I 

108TH CONGRESS 

1ST SESSION H. R. 1386 

To amend part D of title III of the Public Health Service Act to authorize 

grants and loan guarantees for health centers to enable the centers 

to fund capital needs projects, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 20, 2003 

Mr. BONILLA introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend part D of title III of the Public Health Service 

Act to authorize grants and loan guarantees for health 

centers to enable the centers to fund capital needs 

projects, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Building Better Health 

5 Centers Act of 2003’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


erjones on PROD1PC71 with BILLS
2 

•HR 1386 IH 

1 (1) Many health care experts believe that lack 

2 of access to basic health services is our Nation’s sin3 gle most pressing health care problem. Nearly 

4 50,000,000 Americans do not have access to a pri5 mary care provider, whether they are insured or not. 

6 In addition, 43,000,000 Americans lack health in7 surance and have difficulty accessing care due to the 

8 inability to pay for such care. 

9 (2) Health centers, including community health 

10 centers, migrant health centers, health centers for 

11 the homeless, and public housing health centers, ad12 dress the health care access problem by providing 

13 primary care services in thousands of rural and 

14 urban medically-underserved communities through15 out the United States. 

16 (3) Health centers provide basic health care 

17 services to nearly 14,000,000 Americans each year, 

18 including nearly 9,000,000 minorities, 850,000 

19 farmworkers, and 750,000 homeless individuals. 

20 (4) Studies show that health centers provide 

21 high-quality and cost-effective health care. The aver22 age yearly cost for a health center patient is ap23 proximately $1.25 per day. 

24 (5) One of the most effective ways to address 

25 America’s health care access problem is by dramatiVerDate Aug 31 2005 09:50 Apr 27, 2006 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\PICKUP\H1386.IH H1386

erjones on PROD1PC71 with BILLS
3 

•HR 1386 IH 

1 cally expanding access to health centers, as both the 

2 Senate and the President have proposed. 

3 (6) Many existing health centers operate in fa4 cilities that desperately need renovation or mod5 ernization. Thirty percent of health centers are lo6 cated in buildings that are more than 30 years old, 

7 with 12 percent of such centers operating out of fa8 cilities that are more than 50 years old. In a recent 

9 survey of health centers in 11 States, 2/3 of those 

10 centers identified a need to improve, expand, or re11 place their current facility. An extrapolation based 

12 on this survey indicates there may be as much as 

13 $1,200,000,000 in unmet capital needs in our Na14 tion’s health centers. 

15 (7) Dramatically increasing access to health 

16 centers requires building new facilities in commu17 nities that have access problems and lack a health 

18 center. 

19 (8) Health centers often do not have the means 

20 to pay for capital improvements or new facilities. 

21 While most health centers raise some funds through 

22 private donations, it is difficult to raise sufficient 

23 amounts for capital needs without a middle- and 

24 upper-class donor base similar to other nonprofit or25 ganizations like universities and hospitals. 


erjones on PROD1PC71 with BILLS
4 

•HR 1386 IH 

1 (9) Health centers have a limited ability to sup2 port loan payments. Due to an increasing number of 

3 uninsured patients and the fact that many health 

4 care reimbursements are less than the cost of care, 

5 health centers rarely have more than minimal posi6 tive operating margins. Yet lenders are rarely willing 

7 to take risks on nonprofit organizations without 

8 these positive margins. 

9 (10) While the Federal Government currently 

10 provides grants to health centers to assist with oper11 ational expenses used to provide care to a medically12 underserved population, there is no authority to pro13 vide grants to assist health centers to meet capital 

14 needs, such as construction of new facilities or mod15 ernization, expansion, or replacement of existing 

16 buildings. 

17 (11) To assist health centers with their mission 

18 of providing health care to the medically under19 served, the Federal Government should supplement 

20 local efforts to meet the capital needs of health cen21 ters. 

22 SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

23 ACT. 

24 (a) HEALTH CARE FACILITY GRANTS AND LOAN

25 GUARANTEES.—Subpart I of part D of title III of the 


erjones on PROD1PC71 with BILLS
5 

•HR 1386 IH 

1 Public Health Service Act (42 U.S.C. 254b et seq.) is 

2 amended by adding at the end the following: 

3 ‘‘SEC. 330L. HEALTH CARE FACILITY GRANTS AND LOAN 

4 GUARANTEES. 

5 ‘‘(a) ELIGIBLE HEALTH CENTER DEFINED.—In this 

6 section, the term ‘eligible health center’ means a health 

7 center that receives— 

8 ‘‘(1) a grant, on or after the date of enactment 

9 of this section, under subsection (c)(1)(A), (e)(1)(A), 

10 (f), (g), (h), or (i) of section 330; or 

11 ‘‘(2) a subgrant, on or after the date of enact12 ment of this section, from a grant awarded under 

13 such provision of law. 

14 ‘‘(b) GRANT PROGRAM AUTHORIZED.— 

15 ‘‘(1) IN GENERAL.—The Secretary may award 

16 grants to eligible health centers to pay for the costs 

17 described in paragraph (2). 

18 ‘‘(2) USE OF FUNDS.—An eligible health center 

19 that receives a grant under paragraph (1) may use 

20 the grant funds to— 

21 ‘‘(A) modernize, expand, and replace exist22 ing facilities at such center; 

23 ‘‘(B) construct new facilities at such cen24 ter; and 


erjones on PROD1PC71 with BILLS
6 

•HR 1386 IH 

1 ‘‘(C) acquire and lease facilities and equip2 ment (including paying the costs of amortizing 

3 the principal of, and paying the interest on, 

4 loans for such facilities and equipment) to sup5 port or further the operation of such center. 

6 ‘‘(3) LIMITATION.— 

7 ‘‘(A) IN GENERAL.—Subject to subpara8 graph (B), the Federal share of a grant award9 ed under paragraph (1) to expand an existing, 

10 or construct a new, facility shall not exceed 90 

11 percent of the total cost of the project (includ12 ing interest payments) proposed by the eligible 

13 health center. 

14 ‘‘(B) EXCEPTION.—The Federal share 

15 maximum under subparagraph (A) shall not 

16 apply if— 

17 ‘‘(i) the total cost of the project pro18 posed by the eligible health center is less 

19 than $750,000; or 

20 ‘‘(ii) the Secretary waives such max21 imum upon a showing of good cause. 

22 ‘‘(b) FACILITY LOAN GUARANTEES.— 

23 ‘‘(1) IN GENERAL.— 

24 ‘‘(A) IN GENERAL.—The Secretary shall 

25 establish a program under which the Secretary 


erjones on PROD1PC71 with BILLS
7 

•HR 1386 IH 

1 may guarantee not less than 90 percent of the 

2 principal and interest on the total amount of 

3 loans made to an eligible health center by non4 Federal lenders in order to pay for the costs as5 sociated with a capital needs project described 

6 in subparagraph (B). 

7 ‘‘(B) PROJECTS.—Capital needs projects 

8 under this subsection include— 

9 ‘‘(i)(I) acquiring, leasing, modern10 izing, expanding, or replacing existing fa11 cilities; 

12 ‘‘(II) constructing new facilities; or 

13 ‘‘(III) purchasing or leasing equip14 ment; or 

15 ‘‘(ii) the costs of refinancing loans 

16 made for any of the projects described in 

17 clause (i). 

18 ‘‘(C) NOT A FEDERAL SUBSIDY.—Any loan 

19 guarantee issued pursuant to this subsection 

20 shall not be deemed a Federal subsidy for any 

21 other purpose. 

22 ‘‘(2) AUTHORITY FOR LOAN GUARANTEE PRO23 GRAM.—With respect to the program established 

24 under paragraph (1), the Secretary shall assume 

25 such authority— 


erjones on PROD1PC71 with BILLS
8 

•HR 1386 IH 

1 ‘‘(A) as the Secretary has under para2 graphs (2) and (4) of section 330; and 

3 ‘‘(B) under section 1620 as the Secretary 

4 determines is necessary and appropriate. 

5 ‘‘(3) DEFINITIONS.—In this subsection: 

6 ‘‘(A) FACILITIES.—The term ‘facilities’ 

7 means a building or buildings used by a health 

8 center, in whole or in part, to provide services 

9 permitted under section 330 and for such other 

10 purposes as are not specifically prohibited 

11 under such section as long as such use furthers 

12 the objectives of the health center. 

13 ‘‘(B) NON-FEDERAL LENDER.—The term 

14 ‘non-Federal lender’ means any entity other 

15 than an agency or instrumentality of the Fed16 eral Government authorized by law to make 

17 loans, including a federally-insured bank, a 

18 lending institution authorized or licensed to 

19 make loans by the State in which it is located, 

20 and a State or municipal bonding authority or 

21 such authority’s designee. 

22 ‘‘(c) EVALUATION.—Not later than 3 years after the 

23 date of enactment of this section, the Secretary shall pre24 pare a report containing an evaluation of the programs 

25 authorized under this section. Such report shall include 


erjones on PROD1PC71 with BILLS
9 

•HR 1386 IH 

1 recommendations on how this section can be improved to 

2 better help health centers meet such centers’ capital needs 

3 in order to expand access to health care in the United 

4 States. 

5 ‘‘(d) AUTHORIZATION.—For the purpose of carrying 

6 out this section, the Secretary shall use no more than 5 

7 percent of any funds appropriated pursuant to section 

8 330(s) (the subsection relating to authorization of appro9 priations). In addition, funds appropriated for fiscal years 

10 1997 and 1998 under the Departments of Labor, Health 

11 and Human Services, and Education, and Related Agen12 cies Appropriations Acts of 1997 and 1998, which were 

13 made available for loan guarantees for loans made by non14 Federal lenders for construction, renovation, and mod15 ernization of medical facilities that are owned and oper16 ated by health centers and which have not been expended, 

17 shall be made available for loan guarantees under this sec18 tion.’’. 

19 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

20 330(s) of the Public Health Service Act (the subsection 

21 relating to authorization of appropriations) is amended by 

22 striking ‘‘this section’’ and inserting ‘‘this section and sec23 tion 330L’’. 

Æ 


erjones on PROD1PC71 with BILLS