[Congressional Record (Bound Edition), Volume 150 (2004), Part 15]
[House]
[Pages 20805-20810]
[From the U.S. Government Publishing Office, www.gpo.gov]




 ASTHMATIC SCHOOLCHILDREN'S TREATMENT AND HEALTH MANAGEMENT ACT OF 2004

  Mr. BARTON of Texas. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 2023) to give a preference regarding States that 
require schools to allow students to self-administer medication to 
treat that student's asthma or anaphylaxis, and for other purposes, as 
amended.
  The Clerk read as follows:

                               H.R. 2023

       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 ``Asthmatic Schoolchildren's 
     Treatment and Health Management Act of 2004''.

     SEC. 2. FINDINGS.

       The Congress finds the following:
       (1) Asthma is a chronic condition requiring lifetime, 
     ongoing medical intervention.
       (2) In 1980, 6,700,000 Americans had asthma.
       (3) In 2001, 20,300,000 Americans had asthma; 6,300,000 
     children under age 18 had asthma.
       (4) The prevalence of asthma among African-American 
     children was 40 percent greater than among Caucasian 
     children, and more than 26 percent of all asthma deaths are 
     in the African-American population.
       (5) In 2000, there were 1,800,000 asthma-related visits to 
     emergency departments (more than 728,000 of these involved 
     children under 18 years of age).
       (6) In 2000, there were 465,000 asthma-related 
     hospitalizations (214,000 of these involved children under 18 
     years of age).
       (7) In 2000, 4,487 people died from asthma, and of these 
     223 were children.
       (8) According to the Centers for Disease Control and 
     Prevention, asthma is a common cause of missed school days, 
     accounting for approximately 14,000,000 missed school days 
     annually.
       (9) According to the New England Journal of Medicine, 
     working parents of children with asthma lose an estimated 
     $1,000,000,000 a year in productivity.
       (10) At least 30 States have legislation protecting the 
     rights of children to carry and self-administer asthma 
     metered-dose inhalers, and at least 18 States expand this 
     protection to epinephrine auto-injectors.
       (11) Tragic refusals of schools to permit students to carry 
     their inhalers and auto-injectable epinephrine have occurred, 
     some resulting in death and spawning litigation.
       (12) School district medication policies must be developed 
     with the safety of all students in mind. The immediate and 
     correct use of asthma

[[Page 20806]]

     inhalers and auto-injectable epinephrine are necessary to 
     avoid serious respiratory complications and improve health 
     care outcomes.
       (13) No school should interfere with the patient-physician 
     relationship.
       (14) Anaphylaxis, or anaphylactic shock, is a systemic 
     allergic reaction that can kill within minutes. Anaphylaxis 
     occurs in some asthma patients. According to the American 
     Academy of Allergy, Asthma, and Immunology, people who have 
     experienced symptoms of anaphylaxis previously are at risk 
     for subsequent reactions and should carry an epinephrine 
     auto-injector with them at all times, if prescribed.
       (15) An increasing number of students and school staff have 
     life-threatening allergies. Exposure to the affecting 
     allergen can trigger anaphylaxis. Anaphylaxis requires prompt 
     medical intervention with an injection of epinephrine.

     SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS TO SELF-
                   ADMINISTER MEDICATION TO TREAT ASTHMA AND 
                   ANAPHYLAXIS.

       (a) Amendments.--Section 399L of the Public Health Service 
     Act (42 U.S.C. 280g) is amended--
       (1) by redesignating subsection (d) as subsection (e); and
       (2) by inserting after subsection (c) the following:
       ``(d) Preference for States That Allow Students to Self-
     Administer Medication to Treat Asthma and Anaphylaxis.--
       ``(1) Preference.--The Secretary, in making any grant under 
     this section or any other grant that is asthma-related (as 
     determined by the Secretary) to a State, shall give 
     preference to any State that satisfies the following:
       ``(A) In general.--The State must require that each public 
     elementary school and secondary school in that State will 
     grant to any student in the school an authorization for the 
     self-administration of medication to treat that student's 
     asthma or anaphylaxis, if--
       ``(i) a health care practitioner prescribed the medication 
     for use by the student during school hours and instructed the 
     student in the correct and responsible use of the medication;
       ``(ii) the student has demonstrated to the health care 
     practitioner (or such practitioner's designee) and the school 
     nurse (if available) the skill level necessary to use the 
     medication and any device that is necessary to administer 
     such medication as prescribed;
       ``(iii) the health care practitioner formulates a written 
     treatment plan for managing asthma or anaphylaxis episodes of 
     the student and for medication use by the student during 
     school hours; and
       ``(iv) the student's parent or guardian has completed and 
     submitted to the school any written documentation required by 
     the school, including the treatment plan formulated under 
     clause (iii) and other documents related to liability.
       ``(B) Scope.--An authorization granted under subparagraph 
     (A) must allow the student involved to possess and use his or 
     her medication--
       ``(i) while in school;
       ``(ii) while at a school-sponsored activity, such as a 
     sporting event; and
       ``(iii) in transit to or from school or school-sponsored 
     activities.
       ``(C) Duration of authorization.--An authorization granted 
     under subparagraph (A)--
       ``(i) must be effective only for the same school and school 
     year for which it is granted; and
       ``(ii) must be renewed by the parent or guardian each 
     subsequent school year in accordance with this subsection.
       ``(D) Backup medication.--The State must require that 
     backup medication, if provided by a student's parent or 
     guardian, be kept at a student's school in a location to 
     which the student has immediate access in the event of an 
     asthma or anaphylaxis emergency.
       ``(E) Maintenance of information.--The State must require 
     that information described in subparagraphs (A)(iii) and 
     (A)(iv) be kept on file at the student's school in a location 
     easily accessible in the event of an asthma or anaphylaxis 
     emergency.
       ``(2) Rule of construction.--Nothing in this subsection 
     creates a cause of action or in any other way increases or 
     diminishes the liability of any person under any other law.
       ``(3) Definitions.--For purposes of this subsection:
       ``(A) The terms `elementary school' and `secondary school' 
     have the meaning given to those terms in section 9101 of the 
     Elementary and Secondary Education Act of 1965.
       ``(B) The term `health care practitioner' means a person 
     authorized under law to prescribe drugs subject to section 
     503(b) of the Federal Food, Drug, and Cosmetic Act.
       ``(C) The term `medication' means a drug as that term is 
     defined in section 201 of the Federal Food, Drug, and 
     Cosmetic Act and includes inhaled bronchodilators and auto-
     injectable epinephrine.
       ``(D) The term `self-administration' means a student's 
     discretionary use of his or her prescribed asthma or 
     anaphylaxis medication, pursuant to a prescription or written 
     direction from a health care practitioner.''.
       (b) Applicability.--The amendments made by this section 
     shall apply only with respect to grants made on or after the 
     date that is 9 months after the date of the enactment of this 
     Act.

     SEC. 4. SENSE OF CONGRESS COMMENDING CDC FOR ITS STRATEGIES 
                   FOR ADDRESSING ASTHMA WITHIN A COORDINATED 
                   SCHOOL HEALTH PROGRAM.

       The Congress--
       (1) commends the Centers for Disease Control and Prevention 
     for identifying and creating ``Strategies for Addressing 
     Asthma Within a Coordinated School Program'' for schools to 
     address asthma; and
       (2) encourages all schools to review these strategies and 
     adopt policies that will best meet the needs of their student 
     population.

  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. Mr. 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. 2023, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BARTON of Texas. Mr. Speaker, I yield myself of such time as I 
may consume.
  Mr. Speaker, I rise today in strong support of H.R. 2023, the 
Asthmatic Schoolchildren's Treatment and Health Management Act, 
sponsored by the Energy and Commerce subcommittee chairman, the 
gentleman from Florida (Mr. Stearns).
  Over the past 15 years, the number of Americans diagnosed with asthma 
has nearly doubled to an estimated 17 million people, including 5 
million children. The Federal Government has invested significant 
resources to strengthen and improve asthma research and prevention 
activities. The Department of Health and Human Services fiscal 2005 
budget request includes approximately $321 million for direct asthma 
programs.
  When asthma strikes, airways in the lungs become inflamed and 
constricted, causing coughing, wheezing and difficulty breathing. Each 
year, nearly half a million Americans are hospitalized and, 
unfortunately and sadly, more than 5,000 die from asthma. Several 
medications, when properly administered in a timely fashion, are now 
available to treat asthma and/or anaphylaxis.
  Unfortunately, some schools do not permit students to self-administer 
medication for asthma even though the parent or guardian of the student 
has authorized the use of the medication and it is recommended by a 
health care provider, resulting in an unnecessary delay of potentially 
life-saving treatments.
  H.R. 2023 directs the Secretary of Health and Human Services to give 
preference when making asthma-related grants to States that require 
schools to allow students to self-administer medications. H.R. 2023 
does not federally mandate that States allow children to carry 
prescribed asthma medication in schools. The intent of the bill is to 
incentivize States to do the right thing by granting preference for 
asthma-related health program dollars to the States that have 
regulations that put the parents' and the children's safety first.
  Mr. Speaker, I can say, as one of the founding members of Asthma 
Awareness Day here on Capitol Hill, I am very proud that now as 
chairman of the Committee on Energy and Commerce, with the strong 
support and leadership of the gentleman from Florida (Mr. Stearns), we 
can bring this bill forward. I would urge its adoption.
  Mr. Speaker, I ask unanimous consent to yield the balance of my time 
to manage the bill to the subcommittee chairman, the gentleman from 
Florida (Mr. Stearns).
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, millions of Americans, including my wife, suffer from 
asthma. In a classroom of 30 children, on the average, three are likely 
to have asthma. The disease killed more than 200 American children in 
the year 2000. Some States, however, prohibit children from carrying 
emergency asthma medicine to school. Some of these prohibitions occur 
despite the fact that parents have authorized the medication's use. 
This creates an unnecessary

[[Page 20807]]

delay in administering these medications, when it only takes seconds 
for an asthma attack sometimes to turn deadly.
  The ASTHMA Act, H.R. 2023, encourages States to modernize their laws. 
I commend my friend the gentleman from Florida (Mr. Stearns) for his 
leadership on this legislation and my friend, the gentleman from New 
York (Mr. Towns), for introducing the proposal.
  The Centers for Disease Control and Prevention has done terrific work 
in examining and recommending strategies for combating asthma in 
school- based situations and has laid out six strategies for addressing 
asthma in schools. This bill also commends those efforts.
  Allowing children to self-administer their asthma medication will 
save lives and will make our schools healthier and safer. I am pleased 
to support this important legislation.
  Mr. STEARNS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am proud also to author this bill, H.R. 2023, the 
Asthmatic Student Treatment and Health Management Act, ASTHMA, with my 
colleague, the gentleman from Rhode Island (Mr. Kennedy). He and I have 
been working together on this for some time, and we are pleased it came 
to the House floor today. It has been a long haul.
  I also want to thank the gentleman from Texas (Chairman Barton) for 
his early support and providing the leadership in this whole series of 
legislative initiatives. We introduced this bill, the gentleman from 
Rhode Island (Mr. Kennedy) and I, in 2003 on Asthma Awareness Day. 
Frankly, I think it has been building momentum ever since.
  This bill provides incentives for States to guarantee students can 
carry and use prescribed asthma medication while they are at school. It 
is not a mandate, and, frankly incurs no new spending.
  The ``zero tolerance'' movement of the 1980s and 1990s had the 
unintended consequence of depriving students of immediate access to 
their prescribed medication. Often there is a signaling effect in the 
States or industry merely from the existence of Federal legislation, 
sort of a chilling effect. I think our bill elevated the conversation 
here in the United States in school boards and State legislatures.
  Because of this discussion, we now have 31 ``asthma-friendly'' 
States, such as my own State of Florida. Furthermore, of these 31, 19 
extend their protection even further to anaphylaxis medication, like 
epinephrine auto-injectors. On Asthma Awareness Day, May 7, 2003, when 
we first started this, at that time there were only 20 States, and only 
nine with this extra protection.
  As mentioned earlier, over 6.3 million children under the age of 18 
suffer from asthma, probably more than that when you realize a lot of 
people do not even admit to having asthma. It is the most common cause 
of missed school days, 14 million annually. It costs us tremendously in 
lost time, learning, lost productivity and earnings of parents, and 
medical expenses, including costly emergency room visits, not to 
mention the enormous amount of stress for people involved, the parents 
and children.
  September 22, 2003, a Newsweek magazine article cover story, as you 
will remember, said, ``Your Child's Health and Safety: The Latest on 
Allergies and Asthma.'' ``The Allergy Epidemic'' pointed out, ``We have 
conquered most childhood infections, but,'' and this is what is 
important, ``extreme reactions to everyday substances still pose a new 
threat.''
  We read about David Adams of Georgia, whose acute allergic reaction 
to peanuts was stanched by a quick epinephrine injection, ``never sets 
foot outside his home without an emergency supply of epinephrine.''
  This ``Fighting for Air'' article states, ``Asthma among children has 
more than doubled over the past 20 years,'' and at Chicago's Hughes 
Elementary School, ``at this school of 500 students, an astonishing 
one-third have asthma.'' Second grader Zeron Moody ``just wants to play 
without gasping'' for air.
  When asthma attacks, every minute counts. Sadly, there have been 
tragedies when a school child is prevented from swift access to his or 
her asthma medication. A student who must go to the nurse's office, 
even if there is a school nurse, to get his or her prescribed, life-
saving medication, just may run out of time for the initial treatment 
that could save his or her life.
  There is a 2002 article in a magazine called Reason entitled ``Asthma 
Attack: When Zero Tolerance Collides with Children's Health.'' I just 
want to share the horror of a 1991 death of a New Orleans high school 
student, Catrina Lewis, who was simply delayed by security guards 
before being allowed to get to her inhaler from the office. When 
finally it did not help, she asked the school staff to call an 
ambulance. Instead, they spent a half-hour trying to call her mother 
first.
  Catrina's sister, another student, finally called 911, but 
unfortunately, tragically, the emergency help arrived too late. 
Catrina's death resulted in more than heartbreak, but a legal judgment 
against the principal, the counselor and school board. Obviously, in 
this case no one comes out the winner.
  Medical providers prescribe safe, legal treatment, along with 
instructions on how to self-administer to patients diagnosed with 
asthma and severe allergies. Along with parental support, it just makes 
good medical sense to allow a student to treat him or herself and avoid 
this possible tragedy in the classroom.
  I would like to remind young people with asthma in this country that 
throughout history there have been people we know or believe had 
asthma, but they still accomplished great things; not because they had 
asthma, but because they did not let it stop them from finding 
greatness, achievement.
  In the past 3 years, I have shared stories about President Theodore 
Roosevelt and the Italian composer, priest and musician, Antonio 
Vivaldi. In Congress, for Asthma Awareness Day we hosted famous 
athletes who currently have and suffer from asthma. But, frankly, they 
do not let it slow them down, and they still pursue their career: 
Jerome Bettis of the Pittsburgh Steelers, who just last Sunday scored 
two touchdowns, I say to my colleagues; and Jackie Joyner-Kersee, 
Olympic heptathlete, most of us do not know what that is, but that is 
an individual that competes in seven track and field events.
  I would also like to point out another sober but timely point that 
there may arise emergencies where a schoolchild with asthma simply, 
simply needs to have his or her vital medication close at hand and not 
locked in a desk drawer across the campus. We sadly just never know 
these days when a homeland security event might call for a lockdown at 
a school, for students to ``shelter in place.''
  If this happens, that is why this bill is important. We want every 
child to have his or her lifesaving medication on their person and not 
in a shelter-in-place, in a lockdown position.
  In conclusion, Mr. Speaker, H.R. 2023 is an important step for the 
health of school children, for parental rights, and for trust in the 
physician-patient-parent relationship and judgment.

                              {time}  1445

  Again, I appreciate the support of my colleague, the gentleman from 
Rhode Island (Mr. Kennedy), and I appreciate the gentleman from Texas 
(Chairman Barton) for moving this bill, and the gentleman from Florida 
(Chairman Bilirakis) for marking it up in the Subcommittee on Health. 
We made great progress. We need the Senate to follow through, and we 
need to pass this bill today, and I encourage its swift passage in the 
Senate.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 7 minutes to the gentleman 
from Rhode Island (Mr. Kennedy), my friend.
  Mr. KENNEDY of Rhode Island. Mr. Speaker, I rise today as the lead 
Democratic cosponsor of the ASTHMA Act of 2003, and I want to 
acknowledge my good friend and partner, the gentleman from Florida (Mr. 
Stearns), for his excellent leadership on this matter. As

[[Page 20808]]

my colleagues have just heard him speak, he has spoken very eloquently 
to the case that we are making through this legislation.
  I think he illustrated better than anything else the reason why we 
are pushing this legislation when he talked about the story of Catrina 
Lewis. We in Rhode Island, and those stories are happening all over the 
country; in Rhode Island, we have a family, the father, Walter Stone, 
and the mother, Lynn Stone, lost their daughter, Morgan. She was a mild 
asthmatic. She was attending college and was killed when her asthma 
overcame her and she was not able to gain access to her medications.
  This is a life-and-death issue. Unfortunately, many States have made 
it a liability for those students to carry their inhalers to school 
when those students need their medications. If they have not registered 
them in the nurse's office, for example, they are subject to all kinds 
of punishment. Then again, if they need their medication, as those of 
us who have asthma, like myself, know very well, it can come on you 
very quickly; and if you do not have your medication available, you can 
have a much worse time of it. Tragically, as we have seen in Catrina 
Lewis's case and in Morgan Stone's case, it can be fatal.
  The gentleman from Florida (Mr. Stearns), my good colleague, was 
talking about the fact that we have 5,000 people die every year of 
asthma. This is quite extraordinary when people consider that asthma 
must not be that big a deal because when people suffer from asthma, it 
does not look like they are suffering. That is the biggest impediment 
for people in this country when approaching asthma, the fact that most 
people, when seeing an asthmatic, do not see the suffering that an 
asthmatic goes through when they are having an asthma attack, or do not 
see the suffering that someone is going through when they have an 
anaphylactic shock attack because of allergies to food.
  Many times people do not take this seriously, and it is for just that 
reason that we need to pass this legislation. It is because many school 
districts do not take this seriously that we have had the situation 
where too many young people have had to go through unspeakable 
suffering as a result of an asthma attack that could have been treated, 
or they have even suffered death because of the fact that they did not 
have access to their medications. That is why we need to pass this 
legislation.
  We have heard eloquently from the gentleman from Florida (Mr. 
Stearns) about the statistics. But the fact remains, with all of the 
statistics, it is important that people keep in mind that asthma is the 
single leading cause of missed school days in this country.
  Unfortunately, more and more children suffering from asthma are 
uninsured and do not have access to medications, so we also need to 
talk about that. Unfortunately, that cannot be incorporated in this 
legislation, but I know the gentleman from Florida (Mr. Stearns) and I 
both will work hard to make sure that asthma medication is available to 
our children who are not otherwise covered by health insurance. And the 
reason for that is simple: Our children are making the emergency room 
their primary source of medical care when they have asthma attacks and, 
as any physician or parent can tell us, this is the worst kind of 
health care policy we can have in this country.
  We need to do more through the Centers for Disease Control to alert 
families about asthma and to educate families about how to help them 
manage their child's asthma if their children have asthma. These things 
can make an enormous difference in a family's life, and certainly those 
are also objectives that we need to follow as well.
  Mr. Speaker, I know the gentleman from Florida (Mr. Stearns) and I 
both owe a special debt of gratitude to Nancy Sanders, who is President 
and founder of the Allergy and Asthma Network of Mothers of Asthmatics. 
She has really encapsulated all of these issues through her advocacy, 
and she speaks on behalf of all mothers of asthmatics when she 
testifies as she does, and her partner in this effort, Marissa 
Magnetti, who has also worked very hard to get this bill to the floor. 
I want to thank both of them for their good work in getting this bill 
to the floor.
  Mr. Speaker, I want to thank once again my colleagues in the Congress 
who have been helping us, the gentleman from Texas (Mr. Barton) for his 
work in passing this in the committee; and of course, I want to thank 
the gentleman from Florida (Mr. Stearns) for his good work and 
partnership on this legislation.
  Mr. STEARNS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to thank my colleague also for mentioning Nancy 
Sanders, because I was going to save the best for last, Nancy Sanders, 
the director of Mothers of Asthmatics, Allergy and Asthma Network; 
without her energy and her time, we probably would not be here today.
  So in large measure, this is a case where government is acting, 
Congress is acting, but it is because of her and all her volunteers and 
supporters have made this a major objective and mission for their 
actions to try and bring to bear all of the resources of the private 
sector so that we in the government are aware of this problem.
  I know from some of the hearings that we have had, that both the 
gentleman from Rhode Island (Mr. Kennedy) and I have shared, and we 
have had many panels come out and speak, all of this was organized by 
Nancy Sanders. So it is to her credit this bill is on the floor today, 
because of her hard work.
  So I appreciate the gentleman from Rhode Island (Mr. Kennedy) 
bringing that to the attention of the floor, and I want to echo that, 
how important it is to have Nancy Sanders.
  Mr. KENNEDY of Rhode Island. Mr. Speaker, will the gentleman yield?
  Mr. STEARNS. I yield to the gentleman from Rhode Island.
  Mr. KENNEDY of Rhode Island. Mr. Speaker, I thank my colleague for 
yielding.
  She is working, as all of us are, on a number of these other agenda 
items in helping to assist those who suffer from asthma and allergy 
attacks. We have worked on more notification for families when 
purchasing food products to know what is in those food products so that 
they can be alerted to any food type that may trigger anaphylactic 
shock. And I know that these and many other issues are ones that we are 
going to need to continue to work for in the years ahead.
  I thank my colleague for his effort on this and many others of these 
issues.
  Mr. STEARNS. Mr. Speaker, reclaiming my time, I would just give a 
concluding remark. Not often when we come to the House floor do we have 
legislation that will save lives. I had this experience when I was 
working on the defibrillator bill, which the gentleman from Ohio (Mr. 
Brown) is going to offer later on, which is another one of those bills 
that will actually save lives. And this is one that will save lives, 
not to mention the huge amount of stress that will be alleviated by 
parents' knowing that their children will have their medication with 
them at school.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, H.R. 2023, the Asthmatic 
Schoolchildren's Treatment and Health Management Act of 2003, provides 
incentives to States to help guarantee the rights of students to carry 
and use prescribed lifesaving asthma and anaphylaxis medications while 
at school.
  Many students attend schools in States where State and/or local 
statute prohibits them from carrying their prescribed asthma medication 
on their person. Worse, anaphylaxis, including the loss of breathing, 
can accompany a severe asthmatic attack. In an onset of asthma or an 
anaphylactic attack, every minute counts, and a schoolchild who has to 
go to a teacher's desk or school nurse's office to get his or her 
asthma medication may not have sufficient time to initiate treatment.
  I am pleased to be a cosponsor of this legislation, and just in the 
past year and a half since we introduced H.R. 2023, many States are 
passing laws protecting these students. We now have 31 States that 
permit students to possess and self-administer asthma medication, such 
as albuterol inhalers. Of these 31, 19 extend that protection even 
further to include anaphylaxis medication, such as epinephrine auto-
injectors. A year and a half ago,

[[Page 20809]]

there were only 20 States with statutes that protected students to 
possess and self-administer inhalers, and only 9 of those allowed 
permission for epinephrine auto-injectors. Great progress has been 
made, and your vote for H.R. 2023 can only encourage further success.
  In my State of Texas, approximately 900,000 adults, or 6 percent of 
the population, currently have asthma. Children are particularly hard 
hit in having asthma--which really can take away the joy of being a 
child.
  H.R. 2023 encourages states to pass asthma-friendly legislation, 
without new spending, without mandates. This bill directs the Secretary 
of Health and Human Services to give preference to a State's asthma and 
anaphylaxis medication statutes when awarding grants for asthma-related 
programs under its Department (such as Centers for Disease Control and 
Prevention studies). It offers a gentle incentive for States to take 
this easy, healthy step for its young citizens. My State of Texas could 
greatly benefit from such an incentive, as we have a high asthma rate 
and still do not guarantee the rights of children to carry their own 
asthma medication.
  Mr. ENGEL. Mr. Speaker, I rise in support of H.R. 2023, the Asthmatic 
Schoolchildren's Treatment and Health Management Act of 2004. As a 
cosponsor of this important legislation, I look forward to its quick 
enactment. Asthma has had a tremendous impact on our Nation's health. I 
represent the Bronx, Westchester and Rockland County in New York, and 
our community has been hit very hard by asthma, especially our 
children. My family has experienced first-hand the effects of asthma. 
My wife has asthma and two of my kids do as well. So I know how 
important it is that people, especially children, have access to care 
and have the medicine they need when they need it.
  According to the NYC Department of Health in the Bronx, about 25 
percent of children in the Bronx have asthma, as opposed to 15 percent 
nationwide. Hospitalization rates for children are around ten times 
higher than the national average. The Bronx, in particular, leads New 
York City in asthma-related hospitalizations and deaths. Audrey 
Dregante, a Nurse Practitioner at Bronx Lebanon Hospital Pediatric 
Asthma Center has stated that ``Pediatric Asthma is an epidemic in the 
Bronx.''
  There are many factors contributing to asthma that can easily be 
addressed and would save lives and greatly enhance the quality of life 
for so many suffering with asthma. Some of the factors contributing to 
the disease are inadequate housing conditions, such as mold in homes, 
dust mites and insects, and the lack of proper ventilation. The poor 
are less likely to have health care and use emergency room care as 
their primary care provider, and are not getting the proper treatment. 
Low-birth weight babies are surviving in greater numbers and problems 
with lung development may be leading to the rise in asthma cases. Early 
diagnosis and treatment is critical in these instances, as well as pre-
natal care for the poor. The increasing amounts of pollution and 
congestion in urban areas caused by traffic and diesel-powered trucks 
and buses increase the risk for asthma.
  Children in particular have a difficult time with asthma and, as we 
know, proper treatment and control of the disease in crucial. the 
legislation before us today seeks to rectify one situation that is 
preventing children from even carrying their asthma medication. 
Amazingly, many states do not allow kids to self-administer their 
asthma medications in school, which can lead to severe conditions if 
proper treatment is not available in time. New York does allow kids to 
carry and administer their asthma medication. I believe it is 
irrational and irresponsible to prohibit children from having their 
medication readily available. H.R. 2023 would encourage schools to 
allow children to carry their asthma medication by giving those schools 
preference when awarding public health and asthma-related grants. I 
think this is positive legislation that will encourage school districts 
to allow their children to carry and self-administer their asthma 
medicine, which will improve their condition and could save their 
lives. I urge my colleagues to support this legislation.
  Mr. DAVIS of Illinois. Mr. Speaker, I rise today in support of H.R. 
2023, the Asthmatic Schoolchildren's Treatment and Health Management 
Act. Nearly one-third of all people with asthma in our Nation are 
children under the age of 18, according to the American Lung 
Association. This figure translates to more than 6.3 million children. 
Asthma is now the most common, serious, chronic disease among children, 
accounting for 14 million absences from school each year.
  I commend this legislation and believe it is great to allow students 
to self-administer medication to treat that student's asthma. We are 
encouraging the child to control their condition with correct 
management of it as well as giving them the responsibility to go get 
their nebulizer for a breathing treatment or get their inhaler when 
they know they need it. However, we still need to do more for our 
asthmatic children through education and outreach. Doctors say that 
asthma is a disease that can be managed, treated and prevented. Yet 
across our country, in cities like Chicago, there are no centralized 
asthma programs, and many States do not keep an up-to-date count of how 
many children have the disease.
  We have seen asthma continue to strike black children the hardest, 
especially those who live in low-income areas. The 2002 National Health 
Interview Survey, a project of the CDC, found that 12 percent of all 
children under age 18 were asthmatic, and half had suffered an attack 
in the previous year. Black and low-income families get it far more 
often: 18 percent of black children had been diagnosed with asthma, and 
9 percent had suffered attacks, versus 10 and 4 percent for Latino 
children, and 11 and 5 percent for whites. Due to a lack of health 
care, crowded housing, and more exposure to asthma triggers such as 
cockroach feces and dust mites, the asthma rate was also higher for 
children from families whose incomes were less than $20,000 a year.
  Although, most children have mild to moderate problems, and their 
illness can be controlled by treatment at home, too many of our 
asthmatic children are ending up in our emergency rooms. The CDC 
reports that in 1999, 658,000 pediatric emergency room visits were due 
to asthma. The estimated annual rate for emergency room visits among 
children 5 years old or younger is 137.1 per 10,000 persons--the 
highest rate of all age groups. Asthma cost more than $4.6 billion in 
medical care and time lost from school or work. African Americans have 
nearly four times the asthma related emergency room visits as whites 
and are more than three times as likely than whites to be hospitalized 
for asthma.
  Mr. Speaker, unfortunately, Chicago, where I reside, is commonly 
called an epicenter of the Nation's asthma epidemic. I believe that my 
State of Illinois, Chicago and our Congress need to encourage that more 
is done to help our asthmatic children, like education and, as the 
doctors suggest, managing, treating and prevention of this disease as a 
way to keep more of our kids out of the emergency rooms.
  Mrs. CHRISTENSEN. Mr. Speaker, I rise today to join my colleague 
Congressman Cliff Stearns of Florida in the passage of H.R. 2023, the 
Asthmatic Schoolchildren's Treatment and Health Management Act of 2004. 
Mr. Speaker, as a medical doctor I know of nothing more important to a 
patient than the ability to access his/her medication. The bill before 
us today underscores this critical component in the continuum of care 
as it relates to asthma and school-age children.
  I am grateful to Mr. Stearns for introducing this important piece of 
legislation and will be working forward to its impact in African 
American and medically underserved communities. As you know, Mr. 
Speaker, asthma is the 6th-ranking chronic condition in the U.S., and 
the leading serious chronic illness of children in the U.S., and has a 
significant impact on African Americans. Not only do African Americans 
have a higher asthma prevalence rate than Caucasians, but they are also 
more likely to be hospitalized or die due to asthma.
  Data released in 2003 by the Centers for Disease Control and 
Prevention stated that the lifetime prevalence rate is 29 percent 
higher in African Americans than in Caucasians. The asthma attack 
prevalence rate in African Americans is 37 percent higher than in 
Caucasians, and the asthma attack prevalence rates in African-Americans 
are highest among children under the age of 5.
  The CDC also noted that African Americans have nearly four times the 
asthma-related emergency room visits than Caucasians and that African 
Americans are more than three times more likely than Caucasians to be 
hospitalized for asthma. Finally, African Americans are three times 
more likely than Caucasians to die from asthma and more African 
American women die from asthma than any other group.
  A recent study by Guido R. Zanni and Jeannette Wick, entitled 
Counseling Inner-City Youth with Asthma, found that approximately 1 in 
13 school-age children is affected--an increase of 72.3 percent since 
the 1980s. Asthma-related absenteeism amounted to 14 million missed 
school days in 2000.
  The researchers noted that the inner cities have unique challenges 
with asthma-causing agents: Tobacco and cooking smoke, indoor 
allergens, bioaerosols and other air pollutants, respiratory 
infections, and stress. Up to 59 percent of inner-city pediatric asthma 
sufferers live in homes with environmental tobacco smoke. Sensitivity 
to allergens is typical of pediatric asthma. Most inner-city children 
(94

[[Page 20810]]

percent are highly sensitive to inhalant allergens, and 76 percent are 
sensitive to 3 or more allergens. Approximately 36 percent have 
cockroach sensitization. Combining cockroach sensitization with regular 
exposure significantly increases asthma-related hospitalizations, 
emergency room visits, school absenteeism, and lost sleep.
  The researchers noted some of the causes of nonadherence to asthma 
medication regimens by school-age children are created by parental 
health beliefs, the use of multiple care providers, the lack of a 
comprehensive asthma-management plan, psychosocial stressors, 
inadequate attention to triggers and early warning signals, and 
inadequate environmental allergen control. They also noted that many 
schools have a zero-tolerance drug policy, forcing students to smuggle 
and take their asthma medications discreetly or leave their medications 
at home.
  Mr. Speaker, I believe that H.R. 2023 is a step in the right 
direction towards eliminating health disparities by making grants 
available to States, with a preference to States that require public 
elementary and secondary schools to allow students to self-administer 
medication to treat that student's asthma or anaphylaxis under 
specified conditions.
  Again, Mr. Speaker, I believe that this bill is a measure that 
safeguards the health of children with asthma and urge my colleagues to 
support it.
  Mr. ENGEL. Mr. Speaker, asthma has had a tremendous impact on our 
Nation's health. I represent the Bronx, Westchester and Rockland County 
in New York, and we have been hit very hard by asthma, especially our 
children.
  According to the NYC Department of Health, in the Bronx about 25 
percent of children have asthma, as opposed to 15 percent Nationwide; 
hospitalization rates for children are around ten times higher than the 
national average; and the Bronx, in particular, leads New York City in 
asthma-related hospitalizations and deaths. Audrey Dregante, a nurse 
practitioner at Bronx Lebanon Hospital, Pediatric Asthma Center has 
stated that ``Pediatric Asthma is an epidemic in the Bronx.''
  There are many factors contributing to asthma that can easily be 
addressed and would save lives and greatly enhance the quality of life 
for so many suffering with asthma. Many of these factors have to do 
with the economic status of those with asthma and the fact that they 
are not educated on the treatments available. Some of the factors 
contributing to the disease are inadequate housing conditions--
impoverished conditions such as mold in homes, dust mites and insects, 
and the lack of proper ventilation; the poor are less likely to have 
health care and use emergency room care as their primary care provider 
and are not getting the proper treatment; low-birth weight babies are 
surviving in greater numbers, and problems with lung development may be 
leading to the rise in asthma cases--early diagnosis and treatment is 
critical in these instances, as well as pre-natal care for the poor; 
and the increasing amounts of pollution and congestion in urban areas 
caused by traffic and diesel-powered trucks and buses.
  Children in particular have a difficult time with asthma and, as we 
know, proper treatment and control of the disease is crucial. The 
legislation before us today seeks to rectify one situation that is 
preventing children from even carrying their asthma medication. 
Amazingly, many States do not allow kids to self-administer their 
asthma medications in school, which can lead to severe conditions if 
proper treatment is not available in time.
  New York does allow kids to carry and administer their asthma 
medication. I believe it is irrational and irresponsible to prohibit 
children from having their medication readily available. H.R. 2023 
would encourage schools to allow children to carry their asthma 
medication by giving those schools preference when awarding public 
health and asthma-related grants.
  I think this is positive legislation that will encourage school 
districts to allow their children to carry and self-administer their 
asthma medicine, which will improve their condition and could save 
their lives. I urge my colleagues to support this legislation.
  Mr. STEARNS. Mr. Speaker, I yield back the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, 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. 2023, 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.
  A motion to reconsider was laid on the table.

                          ____________________