located. when we see many of the minority health professionals in the country, they got their training, they got their beginning, some of them actually started asking her to health workers, as health aides, as pharmacies assistance, and technicians. now they are full-fledged physicians, full-fledged pharmacist. many of them have earned master's degree in public health, and we think that there's no better way of making sure that low income minorities have opportunities for the highest level of health care than to expand the community health center program. class last . .

>> the approximately 21 puerto of asian-american and prask islanders without health care are our parents, our children and brothers, and our sisters. although all aspects of health reform are important, it is critical for us to topple language and culture barriers. capac is a voice in congress,

and i'm very proud of the long work and long hours that our task force chair that represents capac, congresswoman -- madeleine who represents the territory of guam, and also a new member for capac, the congressman, we're just very glad for him to join us today. we want to make sure that we stand firmly with our partners in chc, cbc to insure that we move in the right direction in health reform. that is why we need to strengthen existing work force, create new programs and invest in community-based approaches to health care. reforms must be integrated into the whole of the health reform bill and not relegated to one little or one title or an afterthought. the great expenses that we see and that we have been struggling

with in the past regarding health care has been originating from those gaps that we have described. the time is now for congress and the president to come together on this issue, and i look forward to continuing my dialogue with the leadership and the president's staff on this important issue. let me reiterate again that the work that the tricaucus along with those in the lbgt community is critical to the entire health program and health approach in this country. thank you. >> congresswoman boar die owe who chairs the health task force. thank you. >> thank you, madam chairman and good day to everyone, that's the word we use for greetings in guam. i join my colleagues today, and they have all stressed that this bill will do so much more than

just expand data collection and bolster diversity in the health work force. and it will also do so far more than reduce the incidents of diseases and chronic conditions in our nation's most underserved communities. this bill will literally save lives, innocent lives, many of which are during their productive life years. it could strengthen the on ongog health care reform efforts because it will fix the most broken aspects of the health care system. for example, in addition to improving health care services and treatments at the patient level, the health, equity and accountability act of 2009 -- which i was an original co-sponsor of this bill -- also includes provisions to strengthen and expand the federal agencies and offices with health jurisdiction including the office of minority health and the national center on minority health and health disparities at the nih, the national institute of health,

which this bill will elevate to an institute. these provisions are necessary because they will bolster efforts to coordinate and strengthen accountability and evaluation of health disparity elimination efforts within and among our largest federal health entities. and so by including these provisions and others from the health equity and accountability act of 2009 in the health care reform bill, we will be insuring that as we work to reform our health care system that we successfully transform every aspect of it in a manner that champions health, equity, and treats every man, woman, and child with dignity and equity regardless of race, background, or geography. this is of particular importance to me because i represent a u.s.er the roir and like my other colleagues representing the u.s. territories, i am very

pleased that this act includes provisions that will finally bring equality in health and health care to the u.s. territories. for example, this bill includes provisions that insure that the public health programs in the u.s. territories will finally be structured and will finally have the resources necessary to adequately and appropriately serve our most medically and financially-needy residents. and this is very important because some of the nation's most devastating health disparity trends are in the territories. for example, the u.s. virgin islands has the second highest aids case rate in the nation, and on guam our health provider shortages are so severe that often residents must go off-island to get the care they need to manage their conditions. and so the health equity and accountability act of 2009 will accomplish what so many previous health bills have failed to do:

to remember the u.s. territories and to include the thoughtful provisions that will improve the health health, the health care and, thus, wellness and lives of all americans including those who do not live on the mainland. that truly is what health equity is all about and is precisely why i'm so honored to be here with my colleagues from the tricaucus standing in unison and in support of this legislation that we feel strongly should be included in the health reform bill. this bill also includes come prehencive -- comprehensive measures to insure cultural and linguistic competence in health care, and this is what my colleague, congressman vel as qez, will address. that's why i introduce her. >> good morning, everyone. i'm chair of the congressional hispanic caucus, and i am pleased to be here today with my tricaucus colleagues and proud

to join them as an original co-sponsor of the health equity and accountability act of 2009. as my colleagues before me mentioned, our nation is engaging in a debate on reforming our broken health care system. as that debate has progressed, the conversation has lacked any concern or commitment to addressing the cultural disparities that exist in our system, believe me. a comprehensive health care reform bill without the aspects that we're discussing here today will be set for failure. one of the key components to our health care system are the health care professionals who make up the work force. our efforts must include strong recruitment, training, hiring and retention of health professionals from all racial and ethnic, ethnic backgrounds

across all health and health care-related positions including researchers and health care executives. creating and expanding a diverse work force on all levels must be a priority, and these efforts must begin in our elementary schools. by beginning early and keeping focused throughout our education system from kindergarten to high school and beyond, we can help increase the currently underrepresented racial and ethnic minorities. and it is important that our health care professionals be familiar with the unique needs and traditions of our communities. for example, within the latino community, the needs of the puerto ricans in brooklyn, new york, might not be the same as the need for the chicanos in l.a. we need to create the avenues that will help increase those opportunities for our community, and that is why we strongly

support the creation of new funding streams as well as our commitment to fully funding existing title vii federal health programs. these programs increase the diversity of the primary care, mental health, dental and oral health provider work force. one of the title vii fundamental goals is the education of primary care providers with an emphasis on the recruitment of underrepresented minorities and disadvantaged populations who can deliver quality health care in our medically-underserved communities. health reform must also include provisions to increase funding of the title viii health profession's programs and to expand and bolster diversity of the nation's nursing work force. we also support increased support for residency training

for advanced practice nurses in order to bolster the nation's primary care work force. the nursing shortage is one of the major shortcomings of our health care system, and we must take aggressive action on that issue. another key component of health care reform is improved prevention and health care services which my colleague, congresswomannaler, chair of the task force will discuss further, and i just want to applaud her leadership and all the efforts she has put into this health care reform legislation. >> thank you, congresswoman. and thank you all very much for joining us today. as my colleagues and friends have stated, the health equity and accountability act of 2009 is a critically important bill that takes the issue of health

disparity beyond just coverage and cost. to address this most critical public health challenge in our nation, our bill applies a comprehensive and sound approach to address the elimination of racial, ethnic, and cultural health disparities. the health equity and accountability act of 2009 includes thoughtful provisions to provide health grants, improve rural health care services, reduce hiv/aids and cancer among racial and ethnic minorities and promote positive health behaviors in women and children so that they may lead longer, healthier lives. america's health is at a critical juncture with persistent disparities between ethnic and racial groups contributing to our country's diminished health status. the onset of preventable disease and premature death.

the future health of america as a whole will be influenced substantially by our success and improving the health of all minority groups. a key component to achieving that goal is to have a public health approach that integrates prevention and wellness across all health care services. so i join my colleagues in support of the preventive measures in this bill from expanding says to prevention education to insuring equity in the quality of preventive care. we are united in our determination to insure that wherever applicable, the elimination of health disparities is integrated into health reform legislation. it is an honor to be a member of the tricaucus, and i want to commend all those who have worked so hard on this bill over the past years, and i am proud

to be an original co-sponsor of the health equity and accountability act of 2009. thank you very much. >> thank you very much. we'll open for questions in just a minute. i believe congresswoman watson would like to make a statement, former, actually, chair when she was in the health and human services committee. >> thank you so much, barbara. i just quickly wanted to say out of the nearly 48 million uninsured, about 8 million are in california, and 6 million of those are children. the climate is right in this period of time to do health care reform. and we know in california because we're the first state in the union that is a majority of minorities that the underserved are people of color for the most part. so we are all working hard, and this bill will help us reach the goal. be sure, being sure there's

disparity, the disparities are done away with, there's equality and responsibility as we come up with a program that will serve the underserved. accessibility is one of the problems, we just had one of our major hospitals in south central close down, and that was the martin luther king hospital. now people have to go a dangerously 18 minutes more away mr. that hospital for emergency -- from that hospital for emergency care. these are some of the things we tend to set up as objectives to reach the goal or comprehensive health care for all americans. thank you. >> dr. brian smedly who's the vice president and directer with the joint center for political and economic studies is not here, but we do have his statement, so we would hope that you'd pick up a copy of the recommendations in the unequal treatment report on health

disparities which is, i think, included in the statement. congresswoman allard has a few brief comments. >> yeah. i wanted to make another point about why prevention is so important because we all know that prevention saves lives, and it improves health outcomes leaving our families and our communities stronger and more resilient. and it also has the potential to save our nation precious health care dollars. for example, the trust for america's health concluded that an investment of $10 per person, per year in proven community-based disease prevention programs could yield a net savings of more than $2.8 billion, billion annually in health care costs in one to two years. that figure grows to $16 billion annually within five years.

so, clearly, in terms of the outcomes of having a healthier nation, we need to have prevention as a part of any health care bill, and with regards to the effort to save money, prevention is key in that aspect as well. so it is clear that prevention has not failed us, but that we in turn have failed prevention. and it must be a part of this, any health care bill. >> okay, thank you very much. we'll open for questions now, and i'd like to thank our staff, also, who have worked so diligently on not only this press conference, but the bill, and all of the research and all of the pulling together the initiative that we've been working on. if it hadn't been for them, i don't think we'd be here today, so thank you all very much. uh-huh? right here. >> senate is ready to have health care legislation, is

anyone working with the senate to try to get any of these provisions included in the bill, and why introduce the whole separate bill if you're not trying to get it into the health care reform legislation? >> the tri-caucus health chairs and tri-caucus chairs have written and begun discussions with the senate on this, and we've also been very much involve inside what the house is putting together. and the house is already talking about including some of the provisions into our house health care reform package. >> can you talk about what some of those provisions are? [inaudible] >> just broadly, and, you know, it's just in the process of being written, i haven't even looked at what they've put out today, but i would imagine community health centers would be a part, the diversity. everyone knows that based on massachusetts and other

experiences that the lack of health care providers has proven to be a barrier to really having everyone have access to health care despite insurance. and so as they plan how we will increase our health care work force, i can pretty much say they've made a commitment to increasing diversity in that work force as well. and there are probably some other provisions, but we're still in discussions on them. >> yeah, and i think what's important to note this bill actually has been introduced this is the third time now. >> it's actually the fourth time, and it is a tri-caucus effort, and the last original sponsor was so lease. before that it was mike honda and before that it was elijah coupling, so it just rotates through the office. in the initial two introductions we did it with the house and senate together, so we're hoping to have a senate sponsor. >> is the tri-caucus unite today

oppose the bill if it duds not include at least some of the major aspects of your proposal? >> well, let me just say -- go on, congresswoman. >> i was just going to say i don't think we're at that point yet, and in any discussions that we have had there is, seems to be a real recognition and acceptance of the fact that the elimination of health disparities is important to reaching the goal of a good, you know, health care plan. so we're very hopeful. we haven't had any indication that the key provisions that we are asking for are not even being considered. [inaudible conversations] >> just a quick comment on that question. i don't think that the principles of our health care plan has been completely shared with the writing team, but i'll

tell you one thing, that if there's no public health option in the health care debate, then there will be a lot of resistance. so in the whole debate the public health option has to be there. and on top of the disparities issue, we mentioned language and also training of health professionals and research at cdc without having any consideration, research, instruction in the health profession and language i think we'd be missing a big part of the needs our communities face. for instance, there was an operation that was going to be had in the county down from my district, and persons happened to speak, and the doctor was

checking to see if he was following and there was no communication between the two, and the wrong leg that wasn't supposed to be amp pew tated, so the man ended up missing two legs. these are just reported incidences. there's over 7,000 reported. how many more are there that have not been reported? so this is critical. >> the office of minority health, what would you like to see in terms of that particular office other than just more money? >> there are several agencies in health and human services that don't have an office of minority health. cms? fda? so we want to see it expanded. it's always been that they have been allowed a budget up to 5 percent of the budget of the agency. we'd like to see a line item budget and more coordination, having more of a say in everything that every policy

coming out of health and human services, than they to right now. do right now. >> the phrase more money seems to back people off on issues, and i'm -- we're here to tell you that without addressing the gaps in disparities in health, it's going to cost you more money. and to anticipate that we have to plan well, invest well so that the return on our investment is saving lives, the health of our country, and ultimately having money to be able to be expended in other areas such as research. >> you want to talk about interns, does it insure says to care? do you think that the public health option is the best way to insure access? is there anything else, or if there's no public health option that can be done, some sort of carveout for low income?

>> well, most of us, i think the entire tri-caucus sports the public health option. because we're faced with 47 million uninsured, and we recognize the choice is central to any insurance reform effort. however, there are so many who don't have that choice now, and it's our duty and really our moral responsibility to provide that option within a public health context very similar to medicare. >> well, we're not satisfied with the care that medicaid beneficiaries get, so we'll need to see some improvements in the medicaid program beginning with at least better reimbursement for providers so that people will have access to quality providers. providers don't even go into

poor neighborhoods because they can't maintain their practices or keep their hospital doors open. so says is not just getting -- access is not just getting into a doctor's or provider's office, it's having the cultural competency, it's also being, having access to all kinds of health care. dental is not one that's included thus far in any of the proposals that we've seen, and we know how important good dental care is, so we would like to see access to dental care. it's expanding sedz in ways, you know, other than just insuring everyone. >> the common carveout -- comment on carveout seems to indicate that the private industry or the other, well, health care providers are willing to do something that should be done. and carve out a portion of their time and their efforts for those

who need it. carveout, in my experience, has never worked because it doesn't help the bottom line for them. i haven't been in the public office with the county, we're responsible for everybody, and when we have a debate about county hospitals versus other hospitals, they always tell us, oh, don't build too many beds. we have enough beds out here, we'll take care of people in emergency care, and it never happens that way. and so, you know, based upon experience, at least for myself, carveout is a nice word, but, you know, it doesn't play out in the future and doesn't indicate that they're willing to go to the extent that this bill and this proposal has. >> and on the issue of, you asked about the office of minority health, but i just want to focus for a minute on the national center for minority and health disparity research that we'd like to elevate to an

institute, the funding level for that center which we were able ten years or almost 11 years ago now to elevate to a center is one of the lowest budgets in nih. and in order to be able to do the kind of research that's needed on communities of color to insure that we're included in clinical trials, to support the minority-serving institutions so that they can strengthen their infrastructure for research, that center needs to have more money, but it also needs to be elevated to the level of an institute so that it also has more transauthority over research happening in any of the other areas that would impact communities of color. >> we've been joined by congressman javier baaer is a who is a member of the hispanic caucus, also member of our democratic caucus leadership team serving as vice chair. thank you very much. let me just reference one point, and i hope, again, that you pick

up dr. smedly's report because he stresses that health equity through health reform, what must address the social determinants of health including those that go beyond the health insurance status that currently have, of course, a detrimental impact on racial and ethnic minorities, so be sure you pick up his report because that is such a big piece of what we want to see incorporated in whatever institute or national office that we elevate to the status that congresswoman christianson was mentioning. >> what are you guys doing to insure as far as crafting language inside the act to insure that the funding is the way that you guys distribute is equitable all across the board so it doesn't suffer the same thing in state public schools and there's a lot of overcrowding in minorities in regards to these free health centers. >> well, funding is going to

probably be our biggest challenge, but we intend to work with state legislators, majors, all elected officials on all levels so that once we do what we do up here that they will work with us to insure that the communities that need the services have them. there are also some independent pieces of legislation. i believe there's one that's going to be introduced that will expand on health centers, and i might just add that senator specter and congressman cummings have introduced legislation. >> and there's going to be grants made available, also, for prevention demonstration projects. so there's different ways that this will be funded. >> and several of us actually serve on the appropriations subcommittee, congressman honda and myself, and that subcommittee actually will have a key role in funding many of the health initiatives that come out of whatever health care