[Congressional Record (Bound Edition), Volume 162 (2016), Part 6]
[House]
[Pages 8610-8620]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              {time}  1945
BRIDGING THE DIVIDE: A CALL TO ACTION BY THE CONGRESSIONAL BLACK CAUCUS 
                 TO ELIMINATE RACIAL HEALTH DISPARITIES

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2015, the gentlewoman from Ohio (Mrs. Beatty) is recognized 
for 60 minutes as the designee of the minority leader.


                             General Leave

  Mrs. BEATTY. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and add 
any extraneous materials relevant to the subject matter of this Special 
Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Ohio?
  There was no objection.
  Mrs. BEATTY. Mr. Speaker, I rise this evening, along with my 
colleague, Congressman Hakeem Jeffries of the Eighth Congressional 
District of New York, for tonight's Congressional Black Caucus Special 
Order hour, Bridging the Divide: A Call to Action By the Congressional 
Black Caucus to Eliminate Racial Health Disparities.
  Mr. Speaker, tonight, the Congressional Black Caucus comes to the 
House floor to discuss our overarching goal of promoting equality for 
African Americans across the healthcare spectrum.
  Mr. Speaker, it is well known that poverty, socioeconomic status, and 
health disparities are closely linked and latched together. For 
example, individuals with low incomes tend to have more restricted 
access to medical care and face greater financial barriers to 
affordable health care, oftentimes contributing to health disparities.
  Last week, Mr. Speaker, the House Republicans released their 
Conference's poverty plan called A Better Way. Unfortunately, but not 
unexpectedly, this Republican antipoverty proposal isn't a better way, 
Mr. Speaker. It isn't even a new way. Quite frankly, Mr. Speaker, it is 
the wrong way. It uses the same trickle-down, discredited policies that 
House Republicans have put forth in the past.
  The House Republicans' poverty elimination proposal would repeal the 
Affordable Care Act and undermine affordable, quality health coverage 
that millions of Americans are now enjoying. It would also cut 
Medicaid, the Children's Health Insurance Program that we refer to as 
CHIP, and it would end the Medicare guarantee--programs with proven 
successes, Mr. Speaker, in reducing health disparities. So this is, in 
part, why we are here tonight.
  We know that health coverage is the first step in securing better 
healthcare outcomes, and Medicaid and CHIP play a vital role in opening 
the doorway to the needed health care, especially for our children.

[[Page 8611]]

  As we address the most pressing challenges in achieving health equity 
and equality for African Americans, I want hardworking American 
families to know that they have voices in Congress that aim to protect 
their safety, invest in their future, and provide affordable health 
care for all.
  With the Affordable Care Act, which every member of the Congressional 
Black Caucus supported when it passed, we have improved access. We have 
improved affordability and quality of health care.
  So tonight, Mr. Speaker, I want to thank President Obama for moving 
the needle forward in helping American families and African American 
families across this great country and Nation to have the financial and 
health security that comes with health care.
  Mr. Speaker, we cannot repeal the ACA. We must continue to improve 
and strengthen it, and we will still have more work to do.
  The Congressional Black Caucus, from its very inception, has long 
been the voice for bridging the divide on racial healthcare 
disparities. No, Mr. Speaker; we have been the voice for standing up 
for American people, and especially individuals who are African 
American, against all disparities. We will not only come to this floor 
tonight. We will continue our fight and we will continue to come to 
this floor.
  Tonight, you are going to hear a lot of our members weave together 
our poverty plan. You are going to have members talk about gun 
violence. You are going to have members talk about all lives matter. If 
we don't end the gun violence, then we are not going to have a healthy 
nation.
  Tonight, I want to applaud my good friend and colleague, 
Congresswoman Robin Kelly of the Second District of Illinois, chair of 
our Congressional Black Caucus Health Braintrust. I want to commend her 
for her report, the 2015 Kelly Report on Health Disparities in America, 
the official congressional analysis of the state of African Americans' 
health in the United States, and her work on the 40 Under 40 Leaders in 
Health Awards, leaders under 40 who are physicians and medical 
professionals. And lastly, let me just thank her for her courage and 
her leadership for recognizing that all lives matter.
  We cannot come to this House floor and talk about poverty programs 
and health care and education and about finance if we do not bridge the 
gap with gun violence. I salute her for no longer standing up until we 
make a difference.
  So tonight, we are coming, Mr. Speaker, with a strong call to action 
for us to keep this wonderful America healthy. You will hear from 
Congresswoman Kelly momentarily.
  Mr. Speaker, I yield to the gentleman from North Carolina (Mr. 
Butterfield), chairman of the Congressional Black Caucus. He is a 
chairman who has been a longtime advocate and voice for not only the 
Congressional Black Caucus, but for his constituents in his 
congressional district in North Carolina. Tonight, he speaks for us. 
Tonight, he speaks for the call of action of us to bridge the gap.
  Mr. BUTTERFIELD. I thank Congresswoman Beatty for yielding to me this 
evening.
  This is such a sad evening for all of us because of the events in 
Orlando. I thank her so very much for having the strength to come to 
the floor tonight to manage the important topic that we are all so 
concerned about.
  I thank Congresswoman Robin Kelly for her incredible work chairing 
the CBC Health Braintrust and all the work she does related to health 
disparities in this country. I thank all of my colleagues for their 
tireless work.
  Before I begin my remarks, let me just say that I sat on the floor a 
moment ago and listened to Congresswoman Corrine Brown. It was an 
incredible 1-minute speech she gave. I want to share in her sentiments 
this evening and align myself with the pain that she and her 
constituents are facing in Orlando. The mass shootings were absolutely 
horrific and unthinkable, under any definition. They are just 
unthinkable.
  My prayers go out to the families in Orlando for their pain and for 
all that they are having to endure because of these mass shootings.
  As someone said a few moments ago, a moment of silence is not enough. 
It is time for this Congress to act. It is time for this body, Mr. 
Speaker, to have a serious debate about gun violence and to pass 
legislation that will deprive people the right to own a high-capacity 
assault weapon and high-caliber bullets and use them to kill innocent 
people. Now is the time.
  136 mass shootings have taken place during the first 164 days of this 
year. It is a sad statistic that we must address. The United States is 
5 percent of the world's population, yet we are 31 percent of the mass 
shootings in the world. It is time to act.
  Let me talk about the topic tonight, very briefly.
  The Congressional Black Caucus has been committed to advancing access 
to affordable health care for all Americans so that we can eliminate 
racially based health disparities. That has been our mission for many 
years.
  Eliminating health disparities means addressing inequities in 
environmental, social, and economic conditions in all of our 
communities. By all measurable statistics, from health outcomes to 
participation in health professions, African Americans lag so far 
behind.
  For example, more than 40 percent of African Americans have high 
blood pressure--a rate that is one of the highest in the world. African 
Americans are more likely to develop hypertension at a younger age and 
are at higher risk of stroke, heart failure, end-stage renal disease, 
and death from heart disease.
  Stroke, Mr. Speaker, is the third leading cause of death in the 
United States. African Americans are 50 percent more likely to 
experience a stroke than White Americans. That is a fact.
  According to the Federal Centers for Disease Control and Prevention, 
African American children are twice as likely to have asthma as White 
children, and Black children are 10 times more likely than White 
children to die of complications from asthma.
  African Americans were, on average, 6 years younger than Whites when 
they suffered sudden cardiac arrest. Cardiac arrest incidence among 
African American men was 175 per 100,000; whereas, the incidence for 
White males was just 84 per 100,000. Cardiac arrest in African American 
women was 90 per 100,000, as opposed to 40 per 100,000 for Caucasian 
women.
  Another illness which disparately impacts the African American 
community is that of prostate cancer. In June of last year, I 
introduced the National Prostate Cancer Plan Act, a bipartisan bill 
which seeks to establish the National Prostate Cancer Council on 
Screening, Early Detection and Assessment and Monitoring of Prostate 
Cancer.
  Prostate cancer impacts one in seven American men and is the second 
leading cause of cancer-related deaths among men in the U.S., with 
nearly 30,000 deaths anticipated just this year. African American men 
are particularly vulnerable, as they are twice as likely to be 
diagnosed with prostate cancer and 2.5 times more likely to die from 
the disease than their White counterparts.
  Just last week, House Republicans released their A Better Way agenda 
to address poverty, but that proposal, like others they have released, 
will not lift Americans out of poverty. In some cases, these types of 
proposals can actually push low-income Americans even deeper into 
poverty, further limiting their access to health care and exacerbating 
health disparities.
  So, Mr. Speaker, it is time for us to continue our efforts to address 
the health disparities and barriers. That is what the Congressional 
Black Caucus is advocating the evening. We are going to continue this 
work until every disparity is removed.
  Mrs. BEATTY. I thank Congressman Butterfield for making us aware of 
136 mass shootings in 164 days of this year. Certainly, that is 
relevant to tonight's topic, because whether it is death by guns or 
death by healthcare disparities, there are too many deaths.
  I think you said it so well when you provided the data and the 
statistics of

[[Page 8612]]

African American men and their mortality rates and what is happening to 
them. And yes, African Americans lag behind, and that is why we stand 
with you bridging the gap and for this call of action.
  Mr. Speaker, I yield to the gentlewoman from Illinois (Ms. Kelly) 
from the Second Congressional District, my colleague, my confidant, and 
my friend. She is a champion of expanding health care. She is a 
champion, Mr. Speaker, of making sure that we understand that 
healthcare disparities must end.
  She is the chair of the powerful and most prestigious Congressional 
Black Caucus Health Braintrust. She strives to increase healthcare 
opportunities for all: for our children, for our senior citizens, and 
for residents of the underserved communities. It is my honor to ask her 
to provide some information on today's topic.

                              {time}  2000

  Ms. KELLY of Illinois. Mr. Speaker, I want to thank my colleagues and 
my classmates, the gentlewoman from Ohio (Mrs. Beatty), my friend, and 
the distinguished gentleman from New York (Mr. Jeffries), for leading 
this important conversation about bridging the divide to eliminate 
racial health disparities.
  But I can't weigh in on that topic until I first address the horrific 
events of yesterday in Orlando, Florida. Our Nation is horrified and 
heartbroken by the tragedy in Orlando. We are disgusted by this brutal 
attack. We will not tolerate terrorism or hate in any form against any 
group of people because this is just not our way.
  These ideas of hate will not endure because there is not strength to 
them. We will win the battle against terrorism and intolerance.
  We will hold leaders accountable who put their NRA score ahead of the 
need to keep guns out of the hands of terrorists. We will stand with 
the LGBTQ community and value their lives, their health, and their 
security from the threat of violence and hate. And we will work to see 
that all Americans enjoy the very same freedoms and protections.
  We have done a lot of moments of silence, but I believe in showing 
respect through action, not silence, and that is why we are here this 
evening to discuss what divides us as a country in a health sense.
  For 45 years, the Congressional Black Caucus has been out front in 
Congress in fighting for these freedoms and protections. And when it 
comes to the matter of health equity, I have worked to champion the 
health policy concerns of vulnerable communities as my predecessors in 
the Congressional Black Caucus Health Braintrust, the Honorable Louis 
Stokes and Dr. Christensen, have done.
  Some of my colleagues here know this, but I want to repeat it for 
anyone who doesn't. Before he was killed, Martin Luther King, Jr., was 
quoted as saying: ``Of all the forms of inequality, injustice in health 
care is the most shocking and inhumane.''
  I couldn't agree more, and as the chair of the Health Braintrust, I 
have worked with many of the people in this room to focus on advancing 
this critical phase of the human rights and civil rights struggle: 
health equity.
  When Benjamin Franklin created the Nation's first public hospital, 
The Pennsylvania Hospital, he did so in order to establish the 
promotion of public health as a core American value. He did so to care 
for our Nation's diseased and sick poor.
  Nearly 300 years later, the Affordable Care Act cemented health care 
as a fundamental right for all Americans. Yet, today, we find ourselves 
at a crossroads in health care. Health disparities in communities of 
color continue to be intractable hurdles in the quest to achieve health 
equity in America.
  African Americans are infected with HIV at a rate that is 8 times 
that of White Americans.
  While White women are more likely to have breast cancer, African 
American women are 40 percent more likely to die from the disease.
  African Americans, Latinos, Asians, and Pacific Islanders, as well as 
Native Americans, are diagnosed with lupus two to three times more 
frequently than Caucasians.
  More than 13 percent of African Americans aged 20 or older have 
diagnosed diabetes. And people of color are two to four times more 
likely than Whites to reach end-stage renal disease.
  This grim snapshot illustrates that, despite the gains we have made 
since the days of Ben Franklin and the ACA, there is still much ground 
to cover in closing the health equity gap.
  Last year, I drafted a comprehensive report, The Kelly Report on 
Health Disparities, an official Congressional analysis of the state of 
minority health in the U.S. that offers a blueprint for reversing 
negative health trends in communities of color.
  The Kelly Report brought Members of Congress together, medical 
professionals, and public health thought leaders to examine the root 
causes and impact of health disparities in America, and provide a 
comprehensive set of legislative and policy recommendations to address 
them.
  The whole can only ever be as healthy as its parts. For America to 
achieve true health equity, lawmakers, community leaders, and industry 
stakeholders must come together and aggressively work to reduce 
disparities nationwide. We all have a part to play in creating a 
healthier America.
  We must take heed of Dr. King's words: ``Of all the forms of 
inequality, injustice in health care is the most shocking and 
inhumane.'' And we can and we must fix that.
  Again, because of what happened in Orlando, and I want to say it is 
the mass shooting that we are talking about, and it is tragic, but the 
night before, one person was shot. And I often liken this to a 747 
crash as we talk about that, but we don't talk about the two-seater. 
And that two-seater, the person that died alone in that club after she 
sung Friday night has a brother, a mother, a father, and their pain is 
just as harsh. So let's not forget that young lady that lost her life. 
And she did not lose her life to someone that was Muslim or someone 
that believed in ISIS. She lost her life to an American young man, a 
Caucasian.
  Mrs. BEATTY. I thank the gentlewoman from Illinois, (Ms. Kelly). And 
how appropriate for tonight for the gentlewoman to remind us, as I ask 
her to constantly do, about why we must, to put it in her words, come 
together. We must do something.
  Madam Speaker, tonight we say to you and to our Republican 
colleagues: Come together and do something.
  I say to the gentlewoman, Congresswoman Kelly: Let today serve as a 
turning point in our Nation's ongoing struggle to stamp out hate of all 
forms. We must mourn those who lost their family members, but we must 
do more than mourn. We must have action. If we are going to have a hope 
for a better America, hate has no place in this great Nation.
  So I thank the gentlewoman, and I will continue to remind others that 
we know firsthand what it does to our community.
  But, Madam Speaker, we stand here tonight speaking to all 
communities. But here is what we know. The NAACP has shared with us 
that African American children and teens accounted for 45 percent of 
all child and teen gun deaths in 2008 and 2009, but were only 15 
percent of the total child population.
  The FBI says that approximately 47 percent of victims of the 165,000 
homicides from 2000 to 2010, including over 111,000 gun-related 
homicides, were Black.
  The Children's Defense Fund, Madam Speaker, says that in 2010, Black 
males between the ages of 15 and 19 were nearly 30 times more likely to 
die in a gun homicide than White males of the same age, and more than 
three times more likely to die in a gun homicide than Hispanic males of 
the same age.
  So, Madam Speaker, tonight you will hear us repeatedly make a call 
for action. You will hear us repeatedly quote great leaders. And I 
think it is worth quoting again what Congresswoman Kelly said, in the 
words of Dr. Martin Luther King: ``Of all the forms of inequality, 
injustice in health care is the

[[Page 8613]]

most shocking and inhumane'' of all inequalities, of all injustices.
  As we speak of great leaders, it is, indeed, my honor and my 
privilege to ask my colleague, the gentleman from the 10th 
Congressional District of New Jersey (Mr. Payne), a man who has made a 
name for himself, a man who understands firsthand as a father of 
triplets, as a spouse, as a ranking member on Homeland Security's 
Subcommittee on Emergency Preparedness, Response, and Communications, a 
man who has been at the forefront in his community, a man who served 
before coming here as an elected official, but, more importantly, a 
person who understands health disparities and the call for action--it 
gives me great honor to yield to the gentleman from New Jersey (Mr. 
Payne) to share some wisdom with us tonight.
  Mr. PAYNE. Madam Speaker, I first want to start by thanking 
Congresswoman Beatty for that very kind and generous introduction. We, 
in our class, are very proud of our colleagues, and we support each 
other in times of need.
  I just would like to also congratulate and acknowledge Congressman 
Hakeem Jeffries, the gentleman from New York, who is also host of this 
Special Order. I appreciate the opportunity to discuss an issue that is 
very personal to me.
  Before I begin, I just want to say that my heart goes out to the 
families and friends of the victims of the horrible tragedy in Orlando, 
and I can only imagine what they are going through.
  The other thing that is illuminating to me is that, as we came here 
and stood up for a moment of silence, after that moment of silence, I 
believe Members were given a 1-minute opportunity to speak on any topic 
that they would like to on the floor, as is customary, and not one 
person from the other side of the aisle mentioned what happened in 
Orlando.
  So not only was it a moment of silence for the leadership in this 
House, but it appears that it is going to be a moment that remains 
silent or a topic that remains silent from the other side of the aisle.
  Madam Speaker, eliminating racial-based health disparities depends on 
our ability to advance access to affordable health care for all. Even 
in the 21st century, health disparities are stark, especially in the 
African American communities, where life expectancies are lower and 
infant mortality rates are higher than among Whites.
  Today, despite improvement in overall health in the United States, 
African Americans and other minority populations lag behind in numerous 
health areas, including access to quality care, timelines of care, and 
health outcomes.
  For years, the Congressional Black Caucus has called on Republicans 
to join us and other House Democrats in developing a plan to eliminate 
racial health disparities, a plan that addresses the causes of health 
disparities, such as inequities in environmental, social, and economic 
conditions in our communities.
  Instead, we get from them proposals like their so-called A Better Way 
poverty proposal, a stale, repackaging of failed policies presented 
under the guise of concern about Americans trapped in poverty.
  Cutting job training programs, food assistance, and Head Start will 
push low-income Americans further into poverty, making it even more 
difficult for them to access the affordable and quality health care 
needed to secure their well-being and the well-being of their families. 
We need to, instead, use the government as a source of good.
  Every American deserves to live in a safe and healthy environment. 
Yet, low-income and minority communities are much more exposed to high 
levels of pollution, resulting in serious health problems such as 
asthma, heart problems, and cancer.
  This is a very real problem across America, a very real problem in my 
district. Thirteen million people, including 3.5 million children, are 
concentrated in the vicinity of transportation facilities and are 
exposed to unhealthy levels of air pollution.

                              {time}  2015

  My district is home to the Port Newark-Elizabeth Marine Terminal, 
part of the Port of New York and New Jersey, the third largest port in 
the country. According to the EPA, 25 percent of children in Newark 
suffer from asthma--three times the State average.
  What we need are additional Federal actions to reduce harmful air 
pollution from ports and congested components of the national freight 
transportation system. The issue is critical to the low-income and 
minority community who suffer the disproportionately adverse health 
effects of these environmental hazards.
  Now, since I am on the topic of environmental justice, I just want to 
remind everyone that the Republicans continue to block any action to 
help the thousands of children facing lifelong damage from drinking 
poisoned water in Flint, including a vote to block the Families of 
Flint Act emergency supplemental. Their radical refusal to address this 
health issue will have tragic consequences for American families, and, 
I think it is representative of their overall inadequate approach to 
health disparities in minority communities.
  The way to eliminate racial health disparities is neither to downplay 
them nor to cut programs that will assist the most vulnerable. It is to 
address the environmental, social, and economic conditions that 
exacerbate those disparities. It is to expand access to quality health 
care that could eliminate or reduce the onset of many of these chronic 
illnesses and disproportionate health outcomes. It is to maintain and 
strengthen our investments in healthcare access and resources for 
disadvantaged populations.
  In closing, Madam Speaker, I also want to stress that health 
education must also be a focus in any efforts to eliminate racial-based 
health disparities. African Americans and other communities are 
disproportionately affected by poor provider-patient communication and 
health literacy issues. Consequently, they often do not have access to 
information that enables them to make the appropriate health decisions.
  We have a responsibility to work with our healthcare institutions and 
community health centers to make it easier for people to find, 
understand, and use the information and services.
  As co-chair of the Congressional Men's Health Caucus, I have hosted 
and participated in a number of outreach events in my district to 
engage directly with constituents about the importance of making 
positive health decisions and staying proactive about their health and 
well-being. So I encourage everyone watching at home to get the 
information you need to make smart health decisions, to get the 
security you and your family deserve, and to get the health care that 
we all need.
  Mrs. BEATTY. I thank Congressman Payne so much for giving us such 
compelling information and data and reminding us that the time is now 
for us to enact those programs that work, and the time is now for us to 
understand what is at risk. Also, let me thank the gentleman for his 
role on the Congressional Men's Health Caucus.
  At this time, I yield to the gentlewoman from the State of Texas (Ms. 
Jackson Lee). The gentlewoman from the 18th Congressional District of 
Texas is someone who I am always amazed when she comes to the mic, 
someone who is well researched, and someone who delivers an oratorical 
message that makes us take pause and pay attention.
  Tonight, I would like to say that Congresswoman Sheila Jackson Lee is 
a movement. Earlier, I heard her use that word in talk about how we, 
Madam Speaker, must be the movement against violence, that we must be 
leading that movement against these disparities in health care.
  Ms. JACKSON LEE. Madam Speaker, there is no doubt how much I 
appreciate the Congressional Black Caucus and Congresswoman Beatty and 
Congressman Jeffries for always being timely in allowing us to give a 
message to our colleagues. We hope maybe the American people will hear 
us, but we accept that this body is the body to which and to whom we 
speak. So I am thankful for that.

[[Page 8614]]

  I want to pay tribute, overall, to the Congressional Black Caucus 
because we are actually here speaking of health disparities, because it 
was the caucus that triggered this debate through the years that we 
have been trying to get universal access to health care and was the 
moving force in the 2009, 2008, and 2010 passage, ultimately, of the 
Affordable Care Act, where the work that we did, joining Congresswoman 
Donna Christian-Christiansen, at that time, and Frank Pallone on the 
Congressional Health Caucus, but on the CBC we had the health 
disparities task to ensure that the language in the Affordable Care Act 
addressed the issue of health disparities.
  There was a large section on that that built on some of the work that 
some of us had already done creating the Office of Minority Health that 
I had worked on in years past. So it was the lightning bolt of the 
caucus, and then working with the Congressional Asian Pacific American 
Caucus and then the Congressional Hispanic Caucus that we raised the 
issue that no one was talking about.
  I remember debating on the floor of the House on the issues of 
dealing with senior citizen African American men and how they access 
health care, how do women access health care, and how do women impacted 
by diabetes access health care. These are some of the diseases that 
have a proclivity to the African American population.
  We were finding out that we even had an issue where medical 
professionals didn't know how to ask the questions. How do you address 
someone who needs to be diagnosed for prostate cancer or may be 
diagnosed for prostate cancer and is an African American male, a senior 
citizen? My father ultimately died from cancer that metastasized from 
the prostate to the lungs and the brain, so we knew we had a serious 
issue.
  So today, I want to mention four points, but I am going to focus on 
the last one, obesity--a question of access to health care and physical 
fitness.
  Many times we live in areas where there is no access to a pool or a 
tennis court. Mental health--if you lived your life in a segregated 
America, if you were called ``Boy'' and ``Girl,'' it is a different 
mental health situation than maybe others may have faced. If you live 
in a situation of poverty, of a single household, maybe--this is not 
across the board--these issues will be impacted. If you lived around 
gun violence, if you saw your 15-year-old friend being shot dead in the 
street, there is a question of mental health that we need access to 
that care for us to be able to reach out or maybe counselors to be able 
to provide for children.
  HIV/AIDS is something that we have lived through. I remember going to 
funerals of friends in the 1980s and into the 1990s, particularly with 
HIV/AIDS. So we have worked in the Congressional Black Caucus to 
massively talk about testing.
  Let me get to this point that I want to dwell just for a moment on, 
and that is gun violence. I was here on the floor earlier with my head 
held down and my heart heavy as my district, today, had a memorial. 
They had one yesterday. We will have one tomorrow and have one on 
Wednesday. I mourn with Congresswoman Corinne Brown of Florida.
  We are offering legislation dealing with the assault weapons and to 
complement legislation already passed or already in place. But it is 
important to note that this is a health issue, because the Centers for 
Disease Control can assess and study every health issue that faces 
America today, but they are legislatively, by law, prohibited by my 
friends on other side of the aisle, by Republicans, disallowed every 
year to give them permission to study gun violence.
  Gun violence is killing our children and killing our families. In 
Orlando, it killed Latinos who happened to be the attendees at the 
Pulse Club. The LGBTQ community was the dominant community, and a 
hateful terroristic act using AR-15s and Glock guns killed them.
  The incident was the deadliest mass shooting. The next deadliest 
incidents in recent history were April 16, 2007, Virginia Tech, 32 
killed, 17 injured; December 14, 2012, Sandy Hook, 26 killed, 1 
injured; October 16, 1991, Killeen, Texas, 23 killed, 27 injured. 
According to Everytown index of mass shootings where four or more 
people are shot and killed, the incident was the ninth mass shooting in 
the United States in 2016, and the 150th mass shooting in United States 
since January 1, 2009.
  The mass shooting with guns impacts both the mental health, the 
sanctity, and the minority community. It is shameful that we are not 
allowed to engage in the kind of research that a Harvard professor 
talked about, and that is the assessing of violence and the assessing 
of violence with guns.
  The materials I have before me make it very clear that most of these 
violent acts are done with guns--done with guns. San Bernardino, 
Chattanooga, Charleston, Garland, Oak Creek, and Fort Hood were all 
done with guns.
  So I stand here today to challenge this issue of health disparities 
to say that the heavy brunt of killings, singular killings, are 
impacted by poverty, lack of access to health care, the proliferation 
of guns in our inner city communities, and the failure of the United 
States Congress to put real gun safety legislation, closing the 
loophole, the Jim Clyburn rule that says that, if you don't get the 
review and approval by ATF, you do not get the gun. You have to wait 
until you get the approval from ATF, which may be trying to determine 
whether this person with multiple problems, mental health or background 
issues, doesn't need to get a gun and then ultimately go kill their 
spouse, their children, their neighbors, their family members or 
strangers.
  So it is my belief today that this health disparities debate is 
crucial, and we should come away from here recognizing that obesity, 
the issues of mental health and HIV/AIDS can be, with great investment, 
researched for cures, or cancer that proliferates in our community, 
triple negative breast cancer, legislation that I have put forward and 
have gotten passed about that impact. But it is the gun violence that 
we are doing absolutely nothing about. The disparities and the impact 
on minority communities is atrocious.
  I want to close simply by saying the word or the acronym LGBTQ 
community. I want to say it over and over again, because I think it is 
shameful that, in our debate, in our recognition of the tragedy of 
Orlando, that we don't acknowledge the horrific hate crime and the 
hatefulness against that community. As I stand here, that community is 
diverse, and there are African Americans who are LGBTQ.
  So I would ask that, as we move forward this week, we will be 
reminded of this hatefulness and we will have a cure. We will be 
reminded of this violence, and we will have a cure. That cure, first of 
all, will be to restrain the use of assault weapons and these weapons 
of war-type bullets that men and women in the United States military 
say have no business on the streets of America.
  I believe, Congresswoman, that health disparities are an important 
wall and division to overcome. I thank the gentlewoman for having this 
Special Order to ensure that we will confront these issues and try to 
save lives.
  Racial disparities refer to the variation in rates of disease 
occurrence and disabilities between socioeconomic and/or geographically 
defined population groups.
  I want to focus on four areas of racial disparities in health that 
impact African Americans that we can do something about: 1. Obesity; 2. 
Mental Health; 3. HIV/AIDS; and 4. Gun Violence.
  African Americans, based on 2015 Census data, comprise 13.2 percent 
of the U.S. population, or about 42 million people.
  Socioeconomic status, in turn, is linked to mental health: People who 
are impoverished, homeless, incarcerated or have substance abuse 
problems are at higher risk for poor mental health.
  As the founder and chair of the Congressional Children's Caucus, I am 
especially concerned about the childhood obesity epidemic among 
African-American youth.
  More than 40 percent of African American teenagers are overweight, 
and nearly 25 percent are obese.
  The percentage of children aged 6-11 years in the United States who 
were obese increased from 7 percent in 1980 to nearly 18 percent in 
2012.

[[Page 8615]]

  African American youth are consuming less nutritious foods such as 
fruits and vegetables and are not getting enough physical exercise.
  This combination has led to an epidemic of obesity, which directly 
contributes to numerous deadly or life-threatening diseases or 
conditions, including the following: Hypertension; Dyslipidemia (High 
Cholesterol or High Triglyceride Levels); Type 2 Diabetes; Coronary 
Heart Disease; Stroke; Gallbladder Disease; Osteoarthritis; Asthma, 
bronchitis, sleep apnea, and other respiratory problems; Cancer 
(Breast, Colon, and Endometrial).
  When ethnicity and income are considered, the picture is even more 
troubling.
  African American youngsters from low-income families have a higher 
risk for obesity than those from higher-income families.
  Efforts such as the Let's Move! Campaign by the First Lady are 
pivotal to ensuring that communities are able to provide healthy snacks 
and food and encourage healthier decisions.
  Since the mid-1970s, the prevalence of overweight and obesity has 
increased sharply for both adults and children.
  Non-Hispanic blacks have the highest age-adjusted rates of obesity at 
47.8 percent.
  According to the CDC, 37.6 percent of men and 56.9 percent of women 
twenty years and over are obese.
  Every year, more than 40 million Americans struggle with mental 
illness.
  African American men are as likely as anyone else to have mental 
illness, but they are less likely to get help.
  Racism continues to have an impact on the mental health of African 
Americans.
  Negative stereotypes and attitudes of rejection have decreased, but 
continue to occur with measurable, adverse consequences.
  Historical and contemporary instances of negative treatment have led 
to a mistrust of authorities, many of whom are not seen as having the 
best interests of African Americans in mind.
  According to the Department of Health and Human Services Office of 
Minority Health:
  Adult blacks are 20 percent more likely to report serious 
psychological distress than adult whites.
  Adult blacks living below poverty are two to three times more likely 
to report serious psychological distress than those living above 
poverty.
  Adult blacks are more likely to have feelings of sadness, 
hopelessness, and worthlessness than are adult whites.
  How African Americans view mental health over generations is a major 
barrier to accessing mental health services and treatment.
  In 1996, MHA commissioned a national survey on clinical depression.
  The survey explored the barriers preventing Americans from seeking 
treatment and gauged overall knowledge of and attitudes toward 
depression.
  This survey revealed that:
  63 percent of African Americans believe that depression is a personal 
weakness.
  This is significantly higher than the overall survey average of 54 
percent.
  Only 31 percent of African Americans believed that depression was a 
``health problem.''
  African Americans were more likely to believe that depression was 
``normal'' than the overall survey average.
  56 percent believed that depression was a normal part of aging.
  45 percent believed it was normal for a mother to feel depressed for 
at least two weeks after giving birth.
  40 percent believed it was normal for a husband or wife to feel 
depressed for more than a year after the death of a spouse.
  Many of these problems persist to this day. As Doctor William Lawson 
of Howard University (and MHA's District of Columbia affiliate) pointed 
out in an NPR interview in 2012, ``Many African-Americans have a lot of 
negative feelings about, or not even aware of mental health services.
  The ``Mental Health: Culture, Race and Ethnicity Supplement'' to the 
1999 U.S. Surgeon General's Report on Mental Health, states the 
following:
  African-American physicians are five times more likely than white 
physicians to treat African-American patients.
  African-American patients who see African-American physicians rate 
their physicians' styles of interaction as more participatory.
  African Americans seeking help for a mental health problem would have 
trouble finding African American mental health professionals: In 1998, 
only 2 percent of psychiatrists, 2 percent of psychologists and 4 
percent of social workers said they were African Americans.
  The public mental health safety net of hospitals, community health 
centers, and local health departments are vital to many African 
Americans, especially to those in high-need populations.
  African Americans of all ages are underrepresented in outpatient 
treatment but over-represented in inpatient treatment.
  Few African-American children receive treatment in privately funded 
psychiatric hospitals, but many receive treatment in publicly funded 
residential treatment centers for emotionally disturbed youth.
  In 2012, there were an estimated 356,268 inmates with severe mental 
illnesses in U.S. prisons and jails.
  There were only 35,000 mentally ill individuals in state psychiatric 
hospitals.
  The report, ``The Treatment of Persons With Mental Illness in Prisons 
and Jails,'' jails ``in 44 of the 50 states and the District of 
Columbia, a prison or jail in that state holds more individuals with 
serious mental illness than the largest remaining state psychiatric 
hospital.'' the report said.
  African Americans today are overrepresented in our jails and prisons.
  People of color account for 60 percent of the prison population.
  The Stanford Law School Three Strikes Project's report stated that, 
``over the past 15 years, the number of mentally ill people in prison 
in California has almost doubled.''
  In California, 45 percent of state prison inmates have been treated 
for severe mental illness within the past year.
  African Americans also account for 14 percent of regular drug users, 
but for 37 percent of drug arrests.
  Illicit drug use is frequently associated with self-medication among 
people with mental illnesses.
  In January 2014, the Texas Observer reported that, of the 9,000 
inmates in Harris County Jail more than 25 percent take medication for 
mental illness, which means that the jail treats more psychiatric 
patients than all 10 of Texas' state-run public mental hospitals 
combined.
  The passage of the Affordable Care Act created access to health care 
for those who purchase health insurance and for the poor living in 
states that are participating in the Medicaid component of the ACA.
  Disparities can occur, if physicians do not refer patients with signs 
of mental illness for proper treatment or if referred patients do not 
seek out treatment.
  Disparities in access to care and treatment for mental illnesses have 
also persisted over time.
  As noted by the Office of Minority Health:
  Only 8.7 percent of adult blacks, versus 16 percent of adult whites, 
received treatment for mental health concerns in 2007-2008.
  Only 6.2 percent of adult blacks, versus 13.9 percent of adult 
whites, received medications for mental health concerns during 2008.
  While 68.7 percent of adult whites with a major depressive episode in 
2009 received treatment, only 53.2 percent of adult blacks did.
  The Affordable Care Act will have an impact on this gap by 2016.
  Depression and other mental illness can be deadly if left untreated.
  Suicide is the third leading cause of death among African Americans 
15 to 24 years old.
  Untreated mental illness can also make African American men more 
vulnerable to substance abuse, homelessness, incarceration, and 
homicide.
  African Americas are the racial/ethnic group most affected by HIV in 
the United States.
  According to the CDC, 44 percent (19,540) of estimated new HIV 
Diagnoses in the United States were among African Americans, who 
comprise 12 percent of the US population.
  HIV/AIDs are now the leading cause of death among African Americans 
ages 25 to 44--ahead of heart disease, accidents, cancer, and homicide.
  At the end of 2012, an estimated 496,500 African Americans were 
living with HIV, representing 41 percent of all Americans living with 
the Virus.
  Of African Americans living with HIV, around 14 percent do not know 
they are infected.
  African Americans accounted for an estimated 44 percent of all new 
HIV infections among adults and adolescents (aged 13 years or older) in 
2010, despite representing only 12 percent of the U.S. population.
  HIV is a sexually transmitted disease or STD; it is also spread 
through intravenous drug use.
  HIV infections spread through sharing of needles has declined with 
needle programs, while the STD rates of infection among African 
Americans has increased at a rate higher than any other ethnic group.
  Have their HIV status checked--not once but annually.
  Know the HIV status of sexual partner.
  If HIV positive: Know how to get on antiviral medication, 2 small 
pills taken each day, and stay on them.
  Where to go for information if you or your partner is HIV positive.

[[Page 8616]]

  In 2010, men accounted for 70 percent (14,700) of the estimated 
20,900 new HIV infections among all adult and adolescent African 
Americans.
  The estimated rate of new HIV infections for African American men 
(103.6/100,000 population) was 7 times that of white men, twice that of 
Latino men, and nearly 3 times that of African American women.
  In 2010, African American gay, bisexual, and other men who have sex 
with men represented an estimated 72 percent (10,600) of new infections 
among all African American men and 36 percent of an estimated 29,800 
new HIV infections among all gay and bisexual men.
  Of those gay and bisexual men, 39 percent (4,321) were young men aged 
13 to 24.
  According to the CDC, the numbers of new HIV diagnoses among African 
American women fell 42 percent between 2005 to 2014, but it is still 
high compared to women of other races/ethnicities.
  Most new HIV infections among African American women (87 percent; 
5,300) are attributed to heterosexual contact.
  In 2012, there were 72,010 Texans living with HIV/AIDS.
  Texas has the 10th highest number of HIV diagnoses in 2013 and ranks 
18th for deaths from HIV.
  Currently 14 percent of the people living with HIV are undiagnosed 
and only 30 percent of the people with HIV are virally suppressed, 
which means that 70 percent of the people who are ill are not on 
medication that can help limit their ability to infect others.
  HIV is an unnecessarily disproportionate burden on the African 
American and Latino community.
  There is a wall of misinformation about the illness and an 
uncomfortable silence regarding the need to speak about the illness not 
only to the young, but also the older persons.
  When treatments were first developed in the 1990s they had lots of 
side effects that made patients very ill.
  Few talk about the advances in HIV treatment that now involve taking 
2 small pills a day with the result leaving patients feeling healthy 
and able to engage in life's normal activities.
  The virus count for those who take their medication is so low that it 
often does not register in tests.
  This does not mean that people are cured, but it does mean that there 
is no reason not to get tested so that you know if you are in need of 
treatment.
  Anyone can become infected--so it is up to all of us to educate our 
families, neighbors, co-workers and friends about getting tested.
  There are some insurance company practices that have a detrimental 
impact on the ability of people with HIV to enroll in qualified health 
insurance plans.
  In states like Texas that are not fully participating in the 
Affordable Care Act's Medicaid expansion this is especially problematic 
for HIV patients who are poor.
  Some states allow insurance carriers to post misleading or 
intentionally vague formularies on market place websites or excluding 
essential HIV medications from drug formularies and impressing high 
cost sharing.
  Out of pocket medication cost each month should be capped.
  Mrs. BEATTY. Madam Speaker, I thank Congresswoman Sheila Jackson Lee 
for reminding us that we should be done with guns like the assault 
weapons. I thank the gentlewoman for reminding us of the impact that 
health disparities have on our communities in this Nation.

                              {time}  2030

  Madam Speaker, I have two documents that will be entered into the 
Record.
  The first document is from Congresswoman Eddie Bernice Johnson. I 
would like to state for the Record that she was the first nurse to 
serve in this United States Congress. And the second is a portion of 
the Special Feature on Racial and Ethnic Health Disparities: 30 Years 
After the Heckler Report.

Special Feature on Racial and Ethnic Health Disparities: 30 Years After 
                           the Heckler Report


                              Introduction

       The 1985 Report of the Secretary's Task Force on Black and 
     Minority Health, released by then Secretary of Health and 
     Human Services Margaret Heckler, documented significant 
     disparities in the burden of illness and mortality 
     experienced by blacks and other minority groups in the U.S. 
     population compared with whites (41). The report laid out an 
     ambitious agenda, including improving minority access to 
     high-quality health care, expanding health promotion and 
     health education outreach activities, increasing the number 
     of minority health care providers, and enhancing federal and 
     state data collection activities to better report on minority 
     health issues. In the 30 years since the Heckler Report, 
     national efforts to improve minority health through outreach, 
     programming, and monitoring have included the formation of 
     the Department of Health and Human Services (HHS) Office of 
     Minority Health in 1986 (42); the annual National Healthcare 
     Quality and Disparities Reports first issued in 2003 (43); 
     the adoption of disparities elimination as an overarching 
     goal of Healthy People 2010 (44); and most recently, an HHS 
     Action Plan to Reduce Racial and Ethnic Health Disparities--a 
     comprehensive federal commitment to reduce and eventually 
     eliminate disparities in health and health care (45).
       Race is a social construct influenced by a complex set of 
     factors (46,47). Because of the complexity and difficulty in 
     conceptualizing and defining race, as well as the increasing 
     representation of racial and ethnic subgroups in the United 
     States, racial classification and data collection systems 
     continue to evolve and expand. In 1977, the Office of 
     Management and Budget (OMB) required that all federal data 
     collection efforts collect data on a minimum of four race 
     groups (American Indian or Alaskan Native, black, Asian or 
     Pacific Islander, and white) and did not allow the reporting 
     of more than one race (48). In 1997, in response to growing 
     interest in more detailed reporting on race and ethnicity, 
     OMB mandated data collection for a minimum of five race 
     groups, splitting Asian or Pacific Islander into two 
     categories (Asian, and Native Hawaiian or Other Pacific 
     Islander) (49). In addition, the 1997 standards allowed 
     respondents to report more than one race. A minimum of two 
     categories for data collection on ethnicity, ``Hispanic or 
     Latino'' and ``Not Hispanic or Latino,'' were also required 
     under the 1997 OMB standards. Consequently, whereas the 
     Heckler Report primarily documented black-white differences 
     in health and mortality due to data limitations, this Special 
     Feature is able to report on more detailed racial and ethnic 
     groups. For example, Figures 19-21 display trends in infant 
     mortality and low-risk cesarean section deliveries, and the 
     current data on preterm births for five Hispanic-origin 
     groups.
       At the time of the Heckler Report, 22.3% of the population 
     were considered racial or ethnic minorities (Table 1). 
     Current Census (2014) estimates identify 37.9% of the 
     population as racial or ethnic minorities (50). In 2014, 
     Hispanic persons, who may be of any race, comprised 17.4% of 
     the U.S. population. Non-Hispanic multiple race persons were 
     2.0% of the population. For the single race groups, non-
     Hispanic American Indian or Alaska Native persons were 0.7%, 
     non-Hispanic Asian persons were 5.3%, non-Hispanic black 
     persons were 12.4%, non-Hispanic Native Hawaiian or Other 
     Pacific Islander persons were 0.2%, and non-Hispanic white 
     persons were 62.1% of the U.S. population in 2014 (50).
       Understanding the demographic and socioeconomic composition 
     of U.S. racial and ethnic groups is important because these 
     characteristics are associated with health risk factors, 
     disease prevalence, and access to care, which in turn drive 
     health care utilization and expenditures. Non-Hispanic white 
     persons are, on average, older than those in other racial and 
     ethnic groups, with a median age of 43.1 years, and Hispanic 
     individuals are the youngest, with a median age of 28.5 years 
     in 2014 (50). About one-quarter of black only persons (26.2%) 
     and Hispanic persons (23.6%) lived in poverty compared with 
     10.1% of non-Hispanic white only persons and 12.0% of Asian 
     only persons in 2014 (51). Non-Hispanic black only children 
     and Hispanic children were particularly likely to live in 
     poverty (37.3% and 31.9%, respectively, in 2014) (52). 
     However, Hispanic individuals are often found to have quite 
     favorable health and mortality patterns in comparison with 
     non-Hispanic white persons and particularly with non-Hispanic 
     black persons, despite having a disadvantaged socioeconomic 
     profile--a pattern termed the epidemiologic paradox (53).
       HHS defines a racial or ethnic health disparity as ``a 
     particular type of health difference that is closely linked 
     with social, economic, and/or environmental disadvantage. 
     Health disparities adversely affect groups of people who have 
     systematically experienced greater obstacles to health based 
     on their racial or ethnic group'' (54). There are many 
     different ways to measure racial and ethnic differences in 
     health and mortality, which can lead to different conclusions 
     (55-58). This Special Feature on Racial and Ethnic Health 
     Disparities (Special Feature) uses the maximal rate 
     difference, one of three overall measures used in Healthy 
     People 2020 to measure differences among groups of people 
     (see Technical Notes). The maximal rate difference is an 
     overall measure of health disparities calculated as the 
     absolute difference between the highest and lowest group 
     rates in the population for a given characteristic (59). The 
     identification of groups that experience the highest and 
     lowest rates in this Special Feature was based on observed 
     rates and was not tested for a statistically significant 
     difference against other rates. Ties in highest or lowest

[[Page 8617]]

     rates were resolved by examining decimal places. With respect 
     to changes in health disparities over time, tracking the 
     maximal rate difference over time enables one to determine 
     whether the absolute difference between the highest and 
     lowest group rates is increasing, decreasing, or stable.
       The Special Feature charts that follow provide detailed 
     comparisons of key measures of mortality, natality, health 
     conditions, health behaviors, and health care access and 
     utilization, by race, race and ethnicity, or by detailed 
     Hispanic origin, depending on data availability. A majority 
     of the 10 graphs in this year's Special Feature present 
     trends in health from 1999-2014. Results indicate that trends 
     in health were generally positive for the overall population 
     and several graphs illustrate success in narrowing gaps in 
     health by racial and ethnic group. Differences in life 
     expectancy, infant mortality, cigarette smoking among women, 
     influenza vaccinations among those aged 65 and over, and 
     health insurance coverage narrowed among the racial and 
     ethnic groups. For example, the absolute difference in infant 
     mortality rates between infants born to non-Hispanic black 
     mothers (highest rate) and infants born to non-Hispanic Asian 
     or Pacific Islander mothers (lowest rate) narrowed between 
     1999-2014. Differences by racial and ethnic group in the 
     prevalence of high blood pressure and smoking among adult men 
     remained stable throughout the study period, with non-
     Hispanic black adults more likely to have high blood pressure 
     than adults in other racial and ethnic groups throughout the 
     period, and non-Hispanic black and non-Hispanic white males 
     more likely to be current smokers than Hispanic and non-
     Hispanic Asian men. For low-risk cesarean sections, influenza 
     vaccinations among adults aged 18-64, and unmet dental care 
     needs, the gap widened among the racial and ethnic groups 
     between 1999-2014.
       Despite improvements over time in many of the health 
     measures presented in this Special Feature, disparities by 
     race and ethnicity were found in the most recent year for all 
     10 measures, indicating that although progress has been made 
     in the 30 years since the Heckler Report, elimination of 
     disparities in health and access to health care has yet to be 
     achieved.


                        Life Expectancy at Birth

       In 2014, life expectancy was longer for Hispanic men and 
     women than for non-Hispanic white or non-Hispanic black men 
     and women.
       Life expectancy is a measure often used to gauge the 
     overall health of a population. Life expectancy at birth 
     represents the average number of years that a group of 
     infants would live if the group were to experience the age-
     specific death rates present in the year of birth. 
     Differences in life expectancy among various demographic 
     subpopulations, including racial and ethnic groups, may 
     reflect subpopulation differences in a range of factors such 
     as socioeconomic status, access to medical care, and the 
     prevalence of specific risk factors in a particular 
     subpopulation (60,61).
       During 1980-2014, life expectancy at birth in the United 
     States increased from 70.0 to 76.4 years for males and from 
     77.4 to 81.2 years for females (Table 15, and data table for 
     Figure 18). During this period, life expectancy at birth for 
     males and females was longest for white persons and shortest 
     for black persons. For both males and females, racial 
     differences in life expectancy at birth narrowed, but 
     persisted during 1980-2014. Life expectancy at birth was 6.9 
     years longer for white males than for black males in 1980, 
     and this difference narrowed to 4.2 years in 2014. In 1980, 
     life expectancy at birth was 5.6 years longer for white 
     females than for black females, and this difference narrowed 
     to 3.0 years in 2014.
       In 2014, Hispanic males and females had the longest life 
     expectancy at birth, and non-Hispanic black males and females 
     had the shortest. In 2014, life expectancy at birth was 7.2 
     years longer for Hispanic males than for non-Hispanic black 
     males and 5.9 years longer for Hispanic females than for non-
     Hispanic black females.


                            Infant Mortality

       During 1999-2013, infant mortality rates were highest among 
     infants born to non-Hispanic black women (11.11 infant deaths 
     per 1,000 live births in 2013).
       Infant mortality, the death of a baby before his or her 
     first birthday, is an important indicator of the health and 
     wellbeing of a country. It not only measures the risk of 
     infant death but it is used as an indicator of maternal 
     health, community health status, and availability of quality 
     health services and medical technology (62,63).
       The infant mortality rate in the United States decreased 
     from 7.04 infant deaths per 1,000 live births in 1999 to 6.75 
     in 2007, and then decreased at a faster rate to 5.96 in 2013. 
     Trends in infant mortality rates during 1999-2013 varied 
     among the five racial and ethnic groups. During 1999-2013, 
     infants born to non-Hispanic black mothers experienced the 
     highest rates of infant mortality (11.11 in 2013) and infants 
     born to non-Hispanic Asian or Pacific Islander mothers 
     experienced the lowest rates (3.90 in 2013). The difference 
     between the highest and lowest infant mortality rates among 
     the five racial and ethnic groups was stable from 1999 to 
     2006 and then narrowed from 2006 to 2013. The difference 
     between the highest (non-Hispanic black) and lowest (non-
     Hispanic Asian or Pacific Islander) infant mortality rates 
     was 9.41 deaths per 1,000 live births in 1999, compared with 
     7.21 in 2013.
       For infants born to Hispanic mothers, the infant mortality 
     rate remained stable during 1999-2008 (5.71 infant deaths per 
     1,000 live births in 1999) and then decreased to 5.00 in 
     2013. During 1999-2013, the infant mortality rate for 
     Hispanic infants varied by the mother's Hispanic-origin 
     group. Throughout this period, infants born to Puerto Rican 
     mothers experienced the highest mortality rates. In all years 
     except 2009, infants born to Cuban mothers and those born to 
     Central and South American mothers experienced the lowest 
     mortality rates at alternate times throughout 1999-2013. The 
     difference between the highest (Puerto Rican) and lowest 
     (Cuban) infant mortality rates among Hispanic-origin groups 
     narrowed from 3.71 deaths per 1,000 live births in 1999 to 
     2.88 in 2013. During 1999-2013, the difference in infant 
     mortality rates was narrower for mothers in the Hispanic-
     origin groups than for mothers in the five racial and ethnic 
     groups.


                             Preterm Births

       In 2014, non-Hispanic black mothers had the highest 
     percentage of preterm births of the five racial and ethnic 
     groups, and Puerto Rican mothers had the highest percentage 
     of preterm births of the five Hispanic-origin groups.
       An infant's gestational age is an important predictor of 
     his or her survival and subsequent health (64-70). Preterm 
     birth prior to 37 weeks gestation affects infant mortality 
     rates and racial and ethnic disparities in infant mortality 
     (Figure 19) (71). The degree of prematurity matters--infants 
     born prior to 32 weeks gestation are at greatest risk of 
     death during infancy, with the risk of infant death 
     decreasing as gestational age increases (72).
       In 2014, 7.7% of singleton births occurred before 37 weeks 
     of gestation; 5.7% at 34-36 weeks; 0.8% at 32-33 weeks 
     gestation; and 1.2% before 32 weeks (data table for Figure 
     20). In 2014, among the five racial and ethnic groups, non-
     Hispanic black women had the highest percentage of singleton 
     births before 37 weeks (11.1%) and non-Hispanic Asian or 
     Pacific Islander women had the lowest percentage (6.8%). Non-
     Hispanic black women also had the highest percentage of 
     singleton preterm births at each preterm gestational age. The 
     difference between the highest (non-Hispanic black) and 
     lowest (non-Hispanic Asian or Pacific Islander) percentages 
     of singleton preterm births among the five racial and ethnic 
     groups was 4.3 percentage points (before 37 weeks), 2.0 
     percentage points (34-36 weeks), 0.6 percentage points (32-33 
     weeks), and 1.7 percentage points (before 32 weeks).
       Among Hispanic-origin groups in 2014, Puerto Rican mothers 
     had the highest percentage of singleton births before 37 
     weeks (9.1%) and Cuban mothers had the lowest percentage 
     (7.2%). The difference between the highest (Puerto Rican) and 
     lowest (Cuban) percentages of singleton preterm births among 
     the Hispanic-origin groups was 1.9 percentage points (before 
     37 weeks) and 1.3 percentage points (34-36 weeks). Central 
     and South American mothers had the lowest percentage of 
     singleton births before 34 weeks. For preterm births before 
     34 weeks, the difference between the highest (Puerto Rican) 
     and lowest (Central and South American) percentages was 0.2 
     percentage points (32-33 weeks) and 0.6 percentage points 
     (before 32 weeks).


             Low-risk Births Delivered by Cesarean Section

       During 1999-2014 non-Hispanic black mothers experienced the 
     highest percentage of low-risk cesarean deliveries among the 
     five racial and ethnic groups (29.9% in 2014); Cuban mothers 
     experienced the highest percentage of low-risk cesarean 
     deliveries among the five Hispanic-origin groups (41.49-6 in 
     2014).
       Cesarean deliveries comprise approximately one-third of all 
     births in the United States (32.2% in 2014) and can place 
     mothers and infants at increased risk for poor health 
     outcomes (74). Over the past decade, professional medical 
     groups have attempted to reduce low-risk cesarean deliveries 
     defined as cesarean deliveries among full term (37 or more 
     completed weeks of gestation), singleton, vertex (head first) 
     births to women giving birth for the first time (75,76).
       The percentage of low-risk births that were delivered by 
     cesarean section increased from 19.5% to 26.6% during 1999-
     2005, stabilized during 2005-2009, and then decreased to 
     26.0% in 2014 (data table for Figure 21). Throughout the 
     period 1999-2014, non-Hispanic black mothers experienced the 
     highest percentage of low-risk cesarean deliveries (29.9% in 
     2014) among the five racial and ethnic groups, while non-
     Hispanic American Indian or Alaska Native mothers experienced 
     the lowest percentage (21.5% in 2014). The difference between 
     the highest (non-Hispanic black) and lowest (non-Hispanic 
     American Indian or Alaska Native) percentages widened from 
     4.8 percentage points in 1999 to 8.4 percentage points in 
     2014.
       Among Hispanic mothers, the percentage of low-risk births 
     that were delivered by cesarean section increased from 18.7% 
     to 24.6%

[[Page 8618]]

     during 1999-2004, increased at a slower rate from 2004-2009, 
     and then remained stable during 2009-2014 (data table for 
     Figure 21). Throughout the period 1999-2014 Cuban mothers 
     experienced the highest percentage of low-risk cesarean 
     deliveries (41.4% in 2014), while Mexican mothers experienced 
     the lowest percentage (24.1% in 2014). Among Hispanic-origin 
     groups, the difference between the highest and lowest 
     percentages of low-risk cesarean deliveries was stable during 
     1999-2002, widened sharply during 2002-2006, and then 
     narrowed during 2006-2014. The difference between the highest 
     (Cuban) and lowest (Mexican) percentages was 11.7 percentage 
     points in 1999, 21.5 percentage points in 2006, and 17.3 
     percentage points in 2014.


                 Children and Adolescents With Obesity

       In 2011-2014 for children and adolescents aged 2-19 years, 
     Hispanic children and adolescents had the highest prevalence 
     of obesity and non-Hispanic Asian children had the lowest 
     prevalence.
       Childhood obesity is a serious public health challenge in 
     the United States and many other industrialized nations in 
     the world (Figure 8) (19,77,78). Excess body weight in 
     children is associated with excess morbidity in childhood and 
     excess body weight in adulthood (13,14). Obesity among 
     children and adolescents is defined as a body mass index at 
     or above the sex- and age-specific 95th percentile of the CDC 
     growth charts (15). Between 1999-2000 and 2013-2014, the 
     percentage of children and adolescents aged 2-19 with obesity 
     increased from 13.9% to 17.2% (79). However, among youth aged 
     2-19, the prevalence of obesity did not change from 2003-2004 
     through 2013-2014 (79).
       In 2011-2014 for children and adolescents aged 2-19, the 
     percentage with obesity was highest for Hispanic children and 
     adolescents and lowest for non-Hispanic Asian children and 
     adolescents. For those aged 2-19, the difference between the 
     highest (Hispanic) and lowest (non-Hispanic Asian) 
     percentages was 13.3 percentage points.
       For children aged 2-5, the percentage with obesity was 
     highest for Hispanic children and lowest for non-Hispanic 
     white children. (The estimate for non-Hispanic Asian children 
     aged 2-5 was not stable and is not shown.) The difference 
     between the highest (Hispanic) and lowest (non-Hispanic 
     white) percentages was 10.4 percentage points for children 
     aged 2-5. For children aged 6-11, the percentage with obesity 
     was highest for Hispanic children and lowest for non-Hispanic 
     Asian children. For children aged 6-11, the difference 
     between the highest (Hispanic) and lowest (non-Hispanic 
     Asian) percentages was 15.2 percentage points.
       In 2011-2014 for adolescents aged 12-19, the percentage 
     with obesity was highest for Hispanic adolescents and lowest 
     for non-Hispanic Asian adolescents. The difference between 
     the highest (Hispanic) and lowest (non-Hispanic Asian) 
     percentages was 13.4 percentage points for adolescents aged 
     12-19 years.


                              Hypertension

       In 2011-2014, non-Hispanic black men and women were the 
     most likely to have hypertension compared with adults in the 
     other racial and ethnic groups.
       Hypertension is an important risk factor for cardiovascular 
     disease, stroke, kidney failure, and other health conditions 
     (80,81). In 2011-2014, 84.1% of adults with hypertension were 
     aware of their status, and 76.1% were taking medication to 
     lower their blood pressure (82). Despite improvement in 
     increasing the awareness, treatment, and control of 
     hypertension, diagnosis and treatment of hypertension among 
     minority groups remains a challenge (83).
       Hypertension is defined as reporting taking 
     antihypertensive medication and/or having a measured systolic 
     blood pressure of at least 140 mm Hg or a measured diastolic 
     blood pressure of at least 90 mm Hg. The age-adjusted 
     percentage of adults aged 20 and over with hypertension was 
     stable during 1999-2014 (30.8% in 2013-2014) (data table for 
     Figure 23). During 1999-2014, non-Hispanic black adults had 
     the highest percentage with hypertension among the three 
     racial and ethnic groups (42.7%, age-adjusted in 2013-2014), 
     while with the exception of 1999-2000, adults of Mexican 
     origin had the lowest percentage with hypertension (28.8%, 
     age-adjusted in 2013-2014). The difference between the 
     highest and lowest age-adjusted percentages of adults with 
     hypertension among the three racial and ethnic groups was 
     stable during 1999-2014; in 2013-2014, the difference between 
     the highest (non-Hispanic black) and lowest (Mexican-origin) 
     percentages was 13.9 percentage points.
       In 2011-2014, the age-adjusted percentage of adult men and 
     women with hypertension was similar (31.0% and 29.7%, 
     respectively, data table for Figure 23). The difference 
     between the highest (non-Hispanic black) and lowest 
     (Hispanic) age-adjusted percentages of men with hypertension 
     among the four racial and ethnic groups was 14.7 percentage 
     points; for women, the difference between the highest (non-
     Hispanic black) and lowest (non-Hispanic Asian) was 19.0 
     percentage points in 2011-2014.


                       Current Cigarette Smoking

       During 1999-2014, differences in cigarette smoking between 
     racial and ethnic groups were larger for women than for men.
       Smoking causes more than 480,000 deaths each year, 
     accounting for about one in five deaths in the United States 
     (84). Smokers are more likely to develop heart disease, 
     stroke, and cancer. Smoking also increases the risk for 
     diabetes, cataracts, rheumatoid arthritis, and stillbirth 
     (85).
       During 1999-2014, the age-adjusted percentage of adults 
     aged 18 and over who were current cigarette smokers decreased 
     from 25.2% to 19.0% for men and from 21.6% to 15.1% for women 
     (data table for Figure 24). Within each of the four racial 
     and ethnic groups, men were more likely to be current 
     cigarette smokers than women.
       In 2014 for men, the age-adjusted percentage of current 
     cigarette smokers was highest for non-Hispanic black men 
     (22.0%) and lowest for Hispanic men (13.8%). The difference 
     between the highest and lowest age-adjusted percentages of 
     current cigarette smokers among the four racial and ethnic 
     groups remained stable during 1999-2014 because levels for 
     men in all racial and ethnic groups declined similarly during 
     this period. The difference between the highest (non-Hispanic 
     black) and lowest (Hispanic) percentages for men was 8.2 
     percentage points in 2014.
       For women, non-Hispanic white women consistently had the 
     highest age-adjusted percentage of current cigarette smokers 
     among the four racial and ethnic groups throughout 1999-2014 
     (18.3% in 2014), while non-Hispanic Asian women had the 
     lowest age-adjusted percentage (5.1% in 2014). For women, the 
     difference between the highest (non-Hispanic white) and 
     lowest (non-Hispanic Asian) percentages narrowed from 17.5 
     percentage points in 1999 to 13.2 in 2014. During 1999-2014, 
     racial and ethnic differences in cigarette smoking prevalence 
     were larger for women than for men.


                         Influenza Vaccination

       During 1999-2014, influenza vaccination was highest for 
     those aged 65 and over and lowest for those aged 18-64, for 
     all racial and ethnic groups.
       Influenza is a serious illness that can lead to 
     hospitalization and sometimes death. Influenza vaccination is 
     especially important for people who are at risk of getting 
     seriously ill from influenza, including those with chronic 
     conditions, older adults, and young children.
       The percentage of adults aged 18-64 who received an 
     influenza vaccination in the past 12 months remained stable 
     during 1999-2006 and then increased to 35.8% in 2014 (data 
     table for Figure 25). This pattern was present for all racial 
     and ethnic groups. Decreases in influenza vaccination 
     coverage in 2005 were related to a vaccine shortage (86). For 
     those aged 18-64, no racial and ethnic group was consistently 
     the most likely to receive influenza vaccination during 1999-
     2014. In 2014, non-Hispanic Asian adults had the highest 
     percentage for influenza vaccination receipt (41.3%) and 
     Hispanic adults had the lowest percentage (27.9%). For adults 
     aged 18-64, the difference between the highest and lowest 
     percentages of adults receiving an influenza vaccination 
     among the four racial and ethnic groups widened from 6.9 
     percentage points in 1999 (non-Hispanic white compared with 
     Hispanic) to 13.4 in 2014 (non-Hispanic Asian compared with 
     Hispanic).
       For adults aged 65 and over, the percentage who received an 
     influenza vaccination in the past 12 months increased from 
     65.7% to 70.1% during 1999-2014. During this period, trends 
     in influenza vaccination coverage varied by racial and ethnic 
     group, and no racial and ethnic group was consistently the 
     most or least likely to receive influenza vaccination. In 
     2014, non-Hispanic Asian adults had the highest percentage 
     for receipt of influenza vaccination (72.7%) and non-Hispanic 
     black adults had the lowest (57.4%). For adults age 65 and 
     over, the difference between the highest (non-Hispanic Asian) 
     and lowest (non-Hispanic black) percentages of older adults 
     receiving an influenza vaccination among the four racial and 
     ethnic groups was stable during 1999-2003 and then narrowed 
     to 15.3 percentage points in 2014.


                       Health Insurance Coverage

       During 1999 through the first 6 months of 2015 among adults 
     aged 18-64, lack of health insurance coverage was highest 
     among Hispanic adults.
       Health insurance is a major determinant of access to health 
     care. Children are less likely to be uninsured than adults 
     aged 18-64 because they are more likely to qualify for public 
     coverage, primarily Medicaid and the Children's Health 
     Insurance Program (CHIP) (see data table for Figure 26 for 
     estimates for children) (26,87). Passage of the Affordable 
     Care Act (ACA) in 2010 (38) authorized states to expand 
     Medicaid eligibility (88) and to establish the health 
     insurance marketplace in 2014.
       For adults aged 18-64, the percentage without coverage 
     increased from 17.9% to 20.5% during 1999-2013, and then 
     decreased to 12.7% in the first 6 months of 2015 (36). During 
     this period, the trend for lack of coverage varied by racial 
     and ethnic group.
       During 1999-June 2015, Hispanic adults aged 18-64 had the 
     highest percentage without coverage (27.2% in the first 6 
     months of 2015), and non-Hispanic white adults aged 18-64 had 
     the lowest, except in the first 6 months of 2015, when non-
     Hispanic Asian adults had the lowest percentage without 
     coverage.
       The difference between the highest and lowest percentages 
     of adults aged 18-64 without health insurance among the four 
     racial

[[Page 8619]]

     and ethnic groups narrowed from 1999-June 2015. This 
     difference was 24.9 percentage points in 1999 (Hispanic 
     adults compared with non-Hispanic white adults) and 19.9 
     percentage points in the first 6 months of 2015 (Hispanic 
     adults compared with non-Hispanic Asian adults).


          Difficulty Accessing Needed Dental Care Due to Cost

       During 1999-2014 among adults aged 18-64, nonreceipt of 
     needed dental care due to cost was lowest among non-Hispanic 
     Asian adults.
       Oral health is integral to general health and wellbeing, 
     and forgoing needed dental health care can have serious 
     health effects (89). In general, fewer adults have dental 
     coverage than medical coverage, and dental coverage tends to 
     be less comprehensive (90-92). In 2012, 44% of dental 
     expenditures among adults aged 18-64 were paid out of pocket, 
     a higher out-of-pocket percentage than for any other type of 
     personal health care expenditure (93).
       The percentage of adults aged 18-64 who did not receive 
     needed dental care in the past 12 months due to cost 
     increased from 9.3% to 17.3% during 1999-2010, and then 
     decreased to 12.6% in 2014 (data table for Figure 27).
       During 1999-2014, non-Hispanic Asian adults aged 18-64 had 
     the lowest percentage of not receiving needed dental care due 
     to cost (6.3% in 2014) among the four racial and ethnic 
     groups. No racial and ethnic group consistently had the 
     highest percentage of not receiving needed dental care due to 
     cost during 1999-2014. The difference between the highest and 
     lowest percentages of adults not receiving needed dental care 
     due to cost among the four racial and ethnic groups widened 
     during 1999-2010, and then remained stable from 2010-2014 for 
     those aged 18-64. This difference was 5.9 percentage points 
     in 1999 (non-Hispanic black compared with non-Hispanic Asian) 
     and 9.4 percentage points in 2014 (Hispanic compared with 
     non-Hispanic Asian).

  Mrs. BEATTY. Madam Speaker, we have heard a lot tonight. We have 
heard the call to action by Members. We have heard the relationship to 
poverty in health disparities, to the socioeconomic conditions of 
African Americans to health disparities. We have heard the relationship 
to death by guns to health disparities. We have heard the data and the 
statistics about the mortality rates from diseases like cardiovascular 
disease, the leading killer for women and African American women and 
men. We have heard about the effect of untreated diabetes and how that 
affects African Americans.
  The list goes on and on, Madam Speaker. I could tell you whether it 
is obesity, whether it is stroke--and certainly as a stroke survivor, I 
understand firsthand the value and the importance of quality, 
affordable health care--that there are some Federal programs that 
actually work and bridge the gap. I could say wonderful things about 
the United States Health and Human Services Office of Minority Affairs 
that provides data and research and services for us.
  But before I ask my colleague, Madam Speaker, to say a few words, I 
ran across something that was said, in my opinion, by one of the most 
powerful individuals that will go down in current history. And 20 years 
from now, Madam Speaker, if I were standing here talking about his 
legacy, health care would be one of them. Let me conclude my part with 
these brief words that he quoted on April 1 of this year:
  ``Our Nation was built on an enduring belief that we are all created 
equal--regardless of the color of our skin or the station into which we 
were born. From the ambitions we hold for ourselves to the way we take 
care of our health, this founding premise serves as the guidepost of 
our national life.''
  Yet, to this day, Madam Speaker, minorities continue to experience 
the healthcare gaps that leave their communities our communities.
  I will add this to his ending that, Madam Speaker, tonight, the 
Congressional Black Caucus asks that we recommit to taking action to 
overcome these disparities. And that person who will leave a great 
legacy for these words is no other than our President of these United 
States, President Barack Obama.
  And now as we begin to close our hour, I yield to the gentleman from 
New York (Mr. Jeffries). I could not think of a better colleague, a 
better coanchor, to come and share with us our call to action.
  My colleague and classmate, Congressman Jeffries, is a scholar, 
someone who sits back, listens, and then comes with resolve. He is 
someone who is no stranger to this process of telling it like it is. He 
is someone who has spent a lot of time and years with his experience to 
speak for the individuals of his district. But tonight, Madam Speaker, 
I asked him to speak for the Congressional Black Caucus. I asked him to 
close us out on our call for action as we talk about the health 
disparities in our African American communities.
  Mr. JEFFRIES. Madam Speaker, I thank my good friend, the 
distinguished gentlewoman from Ohio, and our phenomenal anchor for this 
CBC Special Order hour today and throughout the second session of the 
114th Congress. It has been an honor and a privilege to work closely 
with her. She has done such a phenomenal job, not just on behalf of the 
people she represents in the great city of Columbus, Ohio, but all 
throughout the Nation in her various roles, and certainly in her 
leadership in the Congressional Black Caucus.
  It is with a heavy heart that I stand on the floor of the House of 
Representatives today and, with great sadness, acknowledge the pain and 
the suffering and extend my condolences to those who have suffered this 
great tragedy in Orlando, Florida, the worst mass shooting in the 
history of the United States of America.
  It is a complicated shooting. We understand that it most likely is an 
act of terror, a hate crime of unspeakable proportions. There are 
indications that the shooter may have some degree of mental illness and 
a history of domestic abuse. The shooter appeared to have been, in some 
measure, on the FBI's radar.
  But you can add all those things up and there is still something that 
is missing that we here in Congress have the capacity to deal with, and 
that is the fact that one individual was able to purchase a weapon of 
mass destruction--which should be reserved for war, not the hunting of 
human beings in this great democratic Republic--and inflict death on 49 
individuals and maim in ways that are inhumane to more than 50 others.
  Martin Luther King, Jr., once said: ``In the end, we will remember 
not the words of our enemies, but the silence of our friends.''
  During the 114th Congress, there have been more than 100 mass 
shootings. We often come to the floor of the House of Representatives 
and the Speaker or one of his designees stands at the rostrum and asks 
us, as Members of the House, to stand in a moment of silence. And then 
we go on with business as usual, having done nothing about the 
tremendous gun violence problem that we have in America.
  The rest of the world is looking around and saying: What are they 
doing in the United States of America? Five percent of the world's 
population, 50 percent of the world's guns. It is estimated that there 
are more than 300 million guns circulating throughout this great land. 
The FBI and local law enforcement can't tell you where the overwhelming 
majority of them are because of legislative silence and malpractice.
  This is an issue, of course, that has great impact on the African 
American community. Homicides are the leading cause of death through 
guns of younger African American men. So we in the CBC view it as a 
public health crisis certainly for our community. I think it is one 
that all Americans should view as a health crisis for the entire 
country.
  But the thing that is also troubling--and we will have time to deal 
with this tragedy--is hopefully we will be able to take some 
commonsense steps in the right direction, including making sure that 
individuals who are on the terrorist watch list can't purchase weapons 
of mass destruction. How complicated is that to do?
  But the thing that is striking for many of us in the African American 
community is that, when you look at some of the leading causes of 
death--heart disease being number one, and then, of course, diabetes 
and childhood obesity being problematic, certain forms of cancer, HIV/
AIDS infection--many of these illnesses, these ailments that plague the 
neighborhoods that I

[[Page 8620]]

represent in central Brooklyn, in Bedford-Stuyvesant, in East New York, 
in Ocean Hill-Brownsville, in Canarsie, and in the west end of Coney 
Island, are preventable, preventable by better exercise, preventable by 
dealing with some of the environmental racism that many low-income 
communities of color have been subjected to, resulting in incredibly 
high rates of asthma and other forms of respiratory illness, 
preventable by better diet.
  Senator Booker recently said to many of us--and this has stuck with 
me--that more African Americans in the United States of America die as 
a result of drive-throughs, not drive-bys. That is because the diet, 
the access to healthy food, is limited. The food deserts within which 
many African Americans, particularly at the lowest socioeconomic level, 
are forced to reside in are scandalous.
  So we in the Congressional Black Caucus believe that we have to deal 
with these issues in a more meaningful, comprehensive fashion.
  I am thankful that back at home in the west end of Coney Island, 
Coney Island Cathedral, one of the most important religious 
institutions in Brooklyn, is actively engaged in a public health 
campaign to deal with diabetes and heart disease and many of the other 
ailments that result from a poor diet that exists, a lack of access to 
healthy food in the Black community. It is a campaign that we want to 
take across the Nation.
  We are thankful for the work that has been done by the Congressional 
Black Caucus and by President Obama through his leadership of the 
Affordable Care Act. We now know that over 20 million previously 
uninsured Americans now have access to quality, affordable health 
care--disproportionately African American.
  That is a positive step in the right direction. But instead of trying 
to dismantle this monumental step forward, as House Republicans have 
attempted to do more than 60 times over the last few years, they have a 
clinical obsession with a law that has been declared constitutional--
not once, but twice--by the United States Supreme Court.
  Let's figure out ways to come together as a nation, despite our 
racial, religious, and ethnic differences, to deal with the disparities 
that exist in the African American community and beyond. And let us 
come together as a Congress and as a nation to deal with the scourge of 
hate, in its most recent form, directed at the LGBT community down in 
Orlando in such a horrific and invidious fashion.
  We are better than this. We can do much better here in the United 
States Congress. The Congressional Black Caucus is here to lead the way 
on issues, worked in partnership hand in hand with our colleagues on 
the other side of the aisle, if they are just willing to meet us some 
of the way, to deal with the issues of health disparities in the 
African American community and deal with the scourge of gun violence 
that takes our young boys and girls in shocking numbers and also 
impacts people all across the country.
  I thank the distinguished gentlewoman for her leadership and for once 
again yielding to me and anchoring this Special Order in such a 
phenomenal way.
  Mrs. BEATTY. Madam Speaker, I thank Congressman Jeffries.
  Madam Speaker, as we close out tonight, I can't think of a better way 
to take my last 30 seconds than to speak to you and to speak to America 
and to ask that we take these last seconds in silence as a call to 
action to prevent the guns being on the street, as a call to action to 
reduce the health disparities. But in honor of the families in Orlando, 
we give them our commitment that we stand with them and that I stand 
with all of my friends and constituents and supporters who belong to 
the LGBT community.
  I yield back the balance of my time.
  Ms. EDDIE BERNICE JOHNSON of Texas. Madam Speaker, I rise in honor of 
the special order hour titled ``Bridging the Divide: A Call to Action 
by the Congressional Black Caucus to Eliminate Racial Health 
Disparities.'' I would like to thank my colleagues Congressman Hakeem 
Jeffries and Congresswoman Joyce Beatty for hosting this timely special 
order.
  Historically, racial and ethnic minorities are likely to have the 
highest uninsured rates and are less likely to receive preventive and 
quality health care. While the Affordable Care Act has helped 
minorities afford health insurance and access quality care, there is 
still a need to eliminate existing disparities. For example, the 
Department of Health and Human Services is currently working to expand 
access, end racial and ethnic discrimination, perform outreach to 
underserved communities, improve workforce diversity, and expand data 
collection and reporting.
  While this is an ambitious plan, it is one that is extremely 
necessary. Unfortunately, coverage, access, and outreach may not be the 
only keys to eliminating disparities. Demographic characteristics 
contribute heavily to racial and ethnic health status. For example, 
research shows that privately insured African American and Hispanic 
adults fare worse than privately insured white adults along measures to 
access and use of care. Unfortunately, African Americans and Hispanics 
are less likely to have a regular provider than their white 
counterparts. The same research also showed that privately insured 
African Americans and Hispanics had less confidence in their ability to 
pay for medical costs.
  Since social determinants like economic stability, education, and 
environment play such a large role in how we each view and access 
health care, many of the changes necessary to eliminate racial and 
ethnic disparities require a much larger plan than just a focus on 
health-related programs. Reducing disparities in health truly entails 
addressing racial and ethnic social determinants such as availability 
of safe housing, affordable food, access to education, job 
opportunities, community-based resources, public safety, public 
transportation, and more.
  Our society must make many changes before we can truly eliminate 
racial and ethnic health disparities because that also means 
eliminating disparities in many other sectors. I thank Congressman 
Jeffries and Congresswoman Beatty for hosting this poignant special 
order.

                          ____________________