[Congressional Record (Bound Edition), Volume 146 (2000), Part 17]
[House]
[Pages 25742-25753]
[From the U.S. Government Publishing Office, www.gpo.gov]



 MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH AND EDUCATION ACT OF 
                                  2000

  Mr. NORWOOD. Mr. Speaker, I move to suspend the rules and pass the 
Senate bill (S. 1880) to amend the Public Health Service Act to improve 
the health of minority individuals.
  The Clerk read as follows:

                                S. 1880

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Minority 
     Health and Health Disparities Research and Education Act of 
     2000''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.

  TITLE I--IMPROVING MINORITY HEALTH AND REDUCING HEALTH DISPARITIES 
THROUGH NATIONAL INSTITUTES OF HEALTH; ESTABLISHMENT OF NATIONAL CENTER

Sec. 101. Establishment of National Center on Minority Health and 
              Health Disparities.
Sec. 102. Centers of excellence for research education and training.
Sec. 103. Extramural loan repayment program for minority health 
              disparities research.
Sec. 104. General provisions regarding the Center.
Sec. 105. Report regarding resources of National Institutes of Health 
              dedicated to minority and other health disparities 
              research.

TITLE II--HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH 
                              AND QUALITY

Sec. 201. Health disparities research by Agency for Healthcare Research 
              and Quality.

        TITLE III--DATA COLLECTION RELATING TO RACE OR ETHNICITY

Sec. 301. Study and report by National Academy of Sciences.

                 TITLE IV--HEALTH PROFESSIONS EDUCATION

Sec. 401. Health professions education in health disparities.
Sec. 402. National conference on health professions education and 
              health disparities.
Sec. 403. Advisory responsibilities in health professions education in 
              health disparities and cultural competency.

 TITLE V--PUBLIC AWARENESS AND DISSEMINATION OF INFORMATION ON HEALTH 
                              DISPARITIES

Sec. 501. Public awareness and information dissemination.

                   TITLE VI--MISCELLANEOUS PROVISIONS

Sec. 601. Departmental definition regarding minority individuals.
Sec. 602. Conforming provision regarding definitions.
Sec. 603. Effective date.

     SEC. 2. FINDINGS.

       The Congress finds as follows:
       (1) Despite notable progress in the overall health of the 
     Nation, there are continuing disparities in the burden of 
     illness and death experienced by African Americans, 
     Hispanics, Native Americans, Alaska Natives, and Asian 
     Pacific Islanders, compared to the United States population 
     as a whole.
       (2) The largest numbers of the medically underserved are 
     white individuals, and many of them have the same health care 
     access problems as do members of minority groups. Nearly 
     20,000,000 white individuals live below the poverty line with 
     many living in non-metropolitan, rural areas such as 
     Appalachia, where the high percentage of counties designated 
     as health professional shortage areas (47 percent) and the 
     high rate of poverty contribute to disparity outcomes. 
     However, there is a higher proportion of racial and ethnic 
     minorities in the United States represented among the 
     medically underserved.
       (3) There is a national need for minority scientists in the 
     fields of biomedical, clinical, behavioral, and health 
     services research. Ninety percent of minority physicians 
     educated at Historically Black Medical Colleges live and 
     serve in minority communities.

[[Page 25743]]

       (4) Demographic trends inspire concern about the Nation's 
     ability to meet its future scientific, technological and 
     engineering workforce needs. Historically, non-Hispanic white 
     males have made up the majority of the United States 
     scientific, technological, and engineering workers.
       (5) The Hispanic and Black population will increase 
     significantly in the next 50 years. The scientific, 
     technological, and engineering workforce may decrease if 
     participation by underepresented minorities remains the same.
       (6) Increasing rates of Black and Hispanic workers can help 
     ensure strong scientific, technological, and engineering 
     workforce.
       (7) Individuals such as underepresented minorities and 
     women in the scientific, technological, and engineering 
     workforce enable society to address its diverse needs.
       (8) If there had not been a substantial increase in the 
     number of science and engineering degrees awarded to women 
     and underepresented minorities over the past few decades, the 
     United States would be facing even greater shortages in 
     scientific, technological, and engineering workers.
       (9) In order to effectively promote a diverse and strong 
     21st Century scientific, technological, and engineering 
     workforce, Federal agencies should expand or add programs 
     that effectively overcome barriers such as educational 
     transition from one level to the next and student 
     requirements for financial resources.
       (10) Federal agencies should work in concert with the 
     private nonprofit sector to emphasize the recruitment and 
     retention of qualified individuals from ethnic and gender 
     groups that are currently underrepresented in the scientific, 
     technological, and engineering workforce.
       (11) Behavioral and social sciences research has increased 
     awareness and understanding of factors associated with health 
     care utilization and access, patient attitudes toward health 
     services, and risk and protective behaviors that affect 
     health and illness. These factors have the potential to then 
     be modified to help close the health disparities gap among 
     ethnic minority populations. In addition, there is a shortage 
     of minority behavioral science researchers and behavioral 
     health care professionals. According to the National Science 
     Foundation, only 15.5 percent of behavioral research-oriented 
     psychology doctorate degrees were awarded to minority 
     students in 1997. In addition, only 17.9 percent of practice-
     oriented psychology doctorate degrees were awarded to ethnic 
     minorities.

  TITLE I--IMPROVING MINORITY HEALTH AND REDUCING HEALTH DISPARITIES 
THROUGH NATIONAL INSTITUTES OF HEALTH; ESTABLISHMENT OF NATIONAL CENTER

     SEC. 101. ESTABLISHMENT OF NATIONAL CENTER ON MINORITY HEALTH 
                   AND HEALTH DISPARITIES.

       (a) In General.--Part E of title IV of the Public Health 
     Service Act (42 U.S.C. 287 et seq.) is amended by adding at 
     the end the following subpart:

 ``Subpart 6--National Center on Minority Health and Health Disparities

     ``SEC. 485E. PURPOSE OF CENTER.

       ``(a) In General.--The general purpose of the National 
     Center on Minority Health and Health Disparities (in this 
     subpart referred to as the `Center') is the conduct and 
     support of research, training, dissemination of information, 
     and other programs with respect to minority health conditions 
     and other populations with health disparities.
       ``(b) Priorities.--The Director of the Center shall in 
     expending amounts appropriated under this subpart give 
     priority to conducting and supporting minority health 
     disparities research.
       ``(c) Minority Health Disparities Research.--For purposes 
     of this subpart:
       ``(1) The term `minority health disparities research' means 
     basic, clinical, and behavioral research on minority health 
     conditions (as defined in paragraph (2)), including research 
     to prevent, diagnose, and treat such conditions.
       ``(2) The term `minority health conditions', with respect 
     to individuals who are members of minority groups, means all 
     diseases, disorders, and conditions (including with respect 
     to mental health and substance abuse)--
       ``(A) unique to, more serious, or more prevalent in such 
     individuals;
       ``(B) for which the factors of medical risk or types of 
     medical intervention may be different for such individuals, 
     or for which it is unknown whether such factors or types are 
     different for such individuals; or
       ``(C) with respect to which there has been insufficient 
     research involving such individuals as subjects or 
     insufficient data on such individuals.
       ``(3) The term `minority group' has the meaning given the 
     term `racial and ethnic minority group' in section 1707.
       ``(4) The terms `minority' and `minorities' refer to 
     individuals from a minority group.
       ``(d) Health Disparity Populations.--For purposes of this 
     subpart:
       ``(1) A population is a health disparity population if, as 
     determined by the Director of the Center after consultation 
     with the Director of the Agency for Healthcare Research and 
     Quality, there is a significant disparity in the overall rate 
     of disease incidence, prevalence, morbidity, mortality, or 
     survival rates in the population as compared to the health 
     status of the general population.
       ``(2) The Director shall give priority consideration to 
     determining whether minority groups qualify as health 
     disparity populations under paragraph (1).
       ``(3) The term `health disparities research' means basic, 
     clinical, and behavioral research on health disparity 
     populations (including individual members and communities of 
     such populations) that relates to health disparities as 
     defined under paragraph (1), including the causes of such 
     disparities and methods to prevent, diagnose, and treat such 
     disparities.
       ``(e) Coordination of Activities.--The Director of the 
     Center shall act as the primary Federal official with 
     responsibility for coordinating all minority health 
     disparities research and other health disparities research 
     conducted or supported by the National Institutes of Health, 
     and--
       ``(1) shall represent the health disparities research 
     program of the National Institutes of Health, including the 
     minority health disparities research program, at all relevant 
     Executive branch task forces, committees and planning 
     activities; and
       ``(2) shall maintain communications with all relevant 
     Public Health Service agencies, including the Indian Health 
     Service, and various other departments of the Federal 
     Government to ensure the timely transmission of information 
     concerning advances in minority health disparities research 
     and other health disparities research between these various 
     agencies for dissemination to affected communities and health 
     care providers.
       ``(f) Collaborative Comprehensive Plan and Budget.--
       ``(1) In general.--Subject to the provisions of this 
     section and other applicable law, the Director of NIH, the 
     Director of the Center, and the directors of the other 
     agencies of the National Institutes of Health in 
     collaboration (and in consultation with the advisory council 
     for the Center) shall--
       ``(A) establish a comprehensive plan and budget for the 
     conduct and support of all minority health disparities 
     research and other health disparities research activities of 
     the agencies of the National Institutes of Health (which plan 
     and budget shall be first established under this subsection 
     not later than 12 months after the date of the enactment of 
     this subpart);
       ``(B) ensure that the plan and budget establish priorities 
     among the health disparities research activities that such 
     agencies are authorized to carry out;
       ``(C) ensure that the plan and budget establish objectives 
     regarding such activities, describes the means for achieving 
     the objectives, and designates the date by which the 
     objectives are expected to be achieved;
       ``(D) ensure that, with respect to amounts appropriated for 
     activities of the Center, the plan and budget give priority 
     in the expenditure of funds to conducting and supporting 
     minority health disparities research;
       ``(E) ensure that all amounts appropriated for such 
     activities are expended in accordance with the plan and 
     budget;
       ``(F) review the plan and budget not less than annually, 
     and revise the plan and budget as appropriate;
       ``(G) ensure that the plan and budget serve as a broad, 
     binding statement of policies regarding minority health 
     disparities research and other health disparities research 
     activities of the agencies, but do not remove the 
     responsibility of the heads of the agencies for the approval 
     of specific programs or projects, or for other details of the 
     daily administration of such activities, in accordance with 
     the plan and budget; and
       ``(H) promote coordination and collaboration among the 
     agencies conducting or supporting minority health or other 
     health disparities research.
       ``(2) Certain components of plan and budget.--With respect 
     to health disparities research activities of the agencies of 
     the National Institutes of Health, the Director of the Center 
     shall ensure that the plan and budget under paragraph (1) 
     provide for--
       ``(A) basic research and applied research, including 
     research and development with respect to products;
       ``(B) research that is conducted by the agencies;
       ``(C) research that is supported by the agencies;
       ``(D) proposals developed pursuant to solicitations by the 
     agencies and for proposals developed independently of such 
     solicitations; and
       ``(E) behavioral research and social sciences research, 
     which may include cultural and linguistic research in each of 
     the agencies.
       ``(3) Minority health disparities research.--The plan and 
     budget under paragraph (1) shall include a separate statement 
     of the plan and budget for minority health disparities 
     research.
       ``(g) Participation in Clinical Research.--The Director of 
     the Center shall work with the Director of NIH and the 
     directors of the agencies of the National Institutes of 
     Health to carry out the provisions of section 492B that 
     relate to minority groups.
       ``(h) Research Endowments.--
       ``(1) In general.--The Director of the Center may carry out 
     a program to facilitate

[[Page 25744]]

     minority health disparities research and other health 
     disparities research by providing for research endowments at 
     centers of excellence under section 736.
       ``(2) Eligibility.--The Director of the Center may provide 
     for a research endowment under paragraph (1) only if the 
     institution involved meets the following conditions:
       ``(A) The institution does not have an endowment that is 
     worth in excess of an amount equal to 50 percent of the 
     national average of endowment funds at institutions that 
     conduct similar biomedical research or training of health 
     professionals.
       ``(B) The application of the institution under paragraph 
     (1) regarding a research endowment has been recommended 
     pursuant to technical and scientific peer review and has been 
     approved by the advisory council under subsection (j).
       ``(i) Certain Activities.--In carrying out subsection (a), 
     the Director of the Center--
       ``(1) shall assist the Director of the National Center for 
     Research Resources in carrying out section 481(c)(3) and in 
     committing resources for construction at Institutions of 
     Emerging Excellence;
       ``(2) shall establish projects to promote cooperation among 
     Federal agencies, State, local, tribal, and regional public 
     health agencies, and private entities in health disparities 
     research; and
       ``(3) may utilize information from previous health 
     initiatives concerning minorities and other health disparity 
     populations.
       ``(j) Advisory Council.--
       ``(1) In general.--The Secretary shall, in accordance with 
     section 406, establish an advisory council to advise, assist, 
     consult with, and make recommendations to the Director of the 
     Center on matters relating to the activities described in 
     subsection (a), and with respect to such activities to carry 
     out any other functions described in section 406 for advisory 
     councils under such section. Functions under the preceding 
     sentence shall include making recommendations on budgetary 
     allocations made in the plan under subsection (f), and shall 
     include reviewing reports under subsection (k) before the 
     reports are submitted under such subsection.
       ``(2) Membership.--With respect to the membership of the 
     advisory council under paragraph (1), a majority of the 
     members shall be individuals with demonstrated expertise 
     regarding minority health disparity and other health 
     disparity issues; representatives of communities impacted by 
     minority and other health disparities shall be included; and 
     a diversity of health professionals shall be represented. The 
     membership shall in addition include a representative of the 
     Office of Behavioral and Social Sciences Research under 
     section 404A.
       ``(k) Annual Report.--The Director of the Center shall 
     prepare an annual report on the activities carried out or to 
     be carried out by the Center, and shall submit each such 
     report to the Committee on Health, Education, Labor, and 
     Pensions of the Senate, the Committee on Commerce of the 
     House of Representatives, the Secretary, and the Director of 
     NIH. With respect to the fiscal year involved, the report 
     shall--
       ``(1) describe and evaluate the progress made in health 
     disparities research conducted or supported by the national 
     research institutes;
       ``(2) summarize and analyze expenditures made for 
     activities with respect to health disparities research 
     conducted or supported by the National Institutes of Health;
       ``(3) include a separate statement applying the 
     requirements of paragraphs (1) and (2) specifically to 
     minority health disparities research; and
       ``(4) contain such recommendations as the Director 
     considers appropriate.
       ``(l) Authorization of Appropriations.--For the purpose of 
     carrying out this subpart, there are authorized to be 
     appropriated $100,000,000 for fiscal year 2001, and such sums 
     as may be necessary for each of the fiscal years 2002 through 
     2005. Such authorization of appropriations is in addition to 
     other authorizations of appropriations that are available for 
     the conduct and support of minority health disparities 
     research or other health disparities research by the agencies 
     of the National Institutes of Health.''.
       (b) Conforming Amendment.--Part A of title IV of the Public 
     Health Service Act (42 U.S.C. 281 et seq.) is amended--
       (1) in section 401(b)(2)--
       (A) in subparagraph (F), by moving the subparagraph two ems 
     to the left; and
       (B) by adding at the end the following subparagraph:
       ``(G) The National Center on Minority Health and Health 
     Disparities.''; and
       (2) by striking section 404.

     SEC. 102. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND 
                   TRAINING.

       Subpart 6 of part E of title IV of the Public Health 
     Service Act, as added by section 101(a) of this Act, is 
     amended by adding at the end the following section:

     ``SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND 
                   TRAINING.

       ``(a) In General.--The Director of the Center shall make 
     awards of grants or contracts to designated biomedical and 
     behavioral research institutions under paragraph (1) of 
     subsection (c), or to consortia under paragraph (2) of such 
     subsection, for the purpose of assisting the institutions in 
     supporting programs of excellence in biomedical and 
     behavioral research training for individuals who are members 
     of minority health disparity populations or other health 
     disparity populations.
       ``(b) Required Use of Funds.--An award may be made under 
     subsection (a) only if the applicant involved agrees that the 
     grant will be expended--
       ``(1) to train members of minority health disparity 
     populations or other health disparity populations as 
     professionals in the area of biomedical or behavioral 
     research or both; or
       ``(2) to expand, remodel, renovate, or alter existing 
     research facilities or construct new research facilities for 
     the purpose of conducting minority health disparities 
     research and other health disparities research.
       ``(c) Centers of Excellence.--
       ``(1) In general.--For purposes of this section, a 
     designated biomedical and behavioral research institution is 
     a biomedical and behavioral research institution that--
       ``(A) has a significant number of members of minority 
     health disparity populations or other health disparity 
     populations enrolled as students in the institution 
     (including individuals accepted for enrollment in the 
     institution);
       ``(B) has been effective in assisting such students of the 
     institution to complete the program of education or training 
     and receive the degree involved;
       ``(C) has made significant efforts to recruit minority 
     students to enroll in and graduate from the institution, 
     which may include providing means-tested scholarships and 
     other financial assistance as appropriate; and
       ``(D) has made significant recruitment efforts to increase 
     the number of minority or other members of health disparity 
     populations serving in faculty or administrative positions at 
     the institution.
       ``(2) Consortium.--Any designated biomedical and behavioral 
     research institution involved may, with other biomedical and 
     behavioral institutions (designated or otherwise), including 
     tribal health programs, form a consortium to receive an award 
     under subsection (a).
       ``(3) Application of criteria to other programs.--In the 
     case of any criteria established by the Director of the 
     Center for purposes of determining whether institutions meet 
     the conditions described in paragraph (1), this section may 
     not, with respect to minority health disparity populations or 
     other health disparity populations, be construed to 
     authorize, require, or prohibit the use of such criteria in 
     any program other than the program established in this 
     section.
       ``(d) Duration of Grant.--The period during which payments 
     are made under a grant under subsection (a) may not exceed 5 
     years. Such payments shall be subject to annual approval by 
     the Director of the Center and to the availability of 
     appropriations for the fiscal year involved to make the 
     payments.
       ``(e) Maintenance of Effort.--
       ``(1) In general.--With respect to activities for which an 
     award under subsection (a) is authorized to be expended, the 
     Director of the Center may not make such an award to a 
     designated research institution or consortium for any fiscal 
     year unless the institution, or institutions in the 
     consortium, as the case may be, agree to maintain 
     expenditures of non-Federal amounts for such activities at a 
     level that is not less than the level of such expenditures 
     maintained by the institutions involved for the fiscal year 
     preceding the fiscal year for which such institutions receive 
     such an award.
       ``(2) Use of federal funds.--With respect to any Federal 
     amounts received by a designated research institution or 
     consortium and available for carrying out activities for 
     which an award under subsection (a) is authorized to be 
     expended, the Director of the Center may make such an award 
     only if the institutions involved agree that the institutions 
     will, before expending the award, expend the Federal amounts 
     obtained from sources other than the award.
       ``(f) Certain Expenditures.--The Director of the Center may 
     authorize a designated biomedical and behavioral research 
     institution to expend a portion of an award under subsection 
     (a) for research endowments.
       ``(g) Definitions.--For purposes of this section:
       ``(1) The term `designated biomedical and behavioral 
     research institution' has the meaning indicated for such term 
     in subsection (c)(1). Such term includes any health 
     professions school receiving an award of a grant or contract 
     under section 736.
       ``(2) The term `program of excellence' means any program 
     carried out by a designated biomedical and behavioral 
     research institution with an award under subsection (a), if 
     the program is for purposes for which the institution 
     involved is authorized in subsection (b) to expend the grant.
       ``(h) Authorization of Appropriations.--For the purpose of 
     making grants under subsection (a), there are authorized to 
     be appropriated such sums as may be necessary for each of the 
     fiscal years 2001 through 2005.''.

     SEC. 103. EXTRAMURAL LOAN REPAYMENT PROGRAM FOR MINORITY 
                   HEALTH DISPARITIES RESEARCH.

       Subpart 6 of part E of title IV of the Public Health 
     Service Act, as amended by section 102 of this Act, is 
     amended by adding at the end the following section:

[[Page 25745]]



     ``SEC. 485G. LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH 
                   DISPARITIES RESEARCH.

       ``(a) In General.--The Director of the Center shall 
     establish a program of entering into contracts with qualified 
     health professionals under which such health professionals 
     agree to engage in minority health disparities research or 
     other health disparities research in consideration of the 
     Federal Government agreeing to repay, for each year of 
     engaging in such research, not more than $35,000 of the 
     principal and interest of the educational loans of such 
     health professionals.
       ``(b) Service Provisions.--The provisions of sections 338B, 
     338C, and 338E shall, except as inconsistent with subsection 
     (a), apply to the program established in such subsection to 
     the same extent and in the same manner as such provisions 
     apply to the National Health Service Corps Loan Repayment 
     Program established in subpart III of part D of title III.
       ``(c) Requirement Regarding Health Disparity Populations.--
     The Director of the Center shall ensure that not fewer than 
     50 percent of the contracts entered into under subsection (a) 
     are for appropriately qualified health professionals who are 
     members of a health disparity population.
       ``(d) Priority.--With respect to minority health 
     disparities research and other health disparities research 
     under subsection (a), the Secretary shall ensure that 
     priority is given to conducting projects of biomedical 
     research.
       ``(e) Funding.--
       ``(1) 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 2001 through 2005.
       ``(2) Availability of appropriations.--Amounts available 
     for carrying out this section shall remain available until 
     the expiration of the second fiscal year beginning after the 
     fiscal year for which the amounts were made available.''.

     SEC. 104. GENERAL PROVISIONS REGARDING THE CENTER.

       Subpart 6 of part E of title IV of the Public Health 
     Service Act, as amended by section 103 of this Act, is 
     amended by adding at the end the following section:

     ``SEC. 485H. GENERAL PROVISIONS REGARDING THE CENTER.

       ``(a) Administrative Support for Center.--The Secretary, 
     acting through the Director of the National Institutes of 
     Health, shall provide administrative support and support 
     services to the Director of the Center and shall ensure that 
     such support takes maximum advantage of existing 
     administrative structures at the agencies of the National 
     Institutes of Health.
       ``(b) Evaluation and Report.--
       ``(1) Evaluation.--Not later than 5 years after the date of 
     the enactment of this subpart, the Secretary shall conduct an 
     evaluation to--
       ``(A) determine the effect of this subpart on the planning 
     and coordination of health disparities research programs at 
     the agencies of the National Institutes of Health;
       ``(B) evaluate the extent to which this subpart has 
     eliminated the duplication of administrative resources among 
     such Institutes, centers and divisions; and
       ``(C) provide, to the extent determined by the Secretary to 
     be appropriate, recommendations concerning future legislative 
     modifications with respect to this subpart, for both minority 
     health disparities research and other health disparities 
     research.
       ``(2) Minority health disparities research.--The evaluation 
     under paragraph (1) shall include a separate statement that 
     applies subparagraphs (A) and (B) of such paragraph to 
     minority health disparities research.
       ``(3) Report.--Not later than 1 year after the date on 
     which the evaluation is commenced under paragraph (1), the 
     Secretary shall prepare and submit to the Committee on 
     Health, Education, Labor, and Pensions of the Senate, and the 
     Committee on Commerce of the House of Representatives, a 
     report concerning the results of such evaluation.''.

     SEC. 105. REPORT REGARDING RESOURCES OF NATIONAL INSTITUTES 
                   OF HEALTH DEDICATED TO MINORITY AND OTHER 
                   HEALTH DISPARITIES RESEARCH.

       Not later than December 1, 2003, the Director of the 
     National Center on Minority Health and Health Disparities 
     (established by the amendment made by section 101(a)), after 
     consultation with the advisory council for such Center, shall 
     submit to the Congress, the Secretary of Health and Human 
     Services, and the Director of the National Institutes of 
     Health a report that provides the following:
       (1) Recommendations for the methodology that should be used 
     to determine the extent of the resources of the National 
     Institutes of Health that are dedicated to minority health 
     disparities research and other health disparities research, 
     including determining the amount of funds that are used to 
     conduct and support such research. With respect to such 
     methodology, the report shall address any discrepancies 
     between the methodology used by such Institutes as of the 
     date of the enactment of this Act and the methodology used by 
     the Institute of Medicine as of such date.
       (2) A determination of whether and to what extent, relative 
     to fiscal year 1999, there has been an increase in the level 
     of resources of the National Institutes of Health that are 
     dedicated to minority health disparities research, including 
     the amount of funds used to conduct and support such 
     research. The report shall include provisions describing 
     whether and to what extent there have been increases in the 
     number and amount of awards to minority serving institutions.

TITLE II--HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH 
                              AND QUALITY

     SEC. 201. HEALTH DISPARITIES RESEARCH BY AGENCY FOR 
                   HEALTHCARE RESEARCH AND QUALITY.

       (a)  General.--Part A of title IX of the Public Health 
     Service Act (42 U.S.C. 299 et seq.) is amended--
       (1) in section 902, by striking subsection (g); and
       (2) by adding at the end the following:

     ``SEC. 903. RESEARCH ON HEALTH DISPARITIES.

       ``(a) In General.--The Director shall--
       ``(1) conduct and support research to identify populations 
     for which there is a significant disparity in the quality, 
     outcomes, cost, or use of health care services or access to 
     and satisfaction with such services, as compared to the 
     general population;
       ``(2) conduct and support research on the causes of and 
     barriers to reducing the health disparities identified in 
     paragraph (1), taking into account such factors as 
     socioeconomic status, attitudes toward health, the language 
     spoken, the extent of formal education, the area or community 
     in which the population resides, and other factors the 
     Director determines to be appropriate;
       ``(3) conduct and support research and support 
     demonstration projects to identify, test, and evaluate 
     strategies for reducing or eliminating health disparities, 
     including development or identification of effective service 
     delivery models, and disseminate effective strategies and 
     models;
       ``(4) develop measures and tools for the assessment and 
     improvement of the outcomes, quality, and appropriateness of 
     health care services provided to health disparity 
     populations;
       ``(5) in carrying out section 902(c), provide support to 
     increase the number of researchers who are members of health 
     disparity populations, and the health services research 
     capacity of institutions that train such researchers; and
       ``(6) beginning with fiscal year 2003, annually submit to 
     the Congress a report regarding prevailing disparities in 
     health care delivery as it relates to racial factors and 
     socioeconomic factors in priority populations.
       ``(b) Research and Demonstration Projects.--
       ``(1) In general.--In carrying out subsection (a), the 
     Director shall conduct and support research and support 
     demonstrations to--
       ``(A) identify the clinical, cultural, socioeconomic, 
     geographic, and organizational factors that contribute to 
     health disparities, including minority health disparity 
     populations, which research shall include behavioral 
     research, such as examination of patterns of clinical 
     decisionmaking, and research on access, outreach, and the 
     availability of related support services (such as cultural 
     and linguistic services);
       ``(B) identify and evaluate clinical and organizational 
     strategies to improve the quality, outcomes, and access to 
     care for health disparity populations, including minority 
     health disparity populations;
       ``(C) test such strategies and widely disseminate those 
     strategies for which there is scientific evidence of 
     effectiveness; and
       ``(D) determine the most effective approaches for 
     disseminating research findings to health disparity 
     populations, including minority populations.
       ``(2) Use of certain strategies.--In carrying out this 
     section, the Director shall implement research strategies and 
     mechanisms that will enhance the involvement of individuals 
     who are members of minority health disparity populations or 
     other health disparity populations, health services 
     researchers who are such individuals, institutions that train 
     such individuals as researchers, members of minority health 
     disparity populations or other health disparity populations 
     for whom the Agency is attempting to improve the quality and 
     outcomes of care, and representatives of appropriate tribal 
     or other community-based organizations with respect to health 
     disparity populations. Such research strategies and 
     mechanisms may include the use of--
       ``(A) centers of excellence that can demonstrate, either 
     individually or through consortia, a combination of multi-
     disciplinary expertise in outcomes or quality improvement 
     research, linkages to relevant sites of care, and a 
     demonstrated capacity to involve members and communities of 
     health disparity populations, including minority health 
     disparity populations, in the planning, conduct, 
     dissemination, and translation of research;
       ``(B) provider-based research networks, including health 
     plans, facilities, or delivery system sites of care 
     (especially primary care), that make extensive use of health 
     care

[[Page 25746]]

     providers who are members of health disparity populations or 
     who serve patients in such populations and have the capacity 
     to evaluate and promote quality improvement;
       ``(C) service delivery models (such as health centers under 
     section 330 and the Indian Health Service) to reduce health 
     disparities; and
       ``(D) innovative mechanisms or strategies that will 
     facilitate the translation of past research investments into 
     clinical practices that can reasonably be expected to benefit 
     these populations.
       ``(c) Quality Measurement Development.--
       ``(1) In general.--To ensure that health disparity 
     populations, including minority health disparity populations, 
     benefit from the progress made in the ability of individuals 
     to measure the quality of health care delivery, the Director 
     shall support the development of quality of health care 
     measures that assess the experience of such populations with 
     health care systems, such as measures that assess the access 
     of such populations to health care, the cultural competence 
     of the care provided, the quality of the care provided, the 
     outcomes of care, or other aspects of health care practice 
     that the Director determines to be important.
       ``(2) Examination of certain practices.--The Director shall 
     examine the practices of providers that have a record of 
     reducing health disparities or have experience in providing 
     culturally competent health services to minority health 
     disparity populations or other health disparity populations. 
     In examining such practices of providers funded under the 
     authorities of this Act, the Director shall consult with the 
     heads of the relevant agencies of the Public Health Service.
       ``(3) Report.--Not later than 36 months after the date of 
     the enactment of this section, the Secretary, acting through 
     the Director, shall prepare and submit to the appropriate 
     committees of Congress a report describing the state-of-the-
     art of quality measurement for minority and other health 
     disparity populations that will identify critical unmet 
     needs, the current activities of the Department to address 
     those needs, and a description of related activities in the 
     private sector.
       ``(d) Definition.--For purposes of this section:
       ``(1) The term `health disparity population' has the 
     meaning given such term in section 485E, except that in 
     addition to the meaning so given, the Director may determine 
     that such term includes populations for which there is a 
     significant disparity in the quality, outcomes, cost, or use 
     of health care services or access to or satisfaction with 
     such services as compared to the general population.
       ``(2) The term `minority', with respect to populations, 
     refers to racial and ethnic minority groups as defined in 
     section 1707.''.
       (b) Funding.--Section 927 of the Public Health Service Act 
     (42 U.S.C. 299c-6) is amended by adding at the end the 
     following:
       ``(d) Health Disparities Research.--For the purpose of 
     carrying out the activities under section 903, there are 
     authorized to be appropriated $50,000,000 for fiscal year 
     2001, and such sums as may be necessary for each of the 
     fiscal years 2002 through 2005.''.

        TITLE III--DATA COLLECTION RELATING TO RACE OR ETHNICITY

     SEC. 301. STUDY AND REPORT BY NATIONAL ACADEMY OF SCIENCES.

       (a) Study.--The National Academy of Sciences shall conduct 
     a comprehensive study of the Department of Health and Human 
     Services' data collection systems and practices, and any data 
     collection or reporting systems required under any of the 
     programs or activities of the Department, relating to the 
     collection of data on race or ethnicity, including other 
     Federal data collection systems (such as the Social Security 
     Administration) with which the Department interacts to 
     collect relevant data on race and ethnicity.
       (b) Report.--Not later than 1 year after the date of 
     enactment of this Act, the National Academy of Sciences shall 
     prepare and submit to the Committee on Health, Education, 
     Labor, and Pensions of the Senate and the Committee on 
     Commerce of the House of Representatives, a report that--
       (1) identifies the data needed to support efforts to 
     evaluate the effects of socioeconomic status, race and 
     ethnicity on access to health care and other services and on 
     disparity in health and other social outcomes and the data 
     needed to enforce existing protections for equal access to 
     health care;
       (2) examines the effectiveness of the systems and practices 
     of the Department of Health and Human Services described in 
     subsection (a), including pilot and demonstration projects of 
     the Department, and the effectiveness of selected systems and 
     practices of other Federal, State, and tribal agencies and 
     the private sector, in collecting and analyzing such data;
       (3) contains recommendations for ensuring that the 
     Department of Health and Human Services, in administering its 
     entire array of programs and activities, collects, or causes 
     to be collected, reliable and complete information relating 
     to race and ethnicity; and
       (4) includes projections about the costs associated with 
     the implementation of the recommendations described in 
     paragraph (3), and the possible effects of the costs on 
     program operations.
       (c) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated such sums as may be necessary for fiscal year 
     2001.

                 TITLE IV--HEALTH PROFESSIONS EDUCATION

     SEC. 401. HEALTH PROFESSIONS EDUCATION IN HEALTH DISPARITIES.

       (a) In General.--Part B of title VII of the Public Health 
     Service Act (42 U.S.C. 293 et seq.) is amended by inserting 
     after section 740 the following:

     ``SEC. 741. GRANTS FOR HEALTH PROFESSIONS EDUCATION.

       ``(a) Grants for Health Professions Education in Health 
     Disparities and Cultural Competency.--
       ``(1) In general.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may make awards of grants, contracts, or 
     cooperative agreements to public and nonprofit private 
     entities (including tribal entities) for the purpose of 
     carrying out research and demonstration projects (including 
     research and demonstration projects for continuing health 
     professions education) for training and education of health 
     professionals for the reduction of disparities in health care 
     outcomes and the provision of culturally competent health 
     care.
       ``(2) Eligible entities.--Unless specifically required 
     otherwise in this title, the Secretary shall accept 
     applications for grants or contracts under this section from 
     health professions schools, academic health centers, State or 
     local governments, or other appropriate public or private 
     nonprofit entities (or consortia of entities, including 
     entities promoting multidisciplinary approaches) for funding 
     and participation in health professions training activities. 
     The Secretary may accept applications from for-profit private 
     entities as determined appropriate by the Secretary.
       ``(b) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out subsection (a), 
     $3,500,000 for fiscal year 2001, $7,000,000 for fiscal year 
     2002, $7,000,000 for fiscal year 2003, and $3,500,000 for 
     fiscal year 2004.''.
       (b) Nursing Education.--Part A of title VIII of the Public 
     Health Service Act (42 U.S.C. 296 et seq.) is amended--
       (1) by redesignating section 807 as section 808; and
       (2) by inserting after section 806 the following:

     ``SEC. 807. GRANTS FOR HEALTH PROFESSIONS EDUCATION.

       ``(a) Grants for Health Professions Education in Health 
     Disparities and Cultural Competency.--The Secretary, acting 
     through the Administrator of the Health Resources and 
     Services Administration, may make awards of grants, 
     contracts, or cooperative agreements to eligible entities for 
     the purpose of carrying out research and demonstration 
     projects (including research and demonstration projects for 
     continuing health professions education) for training and 
     education for the reduction of disparities in health care 
     outcomes and the provision of culturally competent health 
     care. Grants under this section shall be the same as provided 
     in section 741.''.
       ``(b) Authorization of Appropriations.--There are to be 
     appropriated to carry out subsection (a) such sums as may be 
     necessary for each of the fiscal years 2001 through 2004.''.

     SEC. 402. NATIONAL CONFERENCE ON HEALTH PROFESSIONS EDUCATION 
                   AND HEALTH DISPARITIES.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary''), 
     acting through the Administrator of the Health Resources and 
     Services Administration, shall convene a national conference 
     on health professions education as a method for reducing 
     disparities in health outcomes.
       (b) Participants.--The Secretary shall include in the 
     national conference convened under subsection (a) advocacy 
     groups and educational entities as described in section 741 
     of the Public Health Service Act (as added by section 401), 
     tribal health programs, health centers under section 330 of 
     such Act, and other interested parties.
       (c) Issues.--The national conference convened under 
     subsection (a) shall include, but is not limited to, issues 
     that address the role and impact of health professions 
     education on the reduction of disparities in health outcomes, 
     including the role of education on cultural competency. The 
     conference shall focus on methods to achieve reductions in 
     disparities in health outcomes through health professions 
     education (including continuing education programs) and 
     strategies for outcomes measurement to assess the 
     effectiveness of education in reducing disparities.
       (d) Publication of Findings.--Not later than 6 months after 
     the national conference under subsection (a) has convened, 
     the Secretary shall publish in the Federal Register a summary 
     of the proceedings and findings of the conference.
       (e) Authorization of Appropriations.--There is authorized 
     to be appropriated such

[[Page 25747]]

     sums as may be necessary to carry out this section.

     SEC. 403. ADVISORY RESPONSIBILITIES IN HEALTH PROFESSIONS 
                   EDUCATION IN HEALTH DISPARITIES AND CULTURAL 
                   COMPETENCY.

       Section 1707 of the Public Health Service Act (42 U.S.C. 
     300u-6) is amended--
       (1) in subsection (b), by adding at the end the following 
     paragraph:
       ``(1) Advise in matters related to the development, 
     implementation, and evaluation of health professions 
     education in decreasing disparities in health care outcomes, 
     including cultural competency as a method of eliminating 
     health disparities.'';
       (2) in subsection (c)(2), by striking ``paragraphs (1) 
     through (9)'' and inserting ``paragraphs (1) through (10)''; 
     and
       (3) in subsection (d), by amending paragraph (1) to read as 
     follows:
       ``(1) Recommendations regarding language.--
       ``(A) Proficiency in speaking english.--The Deputy 
     Assistant Secretary shall consult with the Director of the 
     Office of International and Refugee Health, the Director of 
     the Office of Civil Rights, and the Directors of other 
     appropriate departmental entities regarding recommendations 
     for carrying out activities under subsection (b)(9).
       ``(B) Health professions education regarding health 
     disparities.--The Deputy Assistant Secretary shall carry out 
     the duties under subsection (b)(10) in collaboration with 
     appropriate personnel of the Department of Health of Human 
     Services, other Federal agencies, and other offices, centers, 
     and institutions, as appropriate, that have responsibilities 
     under the Minority Health and Health Disparities Research and 
     Education Act of 2000.''.

 TITLE V--PUBLIC AWARENESS AND DISSEMINATION OF INFORMATION ON HEALTH 
                              DISPARITIES

     SEC. 501. PUBLIC AWARENESS AND INFORMATION DISSEMINATION.

       (a) Public Awareness on Health Disparities.--The Secretary 
     of Health and Human Services (in this section referred to as 
     the ``Secretary'') shall conduct a national campaign to 
     inform the public and health care professionals about health 
     disparities in minority and other underserved populations by 
     disseminating information and materials available on specific 
     diseases affecting these populations and programs and 
     activities to address these disparities. The campaign shall--
       (1) have a specific focus on minority and other underserved 
     communities with health disparities; and
       (2) include an evaluation component to assess the impact of 
     the national campaign in raising awareness of health 
     disparities and information on available resources.
       (b) Dissemination of Information on Health Disparities.--
     The Secretary shall develop and implement a plan for the 
     dissemination of information and findings with respect to 
     health disparities under titles I, II, III, and IV of this 
     Act. The plan shall--
       (1) include the participation of all agencies of the 
     Department of Health and Human Services that are responsible 
     for serving populations included in the health disparities 
     research; and
       (2) have agency-specific strategies for disseminating 
     relevant findings and information on health disparities and 
     improving health care services to affected communities.

                   TITLE VI--MISCELLANEOUS PROVISIONS

     SEC. 601. DEPARTMENTAL DEFINITION REGARDING MINORITY 
                   INDIVIDUALS.

       Section 1707(g)(1) of the Public Health Service Act (42 
     U.S.C. 300u-6) is amended--
       (1) by striking ``Asian Americans and'' and inserting 
     ``Asian Americans;''; and
       (2) by inserting ``Native Hawaiians and other'' before 
     ``Pacific Islanders;''.

     SEC. 602. CONFORMING PROVISION REGARDING DEFINITIONS.

       For purposes of this Act, the term ``racial and ethnic 
     minority group'' has the meaning given such term in section 
     1707 of the Public Health Service Act.

     SEC. 603. EFFECTIVE DATE.

       This Act and the amendments made by this Act take effect 
     October 1, 2000, or upon the date of the enactment of this 
     Act, whichever occurs later.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Georgia (Mr. Norwood) and the gentleman from Ohio (Mr. Strickland) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Georgia (Mr. Norwood).


                             General Leave

  Mr. NORWOOD. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks on S. 1880.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  Mr. NORWOOD. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, whether we care to admit it or not, there are 
disparities in health care in America today. In the minority health 
community, there are clearly significant disparities in health 
outcomes.

                              {time}  2115

  In the African-American community, the Asian-American community, and 
the Hispanic-American community, there are disproportionate incidences 
of cardiovascular disease and certain forms of cancer. This also holds 
true for certain nonminority, low-income, rural communities as well.
  Mr. Speaker, the two questions we must have the courage and the 
determination to answer are why, and what can be done about it? It 
takes courage because the admission of the problem moves us all out of 
our comfort zone, in which we are all too content to just let racial 
and ethnic and class disparities improve on their own and work 
themselves out over time.
  It takes determination, because there is no easy answer. In fact, 
many health care experts sharply disagree on all the underlying causes 
of health disparities.
  Mr. Speaker, all of this takes determination, because there is no 
easy answer. In fact, many health care experts sharply disagree on all 
the underlying causes of health disparities. Many point to the role of 
continued income disparities, others to discrimination in diagnosis and 
prescribed treatments. Some point out a lack of training in our medical 
schools concerning racial, gender and ethnic differences in symptoms 
presented by patients when seeking treatment.
  All of these points make for good debate, but they in no way justify 
doing nothing while patients lives are on the line. There are solutions 
that can be identified right now as providing relief, and the Health 
Care Fairness Act is one of those remedies.
  For this reason, I am proud to cosponsor very similar legislation in 
this body with the gentleman from Georgia (Mr. Lewis) and the gentleman 
from Oklahoma (Mr.  Watts), my good friend, and the gentleman from 
Kentucky (Mr. Whitfield).
  This bill creates a Center for Health Disparities at the National 
Institutes of Health, provides increased funding and incentives for 
minority health and health disparities research and new support for 
educating both our health professionals and patients on common sense 
approaches to increasing the number of positive health outcomes for 
minorities and other health disparity patients.
  Mr. Speaker, I want to draw particular attention to the bill's 
emphasis on education. The bill will provide access to critical funding 
for those schools that are researching health disparities and educating 
the health professionals that will bring treatment to minority and 
health disparity communities. We can wait to do anything unless we 
address each cause or we can move immediately to repair those things 
that we can.
  Mr. Speaker, since we are dealing with the life and health of 
Americans, we have no choice but the latter, and I urge all of my 
colleagues to support this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STRICKLAND. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, I am very pleased that the House is considering the 
Minority Health and Health Disparities Research and Education Act this 
evening. This is legislation that will improve the health status of 
many Americans who suffer the inequity of health disparities. I think 
the need for this bill is demonstrated by the tragic fact that 
minorities in America lag behind other Americans in nearly every health 
indicator, including health care coverage, access to care, life 
expectancy and disease rates.
  Minorities suffer disproportionately from cancer, cardiovascular 
disease, HIV and AIDS and diabetes. Some of these disparities in health 
status are linked to problems of access to care and low levels of 
health care coverage.
  These characteristics also describe my Appalachian constituents from 
rural Ohio, even though my district

[[Page 25748]]

has very few minorities. Not surprisingly, my constituents suffer from 
some of the same disparities in disease and mortality rates, 
particularly for cancer and diabetes.
  S. 1880 is the result of months of bipartisan, bicameral work to 
craft solutions to this complex problem. The bill will create a Center 
for Research on Minority Health and Health Disparities at the National 
Institutes of Health, where research into the causes of and solutions 
to this health crisis will be prompted. It will also create 
opportunities for researchers who are members of health disparity 
populations.
  Mr. Speaker, I would like to thank several Members for their hard 
work on this piece of legislation, the gentleman from Georgia (Mr. 
Lewis); the gentleman from Illinois (Mr. Jackson); the gentleman from 
Mississippi (Mr. Thompson); the gentleman from New York (Mr. Towns); 
the gentlewoman from the Virgin Islands (Mrs.  Christensen); and the 
gentleman from Michigan (Mr.  Dingell), the ranking member. And I would 
especially like to thank the sponsors of this bill for their 
willingness to work with me and the gentleman from Kentucky (Mr. 
Whitfield) to include our constituencies in this important bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. NORWOOD. Mr. Speaker, I reserve the balance of my time.
  Mr. STRICKLAND. Mr. Speaker, I yield 3 minutes to the gentleman from 
Georgia (Mr. Lewis), the primary sponsor of this bill.
  Mr. LEWIS of Georgia. Mr. Speaker, I want to thank the gentleman from 
Ohio (Mr. Strickland), my good friend, for yielding me the time and for 
all of his help. I also want to thank the gentleman from Georgia (Mr. 
Norwood), my colleague and my friend, for all of his help to bring this 
bill before us tonight.
  Mr. Speaker, I, along with the gentleman from Oklahoma (Mr. Watts), 
the gentleman from Mississippi (Mr. Thompson), the gentleman from 
Georgia (Mr. Norwood) and the gentleman from Illinois (Mr. Jackson) 
introduced H.R. 3250, the House companion bill to S. 1880.
  H.R. 3250 passed out of the Committee on Commerce on July the 26.
  As one of the original authors of H.R. 3250, I want to take this 
opportunity to thank my colleagues tonight on both sides of the aisle 
for their dedication and hard work to pass H.R. 3250 and S. 1880.
  Over the past few decades, we have made great advances as a Nation in 
science and medicine. However, all of our citizens have not shared in 
the benefits of these advances. Minority Americans lag behind the rest 
of the country on nearly every health indicator, including health care 
coverage, access to care, life expectancy and disease rates.
  Some striking examples include the African-American infant mortality 
rate, which is twice that all of U.S. infants; and nearly twice as many 
Hispanic adults report they do not have a regular doctor compared to 
white adults. However, health disparities are not limited to minority 
communities. Nearly 20 million white Americans live below the poverty 
line and many live in rural areas where high rates of poverty 
contribute to health disparity outcomes.
  In the Appalachian regions of Kentucky, Tennessee and West Virginia, 
the rates of the five top causes of death in the United States all 
exceeded the national average in 1997. Mr. Speaker, we have a moral 
obligation, a duty and responsibility to find effective ways to 
eliminate these health disparities. Equal access to health care is not 
a privilege, it is a fundamental right. That is why S. 1880 is a good 
bill.
  This legislation will take the necessary step to bridge the health 
disparity gap. The Minority Health and Health Disparities Research and 
Education Act is a comprehensive approach to addressing the complex set 
of factors which surround health disparity.
  Mr. Speaker, let me close by saying the last century saw our Nation 
make great strides. We passed laws to address that right, like equal 
opportunity in employment, education and housing. We also passed the 
Voting Rights Act of 1965 and the Civil Rights Act of 1964. However, 
until now, our country has not given health care the same attention.
  We must focus our attention on bridging the health disparity gap.
  Mr. Speaker, I urge all of my colleagues to vote to pass S. 1880, the 
Minority Health and Health Disparities Research and Education Act.
  Mr. NORWOOD. Mr. Speaker, I reserve the balance of my time.
  Mr. STRICKLAND. Mr. Speaker, I yield 3 minutes to the gentleman from 
Illinois (Mr. Rush), a member of the Committee on Commerce.
  Mr. RUSH. Mr. Speaker, I want to, first of all, commend the gentleman 
from Georgia (Mr. Lewis) and the gentleman from Georgia (Mr. Norwood), 
the gentleman from Ohio (Mr. Strickland), the gentleman from 
Mississippi (Mr. Thompson), and the gentleman from Oklahoma (Mr. Watts) 
for their outstanding work on this bill.
  It is with great pride that I support S. 1880, the Minority Health 
and Health Disparities Research and Education Act of 2000.
  The disparities in health care as they relate to ethnic minorities is 
alarming. Consider these statistics, the infant mortality rate among 
African Americans is still more than double that of white citizens.
  African-American children are significantly more likely than whites 
to experience childhood asthma.
  Heart disease death rates are more than 40 percent higher for African 
Americans than for whites.
  For prostate cancer, it is more than double the rates for whites.
  African-American women have a higher death rate from breast cancer, 
despite having mammography screening rates that is higher than for 
white women.
  The death rate from HIV/AIDS for African Americans is more than 7 
times that for whites. The rate for homicide is 6 times that for 
whites. The suicide right among young African-American men has doubled 
since 1980.
  Many whites living in medically underserved areas suffer from the 
same health care access problems as do members of minority groups. In 
rural Appalachia, 46 percent of counties are designated as health 
professions shortage areas and high rates of poverty contribute to 
health disparity outcomes.
  White Appalachian males between the ages of 35 and 46 are 19 percent 
more likely to die of health disease than their counterparts elsewhere 
in the country, and white Appalachian women are 20 percent more likely 
to die of heart disease.
  Mr. Speaker, this bill addresses this critical problem, and we do 
need to do more to correct these alarming disparities, and the creation 
of the Center for Research on Minority Health and Health Disparities 
within the National Institutes of Health is an excellent step forward.
  Mr. STRICKLAND. Mr. Speaker, I yield 3 minutes to the gentleman from 
Illinois (Mr. Jackson).
  Mr. JACKSON of Illinois. Mr. Speaker, I rise in strong support of S. 
1880, the Minority Health and Health Disparities Research and Education 
Act. This bipartisan legislation holds great promise for reducing the 
health status gap between our Nation's majority populations and our 
ethnic minority and medically underserved communities, helping to 
ensure that no American is left behind.
  Mr. Speaker, the bill's most central feature, section 1, which was 
H.R. 2391, which I proposed a year and a half ago, elevates the Office 
of Research on Minority Health at the National Institutes of Health to 
``Center'' status and puts these health disparities on the exact same 
parity that exists with other prioritized health disparity issues at 
the National Institutes of Health.
  Despite the national economic prosperity and double digit growth for 
NIH, the health status gap amongst African Americans and other 
underserved populations is getting worse and not better.
  As a member of the Subcommittee on Labor, Health and Human Services 
and Education, I had the opportunity during our hearings to carefully 
review

[[Page 25749]]

the program activities and priorities of the NIH and to question the 
researchers who carry out such vital work.
  The unsung hero of today's legislation, who is not a Member of 
Congress, but certainly the former Secretary of Health and Human 
Services, Dr. Louis Sullivan was before the Subcommittee on 
Appropriations in the Senate, and Dr. Sullivan shared with me testimony 
that he had recently presented to that Subcommittee on the Institute of 
Medicine study that demonstrated a disturbingly low level of support 
that is funding support for cancer research among minorities through 
the National Cancer Institute. To improve the response to minority 
health, Dr. Sullivan recommended that the Office of Research of 
Minority Health should be elevated to ``Center'' status because the 
existing structure at NIH did not adequately address or prioritize the 
issue of health disparities.
  After asking scores of questions to the NIH director and the 
directors of the Institutes and Centers during the last year's hearings 
about these disparities, I became more convinced than ever that the 
Office of Research and Minority Health needed to be elevated to 
``Center'' status.

                              {time}  2130

  Consequently, I worked with Dr. Sullivan and other health care 
professionals to fashion a bill that would do just that. And so, Mr. 
Speaker, today S. 1880, among other vital provisions of the bill, 
authorizes the director of the National Center, in collaboration with 
other NIH institutes and centers, to establish a comprehensive plan and 
budget for the conduct and support of all minority health and other 
health disparities research at NIH.
  Mr. Speaker, as I said earlier, passage of this bill is an important 
first step, and I would like to thank all of my colleagues on both 
sides of the aisle who played an important leadership role, including 
Senators Kennedy and Frist, the gentleman from Georgia (Mr. Norwood), 
the gentleman from Oklahoma (Mr. Watts), the gentleman from Georgia 
(Mr. Lewis), the gentleman from Mississippi (Mr. Thompson), the 
gentleman from Virginia (Chairman Bliley), the unsung hero on the 
legislative side of this, the gentleman from Florida (Mr. Bilirakis), 
who walked this bill through a number of hurdles, the gentleman from 
Michigan (Mr. Dingell), and the gentleman from Ohio (Mr.  Brown).
  Mr. Speaker, I ask all of my colleagues to support this important 
measure.
  Mr. NORWOOD. Mr. Speaker, I yield such time as he might consume to 
the gentleman from Florida (Mr.  Bilirakis), chairman of the Commerce 
Subcommittee on Health and Environment.
  Mr. BILIRAKIS. Mr. Speaker, I thank the gentleman from Georgia (Mr. 
Norwood) for yielding me this time. Obviously, I support S. 1880, the 
Minority Health Disparities Research and Education Act of 2000.
  This proposal encompasses H.R. 3250, which is the Health Care Finance 
Act of 2000 which was reported from the Committee on Commerce. The 
gentleman from Illinois (Mr. Jackson) and so many others were so very 
much responsible for that.
  The bill addresses disparities in biomedical and behavioral research 
and health professional education for minority medically underserved 
Americans. There is ample evidence, Mr. Speaker, that some populations 
suffer disproportionately from certain diseases. For example, African 
Americans have a 70 percent higher rate of diabetes than whites. 
Hispanics suffer a rate that is nearly double the rate for whites. 
Vietnamese women suffer from cervical cancer five times the rate of 
white women.
  Mr. Speaker, we need to know why this is the case, and I hope this 
legislation will help. The proposal will create a new National Center 
on Minority Health and Health Disparities at NIH which will be charged 
with coordinating biomedical and behavioral health disparities 
research.
  The bill strengthens research into health care quality and access by 
funding studies at the Agency for Health Care Research and Quality. 
And, finally, the bill provides additional funds for loan repayment 
programs in the Health Resources and Services Administration for health 
professional training and education programs focusing in the causes and 
potential solutions to health disparities among Americans.
  S. 1880 includes some important changes to H.R. 3250 that improve the 
underlying bill. These changes reflect bipartisan efforts to address 
concerns expressed by Members of Congress and the administration. Chief 
among these is the recognition of health disparities in medically 
underserved populations as well as in racial and ethnic minorities.
  Additional changes were made to the bill to address concerns raised 
by the Department of Justice and some Members with potential 
constitutional problems with the bill as introduced. These are all 
positive changes that ensure Americans who suffer from disease and 
death disproportionately to the population at large benefit from the 
research and education provisions in this legislation.
  This is an important piece of legislation, Mr. Speaker, and I urge 
all of my colleagues to join us in a ``yes'' vote.
  Mr. STRICKLAND. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from the Virgin Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentleman from Ohio (Mr. 
Strickland) for yielding me this time. I also want to thank the 
gentleman from Georgia (Mr. Norwood) and the gentleman from Michigan 
(Mr. Dingell), the ranking member, for their leadership and work in 
getting S. 1880 to the floor today.
  Mr. Speaker, I also want to applaud the gentleman from Georgia (Mr. 
Lewis), the gentleman from Mississippi (Mr. Thompson), the gentleman 
from Illinois (Mr. Jackson), the gentleman from Oklahoma (Mr. Watts), 
and Senator Edward Kennedy who sponsored the bill in the other body for 
shepherding this bill through the entire process, as well as all of our 
staff. I thank the leadership in the committee and the House on both 
sides of the aisle.
  Mr. Speaker, health care disparities in people of color, those of low 
socio-economic status, and in our rural areas should cause us all 
concern in this country which boasts of the best in medical expertise 
and the most advanced medical technology. But they exist, and even as 
we turn the page into a new century, the gaps are not closing but 
getting wider.
  Heart disease, cancer, infant mortality, stroke, diabetes, HIV/AIDS 
and mental illnesses are among the diseases which represent the most 
glaring disparities.
  Surely, lack of insurance, deficiencies in the health delivery system 
and the lack of culturally and linguistically competent providers are 
some of the factors responsible. It has been proven that bias and 
prejudice has a significant role as well.
  But there remains much that we do not know, and without more in-depth 
knowledge we will never be able to develop the appropriate remedies. 
Therefore, S. 1880, though long overdue, comes at a critical time, but 
also at a time when this country has the resources and I think the will 
to right the wrongs, to close the gaps, and to bring fairness and 
equity to the system and access to quality health care for all of our 
citizens and residents.
  I am proud, Mr. Speaker, of the role that the Health Brain Trust of 
the Congressional Black Caucus played in this bill's development. I 
want to be proud of this body tomorrow, and so I ask all of my 
colleagues to vote ``yes'' for S. 1880, to vote ``yes'' to the research 
and related activities that will usher in a millennium of health and 
wellness for many who, until now, have been left behind, and to vote 
``yes'' to a healthy and a better America.
  Mr. STRICKLAND. Mr. Speaker, I yield 2 minutes to the gentleman from 
Mississippi (Mr. Thompson), who was an original cosponsor in the 
fashioning of this legislation.
  Mr. THOMPSON of Mississippi. Mr. Speaker, first let me compliment the 
gentleman from Georgia (Mr. Norwood), my colleague, for his leadership 
in helping shepherd this bill to the

[[Page 25750]]

floor this evening for consideration. I would also like to recognize 
the gentleman from Illinois (Mr. Jackson), the gentleman from Oklahoma 
(Mr. Watts), and the gentleman from Georgia (Mr. Lewis), who also 
cosponsored this legislation.
  Mr. Speaker, I am pleased to come before you in support of S. 1880, 
the Minority Health and Health Disparities Research and Education Act 
of 2000.
  Nearly 1 year ago, on November 8, 1999, I introduced H.R. 3250, a 
bill to amend the Public Health Service Act to improve the health of 
minority individuals. I thank Senator Edward Kennedy for introducing S. 
1880, and I am extremely proud to see this bill come to the floor for 
consideration.
  Mr. Speaker, the statistics are alarming when comparing the disparity 
between whites and minorities, alarming when we speak of infant 
mortality rates, alarming when we speak of heart disease death rates, 
alarming when we speak of prostate cancer and breast cancer, and most 
alarming of all, HIV/AIDS infection and death rates for African 
Americans.
  Mr. Speaker, I say for all of us now to come forward in a bipartisan 
manner and pass this bill and take the first step toward correcting 
these alarming disparities for African Americans and all other 
underserved communities. Let us have a quality health care system for 
everyone in the 21st century.
  Mr. STRICKLAND. Mr. Speaker, I yield 1 minute to the gentlewoman from 
North Carolina (Mrs. Clayton).
  Mrs. CLAYTON. Mr. Speaker, I thank the gentleman from Ohio for 
yielding me this time. I want to also commend the sponsors and also 
commend this House in a bipartisan way, recognizing this is an 
excellent opportunity to begin to close the gap between those who have 
access to quality health and those who indeed have not been considered 
in the research.
  I live in rural North Carolina, but I also live in an area called the 
``Stroke Belt.'' And the Stroke Belt indeed affects those persons who 
are African American perhaps a little more than it does other 
individuals. But if we begin to look at the Stroke Belt, it also 
includes white Americans in there. So there is a disparity related to 
poverty, isolation, and ruralness of the community.
  So I want to commend the sponsors of this, because it does, indeed, 
bring a more healthy America and allows the research to work with those 
entities and look at those disparities in ways that will reduce the 
incidence of disease and encourage prevention. I support this bill 100 
percent.

       The bill will be considered under suspension of the rules; 
     40 minutes of debate; not subject to amendment; two-thirds 
     majority vote required for passage. The measure will be 
     managed by Chairman Bliley, R-Va., or Rep. Bilirakis, R-Fla. 
     The Democratic manager will be Rep. Dingell, D-Mich., or Rep. 
     Brown, D-Ohio.
       The Senate passed the bill on Oct. 26 by unanimous consent. 
     The Commerce Committee did not act on the measure.
       Following is a summary of the bill as passed by the Senate. 
     As of press time, it was not known whether the floor manager 
     will move to suspend the rules and agree to the Senate-passed 
     bill, thereby clearing the measure for the president, or 
     whether he would include an amendment, thus sending the bill 
     back to the Senate.
       The Senate passed bill establishes a National Center on 
     Minority Health and Health Disparities in the National 
     Institutes of Health (NIH) to conduct and support research on 
     minority health conditions and disparities between the health 
     of the overall population and the health of minority groups. 
     The measure authorizes $100 million in FY 2001, and such sums 
     as may be necessary for fiscal years 2002 through 2005, for 
     these activities.
       The bill authorizes such sums as may be necessary in fiscal 
     years 2001 through 2005 for centers of excellence for 
     research and training, which would support training in 
     biomedical and behavioral research for members of minority 
     populations.
       The measure authorizes such sums as may be necessary in 
     each of fiscal years 2001 through 2005 for a program under 
     which the federal government would repay certain education 
     loans for individuals who agree to engage in minority health 
     disparity research. Under the bill, the federal government 
     would repay up to $35,000 of the principal and interest on 
     educational loans of such individuals for each year the 
     engage in such research.
       The bill also authorizes $50 million in FY 2001, and such 
     sums as may be necessary for each of fiscal years 2002 
     through 2005, for the Agency for Healthcare Research and 
     Quality to conduct and support research on health 
     disparities.
       This measure is an authorization measure and is not covered 
     by spending limitations in the Budget Act or any budget 
     resolution because it does not directly result in 
     expenditures. As of press time, the Congressional Budget 
     Office had not completed a cost estimate for the bill. In 
     many cases, however, Congress does not appropriate the full 
     amount contained in authorization measures.

  Mr. STRICKLAND. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, this is an excellent piece of 
legislation. I thank the gentleman from Ohio (Mr. Strickland), my good 
friend, for yielding me this time. I thank the gentleman from Georgia 
(Mr. Lewis), the gentlewoman from the Virgin Islands (Mrs. 
Christensen), the gentleman from Mississippi (Mr. Thompson), the 
gentleman from Illinois (Mr. Jackson), and the gentleman from Oklahoma 
(Mr. Watts) for their leadership, along with the gentleman from Georgia 
(Mr. Norwood) and the gentleman from Florida (Mr. Bilirakis) for their 
leadership as well.
  Mr. Speaker, if my colleagues would take a journey with me and 
realize how far we have come on a cure for breast cancer, and part of 
the effort behind that cure was utilizing women in clinicals in the 
National Institutes of Health. This Minority Health and Health 
Disparities Research and Education Act has the same focus; it is to 
concentrate on the enormous disparities that are found with minorities 
in the health care system. In particular, African Americans, Hispanics, 
Asian Americans, Pacific Islanders, Native Americans all have found 
themselves without access to health care, including rural white 
Americans as well.
  It is important that this legislation strengthens research into 
health care quality and access. It examines collection of data on race 
or ethnicity. It addresses the role of health professionals so that 
they will be culturally sensitive to be sure that they understand what 
is occurring. It is very important to educate our health care 
professionals so they can ask the kinds of sensitive questions to 
ensure that if they are speaking to a particular minority group, that 
they can secure from them the information that will allow the physician 
or the health care professional to treat them correctly.
  It is very important that we focus on diet and nutrition and 
immunization for children and find out whether there is an intimidation 
or some concern about why minorities do not have the access, why they 
are not interacting with our health care professionals.
  Mr. Speaker, let me just briefly, as I close, share a story, and I 
will certainly point to this as a cultural concerns of an elderly 
person going into a medical office of a doctor. Happened to be a 
minority, in particular African American. This person was accused of 
taking a bar of soap. Of course that would discourage a particular 
African American or minority, because of some cultural bias to go to 
that particular office again or go to any doctor.
  Mr. Speaker, I think this bill is a good bill to study what will help 
us ensure that all Americans have equal access to health care. This is 
a good bill, and I ask my colleagues to support it.
  Ms. PELOSI. Mr. Speaker, will the gentlewoman yield?
  Ms. JACKSON-LEE of Texas. I yield to the gentlewoman from California.
  Ms. PELOSI. Mr. Speaker, I wish to, in the course of this debate, 
associate myself with the comments of our colleagues who spoke in favor 
of that.
  I would first like to thank the gentleman from Georgia (Mr. Lewis) 
for his tremendous leadership in initiating this legislation, the 
gentleman from Illinois (Mr. Jackson), with whom I serve on the 
Subcommittee on Labor, Health and Human Services, and Education on the 
Committee on Appropriations, who has been a relentless supporter in 
ending the disparity and access to quality health care research and 
prevention, and the gentleman from Mississippi (Mr. Thompson), who has 
been a leader on this issue, as well as the gentlewoman from North 
Carolina (Mrs. Clayton).
  I thank them all for their tremendous work on this issue. They have

[[Page 25751]]

been great leaders in the effort to reduce health disparities, and this 
bill is a testament to their hard work and commitment.
  Mr. Speaker, numerous studies have shown that minority communities 
suffer disproportionately from many severe health problems and have 
higher mortality rates than whites for many treatable health 
conditions. Although we have seen giant leaps in scientific knowledge, 
particularly in recent years, as we have increased our investment in 
the National Institutes of Health, the benefits of those advances are 
not clearly reaching all segments of our society.
  At this point, I would like to recognize the tremendous work of the 
gentleman from Pennsylvania (Mr. Gekas). He and I are co-chairs of the 
Biomedical Research Caucus, but he is our leader in having monthly 
meetings where Members and staff can be made aware of the scientific 
opportunities in the biomedical community. He is a giant on that issue 
in this Congress.
  During our NIH hearings in the Subcommittee on Labor, Health and 
Human Services, and Education, we have heard many alarming statistics 
on racial and ethnic health disparities, including significantly higher 
rates of death from cancer and heart disease, as well as higher rates 
of HIV/AIDS, diabetes, and other health problems.
  HIV/AIDS has been particularly devastating in minority communities. 
African Americans and Hispanics, who represent 12 and 11 percent 
respectively of our Nation's population, now account for 70 percent of 
new HIV cases and nearly 60 percent of new AIDS cases. And African-
American and Hispanic women account for 78 percent of the newly 
reported infections among women.
  Not enough research is being done to understand and eliminate racial 
and ethnic health disparities. According to an Institute of Medicine 
study published in February 1999, Federal efforts to research cancer in 
minority communities are insufficient. The IOM recommended an increase 
in resources in development of a strategic plan to coordinate this 
research.
  I commend the administration for responding to this need by 
implementing the initiative to eliminate racial and ethnic disparities 
in health. The initiative identifies the steps necessary to eliminate 
disparities in the areas of cardiovascular disease, cancer screening 
and management, diabetes, infant mortality, HIV/AIDS and immunizations 
by 2010.
  At this point, I would also like to commend the gentlewoman from 
California (Ms. Waters) for her relentless efforts ongoing but 
especially when she was Chair of the Congressional Black Caucus in 
getting the minority initiative passed and funded. It made a drastic 
difference, but it is still not enough.
  Fulfilling the goals of this initiative must be a top priority. Next 
decade, however, these goals cannot be met without a comprehensive 
effort to improve research on the health of my minority communities and 
develop the interventions capable of reducing these disparities.
  The Center for Minority Health and Health Disparities created by the 
Minority Health and Health Disparities Research and Education Act and 
the full grant-making authority conferred upon it is an important step 
toward this effort. And while I am pleased that this critical issue is 
finally gaining the attention it deserves and again commend the 
gentleman from Georgia (Mr. Lewis) for his leadership, the next step 
forward must be full institute status. This creates a center. It does 
have full grant-making authority, and that is an important distinction. 
Usually an institute gives full grant-making. But I do not know why we 
cannot make this a full institute at the National Institutes of Health.
  It is imperative that, as we continue to increase NIH funding, we 
provide this ongoing issue the permanent attention necessary to 
eliminate current health disparities and prevent future health 
disparities from emerging.
  All Americans deserve a healthy future. I urge my colleagues to vote 
yes on the Minority Health and Health Disparities Research and 
Education Act.
  Mr. STRICKLAND. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, have no other speakers. I would just like to close by 
thanking the gentleman from Georgia (Mr. Norwood) for his wonderful 
leadership in this House on health matters. I also thank the gentleman 
from Georgia (Mr. Lewis) and all those who have had a part in the 
fashioning and the passage of this wonderful piece of legislation.
  Mr. Speaker, I yield back the balance of my time.
  Mr. NORWOOD. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to take just a minute to close this up and thank 
really everybody that has been involved with this over the past 6 
months. I am sorry the gentleman from Oklahoma (Mr. Watts), my good 
friend, is not here. He has worked very hard and worked with me long to 
help us get to this point. He has done things way upstairs back there 
that the rest of us could not do, and I am grateful to him.
  This bill is, in my view, pretty meaningful. It has some very 
interesting prospects for America, one of which is the research. The 
biomedical research that we are talking about under the auspices of NIH 
is going to reveal to us, I believe, some anomalies in health care and 
in medicine that we are not aware of today. At least I hope that is 
where the research takes us.
  Second, and maybe we had not talked about it as much and it is 
equally important to me, is the education factor of this bill. I 
readily admit to anyone who asked, very selfishly I hope a lot of this 
goes to Morehouse Medical School. I hope they do a lot of the education 
and the research right there. And to continue to be selfish, it is for 
a very simple reason. The graduates, the doctors, health care 
professionals that they put out are the people that go into my counties 
and my communities and treat rural Georgia. That is what I am after 
here as much as anything else.
  So I thank all that have been involved. And I know that we will all 
follow this, the research and the education aspects of it, very 
carefully over the coming years and hope and pray that this does what 
we all intend for it to do.
  Mr. ENGEL. Mr. Speaker, I want to commend the authors of this 
legislation and express my strong support for this bill. Historically, 
minorities have been under-represented in health research.
  It is my hope that establishing a National Center for Research on 
Minority Health and Health Disparities at the National Institutes of 
Health will provide the means necessary to meet the health challenges 
many minorities face. With the unique health problems affecting 
different racial and ethnic communities, it is essential that this 
National Center be established to research and develop treatments and 
cures for afflictions that are more prevalent in minorities.
  One of my concerns throughout my tenure in Congress has been the 
effects of smog and pollution that inner-city residents are exposed to 
on a daily basis. Within inner-cities, minorities comprise a large 
portion of the population. I have been a strong advocate on behalf of 
inner-city communities, including my own district, that have been 
unfairly burdened by environmental hazards.
  I included an amendment in the House version of this bill which 
simply stated that the Administrator of Health Care Policy, within the 
National Center for Research on Minority Health and Health Disparities, 
take into account environmental factors when researching the cause of 
health disparities for minority populations. While the Senate version 
of the bill that we are considering today does not include the exact 
language of my amendment, it does accomplish the goal I intended to 
address.
  The legislation clearly states that when researching barriers many 
minorities face in obtaining proper health care, the Administrator of 
Health Care Policy is specifically directed to take into account the 
socioeconomic status, attitudes toward health, the language spoken, the 
extent of formal education, the area or community in which the 
population resides, and other factors the Director determines to be 
appropriate. It is my hope that by identifying health problems caused 
by environmental factors, we can begin to address the issue and enhance 
the quality of life for our urban residents.

[[Page 25752]]

  Mr. Speaker, I want to reiterate my support for this bill, and I urge 
my colleagues to vote in favor of this important legislation.
  Mr. TOWNS. Mr. Speaker, I rise in support of the Health Care Fairness 
Act. As a senior member of the Commerce Committee's Subcommittee on 
Health and Environment, I have long been concerned about the pervasive 
inequality of health services endured by America's minority 
populations.
  At a recent hearing before my subcommittee, we confronted the 
compelling evidence that race and ethnicity correlate with persistent, 
and often increasing, health disparities among U.S. populations. 
Despite notable progress in the overall health of the nation, there are 
continuing disparities in the burden of illness and death experienced 
by African Americans, Hispanics, and others compared to the U.S. 
population as a whole. In fact, current information about the biologic 
and genetic characteristics of racial and ethnic groups does not 
explain the health disparities experienced by these groups compared 
with the white, non-Hispanic population. Given the demographic 
projections for the U.S. population in 2030, I believe that it is 
imperative that Congress establishes a forward-looking strategy to 
address health disparities in minority communities.
  For example, research shows that the AIDS epidemic is 
disproportionately affecting minorities. According to the Centers for 
Disease Control, African Americans, who comprise 13 percent of the U.S. 
population, account for 49 percent of AIDS deaths in 1998. In March 
2000, an audit conducted by the U.S. General Accounting Office assessed 
how government funding on AIDS programs was spent. The audit concluded 
that African Americans and Hispanics were receiving substandard care 
relative to whites in areas such as doctor visits, emergency room care, 
hospitalizations, and drug therapies.
  In order to identify and rectify health disparities that occur among 
minorities, I agreed to cosponsor H.R. 3250, the House companion to S. 
1880, the Health Care Fairness Act. Among other things, this 
legislation would create a new National Center for Research on Minority 
Health and Health Disparities. This center would support basic and 
clinical research, training and the dissemination of information with 
respect to minority health.
  I believe the new National Center will enable us to make real 
progress toward eliminating the daunting gap in health status between 
minorities and the rest of America, and I encourage my colleagues to 
support its passage.
  Mr. CUMMINGS. Mr. Speaker, I rise this evening in support of The 
Minority Health and Health Disparities Research and Education Act.
  During his radio address on February 21st, 1998, President Clinton 
committed the Nation to an ambitious goal by the year 2010:

       To eliminate the disparities in six areas of health status 
     experienced by racial and ethnic minority populations while 
     continuing the progress we have made in improving the overall 
     health of the American people.

  Achieveing the President's vision will require a major national 
commitment to identify and address the underlying causes of higher 
levels of disease and disability in racial and ethnic minority 
communities.
  Contrary to what some may say, this legislation is not a ``quota'' 
bill.
  This legislation that opens the door of fairness and equality for a 
healthy nation.
  Eliminating racial and ethnic disparities in health will require 
enhanced efforts at preventing disease, promoting health, and 
delivering appropriate care.
  This will necessitate improved collection and use of standardized 
data to correctly identify all high risk populations and monitor the 
effectiveness of health interventions targeting these groups.
  Research dedicated to a better understanding of the relationships 
between health status and different racial and ethnic minority 
backgrounds will help us acquire new insights into eliminating the 
disparities and developing new ways to apply our existing knowledge 
toward this goal.
  Improving access to quality health care and the delivery of 
preventive and treatment services will require working more closely 
with communities to identify culturally-sensitive implementation 
strategies.
  At my request, the Committee on Government Reform held a 
Congressional hearing entitled, ``Ethnic Minority Disparities in Cancer 
Treatment: Why the Unequal Burden?''
  The hearing gave us the opportunity to engage in a more exhaustive 
investigation of the disparity issue as it related to ``conventional'' 
treatments for cancer.
  I requested this hearing in response to a study published by the New 
England Journal of Medicine in October 1999, which reported that 
African American patients with early stage lung cancer are less likely 
than whites to undergo life-saving surgery, and as a result are more 
likely to die of their disease.
  The treatment disparities revealed in the study were of great concern 
to me, particularly when considered along with other data regarding 
cancer incidence and mortality rates among minorities as compared to 
the majority population.
  In fact, disturbingly:
  The incidence rate for lung cancer in African American and Native 
Hawaiian men is higher than in white men; Hispanics suffer elevated 
rates of cervical and liver cancer; and Alaskan Native and African 
American women have the first and second highest all-cancer and lung 
cancer mortality rates among females;
  Cancer has also surpassed heart disease as the leading cause of death 
for Japanese, Korean, and Vietnamese populations;
  Further, while surgery is the treatment option for lung cancer in its 
early stages, only 64 percent of African Americans had surgery at this 
stage, as compared to 76.7 percent of white Americans; and
  Paralleling recommended treatment options, cancer death rates among 
African Americans are about 35 percent higher than that for whites, and 
in my district of Baltimore City, 251 African Americans per every 
100,000 die of cancer as compared to 194 of whites.
  Our Nation is in a ``race for the cure.'' However, we must be mindful 
that this race for a healthy America must be run by and for all 
Americans. The entry into this contest should not be dependent on your 
race, but must be based on your humanity. And winning the race for a 
quality, healthy life must be a victory for every citizen, no matter 
their race, ethnicity, or socioeconomic status.
  As we move closer to crossing that victory line, we must all work 
toward a meaningful improvement in the lives of minorities who now 
suffer disproportionately from the burden of disease and disability.
  I will remain committed to the bioethical principles of justice and 
fairness which call for one standard of health in this country for all 
Americans, not an acceptable level of disease for minorities and 
another for the majority population.
  Mr. WATTS of Oklahoma. Mr. Speaker, I would like to begin by thanking 
my House colleagues John Lewis, Bennie Thompson, Charlie Norwood, and 
Jesse Jackson, Jr., who are champions in this important effort to 
address the issue of minority health disparities. This is a matter of 
deep concern to not only African-Americans, but also to Hispanic-
Americans, Native-Americans and other minorities who are clearly 
underserved by the American health care system.
  Despite continuing advances in research and medicine, disparities in 
American health care are a growing problem. This is evidenced by the 
fact that minority Americans lag behind in nearly every single measure 
of heath quality. Those measures include life expectancy, health care 
coverage, access to care, and disease rates. Ethnic minorities and 
individuals in medically underserved rural communities continue to 
suffer disproportionately from many diseases such as cancer, diabetes, 
and cardiovascular diseases. There have been numerous studies in 
scientific journals showing the severity of racial and ethnic 
disparities and the need for action in order to remedy this grave 
problem.
  For these and countless other reasons, it is time for the nation to 
focus on this problem and to work to bring fairness to our minority 
citizens in the nation's public and private health care systems. There 
is no better place to start this effort than the focal point for 
federal research, the renowned and highly respected National Institutes 
of Health.
  Since 1996, Congress has increased funding for basic medical research 
at NIH from $12 billion to over $18 billion--over a 50% increase. These 
funds support 50,000 scientists working at 2,000 institutions across 
the United States. I have been proud to support these increases, but I 
think it is now time that we target some portion of those funds on the 
nation's most acute health problems among our minority citizens--and I 
might add, minority taxpayers.
  Let me say that I am delighted to be a cosponsor of this legislation. 
Among other provisions, this legislation will elevate the existing 
office of Research on Minority Health at NIH to a National Center for 
Research on Minority Health. This upgrade to the level of National 
Center would in itself underscore the importance of this work, and 
along with expanded research and education, improved data systems and 
strengthened public awareness, we will be taking a great leap forward 
in addressing this critical national problem.
  The Minority Health and Health Disparities Research and Education Act 
will increase our

[[Page 25753]]

knowledge of the nature and causes of health disparities, improve the 
quality and outcomes of health care services for minority populations, 
and aid in bringing us closer to our mutual goal of closing the long-
standing gap in health care.
  I am deeply committed to this legislation, and I urge you to support 
my colleagues and me in our effort to rectify this inequality in health 
care.
  Mr. DINGELL. Mr. Speaker, I strongly support S. 1880, the Minority 
Health and Health Disparities Research and Education Act of 2000. I 
urge all of my colleagues to approve this much needed and long overdue 
legislation.
  We have before us a bill aimed at one of the most significant 
challenges in health care research and education. The existence of 
disparities in all aspects of health care is well documented. Reports 
published by the Institute of Medicine and in the New England Journal 
of Medicine and the Journal of the American Medical Association are 
just a few of many that point clearly to the need for quick enactment 
and implementation of the legislation that is before us today. The 
Commerce Committee's hearing on this subject highlighted the fact that 
there are massive differences in the frequency, severity, and 
survivability of many health conditions among different members of our 
diverse population. Unfortunately, where you live, what you earn, and 
the color of your skin make a big difference in health care quality and 
access.
  Great care has been taken in drafting this legislation so that it 
responds to the panoply of disparities issues without running afoul of 
the equal protection clause of the Constitution. Indeed, the Department 
of Justice has concluded that the bill does not trigger strict scrutiny 
under applicable tests for the validity of laws and programs aimed at 
addressing inequities that fall, in some cases, along racial and ethnic 
lines.
  Disparities occur for a variety of reasons, so it is not surprising 
that legislation aimed at identifying and eliminating disparities has 
several facets. First, S. 1880 addresses biomedical issues through the 
establishment of a National Center on Minority Health and Health 
Disparities at the National Institutes of Health. Next, this bill 
directs the Agency for Health Care Research and Quality to carry out 
activities to address disparities in health care quality and access. S. 
1880 also addresses quality and access issues through the Public Health 
Service Act's health professions programs.
  This legislation enjoys broad bipartisan support. I wish to take 
particular note of the fine work of my colleagues, Representatives 
Lewis, Jackson, Thompson, Towns, Strickland, Norwood, Watts, and 
Whitfield. I know that many other of my colleagues on both sides of the 
aisle contributed to the effort of getting this bill before us today 
and I am greatful to all of them. Our colleagues in the Senate, 
particularly Senators Kennedy and Frist, also made significant 
contributions to this bill.
  I urge my colleagues to join me in support of this bill.
  Mr. STARK. Mr. Speaker, one of America's most important assets is the 
diversity of our residents, and this diversity is growing rapidly. 
Between 1991 and 2000, the population of Asians and Pacific Islanders 
increased by 46 percent, Latinos by 40 percent, American Indians by 16 
percent, and African Americans by 14 percent.
  Unfortunately, vestiges of racism--both conscious and unconscious--
still exist, permeating our society and our institutions. Last month, I 
highlighted research findings that demonstrate people of color 
disproportionately lack access to health care, vital treatments, and 
preventive screening measures. In addition, a recent New England 
Journal of Medicine study found that unconscious perceptions and biases 
can be revealed in differential physician recommendations for minority 
individuals seeking heart disease treatment. Taken together, these 
findings underscore the urgency of supporting legislation to improve 
health care quality for diverse communities.
  So far, very little has been done to address these tremendous 
disparities. For example, people of color are disproportionately 
affected by certain types of cancers--Vietnamese American women are 
five times more likely to contract cervical cancer than white women and 
Africa Americans are 35 percent more likely to die from cancer than 
whites. Despite these alarming statistics, the Institute of Medicine 
concluded that federal funding for cancer research among communities of 
color remains insufficient.
  S. 1880, The Health Care Fairness Act is an opportunity to positively 
improve the health care of all Americans by working toward reducing 
these disparities. It is a bipartisan effort that contains many 
important provisions, including an increased commitment to research on 
health disparities, improved data systems, and enhanced quality of care 
for health disparity populations, including low-income, medically 
underserved, racial and ethnic minority, and rural individuals.
  This legislation ensures a prominent focus in our nation's premier 
research agencies--the National Institutes of Health and the Agency for 
Health Care Policy Research--in improving health outcomes for 
populations that have a significant disparity in the rate of disease 
incidence, prevalence, morbidity, mortality, or survival as compared to 
the general population. It also provides grants to our medical, public 
health, dental, nursing, and other health professional schools so that 
curricula to promote improved health care quality can be developed for 
these populations. Furthermore, it designates opportunities for 
training so that our current and future medical providers are equipped 
to join the fight against health disparities due to geography, the lack 
of medical services, race and ethnicity, and socioeconomic status.
  Our country has made phenomenal advancements in science and medicine. 
It is time to ensure that all of our communities share in these 
rewards. This is a chance to help ensure our health care system is 
just, equitable, and equal for all Americans. Support fairness in 
health care, and vote for S. 1880.
  Mr. NORWOOD. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Sununu). The question is on the motion 
offered by the gentleman from Georgia (Mr. Norwood) that the House 
suspend the rules and pass the Senate bill, S. 1880.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the Senate bill was passed.
  A motion to reconsider was laid on the table.

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