[Congressional Record (Bound Edition), Volume 146 (2000), Part 9]
[Senate]
[Pages 12156-12162]
[From the U.S. Government Publishing Office, www.gpo.gov]



THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
                 RELATED AGENCIES APPROPRIATIONS, 2001

  The PRESIDING OFFICER. Under the previous order, the Senate will now 
resume consideration of H.R. 4577, which the clerk will report.
  The legislative clerk read as follows:

       A bill (H.R. 4577) making appropriations for the 
     Departments of Labor, Health and Human Services, and 
     Education, and related agencies for the fiscal year ending 
     September 30, 2001, and for other purposes.
  Pending:

       McCain amendment No. 3610, to enhance protection of 
     children using the Internet.

  Mr. SPECTER. Mr. President, the Labor, Health and Human Services, and 
Education bill before the Senate today contains a program level of 
$104.5 billion, an increase of $7.9 billion or 8.2 percent over the 
fiscal year 2000 program level. This program level was achieved by 
savings in the following areas: The temporary assistance to needy 
families, supplemental security income, and the State children's health 
insurance programs. Further, savings were also achieved by advance 
funding an additional $2.3 billion of education dollars into fiscal 
year 2002, while keeping the same overall level of advances as last 
year. The actual budget authority in the bill is $97.35 billion, the 
full amount of the subcommittee's allocation under section 302(b) of 
the Budget Act.
  Given the subcommittee's allocation there were inadequate resources 
to sufficiently fund important health, education and training programs. 
Therefore savings needed to be found in order to expand these high 
priority discretionary programs. For example, savings were achieved by 
shifting $1.9 billion in unspent fiscal year 1998 State Children's 
Health Insurance Program (SCHIP) funds into fiscal year 2003. Currently 
38 States and the District of Columbia have not spent their SCHIP funds 
which are due to expire on September 30, 2000. By reappropriating 
funds, these 38 States and the District of Columbia will have an 
opportunity to spend these dollars in future years.
  The recommendations made in the bill both keeps faith with the budget 
agreement and addresses the health, education, employment and training 
priorities of the Senate.
  While consistent with the budget agreement, many tough choices had to 
be made. Senator Harkin and I received over 1,800 requests from Members 
for expanded funding for programs within the subcommittee's 
jurisdiction. In order to stay within the allocation and balance the 
priorities established in the budget agreement and expressed in Member 
requests, we had to take a critical look at all of the programs within 
the bill. I want to take this opportunity to thank the distinguished 
Senator from Iowa, Mr. Harkin, for his hard work and support in 
bringing this bill through the committee and on to the floor for full 
consideration by all Senators.
  The programs funded within the subcommittee's jurisdiction provide 
resources to improve the public health and strengthen biomedical 
research, assure a quality education for America's children, and offer 
opportunities for individuals seeking to improve job skills. I'd like 
to mention several important accomplishments of this bill.
  Nothing is more important than a persons health and few things are 
feared more than ill health. Medical research into understanding, 
preventing, and treating the disorders that afflict men and women in 
our society is the best means we have for protecting our health and 
combating disease.
  Since January of 2000, the Labor-HHS Subcommittee has held nine 
hearings on medical research issues.
  We have heard testimony from NIH Institute Directors, medical experts 
from across the United States, patients, family members, and advocates

[[Page 12157]]

asking for increased biomedical research funding to find the causes and 
cures for diseases Alzheimer's and Parkinson's disease, ALS, AIDS, 
cancer, diabetes, heart disease, and many other serious health 
disorders. We have also heard from advocates on both sides of the stem 
cell debate. The bill before the Senate contains $20.5 billion for the 
National Institutes of Health, the crown jewel of the Federal 
government. The $2.7 billion increase over the fiscal year 2000 
appropriation will support medical research that is being conducted at 
institutions throughout the country. This increase will continue the 
effort to double NIH by fiscal year 2003. These funds will be critical 
in catalyzing scientific discoveries that will lead to new treatments 
and cures for a whole host of diseases.
  Head Start: To enable all children to develop and function at their 
highest potential, the bill includes $6.2 billion for the Head Start 
program, an increase of $1 billion over last year's appropriation. This 
increase will provide services to an additional 60,000 children 
bringing the total amount of kids served in fiscal year 2001 to 
936,000. This increase will put us on track to enroll one million 
children in Head Start by the year 2002.
  Community health centers: To help provide primary health care 
services to the medically indigent and underserved populations in rural 
and urban areas, the bill contains $1.1 billion for community health 
centers. This amount represents an increase of $100 million over the 
fiscal year 2000 appropriation. These centers will provide health care 
to nearly 11 million low-income patients, 4.5 million of whom are 
uninsured.
  Youth Violence Initiative: The bill includes $1.2 billion for 
programs to assist communities in preventing youth violence. This 
initiative, begun in fiscal year 2000, will continue to address youth 
violence in a comprehensive way by coordinating programs throughout the 
Federal government to improve research, prevention, education and 
treatment strategies to identify and combat youth violence.
  Drug demand initiative: To curb the effects of drug abuse, the bill 
includes $3.7 billion for programs to help reduce the demand for drugs 
in this country. Funds have been increased for drug education in this 
Nation's schools; youth offender drug counseling, education and 
employment programs; and substance abuse research and prevention.
  Women's health: Again this year, the committee has placed a very high 
priority on women's health. The bill before the Senate provides $4.1 
billion for programs specifically addressing the health needs of women. 
Included in this amount is $27.4 million for the Public Health Service, 
Office of Women's Health, an increase of $6.1 million over last year's 
funding level to continue and expand programs to develop model health 
care services for women, provide monies for a comprehensive review of 
the impact of heart disease on women, and to launch an osteoporosis 
public education campaign aimed at teenagers. Also included is $253.9 
million for family planning programs; $169 million to support the 
programs that provide assistance to women who have been victims of 
abuse and to initiate and expand domestic violence prevention programs 
to begin; $149.9 million for sexually transmitted diseases; $177.5 
million for breast and cervical cancer screening; and $2.7 billion for 
research directed at women at the National Institutes of Health.
  Medical error reduction: The Labor-HHS Subcommittee held several 
hearings to explore the factors leading to medical errors and received 
testimony from family members and patients detailing their experiences 
with medical mistakes. The Institute of Medicine also gave testimony 
and outlined findings from their recent report which indicated that 
98,000 deaths occur each year because of medical errors. The bill 
before the Senate contains $50 million to determine ways to reduce 
medical errors and also recommends that guidelines be developed to 
collect data related to patient safety, best practices to reduce error 
rates and ways to improve provider training.
  LIHEAP: The bill maintains $1.1 billion for the Low Income Home 
Energy Assistance Program (LIHEAP). The bill also provides an 
additional $300 million in emergency appropriations. LIHEAP is a key 
program for low income families in Pennsylvania and cold weather states 
throughout the nation. Funding supports grants to states to deliver 
critical assistance to low income households to help meet higher energy 
costs.
  Aging programs; For programs serving the elderly, the bill before the 
Senate recommends $2.4 billion, an increase of $133 million over the 
fiscal year 2000 appropriation. Included is: $440.2 million for the 
community service employment program which provides part-time 
employment opportunities for low-income elderly; $325.1 million for 
supportive services and senior centers; $521.4 million for congregate 
and home-delivered nutrition services; and $187.3 million for the 
National Senior Volunteer Corps. Also, the bill provides increased 
funds for research into the causes and cures of Alzheimer's disease and 
other aging related disorders; funds to continue geriatric education 
centers; and the Medicare insurance counseling program.
  AIDS: The bill includes $2.5 billion for AIDS research, prevention 
and services. Included in this amount is $1.6 billion for Ryan White 
programs, an increase of $55.4 million; $762.1 million for AIDS 
prevention programs at the Centers for Disease Control; $60 million for 
global and minority AIDS activities within the Public Health and Social 
Services Funds; and $85 million for benefit payments authorized by the 
Ricky Ray Hemophilia Trust Fund Act.
  Education: To enhance this Nation's investment in education, the bill 
before the Senate contains $40.2 billion in discretionary education 
funds, an increase of $4.6 billion over last year's funding level, and 
$100 million more than the President's budget request.
  Education for disadvantaged children: For programs to educate 
disadvantaged children, the bill recommends $8.9 billion, an increase 
of $177.8 million over last year's level. These funds will provide 
services to approximately 13 million school children. The bill also 
includes $185 million for the Even Start program, an increase of $35 
million over the 2000 appropriation. Even Start provides education 
services to low-income children and their families.
  Title VI block grant: For the Innovative education program strategies 
State grant program, the bill contains $3.1 billion, an increase of 
$2.7 billion over fiscal year 2000. Within this amount, $2.7 billion is 
to be used to assist local educational agencies, as part of their 
locally developed strategies, to improve academic achievement of 
students. Funds may be used to address the shortage of highly qualified 
teachers, reduce class size, particularly in the early grades, or for 
renovation and construction of school facilities. How the funds shall 
be spent is at the sole discretion of the local educational agency.
  Impact aid: For impact aid programs, the bill includes $1.030 
billion, an increase of $123.5 million over the 2000 appropriation. 
Included in the recommendation is: $50 million for payments for 
children with disabilities; $818 million for basic support payments, an 
increase of $80.8 million; $82 million for heavily impacted districts; 
$25 million for construction and $47 million for payments for Federal 
property.
  Bilingual education: The bill provides $443 million to assist in the 
education of immigrant and limited-English proficient students. This 
recommendation is an increase of $37 million over the 2000 
appropriation and will provide instructional services to approximately 
1.3 million children.
  Special education: One of the largest increases recommended in this 
bill is the $1.3 billion for special education programs. The $7.1 
billion provided will help local educational agencies meet the 
requirement that all children with disabilities have access to a free, 
appropriate public education, and all infants and toddlers with 
disabilities have access to early intervention services. These funds 
will serve an estimated 6.4 million children age 3-21, at

[[Page 12158]]

a cost of $984 per child. While also supporting 580,500 preschoolers at 
a cost of $672 per child.
  TRIO: To improve post-secondary education opportunities for low-
income first-generation college students, the committee recommendation 
provides $736.5 million for the TRIO program, a $91.5 million increase 
over the 2000 appropriation. These additional funds will assist in more 
intensive outreach and support services for low income youth.
  Student aid: For student aid programs, the bill provides $10.6 
billion, an increase of $1.3 billion over last year's amount. Pell 
grants, the cornerstone of student financial aid, have been increased 
by $350 for a maximum grant of $3,650. The supplemental educational 
opportunity grants program has also been increased by $70 million, the 
work study program was increased by $77 million and the Perkins loans 
programs is increased by $30 million.
  21st Century Community Learning Centers: For the 21st Century After 
School program, the bill provides $600 million, an increase of $146.6 
million over last year's level. This program supports rural and inner-
city public elementary and secondary schools that provide extended 
learning opportunities and offer recreational, health, and other social 
services programs. The bill also includes language to permit funds to 
be provided to community-based organizations.
  Job training: In this Nation, we know all too well that unemployment 
wastes valuable human talent and potential, and ultimately weakens our 
economy. The bill before us today provides $5.4 billion for job 
training programs, $16.7 million over the 2000 level. Also included is 
$652.4 million, an increase of $19.2 million for Job Corps operations; 
$950 million for Adult training; and $1.6 billion for retraining 
dislocated workers. Also includes is $20 million for a new program to 
upgrade worker skills. These funds will help improve job skills and 
readjustment services for disadvantaged youth and adults.
  Workplace safety: The bill provides $1.3 billion for worker 
protection programs, an increase of $90 million above the 2000 
appropriation. While progress has been made in this area, there are 
still far too many work-related injuries and illnesses. The funds 
provided will continue the programs that inspect business and industry, 
assist employers in weeding out occupational hazards and protect 
workers' pay and pensions.
  There are many other notable accomplishments in this bill, but for 
the sake of time, I mentioned just several of the key highlights, so 
that the Nation may grasp the scope and importance of this bill.
  In closing, Mr. President, I again want to thank Senator Harkin and 
his staff and the other Senators on the subcommittee for their 
cooperation in a very tough budget year.
  The PRESIDING OFFICER. Under the previous order, the Senator from 
Missouri, Mr. Bond, is recognized to call up an amendment regarding 
community health centers.
  Mr. BOND. Mr. President, there is another pending amendment; is that 
correct?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. BOND. I ask unanimous consent that the amendment be set aside.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                           Amendment No. 3602

   (Purpose: To increase funding for the consolidated health centers)

  Mr. BOND. Mr. President, amendment No. 3602 is at the desk. I ask 
that it be called up for immediate consideration.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The legislative clerk read as follows:

       The Senator from Missouri [Mr. Bond], for himself, Mr. 
     Hollings, Mr. Cochran, Mr. Daschle, Mr. Hutchinson, Mr. 
     Kennedy, Mr. DeWine, Mrs. Lincoln, Mr. Abraham, Mr. Akaka, 
     Mr. Ashcroft, Mr. Baucus, Mr. Bingaman, Mrs. Boxer, Mr. 
     Breaux, Mr. Bryan, Mr. Burns, Mr. Campbell, Mr. L. Chafee, 
     Mr. Cleland, Ms. Collins, Mr. Craig, Mr. Crapo, Mr. Dodd, Mr. 
     Dorgan, Mr. Durbin, Mr. Edwards, Mr. Enzi, Mr. Feingold, Mrs. 
     Feinstein, Mr. Frist, Mr. Grams, Mr. Inouye, Mr. Jeffords, 
     Mr. Johnson, Mr. Kerry, Mr. Kohl, Ms. Landrieu, Mr. Leahy, 
     Mr. Levin, Mr. Lugar, Mr. Murkowski, Mrs. Murray, Mr. Robb, 
     Mr. Rockefeller, Mr. Santorum, Mr. Smith of Oregon, Ms. 
     Snowe, Mr. Warner, Mr. Wellstone, Mr. Wyden, Mr. Schumer, Mr. 
     Lautenberg, Mr. Bayh, Mr. Grassley, Mr. Sarbanes, Mr. Roth, 
     Mr. Hatch, and Mr. Conrad, proposes an amendment numbered 
     3602.

  Mr. BOND. Mr. President, I ask unanimous consent that further reading 
of the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       On page 23, line 23, strike ``4,522,424,000'' and replace 
     with ``4,572,424,000''.
       On page 92, between lines 4 and 5, insert the following:
       Sec.   . Amounts made available under this Act for the 
     administrative and related expenses for departmental 
     management for the Department of Labor, the Department of 
     Health and Human Services, and the Department of Education 
     shall be reduced on a pro rata basis by $50,000,000.

  Mr. BOND. Mr. President, I rise to offer what I think is a very 
important amendment to increase the funding this bill provides for a 
vital piece of our Nation's health care system--our community health 
centers.
  This amendment, which I am very pleased to offer in conjunction with 
my colleague, Senator Hollings of South Carolina, who has been a long-
time supporter of community health centers--as was the late Senator 
from Rhode Island, the father of the distinguished occupant of the 
chair, who was a great champion of community health centers--along with 
a total of 58 cosponsors, would increase funding for community health 
centers by a total of $50 million for this coming year. That is a $50 
million increase over that which is already included. The offset we use 
to fund this health center increase is a reduction in the departmental 
management fund for the Departments of Labor, Health and Human 
Services, and Education.
  The managers of this bill, Senators Specter and Harkin, clearly had a 
very difficult task in crafting this bill. There is a lot of money in 
it, but there are even more demands and requests for good things that 
this bill does. And they have to compete for the funds that, although 
they are significant, are still limited.
  Despite the competing demands, the underlying bill has a $100 million 
increase for community health centers. I sincerely commend the chairman 
and the ranking member for their efforts to include this very needed 
increase in the funding for the CHCs. At the same time, I believe very 
strongly that adding an additional $50 million for health center 
funding is crucial to ensure that these vital health care providers 
have sufficient resources behind them to do everything they can to 
provide for the uninsured and medically underserved Americans.
  All of us who have talked about health care know that the lack of 
access to care is perhaps the largest single health care problem that 
faces our Nation today.
  Part of this problem is a lack of health insurance. About 44 million 
Americans are not covered by any type of health plan. But an equally 
serious part of the problem is that many people are simply unable to 
get access to a health care provider. Even if they have insurance, a 
young couple with a sick child is out of luck if they can't get in to 
see a pediatrician or other health care provider. In too many urban and 
rural communities around the country, there just are not enough doctors 
to go around.
  I urge my colleagues, if they have not done what I have done--and 
that is, to visit community health centers in their States--that they 
do so. You will be amazed and you will be very uplifted to see the work 
that is going on each and every day in these community health centers.
  Community health centers in a center city, in the poorest 
neighborhoods, are reaching out and helping everyone--from the very 
young to the teenage mother perhaps with a child, or a teenager who is 
expecting a child, to the very elderly, who have difficulty getting 
around.
  We see the same thing in rural areas, in some of the communities that 
are the hardest to access in our State. There are community health 
centers with dedicated physicians and nurses and health care 
professionals who are

[[Page 12159]]

there to answer the health care needs of people who would have no 
chance of getting service were it not for the health centers.
  These community health centers are truly the safety net of our health 
care system. For all of my colleagues, I trust they do know about these 
centers, but for other concerned citizens who may be watching, I 
suggest they find out about the community health centers in their area. 
What are they doing; are they serving people in need? I can tell my 
colleagues, based on the experience in my State, they are delivering 
the service to people who otherwise would not be served, were it not 
for these CHCs.
  We all know there are problems with access to health care. There are 
many good ideas on additional steps we need to take. Some people want 
nationalized health care. Other people want new tax credits, subsidized 
health insurance. Others want to expand governmental health programs. 
Some people want to enhance insurance pooling arrangements. All of 
these have been proposed in an effort to make sure people have the 
health coverage and can get the care they need. As different and as 
diverse and as creative as many of these ideas are, they all have one 
thing in common: They are not going to be passed into law this year. 
All these wonderful ideas are going to come together. They are going to 
clash. We will look at them and talk about them, and we are going to 
refine them and argue about them and go down different roads. They are 
not going to pass this year. The breadth of the disagreement over these 
policy issues and the political complications of an election year make 
it totally unlikely that Congress will bring any of these new ideas to 
reality.
  There is one thing we can still do this year, something we can pass 
into law that will make a big difference for many people who lack 
access to health care. What we can do is dramatically increase funding 
for community health centers and help them reach out to even more 
uninsured and underserved Americans.
  Just for the technical background, health centers are private not-
for-profit clinics that provide primary care, preventive health care 
services in thousands of medically underserved urban and rural 
communities around the country. Partially with the help of Federal 
grants, health care centers provide basic care for about 11 million 
people every year, 4 million of whom are uninsured. Health centers 
provide care for 7 million people who are minorities, 600,000 farm 
workers, close to 1 out of every 20 Americans, 1 out of every 12 rural 
residents, 1 out of every 6 low-income children, and 1 out of every 5 
babies born to low-income families.
  Despite this great work, there are millions of Americans who still 
cannot get access to health care. The demand for the type of care these 
centers provide simply exceeds the resources available. Today we can 
help change this. There are as many as 44 million who are not covered 
by a health plan. We are covering about 11 million. We need to do 
something to make sure we serve those additional people. We are 
building on a program that has proven itself to be effective.
  This is probably the best health care bargain we can get because 
these not-for-profit centers leverage the Federal dollars that go into 
them. They collect insurance from those who are insured. They can 
collect Medicare or Medicaid. They are a vehicle for providing the 
service. The average cost per patient served by a community health 
center in my State is something like $350 a year. That is how much it 
costs them because of the other reimbursements and because of the 
efficiencies and economies of scale. That is less than $1 a day. Not 
too many plans can provide so much bang for the buck, so much important 
delivery of health care service. This is probably the first priority of 
all the health care problems we are facing, and there are many. We can 
do something that will have a real impact on access to care and the 
uninsured. It is the best thing we can do to expand that safety net and 
pursue the search for better health care.
  There are a couple of key reasons why community health centers are so 
important. No. 1, these dollars build on an existing program that 
produces results. Unlike many other health care proposals that suggest 
radically new and untested ideas, health centers are known entities. 
They do an outstanding job. They are known, respected, and trusted in 
their communities.
  Numerous independent studies, in addition to the observations of 
those of us who have traveled around to visit them, confirm that 
community health centers provide high quality care in an efficient and 
cost-effective manner. Health centers truly target the health care 
access problem. By definition, health centers must be located in 
medically underserved communities, which means places where people have 
serious problems getting access to health care. So health centers 
attack the problem right at its source--in the communities where those 
people live. Health centers are relatively cheap. Health centers can 
provide primary and preventive care for one person for less than $1 a 
day, $350 a year. That has to be one of the best health care bargains 
around.
  This proposal is not a Government takeover of health care. 
Admittedly, this amendment calls for more Government spending, but 
unlike most other health care proposals, this funding would not go to 
create or expand a huge health care bureaucracy. This amendment would 
invest additional funds into private organizations which have 
consistently proven themselves to be efficient, high quality, cost-
effective health care providers.
  If this amendment succeeds, it will mean an overall increase in 
health center funding of $150 million. That level of increase will put 
us on a path to double health center funding over 5 years. As my 
colleagues know, this same goal, doubling funding over 5 years, is what 
we challenge ourselves to provide to the National Institutes of Health. 
Through these increased funds to health centers, we continue our 
support for the good work that goes on in health centers. As in NIH, we 
have increased funding for biomedical research that produces medical 
innovations and develops ways to save, improve, and prolong people's 
lives. I have supported those efforts. In fact, the underlying bill 
contains funding increases for NIH that will keep us on the track for 
doubling NIH funding over 5 years for this, the third straight year.
  But as we expand the envelope for what is possible in the world of 
health care, we must also ensure that more Americans have access to the 
most basic level of primary care services, including regular checkups, 
immunizations, and prenatal care. If we are not reaching some 
Americans, it doesn't matter how much we put into health care research. 
It doesn't matter how many innovations we come up with. It doesn't 
matter how many new drugs or new procedures or new techniques we 
develop. If they don't have access to the basic health care system, it 
is not going to help them at all.
  That is why I believe it is so important to set the same noble goal 
we have set for research, doubling funding over 5 years, and adopt it 
for community health centers as well. There is widespread bipartisan 
support for both this 5-year plan as well as for the first-year 
installment. Nineteen of my Senate colleagues cosponsored what I called 
the REACH initiative--a resolution calling on Congress to double health 
center funding over 5 years.
  This resolution has since been made part of the congressional budget 
resolution that establishes our tax and spending goals and priorities. 
Sixty-seven Senators joined in my initial request for the 1-year 
funding increase of $150 million. This amendment, which makes this 1-
year increase a reality, has 57 cosponsors.
  I am pleased to say that Gov. George W. Bush has publicly announced 
his support for funding increases for community health centers 
comparable to what this amendment would provide.
  I thank my colleagues who have joined in these efforts for their 
support. I urge all of my Senate colleagues to support this amendment. 
A dramatic increase in community health

[[Page 12160]]

center funding is one of the first and most important things Congress 
can do this year to truly help the uninsured and medically underserved 
Americans. Let us not waste the opportunity to make it happen.
  I express my thanks to the chairman and ranking member of the 
committee.
  The PRESIDING OFFICER (Mr. Gorton). The Senator from Pennsylvania is 
recognized.
  Mr. SPECTER. Mr. President, I compliment our distinguished colleague 
from Missouri for offering this amendment and for his steadfast support 
over the years. I compliment my distinguished colleague, Senator Bond, 
for his continued support for community health centers. This has been a 
matter he has taken a special interest in and he has organized enormous 
support, with a letter having 67 signatories, 58 cosponsors, and 
reflecting a very broad consensus as to the importance of this program.
  The program would add in the current fiscal year $1.187 billion for 
community health centers. The Appropriations Committee has increased 
funding by $100 million over fiscal year 2000. Senator Bond now wants 
an additional $50 million, with an offset from administrative expenses 
pro rata among the three Departments.
  We are prepared to accept Senator Bond's amendment. This is always a 
matter of finding enough money and adjusting the priorities. There is 
no one among the 100 Senators who knows that better than Senator Bond, 
because he chairs the Appropriations Subcommittee on VA, HUD, and 
Independent Agencies. I think his subcommittee and this subcommittee 
have the toughest job in funding matters. But we agree there ought to 
be more money in community health centers to serve people in both rural 
and urban areas who are disadvantaged and do not have access to primary 
health care.
  There is nothing more important than health, so we are going to 
accept the amendment. When we come to conference, we may have to modify 
the offset as to the administrative cost, but we will do our very best 
to maintain the funding in this important item.
  One other comment. I commented yesterday that the President had 
issued a veto threat after the subcommittee reported out a bill, and 
Senator Harkin had some words for the President, which I thought came 
better from the ranking member in the same party as the President. I 
made the point yesterday--and I think it is worth repeating today--
about the priorities established by Members of Congress. We have 
contacts that the President does not have. There are 535 of us who fan 
out across America. Most of the Senators have fanned out already today, 
going back to their States to assess local needs.
  The Constitution gives the Senate the authority for appropriations. 
Bills have to be signed by the President. But what Senator Bond has 
done is a good illustration of getting a broad consensus. That makes an 
impact upon the subcommittee when we look at our priorities. If 67 
Senators sign a letter and 58 sign on as cosponsors, you wonder what 
happened to the other 9 in the interim. That is a very strong showing, 
and we intend to make that point when we do our best to honor the full 
$150 million increase and as we move down to have an assessment of our 
priorities versus the President's priorities.
  Speaking for the majority, we are prepared to accept the amendment.
  Mr. BOND. Mr. President, I thank my distinguished friend from 
Pennsylvania, the chairman of the committee. If he really wants us to 
get the rest of the 67, we will be happy to go about it. But I found 
the chairman and the ranking member so responsive to my persuasive 
arguments that I didn't think they needed any more weight on this. I 
sincerely appreciate the willingness of the chairman to accept this.
  Mr. DeWINE. Mr. President, I rise today to express my support for 
increased funding for Community Health Centers. These health centers 
offer much-needed primary and preventative health care services to 
hundreds of medically underserved urban and rural communities across 
our country.
  Currently, the Labor, Health and Education Appropriations bill before 
us would provide $100 million in Budget Year 2001 for these health 
centers. The amendment I have cosponsored with Senator Bond and Senator 
Hollings would provide an additional $50 million, bringing the total 
investment to $150 million. This amendment, Mr. President, is very 
important. It deserves the Senate's support. There are millions of 
Americans who rely on Community Health Centers for their health care 
needs. We have an obligation to ensure that those necessary services 
are not interrupted due to a lack of sufficient federal funds.
  The value of the services provided by these health centers becomes 
quite apparent when you consider that right now there are at least 44 
million uninsured people in our nation; and of those 44 million people, 
Mr. President, 4 million of them receive health services from Community 
Health Centers. When you combine the uninsured with the under-insured, 
that total rises to 10 million--yes, Mr. President--10 million patients 
who look to these centers for health care.
  In my own home state of Ohio, the Third Street Community Clinic in 
Mansfield and the Neighborhood Family Practice in Cleveland, for 
example, are just two of the 69 Community Health Centers that serve 
more than 200,000 Ohioans each year. In just the first three months of 
this year, Ohio's Community Health Centers medically treated more than 
29,000 uninsured people, of whom more than 31 percent--nearly one-
third--were children under 18 years of age.
  These health centers provide critical health services to those who 
would otherwise not have access to health care providers. The centers 
offer prenatal care to uninsured or under-insured pregnant moms, and by 
doing so, are working to prevent undue adverse risks to the health of 
unborn babies. The health centers also provide immunizations so that 
young children can continue to be healthy, even those that live in 
medically underserved urban or rural areas.
  And, in practical terms, by providing these and other types of 
primary and preventive care, Community Health Centers save Medicare and 
Medicaid dollars, because these services significantly reduce the need 
for hospital stays and emergency room visits.
  The value of Community Health Centers should not be underestimated--
nor should they be underfunded. The challenge we face today is that we 
have to make sure funding keeps pace with the growing numbers of 
Americans who will be in need of the health care services provided by 
these centers. To keep pace with this rapid growth, the overall budget 
for Community Health Centers will need to increase from $1 billion to 
$2 billion by Fiscal Year 2005. This $1 billion increase would enable 
the health centers to provide care to an additional six to ten million 
people.
  Because of the pressing need to increase funding, I am also a 
cosponsor of Senator Bond's REACH Initiative, which is the ``Resolution 
to Expand Access to Community Health Care.'' This important Initiative 
would double the federal contribution for Community Health Centers over 
the next five years. And, the Bond/Hollings amendment to the Labor, 
Health, and Education Appropriations bill before us now would keep us 
on track of meeting this five-year plan by increasing this year's $100 
million allocation to $150 million.
  I commend my colleagues from Missouri and South Carolina for their 
amendment and for their tireless commitment to Community Health 
Centers. I urge the rest of my colleagues to support this important 
amendment.
  Mr. HOLLINGS. Mr. President, It has been over 30 years since I set 
off on my hunger tour of South Carolina, where I observed first-hand 
the shocking condition of health care and nutritional habits in rural 
parts of my state. The good news is, we have come a long way since 
then. The bad news is, there is still much work to be done. Like the 
``hunger myopia'' I described in my book The Case Against Hunger, we 
suffer today from a sort of ``health care myopia'', a condition in 
which a booming economy and low unemployment rates mask a reality--that 
many Americans eke out a living in society's margins,

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and most of them lack health insurance. Ironically, as the stock market 
soars, so do the numbers of uninsured in our country, at a rate of more 
than 100,000 each month; 53 million Americans are expected to be 
uninsured by 2007.
  The health care debate swirls around us, reaching fever pitch in 
Congress, where I have faith that we will soon reach an agreement on 
expanding coverage and other important issues. However, I see a need to 
immediately address the health care concerns of these left-behind and 
sometimes forgotten citizens. They cannot and should not have to wait 
for Congress to hammer out health care reform in order to receive the 
medical care so many of us take for granted. That's why I am 
sponsoring, along with Senator Bond, this amendment to provide an 
additional $50 million for health centers in this bill. Fifty-seven 
cosponsors have joined us in working toward our objective. I would like 
to thank subcommittee chairman Sen. Specter and ranking member Sen. 
Harkin for their advocacy on behalf of community health centers. I look 
forward to working with them as the bill moves to conference so that we 
may ensure health centers across the nation receive the support they 
deserve.
  While ideas about health care have changed dramatically, community 
health centers have remained steadfast in their mission, quietly 
serving their communities and doing a tremendous job. Last year, 
community health centers served 11 million Americans in decrepit inner-
city neighborhoods as well as remote rural areas, 4.5 million of which 
were uninsured. It's no wonder these centers have won across-the-board, 
bipartisan support. They have a proven track record of providing no-
nonsense, preventive and primary medical services at rock-bottom costs. 
They're the value retailers of the health care industry, if you will, 
treating a patient at a cost of less than $1.00 per day, or about $350 
annually.
  Let me emphasize that this measure is a cost-saving investment, not 
an increase in spending. Not only are these centers providing care at 
low costs, but they are saving precious health care dollars. An 
increased investment in health centers will mean fewer uninsured 
patients are forced to make costly emergency room visits to receive 
basic care and fewer will utilize hospitals' specialty and inpatient 
care resources. As a consequence, a major financial burden is lifted 
from traditional hospitals and government and private health plans. 
Every federal grant dollar invested in health centers saves $7 for 
Medicare, Medicaid and private insurance: $6 from lower use of 
specialty and inpatient care and $1 from reduced emergency room visits.
  The value of community health centers can be measured in two other 
significant ways. First of all, the centers' focus on wellness and 
prevention, services largely unavailable to uninsured people, will lead 
to savings in treatment down the road. And secondly, health centers 
foster growth and development in their communities, shoring up the very 
people they serve. They generate over $14 billion in annual economic 
activity in some of the nation's most economically-depressed areas, 
employing 50,000 people and training thousands of health professionals 
and volunteers.
  It should also be noted that community health centers are just that--
community-based. They are not cookie cutter programs spun from the 
federal government wheel, but area-specific, locally-managed centers 
tailored to the unique needs of a community. They are governed by 
consumer boards composed of patients who utilize the center's services, 
as well as local business, civic and community leaders. In fact, it is 
stipulated that center clients make up at least 51% of board 
membership. This set-up not only ensures accountability to the local 
community and taxpayers, but keeps a constant check on each center's 
effectiveness in addressing community needs.
  In South Carolina, community health centers have a long history of 
meeting the care requirements of the areas they serve. The Beaufort-
Jasper Comprehensive Health Center in Ridgeland, the Franklin C. Fetter 
Family Health Center in Charleston, and Family Health Centers, Inc. in 
Orangeburg were among the first community health centers established in 
the nation. The Beaufort-Jasper Center was very innovative for its day, 
in the late 1960s, tackling not only health care needs, but related 
needs for clean water, indoor toilets and other sanitary services. 
Today, the number of South Carolina health centers has grown to 15. 
They currently provide more than 167,000 people, 38% of which are 
uninsured, with a wide range of primary care services. Yet despite the 
success story, a need to throw a wider net is obvious. Of the 3.8 
million South Carolinians, nearly 600,000 have no form of health 
insurance. That means roughly 15% of the state population is uninsured. 
Another 600,000 residents are ``underinsured,'' meaning that they do 
not receive comprehensive health care coverage from their insurance 
plans and must pay out-of-pocket for a number of specialty services, 
procedures, tests and medications.
  South Carolina's statistics are mirrored nationwide. The swelling 
ranks of the uninsured are outgrowing our present network of community 
health centers. Adopting this amendment will ensure the reach of 
community health centers expands to meet increasing demand. It is our 
responsibility to continue providing our neediest citizens with a basic 
health care safety net. What better way to do that than by building on 
a program with a record of positive, fiscally responsible results? 
Everyone can benefit and take pride in such a worthwhile investment.
  Mr. KENNEDY. Mr. President, it is a privilege to be a sponsor of this 
important amendment to increase funding for community health centers. 
Each year, these centers provide quality health care to 11 million 
Americans in 3,000 rural and inner-city communities in all 50 states, 
including 4.5 million people who are uninsured. As the number of 
uninsured Americans across the country continues to grow, the need for 
the services is especially great.
  Community health centers recently touched Juan Ramon Centeno's life 
in Worcester, Massachusetts. Mr. Centeno was 54 years old when a 
bilingual nurse working with Great Brook Valley Health Center arrived 
at the public housing project where he lived to conduct health 
screenings. Mr. Centeno felt ill, but because he did not have insurance 
or resources for medical care, he had not sought care. The nurse found 
that his blood pressure was high, he had risk factors for diabetes, and 
had not received preventive health care for many years.
  Health center physicians promptly examined Mr. Centeno and found him 
at high risk for a cardiovascular accident. This timely intervention 
enabled Mr. Centeno to receive good health care and to be placed on 
medication through the health center pharmacy, which enables patients 
to obtain prescription drugs at the reduced prices available under 
Medicaid.
  Day in and day out, community health centers are providing life-
saving services like these. Yet too often, the centers are struggling 
to obtain the resources they need. In Massachusetts, over a dozen 
community health centers currently face severe financial difficulties. 
Congress cut Medicare reimbursement rates for the centers in 1997, in 
spite of the fact that the number of people eligible for their services 
continues to rise. The result for many health centers has been 
bankruptcy, low morale among the health care professionals who are 
dedicated to serving the poor, and great concern in the communities 
that this needed access to health care will be lost. It is unacceptable 
for Congress to permit health centers that have proved so effective for 
so many years to suffer such severe financial difficulties, 
particularly in this time of prosperity.
  The Senate made a wise commitment to double the funding over the next 
five years for medical research at the National Institutes of Health, 
and it has kept that commitment. By making a similar commitment to 
double the funding for community health centers--ten percent of the 
cost of the commitment we made to medical research--we can ensure that 
the benefits

[[Page 12162]]

of modern medicine will remain available to millions of low-income 
working families. The Senate is at its best when it approves amendments 
like this one on a bipartisan basis. I intend to do all I can to see 
that this year's final appropriations bill, and future appropriations 
bills, maintain our commitment to the extraordinary work of the 
nation's community health centers.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.
  Mr. HARKIN. Mr. President, this side has no objection to the 
amendment. In fact, we wholeheartedly support the amendment. I 
compliment the Senator from Missouri for his leadership, and I also 
compliment Senator Hollings on this issue.
  Community health centers are really the last sort of backstop for so 
many people in this country who don't have health insurance--44 million 
people in America don't have health insurance. Mainly, these are the 
ones who, right now, for their health needs really need the community 
health centers. We have about seven in our State of Iowa. We are 
opening another one this summer. About 66,000 people are served per 
year in the State of Iowa by our community health centers.
  The really good thing--and the Senator from Missouri knows it--about 
community health centers is they are engaged in preventive health care, 
keeping people healthy in the first place, not just coming in when they 
are sick. They do a lot of outreach work with low-income people. They 
help with their diets, lifestyles, and with the medicines they need to 
keep them healthy. That is one of the great services they provide.
  We increased the funding for community health centers over last year 
by $100 million. This would add another $50 million on to it. The need 
is actually even more than that, but as the Senator from Missouri 
knows, we have all these things we need to balance in the bill. This is 
a welcome addition to our community health centers.
  Again, I compliment the Senator from Missouri for his leadership. We 
happily accept the amendment.
  The PRESIDING OFFICER. Is there further debate on the amendment?
  The question is on agreeing to the amendment.
  The amendment (No. 3602) was agreed to.
  Mr. BOND. Mr. President, I move to reconsider the vote.
  Mr. HARKIN. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. HARKIN. Mr. President, I will soon suggest the absence of a 
quorum. I want Senators to know that we are open for business and for 
taking amendments. Senator Specter and I are willing to sit here and 
take amendments this morning. If Senators have amendments and they are 
around, please come. As you can see, the floor is wide open. You won't 
have a waiting line and you can speak for as long as you want. This is 
the time to come and offer amendments on this bill.
  With that, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. L. CHAFEE. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. L. CHAFEE. Mr. President, I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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