[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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