Where does it hurt? The CBC wants more African-Americans involved in the debate over health care reform.

Nearly a quarter of African-Americans and almost a third of Hispanics are in dire straits if they get sick. Why? Because, they lack health insurance. Of the 37 million Americans without it, 21% are black, 32% are Hispanic and only 11% are white, according to a U.S. Department of Health and Human Services survey. As Congressional committees wrangle over health care reform options, the Congressional Black Caucus (CBC) is striving to ensure that African-American needs are met.

The CBC is concerned with whether reform will increase the number of minority health care providers, guarantee equal access to designated physicians, health clinics and hospitals, and provide quality care for urban and rural areas. Rep. Eddie Bernice Johnson (D-Texas), a former psychiatric nurse and one of only three medical professionals in Congress, lauds health care reform's goal of universal availability. But she points out that many future health care providers will belong to health maintenance organizations (HMOs). And many HMOs in Texas, she notes, have been reluctant to invite African-American doctors, whose patients oftentimes are more seriously ill, to join them.

Rep. Earl F. Hilliard (D-Ala.) is concerned that universal health care may be mitigated by lack of transportation, especially in rural areas. He says reform is meaningless for the black elderly if they are unable to get from home to a doctor.

Rep. Louis Stokes (D-Ohio), chairman of the CBC Health Braintrust, believes African-Americans are in a powerful position to resolve such concerns. CBC members sit on strategic House committees--including Ways and Means, Energy and Commerce and Intergovernmental Relations--key to the development and implementation of reform legislation. Thus, Stokes asserts, "We will be able to

put some black perspective on the issue." Right now, though the CBC likes the Clinton proposal's inclusion of affordable care, less burdensome paperwork and greater emphasis on preventive medicine, many CBC members support a state-administered, single-payer approach, rather than a federally driven system.

Of course, the best time for African-Americans to weigh in on reform is as the legislation is being written. During the past year, the CBC has held health care forums in different districts and brought minority medical experts, including representatives of the predominantly black National Medical Association, before Congress. The goal, says CBC Chairman Rep. Kweisi Mfume (D-Md.), is creating an affordable and accessible health care system that "prevents crises and builds a foundation for generations of healthy and productive citizens."