[Congressional Record (Bound Edition), Volume 159 (2013), Part 5]
[House]
[Pages 6210-6219]
[From the U.S. Government Publishing Office, www.gpo.gov]




                CBC HOUR: ELIMINATING HEALTH DISPARITIES

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2013, the gentleman from Nevada (Mr. Horsford) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. HORSFORD. Mr. Speaker, thank you.
  We are pleased to come to this body at this time for this hour of 
power with the Congressional Black Caucus. This evening, we'd like to 
focus on eliminating health disparities in America.
  Health is a cornerstone of equal opportunity, which is why access to 
quality, affordable care is so important. Sickness not only decreases 
individual and social productivity, but without access to health 
resources, many get sick and never truly recover. Over this next hour, 
members of the Congressional Black Caucus will discuss our priorities, 
working together with the President, our colleagues on the other side 
and throughout this body, and in the other Chamber, to address the 
needs of health care for all Americans, and specifically to eliminate 
the health disparities in the African-American communities.
  I'd like to recognize the chair of the Congressional Black Caucus. 
Under her leadership, the CBC is advancing a number of priorities 
during this 113th Congress. I yield to the gentlelady from Ohio, 
Chairwoman Fudge.
  Ms. FUDGE. I thank the gentleman for yielding, and I want to thank my 
colleagues, both Congressmen Horsford and Jeffries, again for leading 
the Congressional Black Caucus Special Order hour. This hour is to 
discuss health disparities. You both have done an incredible job 
carrying the message of the CBC on the House floor each week, and I 
thank you.
  Mr. Speaker, the health disparities between African Americans and 
other racial and ethnic populations are striking. When compared with 
the country as a whole, African Americans are three times more likely 
to die from diabetes. We account for about 44 percent of all new HIV 
infections among adults and adolescents, despite representing only 
about 13 percent of the U.S. population. African-American men can 
expect to live approximately 6 years less than White men. African-
American women are twice as likely to give birth to low-weight infants, 
and our children are almost five times more likely to be hospitalized 
for asthma.
  Though health disparities manifest in life-threatening ways, such as 
lower life expectancy and higher disease rates, the root cause is 
poverty. Where you live and how you live have a direct effect on how 
long and how well you live. Until we address the persistent poverty 
that plagues our communities, the debilitating cost of health 
disparities will continue to rise.
  According to the Joint Center for Political and Economic Studies, 
health disparities collectively cost minorities more than $1.24 
trillion from 2003 to 2006. We must create and maintain a path toward 
greater health equity in America. We can't afford the status quo.

[[Page 6211]]

  Thankfully, a path to equity has begun to take shape, a path that 
reduces the rates of illness and premature death and increases access 
to quality health care. The solution was and is the Affordable Care 
Act--or, as it is known to many, ObamaCare. We are proud to call it 
ObamaCare because it proves that the President and many in this 
Congress really do care about the health of Americans.
  ObamaCare has already begun to lower the cost of health care by 
providing financial relief for consumers, increasing insurance options, 
investing in preventative and primary care, and placing a focus on 
minority health. The ACA helps decrease health disparities by 
collecting data, strengthening cultural training, and increasing 
diversity in the health care field. These investments are critically 
important and will strengthen America's financial future.
  Some on the other side of the aisle believe the status quo is 
sufficient, that health disparities are not real. Some don't believe 
that the impact of disparities on families is devastating. That's why a 
number of Republicans are again calling for the repeal of the ACA. How 
many times do we have to play this game?
  The CBC will continue to stand up, speak out and defend the 
Affordable Care Act against all of those who oppose it for political or 
ideological reasons. Attaining health equity is to the benefit of all 
Americans, and is not only consistent with the American promise of 
opportunity, but it is critical to the future of Black America.
  Mr. HORSFORD. At this time I would like to recognize the vice 
chairman of the Congressional Black Caucus, a leader on a number of key 
issues that the Congressional Black Caucus is facing this 113th 
Congress, the gentleman from North Carolina (Mr. Butterfield).
  Mr. BUTTERFIELD. Let me thank you, Mr. Horsford, for yielding time 
this evening, and thank you for your leadership not only here in the 
Congress but in the Congressional Black Caucus. You have come to this 
Congress, and you've done so much in such a short period of time. Thank 
you, Mr. Jeffries and Ms. Fudge as well, for your leadership.
  But, Mr. Speaker, I want to start this conversation this evening by 
talking about a 1985 report. President Ronald Reagan was President at 
the time, and the U.S. Department of Health and Human Services issued a 
statement. They called health disparities in the United States of 
America ``an affront both to our ideals and to the ongoing genius of 
American medicine.''
  It's disgusting, Mr. Speaker, that in this year, 2013, health 
disparities still exist in the richest and most powerful country in the 
world. African Americans are disproportionately less healthy. Life-
threatening diseases like high blood pressure, diabetes, and heart 
disease are ravaging our population.
  Oftentimes African Americans that live in rural communities, like the 
one that I represent in North Carolina, don't have insurance, and they 
have difficulty finding a regular primary care doctor, and so they go 
without an annual physical or regular checkups. Sometimes their only 
interaction with a health care provider is when they call 911 because 
their unchecked blood pressure resulted in a heart attack or stroke. By 
then it's too late. If that same person suffering from a stroke would 
have had access to care, their high blood pressure may have been 
diagnosed early.

                              {time}  1940

  They may have been put on medication meant to regulate their 
condition, making a heart attack or stroke less likely.
  Many African Americans do play an active role in their health care, 
but the quality of the care they receive can be much worse than their 
white counterparts, further widening the gulf of disparities.
  A significant driver of these disparities is the lack of health 
insurance, and that's what the gentlelady spoke about a moment ago. 
African Americans make up 13 percent of the entire population, but 
account for more than 50 percent of all people who are uninsured.
  African Americans are also likely to have disproportionately lower 
access to primary care and often receive poorer quality care and face 
more barriers in seeking treatment for chronic-disease management.
  The Affordable Care Act that we're all so proud of was designed to 
put a premium on quality of care, increase access, and encourage and 
reward good health care outcomes. I am a strong supporter of the 
Affordable Care Act, and my constituents in North Carolina are as well.
  Every person should have access to affordable quality health care, 
regardless of who they are, where they come from, or how much money 
they have in their bank accounts.
  Before the Affordable Care Act was signed into law, 50 million people 
lived without health insurance. An additional 38 million people had 
insurance, but it was woefully inadequate and charged them exorbitant 
coinsurance payments and huge copays and completely unmanageable out-
of-pocket expenses, essentially making them uninsured too. That means 
nearly one-third of all Americans were without the very basic insurance 
needed to see a health care professional and receive care at an 
affordable price.
  When President Barack Obama proposed, and Congressional Democrats 
introduced, the Affordable Care Act, Republicans stirred up for a 
battle. And they would scream in the town hall meetings all across the 
country, and even right here on this House floor, about how the bill 
would create death panels that would decide if a person was worthy of 
receiving treatment for a particular disease. That was not correct.
  They would insist that the bill would cut hundreds of millions of 
dollars from Medicare. Not correct. In fact, the Affordable Care Act 
specifically prohibits cuts to the guaranteed Medicare benefits.
  They would bring out charts on this floor and graphs that showed how 
the Affordable Care Act will be a ``job killer'' worse than we have 
ever experienced before. That turned out to be a lie.
  The cost of health care has risen each year, insurance coverage has 
decreased each year, and the amount of uncompensated care has increased 
every year.
  Mr. Horsford, here's a statistic that really stands out with me: in 
1970, the United States spent $75 billion on health care. That was 7.2 
percent of GDP. In 2010, health care spending represented 17.9 percent 
of GDP and, if not for the Affordable Care Act, was expected to reach 
20 percent by the year 2020.
  The U.S. spends more of its dollars for health care-related expenses 
than any other country in the world, and the uncontrolled rise in the 
cost of health care would have been completely unsustainable if not for 
ObamaCare.
  President Obama signed the Affordable Care Act into law and, with the 
stroke of a pen, revolutionized health care in America. Insurance 
companies can no longer deny coverage to people with preexisting 
conditions or charge them more than anyone else. There is now no 
lifetime dollar limit on what insurers will pay for claims.
  Preventative visits to health care providers are now free, yes, free, 
and even include some free vaccinations. Young adults can now stay on 
their parents' policy until they're 26 years old. And all new group 
health plans now have to cover all recommendations by the U.S. 
Preventative Services Task Force.
  Now, millions of people in our country, and in my congressional 
district and, Mr. Horsford, in your congressional district, who were 
living without the most basic health insurance can benefit from the 
most advanced health care technology in the world.
  My only disappointment, Mr. Speaker, is that some of our Republican 
Governors and State legislatures across the country are refusing to 
participate in the expansion of Medicaid. Shame on them.
  Mr. Speaker, in closing, I am confident that because of the 
Affordable Care Act the delta of health disparities in America will 
begin to shrink. No

[[Page 6212]]

matter the color of your skin or the amount of money you have, each and 
every American deserves high-quality health care so they can live long 
and prosperous lives.
  Mr. Horsford, I thank you so very much for yielding time.
  Mr. HORSFORD. Thank you, Mr. Vice Chairman, and thank you for your 
leadership and commitment on these issues. And I know we will continue 
to fight and advocate for the preservation of the Affordable Care Act 
and, as you indicate, the proper implementation of that act with the 
expansion of Medicaid and the other key provisions of the law which we 
need our local and State partners to work with us in providing quality 
health care for all Americans.


                             General Leave

  Mr. HORSFORD. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks on the 
subject of this Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Nevada?
  There was no objection.
  Mr. HORSFORD. At this time I'd like to yield to the chair of the 
Congressional Black Caucus' Health Brain Trust, the doctor in the 
House, the person who knows more about health care than most, the 
honorable gentlewoman from the Virgin Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. Thank you, Mr. Horsford. Thank you and our other 
colleague, Mr. Jeffries, for hosting these Special Orders every week. 
It's been with great pride that we've watched our young new Members 
come to the floor and present the case so forcefully and so effectively 
to the American people and the disparities in all areas that African 
Americans and other people of color and the poor are facing.
  Before I start, Representative Barbara Lee of California could not be 
with us this evening, but her work on HIV and AIDS, and other areas in 
health care, but specifically in HIV and AIDS, both here in the United 
States and across the globe, is worthy of recognition; and I know that 
she'll be entering a statement for the Record on some of the issues 
around HIV and AIDS.
  I want to just go back a little bit and present a little bit of 
historical context on just how long this battle to eliminate health 
disparities has been going on. I'm going to go back--of course, it goes 
back to slavery, but I want to go back to W.E.B. DuBois in 1899, when 
he said, and I'm quoting:

       There have been few other cases in the history of civilized 
     peoples where human suffering has been viewed with such 
     peculiar indifference.

  And then 25 or so years later, and this was mentioned by Congressman 
Butterfield, in 1985, the Heckler Report, where it was said, and I'm 
quoting here:

       There was a continuing disparity in the burden of dealt and 
     illness experienced by blacks and other minority Americans as 
     compared with our Nation's population as a whole.

  And as he said:

       The stubborn disparity remained. The stubborn disparity 
     remained an affront to both our ideals and the genius of 
     American medicine.

  Surgeon General Heckler was very surprised by what that report found, 
but when she asked her researchers, well, why is this, the only answer 
that they could give her is, it's always been that way.
  And so that stubborn indifference that W.E.B. DuBois mentioned in 
1899 continued into as far as 25 years later.
  Almost 20 years later, the IOM issued its unequal treatment report 
which said:

       In unassailable terms, the report found that even when 
     insurance and income are as the same as those of whites, 
     minorities often receive fewer tests, less sophisticated 
     treatment for a panoply of ailments, including heart disease, 
     cancer, diabetes and HIV/AIDS.

  So even when you have insurance, even when your educational level, 
even when your income is the same, you are still not getting the same 
treatment. And so it's no wonder that African Americans and other 
people of color have suffered from disparities for so long.
  So in 2003, led then by Jesse Jackson, Jr., we insisted that there be 
a report every year on health disparities, a national report. And the 
very last one, so we're in our 11th year now, well, we're in our 10th 
year now, and the very last report shows very little change.

                              {time}  1950

  It showed that blacks received worse care--it talks about quality--
than whites for 41 percent of quality measures. Hispanics receive worse 
care than non-Hispanic whites for 39 percent of measures. Asians and 
American Indians and Alaskan Natives receive worse care than whites for 
nearly 30 percent of quality measures. And in terms of access, blacks 
had worse access to care for 32 percent of access measures, Asians for 
17 percent, American Indians and Alaskan Natives for 62 percent, and 
Hispanics 63 percent of the measures.
  So as we look over the years from 1899 to 2011, which is what this 
report is on, there has been very, very little change. Among the themes 
that emerge from the report, health care quality and access are 
suboptimal, especially for racial and ethnic minorities, and this is in 
2011. I'm sure the report this year is not going to be any different. 
Quality is improving, but disparities are not improving.
  There are several areas where disparities are worsening over time 
between minorities and whites. Those are maternal deaths in the black 
population and breast cancer diagnosed at an advanced age for women in 
the black population. Children zero to 40 pounds--their families are 
not getting advice in the Asian population about seatbelts. Adults over 
50 not receiving colonoscopy, sigmoidoscopy or anything in the American 
Indian and Alaskan Native populations.
  So when looking at these reports coming back the same way year after 
year, the Tri-Caucus, the Black, Hispanic and Asian Caucus, when we 
began to debate the Affordable Care Act and to write the Affordable 
Care Act, we came together and said health equity had to be a major and 
core goal of health care reform. We were able to insert into the bill 
many of the provisions that we had worked on for many years to create 
health equity and to begin to eliminate health disparities. So we call 
on all people across the country to support us and make sure that all 
of those attempts to repeal the Affordable Care Act, which would close 
the door that we have been able to open for so many who have not had 
access to quality health care for so long--that door would not be 
closed again.
  Mr. HORSFORD. Thank you again to the gentlelady from the Virgin 
Islands and the chair of the Congressional Black Caucus' health brain 
trust for laying out, again, the hard work that the Congressional Black 
Caucus has been involved with for many years in getting to the point 
with the Affordable Care Act now on the cusp of being fully implemented 
in January of 2014. So when our colleagues on the other side spend time 
bringing up legislation to repeal the Affordable Care Act now more than 
30 times after this legislation has been approved by Congress, it has 
been upheld by the courts, it has been signed by the President, and the 
American public are desperate for quality health care--that is why we 
are coming here today to say enough is enough. Thirty times to repeal 
the Affordable Care Act--how many more times will we waste the 
people's, House's and our time bringing these issues forward when we 
need to be working together to implement the Affordable Care Act in the 
way that it is intended?
  At this time, I would like to yield to the second vice chair of the 
Congressional Black Caucus. She is a strong leader for her 
constituents, the gentlelady from New York (Ms. Clarke).
  Ms. CLARKE. Thank you, very much, Congressman Horsford, and I thank 
you for your leadership along with Congressman Jeffries in leading the 
Special Order hour for the Congressional Black Caucus.
  Mr. Speaker, I rise today to join my colleagues in the Congressional 
Black Caucus to raise awareness about health disparities that continue 
to affect racial and ethnic minorities in the

[[Page 6213]]

United States of America. Despite medical advances that save many lives 
in our country, there has been very limited progress in ending the 
racial and ethnic disparities in health. In a 1985 report, the United 
States Department of Health and Human Services called health 
disparities in this country ``an affront both to our ideals and to the 
ongoing genius of American medicine.'' Now, decades later, health 
disparities still exist between black and white and rich and poor.
  A primary reason for these disparities is, quite frankly, the lack of 
health insurance that has been a problem for all these many years. For 
instance, African Americans make up 13 percent of the entire population 
but account for more than half of all people who are uninsured. Blacks 
also have disproportionately lower access to primary care and face more 
obstacles in seeking treatment.
  Across our Nation, health disparities continue to persist and widen 
in communities historically marginalized as a result of poverty and 
other social, economic and environmental barriers. These communities 
are experiencing a high burden of life-threatening diseases and poor 
health outcomes.
  Population-based approaches such as recent efforts to reduce 
childhood obesity rates, while showing evidence of success, have been 
primarily focused on white children in affluent communities. For 
example, in a report released in 2012 by the CDC, New York showed an 
overall decline of as much as 10 percent in obesity rates for 
kindergartners. However, for poor black children, the decline was only 
1.9 percent, and for Hispanic children it was 3.4 percent.
  In my district in Brooklyn, New York, I represent a very large number 
of immigrants. Close to 40 percent of the residents are first- and 
second-generation Americans. Culturally significant and linguistically 
tailored education is required to address health disparities. This 
education is one of the building blocks upon which improvements in 
early detection and screening in these communities have been built.
  Health disparities are a serious matter. According to the National 
Urban League's State of Urban Health report, in 2009, health 
disparities cost the United States economy $82.2 billion. I firmly 
believe in prevention and addressing health disparities, and that it 
will go a long way in bringing these costs down. It is important that 
we fully engage in a full implementation of the Affordable Care Act. 
This will lead us to closing these disparities, this health disparity 
gap.
  I look forward to working with my colleagues in the Congressional 
Black Caucus and, quite frankly, all Members of goodwill to find solid 
solutions to addressing health disparities in communities of color 
across this Nation.
  Having said that, Mr. Speaker, I thank you for the time.
  Mr. HORSFORD. Thank you to the gentlelady from New York, and I 
appreciate, again, all of her hard work and her commitment on these 
issues and her willingness to, again, reach across the aisle as you 
said. We are here to work with anybody who wants to work with us to 
find solutions to the health care crisis that exists in America. But we 
need them to understand that voting to repeal the Affordable Care Act 
is not that solution. There are many more things that we can do 
together to provide access to health care than we can by repealing this 
very important legislation.
  At this time, I would like to recognize, Mr. Speaker, the gentleman 
from Illinois (Mr. Davis).
  Mr. DANNY K. DAVIS of Illinois. Mr. Speaker, I want to first of all 
commend our colleagues for coming here every week raising issues and 
promoting awareness. Tonight it is health care, health care 
disparities.
  I believe that the big problem with the eradication of the 
disparities is the fact that we, as a nation, have not committed 
ourselves to the concept that health care ought to be a right and not a 
privilege. As the most technologically proficient nation on the face of 
the Earth, as the wealthiest nation with a quality of life for large 
numbers of people--that is commendable--we still have not reached the 
point where we take the position that every person, no matter what 
their status or circumstance, deserves the highest quality of health 
care that our Nation can afford for them.

                              {time}  2000

  So until we reach that point, we will continue to have studies and 
reports and we will continue to look at disparities, and we'll keep 
doing it and doing it and doing it and doing it again.
  We will have legislation like the Affordable Care Act that is 
designed to close some of the gaps. And it does, in fact, close some of 
the gaps, and it's commendable that we have done that.
  But I maintain that we have a health care system that really is a 
sickness care system. We do a good job of treating illnesses and 
sickness when people can get to the places where they get the 
treatment.
  I had a call yesterday from a person who suggested that they had gone 
to the emergency room at the hospital and were given two Tylenol and 
sat in a room for a good period of time. When they inquired of the 
hospital why they had done that, they told them, Well, it's because of 
the ObamaCare; that ObamaCare is causing this to happen to you.
  Now, the person actually has been on Social Security disability for a 
long time, before there was any ObamaCare and there was a way to pay 
for their health care, and somebody took the opportunity to 
misrepresent ObamaCare. I would hope that people would not, especially 
people in the industry, people in the business, would not do that.
  But I also urge individual citizens to take more responsibility for 
our health. You know, there's still disparities in smoking, still 
disparities in drinking too much alcohol, still disparities in not 
having the appropriate diet or the exercise that is needed. So we've 
got to tack on several fronts. We've never put enough resources into 
the systems to make sure that they work properly and appropriately. We 
need to put more money into health education, health promotion, health 
awareness, so that individual citizens have a greater understanding of 
what it is that they individually can do.
  Of course, people who know me know that I promote community health 
centers as the best way of providing ambulatory health care to large 
numbers of low-income people more effectively than anything else we've 
come up with, with the exception of Medicare and Medicaid, in a long 
time. I still promote these institutions as being one of the best ways 
in local communities of having health care delivery where people 
themselves are involved. These centers provide jobs and work 
opportunities and help keep the money in the neighborhood so that the 
impact of poverty is not as great as it would be.
  So, Mr. Horsford, again, I want to thank you; I want to thank Mr. 
Jeffries; and I want to commend the caucus for raising the issues, 
promoting awareness, and helping, hopefully, to develop a different 
level of understanding. Health care ought to be a right and not a 
privilege.
  Mr. HORSFORD. I'd like to thank the gentleman from Illinois and, 
again, just to highlight, as you indicated, the community health 
centers as an important provision of support within the health care 
delivery system.
  Both rural and urban communities suffer from the disproportionate 
distribution of health care resources and access to care. Community 
health care centers play an important component in overcoming that 
care, providing millions of health care services, particularly to 
people of color, access to high-quality and affordable care in both 
rural and urban areas.
  I know in my own district, in Nevada's Fourth Congressional District, 
we have 14 health centers throughout our region. From my rural parts to 
the urban parts, these are very important areas. But unfortunately, 
under the sequester, Mr. Speaker, these are still areas that are under 
attack because cuts to these health care centers are still being 
imposed because of the uncertainty of the sequester.
  In my district, Nevada health centers, they're looking at over 
$700,000 worth of reductions between now and

[[Page 6214]]

September; elimination of nursing positions and elimination of services 
for children and seniors at a time when people are sick and they need 
it the most.
  So I would hope that, again, we can work together with Members on the 
other side to come up with solutions to replace the sequester and to 
fully fund community health centers, who are providing such good care 
to our citizens at this time.
  I would like to yield now, Mr. Speaker, to the gentlelady from Texas, 
Congresswoman Sheila Jackson Lee.
  Ms. JACKSON LEE. I thank the conveners of this Special Order and 
express my appreciation to Mr. Horsford and to Mr. Jeffries for 
continuing to educate our colleagues on extremely important issues. And 
I'm delighted to join the Congressional Black Caucus as it proceeds 
continuously to ensure that we advocate for those who cannot speak for 
themselves.
  I want to take up an issue that has struck home and is being 
confronted by many States, some of which are in the South and some are 
in other places throughout the Nation. I was very pleased to stand with 
my fellow Democrats and support the Affordable Care Act. I could go 
through the journey of 2009 and 2010, when many of us spread out across 
the country and confronted misinformation through town hall meetings, 
controversy, and conflictedness.
  I think that what should be continuously emphasized as the 
President's leadership on one single point: that although health care 
was not listed, per se, in the Constitution, it should be a 
constitutional right. If you read the words or quote the words of the 
Declaration of Independence, we hold these truths to be self-evident, 
that we have certain unalienable rights of life, liberty, and the 
pursuit of happiness, one might argue that education and health care 
fall into those provisions of life, liberty, and the pursuit of 
happiness.
  It was in the context of that framework in the original words of the 
Constitution that, as you open the book that has the provisions of the 
Constitution, the opening phraseology indicates that we have come 
together to create a more perfect Union. I think the Affordable Care 
Act was intended to try and lift the boats of all people.
  Interestingly enough, major hospitals across America were clamoring 
for the passage of this legislation to really do what we're speaking 
about, which is to cut into the health disparities, because our 
hospitals across America were suffering from not being reimbursed on 
uncompensated care for those people who came without insurance. Many of 
them included African Americans, who suffered in larger numbers from 
the difficulties with diabetes, for example.
  Texas, which is now in the eye of the storm, is one of those States 
that has rejected the expansion of Medicaid, which goes to the very 
point of increasing opportunities for those who suffer disparities so 
they can have access to health care. That is largely the problem in 
Texas. Federal funding for the adult expansion far exceeds current 
local expenses for unreimbursed health care costs, having 3 years 
without any match whatsoever and then having the ability to have a very 
small match later on.
  It is estimated that Medicaid expansion would generate more than 
231,000 jobs in 2016, a 1.8 percentage point reduction in the State's 
current unemployment from 6.1 percent to 4.3 percent, and it would 
directly address the disparities in diabetes, heart disease, and HIV/
AIDS, in partnership with our federally qualified health clinics, which 
many States have seen expanded because of the Affordable Care Act. And 
now in my home State, my city in particular, Central Care has now put 
more community health clinics in areas where disparities were severe 
and lives were being lost.
  It benefits children as well. I'd like to cite some numbers here for 
my colleagues to indicate what we would benefit from by the expansion 
of Medicare.

                              {time}  2010

  Unreimbursed health care costs for charity care in 2010, for an 
estimated $4.4 billion in unreimbursed expenses. We would be covering 
that.
  We would also get off the number one list. Texas, number one, ranking 
among States with the greatest share of uninsured residents at 23.8 
percent in 2011, more than 6 million people, compared with the national 
average of 15.7 percent.
  And then, as I indicated, we would, again, eliminate the opportunity 
for low-income adults to be able to secure care. When low-income adults 
don't get care, the children don't get care.
  So I am suggesting that the rejection by Governor Perry, along with 
other Governors, to not accept expanded Medicaid has a direct impact on 
the increase, not only of the uninsured, but the increase in the 
numbers of those suffering from certain diseases who cannot get care 
and, therefore, rather than have preventative care, which an expansion 
of Medicaid would provide, allowing for doctor visits, then the only 
time that we are able to secure health care for them is when they 
arrive in the cities and the counties and the States' emergency rooms, 
where we see a surge in emergency room costs, health care costs, and we 
eliminate the good will and the good intentions of a very good bill 
that answers the question, are we attempting to form a more perfect 
union by establishing a framework of insurance for all Americans, 
hardworking Americans, Americans of Asian descent and African descent 
and Hispanic descent, who have different DNA and cultural indices that 
would lead them to have certain diseases more than others.
  Let me also take note of the fact that one of those particular 
diseases that impacts the African American woman in a more devastating 
manner than in others, and that is triple negative breast cancer that 
impacts Hispanic women, African American women and Anglo women, but 
more so in the African American community. That kind of diagnosis gives 
in this current phrase of time a short and almost devastating 
diagnosis, one that is difficult to recover from, one that sees an 
increase in the loss of life.
  So I would make the argument to Governor Perry and to Governors 
across the Nation who have rejected the expanded Medicaid as a budget 
issue, as a political issue, as a ``I'm going to stand up to the 
President'' issue, you are wrong, you are absolutely wrong, because 
this is not a political issue; this is a life and death question. And I 
want to applaud Governors like those in Florida, who certainly, 
obviously, may not welcome the applause. But I think it's important 
when people stand on principle or what is good for others, that they 
should be applauded.
  So I applaud the Governor of Ohio and the Governor of Florida for 
moving forward on Medicaid expansion. And I would say to my good 
friend, who is leading this very important Special Order, that we need 
to begin to work with the President to find ways to substitute the 
rejection of the Medicaid expansion so that individuals that are in 
these States who cannot speak for themselves, who in actuality have a 
head of State Governor that is making a political decision, a simple 
political decision, will not lose out on the benefits intended by the 
Affordable Care Act, which is to give comfort and to give help and aid 
to those who need health care.
  I finish on this note. I want to thank Dr. Christensen, because when 
we began to write this legislation with the Congressional Black Caucus 
that, one, talked about the health care disparity, which was the 
premise of the fact of expanding health care, it would be a shame if 
after all this work and passage of this bill there would be innocent 
persons in our respective States like Texas that could not benefit from 
something that could save lives.
  I thank the gentleman for yielding.

     Why Texas Should Extend Medicaid Coverage to Low-Income Adults


                             local benefits

       Local savings from the expansion would offset much if not 
     all of the state match in 2016 and 2017. According to reports 
     that cities, counties, hospital districts and local hospitals 
     submit to the state, unreimbursed local health care spending 
     in Texas that local property taxes largely support, totaled 
     $2.5 billion in 2011. In addition, Texas hospitals reported 
     at least $1.8 billion in conservatively estimated 
     unreimbursed health

[[Page 6215]]

     care costs for charity care in 2010, for an estimated total 
     of $4.4 billion in unreimbursed expenses.
       The math is simple--federal funding for the adult expansion 
     far exceeds current local expenses for unreimbursed health 
     care costs. Although the impact of the Medicaid expansion and 
     ACA subsidized insurance would not entirely offset total 
     local expenses, since not everyone currently receiving 
     charity care, such as undocumented immigrants, would be 
     eligible for these programs and since some services may not 
     be covered, much of it would.
       If necessary, the state could use some portion of these 
     savings to fund the required match through an 
     intergovernmental transfer arrangement. Local governments and 
     hospitals would still realize a net gain over current costs 
     from the federal funds the match would generate.
       It is estimated that the Medicaid expansion would generate 
     more than 231,000 jobs in 2016, equivalent to a 1.8 
     percentage point reduction in the state's current 
     unemployment rate--from 6.1 percent to 4.3 percent.


                             state benefits

       In numerous programs, the state pays 100 percent for adult 
     health care that Medicaid would cover under an expansion. For 
     example, the Texas Department of Criminal Justice requested 
     $186.5 million in state appropriations for hospital inpatient 
     and clinical care for its inmates for 2014.
       The federal government contributes nothing toward this 
     purpose now, but with a Medicaid expansion, the state would 
     spend nothing on in-patient hospital care for eligible 
     inmates from 2014 through 2016, and a maximum of just 10 
     percent of these costs by 2020. Similarly, the expansion 
     would cover eligible adults in state mental institutions and 
     juvenile facilities that need non-psychiatric hospital in-
     patient care.
       The state also spends unmatched general revenue for 
     community primary care services, mental and behavioral health 
     services and, soon, women's health care delivered to low-
     income individuals who are not eligible for Medicaid. Other 
     programs include the breast and cervical cancer program, the 
     kidney health care program and the HIV Medication assistance 
     and STD program. Furthermore, the state supplements funding 
     for the County Indigent Health Care (CIHC) program, much of 
     which would be unnecessary under a Medicaid expansion. The 
     state also pays the regular state match for medically needy 
     adults that currently qualify for Medicaid. Under an 
     expansion, the state would be able to use the high federal 
     match rate for newly eligible individuals not covered by 
     Medicare.
       The Comptroller's office estimates that larger caseloads 
     from a Medicaid expansion would net increased revenues from 
     the insurance premium tax due to the large number of persons 
     who will buy health insurance under the exchange, as well as 
     those covered in the expansion. The Comptroller estimates the 
     increased insurance premium tax revenue due to ACA 
     implementation and the Medicaid expansion at $1.3 billion 
     from 2015 through 2019, or an average of $250 million a year.
       In addition to these savings and new revenue that could 
     offset the required state match, the expansion would generate 
     an additional $1.8 billion in new tax revenue from 2014 
     through 2017, assuming moderate enrollment--enough to offset 
     nearly half of the required state match from 2014 through 
     2017. These jobs, many of them in health care, would provide 
     substantial benefits and increased economic security to 
     families and local communities. As employees spend their 
     wages on taxable items, state and local governments benefit 
     from increased tax collections, and the increased economic 
     activity in turn creates other jobs.


                          benefits to children

       According to the Census Bureau, in 2011 Texas had about 
     900,000 or 16.7 percent of the nation's 5 million uninsured 
     children, and nearly 600,000 of the nation's 3.5 million 
     uninsured children with family incomes below 200 percent FPL, 
     again a 16.7 percent share. About 13.2 percent of all Texas 
     children are uninsured, compared to a national average of 7.5 
     percent.
       Bringing Texas up to the national average would require the 
     state to insure an additional 393,000 children, less than the 
     550,000 expected to enroll in Medicaid under a Moderate 
     scenario. After 2014, the national average will increase 
     significantly since most states will expand Medicaid, which 
     means that, without the expansion, the disparity between 
     Texas and other states will grow.
       Studies conducted in the 1980s found that expanding 
     Medicaid to children reduced child mortality by 5.1 percent 
     and infant mortality by 8.5 percent. Assuming the lower 5.1 
     percent rate, the expansion would save the lives of 2,700 
     Texas children every year after full implementation.


                           benefits to adults

       Our children also need healthy parents to provide for their 
     care. Many low-income individuals and families simply cannot 
     afford basic living expenses, health insurance and out-of-
     pocket health care expenses, making a Medicaid expansion 
     imperative.
       The Kaiser Family Foundation estimates that about 41 
     percent of adults covered under the expansion would be 
     parents. Many of them work, but lack health insurance. 
     According to the Census Bureau, 59.9 percent of uninsured 
     adults in Texas work, a higher labor force participation rate 
     than the total population's. According to Kaiser, about 1.2 
     million adults who would be covered under the expansion in 
     Texas are working, about 60 percent of them in agriculture or 
     service industries that tend toward smaller firms and are 
     less likely to offer insurance to employees.
       Only 28.4 percent of the 320,334 Texas private firms with 
     fewer than 50 employees insured their employees in 2011, 
     versus 92.3 percent of the 132,109 larger private firms. And 
     besides working for low wages in firms that do not offer 
     health insurance, many low-income individuals find work only 
     on a part-time or seasonal basis, resulting in poverty-level 
     incomes.
       The Medicaid expansion would cover a person employed in a 
     full-time, minimum-wage job paying $7.25 per hour, which 
     equates to $15,080 per year, just below the 138 percent FPL 
     cutoff. It also would cover a single parent earning $10 per 
     hour (annual wages of $20,800). These wages are generally 
     insufficient to cover basic living and working expenses as 
     well as health insurance.
       The high cost of health insurance affects both employers 
     and workers, but high premiums as well as out-of-pocket 
     medical expenses make it impossible for most low-income 
     workers to afford health care. The 2012 average cost of 
     single coverage was $5,615, and family coverage was $15,745, 
     a 30 percent increase since 2007, according to a recent study 
     by the Kaiser Family Foundation and the Health Research and 
     Educational Trust. Employees paid an average of $951 for 
     single coverage and $4,316 for and $11,429 for family 
     coverage per employee, it is unsurprising that most small 
     employers find it difficult to provide insurance.
       Although the ACA provides subsidized health insurance for 
     individuals above 100 percent of FPL, about 1.4 million 
     uninsured Texas adults aged 18 to 64 who are below 100 
     percent of FPL will not be eligible. Covering most of these 
     adults through Medicaid would mean a healthier workforce and 
     would reduce absenteeism, job loss and unemployment insurance 
     costs to employers. It also would increase income for 
     families with children, thus reducing stress and providing 
     more opportunities.
       And, it would save lives. The Harvard School of Public 
     Health recently compared three states (New York, Arizona and 
     Maine) that expanded Medicaid to childless adults aged 20 to 
     64 between 2000 and 2005 with neighboring states that did not 
     (New Hampshire, Pennsylvania, Nevada and New Mexico). They 
     found not only a higher insured rate in the expansion states, 
     but a 6.1 percent drop in the death rate for adults under age 
     65, or about 2,840 deaths prevented each year for every 
     500,000 persons newly insured. This translates into one life 
     saved per year in the five-year follow-up period for every 
     176 newly insured. In Texas, that would amount to about 5,700 
     lives saved per year under the Moderate enrollment scenario 
     once fully implemented.


                         benefits to employers

       Only 36 percent of U.S. workers in firms with fewer than 25 
     workers have insurance. In a Kaiser Family Foundation survey, 
     48 percent of small employers indicated that the cost of 
     insurance was too high for them to offer it to employees.
       On the other hand, when their uninsured employees become 
     sick, they are more likely to be absent from work longer, 
     creating a burden to their employer and fellow employees. 
     Frequent or prolonged absences for common untreated 
     conditions such as asthma, diabetes, heart disease, allergies 
     and flu can lead to terminations and the costs of recruiting, 
     hiring and training new employees. Expanding Medicaid to 
     adults aged 18 through 64 who are making marginal wages or 
     working in part-time or seasonal positions is an effective 
     way to assist small businesses and their employees alike.
       Finally, we estimate that the Medicaid expansion would 
     generate nearly 71,500 jobs in Texas in 2014, rising to 
     231,100 jobs in 2016, the first year of full implementation. 
     Many of these jobs would be in health care, an industry that 
     pays well and provides good job security and benefits, 
     including health insurance, and wages would average $50,818 
     during the 2014-2017 period--the same as the statewide 
     average for all industries.
       Texas already has the highest rate of uninsured for adults 
     aged 18 to 64 of any state--31 percent compared to a national 
     average of 21 percent in 2011. If Texas does not expand 
     Medicaid, and Wal-Mart and other companies implement their 
     intended policies, the number of uninsured in Texas will grow 
     as it shrinks in states that acted, leaving Texas still at 
     the bottom and digging a deeper hole.


                        findings in other states

       Recent studies in other states have also found that states 
     can finance their share of the expansion using funds already 
     spent on state and locally funded health care for adults and 
     new revenues generated from the expansion. After further 
     study and considering revised trends, several states besides 
     Texas have also substantially reduced their estimates of the 
     state funds required for the expansion.

[[Page 6216]]

       Some governors that previously expressed opposition to the 
     expansion have changed their minds. In particular, Arizona's 
     governor, Jan Brewer, initially in opposition, has recently 
     announced that she will support it as long as Arizona 
     includes an automatic trigger reducing Medicaid optional 
     coverage should the federal government reduce its match rate 
     in the future, a concern expressed by several state 
     governors. After reviewing a new study that identified 
     sufficient existing revenue sources, New Mexico's governor, 
     Susana Martinez, also announced her support for the 
     expansion.
       California. A recent study by the University of California 
     at Berkeley and the University of California at Los Angeles 
     on the California expansion found that increased state tax 
     revenues and savings would largely offset additional 
     spending. It also found that savings in other areas of the 
     budget, including other state health programs, mental health 
     services and state prisons due to the expansion ``would 
     likely be more than enough to offset the $46 to $381 million 
     in annual state General Fund spending for the newly eligible 
     population through 2019.''
       Florida. Florida has recently reduced its estimate of state 
     costs from $26 billion to $5.066 billion over 10 years from 
     2013-14 to 2022-23, including costs for newly eligible adults 
     ($1.767 billion), children who are currently eligible but not 
     enrolled ($3.012 billion) and the cost of shifting, called 
     ``crowd out,'' of currently insured individuals to Medicaid 
     ($0.287 billion). The state now estimates that the expansion 
     would generate $37 billion in federal funds over the ten-year 
     period, of which about $30 billion is for newly eligible 
     adults.
       Ohio. Estimates just published by Ohio State University 
     compare the state's match requirements with the net savings 
     the state would receive from moving adults from state-funded 
     programs to Medicaid over a nine-year period from 2014 
     through 2019, concluding that savings in these programs would 
     provide 41.2 percent of the state match necessary for the 
     expansion. The study estimated that the state would receive 
     net savings of about $1 billion on:
       Better match rate for medically needy adults of $709 
     million.
       Breast and Cervical Cancer Program costs of $48 million.
       Inpatient prison health care costs of $273 million.
       In addition, the study pointed out that there would also be 
     savings on non-Medicaid substance abuse treatment, family 
     planning, pregnant women and other state health care programs 
     for uninsured adults. The study identified other areas of 
     savings as well, including reduced criminal justice costs due 
     to better access to substance abuse treatment.
       The study also found net increases in state revenue from 
     taxes of $2,898 million on: managed care plans ($1.823 
     billion), general revenue ($857 million) from increased 
     economic activity and increased drug rebates to the state 
     from pharmaceutical companies ($218 million). The study 
     estimates that the state will need about $2.5 billion for 
     state match, which would leave a net state fiscal gain of 
     $1.4 billion.
       Wyoming. The Wyoming Department of Health issued a report 
     in November 2012 that also looked for offsets to pay for the 
     Medicaid expansion. The department found that ``participating 
     in the optional expansion of the Medicaid program would 
     result in a projected cost savings for the State General Fund 
     throughout the first 6 years of the ACA implementation 
     (fiscal years 2014-2020).''


                    objections to medicaid expansion

       The ACA and the Medicaid expansion have raised concerns in 
     Texas and some other states about its long-term costs for 
     state and local budgets, as well as other concerns. 
     Objections to expansion in Texas primarily revolve around 
     three arguments:
       Medicaid is ``socialized medicine'' like that practiced in 
     western Europe and expanding it would spread it further;
       The federal government should abandon Medicaid and move to 
     a system of block grants to states, to provide them with more 
     ``flexibility'' in meeting their citizens' health care needs; 
     and
       The added cost burden of expansion, despite extremely 
     favorable federal matching rates, is too much for a program 
     that has already overburdened the state financially.
       Socialized medicine: Medicaid is not socialized medicine. 
     Socialized medicine as practiced in Western Europe, and 
     specifically Great Britain, is a system under which the 
     government not only funds but also operates hospitals, hires 
     health care providers and controls every aspect of health 
     care. Medicaid does not do these things; patients and their 
     health care providers make health care decisions. Medicaid in 
     no way meets the definition of ``socialized medicine.''
       Medicaid is a federal insurance program that matches state 
     funding to provide health care to eligible, low-income 
     citizens who cannot afford private health insurance. States 
     receive federal matching funds and administer the program 
     under federal rules that limit eligibility to certain groups 
     and services and that provide states with flexibility within 
     certain eligibility and service requirements. Texas 
     participates in many similar federal programs that require 
     state matching funds, including transportation, historic 
     preservation and homeland security programs, among others.
       Block grants: Some Texas lawmakers suggest that Medicaid is 
     a ``one-size-fits-all'' program that fails to meet the 
     state's unique demographic and industry needs. They are 
     petitioning the federal government to convert federal 
     Medicaid funding to a block grant, with each state receiving 
     a fixed amount to establish its own state-specific program 
     that might or might not include all the features of the 
     current program. Even for lawmakers who favor a block-grant 
     approach, however, this argument should not affect the 
     decision to extend Medicaid coverage under the ACA. In fact, 
     lawmakers who favor a Medicaid block grant in particular 
     should support extending Medicaid to low-income adults: the 
     government typically bases block grants on historical funding 
     levels, so maximizing federal funding now would better 
     position Texas in the event of any future conversion to block 
     grants.
       Cost burdens: As noted above, state and local governments 
     currently fund all of our expenditures for indigent care and 
     in-patient hospital costs for eligible incarcerated 
     individuals, while the state supplies 100 percent of funding 
     for some adults served in state health care programs that 
     would be eligible for Medicaid. These, combined with hospital 
     charity costs, far exceed the amount Texas would be required 
     to contribute to expand Medicaid. New revenue from insurance 
     premium taxes and economic growth from the infusion of $100 
     billion in federal funds would provide additional revenue 
     sources. Furthermore, opting out of the expansion will not 
     reduce Texans' federal tax burden, nor will expanding 
     Medicaid increase it.
       Concerns that the federal government will not be able to 
     maintain high match rates in the future are unlikely to 
     become reality given that Congressional representatives and 
     senators represent their states. To ensure against this 
     event, however, Texas could build in an automatic 
     ``trigger,'' such as Arizona is doing, to reduce Medicaid 
     optional populations and services should Congress reduce the 
     match rate in the future.
       Governor Rick Perry has described extending Medicaid to 
     low-income adults as ``adding more passengers to the 
     Titanic.'' It would be closer to the case to say that failing 
     to cover adults will doom them like those hapless travelers. 
     Experience in other states indicates that the death rate 
     would fall by 6.1 percent for adults under age 65 if the 
     state expands Medicaid, preventing premature deaths of 5,700 
     Texas adults in each of the five years following the 
     implementation year, or 28,500 Texans over five years. 
     Previous studies also have found reductions of 5.1 percent in 
     the child mortality rate and 8.5 percent in the infant 
     mortality rate attributable to Medicaid coverage.
       Such studies led one author from the Harvard study, Arnold 
     M. Epstein, to conclude: Sometimes the political rhetoric is 
     at odds with the evidence, such as claims that Medicaid is a 
     `broken program' or worse than no insurance at all; our 
     findings suggest precisely the opposite.


                               Conclusion

       Extending Medicaid to low-income adults will save tens of 
     thousands of lives and improve millions more over the next 
     decade and beyond. The jobs created will support hundreds of 
     thousands of people and boost the economy. The additional tax 
     revenue will benefit state and local governments and 
     important public purposes such as education, infrastructure 
     and public safety. Businesses will benefit from healthier 
     employees and lower employer insurance costs.
       State and local government and the state's hospitals 
     collectively spend far more on piecemeal health care for low-
     income Texans than the state's expected match for the 
     expansion. Expanding Medicaid would move thousands of people 
     into managed care from these programs and significantly 
     reduce the use of expensive emergency room treatment for 
     routine care.
       Without expanding Medicaid to adults, Texas will still have 
     to find additional state match for many of the eligible but 
     unenrolled children identified in this report--but without 
     the benefit of the additional state funds that an expansion 
     would free up and without the new revenues that the 
     additional federal funding would generate.
       The decision to expand Medicaid--or not--will affect the 
     lives of millions of Texans for years into the future and is 
     arguably one of the most important decisions that the 
     Legislature has had to make in decades. If politics are set 
     aside, the right decision is obvious.

  Mr. HORSFORD. I thank the gentlelady from Texas. We stand with you 
and your colleagues here on the floor to continue to put pressure on 
leaders, not only in Texas but throughout the country, who do not see 
the value of expanding Medicaid.
  I'm fortunate in Nevada--we have a Republican Governor, but he has 
agreed to provide the expansion for Medicaid, because he understands 
that in Nevada a third of our population is currently uninsured, and 
with the expansion of Medicaid that's going to make sure that fewer 
people turn up in

[[Page 6217]]

the emergency rooms through uncompensated care, which all of us as 
taxpayers end up paying for.
  So this is an issue where Republicans who understand the bottom line 
in terms of health care and cost can work together with us to implement 
good policy for the American people. We'll continue to work with 
Governors that have not seen the light, but we believe that this is a 
plan that will work very effectively.
  Mr. Speaker, can I ask how much time we have remaining?
  The SPEAKER pro tempore. The gentleman has 18 minutes.
  Mr. HORSFORD. Thank you, Mr. Speaker.
  At this time, I would like to turn to several of our new Members of 
the 113th Congress. I'm very pleased and honored to be serving with 
them. I've learned so much from all the Members here, but particularly 
have enjoyed getting to know the new Members of the Congressional Black 
Caucus. There are five new Members.
  I would now like to recognize my good friend, the gentleman from New 
Jersey, the man with the great legacy, who's carrying on the legacy of 
the late Congressman Payne, Representative Payne, Jr., at this time.
  Mr. PAYNE. Mr. Speaker, I thank the gentleman.
  Let me first thank my colleagues, Congressman Horsford from Nevada 
and Congressman Jeffries of New York, for anchoring tonight's CBC's 
Special Order on eliminating health disparities.
  I would also be remiss if I did not acknowledge our leader on health 
issues in the Congressional Black Caucus, Dr. Christensen.
  Mr. Speaker, I would also like to take the opportunity to acknowledge 
a young person on the floor, the gentlelady from Nevada, the young Miss 
Horsford, who is here tonight. This is truly unique quality time to 
spend with your daughter.
  There are numerous factors that contribute to the growing health 
disparities in New Jersey's 10th District--poverty, environmental 
threats, inadequate access to health care, and educational inequities. 
These issues are so interconnected that a piecemeal approach to fixing 
them just will not work. A comprehensive approach that focuses on 
providing access to quality care to all, creating good jobs that 
provide a decent living and increasing educational opportunities for 
low-income communities, is the only way to eliminate health disparities 
once and for all.
  Even in the 21st century, health disparities are stark, especially in 
the African American community, in which life expectancies are lower 
and infant mortality rates are higher. Children of color who live at or 
below the poverty line are much more likely to have asthma, develop 
ADHD and contract diseases because they cannot afford vaccinations.
  So we have a moral obligation to eliminate health disparities. Our 
children and our future generations are depending on us. But narrowing 
the health disparities that exist is not only good for our Nation's 
health, it's good for our Nation's pocketbook.
  Research tells us that access to quality health care could eliminate 
or reduce the onset of many chronic illnesses and disproportionate 
health outcomes that add to astronomical health care costs every year. 
Yet many of my colleagues won't rest until they repeal ObamaCare. The 
fact is, the Affordable Care Act will now provide health care to 9 
million African Americans who are uninsured or underinsured. ObamaCare 
ensures that everyone has access to lifesaving care such as 
preventative cancer screenings, as well as coverage for children with 
preexisting conditions.

                              {time}  2020

  We know that ObamaCare's preventative services will help save lives 
and save money. So why are my Republican colleagues so set on repealing 
it? We have to protect ObamaCare just like we have to protect Medicare 
and Medicaid.
  Sequestration is a direct attack on these already limited health 
resources. Sequestration is an irresponsible, across-the-board cut 
approach that will only contribute to the widening health disparity 
gap. Because of sequestration, Medicare has been cut by $11 billion; 
cancer patients are being turned away from clinics, and they cannot get 
access to the life-saving treatments they need to live; millions in 
funding have been cut from community health centers.
  Furthermore, the effects are very real for the people in New Jersey. 
In my State, nearly 4,000 fewer children will receive vaccines for 
diseases such as measles, mumps, rubella, tetanus, whooping cough, 
influenza, and hepatitis B. There will be millions in cuts to grants 
that would help prevent and treat substance abuse. New Jersey will lose 
nearly $4.9 million in environmental funding that ensures clean air and 
clean water.
  We live in a first world country, and you want me to go back home and 
tell my constituents that we cannot provide them with clean water and 
clean air? This is absolute insanity.
  And to make matters worse, the New Jersey State Department of Health 
and Senior Services will be forced to provide 19,000 fewer HIV tests to 
low-income communities. Sequestration is directly contributing to the 
spread of this fatal disease. In essence, it is providing a death 
sentence to those who are poor and who can't afford the testing.
  So I say to my colleagues tonight: addressing health disparities in 
this country is both a moral obligation and a financial imperative. If 
we are going to truly eliminate disparities, we must start by 
eliminating sequestration, which does nothing but further the burden of 
our distressed citizens. Finally, we must maintain and strengthen our 
investments in health care access and resources for the disadvantaged 
populations that we serve.
  In closing, just as Medicaid and Medicare and Social Security have 
become common threads and fibers of this great Nation, one day 
ObamaCare will be looked at in the same manner.
  Mr. HORSFORD. Thank you very much to the gentleman from New Jersey.
  I would like to now turn to the gentlelady from Ohio. She has come to 
Congress, providing great perspective as a member of the Financial 
Services Committee specifically, but also in her background of higher 
education and in her working on a number of these issues, one of which 
being the need to create a workforce that's trained and ready, 
particularly in the health care sector. I would like to yield to the 
gentlelady from Ohio, Congresswoman Beatty.
  Mrs. BEATTY. First, let me join my other colleagues in thanking my 
freshman class members, Mr. Horsford and Mr. Jeffries, for leading the 
Congressional Black Caucus' important discussion tonight on eliminating 
health disparities in America.
  Tonight, you are hearing a lot of statistics because it is so 
important for us to let America know that low-income Americans, racial 
and ethnic minorities and other underserved populations often have a 
higher rate of disease and fewer treatment options and reduced access 
to health care. So you will hear facts tonight.
  The facts are that African Americans have the highest rate of high 
blood pressure of all population groups and tend to develop it earlier 
in life; African Americans are twice as likely to have diabetes than 
Whites; African Americans are twice as likely to die from stroke than 
Whites; African Americans are more than twice as likely to die from 
prostate cancer than White men; and African American women younger than 
40 years of age are more likely to develop breast cancer than White 
women; infants born to Black women are 1.5 to 3 times more likely to 
die than those born to women of other races or ethnicities; African 
Americans are estimated to be 44 percent of all new HIV infections 
despite representing only 13 percent of the U.S. population.
  These disparities are shocking, and the Congressional Black Caucus 
will not let us ignore them. In 2009, health disparities cost the 
United States economy $82.2 billion. We have to continue to bring 
awareness to this issue within

[[Page 6218]]

our communities and develop strategies to eliminate these disparities 
in a cost-effective way.
  On March 23, 2010, President Obama signed the Affordable Care Act, 
which is a monumental step that helps us address these overwhelming 
statistics in health disparities within our communities. We now have in 
place comprehensive health care reform that improves access to 
affordable care and guarantees that millions of our most at-risk 
citizens will finally be able to receive care. By improving access to 
quality health care for all Americans, the Affordable Care Act actually 
reduces health disparities.
  We share this information so citizens will know that this law invests 
in prevention and wellness, that it gives individuals and families more 
control over their own care, that it expands initiatives to increase 
racial and ethnic diversity in health care professionals by 
strengthening cultural competency training for all health providers, 
and that it improves communications between providers and patients.
  As a lifelong health care advocate and as a stroke survivor and as an 
African American woman, I know the importance of protecting access to 
affordable health care coverage for all Americans, particularly for 
those who are most in need. We need to continue to move forward with 
this legislation and with initiatives that eliminate health disparities 
in America, and I look forward to continuing to work with all of my 
colleagues to improve our health care system. In order to have a 
successful Nation, we must have a healthy Nation. So this is my clarion 
call to all my colleagues--Democrats and Republicans--to help us make 
progress on this critical issue.
  Mr. HORSFORD. I thank the gentlelady from Ohio.
  At this time, I would like to turn to the gentleman from Texas, 
Congressman Veasey, and I would like to thank him again for his hard 
work and contributions to this new 113th Congress.
  Mr. VEASEY. Thank you.
  I would also like to thank the gentleman from the Sagebrush State, 
Steven Horsford, and from the Empire State, Hakeem Jeffries, for all of 
their work on this very important issue and also in talking about the 
importance of the Affordable Care Act and everything that it's going to 
bring to our country. I also want to talk about the health care crisis 
that is ongoing in America today.
  Unfortunately, obesity and the long-term effects associated with this 
condition are all too prevalent in our country. When you look at the 
health statistics, it's quite astounding to say the least. Today in 
America, nearly two-thirds of adults and one in three children are 
overweight. In my own home State of Texas, we have one of the highest 
obesity rates in the country. According to the Centers for Disease 
Control and Prevention, 30 percent or more of Texans are obese.
  The high obesity rate has contributed to the pervasiveness of 
diabetes, heart disease, and other chronic diseases that drain 
resources from our health care system. Increases in food intake, a lack 
of physical activity, and environments that make nutritious choices 
more difficult have all played a role in this obesity epidemic.
  Many children and adults do not have much control over the choices of 
foods they are able to get. Across this country, we are laden with food 
deserts or places where residents may not be able to get to a 
nutritious food option because they do not own a car or have access to 
public transportation, or maybe they don't live along walkable roads. 
This forces families to outsource their daily eating to more accessible 
and sometimes cheaper alternatives, such as fast food, to get their 
daily nutrients. A steady diet with high fat, salt- and sugar-based 
products has led to unhealthy lifestyles.
  Diabetes is one of the more commonly known effects of being 
overweight or obese.

                              {time}  2030

  The disease affects 25.8 million Americans, roughly 8 percent of our 
population. The effects and complications of diabetes can include 
stroke, high blood pressure, blindness, kidney disease, and 
amputations.
  Studies have shown that people with prediabetes who lose weight or 
increase their physical activity can prevent or delay type 2 diabetes 
and in some cases even return their blood glucose levels to normal.
  Each of these statistics is more exacerbated when you look 
specifically at the minority population in our country such as Latinos 
and African Americans and our special-needs population.
  When you break down obesity by race, African Americans have the 
highest rates of obesity at roughly over 35 percent; Latinos, a little 
over 28 percent as compared to the non-Hispanic White population of 
23.7 percent. Individuals with disabilities also have higher rates of 
obesity at 31.2 percent. This is why I introduced House Resolution 195 
designating May as Health and Fitness Month.
  We need to correct our course as a country and get on the path to 
healthier lifestyles. The numbers are clear. We cannot sustain this 
unhealthy path we are on. Not only is it cutting the lives of too many 
Americans short, but it's also costing our country. In 2008, medical 
costs associated with diabetes were estimated to be at $147 billion. 
The medical costs for people who were obese were over $1,400 higher 
than those of normal weight.
  We need to show our children that we can make healthy, nutritious 
choices and increase our physical activity. We must also not forget 
that this must be spread throughout all aspects of our population. 
While tremendous resources have been employed to help combat the 
growing obesity epidemic amongst children, markedly fewer have been 
used to address specific issues regarding how to best help obese 
children with disabilities.
  So, today, let's declare a more nutritious and healthy lifestyle with 
better food choices and more active lives.
  Mr. Horsford, thank you very much.
  Mr. HORSFORD. I thank the gentleman from Texas.
  I know we are wrapping up on our hour, Mr. Speaker.
  I'd like to recognize the co-anchor for this hour, my good friend and 
colleague from New York (Mr. Jeffries), who will provide a bit of a 
synopsis.
  Mr. JEFFRIES. Thank you, Mr. Horsford, for once again co-anchoring 
this Special Order and for your tremendous leadership, and also thanks 
to Dr. Christensen. We are thankful for all that you have done in 
chairing the CBC Brain Trust on Health Care.
  The Affordable Care Act is the law of the land; the President has 
been elected and reelected; the Supreme Court has ruled it 
constitutional. Let's move forward and address the health care 
disparities that have been set forth so eloquently here today, come 
together and deal with the ailments that are facing the American 
people.
  With that, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. DeSantis). Members are reminded not to 
refer to persons on the floor as guests of the House.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today to 
recognize the contributions of the Affordable Care Act to eliminating 
health disparities. Health disparities refer to the unequal health 
outcomes, ability to access health care, and rates of disease that 
impact certain Americans based on their income, race, ethnicity, or 
other identities. These disparities not only have devastating impacts 
on communities of color in my district, but they undermine health in 
historically marginalized communities across the Nation.
  The disparities are staggering. For instance, in 2006, the infants of 
African American women had death rates over twice as high as infants of 
white American women. In 2009, the average American could expect to 
live 78.5 years, but the average African American could only expect to 
live to 74.5 years. African Americans also have significantly higher 
rates of hypertension and HIV than white Americans.
  The impacts are financial as well as human. Eliminating health 
disparities would prevent approximately one million hospital stays per 
year, saving $6.7 billion in health care costs alone. Even more 
stunning, from 2003 to 2006, the direct and indirect costs of racial 
and ethnic health disparities totaled $1.24 trillion in the United 
States.
  Insurance coverage is strongly related to better health outcomes, and 
African Americans have substantially higher uninsured rates

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than white Americans. Beginning in 2014, the Affordable Care Act will 
expand health insurance coverage to millions of Americans who are 
currently uninsured, and will provide subsidies to make coverage 
affordable for low-income Americans. The Affordable Care Act will 
mandate that Medicare and some private insurance plans cover essential 
preventive services at no additional cost, so that more people will be 
able to prevent illness and stay healthy.
  The Affordable Care Act invests in community health centers, which 
offer primary health care to patients regardless of income, and in 
coordinated care measures, such as providing care teams to help 
patients manage chronic diseases and funding home visits for pregnant 
mothers and infants. Patients may be more likely to visit the doctor 
and receive quality care if physicians are able to understand their 
cultural background, so the Affordable Care Act also devotes resources 
to increasing the racial and ethnic diversity of health care providers 
and improving cultural competency training for all providers.
  These are just some of the important ways in which the Affordable 
Care Act is working to eliminate health disparities. I look forward to 
collaborating with my colleagues to support the successful 
implementation of the Affordable Care Act and eliminate health 
disparities for future generations.

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