Alcee Hastings

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, on Friday, March 21, 1997, I was unable to vote due to personal reasons. Thank you for taking notice of this matter.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I am today introducing the Colorectal Cancer Screening Act of 1997 in order to establish colorectal cancer screening as a covered benefit under the Medicare program. Colorectal cancer screening is an important element of what should be a comprehensive program of preventive health care for our senior citizens. Unfortunately, the current Medicare program provides little incentive for Medicare recipients to have regular check-ups and undergo the routine tests that will prevent serious illnesses and detect diseases at their earliest, most treatable stage. This legislation, if enacted, would encourage Medicare recipients to be screened for colorectal cancer by providing Medicare coverage of those tests. I am pleased to be joined by 14 cosponsors in introducing this important legislation. It is particularly timely that this legislation be considered at this time. Over the past 2 to 3 years, there has been a significant amount of work done within the medical community to develop Guidelines and recommendations on how to screen for colorectal cancer. Several new screening guidelines and revised screening recommendations have been released within the past two months, and new screening recommendations are expected to be issued within the next few weeks by the American Cancer Society. These Guidelines and recommendations indicate that there is an emerging consensus that there are a number of different procedures that can be used to screen for colorectal cancer. This legisaltion is based upon that consensus. The move to develop new screening guidelines really started in the spring of 1995 with the release of the ``Guide to Clinical Preventive Services'' by the U.S. Preventive Services Task Force. In this report, the Task Force reversed the position taken in its 1989 report and concluded that there was a sufficient scientific basis upon which to recommend colorectal cancer screening, starting at age 50 for most individuals. The report specifically recommended screening average risk individuals with two procedures--FOBT and sigmoidoscopy--though it raised concerns about the limited effectiveness of these procedures and questioned the willingness of patients to comply with these tests. The report also noted discussed screening with colonoscopy and the barium enema, and concluded that there was insufficient evidence to recommend for or against screening with either test. The report also raised questions regarding the overall cost and risks of screening, particularly with regard to colonoscopy. Many of the questions raised by the U.S. Preventive Services report have been answered. The release of the Task Force report prompted the Agency for Health Care Policy and Research [AHCPR] of the Department of Health and Human Services to initiate a 2-year project to examine the scientific and medical literature on all available options for colorectal cancer screening and to develop Clinical Practice Guidelines on colorectal cancer screening. The AHCPR terminated the development of specific screening recommendations last April, but has completed an ``Evidence Report'' summarizing the current evidence on the various screening procedures. A summary of this report, released in February, concludes that there is evidence to support colorectal cancer screening with all of the screening procedures identified in the Preventive Services Task Force report--FOBT, sigmoidoscopy, the barium enema and colonoscopy. I ask unanimous consent that the Summary of the AHCPR Evidence Report be included in the Record with these remarks. The effort to develop Clinical Guidelines for Colorectal Cancer Screening did not, however, end with AHCPR's decision not to complete the project. Colorectal Cancer Screening Guidelines based on the AHCPR project were completed and published in the February 1997 issue of the medical journal ``Gastroenterology.'' The 16 members of the multidisciplinary expert panel first assembled by the AHCPR were listed as the authors of the Guidelines, and the project was completed under the direction of the American Gastroenterological Association and a consortium of four other gastroenterology organizations that had served as the contractor to the AHCPR. These new Guidelines are endorsed by the American Cancer Society, American College of Gastroenterology, American Gastroenterological Association, American Society of Colon and Rectal Surgeons, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America, Oncology Nursing Society and the Society of American Gastrointestinal Endoscopic Surgeons. The Colorectal Cancer Screening Act of 1997 embodies the screening recommendations included in the clinical Guidelines and supported by the AHCPR Evidence Report. It should be noted that the legislation includes the option for individuals at average-risk and high-risk to be screened with the barium enema. It does so because providing patients and their physicians with the option of being screened with the barium enema is fully supported by these reports, and by the scientific and medical literature that provides the basis for the recommendations. To be specific with regard to the Clinical Practice Guidelines published in Gastroenterology: The Clinical Practice Guidelines recommend screening people at average risk for colorectal cancer with double-contrast barium enema every 5-10 years; The Clinical Practice Guidelines recommend use of the barium enema for screening individuals at high risk for colorectal cancer-- individuals with close relatives who have had colorectal cancer or an adenomatous polyp and people with a family history of hereditary nonpolyposis colorectal cancer--and The Clinical Practice Guidelines recommend use of the barium enema or colonoscopy for surveillance of people with a history of adenomatous polyps or colorectal cancer. Although they have not yet been finalized, I understand that the American Cancer Society will soon issue new recommendations for colorectal cancer screening. The legislation that I introduce today is consistent with the approach that has been taken by the American Cancer Society in developing these new recommendations. One final consideration guided the development of this colorectal cancer screening legislation, and it is that the colorectal cancer is a particularly deadly disease for African-Americans. This is discussed in the Summary of the AHCPR Evidence Report, which notes that the National Cancer Institute and other medical journals have found that black men and women with colorectal cancer have a 50 percent greater probability of dying of colon cancer than do white men and women. The medical literature indicates that this is caused, at least in part, by the fact that African-Americans tend to get colorectal cancer in the right-- proximal--portion of the colon--the portion that is not reached by sigmoidoscopy, the most common screening procedure currently in use. The Colorectal Cancer Screening Act of 1997 provides individuals the option of a full colon screening with the barium enema in order to assure that the screening program we establish in the Medicare program is adequate for African-Americans. It also should be noted that this option is particularly important for other Americans as well, given that it has been shown to be significantly more effective than screening only one-half of the colon with sigmoidoscopy. Moreover, in addition to being effective, the barium enema is one of the most cost- effective screening procedures for both average-risk and high-risk individuals. In conclusion, I would like to emphasize for my colleagues the cost- effectiveness of this legislation. According to the Office of Technology Assessment, colorectal cancer screening is capable of saving thousands of American lives at a cost of only about $13,250 per life year saved. Colorectal cancer screening is also cost-effective when compared with other Medicare-covered procedures such as kidney dialysis--$50,000 per life year saved--and mammography--$40,000 per life year saved. I cite these figures not to argue against these other life-saving devices and procedures, but rather to provide a comparison that demonstrates the importance of Medicare coverage for such cost- effective procedures as colorectal cancer screening at a time when we are working hard to reduce the level of spending in the overall Medicare program. In the end, however, the Colorectal Cancer Screening Act of 1997 is not about cost-effectiveness and economics--it is about saving lives that are unnecessarily lost to this disease. Colorectal cancer strikes about 145,000 Americans each year, and about 55,000 Americans die of the disease each year. This legislation can save many of these lives, and I urge my colleagues to join me in seeking its enactment.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I rise today to honor the contributions of an outstanding American, Dr. LaSalle D. Leffall. Dr. Leffall, a distinguished fellow alumnus of Florida A&M University, is the Charles R. Drew professor of surgery at Howard University College of Medicine, and like the namesake of his chair, his accomplishments are too numerous to list. His profound and unselfish dedication to the African-American community, especially in education and medicine, is unsurpassed, and deserves the highest recognition. Perhaps what distinguishes Dr. Leffall most, Mr. Speaker, is that he epitomizes the concept that education is a ladder. This week Dr. Leffall helped to make that ladder a little easier to climb when he presented a check for $350,000 to Florida A&M University, its largest donation from an individual. When matched with funds from the State of Florida, Dr. Leffall's gift will total more than $500,000. As FAMU's distinguished president, Dr. Frederick Humphries, said, ``This is a monumental contribution from one whose extraordinary achievements have brought honor and distinction to his alma mater and his community.'' A son of the South, Dr. Leffall was born in Tallahassee, FL, and he was born to be great. He graduated summa cum laude from Florida A&M University at the age of 18, and 4 years later, he received his medical degree from Howard University College of Medicine, ranking first in his class. A scholar and a gentleman, Dr. Leffall is a veteran of the U.S. Army, having achieved the rank of captain, M.C., and having served as chief of general surgery at the U.S. Army Hospital in Munich, Germany, from 1960-61, an extraordinary accomplishment for a person of color at that time. A diplomate of the American Board of Surgery and fellow of the American College of Surgeons, Dr. Leffall has served as visiting professor and guest lecturer at more than 200 medical institutions in the United States and around the world. He has authored or co-authored more than 120 articles and chapters. His professional life has been devoted in great part to the study of cancer, especially as it relates to African-Americans. In 1979, it was his privilege to serve as national president of the American Cancer Society, through which he launched a landmark program to study the increasing incidence of mortality of cancer in the African-American community. Dr. Leffall's awards and honors include the Presidential Award, Metropolitan Washington Chapter, American College of Surgeons; the Humanitarian Award, Washington, DC, NAACP; Outstanding Service Award, National Medical Association; National Achievement Award, Democratic National Committee Black Caucus; and the Trumpet Award, CNN Turner Broadcasting System. He has been listed as one of the best doctors in Washington, DC, and Washingtonian of the Year by Washingtonian magazine. Named in honor of his parents, Dr. Leffall's gift will provide critical scholarships for students and professorships in science at Florida A&M University. Equally important, Dr. Leffall's contribution will help open the doors of knowledge for countless young African- Americans, in whose hands the destiny of our society rests. As a Member of the U.S. Congress, and having served in public office for 20 years, I have learned what my predecessors clearly understood. You cannot legislate good will: that comes through education. Because of outstanding individuals like Dr. LaSalle Leffall, the process of cultivating good will is a little further advanced. It is my privilege to honor him before my colleagues in the U.S. Congress, and the American public.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Chairman, I thank the gentleman from Massachusetts for yielding time to me. A gimmick, Mr. Chairman; this Chamber is using our precious time on a gimmick. While schoolhouses are falling down around this country and the homeless are going without shelter and the infirm are going without proper medical care, the House will spend its business today debating an amendment to the Constitution that would limit the people's choice to who shall represent them. Do not just take my word for it, Mr. Chairman. We have the most imminent Americans over the past 220 years who have opposed plans such as the one we are debating today. Alexander Hamilton made it clear that the proponents of term limits were shortsighted thinkers. Term limits, Hamilton argued, could deprive the Nation of the experience and wisdom gained by an incumbent, perhaps just when that experience is needed most. Mr. Chairman, it is worth noting that much of the greatest legislation of our Nation's history was introduced and passed by Congresspersons late in their tenure as Members of Congress. Term limits would have unseated Daniel Webster and Henry Clay 10 years before they forged the 1850 compromise. John Sherman introduced his landmark Antitrust Act in his 29th year in Congress. Paul Douglas introduced the Voting Rights Act in his 16th year in Congress, and the list goes on. I will continue further to enlighten our colleagues about the detriments of term limits, but we have already spent too much time discussing this unnecessary and thoughtless amendment. I urge my colleagues to reject this amendment. I close by quoting Robert Livingston, not our colleague, but a delegate to the New York State Convention to ratify the U.S. Constitution in 1788. He said: The people are the best judges of who ought to represent them. To dictate and control them, to tell them whom they shall not elect, is to abridge their natural rights. This is an absurd species of ostracism--a mode of prescribing eminent merit, and banishing from stations of trust those who have filled them with the greatest faithfulness. I suggest 60 percent has been the turnover. I say to the chairman of the subcommittee, the gentleman from Florida [Mr. McCollum] and the ranking member, the gentleman from Michigan [Mr. Conyers], I want these Members to know that less than 5 percent of all of the legislation we have passed in the last 6 years has come from those 60 percent. I defy the chairman and the ranking member to tell the people of America, and I will go look up their records, how much legislation they passed in their first 6 years.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I take great pride in this opportunity to join the Congressional Black Caucus and other Members of this body to pay tribute to African-Americans who have contributed enormously to this great Nation. I, too, want to thank the gentleman from Ohio, Mr. Stokes, and Representative Maxine Waters, chairperson of the Congressional Black Caucus for their efforts in organizing this special order. As we celebrate Black History Month, we must remember the origins of this celebration, as it dates back to 1926. It was then, that Dr. Carter G. Woodson, a noted historian, and author, initiated the observance of ``Negro History Week.'' Each February, Dr. Woodson, whose own contributions were inestimable, advocated setting aside a week to honor the achievements of African- Americans. The lives of black Americans have improved since the 1950's, and, indeed, there is no doubt that relations between blacks and whites have improved. However, segregation, poverty, discrimination in jobs, housing, and many related problems continue to persist, and continue to erode the so-called American dream. Today, we celebrate an America that is more culturally enriched, intellectually developed, and technologically advanced because of the contributions of African-Americans. However, as the 20th century nears it close, there is still widespread ignorance about African-Americans and our contributions to this society. Of the 40 African-Americans elected to Congress this year, many came from districts supported by black voters. However, the districts were ruled unconstitutional if race was the predominant factor in designing them. But, a 90-percent white congressional district in Texas is ruled constitutional, whereas, a 5-percent black Texas district that sent the late Barbara Jordan to Congress is ruled unconstitutional. Imagine what kind of effect these and other related issues have on the life and mind of a young African-American who knows less about hope and faith than I do. Mr. Speaker, the acceptance by some Americans of Dr. King's message-- that men should not be judged by the color of their skin but by the content of their character has made it possible for blacks to gain considerable influence in various fields. For example, in politics, blacks now serve in unprecedented numbers in elected and appointed positions in Federal, State, and local government, including this great body. We have won recognition in such art forms as literature, film, and theater. We have received some of entertainment's highest awards, including the Oscar, the Tony and Golden Globe honors. We have reached the highest levels in professional sports such as basketball, boxing, tennis, football, and track and field. And, in music, we have made significant influence by creating new musical categories and delighting audiences at home and abroad. These accomplishments are all good news. But they are still not enough. As we continue to debate affirmative action policies, we realize that the struggle to ensure equal opportunity for African-Americans continues. The real issue is civil rights--civil rights that redeem our fundamental American sense of hope and rights that affirm our basic values and aspirations as a Nation. African-Americans continue to have an uphill struggle. However, it is my hope that this Nation would heed the words of the late Justice Thurgood Marshall who said: ``We will only attain freedom if we learn to appreciate what is different, and muster the courage to discover what is fundamentally the same.'' Today, I call on this society to give the ordinary people of this great Nation an equal opportunity, a quality education, and a fair shot at the American dream. Let history record that we in our time faced our challenges remembering who we are and believing that we are more than our brother's keeper.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I thank my colleague from Florida for her remembering our colleague, Frank Tejeda. Mr. Speaker, as we all know, a high quality learning environment is essential to educating our Nation's children. Many may wonder why the President last night spent so much time on the issue usually discussed by State and local government. Well, I believe his concern is warranted. Take Palm Beach and Broward Counties, parts of which I represent, for example. These school systems educate more students from prekindergarten through grade 12 than they can handle. Our schools are pushed to the limit, a limit that some consider to be critically overcrowded. Mr. Speaker, the school doors are bursting at the seams in south Florida and around the Nation. Our schools need our help. Thus, America's leaders need to be partners in education. This partnership among Federal, State, and local governments should be based on a balance between leadership and local flexibility. The goal is to direct resources to the local level to help our communities build much needed schools to alleviate overcrowding. It is crucial, Mr. Speaker, that we work together to find the necessary funds for our schools.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I rise today to pay tribute to one of the greatest Americans who ever lived, Mr. Garland Vernon G.V. Stewart, who departed this life on September 12, 1996. I make this distinction without the slightest hesitance, for Mr. Stewart embodied all the things that good people consider great. Though born at a time when few African-Americans were expected to, or even allowed to, seek high academic training, Mr. Stewart was an educated man, having received degrees from two of the most prominent institutions in the South, Atlanta University and Morehouse College. More significant for a man of his era and circumstances, he also received a masters degree from the University of Michigan. Thus, it can be said that Mr. Stewart was truly a learned man. But education was not what made Mr. Stewart a great man. Rather, it was how he used his education to serve others, that made him great. For almost half a century, G.V. Stewart committed himself to the education and uplifting of his community and his race. From school teacher, to principal, to the first African-American administrator in Hillsborough County, FL, he inspired his students and those around him to seek a better life, and to make life better for others. He believed, as most great men know, that it was his responsibility to reach back for others as others had reached back for him. In this regard, he used his influence, and his own personal resources to ensure that young African-American men and women who desired a college education received one. Many of those individuals are today very successful lawyers, doctors, politicians, judges, and educators, whose debt of gratitude can never be repaid. My own debt of gratitude spans a life time. When I decided to run for the U.S. Senate in 1970, Mr. Stewart was stalwart in his support of me: When others asked, ``Why?,'' Mr. Stewart asked, ``Why not?'' Not only did he encourage me to seek public office, but he backed me financially. As a Federal judge, I was often blessed with Mr. Stewart's wise council, and when I was elected to the U.S. Congress, no one was more proud than him. To say that Mr. Stewart was a community activist is like saying that Ghandi was a philosopher. He was. And in his activism there was genuine purpose and there was great vision. The world, owing so much of its progress to men like G.V. Stewart, will miss his vision and his commitment to serving others--the way he sought to build bridges between people of different orientations. But what it will miss most is the great love that exemplified his life--bestowed not just upon his family and close friends, but those who simply came in contact with him, and many who never did. His legacy is large: the number of Florida's community leaders, educators and other professionals who were influenced by G.V. Stewart is too great to list. The world is a better place for knowing G.V. Stewart, and heaven is a better place for welcoming him. I take pride in honoring my mentor, my friend, and a man who claimed me as a son. I join Congressman Sam Gibbons, Mr. Stewart's close personal friend and Representative, in saluting the life of G.V. Stewart, a great man.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I rise today to introduce a very important bill which will carry out the longstanding intent of Congress in preserving and protecting the rights of Miccosukee Tribe of Indians of Florida. This bill is introduced in a truly bipartisan fashion, with my Florida colleagues Congresswoman Carrie Meek, and Congressmen Lincoln Diaz-Balart and Dan Miller joining me as original cosponsors. This legislation allows for the good people of the Miccosukee Tribe to live in perpetuity in the so-called permit area of Everglades National Park. The Miccosukees have lived and worked for generations in this area. The rights of the Miccosukees are recognized by the Everglades National Park Enabling Act of 1934 and their special use permit. In 1934, the Everglades National Park Enabling Act specifically provided that rights of the Indians were protected. Subsequently, in 1962, and 1973, the tribe was guaranteed that they could build homes, schools, clinics, and other tribal buildings in the 300-plus acres identified in their special use permit. Unfortunately, Mr. Speaker, the Park Service now seeks to restrict Miccosukee activites on their own land--even after the tribe has complied with all Federal, States, and local laws. The intent of this Congress in 1934 was to guarantee the Indians the freedom to live, work, and govern themselves as they wish in this area, not to be governed by the National Park Service. This bill will allow for Miccosukee self-government to continue. These Indians seek nothing more than what we promised them when we passed the park bill in 1934, nothing more than was said on the floor of this House, nothing more than the Department of the Interior confirmed in the special use permit. In 1960, Justice Hugo Black wrote, ``Great nations, like great men, should keep their promise.'' With this bill, we keep our promise to these native Americans, to these fellow citizens of the United States. They deserve nothing less.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I regret that I was absent from the U.S. Congress on Wednesday, September 18, but I was attending a funeral in my home State of Florida.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. I thank the gentleman for yielding time to me. Mr. Chairman, I rise today in support of the Mollohan-Fox amendment, and to express my dismay with the fax that I received from the Christian Coalition urging that I oppose this amendment. Mr. Chairman, I am a Christian and I support this amendment, because following the Christian teachings that I was taught, I believe that helping the poor is a Christian thing to do. Helping the poor access the same legal system to which people with money can access at will is, I believe, a very Christian thing to do. I am dismayed that the Christian Coalition intimates that they speak for Christians. Clearly they do not speak for the poor or the charitable, for if they did, they would not urge us to kill this amendment.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I rise to pay tribute to Mr. Irving George Lieberfarb, a distinguished American from Lake Worth, FL, who recently passed away. Mr. Lieberfarb was a worthy and admirable individual whose absence is a tragic loss to his family and his community. He was very active in the B'nai B'rith movement, and his synagogue Petach Tikva Congregation, on behalf of many worthy causes. It was Mr. Lieberfarb who brought to my attention the matter of Varian Fry, an American who had saved thousands of Jewish lives during World War II, but had never been honored. In 1939 Mr. Fry had requested the State Department allow him to secure the passage of Jewish refugees suffering under the Nazi regime. The Government responded by reluctantly offering merely 200 visas, and eventually put an end to his work by forcing him to return to America. When he criticized the U.S. immigration policy, upon his return, the Government shunned him and refused to recognize his noble deeds. I had read Mr. Lieberfarb's article about Varian Fry and was disturbed that the actions of this man were ignored for so long. Therefore, I introduced H.R. 3352, legislation to award the congressional gold medal of honor to Varian Fry's family in honor of his great accomplishments. Mr. Lieberfarb's efforts for this cause alone exhibits his concern for righteousness and justice. It was an honor to have known him. For this reason, I also wish to insert in the Record the kind words submitted by his family to the New York Times, on Friday, June 28, 1996. Irving George Lieberfarb, of Lakewood Florida, died on June 26, 1996, Beloved husband of Irene, father of Jay and Richard. Loving grandfather of Suzanne and Julie. Brother of Mae Zeller, Daniel, and Eddie. Loving uncle of many nephews and nieces. Always thinking how much he could do for his family. We will never forget your positive influence and always concern for the special interest of the many friends and relations. With love and gratitude, your niece and nephews, Warren, Bonnie, Monte and Jim.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. I thank the Chairman. parliamentary inquiry

Mr. HASTINGS of Florida. Point of order, Mr. Chairman. The gentleman from Iowa will have to withdraw his motion to rise, Mr. Chairman. There was a motion to rise. Just to keep the process correct.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Chairman, I rise in very strong opposition to the amendment.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Chairman, will the gentleman yield?

Mr. HASTINGS of Florida. Mr. Chairman, if the gentleman will continue to yield, in Sweden, where this meeting was held, children are mandated at age 7 to learn English. In Australia, where I visited last year, it is mandatory that their children learn two Asian languages. I am finding it abhorrent that we continue this debate, and I just wish to associate myself with the remarks and the leadership of the gentleman.

Mr. HASTINGS of Florida. Mr. Chairman, I would like very much to thank the gentleman for yielding, and I want to associate myself with the remarks of the gentleman, and add that I am just returned from the European Parliament, the Organization of Security and Cooperation in Europe, where 53 member nations were represented. English was the second language of most of the persons there. They all spoke either two or three languages.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Madam Speaker, like my colleagues previously, I rise to offer my heartfelt condolences to the families of the victims and the injured survivors of the bombing in Dhahran, Saudi Arabia. Also, Madam Speaker, on behalf of the minority of this House, I would like to thank them for recognizing this as the priority issue of the day in allowing the first few of us to speak to this concern. Terrorism and extremism know no territorial boundary. We must, here in this House, engage the international community in working vigilantly to identify and eradicate the perpetrators of terrorism at their cancerous roots. We in this body must give our law enforcers the tools they need to infiltrate terrorist organizations, deport terrorists and choke their funding mechanisms. As President Clinton said yesterday, whoever harms an American anywhere in the world will pay. The difference, however, between us and the perpetrators of this kind of crime is that we resolve our disputes in a legal fashion using the rule of law and not of the jungle or desert.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, when I first became involved in the issue of colorectal cancer screening, I did so not because I am an African-American, but because providing colorectal cancer screening as a covered benefit funded the Medicare Program has the potential to save thousands of lives each year in this country. The statistics on colorectal cancer cannot be ignored. There are about 150,000 new cases of colorectal cancer each year in the United States, and about 60,000 people will die in the United States from that disease each year. Colorectal cancer is the second leading killer of all the cancers. It also is an equal opportunity disease whose victims include Americans of all races, creeds, and ethnic groups. I recently became aware, however, of a number of medical studies that make me realize that, as an African-American, I have a special reason to be concerned about this issue. These studies have found that colorectal cancer strikes African-Americans differently than it does the general population in the United States. Moreover, these differences are critical with regard to screening to detect this disease. The data in these studies make clear that sigmoidoscopy is not an effective screening procedure for African-Americans. Rather, a barium enema or other procedure that views the full colon is clearly preferred for this population, and perhaps for other groups as well. In the opening weeks of this Congress, I introduced a bill, H.R. 1046, that would expand the Medicare Program to provide coverage of periodic colorectal cancer screening services. Because this bill provides coverage for all of the currently available screening procedures, it would allow all Medicare recipients at average-risk for colorectal cancer, including African-Americans, to decide to be screened with the more comprehensive barium enema procedure or, if they prefer, sigmoidoscopy. As of last week, the Colorectal Cancer Screening Act has 30 cosponsors in the House of Representatives, from both sides of the aisle, and the key provisions of the bill were included as part of the comprehensive reform of the Medicare Program in President Clinton's most recent budget proposals. H.R. 1046 is distinguished from other colorectal cancer screening legislation by the fundamental belief that the decision on how to screen each patient should be left to the patient and his or her physician--not the Federal Government. For this reason, H.R. 1046 authorizes Medicare coverage for colorectal cancer screening for individuals at average-risk for colorectal cancer that includes an annual fecal occult blood test [FOBT] and direct screening every 5 years with either a barium enema procedure or sigmoidoscopy. For individuals at high-risk for colorectal cancer, the bill provides an annual FOBT and direct screening every 2 years with either a barium enema procedure or colonoscopy. The bill also authorizes the Secretary of Health and Human Services [HHS] to authorize coverage for new screening procedures as they become available. Unlike other colorectal cancer screening bills that would provide Medicare reimbursement for only some of the currently available screening procedures, H.R. 1046 recognizes that different screening procedures may be appropriate for different individuals. The bill, therefore, provides a range of options and leaves the choice to patients and their physicians. The validity of this approach is confirmed by the medical studies on colorectal cancer in African-Americans. The studies were unanimous in their conclusions--that ``the entire colon of * * * black patients is at greater risk than that of white patients to develop cancer of the colon.'' They found that colon cancer tends to strike African-Americans more commonly on the right side of the colon than the general population in the United States. These studies raise serious questions about the approach taken by other colorectal cancer screening bills, which provide coverage only for sigmoidoscopy and not the barium enema. While the barium procedure allows for screening the whole colon, the flexible sigmoidoscope screens only about one-half of the colon. Sigmoidoscopy does not screen the right side of the colon where African-Americans more frequently develop colon cancer. Thus, providing coverage only for sigmoidoscopy puts African-Americans and possible other unidentified ethnic groups at risk. Let me cite the conclusions of several of these studies: ``Current screening recommendations [sigmoidoscopy] may not be effective enough for preventing colon cancer in this population.'' ``Distribution of Adenomatous Polyps in African-Americans,'' Lisa A. Ozick, MD, Leslie Jacob, MD, Shirley S. Donelson, MD, Sudhir K. Agarwal, MD, and Harold P. Freeman, MD, The American Journal of Gastroenterology, May 1995, p. 758. ``This study points out the potentially discrepant sensitivity and value of this instrument [sigmoidoscope] between black and white patients, suggesting that colonoscopy and/or air contrast barium enema examinations are the screening methodologies of choice in black patients.'' ``Anatomical Distribution of Colonic Carcinomas Interracial Differences in a Community Hospital Population,'' Houston Johnson, Jr., MD and Rita Carstens, RN, Cancer, 1986, p. 999. ``This study challenges this recommendation [sigmoidoscopy every three to five years] as unsatisfactory for blacks since 50 percent of neoplasms could be missed in blacks compared to only 20 percent in whites.'' ``Site-Specific Distribution of Large Bowel Adenomatous Polyps: Emphasis on Ethnic Differences,'' Houston Johnson, Jr., MD, Irving Margolis, MD, Leslie Wise, MD, Dis. Colon Rectum, April 1988, p. 260. ``Data support the clinical impression that blacks have relatively more proximal colonic tumors than the general population. They also suggest that early full study of the colon, including barium enema with air contrast or colonoscopy (opposed to flexible sigmoidoscopy), is highly indicated in screening or work up for earlier diagnosis in patients, especially blacks suspected of polyps or carcinoma of the colon.'' ``Anatomic Distribution of Colonic Cancers in Middle Class Black Americans,'' John W.V. Cordice, Jr. MD, Houston Johnson, Jr. MD, Journal of the American Medical Association, 1991, p. 730. ``Unless barium enema studies or colonoscopic studies are employed, significant numbers of premalignant lesions or early cancers could be missed in a black population if the distribution of lesions found in this study is generally applicable to black populations.'' ``Untreated Colorectal Cancer in a Community Hospital,'' Dr. Houston Johnson, Jr., Journal of Surgical Oncology, July 3, 1984, p. 198. These medical studies have caused me to redouble my efforts on this legislation. We need to enact a colorectal cancer screening bill that serves all Americans, and that provides an equal opportunity for all Americans to have a screening procedure that is effective for them, and which will prevent this horrible disease. Mr. Speaker, I encourage all of my colleagues to reexamine this issue, and to contact me or my staff if you would like to obtain copies of the studies I have cited here, or other studies on colorectal cancer and the alternatives for screening. I also encourage you to join me as a sponsor of H.R. 1046, and to work to establish colorectal cancer screening as a covered benefit under the Medicare program. With this step, we can begin to make serious progress in reducing the avoidable pain, anguish, and excessive medical costs that this disease imposes on all of our citizens. Colorectal Cancer in African-Americans: Medical Studies Indicate That Screening With Sigmoidoscopy and FOBT Is Inadequate for This Population A number of recent medical studies have confirmed earlier reports that polyps and colon cancer occur more commonly in the right (proximal) colon of African-Americans, as compared with the general population. These studies raise questions with regard to the adequacy of colorectal cancer (CRC) screening with sigmoidoscopy, given that a sigmoidoscopy procedure examines only the left (distal) side of the colon, and suggest the use of the barium enema or colonoscopy as preferred screening methodologies for African-Americans. The principal findings of these studies are as follows: (1) ``Distribution of Adenomatous Polyps in African- Americans,'' Lisa A. Ozick, MD, Leslie Jacob, MD, Shirley S. Donelson, MD, Sudhir K. Agarwal, MD, and Harold P. Freeman, MD, The American Journal of Gastroenterology, May 1995, pp. 758-760. ``Previous research has suggested that polyps and colon cancer occur more commonly in the right colon in African Americans compared with the general population.'' (p. 758). ``This study supports previous work that suggests that there is a significant shift to the right in the anatomical distribution of polyps in African-Americans. It also shows that the malignant potential is as high for right-sided polyps as it is for those on the left. Current screening recommendations [sigmoidoscopy] may not be effective enough for preventing colon cancer in this population.'' (p. 758). (2) ``Anatomical Distribution of Colonic Carcinomas Interracial Differences in a Community Hospital Population,'' Houston Johnson, Jr., MD and Rita Carstens, RN, Cancer, 1986, pp. 997-1000. ``This study points out the potentially discrepant sensitivity and value of this instrument [sigmoidoscope] between black and white patients, suggesting that colonoscopy and/or air contrast barium enema examinations are the screening methodologies of choice in black patients.'' (p. 999). ``The finding that . . . indeed the entire colon of this population of black patients is at greater risk than that of white patients to develop cancer of the colon is astounding.'' (p. 1000). (3) ``Site-Specific Distribution of Large Bowel Adenomatous Polyps: Emphasis on Ethnic Differences,'' Houston Johnson, Jr., MD, Irving Margolis, MD, Leslie Wise, MD, Dis. Colon Rectum, April 1988, pp. 258-260. In a study at Queens Hospital Center in New York, it was found that ``[f]ifty-two black and 46 white patients had 130 adenomatous polyps. . . . A separate racial analysis demonstrated an unexpected pattern of distribution among blacks and whites. Adenomatous lesions were more broadly distributed in all segments of the large bowel for blacks, but were disproportionately concentrated in the sigmoid and rectum of whites.'' (p. 259). ``The findings of this study underscore the important ethnic differences in the site distribution of adenomatous polyps. The right-sided dominance of neoplastic lesions in blacks emphasizes the importance of total colonic surveillance to detect these large bowel neoplasms in this racial group.'' (p. 259). ``This study challenges this recommendation [sigmoidoscopy every three to five years] as unsatisfactory for blacks since 50 percent of neoplasms could be missed in blacks compared to only 20 percent in whites.'' (p. 260). (4) ``Anatomic Distribution of Colonic Cancers in Middle Class Black Americans,'' John W.V. Cordice, Jr. MD, Houston Johnson, Jr. MD, Journal of the American Medical Association 1991, pp. 730-732. ``Data support the clinical impression that blacks have relatively more proximal colonic tumors than the general population. They also suggest that early full study of the colon, including barium enema with air contrast or colonoscopy (opposed to flexible sigmoidoscopy), is highly indicated in screening or work up for earlier diagnosis in patients, especially blacks suspected of polyps or carcinoma of the colon.'' (p. 730). (5) ``Untreated Colorectal Cancer in a Community Hospital,'' Dr. Houston Johnson, Jr., Journal of Surgical Oncology, July 3, 1984, pp. 198-200. ``Generally, sigmoidoscopic examinations are recommended to complement physical examinations and stool blood tests. While this recommendation may be appropriate for white patients, it may not be appropriate for black patients. Unless barium enema studies or colonoscopic studies are employed, significant numbers of premalignant lesions or early cancers could be missed in a black population if the distribution of lesions found in this study is generally applicable to black populations.'' (p. 198).

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. Mr. Speaker, I regret that I will be absent from the U.S. Congress on Monday, June 10 and Tuesday, June 11 for personal reasons.

Mr. HASTINGS of Florida

Mr. HASTINGS of Florida. I yield to the gentleman from Indiana.

Mr. HASTINGS of Florida. Mr. Chairman, I move to strike the last word. Mr. Chairman, I associate myself with the remarks of the chairman and the ranking member of the subcommittee, and I am in opposition to the Burton amendment. As indicated, it would cut USAID's operating expenses, as the gentleman from Indiana has said, by $46-plus million to a level of $419 million in fiscal year 1997. The conference report on the fiscal year 1996-97 authorization bill passed by the House and the Senate, as has been pointed out by the subcommittee chair, proposed $465 million in fiscal year 1997, the same as recommended by H.R. 3540, the fiscal year 1997 foreign operations appropriations bill. Mr. Chairman, much about this bill I do not like, but a lot that I like about it is that the chairman and the ranking member and other members of the Committee on Appropriations have gone about in a forthright manner, trying to be as creative as possible in protecting some accounts that we did not protect on the authorizing side. In order to operate at even the $495 million request level in fiscal year 1997, USAID has announced it will have to lay off 200 U.S. direct- hire employees before the end of fiscal year 1996. In addition, 240 direct-hire employees will leave, or through attrition, for a total of 440, a reduction of 17 percent in 2 years. Sometimes when we are on the floor we do not put human faces on these things. My view is cuts of the magnitude proposed in the amendment offered by the gentleman from Indiana, my good friend, would require much deeper staff cuts in the field, seriously damaging USAID's ability to carry out its staff-intensive development programs, particularly child survival and microenterprise, as well as critical programs in the NIS and Eastern Europe. In fact, with such a reduction, it is likely that the agency would have to shut down its operations at some point during fiscal year 1997 for lack of funds. I have pointed out and it has been pointed out previously that the Africa account will suffer substantially. Already, 23 overseas posts in Africa, Asia, the Near East, and Latin America have been cut, producing annual savings in excess of $40 million. I am sure my friend, the gentleman from Indiana, is mindful of that. I see him rising.

Mr. HASTINGS of Florida. I certainly agree with that. That is part of what I was hopeful of pointing out to the gentleman from Indiana. I thank the gentleman for pointing that out, and I stand in opposition to the amendment offered by the gentleman from Indiana.

Mr. HASTINGS of Florida. I yield to the gentleman from Texas.

Mr. HASTINGS of Florida. I think in the final analysis, with a subtle earmark as it exists here, if you take developmental assistance down, you take Africa down. Mr. Chairman, I rise in opposition to the amendment offered by the gentleman from Indiana [Mr. Burton]. The program AID offers across the world are vital for the domestic survival of the countries they serve. They attend to the health and nutrition of children and allow these underdeveloped areas to stabilize their economies, fostering increased trade with the United States and free market economies throughout the world. Furthermore, the cuts to AID would force the agency to cut 200 American jobs by the end of the year and 240 more by the end of 1997. AID has already demonstrated its efforts to streamline over the past 3 years, and is currently discussing the closure and downsizing of additional overseas posts, as my good friend, the gentleman from Indiana, certainly knows. Therefore, the cuts proposed by the Burton amendment are unnecessary and would only further impair the agency's ability to serve its purpose. I would ask that it be opposed.