Mr. President, I am proud to introduce the Healthcare Equality and Accountability Act, along with my colleagues Senators Reid, Durbin, Bingaman, Corzine, Murray, Kennedy Landrieu, Lautenberg, Inouye, Pryor, Mikulski, Obama, Dodd, Lieberman, and Clinton. I want to thank them, as well as my colleagues in the other body, for all of their contributions to this important legislation.
This bill will improve access to and the quality of health care for indigenous people and racial and ethnic minorities who often lack access and suffer disproportionately from certain diseases. It is essential that we expand and improve the health care safety net so that everyone can access the health care services that they need. This legislation will expand health coverage and includes provisions that will increase access to culturally-appropriate and relevant services for our communities.
In addition to improving treatments for the diseases that disproportionately effect indigenous people and racial and ethnic minorities, we need to also focus on preventing these diseases in the first place. This legislation will help combat heart disease, asthma, HIV/AIDS, and diabetes. Diabetes is a disease that disproportionately affects Pacific Islanders, including Native Hawaiians. Among populations in Hawaii, Native Hawaiians had the highest age-adjusted mortality rates due to diabetes for the years 2000 to 2002.
Statistics for U.S.-related Pacific Jurisdictions are difficult to obtain due to underdeveloped reporting and data collection systems. However, available data suggests that diabetes and its complications are growing problems that are creating a greater burden on the health care delivery systems of the Pacific Jurisdictions. For example, in the Republic of the Marshall Islands, mortality data for 1996-2000 reflects that complications from diabetes are the leading cause of death and accounted for 30 percent of all deaths during that period. In American Samoa, mortality data for 1998-2001 shows that diabetes is the third leading cause of death accounting for nine percent of all deaths for that period. In Guam, diabetes has been identified as the fifth leading cause of death and the prevalence rate has been estimated to be seven times that of the United States. Local governments have had to focus on expensive off-island tertiary hospital care and curative services, resulting in the reduction of funds available for community-based primary preventive care and public health services throughout the Pacific Jurisdictions.
There is a need for more comprehensive diabetes awareness education efforts targeted at communities with Native Hawaiian and other Pacific Islander populations. Papa Ola Lokahi, a non-profit agency created in 1988 that functions as a consortium with private and state agencies in Hawaii to improve the health status of Native Hawaiians and other Pacific Islanders, has established the Pacific Diabetes Today Resource Center. Pacific Diabetes Today is designed to provide community members with basic knowledge and skills to plan and implement community-based diabetes prevention and control activities. Since 1998, the Pacific Diabetes Today program has provided training and technical assistance to 11 communities in Hawaii and the Pacific Jurisdictions. However, more can be done to ensure that the diabetic health needs of Native Hawaiians and other Pacific Islanders are being met.
Community-based diabetes programs need to be better integrated into the larger infrastructure of diabetes prevention and control. Comprehensive, specific programs are needed to mobilize Native Hawaiian and other Pacific Islander communities and develop appropriate interventions for diabetes complications prevention and improve diabetes care. My bill, therefore, includes a provision that would authorize a comprehensive program to prevent and better manage the overlapping health problems that are often related to diabetes such as obesity, hypertension, and cardiovascular disease.
I am also pleased that a provision has been included in this bill that would restore Medicaid eligibility for Freely Associated States (FAS) citizens in the United States. The political relationship between the United States and the FAS is based on mutual support. In exchange for the United States having strategic denial and a defense veto over the FAS, the United States provides military and economic assistance to the Republic of Marshall Islands, Federated States of Micronesia and Palau with the goal of assisting these countries in achieving economic self-sufficiency following the termination of their status as U.N. Trust territories. Pursuant to the Compact, FAS citizens are allowed to freely enter the United States. They come to seek economic opportunity, education, and health care. Unfortunately, FAS citizens lost many of their public benefits as a result of the Personal Responsibility and Work Opportunity Act (PRWORA) of 1996, including Medicaid coverage. FAS citizens were previously eligible for Medicaid as aliens permanently residing under color of law in the United States.
After the enactment of PRWORA, the State of Hawaii was informed that it could not claim federal matching funds for services rendered to FAS citizens. Since then, the State of Hawaii, and the territories of Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands (CNMI) have continued to incur substantial costs to meet the health care needs of FAS citizens that have immigrated to these areas.
The federal government must provide federal resources to help states meet the healthcare needs of the FAS citizens that have been brought about by a federal commitment. It is inequitable for a state or territory to be responsible for all of the financial burden of providing necessary social services to individuals that are residing there due to a federal commitment. Mr. President, FAS citizen eligibility must be restored. Furthermore, the State of Hawaii, and the territories of Guam, American Samoa, and the CNMI, should be reimbursed for all of the Medicaid expenses of FAS citizens, and must not be responsible for the costs of providing essential health care services for FAS citizens.
Finally, there is another provision in this bill is of extreme importance to the State of Hawaii, taken from legislation that my colleague from Hawaii, Senator Inouye, has introduced. The provision would provide a 100 percent Federal Medicaid Assistance Percentage (FMAP) of health care costs of Native Hawaiians who receive health care from Federally Qualified Health Centers or the Native Hawaiian Health Care System. This would provide similar treatment for Native Hawaiians as already granted to Native Alaskans by the Indian Health Service or tribal organizations. The increased FMAP will ensure that Native Hawaiians have access to the essential health services provided by community health centers and the Native Hawaiian Health Care System.
Mr. President, this bill would significantly improve the quality of life for indigenous people and ethnic and racial minorities, and I encourage all of my colleagues to support this legislation. Thank you Mr. President.
