[Congressional Record (Bound Edition), Volume 150 (2004), Part 15]
[House]
[Pages 20795-20799]
[From the U.S. Government Publishing Office, www.gpo.gov]




 PATIENT NAVIGATOR OUTREACH AND CHRONIC DISEASE PREVENTION ACT OF 2004

  Mr. BARTON of Texas. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 918) to authorize the Health Resources and Services 
Administration, the National Cancer Institute, and the Indian Health 
Service to make grants for model programs to provide to individuals of 
health disparity populations prevention, early detection, treatment, 
and appropriate follow-up care services for cancer and chronic 
diseases, and to make grants regarding patient navigators to assist 
individuals of health disparity populations in receiving such services, 
as amended.
  The Clerk read as follows:

                                H.R. 918

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Patient Navigator Outreach 
     and Chronic Disease Prevention Act of 2004''.

     SEC. 2. PATIENT NAVIGATOR GRANTS.

       Subpart V of part D of title III of the Public Health 
     Service Act (42 U.S.C. 256) is amended by adding at the end 
     the following:

     ``SEC. 340A. PATIENT NAVIGATOR GRANTS.

       ``(a) Grants.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may make grants to eligible entities for the 
     development and operation of demonstration programs to 
     provide patient navigator services to improve health care 
     outcomes. The Secretary shall coordinate with, and ensure the 
     participation of, the Indian Health Service, the National 
     Cancer Institute, the Office of Rural Health Policy, and such 
     other offices and agencies as deemed appropriate by the 
     Secretary, regarding the design and evaluation of the 
     demonstration programs.
       ``(b) Use of Funds.--A condition on the receipt of a grant 
     under this section is that the grantee agree to use the grant 
     to recruit, assign, train, and employ patient navigators who 
     have direct knowledge of the communities they serve to 
     facilitate the care of individuals, including by performing 
     each of the following duties:
       ``(1) Acting as contacts, including by assisting in the 
     coordination of health care services and provider referrals, 
     for individuals who are seeking prevention or early detection 
     services for, or who following a screening or early detection 
     service are found to have a symptom, abnormal finding, or 
     diagnosis of, cancer or other chronic disease.
       ``(2) Facilitating the involvement of community 
     organizations providing assistance to individuals who are at 
     risk for or who have cancer or other chronic diseases to 
     receive better access to high-quality health care services 
     (such as by creating partnerships with patient advocacy 
     groups, charities, health care centers, community hospice 
     centers, other health care providers, or other organizations 
     in the targeted community).
       ``(3) Notifying individuals of clinical trials and 
     facilitating enrollment in these trials if requested and 
     eligible.
       ``(4) Anticipating, identifying, and helping patients to 
     overcome barriers within the health care system to ensure 
     prompt diagnostic and treatment resolution of an abnormal 
     finding of cancer or other chronic disease.
       ``(5) Coordinating with the relevant health insurance 
     ombudsman programs to provide information to individuals who 
     are at risk for or who have cancer or other chronic diseases 
     about health coverage, including private insurance, health 
     care savings accounts, and other publicly funded programs 
     (such as Medicare, Medicaid, and the State children's health 
     insurance program).
       ``(6) Conducting ongoing outreach to health disparity 
     populations, including the uninsured, rural populations, and 
     other medically underserved populations, in addition to 
     assisting other individuals who are at risk for or who have 
     cancer or other chronic diseases to seek preventative care.
       ``(c) Grant Period.--
       ``(1) In general.--Subject to paragraphs (2) and (3), the 
     Secretary may award grants under this section for periods of 
     not more than 3 years.
       ``(2) Extensions.--Subject to paragraph (3), the Secretary 
     may extend the period of a grant under this section, except 
     that--
       ``(A) each such extension shall be for a period of not more 
     than 1 year; and
       ``(B) the Secretary may make not more than 4 such 
     extensions with respect to any grant.
       ``(3) End of grant period.--In carrying out this section, 
     the Secretary may not authorize any grant period ending after 
     September 30, 2010.
       ``(d) Application.--
       ``(1) In general.--To seek a grant under this section, an 
     eligible entity shall submit an application to the Secretary 
     in such form, in such manner, and containing such information 
     as the Secretary may require.
       ``(2) Contents.--At a minimum, the Secretary shall require 
     each such application to outline how the eligible entity will 
     establish baseline

[[Page 20796]]

     measures and benchmarks that meet the Secretary's 
     requirements to evaluate program outcomes.
       ``(e) Uniform Baseline Measures.--The Secretary shall 
     establish uniform baseline measures in order to properly 
     evaluate the impact of the demonstration projects under this 
     section.
       ``(f) Preference.--In making grants under this section, the 
     Secretary shall give preference to eligible entities that 
     demonstrate in their applications plans to utilize patient 
     navigator services to overcome significant barriers in order 
     to improve health care outcomes in their respective 
     communities.
       ``(g) Coordination With Other Programs.--The Secretary 
     shall ensure coordination of the demonstration grant program 
     under this section with existing authorized programs in order 
     to facilitate access to high-quality health care services.
       ``(h) Study; Reports.--
       ``(1) Final report by secretary.--Not later than 6 months 
     after the completion of the demonstration grant program under 
     this section, the Secretary shall conduct a study of the 
     results of the program and submit to the Congress a report on 
     such results that includes the following:
       ``(A) An evaluation of the program outcomes, including--
       ``(i) quantitative analysis of baseline and benchmark 
     measures; and
       ``(ii) aggregate information about the patients served and 
     program activities.
       ``(B) Recommendations on whether patient navigator programs 
     could be used to improve patient outcomes in other public 
     health areas.
       ``(2) Interim reports by secretary.--The Secretary may 
     provide interim reports to the Congress on the demonstration 
     grant program under this section at such intervals as the 
     Secretary determines to be appropriate.
       ``(3) Interim reports by grantees.--The Secretary may 
     require grant recipients under this section to submit interim 
     reports on grant program outcomes.
       ``(i) Rule of Construction.--This section shall not be 
     construed to authorize funding for the delivery of health 
     care services (other than the patient navigator duties listed 
     in subsection (b)).
       ``(j) Definitions.--In this section:
       ``(1) The term `eligible entity' means a public or 
     nonprofit private health center (including a Federally 
     qualified health center (as that term is defined in section 
     1861(aa)(4) of the Social Security Act)), a health facility 
     operated by or pursuant to a contract with the Indian Health 
     Service, a hospital, a cancer center, a rural health clinic, 
     an academic health center, or a nonprofit entity that enters 
     into a partnership or coordinates referrals with such a 
     center, clinic, facility, or hospital to provide patient 
     navigator services.
       ``(2) The term `health disparity population' means a 
     population that, as determined by the Secretary, has a 
     significant disparity in the overall rate of disease 
     incidence, prevalence, morbidity, mortality, or survival 
     rates as compared to the health status of the general 
     population.
       ``(3) The term `patient navigator' means an individual who 
     has completed a training program approved by the Secretary to 
     perform the duties listed in subsection (b).
       ``(k) Authorization of Appropriations.--
       ``(1) In general.--To carry out this section, there are 
     authorized to be appropriated $2,000,000 for fiscal year 
     2006, $5,000,000 for fiscal year 2007, $8,000,000 for fiscal 
     year 2008, $6,500,000 for fiscal year 2009, and $3,500,000 
     for fiscal year 2010.
       ``(2) Availability.--The amounts appropriated pursuant to 
     paragraph (1) shall remain available for obligation through 
     the end of fiscal year 2010.''.

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


                             General Leave

  Mr. BARTON of Texas. Madam Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material on H.R. 918, the bill now 
under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BARTON of Texas. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, we have a number of bills before the House today, 
dealing with health-related issues that have come out of the committee 
that I have the privilege to chair, the Committee on Energy and 
Commerce. This bill is one of the more important of those bills as it 
attempts to give our citizens the ability to navigate the health care 
system to get the very best possible care in the most time-efficient 
manner.
  I would like to take a step back and reflect on where we have been in 
this Congress and in previous Congresses. As the second session of this 
Congress draws to a close, I think it is entirely fitting that the 
House should devote much of its time today on these health care issues. 
It is not a stretch, in my opinion, to call this House, the 108th 
Congress, the Health Care Congress. I am proud of the many 
accomplishments that the Committee on Energy and Commerce has been 
responsible for in this area over the last 2 years.
  I think the achievement that we will reflect back on and be most 
proud of, of course, is the Medicare Modernization Act, which President 
Bush has already signed into law and which is helping millions of our 
senior citizens as we speak. After years of debate and inaction, this 
Congress finally has delivered in that bill a prescription drug benefit 
to our Nation's seniors.
  Of course, not all of the Medicare Modernization Act's provisions are 
fully up and running yet. They will be phased in over the next several 
years. And when they are totally phased in, I think we will all look 
back and reflect that this was a very good thing that we have done in 
this Congress.
  We should be proud of our achievement. I salute the members of the 
Committee on Energy and Commerce who have worked so long and hard to 
make that happen.
  Prescription drugs are not the only area where this Congress has 
worked to advance the health agenda of the American people. Working 
with President Bush, we have also written laws that upgrade our medical 
device program. We have instituted a new animal drug approval system. 
We have provided for competition in the contact lens marketplace. We 
have updated our poison control center programs.
  I might add that all of those achievements occurred under Congressman 
Billy Tauzin of Louisiana, who, as we speak, is undergoing radiation 
treatment down in Texas for a cancer that he has discovered in his body 
that, hopefully, is being removed.
  We have also improved our Nation's organ donor system and, most 
recently, created a new program to help prevent and educate against 
youth suicide. By any measure, these accomplishments would rival that 
of any Congress in the past.
  Today, we are continuing the good work we have already established in 
the 108th Congress. We have five substantive bills that we are going to 
debate and vote on, hopefully in a positive way, in the next several 
hours, all of which in some way improve the health care system for 
millions and millions of Americans.
  The one we are debating at this moment is the Patient Navigator 
Outreach and Chronic Disease Prevention Act. The Committee on Energy 
and Commerce favorably reported this legislation last week, and it is 
now on the floor.
  Improving health care outcomes for all Americans requires substantial 
improvements in health disparity populations, populations not defined 
solely by race and ethnicity, that have a significant disparity in the 
overall rate of disease incidence, prevalence, morbidity, mortality, or 
survival rates as compared to the health status of the general 
population. Patient navigator programs as provided in this bill provide 
outreach to communities to encourage more individuals to seek 
preventive care and coordinate that care so that they are less at risk 
to have or to maintain a chronic disease.
  For example, the Ralph Lauren Center for Cancer Care and Prevention, 
a partnership between Memorial Sloan-Kettering and North General 
Hospital in Harlem, New York, operates a patient navigator program to 
help patients and family members deal with the complexities of the 
health care system in that area. By coordinating health care services 
through a patient navigator, programs strive to shorten the period of 
time when the patient is screened for cancer or other chronic diseases 
and further diagnosis and treatment, so they can be treated as soon as 
possible.
  H.R. 918, as amended by the Committee on Energy and Commerce, 
authorizes a 5-year demonstration program to evaluate the use of 
patient navigators. Specifically, the legislation requires patient 
navigators to coordinate health care services and provider

[[Page 20797]]

referrals, facilitating the involvement of community organizations to 
provide assistance to patients, facilitate enrollment in clinical 
trials, anticipate barriers within the health care system itself, to 
help ensure prompt diagnostic care and treatment, to coordinate with 
the health insurance ombudsman program, and conduct ongoing outreach to 
health disparity populations for preventive care.
  Grant recipients must establish base-line measures and benchmarks to 
evaluate the program outcome, which all culminate in a final report 
prepared by the Secretary no later than 6 months after the completion 
of the demonstration grant program. The bill authorizes a total of $25 
million over a 5-year period to conduct these demonstration programs.
  I would like to thank the distinguished gentlewoman from the 15th 
Congressional District of Ohio (Ms. Pryce), for her outstanding 
leadership and undying commitment to this particular bill. I would also 
like to thank the chairman of the subcommittee, the gentleman from 
Florida (Mr. Bilirakis), for his work; the ranking member, the 
gentleman from Michigan (Mr. Dingell); the subcommittee's ranking 
member, the gentleman from Ohio (Mr. Brown); and the bill's sponsor, 
the gentleman from New York (Mr. Menendez), for their assistance in 
streamlining this legislation.
  Again, Madam Speaker, I want to congratulate my colleagues on a very 
successful Health Care Congress, and especially on this particular 
bill. If we can get the bills that we are considering today to the 
President's desk, the 108th Congress should go down as one of the best 
ever for health care initiatives.
  Madam Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Madam Speaker, I yield myself 2 minutes, and I 
want to begin by thanking the chairman, the gentleman from Texas (Mr. 
Barton), for his good work today with this whole slew of eight or nine 
bills that we are doing bipartisanly. It is legislation that clearly 
helps health care in this country, and I want to thank Chairman Barton 
for that, and also the chairman of the subcommittee, (Mr. Bilirakis), 
for his work.
  Too many Americans face financial barriers to health care. The 
American Cancer Society and other patient advocates support H.R. 918 
because they know many Americans also face serious nonfinancial 
barriers. These include significant racial and cultural and linguistic 
and geographic barriers, barriers that have contributed to the striking 
disparities across racial and ethnic lines in the incidence and the 
treatment of cancer and other chronic diseases.
  This patient navigator bill is intended to ease the way for patients 
confronting a serious illness in an intimidating array of treatment 
options. With this legislation's passage, we will begin to see 
increased enrollment in clinical trials, we will see greater community 
involvement in health awareness, and we will have a more coordinated 
approach to health care services that will benefit all patients in the 
end.
  I want to commend the gentleman from New Jersey (Mr. Menendez) for 
this legislation, my colleague, the gentlewoman from Ohio (Ms. Pryce), 
for her hard work also on this bill; and I am pleased to support it.
  Madam Speaker, I reserve the balance of my time.
  Mr. BARTON of Texas. Madam Speaker, I yield 5 minutes to the 
gentlewoman from the 15th District of Ohio (Ms. Pryce), our 
distinguished Republican Conference chairwoman.
  Ms. PRYCE of Ohio. Madam Speaker, I thank the gentleman for yielding 
me this time, and I want to begin by commending the gentleman from 
Texas (Mr. Barton), the distinguished chairman of the Committee on 
Energy and Commerce. He has led this committee with great strength 
since he took the helm; we have enjoyed working with him, and I want to 
thank him for his attention to this important issue.
  I also want to extend special thanks to my friend and colleague, the 
gentleman from New Jersey (Mr. Menendez). He has been a great partner 
over the last few years as we have worked this initiative together. We 
represent different parts of the country, and we belong to different 
political parties, but we have put many differences aside and have 
joined together for a great purpose here today. We joined together 
because we understand that cancer, diabetes, and other chronic diseases 
can affect anyone in any part of the country, of any race and of any 
income level.
  Madam Speaker, even with the tremendous advancements we have made in 
prevention, diagnosis, and treatment of illnesses, we understand that 
in far too many communities across this country navigating the health 
care system can be a significant barrier to gaining access to quality 
and affordable service.
  Before I continue, I want to take a moment to extend my appreciation 
to my staff and the staff of the committee for their excellent work and 
the help they have given us. And I want to highlight the American 
Cancer Society, the National Association of Community Health Centers, 
and the National Rural Health Association for their tireless efforts to 
educate our colleagues about the importance of this issue.
  Madam Speaker, each and every day Congress is in session, our 
colleagues on both sides of the aisle debate important issues. 
Sometimes we agree and other times we disagree. But at the end of the 
day, we share the same goal: to return to our districts with something 
positive to tell our constituents about.
  Today, every Member of this body will have the opportunity to report 
to their constituents something positive: that this Congress has taken 
a significant step to ensure that our friends and neighbors across 
America have the tools and resources they need to make good decisions 
about their health and the health of their children.
  Madam Speaker, last year, I had the opportunity to meet two gentlemen 
who pioneered the concept that this legislation is based on, the 
patient navigator concept. Dr. Harold Freeman and Dr. Elmer Huerta were 
two of the most humble, kind gentlemen I have ever had the good fortune 
of getting to know. Let me tell you a little about what they do.
  First, they recognized in their own work as doctors in underserved 
communities that navigating the health care system can be an 
insurmountable barrier for many, many people, especially when they are 
poor, underserved, and uninsured. All we have to do is step in and help 
them. Step out of our homes into communities and we will find families 
and individuals who struggle to find access to the health care that 
they need, both preventive and treatment.
  The concept of these doctors is a great one. The patient navigators 
are angels who guide individuals through the health care system. It is 
truly one of the most creative and innovative ways to address the 
health care needs of these individuals, who may otherwise avoid seeing 
a doctor when they are healthy and avoid treatment when they need it, 
when they are sick.

                              {time}  1400

  Whether based at hospitals, community health centers or cancer 
centers, these programs literally put in place patient navigators to 
help individuals find their way through the often complex health care 
systems that they are confronted with.
  These navigators, like Leka Murdock whom I met during my visit to the 
Ralph Lauren Cancer Center in Harlem, assist people who come through 
their doors with obtaining coverage through the Medicaid system or 
other sources, they obtain cancer screenings or counseling about 
disease prevention, or they make referrals for treatment or clinical 
trial options should an abnormality be detected.
  For people who may otherwise not know or be able to access the 
system, patient navigator programs offer them the tools and resources 
they need to make the good decisions about their health and the health 
of their children. They help break through the red tape that often 
prevents them from getting the information and the treatment so needed.

[[Page 20798]]

  That is why the gentleman from New Jersey and I partnered together to 
introduce, garner support for and move forward this legislation that 
will create innovative demonstration projects in communities across the 
country based on this concept. This bill will link sustained health 
promotion outreach efforts with patient navigator programs. 
Specifically, the bill will make funds available to community health 
centers, cancer centers, rural and frontier serving medical facilities 
and other eligible entities to increase and promote chronic-disease-
prevention screening, outreach and public health education, as well as 
provide patient navigators to help patients overcome the barriers and 
complexities in the system.
  It is my hope that this legislation will serve as a springboard for 
launching many more navigator programs. These are extraordinary 
programs, and they are making real differences in the lives of people 
who are suffering, people who may not otherwise even know that they are 
sick. Or if they do, people who may not do what is necessary to get 
better. These are the people we need to reach, and this bill is a 
healthy start. By furthering this collaboration between the private and 
the public sectors, we will maximize our resources and close in on that 
day when cancer and other chronic diseases no longer threaten the lives 
of our loved ones.
  Mr. Speaker, I urge my colleagues to support this legislation.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 7 minutes to the gentleman 
from New Jersey (Mr. Menendez), the sponsor of the bill.
  Mr. MENENDEZ. Mr. Speaker, I want to thank my colleague from Ohio 
(Mr. Brown) as well as the gentleman from Michigan (Mr. Dingell), 
ranking member on the Committee on Energy and Commerce, as well as the 
gentleman from Texas (Mr. Barton) and the gentleman from Florida (Mr. 
Bilirakis), chairman on the Subcommittee on Health, and all their staff 
for bringing us here today. I want to particularly thank my good friend 
and lead cosponsor from Ohio (Ms. Pryce) and her staff who have been 
actively engaged in this effort and have been instrumental in getting 
the bill to the floor today. And, of course, the gentlewoman from 
Ohio's own personal experiences and her family with the questions of 
cancer have made her such a powerful advocate in this regard.
  This is truly a bipartisan effort and a case study in how, if we 
choose to work together across the aisle, we can really make a 
difference. I began working on this legislation several years ago to 
address the health disparities I saw in my district, a true melting pot 
of America with a very significant Hispanic population. There have been 
many people involved behind the scenes in this effort that I want to 
take the opportunity to thank.
  The first person I spoke to about this issue was David Woodmansee, 
who is the Northeast regional representative for the American Cancer 
Society. The second person I met with was Licy Do Canto who was with 
the American Cancer Society and has continued the fight for patient 
navigators at the National Association of Community Health Centers. 
Dave and Licy, along with the help of ACS employees, were instrumental 
in helping us to take a concept such as patient navigation and turn it 
into a legislative solution for improving health outcomes among all 
populations, particularly underserved populations. I also want to thank 
Karissa Willhite, the Democratic Caucus policy director, for her 
untiring efforts to achieve the success we expect to have today. And we 
cannot talk about patient navigators without thanking three doctors, 
Drs. Harold Freeman, Elmer Huerta and Gil Friedell, who have been 
pioneers in creating patient navigator programs that can be replicated 
across the country, which is exactly what we are doing today.
  There is no question that we as a Nation must do more to improve 
health outcomes and that can only be done when we start at the bottom 
and bring those with the greatest disparities up out of despair. 
Reducing health disparities has been a much-talked-about goal, but we 
cannot achieve better health outcomes without action. We cannot just 
talk about the problem. We have to take action to end the problem.
  The patient navigator bill is an effort to do just that. It will 
ensure that all Americans, regardless of income, race, ethnicity, 
language or geography will have access to prevention screening and 
treatment, and that they will have an advocate at their side helping 
them navigate through today's complicated health care system.
  The bill addresses what I believe are the root causes of health 
disparities in minority and underserved communities. That is, lack of 
access to health care, particularly prevention and early detection. The 
bottom line is, the only way to stay healthy is to see a doctor when 
you are healthy. Unfortunately, patients in health disparity 
communities are less likely to receive early screening and detection, 
so their disease is found at a much later stage and they have less 
chance of survival. That is why we are here today, to give those people 
the chance they deserve for a long, healthy life.
  The patient navigator bill does this by replicating the successful 
models developed by Drs. Freeman, Huerta and Friedell in a national 
demonstration project. It focuses on outreach and prevention through 
community health centers, rural health clinics, Indian health clinics 
and cancer clinics. And it does so by providing patient navigator 
services and outreach in health disparity communities to encourage 
people to get screened early so that they can receive the care they 
need. Patient navigators educate and empower patients, serving as their 
advocates in navigating the health care system.
  In addition to having visited both Dr. Freeman's program in Harlem 
and Dr. Huerta's program here in Washington, my constituents in New 
Jersey and I have seen firsthand the difference patient navigators can 
make in a community. I was able to secure funding for a 1-year 
demonstration project at a community health center in Jersey City, New 
Jersey. The program has screened 842 people and has a caseload of about 
140 patients who were identified through these screenings with abnormal 
findings and are currently benefiting from the help of the patient 
navigator in finding follow-up care and treatment.
  Before I close, I just want to share a story about Hazel Hailey, one 
of the patient navigators at this center and her daughter, Robin 
Waiters. Robin, who was only 36 years old, suffered severe stomach 
pains for 2 years and refused to see a doctor, despite her mother's 
pleas for her to seek medical care. Finally, she had no choice but to 
go see a doctor. Tragically, 3 months later, Robin died from colorectal 
cancer. Her mother, Hazel, who is now a patient navigator, tells us 
about her daughter's last request. She made her mom promise to tell all 
of her friends, family and everyone she could ``that if your body is 
trying to tell you something, listen to it. You could possibly save 
your life.'' Hazel quotes her daughter as saying, ``I am dying because 
I chose not to get help. Fear set in, and I lost out on life.''
  Hazel is fulfilling her promise to her daughter as a patient 
navigator, working every day to ensure that what happened to her 
daughter does not happen to other families. That is why we are here 
today, to ensure that the Hazels across the country have the tools they 
need to educate and empower people about the importance of early 
detection screening and to help them navigate the complexities of the 
health care system so that they can get the treatment and follow-up 
care they need.
  Again, I want to thank my colleague from Ohio (Ms. Pryce) for all of 
her work on this effort as well as all of those who have worked behind 
the scenes to make this concept a reality. We have come too far and are 
too close to simply let the issue die at the end of this Congress, so I 
call upon our colleagues in the other body to join us in making this 
bill a reality this year. There is simply too much at stake if we do 
not act.
  Mr. BARTON of Texas. Mr. Speaker, I yield 3 minutes to the 
gentlewoman from Florida (Ms. Ros-Lehtinen).
  Ms. ROS-LEHTINEN. I thank the gentleman for yielding me this time.

[[Page 20799]]

  While there is no question, Mr. Speaker, that tremendous progress has 
been made across our country in the fight against cancer and other 
diseases, barriers continue to exist between millions of Americans and 
their access to high quality health care. Whether it is due to 
distance, lack of health insurance, limited access to specialists, 
limited language skills, whatever the reason, too many Americans 
continue to receive a narrow range of health care services and limited 
options. That is why I am so pleased to join the gentlewoman from Ohio 
(Ms. Pryce) and the gentleman from New Jersey (Mr. Menendez) as an 
original cosponsor of the Patient Navigator, Outreach, and Chronic 
Disease Prevention Act and to express my heartfelt support for this 
vital piece of legislation that is going to improve the lives of so 
many people.
  This program provides a crucial service, primarily to the 
underinsured and the uninsured members of all populations, and most 
specifically to the Hispanic and African-American populations that 
studies have shown are those who are in those categories of 
underinsured and uninsured. Navigating the health system can be a huge 
barrier for many people. The patient navigator bill will greatly aid 
the community by providing a more efficient service for all. The 
patient navigator bill will also help the communities by providing a 
more efficient service for all minorities because it addresses the 
unique needs of the population that it serves through providing 
culturally sensitive services, including cancer screening, disease 
prevention counseling, assistance in obtaining Medicaid and other 
necessary referrals.
  This important legislation, Mr. Speaker, would ensure early 
prevention screening and timely treatment for all patients. It seeks to 
help close the gap that exists in health care treatment for minority 
communities, thus improving their quality of life and ensuring that the 
minority members of our community are treated with the utmost respect 
and care.
  An example of a successful patient navigator program exists right 
here in our Nation's capital, Mr. Speaker. It is run by Dr. Elmer 
Huerta, one of the founding fathers of the patient navigator program. 
Dr. Huerta conducts a weekly 1-hour show called, Let's Talk About 
Health, Hablemos de Salud, which focuses on health promotion and 
disease prevention. This show reaches about 75 percent of Hispanics and 
Latinos in the United States, over 25 million people, and it extends to 
Latin America. I am proud to be associated with such a dynamic and 
exciting program, and I thank all who have worked tirelessly to make 
this vital program a reality. Muchas gracias.
  Mrs. CHRISTENSEN. Mr. Speaker, I rise today to join my colleague 
Congressman Robert Menendez of New Jersey in the passage of H.R. 918, 
the Patient Navigator, Outreach, and Chronic Disease Prevention Act of 
2003. As you know, Mr. Speaker, I have come to this floor on numerous 
occasions to express my outrage concerning racial and ethnic health 
disparities in this Nation and legislative solutions to address them. 
For years, research has told us that minorities and low-income 
populations are the least likely to receive the health care they need 
to live a long, healthy life. We've done a very good job of identifying 
this problem and finally we have a bill that will begin the process of 
solving them.
  The bill we are passing today while greatly modified enjoys strong 
support from the American Cancer Society, the National Association of 
Community Health Centers, the National Alliance for Hispanic Health, 
the National Hispanic Medical Association, the National Medical 
Association, Racial and Ethnic Health Disparities Coalition, the 
Intercultural Cancer Council and their Caucus, the National Council of 
La Raza, 100 Black Men of America, the National Rural Health 
Association, Asian and Pacific Islander American Health Forum, the 
Cancer Research and Prevention Foundation, and the National Patient 
Advocate Foundation.
  This bill addresses what many of us believe are the root causes of 
health disparities in minority and underserved communities: Lack of 
access to health care in general--and particularly lack of access to 
prevention and early detection--as well as language and cultural 
barriers to care.
  In the 2002 IOM report Unequal Treatment: Confronting racial and 
ethnic disparities in care, research explained that there are a number 
of explanations for the higher rates of disease among minority 
populations, including higher rates of uninsured, reduce access to 
care, and lower quality of care. But all of these barriers point to the 
same underlying problem, minority patients are less likely to receive 
early screening and detection, so their disease is found at a much 
later stage and they have less chance of survival.
  This bill we're passing today will be the process to ensure that all 
Americans, regardless of race, ethnicity, language, income, or 
geography, will have access to prevention screening and treatment, and 
that they will have an advocate at their side, helping them navigate 
through today's complicated health care system.
  The bill before us ensures that navigators are available to help 
patients make their way through the health care system--whether it's 
translating technical medical terminology, making sense of their 
insurance, making appointments for referral screenings, following up to 
make sure the patient keeps that appointment, or even accompanying a 
patient to a referral appointment.
  Mr. Speaker, I also want to acknowledge that the original concept for 
the legislation comes from Dr. Harold Freeman's ``navigator'' program, 
which he created while he was Director of Surgery at Harlem Hospital. 
It is our hope that Dr. Freeman's navigator concept and its laser shape 
focus on comprehensive modeling of prevention services will eventually 
be fully translated in legislative terms. To this end, it is my sincere 
desire that this body would move expeditiously in holding hearing on 
H.R. 3459 the Healthcare Equality and Accountability Act of 2003. It is 
our firm belief that H.R. 3459 expands and accents the comprehensive 
components that Dr. Freedman's navigator program embodies. As you know, 
Mr. Speaker, H.R. 3459 enjoys the support of 104 Members in this body, 
was created by the Congressional Black, Hispanic, Asian Pacific 
American, and Native American Caucuses, and included the introduced 
version of the bill before us today.
  In closing, Mr. Speaker, I want to thank Karissa Willhite of Mr. 
Menendez's office and John Ford and Cheryl Jaeger of the Energy and 
Commerce Committee along with other staff that enabled this bill to 
come to the floor. It urge my colleagues to vote for its adoption.
  Mr. BROWN of Ohio. Mr. Speaker, I have no further requests for time, 
and I yield back the balance of my time.
  Mr. BARTON of Texas. Mr. Speaker, I have no further requests for 
time, and I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Fossella). The question is on the motion 
offered by the gentleman from Texas (Mr. Barton) that the House suspend 
the rules and pass the bill, H.R. 918, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  The title of the bill was amended so as to read: ``A bill to amend 
the Public Health Service Act to authorize a demonstration grant 
program to provide patient navigator services to reduce barriers and 
improve health care outcomes, and for other purposes.''.
  A motion to reconsider was laid on the table.

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