[Congressional Record (Bound Edition), Volume 155 (2009), Part 9]
[House]
[Pages 11460-11462]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       CONGRESSIONAL BLACK CAUCUS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentlewoman from the Virgin Islands (Mrs. 
Christensen) is recognized for 60 minutes as the designee of the 
majority leader.
  Mrs. CHRISTENSEN. Madam Speaker, it is my honor to be here to host 
this hour on behalf of the Congressional Black Caucus. And we want to 
talk about health care this evening.
  Before the votes, I attended a District of Columbia Black AIDS 
Leadership Mobilization Summit; it was a town meeting held at the 
Kaiser Family Foundation. I want to commend the Congressional Black 
Caucus Foundation, the Black AIDS Institute, the Kaiser Foundation, 
NAACP, National Urban League, the YWCA, Southern Christian Leadership 
Conference, the National Council of Negro Women, Us Helping Us, The 
Women's Collective, Balm in Gilead, the National Black Leadership 
Commission on AIDS, Phi Beta Sigma, the National Medical Association, 
and all of the associations which came together to address the epidemic 
in the District of Columbia and around the country.
  On March 16 of this year, the D.C. AIDS Office released its latest 
HIV surveillance report. And what it showed was that the HIV rate in 
the Nation's capital is the highest in the country, and that an 
estimated 3 percent of the population is affected with AIDS. One 
percent would make it an epidemic, so it is of epidemic proportions 
here in the District.
  The D.C. rate of infection is higher than 28 African countries. The 
infection rate puts Washington, D.C. on a par with Uganda. So this is 
an issue that really must be addressed. This is our Nation's capital. 
The Congress has responsibility for the capital, Madam Speaker. I made 
a commitment while I was there that the Congressional Black Caucus 
would work to ensure that this Congress takes that responsibility 
seriously and addresses this serious epidemic that exists in the 
Nation's capital.
  I wanted to mention a couple of things this evening, Madam Speaker. 
Yesterday, Nicholas Kristof wrote a column in the New York Times that 
ought to give us all pause. In it he addresses an issue that many of us 
on the Committee on Homeland Security have raised many times--and I am 
sure Chairman Bennie Thompson continues to work to address--and that is 
the deficient public health system in this country, especially in rural 
communities, in poor communities, and communities of color. I raised 
the issue at the H1N1 hearing in the Health Subcommittee on Energy and 
Commerce last week. I just want to share a few quotes from the article.
  Nicholas Kristof says, ``The flu crisis should be a wake-up call, a 
reminder that one of our vulnerabilities to the possible pandemic is 
our deeply flawed medical system.'' And he quotes from Deborah Burger, 
the co-president of the California Nurses Association, the National 
Nurses Organizing Committee, who says, ``From SARS to avian flu to the 
current escalating outbreak of swine influenza, it has become 
increasingly clear that we are risking a major catastrophe unless we 
act to restore the safety net.''
  Mr. Kristof continues, ``Think of the 47 million Americans who lack 
insurance. They are less likely to receive flu vaccines''--which might 
or might not help,'' he says--``less likely to receive prompt care when 
they get sick, and less able financially to stay home from work. And, 
thus, they are more likely to both die and spread the virus 
inadvertently.''
  He also goes on to say--which is something that we have brought to 
the attention of the Department of Health and Human Services and the 
Department of Homeland Security--``hospitals lack spare beds, 
ventilators, and staff to cope with an epidemic. One study found that a 
flu epidemic would mean that 10 million Americans would need to be 
hospitalized compared with a total of nearly 1 million beds in America, 
about two-thirds of them occupied.
  ``Last year, Chairman Waxman ordered a review of surge capacity,'' 
reports Mr. Kristof, ``in hospitals available for a terror attack. What 
was the surge capacity? He found that more than half of the emergency 
rooms studied were already operating above capacity.''
  The last quote that I want to bring to your attention from this op-ed 
is a quote that he uses from Dr. Redlener, the director of the National 
Center for Disaster Preparedness at Columbia University's Mailman 
School of Public Health. And Dr. Redlener says, and I agree, ``If a 
severe pandemic materializes, all of society would pay a heavy price 
for decades of failing to create a rational system of health care that 
works for us all.''
  A few years ago, we had a Dr. Stephen Wolf from Virginia Commonwealth 
University come and talk to us about a report that he did on health 
care and the discrepancies, the disparities, the gaps in health care 
that the poor rural Americans, Americans of color face. I would like to 
use this quote and share it with you. He says, ``In the end, however, 
it all comes down to priorities. Perhaps we have reached a point when 
progress in providing good care when needed, with compassion and skill 
and without errors, would impress the public as a more meaningful 
medical advance than the rollout of the latest device or pill.'' He 
says, ``failing to establish systems to

[[Page 11461]]

ensure that everyone receives recommended care is causing greater 
disease and deaths at levels that can rarely be offset by medical 
advances.''
  So as we look at the spread of H1N1, this is a call to action to 
really fix the public health system in this country and make sure that 
every community has the kind of infrastructure it needs to address not 
only epidemics, but the everyday illnesses that the people in those 
communities suffer from.
  But we do have an opportunity to address this health care system and 
to address health disparities. The Congressional Black Caucus--which 
has always had the elimination of health disparities as one of its main 
priorities--really welcomes the new political and policy dynamics that 
are currently shaping health care in this country. Because after all of 
the years and money spent on disease entities, we have only made slight 
progress. And even where improvements have been made, the gaps between 
people of color and the white majority have either remained the same or 
the gaps have widened.
  According to testimony given at the Health Subcommittee on Energy and 
Commerce by Dr. Brian Smedley of the Joint Center for Political and 
Economic Studies, he says, ``Access to high-quality health care is 
particularly important for communities of color because deep-held 
status gaps persist among U.S. racial and ethnic groups.'' He goes on 
to say, ``While the Nation has made progress in lengthening and 
improving the quality of life, racial and ethnic health disparities 
begin early in the life span and exact a significant human and economic 
toll.'' He gives us some examples: ``The prevalence of diabetes among 
American Indians and Alaskan natives is more than twice that for all 
adults in the United States. Among African Americans, the age-adjusted 
death rate for cancer is approximately 25 percent higher than for white 
Americans.''
  Although infant mortality, he said, ``decreased among all races 
during the 1980 to 2000 timed period, the black and white gap in infant 
mortality widened.

                              {time}  2045

  ``While the life expectancy gap between African Americans and whites 
has narrowed slightly, African Americans can still expect to live 6 to 
10 fewer years than whites and face higher rates of illness and 
mortality.''
  He goes on to say, ``In terms of lives, this gap is staggering. A 
recent analysis of 1991 to 2000 mortality data concluded that had 
mortality rates of African Americans been equivalent to that of whites 
in that time period, over 880,000 deaths would have been averted.''
  So we welcome and intend to be a part of shaping health care reform. 
And, of course, it does start with universal coverage because here are 
some other statistics:
  Racial and ethnic minorities, although we account for about one-third 
of the U.S. population, account for more than half of the uninsured. 
Racial and ethnic minorities are more likely than whites to report not 
seeing a specialist when it was needed, foregoing needed health care 
because of the costs, and not being insured, they don't have a usual 
source of care. More than five of 10, 55 percent, Hispanics, four in 10 
African Americans were uninsured for all or part of 2007 and 2008, 
compared with just two in 10, or 25 percent, in whites. In total, more 
than three in every four people of color, 76 percent, were uninsured 
for 6 months or more in 2007 and 2008. That data, I believe, comes from 
Families USA.
  So the Congressional Black Caucus is looking at how we would like to 
see universal coverage provided. Of course, we feel that everyone must 
have coverage, and we insist that there be a public option. We have 
joined the Congressional Hispanic Caucus and the Asian Pacific Caucus 
in calling for a public option, and we will support a bill if it has a 
public option.
  But also, and this is a concern that I have, we also need to ensure 
that we don't end up with the same kind of two-tiered system that we 
have today, one for the poor and one for everyone else, even when we 
have a public system. So we either need to figure out a way that that 
public system serves the poor and everyone else where the government 
may pay in for those who are at a certain level of poverty and the 
others pay in through subsidies that are done on a sliding scale or pay 
for it fully, or we need to fix the Medicaid program because the care 
that patients who have Medicaid who actually have access to health care 
is not equal and the outcomes are poorer than those who are insured, 
and in some cases it's the same or poorer than even the uninsured.
  So ensuring that everyone is covered is critically important. It's 
critically important for African Americans and other people of color, 
who bear a disproportionate burden of disease in this country, but it's 
important to every American because to the extent that so many people 
in this country remain uninsured, it adversely affects health care for 
everyone.
  But insurance is just the beginning of what needs to be done to close 
the health disparities gap. For example, insured African American 
patients are less likely than insured whites to receive many 
potentially lifesaving or life-extending procedures such as high-tech 
care like cardiac catheterization, bypass graft surgery, or even kidney 
transplantation. And the IOM report of 2002 showed us that even when 
everything else is equal, educational level, economic level, and 
insurance, African Americans and other people of color get less care. 
Black cancer patients fail to get the same combinations of surgical and 
chemotherapy treatments that white patients with the same disease 
presentation received. African American heart patients are less likely 
than white patients to receive diagnostic procedures, revascularization 
procedures, and thrombolytic therapy, even when they have similar 
incomes, insurance, and other patient characteristics.
  Even routine care suffers. Black and Latino patients are less likely 
than whites to receive aspirin upon discharge following a heart attack; 
to receive the appropriate care for pneumonia; and to have pain, such 
as the kind resulting from broken bones, appropriately treated. 
Minorities are more likely to receive undesirable treatment than 
whites, such as limb amputation for diabetes.
  To so begin to address these, the TriCaucus, which includes the 
Congressional Black Caucus, the Congressional Hispanic Caucus, and the 
Congressional Asian and Pacific Island Caucus, will be reintroducing 
the Health Equity and Accountability Act, which we have introduced in 
the last three Congresses and for which we had hearings held in both 
the subcommittees of Ways and Means and Energy and Commerce last year. 
The bill takes a comprehensive approach and will have budget impact, 
but we are talking about reforming a broken health care system, one 
which many call a ``sick care system.'' And I really think it needs 
more than reforming; it needs a transformation.
  Among the provisions, the bill includes those that would bolster 
efforts to ensure culturally and linguistically appropriate health care 
and remove language and cultural barriers to health care. It would 
improve workforce diversity, strengthen and coordinate data collection, 
ensure accountability and improve evaluation, and improve health care 
services especially for those diseases that are causing the 
disparities.
  But today, after the limited progress we've made in eliminating these 
disparities, we know that in addition to doing all of those things, 
collecting data, increasing the diversity of our workforce, increasing 
accountability, providing for comprehensive programs of care to address 
some of those diseases that cause the gaps and cause people to die 
prematurely from preventable causes, we know that in addition to 
addressing the gaps in the many disease entities that we also have to 
turn our country's focus to disparities in its broader context to the 
pervasive, persistent social determinants or primordial determinants of 
the poor health of our communities. If we don't address these, the root 
causes, the totality of the environments in which we live and suffer 
from this ill

[[Page 11462]]

health, we will never achieve wellness. So if we are to be healthy and 
achieve our optimal health, it's here also that change must occur. That 
is to ensure that the environments in which we live support the 
elimination of health disparities and support good health and our 
overall well-being.
  I think the country is fortunate, and I know the country also 
understands how fortunate it is, and I'm blessed to work with the 
Congressional Black Caucus, where 42 diverse individuals with expertise 
and focus in many different areas such as health, education, economic 
development, job creation, workers' rights, environmental justice, 
housing, and all of the factors that are the underpinnings of our 
health, as a group, we work as a cohesive unit to improve the well-
being of our communities and of all Americans. So I look at our entire 
Congressional Black Caucus agenda as a health agenda because we work on 
the broad agenda that is critical to closing the health gap and 
ensuring that all Americans have access to wellness.
  And it's critical that we do this because the real things, the things 
that underlie our poor health, the things that are really killing us 
are factors like an overabundance of liquor stores in black and Latino 
and poor communities; the flooding of everything we see, read, and hear 
with tobacco advertising; intractable poverty and the way it fosters 
depression, drug abuse, and crime, creating neighborhoods where it's 
impossible to go outdoors and exercise, as we know we must; the refusal 
of businesses, including grocery stores and really medical entities as 
well, to come into poor and communities of color, where pharmacies that 
are there stock and dispense less pain medicine, regardless of how much 
pain the individual is having just because we're in a poor neighborhood 
that is made up mostly of racial and ethnic minorities; the profiling 
by the criminal justice system that makes some people wrong just 
because of the color of their skin or puts the mentally ill into the 
criminal justice system rather than into treatment; the racism and 
discrimination that denies racial and ethnic minorities the same 
quality of health care that I spoke about earlier that others take for 
granted and that pays less in our neighborhoods and so provides a 
strong and effective disincentive for hospitals and the other providers 
we need to come into our communities and stay there; the fact that too 
many of those providers that we do have don't understand our culture or 
our language; and all of the many assaults on our very humanity that 
weakens the well-known strength of spirit and the will to do the things 
that we know will improve our health and our quality of life. All of 
this is still not fully on the radar screen of most who set and 
implement policy, and this is something else that we must change.
  Yet communities around the country, with or without our help, are 
taking on some of these issues and creating miracles and making 
dramatic changes in people's lives. We intend to help these communities 
and other communities become agents of change and to develop not just a 
better system of health delivery but an entire culture and environment 
of wellness.
  Today I introduced the Health Empowerment Zone bill, through which we 
plan to give these communities the resources and the technical 
assistance that they need to improve their health and well-being. 
Through this bill communities can apply. The Department of Health and 
Human Services would provide the technical assistance and some 
resources to help that community form a community coalition to identify 
their health care challenges, to do a community assessment and to 
develop a strategic plan. Then the community would apply for 
designation as a health empowerment zone, and if they're so designated, 
they would have the opportunity to be a priority for programs that 
already exist in our government.
  So this bill will not be a costly bill. We're talking about a little 
bit of startup money to these communities and, more than that, 
technical assistance to help them to do their community assessment and 
do their plan, and the help that they will get to implement that plan 
and turn around their community and make it a place where people can be 
well would come from programs that already exist. These communities 
would just have priority, and this is an attempt for us to address the 
social determinants of health, which we all know are critical if we are 
going to eliminate disparities and create healthy communities and a 
more healthy country. So we intend to help these and other communities, 
as I said, and we introduced that bill today.
  Last week we held our Spring Health Brain Trust with the National 
Minority Quality Forum, and the messages that came from that meeting 
were very clear: Our health care system needs not just reform; it needs 
transformation. It will require an investment that goes beyond 
providing universal coverage because we have seen through many reports, 
the IOM and many more research papers, that minorities, people who 
speak a different language, people of color, even when they are 
insured, don't get the kind of care that the rest of the population 
gets. The message came loud and clear that we need to reform Medicaid 
and ensure that that access really provides quality health care.
  And, lastly, I would say that the message that we'd like to send out 
of that is that we know that it will cost a fair amount of money, but 
it's our health that we are talking about. We know that many people 
think or many of the pundits say that perhaps our President is trying 
to do too much, but we say we need all of it. And we stand with our 
President as he calls on us to reform our health care system or, 
rather, transform our health care system and ensure that quality health 
care is accessible, available to each and every American.
  I just want to close with another quote from the Closing the Gap 
Report that was written in 2005 that addresses the issue of health 
inequities, and the quote says: ``Inequities within the health care 
system and within larger social, environmental, and economic structures 
persist not because of a dearth of solutions but because of a failure 
of political will.'' And I call on my colleagues to let us develop that 
political will. Let us eliminate disparities that are causing the 
premature death of people of color, poor, and rural Americans in this 
country, and let's transform our health care system so that everyone 
has access to quality, comprehensive health care.

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