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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Building Better Health 
Centers Act of 2003’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
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(1) Many health care experts believe that lack 
of access to basic health services is our Nation’s sin-
gle most pressing health care problem. Nearly 
50,000,000 Americans do not have access to a pri-
mary care provider, whether they are insured or not. 
In addition, 43,000,000 Americans lack health in-
surance and have difficulty accessing care due to the 
inability to pay for such care. 
(2) Health centers, including community health 
centers, migrant health centers, health centers for 
the homeless, and public housing health centers, ad-
dress the health care access problem by providing 
primary care services in thousands of rural and 
urban medically-underserved communities through-
out the United States. 
(3) Health centers provide basic health care 
services to nearly 14,000,000 Americans each year, 
including nearly 9,000,000 minorities, 850,000 
farmworkers, and 750,000 homeless individuals. 
(4) Studies show that health centers provide 
high-quality and cost-effective health care. The aver-
age yearly cost for a health center patient is ap-
proximately $1.25 per day. 
(5) One of the most effective ways to address 
America’s health care access problem is by dramati-
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cally expanding access to health centers, as both the 
Senate and the President have proposed. 
(6) Many existing health centers operate in fa-
cilities that desperately need renovation or mod-
ernization. Thirty percent of health centers are lo-
cated in buildings that are more than 30 years old, 
with 12 percent of such centers operating out of fa-
cilities that are more than 50 years old. In a recent 
survey of health centers in 11 States, 2/3 of those 
centers identified a need to improve, expand, or re-
place their current facility. An extrapolation based 
on this survey indicates there may be as much as 
$1,200,000,000 in unmet capital needs in our Na-
tion’s health centers. 
(7) Dramatically increasing access to health 
centers requires building new facilities in commu-
nities that have access problems and lack a health 
center. 
(8) Health centers often do not have the means 
to pay for capital improvements or new facilities. 
While most health centers raise some funds through 
private donations, it is difficult to raise sufficient 
amounts for capital needs without a middle- and 
upper-class donor base similar to other nonprofit or-
ganizations like universities and hospitals. 
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(9) Health centers have a limited ability to sup-
port loan payments. Due to an increasing number of 
uninsured patients and the fact that many health 
care reimbursements are less than the cost of care, 
health centers rarely have more than minimal posi-
tive operating margins. Yet lenders are rarely willing 
to take risks on nonprofit organizations without 
these positive margins. 
(10) While the Federal Government currently 
provides grants to health centers to assist with oper-
ational expenses used to provide care to a medically- 
underserved population, there is no authority to pro-
vide grants to assist health centers to meet capital 
needs, such as construction of new facilities or mod-
ernization, expansion, or replacement of existing 
buildings. 
(11) To assist health centers with their mission 
of providing health care to the medically under-
served, the Federal Government should supplement 
local efforts to meet the capital needs of health cen-
ters. 
SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT. 
(a) HEALTH CARE FACILITY GRANTS AND LOAN 
GUARANTEES.—Subpart I of part D of title III of the 
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Public Health Service Act (42 U.S.C. 254b et seq.) is 
amended by adding at the end the following: 
‘‘SEC. 330L. HEALTH CARE FACILITY GRANTS AND LOAN 
GUARANTEES. 
‘‘(a) ELIGIBLE HEALTH CENTER DEFINED.—In this 
section, the term ‘eligible health center’ means a health 
center that receives— 
‘‘(1) a grant, on or after the date of enactment 
of this section, under subsection (c)(1)(A), (e)(1)(A), 
(f), (g), (h), or (i) of section 330; or 
‘‘(2) a subgrant, on or after the date of enact-
ment of this section, from a grant awarded under 
such provision of law. 
‘‘(b) GRANT PROGRAM AUTHORIZED.— 
‘‘(1) IN GENERAL.—The Secretary may award 
grants to eligible health centers to pay for the costs 
described in paragraph (2). 
‘‘(2) USE OF FUNDS.—An eligible health center 
that receives a grant under paragraph (1) may use 
the grant funds to— 
‘‘(A) modernize, expand, and replace exist-
ing facilities at such center; 
‘‘(B) construct new facilities at such cen-
ter; and 
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‘‘(C) acquire and lease facilities and equip-
ment (including paying the costs of amortizing 
the principal of, and paying the interest on, 
loans for such facilities and equipment) to sup-
port or further the operation of such center. 
‘‘(3) LIMITATION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Federal share of a grant award-
ed under paragraph (1) to expand an existing, 
or construct a new, facility shall not exceed 90 
percent of the total cost of the project (includ-
ing interest payments) proposed by the eligible 
health center. 
‘‘(B) EXCEPTION.—The Federal share 
maximum under subparagraph (A) shall not 
apply if— 
‘‘(i) the total cost of the project pro-
posed by the eligible health center is less 
than $750,000; or 
‘‘(ii) the Secretary waives such max-
imum upon a showing of good cause. 
‘‘(b) FACILITY LOAN GUARANTEES.— 
‘‘(1) IN GENERAL.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish a program under which the Secretary 
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may guarantee not less than 90 percent of the 
principal and interest on the total amount of 
loans made to an eligible health center by non- 
Federal lenders in order to pay for the costs as-
sociated with a capital needs project described 
in subparagraph (B). 
‘‘(B) PROJECTS.—Capital needs projects 
under this subsection include— 
‘‘(i)(I) acquiring, leasing, modern-
izing, expanding, or replacing existing fa-
cilities; 
‘‘(II) constructing new facilities; or 
‘‘(III) purchasing or leasing equip-
ment; or 
‘‘(ii) the costs of refinancing loans 
made for any of the projects described in 
clause (i). 
‘‘(C) NOT A FEDERAL SUBSIDY.—Any loan 
guarantee issued pursuant to this subsection 
shall not be deemed a Federal subsidy for any 
other purpose. 
‘‘(2) AUTHORITY FOR LOAN GUARANTEE PRO-
GRAM.—With respect to the program established 
under paragraph (1), the Secretary shall assume 
such authority— 
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‘‘(A) as the Secretary has under para-
graphs (2) and (4) of section 330; and 
‘‘(B) under section 1620 as the Secretary 
determines is necessary and appropriate. 
‘‘(3) DEFINITIONS.—In this subsection: 
‘‘(A) FACILITIES.—The term ‘facilities’ 
means a building or buildings used by a health 
center, in whole or in part, to provide services 
permitted under section 330 and for such other 
purposes as are not specifically prohibited 
under such section as long as such use furthers 
the objectives of the health center. 
‘‘(B) NON-FEDERAL LENDER.—The term 
‘non-Federal lender’ means any entity other 
than an agency or instrumentality of the Fed-
eral Government authorized by law to make 
loans, including a federally-insured bank, a 
lending institution authorized or licensed to 
make loans by the State in which it is located, 
and a State or municipal bonding authority or 
such authority’s designee. 
‘‘(c) EVALUATION.—Not later than 3 years after the 
date of enactment of this section, the Secretary shall pre-
pare a report containing an evaluation of the programs 
authorized under this section. Such report shall include 
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recommendations on how this section can be improved to 
better help health centers meet such centers’ capital needs 
in order to expand access to health care in the United 
States. 
‘‘(d) AUTHORIZATION.—For the purpose of carrying 
out this section, the Secretary shall use no more than 5 
percent of any funds appropriated pursuant to section 
330(s) (the subsection relating to authorization of appro-
priations). In addition, funds appropriated for fiscal years 
1997 and 1998 under the Departments of Labor, Health 
and Human Services, and Education, and Related Agen-
cies Appropriations Acts of 1997 and 1998, which were 
made available for loan guarantees for loans made by non- 
Federal lenders for construction, renovation, and mod-
ernization of medical facilities that are owned and oper-
ated by health centers and which have not been expended, 
shall be made available for loan guarantees under this sec-
tion.’’. 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 
330(s) of the Public Health Service Act (the subsection 
relating to authorization of appropriations) is amended by 
striking ‘‘this section’’ and inserting ‘‘this section and sec-
tion 330L’’. 
Æ 
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