[Congressional Record Volume 140, Number 108 (Monday, August 8, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 8, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

  Mr. WISE. Madam Speaker, I am going to be talking tonight about 
health care, about how the leadership health care plan would affect a 
number of individuals. But before I do, I would like to talk about 
refrain I am now hearing from those who really do not want to do 
anything about health care. That is, why not delay. Let us delay this 
for another month or so. Let us delay this for another year, is the 
refrain I am hearing. There are many different proposals out there. 
Congress can get it together better with some delay.
  Well, let us look at what delay means. First of all, it is not as 
though health care had not been before the Congress and the American 
people for a significant amount of time. I harken back to the fact that 
just a couple short years ago, President Bush submitted to the Congress 
his idea of comprehensive health reform, basically dealing with 
vouchers to low-income persons to buy insurance, but he was trying to 
address in his own way the problem that was there.
  President Reagan submitted comprehensive health reform legislation. 
President Carter submitted comprehensive health reform legislation. 
President Nixon, yes, President Nixon, in 1974, 20 years ago, submitted 
very comprehensive health care legislation and, indeed, historians 
please note, submitted the first employer-mandate provisions. President 
Nixon would have actually, his measures would be tougher than the ones 
that Senator Mitchell and others are espousing in the Senate.
  President Nixon proposed that all employers contribute 65 percent of 
a premium cost; employees contributing 35 percent, which would then 
change after several years to 75/25. So this issue goes back 20 years.
  The reason each President and each Congress has tried to come to 
grips with health care is because the problem worsens, because health 
care costs have gone up several times the rate of inflation, because 
larger numbers of people are not insured, because the inequities of 
people who work on their feet every day, 8 to 10 hours, and they are 
not covered by health insurance.
  So more and more we see the problems first hand, and more and more 
the people demand action. And, yes, if we delay, then some things are 
not going to happen. There will not be guaranteed private health 
insurance for all. There will not be shared responsibility, employers, 
employees, and government all sharing in the cost in this. There will 
not be the flexibility necessary for states to have their own programs, 
as well as for individuals and businesses to have their flexibility and 
their choice to choose their provider and their plan.
  I guess I am also concerned because, yes, this Congress can delay 
again, as it has in some ways for 20 years. But what happens when we 
do? Because in health care, what happens is, we get balms, poultices, 
Bank-Aids administered to what are now deep internal injuries. And just 
as balms, poultices and Band-Aids, rubbing root bark and other things 
into your wounds do not do much for internal injuries, neither will 
delay do much for health care.
  All of America ought to be concerned about what delay means. Delay 
means to the Medicare recipient, the person over 65 who depends upon 
Medicare, that means that Congress is going to be coming back again 
most likely cut even further in the name of deficit reduction. Delay 
means to the Medicaid recipient, that low-income person, that that 
medical program is going to continue to shrink as States find less 
and less of their resources to match.

  To the private insurance holder, to the employee who is covered by 
their employer's insurance, to the self-employed individual who has 
private insurance, to anyone who has private insurance, beware of what 
delay means, because what delay means is that your insurance is put 
more at risk, because that means that Congress will not have dealt with 
cost shifting, the fact that 30 percent of the premium dollar today 
that a private insured person pays, 30 percent of that goes to paying 
for those who do not have insurance or do not have the ability to pay 
the full cost of their health care.
  The business operator, the small business person ought to be very 
concerned about delay, because they know that the insurance that they 
bargained for, when they are able to get it, costs them 30 to 40 
percent more than a comparable policy for a larger company.
  Madam Speaker, I yield to the gentleman from Illinois [Mr. Durbin].
  Mr. DURBIN. Madam Speaker, I would like to stand in support of the 
gentleman's comments about moving on health care quickly. I think one 
thing that is often overlooked, the opponents of health care have said, 
put it off. It will not hurt. We will do it another day.
  They ignore the fact that if we do nothing about health care in this 
country, the health care insurance premiums for every individual and 
family will double in the next 6 years.

                              {time}  1810

  None of us expects our salaries to double in the next 6 years. That 
means less take-home pay for working Americans if we do not address 
this problem today. Most certainly, the cost of the health care will 
continue to go up, but we hope by our action to slow down the rate of 
increase, so that American families have more take-home pay.
  The folks who want to put this off for a year or 2 years are just 
delaying not only the inevitable, but creating more pressure on working 
families and businesses across America. I support the gentleman 
completely on his call for immediate action by Congress.
  Mr. WISE. I appreciate that. The gentleman states the issue very 
succinctly. GM now says that they pay more for health insurance than 
they do for the steel in an automobile.
  Where does that health insurance come from? It comes from the real 
take-home pay of workers, so what happens is, people's take-home pay is 
sacrificed in order to try to keep a benefit package. The benefit 
package itself, as most employees know, is shrinking as well, so we 
lose on the take-home pay, we lose on the benefit package as well.
  Mr. DURBIN. If the gentleman will continue to yield, let me give you 
an example. In my hometown of Springfield, IL, a local company was in 
negotiation with their labor force for a new contract. They ended up 
with an agreement to increase the wages for their employees at $1 an 
hour for the next year, and the employees had a meeting to ratify it. 
At that meeting they were told ``Incidentally, you will not see a penny 
of it. That whole dollar of it is going to go into your health care 
insurance, just to keep it at the same level it is today.''
  So what working families face, if we take the Republican attitude, 
which is ``put this off indefinitely, or only do a little bit around 
the edges,'' is that working families are going to hear that over and 
over: ``You got a pay raise but you did not see it. It got eaten up the 
increased cost of benefits.''
  That is why I think it is important to keep that context in mind 
during the next 2 weeks of deliberation.
  Mr. WISE. As the gentleman also pointed out the other night on this 
floor, not only do you have to be concerned about delay, but if you 
deal only with insurance reform, which sounds good, but you do not have 
universal coverage, that is, guaranteed private insurance that covers 
everybody, then what happens is you make the problem worse.

  And indeed, that middle-income person with private insurance will end 
up paying more, because without everyone being covered, then the 
healthy opt out, the sick get in, prices go up for everybody, and the 
result is that to the insured person and to the middle income person, 
particularly, the Lewin study that came out just a couple of weeks ago 
conclusively demonstrates middle income and insured people will pay 
more under tinkering around the edges, as opposed to universal 
coverage, which has been proposed by the leadership plan.
  Mr. LEVIN. Will the gentleman yield?
  Mr. WISE. I yield to the gentleman from Michigan.
  Mr. LEVIN. Both of you gentleman make an excellent point. The 
gentleman from Illinois has indicated how in disputes between 
management and labor, more and more health care has become the focal 
point, and everybody should understand that inflation in health care 
costs, the issue of affordability has more and more been projected into 
disagreements between management and labor.
  It is really an artificial set of problems. We ought to be able to 
resolve those problems so they do not disrupt sound labor-management 
relations on the floor of the factory, they are so critical there.
  Also, the gentleman from West Virginia [Mr. Wise], as the gentleman 
from Illinois [Mr. Durbin] pointed out earlier, has underlined a number 
of additional points. The number of uninsured persons has been going 
up, not down.
  Also, these experiments with community rating when everybody is not 
getting into the system, these experiments have turned out to increase 
rates for most people. Community rating without broadened coverage 
means higher premiums for a large proportion of the insured, is that 
not correct?
  Mr. DURBIN. If the gentleman will yield further, absolutely. If we do 
not make universal coverage part of it, you create a bigger problem. 
The reason is obvious.
  All of us want to see an end to discrimination based on preexisting 
conditions. Eighty-one million Americans have some preexisting health 
condition: cancer in their family, a heart disease, back surgery, 
diabetes, a child who was born with a congenital problem. Eighty-one 
million Americans, a third of our country, face preexisting conditions. 
As a result, they either cannot get insurance, cannot afford insurance, 
find it is very limited in its application.
  What we want to do is get rid of that. But if you don't do that in 
the context of bringing everyone into the insurance pool, then you have 
what you call adverse selection. People sit back and say ``I will wait 
until I get the diagnosis, and then I will buy insurance,'' which is a 
recipe for disaster. It means insurance premiums are going to go up 
precipitously and companies will not be able to write the policies. 
Universal coverage is a critical part.
  If I might add, I don't know if the gentleman wanted to touch on this 
subject this evening, but another thing that is very topical is just 
what is going to happen this week in the health care debate. There has 
been a suggestion by a Republican in the other body that there may be a 
filibuster. I don't know what might happen in the House of 
Representatives here.
  I don't think the American people want gridlock in Congress on health 
care, for goodness' sake. For 2 years this country has been in a full 
debate on this issue. They elected us to come here and make a decision.
  Now the thought that we would somehow get all tangled up in ourselves 
again, with the Republicans calling for ``go slow'' or ``don't do it, 
wait another year, another 10 years,'' that just does not strike me as 
the mandate all of us were given by the voters in the last election. 
Up-or-down, let us vote this issue. Let us see who is in favor of 
universal coverage, who wants health care reform, and who wants to put 
the fight off to another day or walk away from it altogether.
  Mr. WISE. The gentleman makes a good point. I have heard in my town 
meetings, and I suspect it is the same for every Member here, no 
shortage of airing of views, no shortage of debate, no shortage of 
opinions, and a debate has taken place across this country that has 
been evolving for many years, but particularly in the last year and a 
half.
  Madam Speaker, I would greatly regret if there were any attempt to 
filibuster, to make it impossible to have that up-or-down vote. I am 
happy to stand on my record, up-or-down. I think the greatest tragedy 
is that the American people are denied the opportunity to hear that 
debate and to see the votes actually take place.

  Mr. LEVIN. If the gentleman will yield further, on this point that 
the gentleman from Illinois has raised so succinctly, the three of us 
are among Members who go home, who are home a lot, who hold town 
meetings, who really want to tap into what our constituents feel. We 
came to Congress together, and have continued very much to do that.
  I was home, as every weekend, this weekend. Several people said to me 
``Do not go too fast. Know what you are doing.'' For those who are 
listening to us, I want everybody to be assured that we are going to 
follow that principle. We are not going to just rush this thing 
through. We are going to have a lot of debate.
  However, full debate is not the same as inaction. We will have a 
full-scale discussion on this floor, and we will have a full Chamber. 
We will spend a number of days and everybody will be able to speak 
their piece.
  But as you said to the gentleman from West Virginia [Mr. Wise], we 
have been looking into this issue for a number of years now. The 
subcommittee that I sit on, the Subcommittee on Health of the Committee 
on Ways and Means, had innumerable hearings. We spent week after week 
after week usefully putting together a bill. I want everybody to know 
this. The legislation did not come out of thin air. We changed it from 
the original Clinton proposal.
  Madam Speaker, we had a number of weeks, both parties developing 
their proposals. Then we went into formal subcommittee markup, and we 
had a number of weeks of markup on television. It was not behind the 
scenes, it was on television, for everybody to see. Then we had full 
consideration in the full Committee on Ways and Means.
  So to those who are worried that we will rush this, we will not. We 
will not. But the American people, as the gentleman from West Virginia 
[Mr. Wise] and the gentleman from Illinois [Mr. Durbin] have said, they 
do not want us to do nothing. They do not want us to do anything at 
all, but they want us to use the experience in this body, the feedback 
from home, the fact that as we have gone on in this country, our health 
care problems in many respects have worsened, and they want us to step 
up to the plate. We are going to do that with deliberate speed, with 
deliberate speed.
  Mr. WISE. I thank the gentleman.
  Mr. DURBIN. If the gentleman will continue to yield, I think the 
gentleman from Michigan raises a good point here.
  A lot of the critics now of doing health care reform have been 
bringing scales to Capitol Hill and weighing health care reform bills 
and saying ``Oh, my goodness, this bill weighs 10 pounds, this bill 
weighs 10 pounds. Surely Congress could not consider a bill that weighs 
10 pounds.'' That does not get down to the basics here.

                             {time}   1820

  The basics we face is the fact that any Member of Congress who has 
been diligent over the last several years has come to understand the 
basic concepts behind health care reform. I dare say that a couple of 
years ago I would have flunked the exam on health care reform. Today I 
think I would pass it, because I have spent time with doctors, with 
hospital administrators, with nurses, with chiropractors, with 
pharmacists, with the constituents I represent, and I have become 
conversant with the technical terms involved in health care reform. I 
am still no expert, but I understand the concepts that we are dealing 
with here and every Member of Congress I think in all honesty is in 
that same position, if they had been diligent over the last year and a 
half. There is no reason to shirk away from this major responsibility. 
In fact if the gentleman will allow me just one more moment, the thing 
that I am concerned about is that: If we walk away from this issue, if 
we walk away from this challenge, if we end up saying to working 
families across America, ``I'm sorry, your health care premiums are 
going to double over the next 6 years and Congress couldn't get its act 
together,'' I do not want to go home and tell that story.
  The other thing we have to remember, while we have been debating, the 
health care system in this country has changed and is changing 
dramatically. In my part of the world in the Midwest we now have this 
concept of managed care where doctors and hospitals have folks looking 
over their shoulders trying to control costs. Some of these health care 
providers who a year and a half ago said stay away from this issue are 
now coming to my office saying, ``Get involved in this issue. We need 
some people to step in and try to smooth out this process.''
  So I say to the people who are listening and following the debate, we 
want to make sure that these changes are positive for every family and 
business and health care provider in this country and walking away from 
the issue is not going to guarantee that.
  Mr. WISE. And walking away because people are throwing up bogeymen to 
try and frighten you. Bureaucracies, I heard that one over the weekend, 
from some of the leaders on the other side of the aisle. New 
Bureaucracies created, faceless bureaucracies.
  Have you ever tried to deal with the Rock, I'm talking about 
Prudential, with their office in Philadelphia or New York or wherever 
it is on a claim? Have you ever been in a rural hospital as I was a 
couple of months ago and had a physician express his great frustration 
because there was a routine procedure he wanted to perform on a patient 
but he had to negotiate with a peer physician for an insurance company 
in New York and he is in Richwood, WV? Have you ever had people with 
the claims forms sent back endlessly? It goes on and on.
  Why is it that in all of our physicians' offices, most of the time 
there will be more people employed doing paperwork than clinical work? 
And that is not just because of Government bureaucracy and yet we need 
to do some simplification there, but it is because of the incredible 
bureaucracy that is built up.
  The gentleman makes a point about managed care. In 1980, 4 percent of 
the work force in this country was under a managed care plan. Today it 
is 54 percent and mounting quickly. I look at the chemical industry in 
the Kanawha Valley where I come from. A few years ago, there was no 
managed care. Today almost every major employer has signed up with a 
managed care plan. So this is upon us. Bill and Hillary Clinton and a 
500-person task force and Democrats and some Republicans never had to 
appear on the scene. This has all been happening. The question is 
whether it is going to happen in a way that is advantageous. While it 
has been happening, other things have been happening. Health care costs 
going up 2 to 3 times the rate of inflation, rates of uninsured going 
up sharply, small businesses having to drop out. The gentleman points, 
I think, to a lot of functions that are taking place.
  One more reason why we cannot delay, it suddenly occurred to me, and 
I would really appreciate the experience of the gentlemen. In West 
Virginia, our legislature has wrestled with comprehensive health care 
for the last 3 years. They got up close to it this year and said:
  Wait a minute. The Federal Government is certainly going to act soon 
and it would be not a good decision for us to go ahead and not be able 
to match our system up with the Federal system.
  I know Vermont and other States have taken the same approach, saying, 
``We know something has to be done but until the Federal Government 
provides a basic pattern, leadership for us to follow, then we can't go 
ahead.'' Now are going to say one more year and one more year after 
that? The States justifiably will not wait nor should they wait. Yet at 
the same time they need the Federal Government as their partner.
  Mr. LEVIN. Would the gentleman yield on that important point?
  Mr. Speaker, we need a State-Federal partnership and we do not want 
dictates from Washington determining all this as the gentleman's charts 
will show. We are really building on the present system. We are not 
turning it upside down. We are trying to take the bureaucracy out of 
this and a lot of the paperwork. So when the gentleman gives his 
examples, I think a lot of people are going to say, ``You know, this 
proposal will make it better for those of us who have good insurance, 
it is not going to disrupt it.'' And for those who do not, there will 
be an improvement. But I think what the charts may show more than 
anything else is that we all have a stake.
  Some people have said to me, ``Why not just take care of the 
uninsured? Don't worry about the rest of us.'' The problem is that what 
is involved here affects all of us, that health care has been going up 
for all of us.
  Indeed, I do not think it is too much of an overstatement, maybe a 
bit, but not much, that the insured population, those of us who are 
insured, have about as much at stake in health reform as the uninsured. 
A lot of families are being threatened with loss of their insurance 
because the costs have been going up. When I was a young lawyer, I 
represented health and welfare funds. The employer paid 10 cents an 
hour, 10 cents an hour, and it was pretty decent care. Today that 
employer pays $3.75 an hour. Those employees who are working have a 
stake in health care reform because their employer cannot continue to 
pay, every year, 30 or 40 or 50 cents an hour more for insurance 
coverage.

  So we all have a stake in this. I think that the gentleman's charts 
are going to show that this plan is not a revolution. It does not turn 
the system upside down. What it does is keep what is good and take out 
and reform what is bad. We need to do it and not next year or 2 or 4 
years from now, but we need to start doing it now.
  I finish with this point: This plan phases in, right? No one is 
talking about tomorrow, everybody being covered. We know how difficult 
that would be. But we are saying over a reasonable period of time, it 
is important to get everybody in the system because in the end, it will 
be stronger for each and every one of us. And the gentleman is so 
right. We cannot say to the States, ``go ahead and do it yourself'' 
without regard to what will be done in Washington, because it will not 
happen.
  Second, there are too many companies who have employees across State 
lines. We cannot do this just piece by piece.
  This point is also important: The plan is built on partnership. It 
does leave considerable leeway to the States. If they want to, for 
example, displace what is called Medicare C, they can do it entirely by 
having a pool arrangement on their own.
  The time to move, to begin to move, is this year, and I think our 
constituents, when they hear more and more about the plan, are not 
going to adopt the motto of the Brooklyn Dodgers of old: ``Wait till 
next year.'' They say, ``Face up to this issue, let's face up to it 
this year, let's do it reasonably, let's do it with care, but let's do 
health care with care now, not next year.''
  Mr. WISE. The gentleman makes excellent points.
  Mr. LEVIN. I congratulate the gentleman from West Virginia for this 
special order and after the gentleman from Illinois participates 
further, I think everybody is waiting to see what these scenarios look 
like so we can all identify with them.
  Mr. WISE. I appreciate that.
  Mr. DURBIN. If I can make two final points before the gentleman from 
West Virginia returns to the illustrations that I think will set some 
people at ease when they consider what this plan is going to do, the 
impact that it will have on families and businesses and retired people, 
and I hope that they will stay tuned as the gentleman presents these 
scenarios. May I make two points, though. The one is there are people 
who say, ``Why get involved in this? Businesses that can, will provide 
health insurance and most people are insured, so why worry about it?''
  Statistics tell us over the last 10 years, the percentage of 
businesses offering health insurance to their employees has been 
diminishing. It has been going down because the cost is getting so 
high. These are big businesses and small businesses alike that no 
longer can offer health care benefits. If we do not do something about 
it, that trend will continue. So relying on the current system, the 
status quo, is not going to solve the problem.
  I want to go back to a point the gentleman from West Virginia made, 
which I think is excellent. So many States are holding back from doing 
anything to help themselves waiting for the Federal Government to take 
the lead. When the Republicans stand up and say put it off till next 
year, or the next decade, they are putting off decisions for each of 
the States as well.
  My home State of Illinois is in bankruptcy. We have been bankrupt for 
several years. I do not blame the Governor or the General Assembly, but 
I do blame the circumstances they face, and I have asked the Governor 
what is causing our bankruptcy. He said:
  There are 3 reasons. Medicaid, Medicaid, and Medicaid.
  In other words, the State's payment of health care costs for poor 
people continue to go up so dramatically that they cannot budget for 
them quickly enough and certainly cannot raise taxes to cover them.

                              {time}  1830

  Mr. WISE. That is where the State is matching a smaller percent than 
what the Federal Government is putting in.
  West Virginia is the highest matched State at 25 cents for the State 
for every 75 cents, and West Virginia's legislature spent almost their 
entire session simply trying to come up with the money to meet the 
expanding demand for the service, and I suspect that same is true in 
Illinois and in other States.
  Mr. DURBIN. We in Illinois have not done as well as West Virginia 
with our 50-cent match. We have only 50 cents matched by the Federal 
Government on a 50-50 basis.
  There are two things in this plan that can make a difference. The 
first thing is 40 percent of Medicaid costs in Illinois is for folks in 
nursing homes, the elderly, the disabled folks who have no source of 
income and turn to Medicaid to stay in nursing homes, 40 percent of our 
cost. This plan addresses the whole area of home health care, and I 
leave it to the gentleman and his illustrations to point this out. It 
can be helpful, will not solve the problem, but it can be helpful.
  The second thing, the remaining 60 percent of the Medicaid State 
health care costs are for poor people. I talked with a representative 
from a national insurance company who has no axe to grind, no dog in 
this race. He said I just want to let you know you can save a lot of 
money when it comes to Medicaid by having managed care. We in Illinois 
pay over $400 per month on average for a recipient. He said the average 
managed care cost is $160 per month. So bringing in some of the 
efficiencies we are talking about in health care reform can start 
bringing down the cost of health care for poor people under Medicaid, 
and thereby lessen the pressure on States.
  The final illustration is one that I will use of my constituent, a 
lady who told me, ``Congressman, I have a part-time job, but I still 
have my Medicaid insurance because a part-time job does not provide any 
health care benefits, and I still cannot get doctors to see me, and I 
have a young child.'' This mother with a young daughter, who had a high 
fever for several days, in desperation, could not get in to see a 
doctor and went to the emergency room. Who would not? I am not blaming 
her. But the cost of that health care for the little girl was three 
times or four times what it would have been if she had gone through the 
ordinary course of medical care.
  This plan we are talking about starts bringing in everyone for 
similar medical treatment so that you do not have these inequities that 
cost us so much money and run the cost of the program through the roof 
that all of us end up paying for.
  I think those are important parts that will end up helping not only 
individuals and families, but helping the States out of their bankrupt 
situations. I salute my colleague from West Virginia. I know he is 
going to turn to his charts now and give us some specific examples. I 
hope during the course of this week we can keep our eye on the prize 
here. We have a once in a political lifetime opportunity. Harry Truman 
challenged us to do this and 50 years later we are going to meet that 
challenge. I hope Members of the Congress, Democrats and Republicans, 
will rise to it.
  I thank the gentleman for his leadership on this issue.
  Mr. WISE. I thank the gentleman who has been extremely active on this 
issue for a long time, and particularly in the special orders.
  I might say the West Virginia legislature will meet again in January 
for their regular 60-day session. Obviously, with the new Congress 
coming in, where there has not been action by the previous Congress, it 
will leave that burden to our legislature and every other legislature. 
It will be year after year before anything gets done.
  Let us turn now to how the leadership plan would actually work for 
Americans in different situations.
  First of all I am going to quickly run through this. Mary works full 
time for a large company, over 100 employees, and is currently insured. 
Under the House Democratic bill, not much changes for her really 
because she continues to receive coverage under a private health plan 
offered by her employer, or if she chooses, something called a medical 
savings account, if offered by her employer. She has a little more 
choice than she does now because right now the employer offers the 
plan, the employers negotiate exclusively, and it is pretty much take 
it or leave it. Now she would have a choice of at least one plan 
offering unrestricted choice of doctor and one managed care plan. She 
would continue to have the same or better benefits. Her employer would 
pay at least 80 percent of the cost of her premium, and while we have 
discussed in previous meetings about the burden on the employer, this 
game is not sock it to the employer. The employer, particularly small 
business employers, those with 100 employees or less, get certain 
assistance in providing that coverage. Incidentally, of course, they 
get a tax deduction as well as offsets we hope for workers' 
compensation costs as well, because now there is universal coverage. 
That means everybody is covered. The employer will not have to pay 30 
percent more in their premium covering all of the other business' 
employees who are not covered. So the employer sees some benefits too.
  She pays for her share of the premium through payroll deductions. 
Many people already do that. She never loses her coverage if she 
changes or loses her job because there was insurance reform in this 
package as well. So the caps, the lifetime caps are gone, the 
preexisting exclusions, the fact that they could deny her child 
coverage because the child has a preexisting illness, that is gone. She 
receives help. The employee receives help paying for her share of the 
coverage if her household income is up to $38,400, if she is married 
and has two or more children, or is a family of four, or up to $27,000 
if she is a single parent with one child, or up to $17,000 if she does 
not have children and is single. In other words, there is assistance 
for her to make her 20 percent cost of the premium share.
  So that is what happens for one person who already has insurance 
working for a large company.
  This is Bob, no relation to the present speaker. Bob is working full 
time for a large company but does not currently have insurance. 
Remember, the previous person, Mary, worked for the large company and 
had insurance. Bob does not.
  Under the House Democratic plan Bob would, by January 1, 1997, about 
2\1/2\ years from now, for the first time receive private insurance 
through his employer or a medical savings account, if offered by his 
employer. Let us remember that. The employer, a large employer, over 
100 employees, has until January 1, 1997, more than 2 years to come 
into compliance. That is the large employer.
  The second employer, Mr. Speaker, under 100 employees has until 
January 1999, over 4 years to come into compliance. So for those who 
say you are rushing into something, you are being precipitous, 
absolutely not. There is much time for implementation, for scrutiny, 
for fine-tuning, if necessary.
  Second, once again, Bob, by virtue of this legislation, would now 
have a choice of at least one plan offering unrestricted choice of 
doctors, fee for service, choose his doctor, or one managed care plan. 
Or he could, if offered by the employer, choose a medical savings 
account. His employer pays 80 percent of the cost of the premium. Bob 
pays for his share of the cost of the premium through payroll 
deductions. As in the case of Mary, he pays for his premium based upon 
a sliding scale of his income. And once again, he never loses his 
coverage if he changes or loses his job, or if he or his family become 
ill.
  Let us talk about someone who is presently receiving coverage through 
the Medicaid Program, that is medical care for the low income, for the 
indigent. We were talking just a few minutes ago about the single 
greatest cost to the States today, one of the causes, major causes for 
the Federal budget deficit, because health care costs are rising to the 
Federal Government, is Medicare and Medicaid at 12 percent a year, so 
you can see the need to get this under control.
  Under the House Democratic plan Mrs. White would no longer be in 
Medicaid but would now have the same coverage as all other employees. 
If she works for an employer with fewer than 100 employees, these are 
her choices: a private plan offered by her employer, a private plan 
offered through the Federal employees' health benefits pool or plan, 
and nine million persons presently are members of that plan. And it is 
often touted as a model because employers pay and employees pay, and 
they are able to have a variety of private plans to choose from. She 
could, if offered by her employer, use a medical savings account. The 
medical savings account is a plan by which the employer pays for a high 
deductible policy, say $2,000. The difference then the employer 
deposits every year into an account which is tax free to Mrs. White.

                              {time}  1840

  It is to be used only for medical expenses, and she chooses how she 
uses it for medical expenses, to go get the primary care checkup, for 
instance, to do the prenatal screening, whatever it is. If there are 
major medical expenses, then the catastrophic policy kicks in.
  If her employer chooses not to offer private coverage, she may obtain 
coverage through a Medicare Part C program. We presently have in this 
system Medicare Part A and Part B for senior citizens. Now there would 
be a Medicare Part C, and if her employer chooses Medicare Part C, she 
will have the choice of a plan offering an unlimited choice of doctors 
or a managed care plan. If she goes to work with an employer with more 
than 100 employees, a large employer, she ends up much the same as 
before, having a choice between at least one plan offering unrestricted 
choice of doctors and one managed-care plan, getting assistance on her 
premium, paying for her share on a sliding scale of her income, and 
never losing her coverage.
  Let me just note in this case, she is on Medicaid and is employed. 
Secretary Shalala, Secretary of Health and Human Services, has 
estimated the single greatest welfare reform package that could pass 
would be legislation similar to this. Because what it would do is it 
would say to the person who is not employed on Medicaid, the welfare 
recipient, if you take a job, you will not lose your health coverage, 
and then up to one million people would come off the welfare rolls, 
because now they know that if they go to work they would not leave 
their children without health care coverage.
  Think how ludicrous our situation is. We want to encourage people to 
go to work. We want them to do whatever is necessary to earn a gainful 
living. Yet we tell them, if you leave welfare, you lose health 
benefits for your children, if you stay on welfare, you keep benefits. 
That is a crazy system. This begins now to change that.
  Mrs. Jones is a senior citizen now. She currently receives coverage 
through the Medicare Program.
  Could I do an aside on Medicare, Madam Speaker, just for a moment: 
Because I am fascinated by some opponents of this who say we do not 
want a Government-run health care program.
  First of all, the program, the House leadership plan, is about as 
least Government-run as possible. It is based upon private health 
insurance and the private market and using market forces and 
competition to keep prices down. It does set up a Medicare Part C 
Program though. Those who say that, the others, and it is the same 
voice, they then beat their breasts and say they do not want anything 
to happen to Medicare.

  What is Medicare? Medicare is a single-payer system run strictly by 
the Federal Government. It is an employer mandate in which every 
employer contributes a certain percentage of payroll and every employee 
contributes a certain percentage of payroll. So what you have is one of 
the most popular health delivery systems in the country today, is 
single-payer run by the Government, employer mandate, and incidentally 
has total freedom of choice for the consumer. The senior citizen is 
able to choose his or her doctor, his or her hospital, his or her 
provider.
  Anyway, Mrs. Jones is on Medicare. She would, under the House plan, 
continue to get her coverage through the Medicare Program. She knows 
it. She does not want anything to happen to that Medicare card. Nothing 
does happen. She would continue to have a choice of plan with 
unrestricted choice of doctors, or if she chooses, she could enter a 
managed care plan. She, though, however, would now, and all senior 
citizens, would receive a new prescription drug benefit that would 
provide unlimited drug coverage, outpatient pharmaceuticals, one of the 
most pressing needs for many of our senior citizens. She pays the first 
$500 for her prescriptions. There is a 20-percent copayment. She would 
never pay more than $1,000 a year on prescription drugs and would pay a 
premium for this of roughly $8.50 per month.
  She receives, in addition, annual mammograms, receives better mental 
health benefits, beginning in the year 2003, so you can see, Madam 
Speaker, the long phase-in period we have, the limit on the total 
amount she might have to pay each year. She would see a slowdown in 
increases in what she is paying in part B premiums, and she would be 
eligible to participate in a new home and community based long-term-
care program.
  Long-term care, as one of the gentlemen was saying earlier, nursing 
home care, is one of the most expensive costs in health care today. 
Long-term care at home is much better for the patient and much better 
for the pocketbook as well, and there is significant improvement in 
that under this.
  What about the self-employed person, the self-employed farmer? Let us 
take Fred, a self-employed farmer. Under the House Democratic plan, and 
for self-employed people right now, health care is often the luxury 
they cannot afford.
  First of all, he would be able to choose coverage under either a 
private plan he goes out and negotiates for. He could take Medicare 
Part C. If he chooses Medicare Part C, he then pays his share into it, 
and he has a choice of a plan offering an unlimited choice of doctors 
or managed-care plan. He can choose a private plan offered through the 
Federal Employee Health Benefits Program, much like every Federal 
employee and Members of Congress use today in which there is a pool of 
private plans, and once a year you can choose the plan that is best 
suited to your needs, whether it be an HMO, health maintenance 
organization, whether it is a PPO, whether it is a fee for service, 
high option, low option, you name it, you pick it.
  He would have access to fair community rated insurance prices under 
each of these options. They could not discriminate against him because 
he is rural, or because he is maybe urban, or because he is 45 versus 
25. He would deduct 80 percent of the cost of his premium for himself 
and his family; he could deduct it as a tax deduction. Presently a 
self-employed person is not able to take any tax deduction for the cost 
of their insurance. The 25-percent deduction expired the first of this 
year. He would be able to take now 80 percent. He would receive help 
paying for his premium if his household income is below poverty level. 
He would have greater access to more and better rural health care 
facilities.

  So what is now unattainable to self-employed persons now becomes 
something easily within reach.
  Mrs. Smith works in a small company, small business here, and is 
currently insured. Now, under that, I want to congratulate Mrs. Smith's 
employer. A small business providing health insurance is a very, very 
difficult obligation. It is often 30 to 40 percent more costly than the 
same policy negotiated by a larger company, but the paperwork is more 
awesome, particularly because small businesses do not have personnel 
departments. So she presently has insurance in her small company under 
100 employees.
  Under the House Democratic plan, Ms. Smith would receive coverage 
under either her employer's private plan, a private plan offered 
through the Federal Employees Health Benefit Program, once again, all 
private insurance. If the employer chooses not to offer coverage, she 
could choose Medicare part C, and if her employer chooses Medicare part 
C, Ms. Smith will have a choice of a plan either fee for service, 
unrestricted choice of physician, or she can opt for a managed-care 
plan. She could have the option, if the employer offers it, of the 
medical savings account.
  Once again, under every scenario, first of all, the employee has two 
things they do not have today. They have guaranteed insurance. They do 
not have that today. They also have far more choice than they have 
today.
  Today the employer negotiates for the policy and says, ``This is the 
policy. Here is your obligation. Take it or leave it.'' Here you have a 
number of options. She would have benefits that will be the same or 
better. Her employer will pay 80 percent of the cost of the premium, 
and she gets assistance based upon her income. She has no premium 
obligation if her household income is below the poverty level or if she 
is an SSI or AFDC recipient, she never loses coverage if she loses her 
job or if she or her family get sick.
  Let me talk about the small business employer for a second. To those 
who want to talk about how this is going to be a job killer, to the 
fact that small business employers, Ms. Smith's employer, will not be 
able to pay, remember that for the small business employer there is 
significant assistance, while required to pay 80 percent of the cost of 
the premium, at the average wage in the company and the number of 
employees is below a certain level, then they would get additional 
assistance. They could get up to 50 percent of the premium as a tax 
deduction, meaning they are only paying 40 percent of the cost of that 
premium.
  So that is a significant saving for the employer and making it 
possible for many small business employers to offer the same or better 
policy at the same or lesser rate.
  Now, let us see, we are running through these. Dr. Jones is a primary 
care physician in a rural town. This hits home to me, Madam Speaker, 
obviously, representing one of the most rural States east of the 
Mississippi. Under the House Democratic plan, Dr. Jones would see 
several important changes.
  First of all, he would see Medicare bonus payments for providing 
primary care services in rural health professional underserved shortage 
areas. They would be doubled from 10 percent to 20 percent, incentive 
to get physicians into medically underserved areas.
  Physicians providing services in rural health professional 
underserved shortage areas would be eligible for a tax credit, a 
credit, that is a dollar off of taxes, not a dollar of deduction but a 
dollar off of taxes, a tax credit of $1,000 per month, and nurse 
practitioners and others, physician's assistants and certified nurse-
midwives, would be eligible for a tax credit of $500 per month.

                              {time}  1850

  Number of doctors practicing in rural areas will be increased under 
the National Health Service Corps. Substantial additional Federal 
operating support for rural community and migrant health clinics, 
community health network program created make it easier for the 
delivery of primary care.
  One billion dollars a year available to rebuild and expand capacity 
of health care facilities serving underserved areas. New funds provided 
for the development of managed care plans in rural areas. Reimbursement 
for Medicaid patients, Medicaid, serving the low-income person. Rural 
areas will be significantly increased in this amount as these patients 
are brought into private plans.
  That is the other thing. Medicaid patients, right now Medicaid does 
not reimburse the full cost of service. A Medicaid patient would now 
have a card that would reimburse at a much higher rate. So that is 
another incentive for practitioners and hospitals to serve these 
patients.
  Currently, uninsured patients will be covered. So you can see that 
for Dr. Jones there is significant economic incentive now to be in that 
medically underserved area that presently does not exist.
  Hospitals, one of the great concerns is what happens to hospitals. 
Under the Good Health Hospitals, under the House Democratic plan, it 
has something that is not now available, it would have something under 
the House Democratic plan it does not presently have. There is no 
guarantee of payment today. Under this plan, there is guaranteed 
reimbursement for all patients. Presently, the average hospital, 5 
percent of costs are provided for free; more significantly, a much 
larger percentage than that of costs for what people are able to pay 
does not cover the cost of their care. The hospital either eats it or 
shifts it to all other ratepayers, particularly those with private 
insurance.
  There would be greatly increased reimbursement for Medicaid 
recipients. There would be much less--hospitals would be less affected 
by adjusted Medicare cuts. There would be a significant reduction in 
paperwork because you have simplification here, administrative 
simplification, single forms, single uniform forms that are being used 
instead of a cornucopia of forms that different insurance companies and 
governmental entities use. There would be simplified billing and 
reimbursement processes, and they would receive more money to rebuild 
and maintain their facilities.
  One of the great concerns is for teaching hospitals, medical schools 
for instance. There are provisions in this legislation that would 
recognize the special role that teaching hospitals fill, and they would 
assess a fee of 1 percent of payroll that would go into a fund that 
would be applied to teaching hospitals to make sure our Nation's 
research continues to be of the best quality in the world.
  So these are some of the scenarios, how the House Democratic plan 
would play out. Let me just conclude as I began, Madam Speaker: That 
is, to those who urge delay, to delay another year, another 2 years, 3 
years, means all these people get delayed. How much longer before the 
family in Jefferson County with two children, with a rare blood 
disease, where parents, both working, had to quit their jobs because 
their insurance would not cover those children?
  How long until they get coverage? How long until the utility 
executive I talked to a couple of months ago who was frightened to 
death because his company is changing insurance carriers and he may not 
be able to have his children, who have a preexisting condition, covered 
under the new carrier?
  How long until many of the other stories that each of us knows, how 
long until those glass jars that I see on the countertops in fast-food 
outlets and convenience stores raising money for somebody's kidney 
dialysis or somebody's heart problem or somebody's hospitalization, how 
long until those are removed? That is what delay is all about.
  Madam Speaker, I urge there not be talk of delay. It has been thought 
through, it is a methodical process. The time to act is now, not only 
for the scenarios that I outline here, but for all the men and women of 
our country.

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