[Congressional Record Volume 140, Number 25 (Wednesday, March 9, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                       SMALL FIXES ARE NOT ENOUGH

 Mr. DASCHLE. Mr. President, as Congress debates various health 
reform options, it is crucial we give each proposal the same scrutiny 
and critical analysis we are devoting to the President's plan. With 
this premise in mind, I would like to call my colleagues' attention to 
a recent editorial in the New York Times. Written in response to public 
criticism of the institutional reforms recommended by the President, 
this editorial points to some of the shortcomings of the small fixes 
approach advocated by some Members of Congress.
  The editorial asserts that tinkering is not enough. It suggests that 
small-fix insurance reforms would not be easily enforceable, and that 
if the currently unregulated market is left alone, Congress will remain 
in the position of responding to specific abuses by passing 13 trillion 
pages of rules to stop these practices. The Times editorial also 
suggests that a more effective, less regulatory way to address this 
issue is to establish mandatory purchasing cooperatives, or health 
alliances, that would make every policy equally accessible to everyone 
in their region.
  Since even alliances will be unable to stop all insurance 
discrimination, the editorial asserts that a standard set of benefits 
must be a keystone to the plan. This means that insurers will have to 
provide an identical set of benefits to every enrollee. Minimal fixes, 
on the other hand, cannot achieve coverage of all the uninsured, will 
allow for exclusion of pre-existing conditions even if only for a 
limited time period, and cannot achieve real portability.
  The Times editorial concludes with the following statement:

       Every American ought to have coverage that is portable, 
     community-rated and guaranteed--operating through a system 
     that is fair, dependable, and free of loopholes. Alliances 
     and a standard benefits package look like the best road to 
     those goals. Anything less does not deserve to be called 
     reform.

  That conclusion merits the serious reflection of all who are 
interested in the health reform effort.
  I ask that the full text of the New York Times editorial be printed 
in the Record.
  The editorial follows:

                     Health Tinkering Is Not Reform

       Representative Pete Stark, the California Democrat who 
     heads a House subcommittee on health policy, says that 
     Congress ought to scrap the purchasing cooperatives, or 
     alliances, that lie at the core of the Administration's 
     health care bill. The Senate minority leader, Bob Dole, and 
     another Republican Senator Phil Gramm of Texas, say that 
     Congress ought to gut the other institutional reforms 
     proposed by the President as well--and stick to small fixes. 
     In the next few weeks Congress will decide whether it will 
     overhaul or merely tinker with health care.
       Tinkering is not enough. To see why, imagine that Congress 
     takes the go-slow approach and does little more than require 
     insurance companies to make their policies portable (workers 
     can keep the policy when they leave their current employer), 
     community rated (the chronically ill pay the same premiums as 
     the healthy) and guaranteed (insurers are required to sell to 
     applicants regardless of preexisting medical conditions).
       These small-fix insurance reforms are not enforceable if 
     Congress leaves the current unregulated--and uncompetitive--
     market largely in place. The Government would find it 
     difficult, for example, to check whether insurance companies 
     were serving all potential applicants. Did the insurer 
     recruit only in Scarsdale? Did the insurer answer phone calls 
     from potential applicants in Harlem? Did the insurer tailor 
     its benefits package so that AIDS patients would not apply?
       Congress could, of course, enact 13 trillion pages of rules 
     to stop these practices. But a more effective, less 
     regulatory answer is to require most individuals or their 
     employers to buy coverage through a cooperative, or alliance. 
     The alliance, not the insurers, would then make every policy 
     equally accessible to everyone in the region. The alliance is 
     also positioned to transfer money from insurers who, through 
     trickery or happenstance, do not enroll many AIDS patients to 
     insurers who do; that is the only effective way to force 
     insurers to serve the chronically ill.
       Even the power of the alliance will probably not stop 
     insurers from all discrimination. So Congress will need to 
     insist that insurers provide an identical set of health 
     benefits--known as a standard benefits package--to every 
     enrollee. That way policies cannot be crafted to attract only 
     healthy applicants.
       Minimal fixes would leave too many loopholes. If reach of 
     us is guaranteed the chance to buy coverage whenever we want 
     at community rates, none of us who have a choice about 
     coverage--who are not automatically insured through work--
     will buy until we get sick. That would leave only the sick to 
     buy coverage--at what would have to be prohibitively high 
     premiums. Under such rules, 20-something-year-old couples 
     would wait till the wife becomes pregnant before purchasing 
     insurance.
       Advocates of small-fix reform would almost certainly have 
     to allow insurers to exclude coverage for preexisting 
     conditions for at least, say, nine months. But that provision 
     would leave millions of Americans temporarily unable to get 
     insurance and would not stop many others from gambling that 
     they could do without insurance--knowing they could always 
     flee to the nearest emergency room largely at public expense. 
     The solution is to make insurance mandatory, as President 
     Clinton proposes, so that no one, when well, can skip paying 
     premiums.
       Real portability is another fix that takes more than a 
     flick of the legislative pen. Congress may promise workers 
     that they can continue to buy their old policy after they 
     change jobs; but what good is that promise if their new 
     employer doesn't include the old plan amount available 
     health-care options? Again alliances are an answer. If people 
     get coverage through alliances, rather than employers, they 
     would retain access to their old plans as long as they 
     continued to work in the same region.
       Every American ought to have coverage that is portable, 
     community-rated and guaranteed--operating through a system 
     that is fair, dependable and free of loopholes. Alliances and 
     a standard benefits package look like the best road to those 
     goals. Anything less does not deserve to be called 
     reform.

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