Floor Statements

Mr. Chairman, I have an amendment at the desk.

Mr. Chairman, I rise today to offer an amendment that would require the GAO to conduct a study that highlights the impact that elimination of funding would have on the number of physicians that would be trained if this program were allowed to continue as intended.

Countless studies have demonstrated a serious and growing shortage of health professionals facing the United States--most critically a shortage of primary care physicians and dentists. However, where I come from, there is a

shortage of specialties as well. With an existing shortage well established and an aging population increasing, our country desperately needs investments in the health care workforce, not rescissions.

In my home State of California alone there are 567 designated health professional shortage areas, which include a population of more than 3.8 million medically underserved individuals. In California's San Joaquin Valley, there are already fewer than 87 primary care physicians for 100,000 patients of population. The doctor/patient ratio in my region is not getting better; it is getting significantly worse. That is why I have consistently advocated for the need to improve access to care and address this vital shortage.

All eight counties in the San Joaquin Valley have been designated as medically underserved by the Department of Health and Human Services, including Merced, Stanislaus, San Joaquin, Madera, and Fresno Counties. At one point a few years ago, we were down to one pediatrician for the entire county of Merced. With the passage of the Affordable Care Act, we were able to include additional funding for these medical residency programs to help address the mounting health care profession shortage in already established underserved areas.

The new Teaching Health Centers Graduate Medical Education Program is intended to be an investment that helps struggling underserved communities deal with the reality of increasing demands on an already strained health care system. Studies have shown that the most effective way to attract and retain new doctors in underserved areas is to allow medical students to complete their medical residency programs in the communities that are in need. Graduating physicians most often practice in the communities where they have completed their residency training, which is why this program is uniquely important. My wife is a perfect case in point, a primary care physician who stayed in our community and practiced for 18 years after she finished the program.

Without these critical investments, the lack of care will most certainly have a costly price on the health and well-being of many rural underserved communities, including those I represent.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I demand a recorded vote.

Offered By: Mr. Cardoza

Amendment No. 5: In section 1, add at the end the

following:

(d) Effective Date.--Subsections (a) and (b) shall not take

effect until the date there no longer are any areas

designated as health professional shortage areas under

section 332 of the Public Health Service Act (42 U.S.C.

254e).

Offered By: Mr. Cardoza

Amendment No. 6: Page 4, after line 12, add the following:

(d) GAO Study and Report on Physician Shortage.--The

Comptroller General of the United States shall conduct a

study to determine--

(1) the extent to which there is a shortage of physicians

in the United States, including case studies of areas with

significant shortages of physicians, such as the Central

Valley of California;

(2) the impact that expanding existing and establishing new

approved graduate medical residency training programs under

section 340H of the Public Health Service Act (42 U.S.C.

256h), using the funding appropriated by subsection (g) of

such section, as in effect on the day before the date of the

enactment of this Act, would have on the number of physicians

that would be trained if such funding were not rescinded and

made subject to the availability of subsequent appropriations

by subsections (a) and (b) of this section; and

(3) the impact that the enactment of subsections (a) and

(b) will have on the number of physicians who will be trained

under approved graduate medical residency training programs

pursuant to such section 340H.

Offered By: Mr. Cardoza

Amendment No. 9: Page 4, after line 12, add the following:

(d) GAO Study and Report on Physician Shortage.--The

Comptroller General of the United States shall conduct a

study to determine--

(1) the impact that expanding existing and establishing new

approved graduate medical residency training programs under

section 340H of the Public Health Service Act (42 U.S.C.

256h), using the funding appropriated by subsection (g) of

such section, as in effect on the day before the date of the

enactment of this Act, would have on the number of physicians

that would be trained if such funding were not rescinded and

made subject to the availability of subsequent appropriations

by subsections (a) and (b) of this section; and

(2) the impact that the enactment of subsections (a) and

(b) will have on the number of physicians who will be trained

under approved graduate medical residency training programs

pursuant to such section 340H.

Mr. Speaker, May 15th through the 21st is National EMS Week, a week set aside to reflect upon and honor the life-saving and heroic role the Emergency Medical Services, EMS, community plays in our society. While everyone associated with the EMS system is worthy of due praise, I rise today to pay tribute to one particular segment of the EMS system.

In conjunction with EMS Week, the Association of Air Medical Services is instituting the inaugural MedEvac Hour, asking those who are participating in EMS Week to find one hour of the week to recognize the contributions of all those involved in helicopter and fixed-wing aircraft medical transport. As a co-chair of the Congressional Air Medical Caucus, I recognize the vital role the air medical community plays in this nation's health care system.

I would like to take this opportunity to especially commend the exemplary services provided to my constituents in California's 18th congressional district: PHI Air Medical of Modesto, Medi-Flight of Modesto and Merced, REACH Air Medical Services of Stockton, Sky Life Central California of Fresno, and the California Highway Patrol-- Central Division. The work they do saves lives and we are grateful for it.

Numerous studies have shown that the first hour following a trauma is a critical period in determining the final health outcome of the patient. However, 46.7 million Americans live more than an hour away from a Level 1 or Level 2 trauma center. When time and distance are critical, helicopter MedEvac is the quickest and most efficient way to get critical level medical care to the patient. MedEvac helicopters are most often utilized for time-sensitive illnesses and injuries such as severe trauma, heart attacks, or strokes. In remote rural areas, MedEvac helicopters are often the only access to definitive treatment and diagnosis. It is estimated that MedEvac helicopters transport approximately 400,000 patients annually, with MedEvac fixed-wing aircraft transporting an additional 100,000-plus patients over longer distances annually.

As early as 1926, the United States Army Air Corps used a converted airplane to transport patients from Nicaragua to an Army hospital in Panama, 150 miles away. Routine MedEvac transport utilizing helicopters began during the Korean conflict in the 1950s. In March of 1970, the Maryland State Police transported the first critically injured trauma patient by helicopter in the United States. The first civilian hospital-based medical helicopter service in the United States was established in 1972 at St. Anthony's Hospital in Denver, Colorado.

As of the close of 2009, there were over 4,400 MedEvac pilots, 600 physicians, 5,500 nurses, and 5,300 paramedics/EMTs staffing MedEvac vehicles, both fixed-wing and helicopter, in the United States. These people save lives every day, providing critical level medical care and safe, rapid transport to the most appropriate health care facility during the most dire of circumstances. In addition, we cannot overlook the many other people, from aviation mechanics to communication specialists, that play a key role in MedEvac operations.

All of the dedicated men and women of the MedEvac community deserve our heartfelt thanks. I urge all of my colleagues, during this National EMS Week, to take a moment to recognize these unsung heroes and the life-saving services the MedEvac community brings to their districts and across the nation.

Offered By: Mr. Cardoza

Amendment No. 1: At the end of the bill, add the following

new section:

Offered By: Mr. Cardoza

Amendment No. 1: At the end of the bill, add the following

new section:

Offered By: Mr. Cardoza

Amendment No. 484: At the end of the bill (before the short

title), insert the following:

Offered By: Mr. Cardoza

Amendment No. 499: At the end of the bill (before the short

title), insert the following:

Offered By: Mr. Cardoza

Amendment No. 58: At the end of the bill (before the short

title), insert the following:

Sec.__. The amount otherwise made available by this Act

for the Office of the Secretary of the Department of Housing

and Urban Development is hereby reduced to $0.

Offered By: Mr. Cardoza

Amendment No. 59: At the end of the bill (before the short

title), insert the following:

Sec.__. None of the funds made available by this Act may

be used to pay the travel expenses of the Secretary of

Housing and Urban Development.

Offered By: Mr. Cardoza

Amendment No. 60: At the end of the bill (before the short

title), insert the following:

Offered By: Mr. Cardoza

Amendment No. 61: At the end of the bill (before the short

title), insert the following:

Offered By: Mr. Cardoza

Amendment No. 62: At the end of the bill (before the short

title), insert the following:

Madam Speaker, I rise today to say a few words honoring my friend and colleague, Rep. Gabrielle Giffords.

I first came to know Gabby when she joined the Blue Dog Coalition, a group of moderate, fiscally conservative Democrats of whom I have served as co-chairman.

I came to know--and admire--Gabby more when I travelled to her district in southern Arizona to host a town hall on agriculture with her.

As all who have met her know, Gabby is a bright, energetic young woman who is deeply committed to public service. That inner

strength will no doubt carry her through this tragedy and to a full recovery.

As painful as it may be too admit, this tragedy was not unexpected. Gabby's office had been the target of violence before.

And, as all of us who have held public events over the past few years know, the anger and vitriol has been escalating.

Sadly, it was only a matter of time before hateful speech turned to hateful action.

Passionate public debate is essential to our democracy. It is what our founders fought and died for, and it is what made the United States unique among nations at our birth.

But we must maintain respect and civility in our discussions. Elected officials have a responsibility to set an example and behave like statesmen.

The media have a responsibility to encourage debate, without feeding the flames of anger.

And the public has a responsibility to stand up and be strong voices in our democracy, without degrading the debate into petty name-calling.

As one of my colleagues said recently about a verbal attack made against him, ``It's not what you meant to say that matters, or even how I understand it. What matters is how your words are interpreted by the least sane person in my district.''

I look forward to the day--hopefully soon--when we will see Gabby back on this floor, fighting for her constituents in southern Arizona.

Until then, instead of pointing fingers and playing the blame game, let's take this tragedy as an opportunity to return civility to our democracy.