the house today.
  This year, more than 200,000 American women will be diagnosed with 
breast and cervical cancer. These women are our mothers, our 
grandmothers, our sisters, our colleagues and our friends.
  In 1990, Congress took the first step toward the fight against breast 
and cervical cancer by passing the Breast and Cervical Cancer Mortality 
Prevention Act. This law authorized a breast and cervical cancer-
screening program for low income, uninsured or underinsured women 
through the Center for Disease Control (CDC). Since its inception, the 
program has screened more than 500,000 women. Unfortunately, that is 
not enough. This program fails to provide any federal resources to pay 
for treatment once women are diagnosed with breast or cervical cancer.
  H.R. 4386, The Breast and Cervical Treatment Act is a bipartisan 
piece of legislation which would provide Medicaid assistance to treat 
low-income, uninsured or underinsured women diagnosed breast or 
cervical cancer. Under this bill, the low income, uninsured or 
underinsured women diagnosed under the CDC Program will now receive the 
necessary treatment they need and deserve.
  In the last decade we have made great strides in fighting against 
breast and cervical cancers. I am pleased to support this bill because 
the passage of this legislation today will give many women who were 
once hopeless a fighting chance to survive this terrible disease.
  Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I urge a yes vote, and I yield back the 
balance of my time.
  The SPEAKER pro tempore (Mr. Barrett of Nebreska). All time for 
debate has expired.
  Pursuant to House Resolution 628, the previous question is ordered.
  The question is on the motion offered by the gentleman from Florida 
(Mr. Bilirakis).
  The motion was agreed to.


  A motion to reconsider was laid on the table.

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