I
106TH CONGRESS
1ST SESSION
H. R. 3250
To amend the Public Health Service Act to improve the health of minority
individuals.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 8, 1999
Mr. THOMPSON of Mississippi (for himself, Mr. LEWIS of Georgia, Mr. NOR-
WOOD, Mr. JACKSON of Illinois, Mr. BROWN of Ohio, Mr. TOWNS, Ms.
ROYBAL-ALLARD, Mr. RODRIGUEZ, Mr. UNDERWOOD, Mr. FILNER, Mrs.
CHRISTENSEN, Mr. CONYERS, Mr. WYNN, Mr. GONZALEZ, Mr. HILL-
IARD, Ms. CARSON, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. SCOTT,
Ms. KILPATRICK, Mr. CLYBURN, Mr. RUSH, Mr. CUMMINGS, Mr. PAYNE,
Mr. DIXON, Mr. FORD, Ms. MILLENDER-MCDONALD, Ms. WATERS, Mr.
MEEKS of New York, Mr. BISHOP, Mrs. MEEK of Florida, Mrs. JONES
of Ohio, Mr. DAVIS
of Illinois, Ms. LEE, Ms. MCKINNEY, Mrs.
NAPOLITANO, Ms. JACKSON-LEE of Texas, Mrs. CLAYTON, Mr. WATT of
North Carolina, Mr. FATTAH, Ms. PELOSI, Mr. ABERCROMBIE, and Mr.
GEORGE MILLER of California) introduced the following bill; which was
referred to the Committee on Commerce
A BILL
To amend the Public Health Service Act to improve the
health of minority individuals.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Health Care Fairness Act of 1999’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I—IMPROVING MINORITY HEALTH THROUGH THE NA-
TIONAL INSTITUTES OF HEALTH; ESTABLISHMENT OF NA-
TIONAL CENTER
Sec. 101. Establishment of National Center for Research on Minority Health
and Health Disparities.
Sec. 102. Centers of excellence for research education on health disparities and
training.
Sec. 103. Extramural loan repayment program for biomedical research.
Sec. 104. General provisions regarding the Center.
Sec. 105. Report regarding methodology for determining resources of National
Institutes of Health dedicated to research on minority health.
Sec. 106. Report by Director of Center regarding resources of National Insti-
tutes of Health dedicated to research on minority health.
TITLE II—MINORITY HEALTH RESEARCH BY THE AGENCY FOR
HEALTH CARE POLICY AND RESEARCH
Sec. 201. Minority health research by the Agency for Health Care Policy and
Research.
TITLE III—DATA COLLECTION RELATING TO RACE OR
ETHNICITY
Sec. 301. Study and report by National Academy of Sciences.
TITLE IV—MEDICAL EDUCATION
Sec. 401. Grants for health care education curriculum development.
Sec. 402. National conference on continuing health professional education and
disparity in health outcomes.
Sec. 403. Continuing medical education incentive program.
Sec. 404. Advisory committee.
Sec. 405. Cultural competency clearinghouse.
TITLE V—MISCELLANEOUS PROVISIONS
Sec. 501. Office for Civil Rights.
Sec. 502. Development of standards; study to measure patient outcomes under
the medicare and medicaid programs by race and ethnicity.
Sec. 503. Departmental definition regarding minority individuals.
Sec. 504. Conforming provision regarding definitions.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) The United States ranks below most indus-
trialized nations in health status as measured by
longevity, sickness, and mortality.
(2) The United States ranks 24th among indus-
trialized nations in infant mortality.
(3) This poor rank in health status is attributed
in large measure to the lower health status of Amer-
ica’s minority populations.
(4) Many minority groups suffer disproportion-
ately from cancer. Disparities exist in both mortality
and incidence rates. For men and women combined,
African Americans have a cancer death rate about
35 percent higher than that for whites. Paralleling
the death rate, the incidence rate for lung cancer in
African American men is about 50 percent higher
than white men. Native Hawaiian men also have ele-
vated rates of lung cancer compared with white men.
Alaskan Native men and women suffer from higher
rates of cancers of the colon and rectum than do
whites. Vietnamese women in the United States have
a cervical cancer incidence rate more than 5 times
greater than white women. Hispanic women also suf-
fer elevated rates of cervical cancer.
(5) Infant death rates among African Ameri-
cans, Native Americans, and Alaska Natives, and
Hispanics were well above the national average. The
greatest disparity exists for African Americans. The
overall Native American rate does not reflect the di-
versity among Indian communities, some of which
have infant mortality rates approaching twice the
national rate.
(6) Sudden infant death syndrome (referred to
in this section as ‘‘SIDS’’) accounts for approxi-
mately 10 percent of all infant deaths in the first
year of life. Minority populations are at greater risk
for SIDS. In addition to the greater risks among Af-
rican Americans, the rates are 3 to 4 times as high
for some Native American and Alaskan Native popu-
lations.
(7) Cardiovascular disease is the leading cause
of death for all racial and ethnic groups. Major dis-
parities exist among population groups, with a dis-
proportionate burden of death and disability from
cardiovascular disease in minority and low-income
populations. Stroke is the only leading cause of
death for which mortality is higher for Asian-Amer-
ican males than for white males.
(8) Racial and ethnic minorities have higher
rates of hypertension, tend to develop hypertension
at an earlier age, and are less likely to undergo
treatment to control their high blood pressure.
(9) Diabetes, the 7th leading cause of death in
the United States, is a serious public health problem
affecting racial and ethnic communities. The preva-
lence of diabetes in African Americans is approxi-
mately 70 percent higher than whites and the preva-
lence in Hispanics is nearly double that of whites.
The prevalence rate of diabetes among Native Amer-
icans and Alaska Natives is more than twice that for
the total population and at least 1 tribe, the Pimas
of Arizona, have the highest known prevalence of di-
abetes of any population in the world.
(10) The human immunodeficiency virus (re-
ferred to in this section as ‘‘HIV’’), which causes ac-
quired immune deficiency syndrome (referred to in
this section as ‘‘AIDS’’), results in disproportionate
suffering in minority populations. Minority persons
represent 25 percent of the total United States pop-
ulation, but 54 percent of all cases of AIDS.
(11) More than 75 percent of AIDS cases re-
ported among women and children occur in minority
women and children.
(12) Nearly 2 of 5 (38 percent) Hispanic
adults, 1 of 4 (24 percent) African American adults,
and 1 of 4 (24 percent) Asian-American adults are
uninsured, compared with 1 of 7 (14 percent) white
adults.
(13) Elderly minorities experience disparities in
access to care and health status, in part because
medicare covers only half the health care expenses of
older Americans.
(14) Two of 5 Hispanics and 2 of 5 African
Americans age 65 and older rate their health status
as fair or poor, compared with less than 1 of 4 (23
percent) white Americans 65 and over.
(15) Nearly 2 of 5 (39 percent) African Amer-
ican adults and almost half (46 percent) of Hispanic
adults report that they do not have a regular doctor,
compared with 1 of 4 (26 percent) of white adults.
(16) Minority Americans 65 and older are less
likely to have a regular doctor or to see a specialist.
(17) Ninety percent of minority physicians pro-
duced by Historically Black Medical Colleges live
and serve in minority communities.
(18) Almost half (45 percent) of Hispanic
adults, 2 of 5 (41 percent) Asian-American adults,
and more than 1 of 3 (35 percent) African American
adults report difficulty paying for medical care, com-
pared with 1 of 4 (26 percent) white adults.