[Congressional Record Volume 140, Number 98 (Monday, July 25, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


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

 
                         UNIVERSAL HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994, and June 10, 1994, the gentleman from South Carolina 
[Mr. Derrick] is recognized for 60 minutes as the majority leader's 
designee.
  Mr. DERRICK. Madam Speaker, who is it we are trying to help in this 
effort to reform our health care system? The very poor have their 
health coverage through Medicaid. The very rich don't need our help 
since they can buy health coverage at any cost. The truth is middle-
income Americans should be the focus of health care reform. Everyone 
agrees we must move cautiously to make sure these Americans are treated 
fairly.
  Many policymakers and opinion shapers are saying we should take 
health reform a step at a time for this very reason. However, a new 
study shows this approach would hurt the very people we are trying to 
help.
  The study shows health care reform promising anything less than 
universal coverage will increase the cost of health care for middle-
income Americans. Once again, asking those struggling to support their 
families to foot the bill.
  The study, commissioned by the Catholic Health Association, analyzed 
several of the most prominent health plans currently before Congress. 
The study looked at how each of the plans would affect the American 
family. Specifically, it analyzed which families would pay more for 
their health care and which would pay less based on household incomes.
  Listen to the findings of the study:

       Our analysis shows that premiums are lower under universal 
     coverage than under insurance market reform linked to 
     subsidies. Further, we estimate that middle income families 
     that currently have insurance will pay more in general for 
     health care under partial reform than under reform that 
     includes universal coverage. In addition, for currently 
     insured households earning less than $100,000 annually, 
     health spending will decline under universal coverage with an 
     employer mandate and cost constraints.

  The number that jumped out at me when I looked at the study was $344. 
That's how much more a year a family making $35,000 annually will pay 
for health coverage under incremental reform.
  That same family would save $165 per year under a system offering 
universal coverage. And your next question is, ``How can that be?'' 
``How is it that more people can have health care for less cost.'' The 
answer is very simple.
  The more people there are to spread the cost around, the lower the 
cost will be for any given family. That is why universal coverage is so 
important.
  Without universal coverage, insurance reforms will only exacerbate 
the already critical situation for middle-income Americans. If we 
require insurance companies to offer insurance to anyone regardless of 
their medical background or other criteria but not require everyone to 
have insurance, the young and the healthy will opt out of health 
insurance altogether, and the risk pool will become less stable. The 
result will be higher premiums for everyone and only a small reduction 
in the number of uninsured.
  But this is exactly what many would have us do. A managed competition 
approach to health care reform with insurance reforms and subsidies for 
the poor, but without universal coverage, would really sock it to 
middle income American families. And that is not right, and it's not 
what any of us want to do.
  Some would-be reformers are saying: ``Let's go slow on health care 
reform.'' They say: ``Let's only go part way and see what happens.'' 
They say: ``What's wrong with taking this one step at a time by passing 
the reforms we all can agree on?''
  To go slow and enact nonuniversal health care reform is to do the 
very harm we are trying to avoid. We knew it would cost us in human 
terms if we failed to achieve universal coverage. Now we see it will 
also cost us financially.
  The incremental approach to health care reform proposed in the Dole 
plan, the Cooper bill, the Senate Finance bill, the Rowland-Bilirakis 
bill, and others will benefit the poorest Americans through subsidies. 
The wealthiest Americans don't need our help. It is middle-income 
Americans who will suffer. The overwhelming majority of Americans will 
bear the weight of our timidity. These are real Americans and their 
families that are simply struggling to make ends meet. We must not make 
their job any harder.

  Before we look at exactly what the study found, let me say a word 
about the study. This is an independent examination by Lewin-VHI, a 
nonpartisan, nonpolitical, well respected analysis firm that looks at 
numbers--not opinions.
  As the firm looked at different likely scenarios for health care 
reform, they started with the simplest: insurance reforms alone. What 
they found was these reforms would only bring in 1.1 million more 
people to the health insurance system. These are people who previously 
couldn't get or maintain their coverage due to the high cost of an 
individual policy or because of a preexisting condition. These are 
people who currently lose their health coverage when they change or 
lose their jobs. It is a step in the right direction, but a small one 
since this amounts to only 3 percent of all the currently uninsured.
  When they combined insurance reforms with subsidies for the poorest 
Americans, the number of the uninsured dropped by 40 percent. Again, 
this would be a welcomed change, yet the number of those without health 
insurance would remain high at 22 million.
  ``Fine,'' some say, ``that's a good start, and we can do it without 
disrupting all those people who are happy with their health insurance 
coverage today. What's wrong with that?''
  The study found, and the experience of New York State proves, that 
with insurance reforms and subsidies, more higher risk individuals will 
be brought into the system. Medical costs to the insurer will increase, 
and these increases will be passed onto the consumer in higher 
premiums.
  With these higher premiums, many of the young and healthy will decide 
they can do without health insurance for the time being--gambling they 
can pick it up when they need it. The result of this nonuniversal 
reform is the elderly and sick will maintain their insurance, racking 
up higher and higher medical costs. The young and healthy won't be 
there to offset these costs, and the premiums for those who currently 
have insurance will increase tremendously.
  Keep in mind, under these nonuniversal reforms, 22 million Americans 
will still be without health insurance. And as is the case today, none 
of them will be turned away from a hospital emergency room when they 
need care. The cost of this care--projected to be $25 billion annually 
by 1998--will continue to be passed on to paying consumers. Under non-
universal reform, the cost-shifting onto hard working, middle-income 
Americans continues.
  While the study found such incremental reforms raised the annual 
premium for a middle-income family by $344, a program of universal 
coverage actually lowered that same family's costs by $165 a year.
  Mr. Speaker, I have given a general overview of why it is so very 
important to pursue a universal approach to health care reform. Middle-
income Americans should not have to foot the bill, once again, for the 
rest of the country. This study should be a giant wake up call to this 
Congress that unless we have the courage to confront this problem head 
on, we will be hurting the very people we profess to be trying to help.

                              {time}  1920

  But that is not the case. The reverse, the absolute opposite of that, 
is the case.
  If we do anything less in this House on health care than universal 
coverage, it is going to be the middle income, those who have insurance 
now, that are going to end up picking up the tab, and the rates are 
going to go up more than they are now tremendously, because if we do 
not have a universal coverage and a mandate, what is going to happen is 
that those who need insurance like those who have preexisting 
illnesses, those who have an unhealthy situation or are getting to an 
age where they are more concerned about their health care, are going to 
keep their insurance, and it is going to mean that the healthy people 
in this country will tend to back away from it right now, and it will 
mean that the average family with an income between $30,000 and $39,000 
a year will pay $344 more a year for insurance. If we have universal 
health care, they will pay $165 less a year, and under this plan, we 
still have 22 million Americans who are uninsured.
  Mr. Speaker, I yield to the gentleman from Oklahoma [Mr. Synar].
  Mr. SYNAR. Mr. Speaker, I thank the gentleman for yielding to me.
  Mr. Speaker, we have to ask ourselves tonight, and as we complete 
this debate on national health care, is it worthwhile to provide 
limited health care reform without guaranteeing affordable insurance 
for everyone. Well, put another way: Is doing something always better 
than doing nothing?
  The gentleman from South Carolina, with his eloquent remarks, along 
with the presentation of the Catholic Health Association study, gives 
us that answer, and that answer is ``no.''
  You know, Democrats and Republicans, and generally all Americans, 
agree on the need for health care reform and the need to eliminate 
preexisting-condition coverage exclusion, to bar lifetime limits which 
allow insurance companies to cut off coverage after certain dollar 
amounts are claimed, to prevent insurance companies from denying 
certain people coverage, and generally Americans agree that subsidizing 
health care coverage for the poor is a noble and important mission.
  But these insurance reforms on their own will not result in real 
health care reform benefiting working-class Americans. The only way 
insurance will be affordable is to have everyone insured and to enact 
cost-containment measures to make health care affordable.

  By involving all Americans in health care coverage and applying cost-
control mechanisms, there will be several phenomena which will occur 
very immediately. Insurance companies will no longer be able to deny 
coverage to anyone including the elderly who are not yet eligible for 
Medicare. Insurance companies will not be able to deny coverage to 
everyone who has some type of disease, and insurance companies will no 
longer be able to deny coverage to everyone just because they have been 
sick at some time.
  You know, if cost controls are not part of the health care reform, 
the new insured population will drive up premiums and will lead to 
healthy people dropping their coverage. Anyone will be able to obtain 
insurance when they get sick, since incremental health care will 
prevent insurance companies from refusing to cover people, but the fact 
is that the remaining insured pool will become older, less healthy, and 
the pool's insurance premiums will skyrocket. That is what occurred in 
New York last year, and it would spread nationwide.
  Let me quote the Wall Street Journal from June 15, 1994:

       For the past year, New York State has tried community 
     rating without a law requiring everyone to have health 
     insurance. Now, insurance companies are raising prices again 
     in order to cover the medical needs of those sicker people 
     left in the pool. State Insurance Department figures show 
     that as of January 1, 9 months after the new law took effect, 
     25,477 fewer people had health insurance individually or in 
     smaller employer groups.

  As the Catholic Health Association study reports and as the gentleman 
from South Carolina pointed out, families making from $20,000 to 
$30,000 will have to shell out an additional $200 a year for insurance 
premiums, and families making between $30,000 and $40,000 will have to 
pay $344 dollars more a year for the same coverage they have now.
  Well, folks, the people in Oklahoma that I represent do not make over 
$40,000 a year, by and large, and I cannot and will not ask them to 
absorb the costs of health care reform. We need to make sure all 
Americans are insured, but that the costs are kept under control.
  I have 120,000 people in my congressional district in Oklahoma who 
have no health care insurance, but what is extremely disturbing is that 
105,000 of these people are in working families.
  But what is Congress going to tell these people if we do half a loaf 
package of reform? It will be really great if you are elderly or if you 
have a preexisting condition, but if you are healthy and just starting 
a family, you will find you are out of luck, because the premiums will 
be too expensive to afford.
  Is that what we want to take back and tell the citizens of our 
districts and our States? It is certainly not what I want to tell 
701,000 Oklahomans who are without insurance.
  We have come too far not to complete the whole job, which is 
affordable health care for all Americans. That is what Americans are 
demanding. That is what Americans are expecting. And that is what we 
should deliver and nothing less.
  Mr. DERRICK. Madam Speaker, I yield to the distinguished gentlewoman 
from California [Mr. Pelosi].
  Ms. PELOSI. I thank the gentleman very much for yielding, and I thank 
the gentleman for his leadership in calling this special order this 
evening; thank you for your other work on this important issue, 
universal coverage for all Americans.
  I was so pleased to see the recognition the gentleman received at the 
White House, not only from the President and the First Lady but also 
from small business people across America, joining our colleagues in 
saluting your work in this effort.
  My colleagues, our colleague, the gentleman from South Carolina [Mr. 
Derrick], has talked about the analysis of the Catholic Health 
Association of America which shows that premiums are lower under 
universal coverage than under insurance market reforms linked to 
subsidies.
  I have a couple of charts I want to go into further detail on that, 
but first I did want to mention that the need for this universal 
coverage, we all know that the strength of our country should be 
defined in the health and well-being of our people. We also know that 
there are tens of millions of people in our country, because of having 
a precondition, diabetes, a heart condition, the list goes on, 
every person in America, everyone in a family with a precondition knows 
that list, cannot have access to universal coverage.

  We also know that there are many people in America who in any given 
year may have run out of their lifetime limits for access to health 
care. For that and other reasons, there are 37\1/2\ million Americans 
who are uninsured.
  It is important for us to have real health care reform also because 
of the fiscal health of our Nation. We all know that the largest 
single, largest rising increase in our deficit springs from rising 
costs of health care. And so for that reason, I think it is important 
that we have true health care reform which truly addresses the needs of 
our people.
  First of all, I want to show a chart that demonstrates what the 
gentleman from South Carolina [Mr. Derrick] was informing us on 
earlier: Partial reform does not help the middle class. Make no 
mistake, if we do partial reform, the middle class gets socked.
  I call my colleagues' attention to this chart. On this chart, the red 
indicates the number of people who have health care, who would have 
health care coverage under partial reform. Those families with $15,000 
and below income, the number of those uninsured is reduced drastically 
down to this, but as we get closer to $15,000 to $23,000, the number of 
uninsured is just a very small bit to those who are now insured. When 
we get to families with an income of $30,000 to $46,000 a year, the red 
indicates those who are uninsured now, and the yellow indicates those 
who will be uninsured under partial coverage. The middle class gets no 
improvement in its coverage, and in some cases, the premiums are 
increased for less coverage.

                              {time}  1930

  As income goes up, it does not change drastically, but as our 
colleague, the gentleman from South Carolina [Mr. Derrick] mentioned, 
for those in the very high-income bracket we do not have as much 
concern as those in middle income who can be pauperized by someone in 
their family becoming ill.
  On another chart I want to indicate in another way what happens under 
three different scenarios. The current system, of course, 37.2 million 
uninsured. That does not include the underinsured, which brings the 
number even higher, but talking about the uninsured for a moment, 32.7 
million. Under insurance market reform only, 1.1 million Americans 
would be covered. We have a net increase of 1.1 million Americans 
covered, leaving 36.1 million Americans still uninsured.
  That is a percentage reduction of the uninsured of 3 percent.
  Insurance market reform with subsidies, some of it we have seen in 
managed competition, 14.9 million become insured. We still have 22 
million people uninsured, a 40-percent reduction.
  These charts I think indicate that middle-income families that 
currently have insurance will pay more in general for health care under 
partial reform than under reform that includes universal coverage, for 
a number of reasons that I will go into.
  For currently insured households earning less than $100,000 annually, 
health spending will decline under universal coverage with employer 
mandate and cost constraints. I wanted to indicate that the insurance 
market reform, just this scenario, 1.1 million includes guaranteed 
renewability and portability, limits on preexisting condition 
exclusions and community rating for individuals in small group markets. 
That is markets under 100. With all of that reform, still only 1.1 
million.
  As specified in the Managed Competition Act, which is a partial 
change, 100 percent premium subsidy for persons with income below 
poverty, and sliding-scale subsidies for persons up to 200 percent of 
poverty. The act also includes changes in the tax deductibility of 
premium payments.
  In any case, we estimate that the insurance reforms alone are not 
sufficient.
  How does this translate into dollars? The uninsured would consume 
about $45.5 billion in health services in 1998. Persons who remain 
under the Managed Competition Act, if that were to become law, would 
continue to consume about 55 percent of this amount, or $24.8 billion. 
That amount of money would still have to be spent on the uninsured 
should the Managed Competition Act prevail. This amount includes out-
or-pocket spending, free care provided by physicians, hospital 
uncompensated care, and care provided in public hospitals and clinics.
  Much of the remaining care for the uninsured would continue to be 
financed through cost shifting to the privately insured. As markets 
become increasingly competitive, physicians and hospitals will be put 
under increasing pressure to either avoid the uninsured or lose 
financially. In this way partial reform could perpetuate the 
destabilizing effects of the cost shifts. That is the reason so many 
businesses who provide health insurance support reform, universal 
coverage. They are paying the price right now for those who are 
uninsured.
  The charts give us a message. This analysis, the Catholic Health 
Association of America gives us a message, the information, but I want 
to put the message further into the words of one of my constituents who 
sent me a copy of a letter she sent to the President:

       Dear Mr. President: I'd like to applaud your efforts on 
     behalf of health care reform. Just recently, I have quit my 
     job and plan to move out of state. To continue my medical and 
     dental benefits would have cost me $215.41 a month (for 
     single coverage). I'm single with no dependents and in 
     excellent health. Because I cannot afford this, I will opt to 
     go without health insurance coverage until I'm employed 
     again. If I get sick (I pray that I won't), I will simply go 
     to a County Hospital or emergency room. This is an appalling 
     state of affairs. I'm single with no dependents and in good 
     health, but cannot afford to be covered until and unless I 
     get a job.

  She goes on to say, as Mr. Derrick said earlier, ``Health care reform 
is a middle-class issue, not simply an imperative for the poor, 
elderly, sickly or homeless. This legislation securing universal health 
care coverage must be passed this year''. She also goes on to say, 
``Mr. President, get on with the job of health care reform. Pass 
legislation that will benefit everyone''.
  As Mr. Derrick said earlier, some of these plans help those at the 
low end of the scale, and those at the high end of the scale we are not 
as worried about. It is the middle class.
  Under a 95 percent coverage reform plan, Americans in the $30,000 to 
$46,000 income bracket see no decrease in the number of those 
uninsured. It was George Bernard Shaw who said, ``The sign of a truly 
intelligent person is someone who is swayed by statistics.'' I think 
these statistics send a very eloquent message that the middle class has 
a problem with anything but universal coverage. I am pleased to join my 
colleague, the gentleman from South Carolina [Mr. Derrick].
  Mr. DERRICK. I thank the gentlewoman from California very much for 
her articulate presentation of why we need universal health care.
  Madam Speaker, I am pleased to yield to the distinguished gentleman 
from South Carolina [Mr. Clyburn].
  (Mr. CLYBURN asked and was given permission to revise and extend his 
remarks.)
  Mr. CLYBURN. I thank the gentleman for yielding to me.
  Madam Speaker, in the ongoing health care debate, we hear discussions 
over and over again on the kind of health care our Nation's citizens 
will have, both with and without universal coverage.
  We hear a lot about those who are satisfied with their coverage. We 
also hear much about the uninsured, but, Madam Speaker, I want to 
concentrate for a few minutes on the core of America--the working men 
and women who make up what we often call the middle class--and how 
their health insurance will be affected by what we may or may not do.
  Allow me to paint two pictures for you. Two pictures of America after 
health care reform, one with universal coverage, and the other without 
universal coverage. And then you decide where you and your family would 
most like to live.
  If you are a middle class, working taxpayer, making between $20,000 
and $75,000 a year in the Sixth Congressional District of South 
Carolina--or any other congressional district in the country, for that 
matter; and if we were to pass a plan which covers only 91 percent of 
Americans, such as that under the Cooper, managed competition bill, you 
can expect to see an increase in your yearly premium.
  Let us take a look at the figures on this chart. The first picture I 
want to paint.
  The columns represent changes in health care premiums, if we only do 
incremental reform, as many opponents of universal coverage are 
advocating.
  You can readily see that the biggest increase in premiums is the 
column which represents those who make over $30,000 but less than 
$40,000 a year. And if you make between $20,000 and $30,000 a year, you 
can expect an increase of over $200 per year in your annual premiums.
  If you make over $40,000 a year, but less than $50,000, you will 
experience an increase of $137 per year. Under this plan, you will only 
experience a decrease if you make less than $20,000 or between $75,000 
and $100,000 a year.
  Now, I do not know about you, but to me and the people of my 
district, that could mean a car payment for those who make between 
$30,000 and $40,000 a year, or child care payments for those who make 
between $20,000 and $30,000 a year, and a college student's textbooks 
for those who make between $40,000 and $75,000 a year. And, my follow 
colleagues, I wage my bet that you have many people who fit into this 
average American household category living in your districts as well.
  This picture, as all can see, shows that the managed competition 
concept of health care reform delivers devastating body blows to 
middle-income Americans at almost every level.
  If you are a middle-class, working taxpayer and we pass a health care 
reform bill with universal coverage, you can expect to pay less than 
you are currently paying for health insurance premiums each year.
  Let us look at another chart, the other picture, if you please.
  What you can readily see is that the same people who would see a 
dramatic increase in their premiums under the incremental reform plan 
would experience a large decrease in their annual premiums under 
universal coverage.
  If you make between $30,000-$39,000 a year, your savings could be as 
much as $165 each year. Again, that's $165 hard-earned dollars that you 
could save with universal coverage.
  Under universal coverage, everybody in America making less than 
100,000 a year will experience dramatic savings.
  And those making over $100,000 a year would experience only a $210 
increase in their annual premiums.
  Health care reform, without universal coverage, will mean 
significantly higher--not lower--health care costs for middle-class 
Americans who presently have health insurance.
  By implementing universal coverage, the increase in average premiums 
is averted because, not only would the sick and medically needy be 
included in the insurance pool, but also the young and healthy people 
who do not require as much medical service.
  By including everyone, the people who do not regularly use the 
insurance services drive down the premiums for everyone.
  Just think of this concept in simple terms. If the only people in the 
pool are the elderly and medically needy who require excessive amounts 
of medical attention, the premiums will be high because these high-use 
patients will be supporting the costs of others just like themselves.
  However, if universal coverage is implemented, many more young, 
healthy people will be in the insurance pool. When this diversity is 
reached in the pool, the picture is quite different.
  The low-use people who rarely use medical services will cause the 
costs to drop dramatically because the total dollar amount of medical 
care required by all of those in the pool is much lower. When this 
happens, the premiums dramatically go down for all of those in the 
pool. That's the beauty of universal coverage.
  Besides, without universal coverage young, healthy people will opt 
out of the insurance market when premiums are raised thus causing 
higher premiums for the medically needy who remain.
  Also, without universal coverage, many employers who presently 
provide health insurance for their workers are likely to reduce 
coverage or stop coverage altogether.
  With 9 out of 10 insured Americans currently receiving health care 
through their employers, we cannot afford to risk reducing their share 
of health care coverage. When dealing with the employer share of the 
costs, it is important to notice the significant savings, once again, 
by passing health reform legislation with universal coverage.
  Now let me summarize for you the first picture I showed you earlier 
of the Nation's workers who make over $20,000 a year and less than 
$75,000 a year. For them alone, the total increase spending on premiums 
adds up to $7.8 billion.
  That Madam Speaker, is money that could be saved if we pass health 
reform legislation with universal coverage.
  Now to summarize the second picture.
  These same people will experience a $5 billion reduction in spending 
for themselves and their employers, if universal coverage is enacted.
  Again, I ask, what kind of health care legislation you and your 
family would be better off with? I believe the answer is universal 
coverage.
  Finally, Madam Speaker, one of the things which has been often 
overlooked in this debate is the fact that the majority of uninsured 
persons fall between the ages of 30 and 44, which is the age category 
with a highest percentage of working persons. Of uninsured Americans, 
84 percent are from working families. It is these people who will be 
forced to pick up the tab for health insurance if only partial, rather 
than universal, coverage is erected.
  Madam Speaker, I continue to hear the talk show hosts and many of my 
friends on the other side ask, ``Where is the promised middle class tax 
cut?'' I maintain it is right here in health care reform with universal 
coverage, and those of us who fail to recognize or acknowledge it are 
either short sighted or a bit disingenuous.
  The middle class of America is deserving of universal coverage and 
the men and women of this Congress, in my opinion, are duty-bound to 
grant it.

                              {time}  1940

  Mr. DERRICK. Madam Speaker, I thank the gentleman from South Carolina 
[Mr. Clyburn] for his excellent and very articulate remarks on the need 
for universal coverage.
  Madam Speaker, it is with a great deal of pleasure that I yield to 
the gentleman from California [Mr. Fazio].
  Mr. FAZIO. Madam Speaker, I want to thank the gentleman from South 
Carolina, both my friends from South Carolina, for their contributions 
this evening. The gentlewoman from California [Ms. Pelosi] and I from 
the other side of the country have come together with those two 
gentlemen, and certainly with others like the gentleman from Oklahoma 
[Mr. Synar] and have reached a very similar conclusion based on the 
work of the Catholic Health Association and its very important study. 
Results are evident. I think all of us have heard the message tonight; 
it is loud and clear. Plans for reform that do not provide universal 
coverage really will not add up to much at all.
  In fact, Madam Speaker, I think I, for one, am unwilling to go back 
to my constituents in northern California and say, Yes, Congress has 
passed a health reform bill, but you will be paying more and getting 
less. You'll still be at risk of having your insurance taken away. 
You'll pay taxes for the health care costs of other people, many of 
whom don't work, and, despite all of that, we still cannot guarantee 
you that you will have coverage, and if you're fortunate enough to get 
it, you'll pay more for it, and or course if you're a small business, 
if you own a small business trying to compete in this environment, 
you'll continue to pay more for your own insurance and for your 
employees as well.
  Partial reforms just do not get the job done. As tonight's discussion 
has clearly demonstrated, as the gentlewoman from California [Ms. 
Pelosi] outlined in her presentation, insurance market reforms alone 
will have little impact on the number of people who are covered.

                              {time}  1950

  We are only going to cover an additional three percent of all the 
uninsured, if we just do some tinkering with the insurance laws at the 
State level and so-called reform insurance. Even with subsidies, which 
will be hard to come up with, but even if we obtain subsidies in 
addition to those insurance reforms, we still cover only 40 percent of 
the people who today in our society are uninsured.
  So after hearing all the evidence presented in this study, the 
Catholic Health Association study that we are referring to this 
evening, I think the middle class is being stuck with a pretty big bill 
for a plan that would only get 40 percent of the uninsured covered, and 
at the same time a plan that potentially leaves them out of the 
picture.
  Now, some might say, well, covering 40 percent is at least a good 
start. But I think it is important that we remember the real live 
consequences of this debate and who it is we are going to stick with 
the bill for health care reform.
  The poor are helped. You can see the benefit on the left side of this 
chart. You actually do eat into the people who make less than $15,000 a 
year. They do benefit.
  The wealthy at the other end of the spectrum, off this chart, are 
doing quite well, thank you. We do not have to worry about their 
ability. They are left in good shape.
  But the middle class, as usual, pays the freight. And you can see as 
a result of this chart almost no impact, moving from the red down to 
the yellow, in the middle income from $50 to $70 thousand a year, a 
very little gain is made at all in whittling away the uninsured in 
those particular income brackets.
  We have to go further. We have to do more. My northern California 
district may be a good example. There are 105,000 people without health 
insurance. Over 85 percent or 90,000 of them, are uninsured, and still 
working every day, working hard at their jobs, juggling family 
responsibilities, trimming their family budgets in order to make things 
meet, still going to bed at night worrying about whether they will 
cover the bills if anyone got seriously ill. They live with a constant 
question mark. How will they afford to pay for their family's health 
care? Some 25,000 of those 105,000 people are children. As hard as 
their parents work to put a roof over their heads or assure they 
receive a good education or provide a healthy environment for them, 
they cannot afford health insurance for their family on modest incomes. 
No matter how hard they try to work to get ahead, they are priced out 
of the insurance market today.
  But under these suggested partial reforms, and I think the Dole bill 
is perhaps the best example of them, it would take a tremendous amount 
of effort to cover even 60 percent of those people. So some 42,000 
people in my district, mostly hard working middle class people, would 
be left with the following assumption: We reformed health care, but we 
are asking you, you folks in the middle class, to foot the bill, and at 
the same time we simply could not find a mechanism to come up with a 
plan that would guarantee coverage for you.
  Incrementalism is not the solution. Plans that do not have the 
courage to go to the ultimate goal of universal coverage fail in so 
many ways that this report finally brings to light.
  I find it particularly troubling that there are those in Congress 
that think an incremental insurance reform-only bill would be the safe 
political compromise for reform. Let there be no doubt about what this 
report is saying Congress would do if we passed a bill that enacts 
insurance reform that only offers universal access. That is the key 
word.

  This is a quote from the Catholic Health Association study:

       Middle income families that currently have insurance will 
     pay more in general for health care under partial reform than 
     under reform that includes universal coverage.

  Sometimes I think it is counterintuitive. We think if we cover 
everybody it will cost us more money. Yet what we found in this study 
is that in fact it will cost us less if we get everybody into a health 
care system, contributing in good times as well as bad, when you are 
healthy as well as when you are sick.
  Incremental reform will force families making between $20,000 and 
$75,000 per year to spend more on health care, while giving them no 
added security in return.
  For example, by 1998, a family premium would increase by $260 per 
year under a plan for reform, which would increase access to health 
care, but not guarantee universal coverage. If we passed a partial 
reform bill, we would be helping the poor with subsidies, the rich 
would be able to maintain their coverage, and the middle class would be 
left to fend for themselves. And we have a very good example of what 
happens in this sort of approach.
  Look to New York State. It is pretty easy to see how partial reform 
would encourage more gaming of the insurance system, driving costs up 
for those that we want to stay in the system. Insurance reform alone 
creates the incentive to stay out of the health care system until a 
health problem develops. If you know you are going to be able to get 
coverage when you are sick, why buy it when you are healthy? What is 
the incentive to pay for coverage before that time?
  Perhaps you are a young family and you decide to wait until you 
decide to plan to have children. But you fail to contribute up until 
that year when your health care costs in the insurance system are 
particularly high. The spiraling cost problem with partial health 
reform can be seen right now in New York as a result of legislation 
enacted a little over a year ago.
  Last year New York put health insurance reforms in place which 
created community rating and open enrollment. In other words, insurers 
have to offer insurance to anyone seeking it, regardless of their 
health status. However, this State reform does not require that every 
one be in this system. It is the incremental plan we have been talking 
about here, the Dole plan.
  The dynamic which this study describes is exactly what is happening 
in New York today. Insurance reforms extended coverage to the sick and 
older people who are traditionally higher users of health services. 
There were no more prior conditions. People could enter into the system 
that perhaps discriminated against them before. But without universal 
coverage to ensure that healthier, low-risk individuals and families 
are included in insurance pools, the level of costs increased for 
everyone left with insurance in the system. Higher risk insurance pools 
resulted in premium increases for those with insurance, causing many 
healthy young people and small businesses to drop out. They could not 
handle the additional costs. The risk pool shrunk further, increasing 
the level of risk for those that remained, and, as a result, we have 
premium increases all over again.
  Additional premium increases drive out more young families, more 
healthy people, small businesses, and the spiral continues. We go round 
and round. Costs go up, more people drop out. Costs go up further, more 
people drop out again.
  So the people that are left in the system are paying exorbitant 
rates, while other people are waiting for the day they think they will 
need insurance, the day they are sick.
  In New York, as of January 1st, 9 months after the new law took 
effect, over 25,000 fewer people had health insurance individually or 
in small employer groups, plus these groups saw an average rate 
increase of 18 percent. Some insurers increased rates by as much as 35 
percent. And this was the result of a law designed to increase access 
to affordable insurance.
  This State's experience with partial health reform gives us some fair 
warning about the problems with this approach. Universal access is not 
universal coverage. Everyone needs to be in the system. Let us contrast 
New York with the reform experience with the State of Hawaii, a State 
that implemented health reform with universal coverage.
  Under the Hawaiian system of universal coverage through an employer 
mandate, health insurance premiums are about 30 percent less expensive, 
even though as we all know, in Hawaii almost everything else costs more 
than it does on the mainland. Under Hawaii's reform, which included 
universal coverage, costs are lower and almost everyone is covered.
  The plan for health reform that does not bring everyone into the 
system will just continue to shift costs around within the system, most 
often sticking the hard working middle class with the final bill. The 
vast majority of the millions left out under the partial reforms would 
be middle class working families, families who work hard every day, 
play by the rules, and, after this debate, they can end up worse off 
then before we started.

                              {time}  2000

  What a cruel hoax after 2 years of debate over health care reform.
  So this study reinforces just what is at stake in a plan without 
universal coverage. Every American remains at risk of having their 
insurance taken away. Middle class families will pay taxes for the 
health care of millions of others who do not work. But they will not be 
able to get coverage or if they do, they will pay far more than they 
should.
  Health premiums will continue to spiral upward. And business, 
particularly small business, will continue to pay even more.
  So you can see health reform without universal coverage is no reform 
at all. So we have to move beyond the lowest common denominator, 
politics, that so many like to use in this institution. We have to be 
bold because if we fail, we will fall short. We will fall short of the 
goals we have set for ourselves and for our constituents.
  People will continue to pay much more. We will have no cost-
containment for people who desperately need it and will make only 
incremental improvement in the number of people in our society who are 
uninsured today.
  I wanted to thank my colleague from South Carolina for his leadership 
in that this Catholic Health Association study really changes the 
dynamic of the political debate that we are just about to begin here in 
Congress. It brings clearly to the fore the stake the middle class has 
in bringing about universal coverage. It is not something we do with a 
bleeding heart concern for the poor. It is something that is in the 
economic interest of the people who work every day and earn from 
$15,000 to $75,000 a year.
  I want to thank my colleague for giving us a chance to reiterate this 
study's important point to our colleagues and to our constituents.
  Mr. DERRICK. Madam Speaker, I thank the gentleman from California for 
his very articulate statement. Once again, making us understand that to 
do just a little is not enough and that there are things worse than 
doing nothing. And that would be to come up with a plan that many 
advocate that would not be universal coverage.
  What we would end up with would be we would have fooled the American 
people into thinking that everyone was going to be covered and that 
there was going to be a reduction in the cost to them. That is just not 
the case unless we have universal coverage.
  I know as I looked at the figures in the beginning, it was hard to 
really understand this, because our traditional image of Government is 
that whatever we do, it is going to sock it to the middle income people 
in this country and they are going to end up paying for it. And they do 
end up paying for most of our taxes that support this Government. But 
in this particular case, if we do not go to universal coverage, the 
very people, not the very rich who can afford the best health care, not 
the very poor who are taken care of on Medicaid, but the very people 
that we are trying to help we will not help.
  I think there is also another misconception in this country. That is, 
that poor people are running up our health care bills and do not have 
coverage. It is not them. It is men and women, four out of five people 
in this country who do not have insurance coverage are either working 
every day or a part of a family with a working member that just can no 
longer afford insurance coverage.
  It is so very, very important that I would ask my colleagues, but 
also ask those folks back home who may be watching us here tonight, to 
urge their Members to support universal health care coverage.

  I yield to the gentlewoman from California [Ms. Pelosi].
  Ms. PELOSI. Madam Speaker, I thank the gentleman for calling this 
special order tonight. As he was speaking, he reminded me, as did our 
colleague from California, of the many more reasons that we do not have 
time to go into tonight but that our colleagues on other evenings will 
go into about why we cannot make incremental change.
  There is a constituency for change out there now that understands in 
each person's personal life why it is important for us to have 
universal coverage for all Americans. It is about a person's health and 
well-being.
  I mentioned earlier, and it has been mentioned many times, why it is 
important to our own national budget. But in terms of the economy of 
our country beyond individual personal good health and physical health 
of our national budget, it is important that we make real change, too, 
because working-class Americans, people who work, as the gentleman from 
California [Mr. Fazio] said, work every day, trying to make ends meet 
and still do not have health insurance, they would be less likely, for 
example, to leave their jobs to go start a new business. Or less likely 
to change jobs and take a chance doing something else.
  The dynamic and the vitality, the dynamism and the vitality of our 
own economy is hurt, is harmed by that job lock or that lack of bold 
necessary, which people have to, if they have family and the rest, they 
cannot take the same kinds of chances. So I think individuals are well-
served in their personal well-being, certainly our national budget is 
well-served by our making this bold step. But our economy, also, and 
the dynamic of our whole country is well-served by people not being 
menaced by being sick, not being pigeonholed by not having mobility.
  Mr. DERRICK. Madam Speaker, I yield to the gentleman from California.
  Mr. FAZIO. Our colleague was very eloquent in describing the burdens 
of middle-class people. This chart shows exactly what will happen if we 
fail to have the courage to move to universal coverage, something that 
every other industrialized nation in the world has done long ago.
  If we go the incremental route, people earning between $20,000 and 
$75,000 a year are going to pay an additional $7.8 million out of their 
pockets to pay for what, in some cases, will not be adequate health 
care. In other cases, it will be fine, but at greater cost.
  On the other hand, if we can move to universal coverage, those very 
hard-pressed people that the gentleman from South Carolina [Mr. 
Clyburn] was discussing and the costs that they are fighting to 
overcome, the costs of books and the cost of educating a family in 
general, for example, we will give them a $5 billion savings, a 
reduction in spending for health care that could translate into meeting 
all those other needs.
  We talk about a tax cut for the middle class, as the gentleman from 
South Carolina [Mr. Clyburn] said, this is something significant in the 
family budgets of people who have insurance today. They do not think 
this is all about them, because universal coverage is to bring other 
people into the system. But they will be the ones who benefit most, 
because when we get working in a health care system as a country 
together, we can see real reductions in the family budgets of many, 
many millions of middle-class families.
  Mr. DERRICK. Madam Speaker, in closing, let me just say that this is 
a health care issue. If we do not have universal coverage, we do not, 
we miss about 22 million people who will still not have health care 
coverage in this country. The average middle-income person will see 
their insurance premiums go up. But not only that, we miss our 
opportunity to do something about the economic issue. It would truly be 
a celebration for the free enterprise system in this country, because 
we spend 30 to 40 percent more on health care in this country than any 
other of the major industrialized nations, which causes us to have to 
charge more for what we make.
  For instance, the automobile manufacturers spend more for health care 
than they do for the steel that goes in their automobiles. It amounts 
to $1,100 or $1,200 a car, whereas many of our competitors only spend 
$500 or $600 a car. It is not only just automobiles. It goes on and on 
and on throughout our economy.
  It will go a long way to creating more jobs, to bringing down our 
deficit, so let us pass universal health care.

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