Danny Davis

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I thank my friend for yielding. I rise to join with my colleagues and to share with them and with America our appreciation for the contributions made to African Americans in the history and development of this Nation. This year's theme, African Americans in Business: The Path Toward Empowerment, is the most appropriate one, and I am pleased to have in my own congressional district some of the most well-known and productive businesses in America. I represent Harpo Studios, which is owned by Oprah Winfrey and is known all over the world. In my congressional district is the First Baptist Congregational Church, which was a stop on the underground railroad, and is now building houses and a community under the leadership of its pastor, Dr. Authur Griffin. I have in my district the Johnson Publishing Company, which was put together and developed by Mr. John H. and Mrs. Eunice Johnson and is now operated by their daughter, Mrs. Linda Johnson Rice, and is home to many great writers like Lerone Bennett and Alex Poinsett. In my district I have the Parker House Sausage Company and its esteemed president, Mr. Daryl Grisham. It is also my pleasure to represent and to use Rabon's High-Tech Automotive Center at Kostner and Roosevelt Road in Chicago, which is known and owned by Mr. Lee Rabon, and is known for its precision automotive work. I also represent Shine King, the best shoe shine shop in America, owned by Mr. James Cole who has parlayed his original shoe shine shop into two shops, part ownership of a bank, a construction company, King Construction, and vast real estate holdings. Mr. Cole's shine boys are known to earn between $400 and $500 a week, shining shoes. Many of them have gone on to become doctors, lawyers, policemen, school teachers and businesspersons in their own right. The most famous of this group is the renowned National Basketball Association star and businessperson, Isiah Thomas, or Zeke, as he was known around the shop and throughout the NBA. Mr. Cole was recently featured in the Chicago Sun Times and WGN Channel 9 television as a result of the work that he has done through his businesses with young boys growing up in his community. I also pay tribute, Mr. Speaker, to the many members of the public housing community in my district, Ms. Martha Marshall, Shirley Hammonds, Cora Moore, Mattie McCoy, Mamie Bone, Mary Baldwin, and Mildred Dennis, for the outstanding leadership they are providing as they manage the recently developed businesses that public housing residents in the city of Chicago are putting together, managing, owning, and carrying out the duties and responsibilities of redeveloping their own communities. So they are a part of this great legacy that we know as African-American history. I commend the gentleman from Ohio (Mr. Stokes) of this event for the leadership that he has displayed throughout the years, but in taking out this Special Order, and pay tribute to the leader of the Congressional Black Caucus, the erstwhile gentlewoman from California (Ms. Waters). As a result of her leadership, the gentleman's leadership, the work of people all over America, the legacy and the history will continue. I thank the gentleman.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, it seems as though we are beginning this year on the same note as last year but with a different tune. Today we are going to vote on House Joint Resolution 343, an effort to deny the legitimate payment of bills incurred by the President's Task Force on National Health Care Reform convened in 1993. Some Members of this body do not want to pay the bills because they did not like the recommendations. Let us be serious. Let us get on with the real business of this country like providing health care to indigent children, protecting Social Security, fixing our roads and bridges, providing day care, creating jobs with livable wages, hiring teachers and lowering class size. Let us vote down House Joint Resolution 343 and get on with the real business of the American people.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise today to declare my enthusiastic support for H.R. 2020, the Medicaid Attendant Community Services Act. This bill is of vital importance, because in all of our districts and throughout America, there are hundreds and thousands of people who have been taken from their families, stripped of their assets, and deprived of their basic human rights because they have disabilities or chronic health conditions. Our current system of disbursing Medicaid funds encourages and rewards this injustice. I recently met with a group of my constituents with disabilities that are physically challenged. Many had lived in nursing homes, not because they had wanted to, but because our system gave them no other choice. They simply want to live independently. H.R. 2020 will give them the opportunity to do just that.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise today to reluctantly oppose this conference report. I agree with all of the good things that we have heard and will continue to hear about. However, I have some serious concerns regarding the census component. The so-called census compromise leaves several loopholes which could seriously hamper the ability of the Census Bureau to utilize sampling as a technique to conduct the 2000 Census. In essence, this compromise allows opponents of sampling an opportunity to disrupt, discredit, and dismantle an accurate census. The census is far too important to become so politicized. I would like to support this agreement. However, it does not ensure a fair and accurate census count. In this democracy every American must be counted in order to count. In the last census we missed over 4 million people. This agreement bestows upon the Speaker the unprecedented power to file a lawsuit on behalf of the House to challenge sampling. If we allow this agreement to go forward, African Americans, Hispanics, Asian Americans and other minorities can expect to have significant numbers of their population undercounted. Therefore, these communities will be underrepresented, not only in the halls of Congress but throughout government. I believe that every person must count; therefore, every person must be counted.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise in support of the reauthorization of the SBA bill, but I also want to commend and congratulate the gentleman from Missouri, Chairman Talent, and the gentleman from New York, Mr. LaFalce, the ranking member, for their exemplary leadership in bringing this legislation to the floor. I also want to acknowledge the strong presence of the gentlewoman from New York [Ms. Velazquez] in making sure that the 8(a) procurement program is protected at all costs. I also would extend my appreciation to Administrator Alvarez for her sensitivity and professionalism and hard work to make sure that areas of conflict were worked out. But I am most pleased because this legislation, in addition to all of those excellent programs that we have already heard about, the micro lending program, the 8(a) program, the 504 program, all of them are excellent. But in addition, we now have a new concept, something called HUBZones, which are designed to bring additional resources to hard- pressed, severely depressed urban and rural communities throughout America, areas that, no matter what is said, none of the other programs has been able to do as much as there is that is needed to be done. So I am hoping that with this new addition, we will see additional improvements, additional resources. It is a great program, and I am very pleased to lend my support to it and ask that all Members vote in favor of it.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise today to remember two men who, though not Americans, deeply impacted America and the American people: Michael Manley and Cheddi Jagan. It is appropriate to remember them on the floor of the U.S. House of Representatives today because as we engage in the global market, we need to also be engaged in the discussion of global freedom within this structure. Just as Toussaint L'Ouverture, the Haitian patriot who led the rebellion of 1791 to liberate the slaves in Haiti and helped inspire the struggle of African-Americans for their own freedom, Michael Manley and Cheddi Jagan, by their example in seeking independence and empowerment in their small nations, helped inspire and motivate the struggle for equality and empowerment in post-World War II America and throughout the world. Michael Manley and Cheddi Jagan lived very different lives in very different countries but their struggles in life seemed to intersect just as their untimely deaths within days of each other brought them together at death. The Caribbean lost two giants in 2 days. They were both outstanding patriots and freedom fighters and their struggle echoed throughout the world. They were both practitioners of the art of mass struggle and devoted their lives to the common people. Respect and admiration for their lives and works extends far beyond the Caribbean. Cheddi Jagan was the former President of Guyana and Michael Manley was the former Prime Minister of Jamaica. The world press, especially the Caribbean press acknowledged that the movement for self-rule, economic freedom and justice, workers rights, and human rights has suffered a great loss in these two visionaries. Dr. Jagan, the son of indentured Indian immigrants and a U.S. trained, Howard Dental School and Chicago's Northwestern University, dentist, has been described by many as champion of the poor. Disgusted by conditions in then British Guiana, Jagan became involved in the labor movement and was elected to the colonial legislature in 1947. Jagan, founded the Peoples' Progressive Party which the dominant political force in the 1950's until the British Government sent in troops and forced Jagan's resignation as Prime Minister. Jagan helped Guyana to independence from British rule in 1996. Dr. Jagan was reelected in 1992. Jagan was the author of a host of books on Caribbean history. His writings brought the Caribbean region to the attention of the world and filed in important parts of the history of the Americas. Dr. Jagan was a special kind of visionary: one who dreamed of a better day and could put it into motion. Michael Manley was a great orator, a champion of human rights and a statesman of courage and conviction. Jamaica's most charismatic leader, he was acknowledged to be the central, driving force in cementing Caribbean unity and establishing a Caribbean community. Manley, the son of Peoples' National Party founder Norman Manley and Edna Manley an artist and sculptor, went to war at age 19 as a member of the Royal Canadian Air Force. After the war he went to Jamaica College, became an activist in the West Indies Student Association. After graduation he became a journalist, and influenced by his experiences became involved in the trade union movement. After his farther's death he became a leader of the PNP and was elected Prime Minister 3 years later in 1972. He served as Prime Minister for 11 years and then was reelected in 1989 and served until health problems forced him to resign in 1992. It was said of Manley, ``He showed us that the politics of nation, the ideologies and theories of government, are as relevant to the school girls and boys as to the guys in parliament.'' As we remember these two great gentlemen whose hard work, tireless determination, tenacity, and altruistic dedication for peace, justice, human and civil rights, self rule and empowerment, education, jobs and health care we are inspired to draw great strength from the common roots we share, the common problems we face and the common belief that the will and improvement of the people is the best and, ultimately, only guarantee of democracy.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise to recognize the students at John Milton Gregory elementary School located in the 7th Congressional district on Chicago's Westside. Recently, we conducted a town hall meeting on education with the student body at that school. I would like to thank Dr. Hazel Steward, education officer for the Chicago Public Schools [CPS], Mr. Artie Borders, principal at Gregory and Mr. Lafayette Ford, local school council liaison for the CPS, for their assistance. The meeting will be broadcast on Cable Access TV (channel 19) on November 19, 1997 at 2 p.m., and again at 7 p.m. The Gregory students were informed, thoughtful, and articulate. They were genuinely concerned about the differences between inner city and suburban schools. The questions were, and I quote, ``Why are suburban books newer than ours?'' ``Why are suburban desks newer than ours?'' ``Why is our equipment older?''; and ``Why don't we have recess anymore?'' These were big questions from young people that are intelligent enough to understand and recognize these differences. Gregory students were asking the same type of questions as Members of Congress. In response to their questions, I had to tell the children at Gregory School that the majority in Congress was more committed to funding a $21 billion weapons program to purchase nine B-2 stealth bombers than placing these resources where they are desperately needed; in our educational system. I had to tell the children at Gregory that the U.S. Air Force does not even want or need these bombers. I had to tell the children at Gregory that the average urban school needs $1.7 million for repairs and upgrade, and we claim the title of being the riches country in the world. And I had to tell the children at Gregory that the majority in Congress does not see the need to heavily invest in our Nation's future, our children. Anyone who does not understand why we should be investing in public education ought to tune in on November 19 and be enlightened.

Mr. DAVIS

Mr. DAVIS. Mr. Speaker, I rise today to introduce legislation creating a cold war memorial. This bill will authorize a commission to establish a memorial to honor the military and civilian personnel of the Department of Defense, members of the intelligence community, members of the foreign service, and others who served the United States in pursuit of its cold war aims. This legislation will also commemorate the involvement of the United States in that conflict. Mr. Speaker, I believe that this legislation is important, not only because it honors the people who valiantly fought the cold war, but will help future generations understand and learn about one of the most dangerous times in American history. The cold war may not have been as intense as World War II or as widely viewed as the Vietnam war, but it was just as real and just as dangerous. The United States officially entered this conflict on March 12, 1947 and won it on December 31, 1991 at the stroke of midnight. During that time, America saw the creation of the Central Intelligence Agency [CIA], and the implementation of both the Marshall plan, and the Truman doctrine. Mr. Speaker, the cold war was a war that the United States won. It took 50 years to win, but it showed the whole world what we have always known, that a democratic form of government will outlast a communist form of government. As we look at the world now we see that the former Eastern bloc countries are democratic and are now becoming partners with the United States in a whole host of issues. This would not have been possible without these cold war warriors tremendous efforts. This in itself is reason to erect a monument. Mr. Speaker, it is my hope that all of my colleagues will support the passage of this legislation.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I ask unanimous consent to claim the special order time of the gentleman from Illinois [Mr. Poshard].

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise today in opposition to fast track. Mr. Speaker, the labor movement has always been the home of the American worker. It has been the safe haven for the American dream. But today we are in a time of conflict. There are contemptuous winds blowing in the direction of the American worker. I have always believed that democracy vests its rights in the living person: one person, one vote. However, the economic markets recognize only money, not people: one dollar, one vote. These markets give no choice to the workers or their families. When the market seeks solely to make a profit, it is an instrument of oppression. It is an instrument which allows the few to monopolize society's resources, leaving the less fortunate without health care, jobs, and other means of livelihood. Some say that the opponents of fast track would stop United States participation in the global economy and threaten our Nation's jobs. Supporters say fast track helps our country stay competitive and maintain a strong economy by ending unfair trade barriers imposed by foreign governments. Throughout my public career I have always been an advocate for equality and fairness, but I recognize the difference between fairness and laissez faire-ness. This trade agreement will only consider corporate interest deals, while efforts to improve the conditions of workers' rights are muffled. According to a University of Illinois study, the city of Chicago lost 80,000 manufacturing jobs between the years 1980 and 1990. These jobs were jobs that enabled workers to purchase homes, pay college tuition, participate in the American dream. At present, my district has recently lost five industries to other countries, leaving 704 workers unemployed and jobless. Mr. Speaker, markets are important institutions, and they have an essential place in any democratic society, as long as these markets function within the framework of democratically determined rules and public safeguards. I am in support of American competitiveness and want a democratically fair playing ground for all of our country's companies. But there is nothing democratic about giving jobs to other countries. There is nothing democratic about reducing American workers' benefits and wages. There is nothing democratic about environmental deregulation, and there is nothing democratic about ignoring the rights of thousands of workers for the approval of a few companies. A. Phillip Randolph once said: At the banquet table of life, there are no reserved seats. You get what you can take, and you keep what you can hold. If you can't take anything, you won't get anything, and if you can't hold anything, you won't keep anything. A. Phillip Randolph was so right. So today let us take back workers' rights, so that the American workers can hold onto their lives and hold on and make real the American dream.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise today to express my extreme disappointment with the Supreme Court's ruling yesterday that allows the ban on affirmative action in California to stand. The Supreme Court's decision yesterday is consistent with its trend to reverse the gains of African-Americans, women, and minorities in this country. The Court's unwillingness to take this case and decide it on the merits will spur an all-out frontal attack on initiatives that seek to ensure that minorities receive equal opportunity and fairness in contracting, higher education, employment, and many other areas. Campaigns to eliminate preferences based on race and sex are under way in several States. Today voters in Houston, the Nation's fourth largest city, had an initiative on the ballot to end affirmative action in the area of public contracts. Perhaps W.E.B. Dubois was right when he said that the problem of the 21st century will be the problem of the color line. Proponents of dismantling affirmative action have argued that discrimination and isolation are no longer barriers to achievement. However, the statistics bear out a different result. The U.S. Department of Labor's Glass Ceiling Commission report, released March 16, 1995, shows that while white men are only 43 percent of the Fortune 2,000 work force, they hold 95 percent of the senior management jobs. In addition, this report revealed that women are only 8.6 percent of engineers, less than 1 percent of carpenters, 23 percent of practicing attorneys, 16 percent of police, and 3.7 percent of firefighters. Women and minorities are 66 percent of the population in this country, but only 35 percent of physicians, 20 percent of tenured professors, and 6 percent of school superintendents. Minority enrollments in law school and other graduate programs are plummeting for the first time in decades. Women make up 80 percent of the health service professionals, but white males dominate the senior management positions. It is plain that America is still a society where race and sex play major roles in how far you can go. The concept of affirmative action encompasses three fundamental principles of fairness: First, ensuring that every American has access to education; second, ensuring that every American has access to good jobs; and the third basic principle of affirmative action for which there can be no retreat is ensuring that every American has the opportunity to advance as far in their field as their talents and hard work will take them. Affirmative action is really all about our Nation's economic competitiveness. It is about being inclusive and not exclusive. In other words, it is about making sure that every American regardless of gender or race has an opportunity to live out the American dream. It is about trying to make sure that individuals do, in fact, have access to equal opportunity. The Supreme Court's decision yesterday is a major setback for equal opportunity and diversity in this country. However, I urge all citizens who want to shatter the infamous glass ceiling, who want to make America's Statue of Liberty ring true when she says, I welcome your poor, tired, huddled masses of immigrants to our borders, to oppose efforts to end Federal affirmative action. If we end Federal affirmative action, we are likely to see the gap between the haves and the have-nots widen. We are likely to see contracting for minorities, women and small businesses severely decline. In addition, we are likely to see opportunities for higher education continue to be reduced. Therefore, I urge the masses to mobilize and defeat those who would take us backwards rather than forward. Affirmative action must remain a reality in America.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise today in strong opposition to this bill, which is cleverly disguised and masquerades to help empower low-income families to send their children to the best public or private schools. This is nothing more than a third in a series of voucher bills. However, the HELP Scholarship Act is different. This is not a back- door, covert attempt to dismantle public education. This is an all-out, overt, frontal assault to help undermine and destroy public schools. This bill reminds one of Dracula in that it seeks to suck the blood out of public education. Currently, 90 percent of America's children benefit from public schools. This bill provides no funds to improve public schools, which are in dire need of repair, teacher training, and curriculum development. This bill is anti-public education. I urge that we reject it and say no. Halloween was last week, Halloween was last week. This bill is trick or treat, with more tricks than treats.

Mr. DAVIS

Mr. DAVIS. Dr. Leroy Anderson.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, reclaiming my time, the gentleman from South Carolina [Mr. Clyburn] is just so on target, and again, I want to compliment him. I also want to compliment him because we recently just finished an outstanding legislative weekend of the Congressional Black Caucus, and he was the chairperson of that activity. Every place that I go back in my district in Chicago and out in the suburban areas and throughout the country, there are people who tell me what an outstanding weekend they thought it was, and I always say to them, ``Well, one the reasons is the fact that we had an outstanding chairman.'' So I commend him for that.

Mr. DAVIS of Illinois. My colleague jogged my memory, he started talking about Dr. Anderson and I remembered other people, like Dr. Stephen Joseph; Jack Geiger; Count Gibson; Jerry Ashford out of Boston, who became the first director of the association; Dr. Sam Rodgers from Kansas City, where they eventually named a center there for him; Dr. Charles Swett out of Chicago; Clifton Cole out of Los Angeles, who became the first president of our association; Dr. Batcheler from Detroit; a woman named Earline Lindsey out of Chicago; another lady, Delores Lindsey out of Cincinnati; and Pepper Jacques out of Detroit; and Eloise Westbrook from out in San Francisco; and Harvey Holzberg out of New York; and Tom van Koffenen, who now directs the association, who came on and has been there I guess now 25 years or so, continuing to advocate, continuing to develop, to plan, to orchestrate and to provide technical assistance and help these centers to grow. Because even though we have experienced a tremendous amount of success, there are still 43 million medically underserved people in this country, and these are people who do not have adequate access to health care services and often have poor health status. It is critical that health reform include special measures to meet their needs if our goal of cost containment is to be realized. The underserved are exactly the ones who end up on emergency room doorsteps. Studies have shown, for example, that up to 80 percent of emergency room visits in underserved visits are non-urgent care. If the underserved do not have their preventive and primary health care needs met in health reform, then our goal of cost containment will be unattainable. Health centers have shown that we give top quality care and constrained cost for our communities. For example, inpatient hospital admission rates for health center patients have been up to 67 percent lower than for those served by other providers, including hospital outpatient departments or private physicians. I do not know if you can get much better than that. The length of stay for hospital patients served by health centers has been found to be only one-third as long as that for patients who are seen by outpatient departments and half as long as that of outpatients served by private physicians. Studies have also shown that regular use of a health center has produced a 33-percent savings to Medicaid on both per case and per person yearly basis. This is for total costs for all services. Health centers are among the few Federal programs that empower communities to craft long-range solutions to their health problems. By law, of course, health centers must be governed by a board of directors, a majority of whom must be patients of the facility. Only through the health center programs are consumers in the driver's seat of their primary care delivery site. And only through health centers are underserved communities assured that their primary care provider will respond to their specific needs. It is for these reasons and others that health centers have attracted such broad bipartisan support. Virtually all major health reform proposals introduced in the Congress over the past few years have included funding and other provisions for community health centers. That means that a majority of the Members of this House, whether they be Democrats or Republicans or Independents, have stated that they think health centers are the best hope for addressing the needs of the underserved populations. When it comes to access to care, health centers are something we can all support. Most of these legislative proposals have called for efforts to respond to the needs of underserved Americans in 3 very important ways. First, they have called for an expansion of the community health center program, including flexible authority to make grants to other community based providers and to establish community owned and operated networks and plans consistent of safety net providers. Secondly, they have included provisions encouraging managed care plans to include health centers in their provider networks and to make sure that these providers are not put at undue risk. This will preserve the existing safety net primary care infrastructure in underserved areas and assure their full participation in the new health system. Thirdly, they have encouraged the inclusion of health centers in health professions education and training. This will ensure that primary health care professionals are trained and practice in underserved areas where they are most needed. This is a critical point in the history of the health center movement. It demonstrates that to get health care to the people who cannot afford it, the Federal Government must chip in a critical share. It comes in the form of health center operating grants. The best action we can take for those health professionals who want to give something back to their communities is to ensure a broad base of federally assisted community based providers in underserved areas. This will give these professionals a place to train and practice with the quality care environment and all the supports they will need. The health centers in my home State are all jewels. As a matter of fact, they are indeed worth their weight in gold. They are cost effective, responsive to community needs, and the patients just love them. I cannot think of much more that we could ask of a group of providers. And so I would certainly want to urge this Congress and all of my colleagues to continue to provide the support that has been provided over the years and let us continue with one of the most effective programs that we have ever seen for the provision of quality comprehensive health care to large numbers of poor people in this country. I really thank the gentleman from South Carolina [Mr. Clyburn] for sharing. It is also an indication of caring. If the gentleman has got some other comments, please go right ahead.

Mr. DAVIS of Illinois. I thank the gentleman. I will just make a little special recognition to a few of the community health centers that operate in my district. I always say that I have the most fascinating district in the United States of America. These people have simply gone above and beyond being just good providers of primary care. For example, under the tireless leadership of Berniece Mills-Thomas, executive director of the Near North Health Service Corporation which provides primary care to women, infants, school age children and their parents, we have seen that infant mortality has gone down significantly in the area that they service around Cabrini Housing Development. Actually they have reduced infant mortality over the years from 26.6 per 1,000 live births to now 12.8 per 1,000 live births. That is an outstanding indicator of the impact, of the effectiveness. The Winfield Moody, I can remember traveling around the country with Mrs. Moody as they were getting that community's health center started. And we have the Erie Family Center under the strong leadership of Rupert Evans, who is the executive director. This center has done an outstanding job of providing care to the communities in and around it, Humboldt Park, West Town. Plus the Erie integrated care program is the only bilingual primary care provider serving HIV and HIV/AIDS infected patients in the city of Chicago. They have a great pediatric program. We also have a number of other centers, such as the Daniel Hale Williams Center, the Mercy Diagnostic, the Sinai Family Centers, which just received a substantial grant of $8 million not very long ago to continue its great work, the Alivio Medical Center, Circle Family Center, the Mill Square Health Center, Komed, New City, the Cook County Network. All of these are centers that provide not only the best of care but also opportunities for people to work, for people to have jobs, for people to plan, for people to serve on the boards of directors, to make decisions, to decide what their neighborhoods and communities will be. And so in its 30th year, I just thought that this would be an excellent time to stop and pause and pay tribute to this great group of centers that are operating and remember some of the individuals who made it happen, people out of New York like Paul Mejias and Janice Robinson, Curtis Owens from Philadelphia, Dan Cantrell from Chicago, Dave Simmons from Boston, Aaron Shirley from Jackson, Mississippi, Melba McAfee from Jackson, Mississippi, and other people from all over the country. I just hope that some historian who has been involved in the efforts is writing a history so that 100 years from now when we look back and look at where health care has come and look at our health care delivery systems, we will recognize the tremendous role that the community health center movement has played. Mr. Speaker, I would like to include some additional documents here that I would like to insert: ``The American Health Care Revolution and the Critical Role of Health Centers.'' ``Health Centers Are Unique in Structure and Mission.'' ``Why Health Centers Work for the Nation.'' ``Community, Migrant & Homeless Health Centers.'' ``And from the Bureau of Primary Health Care, its depiction of what the health center movement has meant to primary care services in the country.'' ``The material referred to is as follows: The American Health Care Revolution and the Critical Role of Health Centers A revolution in the American health care system is well underway and by all accounts will dramatically transform that system over the next few years. More than two-thirds of privately-insured individuals, or 120 million people, are already enrolled in some form of managed care, with continuing substantial annual increases in managed care enrollment.\1\ This revolution has been driven by employers' and insurers' demands that costs be held down or even reduced, and that providers share financial risk. Managed care plans have willingly complied with those demands, bargaining for significant reductions in provider charges or rates. Though doubts continue to persist as to the long-term ability of managed care systems in holding down health care costs, data from 1994 and 1995 show medical cost inflation rates in the single digits for the first time in over a decade. Clearly, the era of open-ended, fee-for-service medicine is over. --------------------------------------------------------------------------- Footnotes at end of article. --------------------------------------------------------------------------- While public insurance programs have moved more slowly, they too--especially Medicaid--are now outpacing the private sector in their rates of managed care enrollment. In 1990, a little over 2 million Medicaid beneficiaries were enrolled in managed care plans; that number jumped to an estimated 11 million by the end of 1995 \2\. Most of that growth has been accomplished through the use of Medicaid waivers, which the current Administration has granted to more than a dozen states under Section 1115 of the Social Security Act, allowing those states to bypass Medicaid law requirements in establishing state managed care initiatives and other reforms. The recently-enacted Balanced Budget Act of 1997 contains far-reaching provisions that give states substantial flexibility to re-structure their Medicaid programs in order to enroll most of their Medicaid populations in managed care plans.\3\ Under the right circumstances, the American health care revolution can significantly improve both the availability and quality of health care for most Americans while containing costs by reducing the provision of unnecessary or inappropriate care. However, the success of both private market and public financing reforms could be significantly undermined if adequate attention is not given to two other key factors: The recent acceleration in the use of Medicaid managed care raises questions as to whether the managed care industry has the capacity and infrastructure to absorb millions of patients who differ dramatically in socioeconomic and health status, education and health care needs from their traditional enrollees, and experience numerous barriers to access to health care services--making them among the most difficult-to-reach and needy patients in the health care system.\4\ Medicaid beneficiaries and other low income Americans have higher rates of illness and disability than other Americans, and thus accumulate significantly higher costs of medical care.\5\ By contrast, most managed care organizations have, until recently, principally focused their enrollment and infrastructure in reasonably affluent, healthy, well-educated suburban patient bases. Therefore, in implementing Medicaid managed care programs, states are moving millions of individuals into health care delivery systems which have had little experience in providing care to them. Without an adequate infrastructure, this difficult-to- reach and needy population may be denied access to basic health care. At the same time, more than 43 million Americans have no health insurance and that number is rising by more than 100,000 each month.\6\ A recent report found that the uninsured are almost twice as likely to lack a regular source of care, have fewer ambulatory visits, and have a higher rate of medical emergencies, than those who have insurance. They frequently depend on hospitals and emergency rooms for even basic care often due to severe shortages of appropriate primary health services in their communities \7\. As more privately-insured Americans join managed care plans, and as plans increasingly demand maximum cost-efficiency from their providers, providers will be less able to provide care to individuals who are uninsured or whose insurer pays less than the cost of care that is provided (as is true of both Medicare and Medicaid today). Clearly, the long-term success of the American health care revolution will depend upon steps to assure the availability, and encourage the use, of cost-effective preventive and primary health care for uninsured low income working families; and the key to the longer-term survival of managed care organizations will be the adequacy of their Medicare and Medicaid enrollees' access to lower-cost primary and preventive care, as well as their expertise in managing enrollee costs. To be successful in these efforts, the new American health care system and its managed care plans will need the resources and know-how of providers that have a history of cost-effective, quality service to Medicaid beneficiaries and other low income populations--providers such as America's Health Centers. why health centers? For more than 30 years, Health Centers have served as ``managed care'' providers for publicly-insured and uninsured families. Nationwide, 2700 local health center service sites currently deliver preventive and primary health care to more than 10 million people--including 3.8 million Medicaid recipients, 1 million Medicare beneficiaries, and 4.2 million people who have no health insurance--in urban and rural underserved communities across the country. The underlying goal of the health center programs has been to help communities and their people to take responsibility for their health; toward that end, the programs have facilitated the flow of public and private resources, enabling the communities themselves to establish and operate health centers and to develop innovative programs to meet their health needs. Health Centers have historically operated with very limited budgets and have developed considerable expertise in managing patients with significant health needs in low cost settings, providing access to primary and preventive health services. With literally thousands of communities across the country suffering from acute shortages of cost-effective preventive and primary health care service providers, with the numbers of uninsured Americans rising each month, and with cost controls making it increasingly impossible for other providers to continue offering care to those without coverage, health center programs are today, more than ever, critical to the success of the new American health care system. This is especially true because health centers: Are, by law, located exclusively in rural and inner city communities that have been designated as ``medically underserved,'' because they have far too few ``front-line'' providers and poor health status indicators. I these communities, health centers are frequently the only available and accessible primary care provider. Care for those whom other providers do not serve because of their high costs and complex health needs. Offer high quality preventive and primary health care under one roof, in a ``one-stop caring'' system. Have had a major impact on the health of their communities and provide care in a highly cost-effective fashion. health centers are a private sector alternative Although health centers have a broad, prevention-focused perspective on many health problems, they are much like private medical practices, staffed by physicians, nurses, and other health professionals. They differ from private medical practices, however, by their broader range of services, such as social service and health education, and by their management structure. Health centers are owned and operated by communities through volunteer governing boards composed of leaders and residents of the communities they serve. They function as non-profit businesses with professional managers; purchase goods and services; provide employment; and make an economic impact within their community. Because they exist to serve their communities, health centers are committed to seeking out and combining resources from a variety of sources to ensure that access to primary health care services is made available to all community residents, regardless of their financial or insurance status. Patients who can afford to pay are expected to pay. Medicare and Medicaid patients are always welcome. And insurance companies are billed on behalf of patients with coverage. The centers' Board and staff also work to obtain support from other sources, such as local governments and foundations, to ensure that care is available for all patients based on ability to pay. In order to maximize limited resources, these private, non- profit community practices have developed community linkages with local health departments, hospitals, nursing homes, pharmacists and others to ensure that services are coordinated and to eliminate duplication of effort. Although some services may not be available on-site, the health center does coordinate care and referrals to other providers in a way that assures true ``one stop caring'' for its patients. health centers are found where they're needed most By law, all Health Centers must be located in and serve medically underserved areas and/or populations--and their 2,700 sites are split evenly between rural and urban communities. The residents of these communities suffer from the most profound shortage of accessible primary health care services and, not surprisingly, exhibit some of the most severe health problems and the poorest health status of all American communities. More than 43 million people, living in these inner-city and rural communities, remain seriously medically underserved because of special needs or circumstances \8\: They are overwhelmingly members of low income families, and are disproportionately young. Many are uninsured, but 60 percent of them already have some form of insurance (including Medicare and Medicaid). Many live and work in areas with too few providers of care, while others face serious non-financial barriers to care (such as language or physical disabilities), or have complex health and social problems. In simplest terms, the medically underserved are people who can't get care when they need it, and when it is most appropriate--to prevent the onset of a health problem or illness, or to diagnose and treat a condition in its earliest stages--because of who they are, where they live, or because of their health status. Two recent reports found that, even when insured, these Americans continue to face significant barriers to care, especially to primary and preventive health services, and as a result have measurably poorer health outcomes and overall health status.\9\ health centers serve the most vulnerable of all Health center patients are almost universally among the most vulnerable of all underserved people in America today-- persons who even if insured, nonetheless remain isolated from traditional forms of medical care because of where they live, who they are, and their frequently far greater levels of complex health care needs: Fifty percent reside in isolated rural areas; the other half live in economically depressed inner city communities. Virtually all patients have family incomes below 200 percent of the federal poverty level ($28,700 annually for a family of four in 1994). Nearly one in two is completely uninsured, either publicly or privately, and more than one-third depend on Medicaid. 44 percent of all patients are children under 18, and thirty percent are women of childbearing age (nearly one in ten is pregnant). Health centers delivered over 400,000 babies last year--10 percent of all births and 1 in 5 low income births \10\. Because of factors such as poverty or homelessness, and other social-environmental threats that permeate low income/ underserved communities, health center patients are at higher risk for serious and costly conditions (such as asthma, tuberculosis, or high-risk pregnancies) than the general population, and require unique health services not typically offered by traditional providers, including most managed care entities. health centers are clinically effective Health centers provide more than just care for illness or episodic conditions. They offer a ``health care home'' for all residents of an underserved area. Like any good family doctor's office, they provide ongoing care and health management for families and individuals through all life stages. Care is provided in the office whenever possible; physicians are on the medical staffs of their local hospitals; and referrals to other providers are made whenever needed. Health center practices are staffed by a team of board certified or board eligible physicians, physician's assistants, nurses, dentists, social workers and other health professionals. In rural areas, physicians are typically family practitioners, while larger urban centers are usually staffed with interdisciplinary teams of internists, pediatricians, and obstetricians. Almost 98% of the more than 5,000 health center physicians are board-certified or eligible \11\, and all are required to have hospital admitting privileges. The hallmarks of effective primary health care are the entry point it provides into the entire system of care, its comprehensiveness, continuity, and responsiveness to the needs of the patients served. Because primary care must be patient-centered to be effective, it is not the same for everyone--one size cannot fit all. Local centers have developed special intervention programs for significant health care needs in their community, including strong obstetrical practices to fill a gap in their community or a special focus on patients with diabetes, or hypertension or AIDS. Many centers have developed special outreach programs to help overcome the cultural and language barriers faced by people who speak little or no English in obtaining primary health care access \12\. Centers also emphasize services designed to enhance the effectiveness of the medical care provided, such as community outreach, health/nutrition education, and case management. Some 98 percent of health centers offer health education services; over 90 percent offer case management services; more than three-quarters offer preventive dental services and in-house laboratory services. All health centers employ outreach and patient relations workers from the communities they serve \13\. Health centers are required by the U.S. Public Health Service (PHS) to update their quality assurance program and health care plan in response to annual community need assessments, and are required to report to PHS outcome measures, including immunization rates, low birth weight reduction, hospital admission and length of stay \14\. Available literature provides extensive documentation of the quality and effectiveness of care offered by health centers, using factors such as patient health outcomes, satisfaction and health status of the community. These studies provide strong evidence that where there is a health center, the level of health of the community is dramatically improved. For instance: Infant mortality: Communities served by health centers have been shown to have infant mortality rates from ten to forty percent lower than communities not served by health centers. The provision of health center services also has been linked to improvements in the use of prenatal care and reductions in the incidence of low birthweight \15\. Incidence of disease/hospitalization: Health centers have been shown to reduce rheumatic fever and untreated middle ear infections in children and have significantly increased the proportion of children who are immunized against preventable disease \16\. Use of preventive care: Health centers have increased the use of preventive health services such as Pap smears and physical exams \17\. Effectiveness of care: Health center patients have been shown to have lower hospital admission rates, shorter lengths of stay and make less inappropriate use of emergency room services \18\. Two recent (1994 and 1995) system-wide studies of thousands of Medicaid patient medical records in Maryland found that health centers scored highest among all providers for the proportion of their pediatric patients who had received preventive services, including immunizations; and that health centers consistently scored at or near the highest in 21 separate measures of quality assessment, even though their costs of care were among the lowest of the various provider types reviewed \19\. Health center patients are also overwhelmingly satisfied with their care and treatment. According to a 1993-1994 nationwide study of health center patients conducted by the Picker/Commonwealth Fund: 96% of health center patients were very satisfied or satisfied with the quality of their care; 97% would recommend the health center to friends and family; 95% receive regular health care services, even when they are not sick (preventive and primary care services); 87% have never had a concern or complaint. Health Center Cost-Effectiveness Is Second to None Health centers are subject to ongoing Federal scrutiny of their cost-effectiveness and quality of care. Cost screens applied to health centers by the U.S. Public Health Service and the Health Care Financing Administration, such as administrative costs and costs per patient visit, are virtually unparalleled in the health care industry. The result is that health centers provide quality, comprehensive primary care to some of the hardest-to-reach patients in the health system at a price second to none. Several recent studies have found that Medicaid patients who regularly use health centers cost significantly less than those who use private primary care providers, such as HMO's, hospital outpatient units or private physicians. For instance: In Washington state in 1992, health center patients were found to be 36% less expensive for all services than patients of other primary care providers and used 31% fewer emergency room services \20\; In California in 1993, health center patients were 33% less expensive overall (controlling for maternity services), and had 27% less total hospital costs \21\; In Maryland in 1993, health center patients had lowest total payments; lowest ambulatory visit cost; lowest incidence of inpatient days and lowest inpatient day cost; health center patients were one-third as likely as hospital outpatient unit patients to be admitted on an inpatient basis and were half as likely to have unstable chronic medical diagnoses as patients of other providers \22\; In New York in 1994, health center patients were 22-30% less expensive overall, and had 41% lower total inpatient costs; diabetics and asthmatics who were regular health center uses had 62% and 44% lower inpatient costs, respectively \23\. These findings are consistent with those from dozens of previous studies on the cost-effectiveness and quality of care provided through the health center model, and in particular addressing the health centers' demonstrated and historic savings to state Medicaid programs. Taken together, these studies have found that: Use of health centers led to lower utilization of more costly emergency rooms, ranging from 13 percent to 38 percent in the case of pediatric emergency room use. \24\ Health centers have reduced inpatient admission rates for their patients by anywhere from 22 percent to 67 percent, reduced the number of patients admitted per year and the length of stay among those who were admitted. \25\ Health centers have achieved such tremendous success because, like managed care organizations, they are a first point of entry for their patients into the health care delivery system, and they manage their patients' care to keep them healthy and out of costly emergency rooms, hospitals, and specialists' offices. They are also experienced in the management of health care costs, since they must run their programs within a limited annual budget. Health centers are well tested and highly successful models of community-based health care. They are partnerships of people, governments, and communities working together to meet local health care needs in an culturally competent, effective and efficient way. Health centers develop primary care infrastructure in areas of the nation that need it most with limited Federal assistance. Federal grants to health centers average less than $100 annually per patient. This represents a small investment for what centers accomplish in strengthening community health and fostering prevention and health education. The Health of Each Health Center is Always Leadership And Accountability Health centers are professional health care organizations providing a comprehensive range of high quality services for their community. But their most distinctive feature is that the health centers are developed and run by their communities, and are dedicated to the needs of their people. Health center governing boards are composed of local community leaders and residents who care about the primary health care access needs of their community and are committed to working together to make a difference. Federally funded centers are required to have patients as a majority of their governing board members. The empowerment and involvement of local citizens in planning and governance has been the essential characteristic that has made in possible for health centers to make a real difference in underserved communities, in terms of both the sense of ownership they help foster and the tangible benefits they yield. In recent years, the role of community governance has achieved increased recognition and respect, especially because it promotes direct involvement by local residents in developing the services they use. Because of their commitment to their local communities, health centers have become an effective solution for primary health care access in thousands of communities across the nation, affirming their vital role in America's future health care system. The Health Center Experience: Limited Investment Generates Outstanding Success Health center achievements over the past 30 years show how much is known about how to make a difference in the health of the poor and how far even a modest investment will go. Every Federal dollar invested in health centers leverages another two dollars in other revenues--in addition to the Medicare and Medicaid savings they produce. Health centers understand and respond to their communities' most urgent health care needs. Health centers care for those whom other providers cannot or will not serve. Health centers offer high quality medical care. Health centers have had a major impact on the health of their communities and provide care in a highly cost-effective fashion. There is no better health care bargain anywhere--public or private. Perhaps the greatest testament to the unique ability of health centers to design services that are accessible to their patients is that, ironically, health centers report that for every 10 patients currently served there are another 3 on local centers' waiting lists who are seeking care there \26\. And those on health center waiting lists do not even begin to take into account the far larger number of persons who need the services of health centers but who do not have a center within reach--particularly in the nearly 1,000 underserved U.S. counties that today have no health center \27\. Health Centers Can Do So Much More As policy makers consider options for improving the reach and effectiveness of America's health care system, they would do well to seriously consider including steps to: Expand the network of health centers to ultimately reach all medically underserved people and communities. With current funding, health centers are able to reach just 9 million of the 43 million medically underserved Americans who would benefit from their services. This effort could be accomplished incrementally over several years, with each additional $100 million in funding for health centers extending services to an additional 1 million people in some 400 communities. Assist health centers to fully participate in managed care, by allowing them to form or join Provider Sponsored Networks as fully integrated partners, and by ensuring that any Medicaid or Medicare reforms include supplemental payments to health centers--in addition to other reimbursements from Medicare or Medicaid, or from managed care plans--for the purpose of making sure that health centers receive sufficient funds to adequately care for their Medicaid patients. Without sufficient resources to meet the needs of their patients, centers and clinics would be forced to substantially reduce their services and patient loads (mostly uninsured patients), and many could go out of business. Involve health centers in the training of the enhanced primary care workforce required for the future, by making teaching health centers eligible for direct payment of their health professions teaching costs. The Council on Graduate Medical Education (COGME), as well as the Institute of Medicine, and the Physician Payment Review Commission, have recommended revision of current GME policies to support expanded primary care and ambulatory training programs; and health centers represent the ideal site for training in comprehensive preventive and primary ambulatory health care, because they have an established history of functioning as interdisciplinary care environments, providing quality, comprehensive primary and preventive care. Health centers provide comprehensive, continuous care to their patients regardless of insurance status or ability to pay. It is this ability to offer continuous care that makes the health centers unique and particularly valuable. Health centers form a critical base on which to build managed care systems for low-income and medically underserved populations. Already, health centers are managed care providers for over 1.5 million Medicaid patients, and that number is expected to more than double over the next year or two. The road to long-term managed care plan viability and effectiveness can be made smoother by the inclusion of health centers in managed care networks. As experienced and effective health care providers to the medically underserved, health centers can provide the primary care infrastructure network which managed care systems need to provide cost efficient quality health care. Health centers have much to offer managed care systems and stand ready to collaborate with them. notes \1\ ``Market Strategies and the Growth of Managed Care'', Paper Presented by Howard Bailit, D.M.D., Ph.D., Senior Vice President for Health Services Research, Aetna Health Plans, to the Annual Meeting of the Association of Academic Health Centers, September 29, 1994. \2\ Testimony of Bruce Vladeck, Administrator, Health Care Administration (HCFA), before the House Committee on Government Reform and Oversight, January, 1996. \3\ See Subtitle H of Title IV of P.L. 105-33, the Balanced Budget Act of 1997. \4\ Holahan, Liska and Obermaier, Medicaid Expenditures and Beneficiary Trends, 1988-1993; Report to the Kaiser Commission on the Future of Medicaid by The Urban Institute, September 1994. \5\ Health Insurance of Minorities in the U.S., Report by the Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, 1992 and Green Book, Overview of Entitlement Programs Under the Jurisdiction of the Ways and Means Committee, U.S. House of Representatives, 1994. \6\ Employee Benefits Research Institute, Sources of Health Insurance and Characteristics of the Uninsured, EBRI Special Report and Issue Brief No. 158, February, 1995. \7\ Baker, Laurence, and Baker, Linda, ``Excess Costs of Emergency Department Visits for Nonurgent Care,'' Health Affairs, Winter 1994: 162-171. \8\ Hawkins, Daniel, and Rosenbaum, Sara, Lives in the Balance: A National, State and County Profile of America's Medically Underserved (National Association of Community Health Centers, 1993). \9\ Grumback, Kevin, et al, Primary Care Resources and Preventable Hospitalization in California, CPS Report, California Policy Seminar, May 1995; and Kohrs, Francis P., MD, and Mainous, Arch G., PhD, ``The Relationship of Health Professional Shortage Areas to Health Status, Archives of Family Medicine, Vol. 4, August 1995: 681-685. \10\ Data from 1995 health center reports to the Bureau of Primary Health Care, HHS. \11\ Data from Bureau of Primary Health Care, 1994. \12\ See Community and Migrant Health Centers; Critical Components of Health Reform (National Association of Community Health Centers, 1993). \13\ Lewin-ICF, 1991 Survey of Health Centers. \14\ See Program Expectations for Community and Migrant Health Centers, Bureau of Primary Health Care, HHS (1994). \15\ Grossman, Michael, and Goldman, Fred, ``An Economic Analysis of Community Health Centers,'' National Bureau of Economic Research (1983); see also Schwartz, Rachel, and Poppen, Paul, Measuring the Impact of Community Health Centers on Pregnancy Outcomes, Abt Associates (1982), and M.B. Wingate, et al, ``Obstetric Care in a Family-Health Oriented Neighborhood Health Center, ``Medical Care'' 14, 4 (April 1976): 315-325. \16\ Mary E. Biscoe et al, ``Follow-up Study of the Impact of Rural Preventive Care Outreach Program on Children's Health and Use of Medical Services'', American Journal of Public Health 70, 2 (February 1980); 151-156; Theodore J. Columbo et al, ``The Effect of Outreach Workers' Educational Efforts on Preschool Children's Use of Preventive Services'', American Journal of Public Health 69, 5 (May 1979): 465-468; and David L. Cowan et al, ``Impact of a Rural Preventive Care Outreach Program on Children's Health,'' American Journal of Public Health 68, 5 (May 1978: 471-476; and Leon Gordis, ``Effectiveness of Comprehensive Care Programs in Preventing Rheumatic Fever'', New England Journal of Medicine 289, 7 (August 16, 1973): 331-335. \17\ Sheils A. Gorman and Hannah Nelson, ``Meeting the Data Needs of Neighborhood Health Centers,'' (Presented at the 102nd meeting of the American Public Health Association, 1984); and John C. Hershey and John R. Moore, ``The Use of an Information System for Community Health Services Planning and Management,'' 13 Medical Care (February 1975): 114. See also Joel J. Alpert, et al, ``Effective Use of Comprehensive pediatric Care'', American Journal of Diseases of Children 116 (November 1968): 529-533; and Theodore J. Columbo, et al, ``The Effect of Outreach Workers' Education Efforts on Use of Preventive Services by a Poverty Population,'' (Presented at the 104th meeting of the American Public Health Association, 1976). \18\ De Prez, Ronald, et al, ``The Substitutability of Outpatient Primary Care in Rural Community Health Centers for Inpatient Hospital Care,`` Health Services Research 22,2 (June 1987): 207-233; Gretchen V. Fleming and Ronald M. Anderson, ``The Municipal Health Services Program: Improving Access to Primary Care with Increasing Expenditures,'' Medical Care 24,7 (July 1986): 565-579; Howard E. Freeman, K. Jill Kiecolt, and Harris M. Allen, ``Community Health Centers: An Initiative of Enduring Utility'', Milbank Memorial Fund Quarter 60,2 (Spring 1982): 245-267; Marsha R. Gold and Robert G. Rosenburg, ``Use of Emergency Room Services by the Population of a Neighborhood Health Center'', Health Service Report 89,1 (January-February 1974): 65-70; Louis I. Hochheiser, Kenneth Woodward, and Evan Charney, ``Effect on Neighborhood Health Center on the Use of Pediatric Emergency Departments in Rochester, New York'', The New England Journal of Medicine 285,3 (July 15, 1971): 148- 152; Gordon T. Moore, Rosemary Bonanno, and Roberta Bernstein, ``Effect of a Neighborhood Health Center on Emergency Room Use'', Medical Care 10,3 (May-June 1972): 240- 247; and Elliot Sussman, et al, ``Can Primary Care Deliver?'', Journal of Ambulatory Care Management 2,3 (August 1979): 29-39. \19\ Starfield, Barbara, et al, ``Costs vs. Quality in Different Types of Primary Care Settings,'' Journal of the American Medical Association 272,24 (December 28, 1994); 1903-1908; and Stuart, Mary e., et al, ``Improving Medicaid Pediatric Care,'' Journal of Public Health Management Practice 1(2) (Spring, 1995): 31-38. \20\ Braddock, Dennis, et al, Using Medicaid Fee-For-Service Data to Develop Health Center Policy, Washington Association of Community Health Centers and Group Health Cooperative of Puget Sound (1994). \21\ Health Services Utilization and Costs to Medicaid of AFDC Recipients in California Served and Not Served by Community Health Centers, Center for Health Policy Studies/ SysteMetrics (1993). \22\ Steinwachs, Donald M., and Stuart, Mary E., (Johns Hopkins Univ. School of Public Health and Hygiene), ``Patient-Mix Differences Among Ambulatory Providers and Their Effects on Utilization and Payments for Maryland Medicaid Users,'' Medical Care 34,12 (December 1993): 1119- 1137. \23\ Utilization and Costs to Medicaid of AFDC Recipients in New York Served and Not Served by Community Health Centers, Center for Health Policy Studies (1994). \24\ Hockheiser, L., Woodward, K., and Charney, E., ``Effect of the Neighborhood Health Center on the use of Pediatric Emergency Departments in Rochester, New York,'' 285 New England Journal of Medicine 148 (July 15, 1971). \25\ ``Final Report for Community Health Center Cost Effectiveness Evaluation,'' JRB Associates for U.S. Department of Health and Human Services, Contract No. 100-78- 0138 (1981). See also Davis, Karen and Schoen, Cathy, Health and the War on Poverty: A Ten-Year Appraisal (Brookings Institution, Washington, D.C., 1977). \26\ Lewin-ICF, 1991 Survey of Health Centers. \27\ Hawkins, Daniel, and Rosenbaum, Sara, op cit.

Mr. DAVIS of Illinois. Mr. Speaker, about 30 years ago, there emerged on the American scene, as a result of the civil rights movement, demonstrations, marches, protests, action on the part of the United States Congress, initiation of the war on poverty, there emerged a new set of health service delivery mechanisms, something that we today know as community health centers. They started out with the name neighborhood health centers as part of the OEO antipoverty program. Every community that OEO would go into, making an assessment to look at the issue of poverty, there would always emerge the issue of a lack of health care resources, the issue of there not being services available to the people who lived in inner cities and rural communities. As a result of that, these pioneering centers came on the scene. Today I rise to underscore that they are indeed a vital component of our health care system and one that focuses on providing the access to primary and preventive health care services that coverage alone cannot assure. As we all know too well from our experience over the years with Medicaid, the possession of an insurance card will not necessarily guarantee Americans access to health care. Nowhere is this more true than in our inner city and rural, medically underserved communities. I had the good fortune of taking a job at the Martin Luther King, Jr. Neighborhood Health Center in the City of Chicago as its director of training, which sharpened my interest in health care, and ultimately continued to work in that area and had the good fortune to see the emergence and development of this group of inner-city, rural migrant health programs throughout the country, got involved and eventually became, after the group had developed, a national association which even to this day still exists, is very vibrant, viable and a valuable part of the American health care delivery system. Every place that we went we found that underserved communities desperately need the health care system to deliver three things: One, the presence of a medical home that offers high quality care regardless of a person's health or social status or his or her ability to pay for services and that is accessible in terms of location of hours of service for those who do not have private transportation or cannot take time off from the workday. Second, adequate numbers of highly trained, culturally competent health professionals to staff these facilities; and, thirdly, the assurance that their medical home will not be driven out of business due to excessive financial risk or inadequate reimbursement simply because they care for those who are the sickest and hardest to reach. I strongly believe that our health system should be built and should build on what works. Among the programs that have worked best for the underserved are the community migrant and homeless health center programs. Over the past 30 years, these centers have established an unparalleled, uniquely successful record of providing quality, cost- effective primary and preventive care to the hardest-to-reach populations across the Nation, recruiting and retaining health professionals where they are most needed and empowering communities to develop long-range solutions to their health needs. Health reform should invest in such success by preserving and building upon these programs in preparation for the implementation of reform so that universal coverage will truly guarantee access to quality care for everyone. One of the things that I liked best about the community health center movement is that they have spurred the development of so many individuals. I am certain without a doubt that I would not be standing here today as a Member of the United States Congress had I not gotten involved with the community health center movement in my community that not only brought services, but also provided opportunities for individuals to be trained, for individuals who had never been in the health business to develop careers. I remember some of the great training programs that the association developed where individuals could go off to the University of Michigan and acquire a master's degree in public health on the weekends while working in their local centers. Or they could go out to the University of California for six-week periods at a time and acquire Master's degrees in health administration while retaining the job that they had back in their local communities. So I am so pleased that one of the real people who have seen these developments is also here to join with me this evening, in the person of the esteemed Representative from the State of South Carolina [Mr. Clyburn]. We will be delighted to have him join and share with us.

Mr. DAVIS of Illinois. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks on the subject of my special order.

Mr. DAVIS of Illinois. Thank you so much. I really appreciate your being here. You mentioned Franklin C. Fetter. I remember when that center started, and I remember that it had a director who was there for a long period of time, just an outstanding gentleman. I am thinking of people that I knew then in South Carolina, like Georgia Goode and Tom Barnwell, I mean, people who were so committed and so dedicated and gave so much of themselves to make sure that these centers got started and that they continue. Who was the gentleman I am trying to think of?

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I want to thank the gentleman from California for yielding time to me. Mr. Speaker, I first met Walter when we were candidates and we were waiting to make our television appearance at the Democratic Convention, to be made up. Walter looked at me and said, I do not know if the makeup is going to help you or not, but I do not think it is going to do much for me. So Walter had a great sense of humor, but also a great sense of sensitivity, always talking about those things that meant much. My best memory, fondest and perhaps last memory of Walter was just last week. We were walking over to vote, and there was a young man with him about 12 years old who was just as excited as he could be. Walter introduced him to me and said, this is the chairman of my youth council. These people are the future of America. And I thought that that was just one of the greatest ways to remember Walter, always nurturing, always teaching, and always looking forward to tomorrow. Yes, we shall, indeed, miss him.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise in objection to the motion to instruct conferees on H.R. 2267. In this motion is an effort to close the process of Americanization to thousands of qualified human beings who are a valuable part of America's future. Mr. Speaker, 245(i) permits certain family and employment-based immigrants to adjust their status to that of permanent residence while remaining in the United States. The enactment of Section 245(i) has generated between $100 and $200 million annually in additional revenues for the U.S. Government and reduces the State Department's visa processing caseload by an average of 30 percent. In 1996 the immigration law increased the fine from $650 to $1,000 and required that at least 80 percent of the funds generated be deposited in a INS account, to be used as the INS wishes. Failure to extend this provision of the law would result in a shortage in resources for both the INS and the State Department and create a backlog in application processing. Section 245(i) is not an amnesty, it does not allow illegal immigrants to buy their U.S. status. It can only be used by prospective lawful permanent residents and under close and careful scrutiny of Federal authorities. In order to adjust their status under this provision of the law, eligible immigrants must meet the same criteria as they would if their visa applications were processed overseas. Mr. Speaker and colleagues, I believe in the words of Ms. Emma Lazurus when she wrote: Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door? I strongly urge my colleagues to join me in opposition to this motion and believe in the words of Emma Lazurus and I ask her clarion call become a relic of history? No, it is and will remain a viable statement of American values. Thank you Mr. Speaker and I yield back the balance of my time.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Speaker, I rise today in strong support of the Rangel substitute. I support the Rangel substitute because the original bill is nothing more than another backdoor attempt to try and dismantle public education. I have listened to people talk about helping those with low income. My statistics suggest that low-income people in my community, who earn less than $40,000 a year, do not have any discretionary money to invest in a tax plan. They do not have any additional money that they can use for education. I submit that public education is the only real safeguard that exists in this country for the preservation of democracy. Anything less than that, Mr. Speaker, is going against the grain, it is going against the wishes of the American people, it is going against the needs of those in middle America. I urge strong support for the Rangel substitute.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Madam Speaker, I rise today in strong opposition to this bill in its current form. This bill is anything but noncontroversial. This bill deals with one of the great issues of our day, what type of drug policy will we have. Any effective drug policy in America or any nation must include at least 3 components: Treatment, education, and prevention. This bill does not include in a real way these 3 components. An effective drug control policy must embody the principle of treatment because through treatment people are healed of their addictions. Through treatment we can reduce the number of addicts. However, this bill prohibits the use of HIDTA funds for treatment of people who are chemically dependent. In fact, this bill provides no real ideas for treatment strategies. This is the first reason it should be rejected. The second principle that must be a part of any effective drug control policy is education. Education gives people an opportunity to understand how to move away from that which they are using. However, this bill does not provide any real component of education. It sets up grandiose targets for reductions in drug use that are unrealistic and unachievable. This bill lacks the serious components of education and therefore must be opposed for that reason. Finally, the third principle that must be a part of any effective drug control strategy is prevention. An ounce of prevention goes a long way toward reducing the number of people addicted to drugs. Prevention comes in many forms. It could be a job, it could be hope for someone who was hopeless, it could be interdiction, reducing the supply. This bill provides no real prevention strategies other than the old ``lock them up, throw away the key,'' which we already know does not, will not, and cannot work. This bill is too important to not debate. I urge that we oppose it on the suspension calendar and have a full debate so that we can really get at the issues.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Madam Speaker, I thank the gentleman for yielding me this time. Like all my colleagues who have spoken, I too would like to see campaign finance reform brought to the floor of this House and done so immediately. I rise, however, to raise another issue. I think that the Coast Guard bill is a good one, but I raise a concern that has adversely affected the Chicago area, which I represent. For many years the Coast Guard Air Station helicopter facility located in Glenview, IL, patrolled southern Lake Michigan, an area with a high volume of recreational traffic. Recently that facility was relocated to Muskegon, MI, more than 100 miles away. Under the current setup, it takes a helicopter twice as long to get from Muskegon to the Chicago area as it did from Glenview. Some authorities have contended that moving the unit out of the Chicago area has dramatically compromised the safety margin for those persons who frequent the lakefront. A recent Chicago Sun Times article reported that during the past year, 26 people have died on southern Lake Michigan as compared to 4 deaths during the previous year. It has been observed that the number of deaths on southern Lake Michigan have continued to spiral upward since the Coast Guard's decision to relocate to Muskegon. Mr. Speaker, it is my hope that the U.S. Coast Guard will reevaluate this move, which is possibly responsible for a number of senseless deaths. I would also request that the Subcommittee on Coast Guard and Maritime Transportation review this location site. A site closer to the Chicago metropolitan area could save many lives.

Mr. DAVIS of Illinois

Mr. DAVIS of Illinois. Mr. Chairman, I rise in strong support of the Moran substitute for three basic reasons. One, it eliminates the opportunity to waive the prevailing wage. Anybody working, no matter what they work on, should be adequately paid. It takes the caps off of medical malpractice, which is nothing more than an attempt to backdoor tort reform to the detriment of consumers. And of course it eliminates vouchers, which have been spoken to all evening. The fact of the matter is that public education has been the greatest equalizer existing on the face of this Earth. It is the main way that most of us were able to move beyond the immediacy of our burden, of our circumstances. I believe that if we want to equalize America, public education is the way.