[Congressional Record Volume 140, Number 1 (Tuesday, January 25, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: January 25, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
       PROPOSED INTRODUCTION OF THE CONSENSUS INTERIM HEALTH ACT

  Mr. GRAMM. Mr. President, today I am introducing the Consensus 
Interim Health Act. I think this is an important bill. Let me explain 
why.
  We have had seven bills that have been put forward to reform 
America's health care system, and they vary greatly in terms of how 
they would go about the task. They represent varying philosophies. They 
represent various levels of transformation of the current system.
  But one thing I have noticed is that there are several features that 
are common to all of these bills. Every one of the health care reform 
packages put together and introduced or discussed to this point has had 
a provision to make it possible for people to change jobs in America 
without losing their health insurance.

  Every proposal that has been put forward would make health insurance 
permanent so that when Americans get health insurance, even if they get 
very sick, they can be guaranteed that they will never see their health 
insurance policy canceled. Every proposal that has been put forward in 
some form makes it possible for small business to pool its resources, 
to be more competitive in being able to spread risk in the purchase of 
private health insurance.
  Every proposal that has been put forward in all of the seven bills 
tries to deal with the overwhelming burden of paperwork. And every one 
of the proposals put forward in some way or another tries to make it 
possible for health care providers to purchase health care equipment 
jointly and to operate it jointly to reduce overhead and reduce cost.
  Mr. President, I will be introducing later a comprehensive bill of my 
own, which I am proud to say has been cosponsored by many of my 
colleagues in the Senate and many of my colleagues in the House.
  But today, I want to introduce a bill which simply does the things 
that we agree on. This bill, which I call the Consensus Interim Health 
Act, tries to do the things that we all agree on. My suggestion is that 
we go ahead and adopt a bill similar to this bill and that we use the 
consensus that we agree on to hammer out the tough issues later this 
year to adopt a comprehensive health reform package.
  What this bill will do is provide a vehicle whereby every American 
can change jobs without losing his or her health insurance; where every 
American will know that if they buy a health insurance policy or if 
they have one now it can never be canceled because they get sick, and 
if they buy one in the future the rates cannot vary based on their 
state of health.
  This bill will allow small businesses to pool their resources to 
purchase health insurance. It will let groups like the Farm Bureau, 
churches, and even communities pool resources together to get better 
rates.
  It will deal with paperwork by going to the source. The Federal 
Government pays 31 percent of the bills in health care today and it 
generates two-thirds of the paperwork.
  What this bill does is sets out a 5-year program to reduce the amount 
of paperwork required in Federal programs by 75 percent. It requires 
the States to do the same. It sets up a private commission made up of 
health care providers and health insurance purchasers to come up with 
one form and then, in order to get Government reimbursement, everybody 
has to use that form.
  Finally, we change our antitrust laws to let health care providers 
jointly purchase medical technology to hold down costs and to spread 
overhead. Every one of these provisions is present in each of the 
health care reform packages. These are the things that we agree on.
  Mr. President, I think we should begin by acting to give the American 
people some success.
  Now, some people say, it is not worth improving the system if you are 
not going to throw it out and reinvent it. And 75 percent of the 37 
million Americans who at least 1 day last year did not have health 
insurance would see their problems solved if we made insurance portable 
and if we made insurance permanent.
  So I think this is an important action.
  I am disappointed that the President issued a statement today 
opposing this bill. The President's basic view is if you are not going 
to reinvent the health care system, if you are not going to destroy 
what we have and start over in building the health care system in the 
image of Government, it is not worth doing.
  Well, I disagree with that, Mr. President. But I think more 
importantly the American people do. This is something we could do now. 
This is something we could do for the American people. This is 
something we agree on. And my view is, why should we wait?
  Mr. President, I ask unanimous consent that a summary of the 
Consensus Interim Health Act be printed in the Record.
  There being no objection, the summary was ordered to be printed in 
the Record, as follows:

                    The Consensus Interim Health Act


   I. ENHANCE SECURITY FOR THOSE PRESENTLY INSURED BY MAKING PRIVATE 
                    INSURANCE PORTABLE AND PERMANENT

                              Portability

       To enhance the capacity of American workers to change jobs 
     without losing their health insurance coverage, existing law 
     under COBRA (which allows individuals temporarily to continue 
     their health insurance coverage after leaving their place of 
     employment by paying their premiums directly) would be 
     modified to allow individuals two additional lower-cost 
     options to keep their health insurance coverage during their 
     transition between jobs. Workers could:
       (A) Continue their current insurance coverage during the 18 
     months covered by COBRA by paying their insurance premiums 
     directly;
       (B) Continue their current insurance coverage during the 18 
     months covered by COBRA by paying their insurance premiums 
     directly, but with a lower premium reflecting a $1,000 
     deductible; or
       (C) Continue their current insurance coverage during the 18 
     months covered by COBRA by paying their insurance premiums 
     directly, but with a lower premium reflecting a $3,000 
     deductible.
       With these options, the typical monthly premium paid for a 
     family of four would drop by as much as 20 percent when 
     switching to a $1,000 deductible and as much as 52 percent 
     when switching to a $3,000 deductible.
       In addition, individuals would be permitted to make 
     penalty-free withdrawals from their Individual Retirement 
     Accounts and 401(k)s to pay for health insurance coverage 
     during the transition period.
       The transition period of coverage would end once a person 
     is in a position to get coverage from another employer.

                               Permanence

       Health insurance would be made permanent (belonging to the 
     family or individual) by these three reforms.
     Those with individual coverage
       (A) No existing health insurance policy can be cancelled 
     due to the state of health of any person covered by the 
     policy. Insurance companies must offer each policy holder the 
     option to purchase a new policy under the conditions of part 
     B of this section with the terms to be negotiated between the 
     buyer and seller of the policy.
       (B) all individual health insurance policies written after 
     the enactment of this legislation must be guaranteed 
     renewable, and premiums cannot be increased based on the 
     occurrence of illness.
     Those with group coverage
       (A) Existing group policies must provide each member of the 
     group the right to convert to an individual policy when 
     leaving the group. This individual policy will be rated based 
     on actuarial data, but cannot be cancelled due to the state 
     of health of those covered by the policy. In addition, any 
     group policy holder (ie. employer obtaining coverage on 
     employees' behalf) will have the right to purchase a new 
     group policy under the conditions stated under part B of this 
     section with the terms to be negotiated between the group's 
     benefactor or representative and the seller of the group 
     policy.
       (B) All group policies issued after enactment of this 
     legislation must be permanent, and premiums cannot be 
     increased based on the health of the members covered under 
     the group policy. In addition, similar to part A of this 
     section, new group policies must provide each member of the 
     group the right to convert to an individual policy when 
     leaving the group. However, the premium charges of the 
     individual leaving the new group plan cannot be based on the 
     individual's state of health and cannot be cancelled except 
     for nonpayment of premiums.
     Those with employer-provided self-funded coverage
       (A) Companies currently operating self-funded plans must 
     make arrangements with one or more private insurers to offer 
     individuals leaving the self-funded plan individual coverage. 
     The individual policy will be rated based on actuarial data, 
     but cannot be cancelled due to the state of health of those 
     covered by the policy.
       (B) All self-funded plans created after enactment of this 
     legislation must (like part A of this section) make 
     arrangements with one or more private insurers to offer 
     individuals leaving the self-funded plan individual coverage. 
     However, the premium charges of the individual leaving the 
     self-funded plan cannot be based on the individual's state of 
     health and cannot be cancelled except for nonpayment of 
     premiums.


  ii. allow small businesses to pool their health insurance purchases

       Regulatory and legal impediments that restrict the ability 
     of small businesses and other organizations (trade and 
     professional groups, churches, etc.) to group together 
     voluntarily to allow their employees or members to pool their 
     health insurance purchases will be removed.


          iii. enhance efficiency through paperwork reduction

       (A) Medicaid, Medicare, and all other federal entities 
     involved in the funding or delivery of health care shall 
     standardize their health care forms and must reduce their 
     total health care paperwork burden by 50 percent within two 
     years of enactment of this legislation. The paperwork burden 
     must be reduced by another 50 percent over the following 
     three years, achieving a total paperwork reduction of 75 
     percent over a 5-year period.
       (B) State agencies involved in the funding or delivery of 
     health care, like federal entities, shall standardize their 
     health care forms. Also like federal entities, within five 
     years of enactment, states must reduce their total health 
     care paperwork burden by 75 percent in order to remain 
     eligible for federal health assistance.
       (C) A private commission will be established to develop, 
     within 12 months from enactment, standardized forms to be 
     used by private health care providers and private insurers. 
     In order to receive federal reimbursement, private health 
     care providers and private insurers must use these 
     standardized forms. This commission shall be comprised solely 
     of private health care providers and private insurers.


iv. promote efficiency in the health care market by removing antitrust 
                                barriers

       By limiting certain antitrust impediments that restrict 
     cooperative efforts, communities and providers will be given 
     an opportunity to coordinate the delivery of health care and 
     enter into joint ventures that promote greater efficiencies, 
     and expand access.
  (The remarks of Mr. Gramm pertaining to the introduction of S. 1788 
are located in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Mr. GRAMM. I think these are important bills. I want to thank the 
Chair for staying during lunchtime to allow me to speak about them, and 
I will introduce them at the end of the session.
  I thank the Chair and yield the floor.
  The PRESIDENT pro tempore. The bills will be received when introduced 
at the end of the session and appropriately referred.

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