Patient Navigator Outreach and Chronic Disease Prevention Act of 2004

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

Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous material on H.R. 918, the bill now under consideration.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, we have a number of bills before the House today, dealing with health-related issues that have come out of the committee that I have the privilege to chair, the Committee on Energy and Commerce. This bill is one of the more important of those bills as it attempts to give our citizens the ability to navigate the health care system to get the very best possible care in the most time-efficient manner.

I would like to take a step back and reflect on where we have been in this Congress and in previous Congresses. As the second session of this Congress draws to a close, I think it is entirely fitting that the House should devote much of its time today on these health care issues. It is not a stretch, in my opinion, to call this House, the 108th Congress, the Health Care Congress. I am proud of the many accomplishments that the Committee on Energy and Commerce has been responsible for in this area over the last 2 years.

I think the achievement that we will reflect back on and be most proud of, of course, is the Medicare Modernization Act, which President Bush has already signed into law and which is helping millions of our senior citizens as we speak. After years of debate and inaction, this Congress finally has delivered in that bill a prescription drug benefit to our Nation's seniors.

Of course, not all of the Medicare Modernization Act's provisions are fully up and running yet. They will be phased in over the next several years. And when they are totally phased in, I think we will all look back and reflect that this was a very good thing that we have done in this Congress.

We should be proud of our achievement. I salute the members of the Committee on Energy and Commerce who have worked so long and hard to make that happen.

Prescription drugs are not the only area where this Congress has worked to advance the health agenda of the American people. Working with President Bush, we have also written laws that upgrade our medical device program. We have instituted a new animal drug approval system. We have provided for competition in the contact

lens marketplace. We have updated our poison control center programs.

I might add that all of those achievements occurred under Congressman Billy Tauzin of Louisiana, who, as we speak, is undergoing radiation treatment down in Texas for a cancer that he has discovered in his body that, hopefully, is being removed.

We have also improved our Nation's organ donor system and, most recently, created a new program to help prevent and educate against youth suicide. By any measure, these accomplishments would rival that of any Congress in the past.

Today, we are continuing the good work we have already established in the 108th Congress. We have five substantive bills that we are going to debate and vote on, hopefully in a positive way, in the next several hours, all of which in some way improve the health care system for millions and millions of Americans.

The one we are debating at this moment is the Patient Navigator Outreach and Chronic Disease Prevention Act. The Committee on Energy and Commerce favorably reported this legislation last week, and it is now on the floor.

Improving health care outcomes for all Americans requires substantial improvements in health disparity populations, populations not defined solely by race and ethnicity, that have a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates as compared to the health status of the general population. Patient navigator programs as provided in this bill provide outreach to communities to encourage more individuals to seek preventive care and coordinate that care so that they are less at risk to have or to maintain a chronic disease.

For example, the Ralph Lauren Center for Cancer Care and Prevention, a partnership between Memorial Sloan-Kettering and North General Hospital in Harlem, New York, operates a patient navigator program to help patients and family members deal with the complexities of the health care system in that area. By coordinating health care services through a patient navigator, programs strive to shorten the period of time when the patient is screened for cancer or other chronic diseases and further diagnosis and treatment, so they can be treated as soon as possible.

H.R. 918, as amended by the Committee on Energy and Commerce, authorizes a 5-year demonstration program to evaluate the use of patient navigators. Specifically, the legislation requires patient navigators to coordinate health care services and provider referrals, facilitating the involvement of community organizations to provide assistance to patients, facilitate enrollment in clinical trials, anticipate barriers within the health care system itself, to help ensure prompt diagnostic care and treatment, to coordinate with the health insurance ombudsman program, and conduct ongoing outreach to health disparity populations for preventive care.

Grant recipients must establish base-line measures and benchmarks to evaluate the program outcome, which all culminate in a final report prepared by the Secretary no later than 6 months after the completion of the demonstration grant program. The bill authorizes a total of $25 million over a 5-year period to conduct these demonstration programs.

I would like to thank the distinguished gentlewoman from the 15th Congressional District of Ohio (Ms. Pryce), for her outstanding leadership and undying commitment to this particular bill. I would also like to thank the chairman of the subcommittee, the gentleman from Florida (Mr. Bilirakis), for his work; the ranking member, the gentleman from Michigan (Mr. Dingell); the subcommittee's ranking member, the gentleman from Ohio (Mr. Brown); and the bill's sponsor, the gentleman from New York (Mr. Menendez), for their assistance in streamlining this legislation.

Again, Madam Speaker, I want to congratulate my colleagues on a very successful Health Care Congress, and especially on this particular bill. If we can get the bills that we are considering today to the President's desk, the 108th Congress should go down as one of the best ever for health care initiatives.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield 5 minutes to the gentlewoman from the 15th District of Ohio (Ms. Pryce), our distinguished Republican Conference chairwoman.

Mr. Speaker, I yield 3 minutes to the gentlewoman from Florida (Ms. Ros-Lehtinen).

Mr. Speaker, I have no further requests for time, and I yield back the balance of my time.

Mr. Speaker, I want to thank my colleague from Ohio (Mr. Brown) as well as the gentleman from Michigan (Mr. Dingell), ranking member on the Committee on Energy and Commerce, as well as the gentleman from Texas (Mr. Barton) and the gentleman from Florida (Mr. Bilirakis), chairman on the Subcommittee on Health, and all their staff for bringing us here today. I want to particularly thank my good friend and lead cosponsor from Ohio (Ms. Pryce) and her staff who have been actively engaged in this effort and have been instrumental in getting the bill to the floor today. And, of course, the gentlewoman from Ohio's own personal experiences and her family with the questions of cancer have made her such a powerful advocate in this regard.

This is truly a bipartisan effort and a case study in how, if we choose to work together across the aisle, we can really make a difference. I began working on this legislation several years ago to address the health disparities I saw in my district, a true melting pot of America with a very significant Hispanic population. There have been many people involved behind the scenes in this effort that I want to take the opportunity to thank.

The first person I spoke to about this issue was David Woodmansee, who is the Northeast regional representative for the American Cancer Society. The second person I met with was Licy Do Canto who was with the American Cancer Society and has continued the fight for patient navigators at the National Association of Community Health Centers. Dave and Licy, along with the help of ACS employees, were instrumental in helping us to take a concept such as patient navigation and turn it into a legislative solution for improving health outcomes among all populations, particularly underserved populations. I also want to thank Karissa Willhite, the Democratic Caucus policy director, for her untiring efforts to achieve the success we expect to have today. And we cannot talk about patient navigators without thanking three doctors, Drs. Harold Freeman, Elmer Huerta and Gil Friedell, who have been pioneers in creating patient navigator programs that can be replicated across the country, which is exactly what we are doing today.

There is no question that we as a Nation must do more to improve health outcomes and that can only be done when we start at the bottom and bring those with the greatest disparities up out of despair. Reducing health disparities has been a much-talked-about goal, but we cannot achieve better health outcomes without action. We cannot just talk about the problem. We have to take action to end the problem.

The patient navigator bill is an effort to do just that. It will ensure that all Americans, regardless of income, race, ethnicity, language or geography will have access to prevention screening and treatment, and that they will have an advocate at their side helping them navigate through today's complicated health care system.

The bill addresses what I believe are the root causes of health disparities in minority and underserved communities. That is, lack of access to health care, particularly prevention and early detection. The bottom line is, the only way to stay healthy is to see a doctor when you are healthy. Unfortunately, patients in health disparity communities are less likely to receive early screening and detection, so their disease is found at a much later stage and they have less chance of survival. That is why we are here today, to give those people the chance they deserve for a long, healthy life.

The patient navigator bill does this by replicating the successful models developed by Drs. Freeman, Huerta and Friedell in a national demonstration project. It focuses on outreach and prevention through community health centers, rural health clinics, Indian health clinics and cancer clinics. And it does so by providing patient navigator services and outreach in health disparity communities to encourage people to get screened early so that they can receive the care they need. Patient navigators educate and empower patients, serving as their advocates in navigating the health care system.

In addition to having visited both Dr. Freeman's program in Harlem and Dr. Huerta's program here in Washington, my constituents in New Jersey and I have seen firsthand the difference patient navigators can make in a community. I was able to secure funding for a 1-year demonstration project at a community health center in Jersey City, New Jersey. The program has screened 842 people and has a caseload of about 140 patients who were identified

through these screenings with abnormal findings and are currently benefiting from the help of the patient navigator in finding follow-up care and treatment.

Before I close, I just want to share a story about Hazel Hailey, one of the patient navigators at this center and her daughter, Robin Waiters. Robin, who was only 36 years old, suffered severe stomach pains for 2 years and refused to see a doctor, despite her mother's pleas for her to seek medical care. Finally, she had no choice but to go see a doctor. Tragically, 3 months later, Robin died from colorectal cancer. Her mother, Hazel, who is now a patient navigator, tells us about her daughter's last request. She made her mom promise to tell all of her friends, family and everyone she could ``that if your body is trying to tell you something, listen to it. You could possibly save your life.'' Hazel quotes her daughter as saying, ``I am dying because I chose not to get help. Fear set in, and I lost out on life.''

Hazel is fulfilling her promise to her daughter as a patient navigator, working every day to ensure that what happened to her daughter does not happen to other families. That is why we are here today, to ensure that the Hazels across the country have the tools they need to educate and empower people about the importance of early detection screening and to help them navigate the complexities of the health care system so that they can get the treatment and follow-up care they need.

Again, I want to thank my colleague from Ohio (Ms. Pryce) for all of her work on this effort as well as all of those who have worked behind the scenes to make this concept a reality. We have come too far and are too close to simply let the issue die at the end of this Congress, so I call upon our colleagues in the other body to join us in making this bill a reality this year. There is simply too much at stake if we do not act.

Madam Speaker, I thank the gentleman for yielding me this time, and I want to begin by commending the gentleman from Texas (Mr. Barton), the distinguished chairman of the Committee on Energy and Commerce. He has led this committee with great strength since he took the helm; we have enjoyed working with him, and I want to thank him for his attention to this important issue.

I also want to extend special thanks to my friend and colleague, the gentleman from New Jersey (Mr. Menendez). He has been a great partner over the last few years as we have worked this initiative together. We represent different parts of the country, and we belong to different political parties, but we have put many differences aside and have joined together for a great purpose here today. We joined together because we understand that cancer, diabetes, and other chronic diseases can affect anyone in any part of the country, of any race and of any income level.

Madam Speaker, even with the tremendous advancements we have made in prevention, diagnosis, and treatment of illnesses, we understand that in far too many communities across this country navigating the health care system can be a significant barrier to gaining access to quality and affordable service.

Before I continue, I want to take a moment to extend my appreciation to my staff and the staff of the committee for their excellent work and the help they have given us. And I want to highlight the American Cancer Society, the National Association of Community Health Centers, and the National Rural Health Association for their tireless efforts to educate our colleagues about the importance of this issue.

Madam Speaker, each and every day Congress is in session, our colleagues on both sides of the aisle debate important issues. Sometimes we agree and other times we disagree. But at the end of the day, we share the same goal: to return to our districts with something positive to tell our constituents about.

Today, every Member of this body will have the opportunity to report to their constituents something positive: that this Congress has taken a significant step to ensure that our friends and neighbors across America have the tools and resources they need to make good decisions about their health and the health of their children.

Madam Speaker, last year, I had the opportunity to meet two gentlemen

who pioneered the concept that this legislation is based on, the patient navigator concept. Dr. Harold Freeman and Dr. Elmer Huerta were two of the most humble, kind gentlemen I have ever had the good fortune of getting to know. Let me tell you a little about what they do.

First, they recognized in their own work as doctors in underserved communities that navigating the health care system can be an insurmountable barrier for many, many people, especially when they are poor, underserved, and uninsured. All we have to do is step in and help them. Step out of our homes into communities and we will find families and individuals who struggle to find access to the health care that they need, both preventive and treatment.

The concept of these doctors is a great one. The patient navigators are angels who guide individuals through the health care system. It is truly one of the most creative and innovative ways to address the health care needs of these individuals, who may otherwise avoid seeing a doctor when they are healthy and avoid treatment when they need it, when they are sick.

Whether based at hospitals, community health centers or cancer centers, these programs literally put in place patient navigators to help individuals find their way through the often complex health care systems that they are confronted with.

These navigators, like Leka Murdock whom I met during my visit to the Ralph Lauren Cancer Center in Harlem, assist people who come through their doors with obtaining coverage through the Medicaid system or other sources, they obtain cancer screenings or counseling about disease prevention, or they make referrals for treatment or clinical trial options should an abnormality be detected.

For people who may otherwise not know or be able to access the system, patient navigator programs offer them the tools and resources they need to make the good decisions about their health and the health of their children. They help break through the red tape that often prevents them from getting the information and the treatment so needed.

That is why the gentleman from New Jersey and I partnered together to introduce, garner support for and move forward this legislation that will create innovative demonstration projects in communities across the country based on this concept. This bill will link sustained health promotion outreach efforts with patient navigator programs. Specifically, the bill will make funds available to community health centers, cancer centers, rural and frontier serving medical facilities and other eligible entities to increase and promote chronic-disease- prevention screening, outreach and public health education, as well as provide patient navigators to help patients overcome the barriers and complexities in the system.

It is my hope that this legislation will serve as a springboard for launching many more navigator programs. These are extraordinary programs, and they are making real differences in the lives of people who are suffering, people who may not otherwise even know that they are sick. Or if they do, people who may not do what is necessary to get better. These are the people we need to reach, and this bill is a healthy start. By furthering this collaboration between the private and the public sectors, we will maximize our resources and close in on that day when cancer and other chronic diseases no longer threaten the lives of our loved ones.

Mr. Speaker, I urge my colleagues to support this legislation.

Mr. Speaker, I rise today to join my colleague Congressman Robert Menendez of New Jersey in the passage of H.R. 918, the Patient Navigator, Outreach, and Chronic Disease Prevention Act of 2003. As you know, Mr. Speaker, I have come to this floor on numerous occasions to express my outrage concerning racial and ethnic health disparities in this Nation and legislative solutions to address them. For years, research has told us that minorities and low-income populations are the least likely to receive the health care they need to live a long, healthy life. We've done a very good job of identifying this problem and finally we have a bill that will begin the process of solving them.

The bill we are passing today while greatly modified enjoys strong support from the American Cancer Society, the National Association of Community Health Centers, the National Alliance for Hispanic Health, the National Hispanic Medical Association, the National Medical Association, Racial and Ethnic Health Disparities Coalition, the Intercultural Cancer Council and their Caucus, the National Council of La Raza, 100 Black Men of America, the National Rural Health Association, Asian and Pacific Islander American Health Forum, the Cancer Research and Prevention Foundation, and the National Patient Advocate Foundation.

This bill addresses what many of us believe are the root causes of health disparities in minority and underserved communities: Lack of access to health care in general--and particularly lack of access to prevention and early detection--as well as language and cultural barriers to care.

In the 2002 IOM report Unequal Treatment: Confronting racial and ethnic disparities in care, research explained that there are a number of explanations for the higher rates of disease among minority populations, including higher rates of uninsured, reduce access to care, and lower quality of care. But all of these barriers point to the same underlying problem, minority patients are less likely to receive early screening and detection, so their disease is found at a much later stage and they have less chance of survival.

This bill we're passing today will be the process to ensure that all Americans, regardless of race, ethnicity, language, income, or geography, will have access to prevention screening and treatment, and that they will have an advocate at their side, helping them navigate through today's complicated health care system.

The bill before us ensures that navigators are available to help patients make their way through the health care system--whether it's translating technical medical terminology, making sense of their insurance, making appointments for referral screenings, following up to make sure the patient keeps that appointment, or even accompanying a patient to a referral appointment.

Mr. Speaker, I also want to acknowledge that the original concept for the legislation comes from Dr. Harold Freeman's ``navigator'' program, which he created while he was Director of Surgery at Harlem Hospital. It is our hope that Dr. Freeman's navigator concept and its laser shape focus on comprehensive modeling of prevention services will eventually be fully translated in legislative terms. To this end, it is my sincere desire that this body would move expeditiously in holding hearing on H.R. 3459 the Healthcare Equality and Accountability Act of 2003. It is our firm belief that H.R. 3459 expands and accents the comprehensive components that Dr. Freedman's navigator program embodies. As you know, Mr. Speaker, H.R. 3459 enjoys the support of 104 Members in this body, was created by the Congressional Black, Hispanic, Asian Pacific American, and Native American Caucuses, and included the introduced version of the bill before us today.

In closing, Mr. Speaker, I want to thank Karissa Willhite of Mr. Menendez's office and John Ford and Cheryl Jaeger of the Energy and Commerce Committee along with other staff that enabled this bill to come to the floor. It urge my colleagues to vote for its adoption.

I thank the gentleman for yielding me this time.

While there is no question, Mr. Speaker, that tremendous progress has been made across our country in the fight against cancer and other diseases, barriers continue to exist between millions of Americans and their access to high quality health care. Whether it is due to distance, lack of health insurance, limited access to specialists, limited language skills, whatever the reason, too many Americans continue to receive a narrow range of health care services and limited options. That is why I am so pleased to join the gentlewoman from Ohio (Ms. Pryce) and the gentleman from New Jersey (Mr. Menendez) as an original cosponsor of the Patient Navigator, Outreach, and Chronic Disease Prevention Act and to express my heartfelt support for this vital piece of legislation that is going to improve the lives of so many people.

This program provides a crucial service, primarily to the underinsured and the uninsured members of all populations, and most specifically to the Hispanic and African-American populations that studies have shown are those who are in those categories of underinsured and uninsured. Navigating the health system can be a huge barrier for many people. The patient navigator bill will greatly aid the community by providing a more efficient service for all. The patient navigator bill will also help the communities by providing a more efficient service for all minorities because it addresses the unique needs of the population that it serves through providing culturally sensitive services, including cancer screening, disease prevention counseling, assistance in obtaining Medicaid and other necessary referrals.

This important legislation, Mr. Speaker, would ensure early prevention screening and timely treatment for all patients. It seeks to help close the gap that exists in health care treatment for minority communities, thus improving their quality of life and ensuring that the minority members of our community are treated with the utmost respect and care.

An example of a successful patient navigator program exists right here in our Nation's capital, Mr. Speaker. It is run by Dr. Elmer Huerta, one of the founding fathers of the patient navigator program. Dr. Huerta conducts a weekly 1-hour show called, Let's Talk About Health, Hablemos de Salud, which focuses on health promotion and disease prevention. This show reaches about 75 percent of Hispanics and Latinos in the United States, over 25 million people, and it extends to Latin America. I am proud to be associated with such a dynamic and exciting program, and I thank all who have worked tirelessly to make this vital program a reality. Muchas gracias.