Madam Speaker, it is my honor to be here to host this hour on behalf of the Congressional Black Caucus. And we want to talk about health care this evening. Before the votes, I attended a District of Columbia Black AIDS Leadership…
Madam Speaker, it is my honor to be here to host this hour on behalf of the Congressional Black Caucus. And we want to talk about health care this evening.
Before the votes, I attended a District of Columbia Black AIDS Leadership Mobilization Summit; it was a town meeting held at the Kaiser Family Foundation. I want to commend the Congressional Black Caucus Foundation, the Black AIDS Institute, the Kaiser Foundation, NAACP, National Urban League, the YWCA, Southern Christian Leadership Conference, the National Council of Negro Women, Us Helping Us, The Women's Collective, Balm in Gilead, the National Black Leadership Commission on AIDS, Phi Beta Sigma, the National Medical Association, and all of the associations which came together to address the epidemic in the District of Columbia and around the country.
On March 16 of this year, the D.C. AIDS Office released its latest HIV surveillance report. And what it showed was that the HIV rate in the Nation's capital is the highest in the country, and that an estimated 3 percent of the population is affected with AIDS. One percent would make it an epidemic, so it is of epidemic proportions here in the District.
The D.C. rate of infection is higher than 28 African countries. The infection rate puts Washington, D.C. on a par with Uganda. So this is an issue
that really must be addressed. This is our Nation's capital. The Congress has responsibility for the capital, Madam Speaker. I made a commitment while I was there that the Congressional Black Caucus would work to ensure that this Congress takes that responsibility seriously and addresses this serious epidemic that exists in the Nation's capital.
I wanted to mention a couple of things this evening, Madam Speaker. Yesterday, Nicholas Kristof wrote a column in the New York Times that ought to give us all pause. In it he addresses an issue that many of us on the Committee on Homeland Security have raised many times--and I am sure Chairman Bennie Thompson continues to work to address--and that is the deficient public health system in this country, especially in rural communities, in poor communities, and communities of color. I raised the issue at the H1N1 hearing in the Health Subcommittee on Energy and Commerce last week. I just want to share a few quotes from the article.
Nicholas Kristof says, ``The flu crisis should be a wake-up call, a reminder that one of our vulnerabilities to the possible pandemic is our deeply flawed medical system.'' And he quotes from Deborah Burger, the co-president of the California Nurses Association, the National Nurses Organizing Committee, who says, ``From SARS to avian flu to the current escalating outbreak of swine influenza, it has become increasingly clear that we are risking a major catastrophe unless we act to restore the safety net.''
Mr. Kristof continues, ``Think of the 47 million Americans who lack insurance. They are less likely to receive flu vaccines''--which might or might not help,'' he says--``less likely to receive prompt care when they get sick, and less able financially to stay home from work. And, thus, they are more likely to both die and spread the virus inadvertently.''
He also goes on to say--which is something that we have brought to the attention of the Department of Health and Human Services and the Department of Homeland Security--``hospitals lack spare beds, ventilators, and staff to cope with an epidemic. One study found that a flu epidemic would mean that 10 million Americans would need to be hospitalized compared with a total of nearly 1 million beds in America, about two-thirds of them occupied.
``Last year, Chairman Waxman ordered a review of surge capacity,'' reports Mr. Kristof, ``in hospitals available for a terror attack. What was the surge capacity? He found that more than half of the emergency rooms studied were already operating above capacity.''
The last quote that I want to bring to your attention from this op-ed is a quote that he uses from Dr. Redlener, the director of the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health. And Dr. Redlener says, and I agree, ``If a severe pandemic materializes, all of society would pay a heavy price for decades of failing to create a rational system of health care that works for us all.''
A few years ago, we had a Dr. Stephen Wolf from Virginia Commonwealth University come and talk to us about a report that he did on health care and the discrepancies, the disparities, the gaps in health care that the poor rural Americans, Americans of color face. I would like to use this quote and share it with you. He says, ``In the end, however, it all comes down to priorities. Perhaps we have reached a point when progress in providing good care when needed, with compassion and skill and without errors, would impress the public as a more meaningful medical advance than the rollout of the latest device or pill.'' He says, ``failing to establish systems to ensure that everyone receives recommended care is causing greater disease and deaths at levels that can rarely be offset by medical advances.''
So as we look at the spread of H1N1, this is a call to action to really fix the public health system in this country and make sure that every community has the kind of infrastructure it needs to address not only epidemics, but the everyday illnesses that the people in those communities suffer from.
But we do have an opportunity to address this health care system and to address health disparities. The Congressional Black Caucus--which has always had the elimination of health disparities as one of its main priorities--really welcomes the new political and policy dynamics that are currently shaping health care in this country. Because after all of the years and money spent on disease entities, we have only made slight progress. And even where improvements have been made, the gaps between people of color and the white majority have either remained the same or the gaps have widened.
According to testimony given at the Health Subcommittee on Energy and Commerce by Dr. Brian Smedley of the Joint Center for Political and Economic Studies, he says, ``Access to high-quality health care is particularly important for communities of color because deep-held status gaps persist among U.S. racial and ethnic groups.'' He goes on to say, ``While the Nation has made progress in lengthening and improving the quality of life, racial and ethnic health disparities begin early in the life span and exact a significant human and economic toll.'' He gives us some examples: ``The prevalence of diabetes among American Indians and Alaskan natives is more than twice that for all adults in the United States. Among African Americans, the age-adjusted death rate for cancer is approximately 25 percent higher than for white Americans.''
Although infant mortality, he said, ``decreased among all races during the 1980 to 2000 timed period, the black and white gap in infant mortality widened.
``While the life expectancy gap between African Americans and whites has narrowed slightly, African Americans can still expect to live 6 to 10 fewer years than whites and face higher rates of illness and mortality.''
He goes on to say, ``In terms of lives, this gap is staggering. A recent analysis of 1991 to 2000 mortality data concluded that had mortality rates of African Americans been equivalent to that of whites in that time period, over 880,000 deaths would have been averted.''
So we welcome and intend to be a part of shaping health care reform. And, of course, it does start with universal coverage because here are some other statistics:
Racial and ethnic minorities, although we account for about one-third of the U.S. population, account for more than half of the uninsured. Racial and ethnic minorities are more likely than whites to report not seeing a specialist when it was needed, foregoing needed health care because of the costs, and not being insured, they don't have a usual source of care. More than five of 10, 55 percent, Hispanics, four in 10 African Americans were uninsured for all or part of 2007 and 2008, compared with just two in 10, or 25 percent, in whites. In total, more than three in every four people of color, 76 percent, were uninsured for 6 months or more in 2007 and 2008. That data, I believe, comes from Families USA.
So the Congressional Black Caucus is looking at how we would like to see universal coverage provided. Of course, we feel that everyone must have coverage, and we insist that there be a public option. We have joined the Congressional Hispanic Caucus and the Asian Pacific Caucus in calling for a public option, and we will support a bill if it has a public option.
But also, and this is a concern that I have, we also need to ensure that we don't end up with the same kind of two-tiered system that we have today, one for the poor and one for everyone else, even when we have a public system. So we either need to figure out a way that that public system serves the poor and everyone else where the government may pay in for those who are at a certain level of poverty and the others pay in through subsidies that are done on a sliding scale or pay for it fully, or we need to fix the Medicaid program because the care that patients who have Medicaid who actually have access to health care is not equal and the outcomes are poorer than those who are insured, and in some cases it's the same or poorer than even the uninsured.
So ensuring that everyone is covered is critically important. It's critically important for African Americans and other people of color, who bear a disproportionate burden of disease in this
country, but it's important to every American because to the extent that so many people in this country remain uninsured, it adversely affects health care for everyone.
But insurance is just the beginning of what needs to be done to close the health disparities gap. For example, insured African American patients are less likely than insured whites to receive many potentially lifesaving or life-extending procedures such as high-tech care like cardiac catheterization, bypass graft surgery, or even kidney transplantation. And the IOM report of 2002 showed us that even when everything else is equal, educational level, economic level, and insurance, African Americans and other people of color get less care. Black cancer patients fail to get the same combinations of surgical and chemotherapy treatments that white patients with the same disease presentation received. African American heart patients are less likely than white patients to receive diagnostic procedures, revascularization procedures, and thrombolytic therapy, even when they have similar incomes, insurance, and other patient characteristics.
Even routine care suffers. Black and Latino patients are less likely than whites to receive aspirin upon discharge following a heart attack; to receive the appropriate care for pneumonia; and to have pain, such as the kind resulting from broken bones, appropriately treated. Minorities are more likely to receive undesirable treatment than whites, such as limb amputation for diabetes.
To so begin to address these, the TriCaucus, which includes the Congressional Black Caucus, the Congressional Hispanic Caucus, and the Congressional Asian and Pacific Island Caucus, will be reintroducing the Health Equity and Accountability Act, which we have introduced in the last three Congresses and for which we had hearings held in both the subcommittees of Ways and Means and Energy and Commerce last year. The bill takes a comprehensive approach and will have budget impact, but we are talking about reforming a broken health care system, one which many call a ``sick care system.'' And I really think it needs more than reforming; it needs a transformation.
Among the provisions, the bill includes those that would bolster efforts to ensure culturally and linguistically appropriate health care and remove language and cultural barriers to health care. It would improve workforce diversity, strengthen and coordinate data collection, ensure accountability and improve evaluation, and improve health care services especially for those diseases that are causing the disparities.
But today, after the limited progress we've made in eliminating these disparities, we know that in addition to doing all of those things, collecting data, increasing the diversity of our workforce, increasing accountability, providing for comprehensive programs of care to address some of those diseases that cause the gaps and cause people to die prematurely from preventable causes, we know that in addition to addressing the gaps in the many disease entities that we also have to turn our country's focus to disparities in its broader context to the pervasive, persistent social determinants or primordial determinants of the poor health of our communities. If we don't address these, the root causes, the totality of the environments in which we live and suffer from this ill health, we will never achieve wellness. So if we are to be healthy and achieve our optimal health, it's here also that change must occur. That is to ensure that the environments in which we live support the elimination of health disparities and support good health and our overall well-being.
I think the country is fortunate, and I know the country also understands how fortunate it is, and I'm blessed to work with the Congressional Black Caucus, where 42 diverse individuals with expertise and focus in many different areas such as health, education, economic development, job creation, workers' rights, environmental justice, housing, and all of the factors that are the underpinnings of our health, as a group, we work as a cohesive unit to improve the well- being of our communities and of all Americans. So I look at our entire Congressional Black Caucus agenda as a health agenda because we work on the broad agenda that is critical to closing the health gap and ensuring that all Americans have access to wellness.
And it's critical that we do this because the real things, the things that underlie our poor health, the things that are really killing us are factors like an overabundance of liquor stores in black and Latino and poor communities; the flooding of everything we see, read, and hear with tobacco advertising; intractable poverty and the way it fosters depression, drug abuse, and crime, creating neighborhoods where it's impossible to go outdoors and exercise, as we know we must; the refusal of businesses, including grocery stores and really medical entities as well, to come into poor and communities of color, where pharmacies that are there stock and dispense less pain medicine, regardless of how much pain the individual is having just because we're in a poor neighborhood that is made up mostly of racial and ethnic minorities; the profiling by the criminal justice system that makes some people wrong just because of the color of their skin or puts the mentally ill into the criminal justice system rather than into treatment; the racism and discrimination that denies racial and ethnic minorities the same quality of health care that I spoke about earlier that others take for granted and that pays less in our neighborhoods and so provides a strong and effective disincentive for hospitals and the other providers we need to come into our communities and stay there; the fact that too many of those providers that we do have don't understand our culture or our language; and all of the many assaults on our very humanity that weakens the well-known strength of spirit and the will to do the things that we know will improve our health and our quality of life. All of this is still not fully on the radar screen of most who set and implement policy, and this is something else that we must change.
Yet communities around the country, with or without our help, are taking on some of these issues and creating miracles and making dramatic changes in people's lives. We intend to help these communities and other communities become agents of change and to develop not just a better system of health delivery but an entire culture and environment of wellness.
Today I introduced the Health Empowerment Zone bill, through which we plan to give these communities the resources and the technical assistance that they need to improve their health and well-being. Through this bill communities can apply. The Department of Health and Human Services would provide the technical assistance and some resources to help that community form a community coalition to identify their health care challenges, to do a community assessment and to develop a strategic plan. Then the community would apply for designation as a health empowerment zone, and if they're so designated, they would have the opportunity to be a priority for programs that already exist in our government.
So this bill will not be a costly bill. We're talking about a little bit of startup money to these communities and, more than that, technical assistance to help them to do their community assessment and do their plan, and the help that they will get to implement that plan and turn around their community and make it a place where people can be well would come from programs that already exist. These communities would just have priority, and this is an attempt for us to address the social determinants of health, which we all know are critical if we are going to eliminate disparities and create healthy communities and a more healthy country. So we intend to help these and other communities, as I said, and we introduced that bill today.
Last week we held our Spring Health Brain Trust with the National Minority Quality Forum, and the messages that came from that meeting were very clear: Our health care system needs not just reform; it needs transformation. It will require an investment that goes beyond providing universal coverage because we have seen through many reports, the IOM and many more research papers, that minorities, people who speak a different language, people of color, even when they are insured, don't get the kind of care that the rest of the population gets. The message
came loud and clear that we need to reform Medicaid and ensure that that access really provides quality health care.
And, lastly, I would say that the message that we'd like to send out of that is that we know that it will cost a fair amount of money, but it's our health that we are talking about. We know that many people think or many of the pundits say that perhaps our President is trying to do too much, but we say we need all of it. And we stand with our President as he calls on us to reform our health care system or, rather, transform our health care system and ensure that quality health care is accessible, available to each and every American.
I just want to close with another quote from the Closing the Gap Report that was written in 2005 that addresses the issue of health inequities, and the quote says: ``Inequities within the health care system and within larger social, environmental, and economic structures persist not because of a dearth of solutions but because of a failure of political will.'' And I call on my colleagues to let us develop that political will. Let us eliminate disparities that are causing the premature death of people of color, poor, and rural Americans in this country, and let's transform our health care system so that everyone has access to quality, comprehensive health care.