[Congressional Record Volume 140, Number 89 (Tuesday, July 12, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 12, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

  Ms. KAPTUR. Mr. Speaker, it has been very interesting for me this 
evening to listen to some of my colleagues on the issue of health 
insurance reform, the topic that I want to speak about tonight. I think 
it is important to start out and say that many of the individuals who 
have spoken this evening, including myself, do not serve on any of the 
major drafting committees that have been working very assiduously here 
trying to put measures together for the Nation. This is important, I 
think, for the public to understand, because the majority of Members in 
here have not been afforded the opportunity to participate in the 
crafting of these bills that are before us.

                              {time}  1930

  That does not mean that we would not be willing participants, but in 
the way the process works, we are not the first at the table.
  The other feature which has been very interesting to me as I have 
watched the various bills emerge and listened to some of the rhetoric 
here, including some on the floor this evening, is I think that 
partisanship, unfortunately, has been playing too great a role here in 
Washington, and I think that it is tending to blur the very real desire 
of the American people to continue to have the finest health care 
system in the world. We know that there are some cracks in the system 
that need to be repaired, but partisanship, I think, has gotten far too 
loud, rather than people thinking about, very carefully, how we improve 
on a very fine system.
  We ask ourselves what does a Member of Congress do if you don't serve 
on one of the key drafting committees, and if you are very troubled by 
some of the ugly partisanship that has already begun to creep its way 
into the institution, even before final bills are before us?
  I guess Mr. Speaker, I would like to take the opportunity this 
evening to call your attention to a process that I was able to use in 
my own congressional district in northwest Ohio, the Greater 
Metropolitan Toledo area, to fashion a report card, a scorecard, 
against which our community intends to measure any bill or bills 
brought before this Congress. We really created our own bill.
  For over a year we have been working very, very hard with a broad 
coalition of hundreds of citizens in our community. They are Democrats, 
they are Republicans, they are Independents, and I would guess there 
are probably even a few undecideds in the group. They included 
representatives of big business, of small business, insurance sales 
people, consumers, nurses, doctors, chiropractors, psychologists, 
hospital directors, HMO directors, trade unions, senior citizens, 
attorneys, medical students, medical hospital presidents. You get the 
idea. We had them all in the same room.
  This was not easy to do. It took us a very long time, and it took 
them time to be honest with one another and take a very hard look at 
our own community, and we made some fascinating discoveries.
  In the State of Ohio, one of the largest States in the Union, you 
cannot find out comparative cost information about policies. If you 
call down to our State insurance office down in Columbus, OH, and you 
say, ``Give us a list of all the insurance plans in our region of Ohio 
what their benefits are, what their costs are, and what their quality 
assurance measures are, how satisfied are people with those plans,'' no 
one can tell you.
  It was difficult to talk about reforming a system that it is very 
hard to get information about. Nonetheless, our group that we called 
our Kitchen Cabinet of 100, our coalition, worked on a draft, and I am 
so very proud of them because they represent the type of Americans that 
this institution needs to listen to. They spent hours and hours of 
volunteer time trying to put together their own measure, people of very 
different interests, but people who fundamentally agreed that every 
single American should be covered by health insurance.
  We surveyed our community, Thousands of questionnaires were returned. 
We learned that most people in our community, over 85 percent, were 
satisfied with the quality of care in our area. We don't want to do 
anything to jeopardize that quality of care.
  We also learned a majority of our people are satisfied with the type 
of coverage that they have. Half are satisfied, but the other half were 
not satisfied. Our proposal thus aims to keep satisfied those citizens 
who are satisfied with their coverage, and to include those who have 
been left out or unduly discriminated against in the insurance market.
  The major shortcoming people cited to us was the overcomplicated 
nature of the existing health insurance system. We do not hear too much 
about that here in Washington, and yet the reality of ordinary people 
across this country is, you hate to read those insurance policies, for 
those people who wear bifocals you can hardly see the bottom lines, but 
really, people do not like the insurance market because it is so 
difficult to understand.
  However, only a small percentage of citizens view transforming our 
system into some sort of government-run system or single-payer system 
as the solution. They really do not want that.
  We found serious administrative and cost overrun problems exist in 
the private sector as well as in government insurance systems due to 
the very nature in which they are put together. We found high levels of 
satisfaction, on the other hand, and sound management within certain 
plans we identified in our local community as being self-insured and 
self-administered.
  In fact, we used some of those as the models for what we created. Our 
group concurred with the President and First Lady that every American 
must have a medical insurance home with coverage that is high quality. 
We don't want to leave anybody out. We believe insurance should be 
affordable, it should be private, if at all possible, cover pre-
existing conditions, and not exclude people because someone in their 
family might be sick, and also portable.
  We also believe that any reform bill must focus on covering people, 
not medical incidences, which the current system does too often. The 
current private and public insurance systems place medical decisions 
today, and each of you think about this with your own families, in the 
hands, too often, of billing clerks, results in medical care being 
directed by financial intermediaries at some 800 number that you have 
to call if you are a doctor, if you are a patient, if you are a family 
member, rather than that medical care being directed by medical 
professionals closest to the patient.

  This system has to change, not just in the private sector but in the 
public sector as well. Thus, the central focus of our proposal is 
health coverage for each citizen made available at the local level 
through participation in any one of a broad range of what we called 
affinity health groups. That means people in those groups would have a 
common bond.
  These groups could either be profit or not-for-profit, but it would 
be the common bond that would hold the group together, chartered at the 
State level but operating locally with a governing board. Each affinity 
group's board would include some of the insureds' consumer 
representation from that group, and that affinity group would serve as 
the medical insurance home and primary organizer of services for 
members, including marketing the system to employers. They would 
coordinate health care payment methodologies, so people are not pulling 
their hair out trying to fill out all these forms, and we would provide 
Federal assistance on a sliding fee scale for people needing subsidized 
care.
  To assure coverage for all, each citizen's enrollment, along with 
quality information about that plan from each affinity group, would be 
reported to a national health board through the Federal income tax 
system, with each affinity group assigned a tax identification number. 
Citizens in their own communities could then select annually from among 
these different choices, and States would be directed to community rate 
these affinity groups.
  Most of these groups would be formed through existing employer-based 
plans, because in our area, the vast majority of people receive their 
insurance through employers. Additional plans, however, serving 
individuals--for example, the self-employed, who are truly 
discriminated against in today's market, farmers, people who are 
unemployed, members of small business consortia, can also, through 
State law, create one of these affinity groups to assure universal 
coverage, and create at the local level real competition for insureds 
at the local level, even for those who are subsidized. We do not want 
to throw all subsidized people into one plan and say ``That is their 
plan.'' We want different plans at the local level to compete for those 
patients.
  Citizens who fall into no other group, for whatever reason, would be 
able to obtain health benefits through a Federal health benefit plan or 
plans organized at the local level as an affinity group. In addition, 
States would be given broad latitude to create other affinity groups to 
compete for the subsidized clients, including hospital-based HMO's, 
which in my community are already competing for subsidized patients and 
doing very well, I might add.
  Affinity groups, your medical insurance home, would be responsible 
for organizing a full range of provider services for members, and broad 
physician choice would be negotiated through the affinity groups. 
Everyone would have a home. You would belong somewhere in this vastly 
complicated world of medical insurance, and it would be your plan. You 
could participate as a consumer on the board, and you would have a say. 
You could help run that plan, make sure it is well managed, and there 
would be participation.
  Mr. Speaker, our Kitchen Cabinet's proposal for health insurance 
reform incorporates the following seven major features: First of all, 
again, responsibility for premiums would be shared between employers, 
employees, and the general public. Our plan builds on the existing 
employer-based system. We do not want to throw out the system that we 
have spent almost a century building.
    
    

                              {time}  1940

  Every employer would be required to pay a minimum of 50 percent of 
each full-time employee's premium. Now how do we define full time? Our 
group said at least 1,500 hours per year. There is a 90-day waiting 
period before an employer is fully responsible for that employee's 
health benefits, and during that period of time those folks would be 
covered through one of the other plans in the area.
  Generally businesses with fewer than 25 employees who pass the 
discrimination test for 401(D) plan contributions and the criteria for 
a Federal small business loan would be eligible for subsidy. That is 
important because we do not want to leave any business out and we want 
to make sure that businesses cannot cost shift and those who want to 
cover their employees are treated fairly and these two measures are 
very likely to help do that. But subject Chapter S corporations would 
be exempt from subsidy.
  Second, our plan would provide, through Federal incentives, that 
would give choice to any individual who is currently subsidized in the 
health market and would allow but not require individuals who are on 
Medicare, who are perhaps in the veterans' system, people who access 
CHAMPUS or CHAMPVA and other Government-subsidized plans to form or 
join such an affinity group if they so choose.
  Medicaid recipients would be required to join an affinity health 
group and Medicaid as we know it would disappear. The veterans' health 
system could function locally as its own affinity health group so we 
would not disturb the veterans who are satisfied with their care across 
our country.
  Third, under our plan, as I mentioned, Medicaid as it currently 
exists would disappear. Health insurance payments to subsidized 
individuals would be graduated up to 250 percent of poverty level and 
would take the form of an earned income health tax credit refunded on 
an annual basis. Able-bodied persons in this country who are not 
working, but receiving the entirety of their health insurance through 
Government subsidy, would be encouraged to pay back a portion of their 
benefits through voluntary service in a local community services 
corporation.
  We do not believe that anything should be for free in this Nation and 
we think at the local level communities under State legislation can 
figure out ways for people to help pay back some of the care that they 
may have received for free.

  Fourth, to streamline the unnecessarily complex insurance market, the 
Federal Government under our proposal is asked to define the basic 
benefit plan for all people in all affinity groups across the country. 
The insurance market would be required to standardize beyond that basic 
plan optional supplemental insurance plans to include no more than 
nine.
  That means that some of the additional benefits that are not included 
in the basic plan, for instance foreign travel, or interstate travel 
which costs a little bit more would have a separate plan that would 
incorporate that for which you would pay a little bit more, not covered 
in the basic plan, but we would eventually have a market clearing where 
beyond the basic plan there would be nine additional plans across our 
country and within each State and people would be able to understand 
and compare the various plans, their costs, and their benefits.
  One standard claim form will be utilized, and providers will be 
required to submit claims initially to each affinity group rather than 
to the patient. I hear from people all of the time how they hate this 
insurance paperwork and by having a medical insurance home, an affinity 
group that would be your own, that paperwork could be handled by the 
group, not by the patient. The patient could be sent the adjusted 
billing and they could check at that point but they would not have all 
of the hassle that we have today in the system.
  Fifth, we have dealt with the antitrust and malpractice issues. 
Antitrust, medical malpractice and tort reform would be implemented 
with alternative dispute resolution mandatory before a medical 
malpractice claim can be tried. There is a cap on pain and suffering of 
$250,000 that is proposed with punitive damages awarded to State health 
budgets. Those State health budgets would be added to the Medicaid and 
other Federal funds that would be going to subsidize patients and it 
would help to contribute to the costs of covering those who cannot 
afford their own care.
  Finally, attorneys fees will be capped at 20 percent of the first 
million dollar of awards, 10 percent of $2 million awards and 5 percent 
of awards of $3 million or more.
  Six, we deal with the issue of quality assurance. Quality assurance 
will be strengthened by requiring consumer information reporting to the 
State on each affinity group's performance according to standard 
quality format.
  That means that you can compare how good your plan is to someone 
else's, including comparisons of benefits and costs for all plans which 
you cannot get today as well as provider performance. You can find out 
more about the price of televisions and their performance from consumer 
reports today than you can find out about your benefits under insurance 
and their costs. This needs to be changed. We think we have a very 
simple way of doing that.
  Finally, how are we going to find qualified doctors for the future. 
The young people in medical school today are paying so much money for 
their educations. Our committee thought it was very important to deal 
with the issue of where physicians and medical professionals will come 
from in the future in order to maintain enough committed physicians and 
other health care professionals. To build on the number of family 
practice and primary care physicians, Federal policy would be 
implemented to reduce interest rates on student loans to a lower 
percentage than the current rates and a percentage of a new physician's 
patients would be referred through the local affinity groups each year 
in order to help that physician pay back some of the investment made in 
their education.
  Let me end this evening by saying I am so proud of the people of my 
community in putting this proposal together. I wish I could move you 
all here to Washington and you could conduct the debate in this 
Congress because I really believe you have the answer. I wish we could 
put the partisanship aside and put the kind of practical hard-headed 
thinking that went into this proposal before the Nation.
  The work of our Kitchen Cabinet truly represents thousands and 
thousands of hours from a broad cross section of citizens who had 
ideas, thousands of years of experience in all of these different walks 
of life. They heard each others' opinions and they were able to 
compromise. They rose above their own profession, they rose above their 
own partisanship, they did it for the good of their community, of their 
neighbors, of their friends and for the country. We offer this proposal 
as one set of ideas from one place in America's heartland on the 
direction of our health care and our health insurance as a nation.
  I am very proud to serve the Ninth District of Ohio. I think our 
people have something very important here to offer the Nation and I 
would ask my colleagues to take a very serious look at the summary 
proposal I will place in the Record this evening as well as available 
in our office a very lengthy explanation of the entirety of the bill 
proposed by the people of Ohio's Ninth District.

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