[Congressional Record Volume 140, Number 30 (Thursday, March 17, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: March 17, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
HEALTH CARE COVERAGE IN AMERICA
Mr. REID. Mr. President, I yield myself 10 minutes.
The health plan that is now before Congress that has been given to us
by the President of the United States builds on the current system. It
is not a radical departure from what has been going on as it relates to
how people will be cared for. It builds on a system of employer
responsibility.
At present, there are 9 out of every 10 Americans who receive their
health care coverage through their employers; that is, Mr. President,
90 percent of the people who have health insurance in America receive
it as a result of their job. Only 10 percent of the health care
coverage in America today is, in effect, private insurance, nonemployer
driven.
Still, in spite of this fact, there are over 30 million Americans who
work every day who have no insurance coverage for their health. In
fact, 85 percent of uninsured Americans are in the working class. There
is a false premise out in the public that those people who have no
insurance are deadbeats, unwilling to work. In fact, that is not true.
Eighty-five percent of the people who have no health insurance are
people who work every day. These are people who need their coverage,
should have their coverage.
Our present system is also a burden on those who cover their
employees because they, in effect, are not competitive. I am sure, Mr.
President, you had some of the same people visit you last week that
visited me: People who represented retail merchants throughout America.
One of the big problems they have is that the second largest employer
in America employs some 600,000 people and provides insurance for only
10 percent of their employees; 90 percent of the employees have no
insurance of this huge, huge employer. It is Wal-Mart, Mr. President.
There are some employees who work there that can get insurance
through different methods, but basically, as we speak, I was told that
90 percent of the people who work at Wal-Mart have no insurance.
So those employers that provide insurance that are competing with
that company are not able to compete because they are doing something
that costs them a lot of money to provide for their employees. My point
is that those who provide insurance for their employees really are
going at it with some risk.
Those people who have no insurance are provided for in a very, very
expensive way. I had visiting with me yesterday a gentleman who is a
nurse. Prior to becoming a nurse, which was 3 years ago, he worked as a
paramedic on an ambulance. He said there were numerous occasions--
numerous, numerous occasions--in Nevada where a person could not afford
a cab to be taken to the hospital or to a doctor, so they would call
for an ambulance to be taken to the emergency room. At that time, the
cost for the ambulance was $490-some-odd. Of course, the ambulance
people never got paid and the person got the most expensive care
available; that is, care in an emergency room at a hospital.
That is a tremendous burden on everyone--everyone. Anyone able to
hear me today, that is a burden on them. Why? Because they have
increased insurance premiums, higher hospital and doctor bills and, of
course, higher taxes for indigent care.
We pay for those who have no insurance anyway. Therefore, what we are
talking about with a system that is now before us is employer
responsibility. Spread it out but make it fair.
On St. Patrick's Day, Mr. President, I think it is appropriate that
we talk about a woman with an Irish name, by the name of Erin Dowell. I
have talked about her on the floor on other occasions.
Approximately 5 weeks ago, she was in Washington, DC, testifying
about the high cost of medical care. That was the first time I met this
fine young woman from Reno, NV. But that was the beginning of a
relationship I will never ever forget.
I have maintained, since that time, contact with Erin. She was here
at a time when her disease--that is, some type of leukemia--was in
remission. She was healthy, she was vibrant, she was able to testify.
Just 10 days later, I saw her in Reno, NV, bedridden, totally different
in appearance, ashen in color, covered with an electric blanket trying
to stay warm, trying to be comfortable.
At that time I met her family for the first time. We were hopeful
that she would get better.
See, the reason I am so concerned about Erin is that she has leukemia
and can be cured. She has a perfect donor match, but because of the
redtape with our present medical system, she was not able to have that
transplant when she was in remission.
Now, of course, she is not in remission. She is very, very ill. She
is not now, Mr. President, home at bed covered with that electric
blanket, but she is now in a hospital in Reno.
I am sad to say that about 10 days ago she had a serious condition
and she had to be rushed to the intensive care ward. She had problems
with her heart. She is now out of intensive care but is very, very,
very ill.
I have not been able to speak with her for a couple of weeks--she has
been that sick--so I have spoken to her family.
I mention this because I am going to stay on Erin Dowell's case. I am
doing it with her permission. She wants the American public to know
about people who get lost in the present system.
Mr. President, she realizes, we realize, she could die before she
gets her bone marrow transplant. She may never come out of this sick
condition she is in now. She may never again go into remission so that
she can have this transplant.
She was working. She had an accident, industrial accident. She went
on industrial compensation. The day before she was to go back to work,
she was diagnosed as having leukemia. She has no insurance, and she has
been shuttled around like a bag of potatoes. The fact is she has never
had the opportunity to be treated during the last time she was in
remission. This is really a sad example of what goes on in our present
health care system.
Mr. President, businesses like the small businesses where Erin
worked, where she was hurt originally, want to insure their employees.
Forty percent of them do not. Why? They cannot afford it. Why? Because
they pay 35 percent more for the same insurance that a big business
has. Their premiums increase 50 percent more than big business. Forty
cents of every dollar spent on health care goes to administrative
costs, 10 percent for fraud. Preexisting condition restrictions prevent
many companies from purchasing insurance.
Let me give you an example, Mr. President. There is a little
organization, a nonprofit organization in Las Vegas, NV called the
Nevada Association of Latin Americans, a wonderful organization that
has been in existence for 25 years. They help the underprivileged.
I ask unanimous consent that a letter to Mrs. Clinton from them be
printed in the Record.
I also ask unanimous consent that a letter to them denying coverage
be printed in the Record.
There being no objection, the letters were ordered to be printed in
the Record, as follows:
Nevada Association of
Latin Americans, Inc.,
Reno, NV, October 1, 1993.
Hillary Rodham Clinton,
White House, Office of the First Lady, Washington, DC.
Dear First Lady: Thank you for the enormous work you are
doing for the Health Care Reform. I know you received over
700,000 letters and my letter won't add anything new to the
fund of knowledge you already have.
However, I want to share with you our experiences here with
Insurance companies. As you are testifying on Capitol Hill,
we are being rejected by an HMO Insurance Carrier because one
of our staff members has diabetes and two are pregnant. We
are a small non-profit, social service agency, with a staff
of twenty-three, which serves primarily the economically
disadvantaged Hispanics of Southern Nevada. Our agency has
been in existence for 25 years. The only benefit our staff
receives is Group Health Insurance. Most of our staff start
at $4.50 an hour. We are not insurable as a group because of
the pre-existing conditions of three staff members.
Please do whatever is in your power to fight for us. We
need the security of Universal Coverage which the President
spoke about at the Joint Congressional Session. As far as we
are concerned, Health Care Reform is not a political issue--
it is our life and the life of poor people we serve. Please
do not allow the Congress to delay the passage of the Health
Care Reform Bill. We cannot wait without health insurance.
I wish you all the success in this endeavor.
Sincerely,
Avi L. Almeida, Ph.D.,
LASW, President and
Chief Executive Officer.
FHP Health Care,
Las Vegas, NV, September 29, 1993.
Re: Nevada Association of Latin Americans
Scott Carson,
Southwest Benefits,
Las Vegas, NV.
Dear Scott: Thank you for considering FHP for your above
mentioned client. Unfortunately, we are not able to offer our
services to this group at the present time due to health
conditions which currently exist.
If you have any questions regarding this matter, please
feel free to contact me.
We at FHP appreciate your patronage, and strive to provide
you with quality service.
Sincerely,
Sally Noitz,
Account Executive.
Mr. REID. They say their staff starts at $4.50 an hour. The only
benefit they got was group health insurance. Now they cannot get that.
Why? Because two of their employees were pregnant and one had diabetes
so they were denied coverage.
So there is no misunderstanding, recognize, Mr. President, that the
denial of coverage does not apply only to institutions dealing with the
needy and the poor like the Nevada Association of Latin Americans but
also the so-called rich have trouble getting insurance.
I went to an ophthalmologist in Las Vegas, and as we were sitting
talking after my examination, he said, ``Harry, I hope you can do
something about the health care system.'' He said, ``I have 27
employees.'' This is an outstanding physician who has been in practice
for many years, has a wonderful reputation. He said, ``Harry, I have 27
employees. One of my employees got cancer and they are not going to
rewrite my policy. I am having a tough time finding somebody who will
cover my 27 employees.''
So this is endemic. It is a problem with everybody in America today.
We have to change the system. The present system is simply not working.
We need to understand that small businesses will be better off by far
if we have a fair employer responsibility program. And we have one
contained in the President's bill. It creates an even playing field
which allows small businesses to pool. It eliminates insurance
practices that discriminate. It reduces the administrative burden.
Shared employer responsibility, under the plan that I am talking
about, will allow those who currently want to provide coverage to do
so. It is imperative that we insure working Americans so they can have
insurance coverage. We must spread the responsibility evenly. That is
what this legislation will do. Businesses that provide coverage are
bearing a disproportionate share of the health care burden. Businesses
that do provide coverage are subsidizing the care of those that do not.
Remember, Mr. President, working Americans without coverage will
still get care--care that will be paid for by you and me and those
businesses providing coverage for their employees. Under the present
system, the companies that provide coverage pay for everybody else. The
example: People calling an ambulance so they can go to an emergency
room. I don't think that is the fair way to do it.
Let us allow those 60 percent of small businesses to have fairness.
Let us allow the other 40 percent to be covered so that we have an even
playing field. We cannot afford to maintain the status quo. We have
three choices: The status quo, the system that we are talking about
now, or we have the employee bear all the responsibility. The only one
that is fair is shared responsibility; that is, the employer and the
employee. I think it is time we put an end to the status quo by moving
forward with this progressive, fair legislation.
Mr. President, I yield to the Senator from Washington the remaining
time under my control.
Mrs. MURRAY. I thank my colleague from Nevada.
The ACTING PRESIDENT pro tempore. The Senator from Washington is
recognized.
Mrs. MURRAY. Mr. President, I rise today to talk about a subject that
has generated a great deal of debate in our discussion of health care
reform: the so-called employer mandate. Some people prefer the term
shared responsibility. Others talk about workplace benefits. If we
spend time debating which term to use, we will never make real progress
toward reform.
We will also miss a crucial point. Whatever term we choose, we are
not talking about a new system, or something that has never been tried
in this Nation. We are speaking about one of the cornerstones of our
system today. That is right, the President's plan is built upon our
present system, in which most of us with health care coverage get it
through the workplace. It is as simple as that.
As we speak with employer mandates, I would also like to share with
my colleagues what is going on in my State of Washington. While
lobbyists in this Washington are arguing over alliances and mandates,
we in the other Washington are doing health care reform.
After several years studying different ways to improve health care
for the people of Washington, the Washington State Legislature in April
1993, passed landmark legislation to reform the health care system. The
model for Washington State's plan was not an individual mandate, not
single-payer, and not a tax-driven plan, but an employer mandate. This
is the same model on which the Health Security Act, S. 1757, is based.
Like the President's plan, the Washington State Health Services Act
will guarantee every citizen of the State a lifelong, comprehensive
package of benefits, regardless of a person's employment or health
status. There are no preexisting conditions and coverage can be ended
only because of failure to pay.
The Washington State plan also has alliances--they are voluntary and
we call them health insurance purchasing cooperatives--we have a choice
of plans, we have cost containment, and we have discounts for small
businesses. We have much of what is in the President's plan. The major
difference is: as we speak, we in Washington State are implementing
ours.
The Washington Health Services Act requires all Washington residents
to be covered by a uniform benefits package from a certified health
plan by no later than July 1, 1999. The act requires employers to pay
at least half of the cost of an available certified health plan, and
employees must be able to choose from one of three plans. Also, like
the Clinton plan, you and your family will not lose health coverage if
you change jobs, lose your job, or come down with a catastrophic
illness.
Mandatory coverage is being implemented in phases over a 4-year
period. By July 1, 1995, all employers with more than 500 employees
must pay at least 50 percent of the lowest premium charged for an
employee's coverage under an available certified health plan. By July
1, 1996, the employer must also pay at least half the cost of dependent
care coverage for all dependents of the employee. Large employers may
also contract directly with a certified health plan using combined
employer and employee contributions. Employers with 100 or more
employees come into the system by July 1, 1996 and small employers a
year later.
We have provisions for covering part-time employees and migrant
workers, and discounts for small businesses with fewer than 25
employees.
Naturally, these changes will not take place overnight. They are
being implemented gradually, according to the schedule in the law. But
they are being implemented.
I am especially proud of the employer's health purchasing co-op in
Seattle. Discussions about creating the co-op predate enactment of the
Washington Health Services Act, but the key features of the co-op
closely track the requirements of the law. The co-op is working out
final details for its formal establishment with the State Insurance
Commissioner.
The co-op has 240 employer members. They include such diverse
companies as Alaska Airlines, Airborne Express, Boise Cascade,
Doubletree Hotels, Microsoft, Nordstrom's, the Port of Tacoma, REI, the
Seattle Times, and Weyerhaeuser.
The co-op has an employee pool of about 600,000 individuals in the
Puget Sound area. It is organized as an employer democracy: each
employer has one vote. The co-op, acting as a kind of collective
bargaining agent on behalf of its members, has contracted with three
health plans for services. Each one had to provide guaranteed rates, a
broad choice of providers with incentives to use managed care, and an
emphasis on wellness and preventive care. Startup costs were about
$450,000.
I believe the Puget Sound Employer's Health Purchasing Co-op offers a
good example of what health care will look like under reform. It is
certainly what it will look like in my State. I hope it is what it will
look like throughout this country.
The 240 companies in the Puget Sound co-op are acting responsibly.
They are not back here fighting against employer mandates. They are
trying to improve health care for their employees, their families, and
their communities. This is what health care reform is all about.
The idea of shared responsibility for health care is sound and it is
fair. And, as I said earlier, it is not new. It is especially important
for those who have remained on welfare to keep their Medicaid benefits.
Under our reformed system, those individuals will be able to move into
the work force without fear of losing their health coverage.
Last year, few believed the President and Congress would pass a
budget that actually cuts the growth in the deficit. But we did it.
This year, I will work just as hard to pass Federal health care reform
legislation.
Mr. SHELBY addressed the Chair.
The ACTING PRESIDENT pro tempore. The Chair recognizes the Senator
from Alabama [Mr. Shelby].
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