[Congressional Record Volume 140, Number 109 (Tuesday, August 9, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                THE SUCCESS OF HAWAII'S HEALTH CARE PLAN

  The SPEAKER pro tempore (Mr. Poshard). Under the Speaker's announced 
policy of February 11, 1994, and June 10, 1994, the gentleman from 
Hawaii [Mr. Abercrombie] is recognized for 60 minutes as the designee 
of the majority leader.
  Mr. ABERCROMBIE. Mr. Speaker, at this time I would like to yield to 
the gentleman from Idaho [Mr. LaRocco].
  Mr. LaROCCO. Mr. Speaker, I thank the gentleman from Hawaii for 
yielding. I had asked the gentleman from Michigan if he would yield 
during this special order. I did not have my own time tonight, and the 
gentleman from Michigan would not yield to me, and I am very happy that 
the gentleman from Hawaii [Mr. Abercrombie] yielded to me.
  I was going to raise the issue during the prior discussion on the 
floor here when the gentleman from California said that the majority 
party had violated rules. I was simply going to ask the question: What 
rules? Instead of coming to the well of the House and saying the rules 
have been violated, I simply was going to clear the record, but there 
was no citation of any rules, and that was sort of the tenor of the 
debate and the discussion we heard before.
  Let me simply say to my colleagues from Hawaii that I came to the 
floor tonight to listen to a new group of Members of the House, to hear 
some fresh ideas, to hear something that might be imparted to us as 
fellow Members of the House and fellow legislators about some 
enthusiasm for solving the problems in the United States, for 
responding to the needs of the country, and what I heard was embracing 
the status quo, obfuscation, obstructionism and just plain old 
emotional appeals about what is going on here in the House of 
Representatives, and I was absolutely astounded, I might say, to hear 
the----
  Mr. KINGSTON. Will the gentleman yield?
  Mr. ABERCROMBIE. Mr. Speaker, I believe the time is mine and not the 
gentleman in the well's opportunity or obligation to yield, and, given 
the fact that we were unable to get time previously, I think we ought 
to take the time now. So, I do not think it proper to yield at the 
present time.
  The SPEAKER pro tempore. The gentleman from Hawaii [Mr. Abercrombie] 
has yielded to the gentleman from Idaho [Mr. LaRocco].
  Mr. LaROCCO. Mr. Speaker, I thank the gentleman from Hawaii for 
continuing to yield to me.
  But I heard this emotional appeal, both toward the Members on the 
floor and, I guess, to the American people, that something is going to 
be ramrodded down someone's throat here.
  I looked at a clipping from the Washington Post from 1992 saying that 
the Bush administration did not want to deal with the question of 
health care. It was absolutely astounding to me, and I think that is 
one of the reasons why President Bush, then-President Bush, was not re-
elected, because he did not want to come to grips with the problems, 
and the gentleman from Hawaii and I, we held town meetings in 1991, 
1992.
  I remember in Napa, ID, 300 people came out to talk to me about 
health care. Two hundred fifty people came out to talk to me in 
Lewiston because they had concerns. I had truck drivers who were out of 
work who cried at those town meetings because they lost their health 
care benefits, and now I listen to so-called fresh ideas that were 
supposed to come to the floor of the House tonight, and all I hear is 
that we do not want to deal with preexisting conditions, we do not want 
to deal with pharmaceuticals and drugs for senior citizens, we do not 
want to deal with long-term health care, we do not want to deal with 
choice, we do not want to deal with cost containment, and we do not 
want to deal with deficit reduction. We just want to come to the floor 
and say, as my colleagues know, something is going on here that is not 
right.
  Well, what is going on here is hard work, and I thought that what I 
would hear from our colleagues who recently joined us in the House of 
Representatives, that I came here to work, I came here to work hard, I 
came there to work double shifts, I came here to work weekends, and now 
what I hear is that people do not want to work on the bills that have 
gone to the committees of this House to deal with health care.
  I do not know why there is not that kind of commitment to hard work 
when the work has been done in the committees, and all we see are the 
stacks of bills, so called--as my colleagues know, it is too tough to 
read. Well it is not too tough to work. It is not too tough to work.
  Mr. ABERCROMBIE. I will yield time at the end of the gentleman's 
presentation if the other Members on the floor would kindly wait until 
the end of his presentation.

                              {time}  2140

  Mr. LaROCCO. I remember the gentleman from Michigan would not yield 
to me when I had a question about what they meant about the majority 
breaking the rules of the House. I have had a question about what rule 
and if I could get a citation. I could not get anybody to yield to me. 
I thank the gentleman for yielding.
  I am going to conclude by saying I came to this body to work, to 
resolve the problems that are facing the American people. We have a 
head start on this issue because we are in our third year of deficit 
reduction. The economy is in a ``go'' mode, consumer confidence is up, 
inflation is down. We have seen 5 million people in America in the 
first year refinance their homes. They have embraced this economic 
recovery, and the second stage in economic recovery and deficit 
reduction is the health care reform plan. I hope that we can come 
together here and resolve this issue.
  I thank the gentleman for yielding to me. I thought I would hear some 
new ideas, but I heard that some people do not want to work and they do 
not want to come together and help us resolve this issue. I thank the 
gentleman from Hawaii for yielding to me.
  Mr. BUYER. Will the gentleman yield to me?
  Mr. ABERCROMBIE. Certainly.
  Mr. BUYER. The gentleman from Hawaii [Mr. Abercrombie] is one of the 
gentleman I respect in this body in the health care debate.
  Mr. ABERCROMBIE. We have some short-term debates ourselves.
  Mr. BUYER. To the gentleman from Idaho [Mr. LaROCCO] on the 
characterization on how he spun this, I think I must award you the spin 
master of the year award. Those of us that came to this body as 
freshmen are greatly upset right now with how health care is trying to 
be rammed down without having the opportunity for us to actually jump 
into the Gephardt bill. That is our disappointment that is expressed 
here. Many of us support the Rowland-Bilirakis bill. For you to stand 
here and say that we do not support preexisting conditions, that we 
don't want to address the access, we don't want to address cost 
containment, is a complete farce and is false. When we stand here and 
say we support the Rowland-Bilirakis, we want to reform preexisting 
conditions, address the issue of portability and job lock, and have 
greater integration in health care, both vertically and horizontally, 
to address greater risk pooling of businesses out there so that 
businesses can provide affordable health care to the employees, have 
the Medisave accounts, specifically address the issues of tort reform 
and medical malpractice reform, fraud abuse. The list is endless. We 
just want that opportunity to have substantive incremental reforms in 
the present system without having the government take over.
  Mr. ABERCROMBIE. I will be happy to add to the list, if I can reclaim 
my time.
  Mr. BUYER. I appreciate your opportunity to yield to me, and I thank 
you.
  Mr. ABERCROMBIE. When I reclaim my time, I promise you I will address 
the questions you raised in the previous hour. I hope I will address 
them in a straightforward manner.
  Mr. BUYER. I thank the gentleman.
  Mr. HORN. If the gentleman will yield 30 seconds, I thank the 
gentleman. As he knows, I have been on his side in a few of these 
rights. He is one of the most eloquent speakers in the House.
  Mr. ABERCROMBIE. I understand you have been forgiven by your 
colleagues for that on more than one occasion.
  Mr. HORN. I would say to the gentleman and his colleague from Idaho, 
you made a mistake when you said this group of freshman don't want to 
work. I know who has been in the subcommittees and the committees of 
this Congress. There has usually been plenty of us as freshmen on 
committees of 25-plus, the chairman and ranking Republican member, on a 
few committees on which I serve, and we put in our time. I see a lot of 
absentees. I see them in both parties.
  I think you picked on the wrong group. We didn't talk about not 
wanting to read, not wanting to do the work. We talked about wanting to 
read, wanting to go through those thousands of pages, wanting to know 
what is in them. And if one of you can tell me what is in the Clinton-
Gephardt bill that has not yet printed, I will be grateful to hear it, 
because you are the only person that knows that I have talked to in the 
majority party.
  What we object to is the process. We are not talking substance right 
now. I happen to have been for universal health care coverage since 
1951. I don't know if you were born then or not. But I was for it as of 
1951.
  Mr. ABERCROMBIE. Are you addressing me?
  Mr. HORN. I know you were, Neil. But the fact is, a lot of us have 
spent a lot of time in different roles on these particular issues. And 
what we do not like is the violation of representative government when 
people design these things in the back rooms, don't share, no 
bipartisan cooperation. In the Senate, 30 years ago, we had constant 
bipartisan cooperation on Medicare, civil rights, voting rights, you 
name it.
  Mr. LaROCCO. If the gentleman would yield, I wanted to get some time 
so I could ask you what rule the majority has violated. You said they 
violated a rule. Could you cite that rule to the House? You said they 
violated a rule.
  Mr. HORN. What I have said is they not only insulted our constituents 
by not permitting time for consultation, as far as I am concerned they 
insulted this House. And I am amazed that more of you are not upset 
about it, because we do have an orderly process.
  Mr. LaROCCO. They didn't violate a rule; you don't have a citation of 
a rule then?
  Mr. HORN. Where is the reference to this new bill nobody knows about?
  Mr. ABERCROMBIE. I think I will reclaim the time and try to address 
the principal question, if it is all right with everyone, about the 
sense of urgency.
  I think if I was to hopefully summarize and characterize the previous 
discussion, it was that of the Democrats in general, although if there 
is to be a bipartisan approach on this, it obviously would involve not 
only the Democrats, but the Republican and our Independent Member, 
perhaps are exhibiting what might be characterized, in fact was 
characterized in context as the Democrats are displaying a sense of 
urgency that is perhaps not quite appropriate to the weight of the bill 
in one instance, the literal weight of the bill, and the substance of 
the bill.
  I would like to take issue with that, and I am going to be joined in 
that by my colleague, the gentlewoman from Hawaii [Mrs. Mink] who 
preceded me in this body and was instrumental in the passage of some of 
the previous legislation, including Medicare.
  I would like to bring before those who remain here in the House, and 
before the country and the rest of the Congress who may be watching us 
and listening at this time, a bit of the history, so that we can 
understand that the reason we have this sense of urgency is that this 
is not a new question, and that the elements of the Gephardt bill, 
again hopefully characterizing and summarizing what was said by our 
Republican colleagues previously, that the substance of the Gephardt 
proposal, the Democratic proposal to come before us, has in fact been 
discussed at length, has in fact had numerous hearings over the better 
part of half a century.
  As my good friend, the gentleman from California [Mr. Horn] 
indicated, he had an involvement here as a member of the staff of the 
Congress as far back as 1951, if I remember----
  Mr. HORN. Not 1951, 1965.
  Mr. ABERCROMBIE. I beg your pardon--1951 was the proposition of 
universal coverage. I might say that in Hawaii, the question first 
arose in 1947.
  I am going to be using for my reference, Mr. Speaker, and for those 
who remain, a book that was printed published under the auspices of the 
Hawaii Medical Services Foundation, a book called ``The Aloha Way: 
Health Care Structure and Finance in Hawaii.'' It is written by the 
well-known health policy analyst and advocate, Emily Friedman, of 
Chicago, IL.
  I think, Mr. Speaker, that those who would examine Ms. Friedman's 
credentials will find that there are very few, if any, individuals in 
the country better prepared to write this history of the health care 
structure and finance system in Hawaii.
  Let me move most directly then, given the time that we have, and 
hopefully to bring down the level of rhetoric, if you will, on this 
issue, to the actualities.
  In this instance I ask my colleagues and people across the country to 
take a deep breath, sit back for a minute, listen to some of the 
history in a State that has already had prepaid health care, universal 
coverage, based on employer participation with the employees, for 20 
years. This information has been routinely made available, not only to 
Members of this Congress, but as my colleague, the gentlewoman from 
Hawaii [Mrs. Mink] will attest, to individuals and groups all across 
the country.

                              {time}  2150

  This is not a new proposition. In the next few minutes, I will 
explain that this agenda of universal health coverage had its origins 
in Hawaii just about the time that Harry Truman first proposed national 
health care for the whole country. So if there is a sense of urgency in 
trying to get this passed, it has to do with two very simple things.
  We are approaching the end of this Congress and it would seem to me 
entirely suitable and entirely appropriate that after a discussion that 
has taken place since at least 1948, that we should, as responsible 
individuals, certainly as responsible legislators in a national body 
such as the House of Representatives, be prepared to finally conclude 
this debate.
  We had what is termed in Ms. Friedman's history, and I will be 
quoting both directly and paraphrasing Ms. Friedman as I move along in 
the next few minutes, that two statutes, and I want to indicate, as I 
go along, and I will enter into the record at the appropriate point, 
Mr. Speaker, that our bill, far from being 1,400 pages long and maybe 
over the passage of all these past 20 years it needs to be that long, I 
do not know, but I concerned about the principles that are involved.
  Our bill is only 10 pages long, approximately, only 10 pages long. 
The study upon which the law was based is only about 95 pages long. So 
we need not complicate this process.
  I am here as the beneficiary of those who have come before me in our 
lifetime, the people who put this plan together 20 years ago are still 
participating in the political process, still contributing to the well-
being of our citizenry.
  We had two plans: the Prepaid Health Care Act, very simple concept, 
very simple proposition, Prepaid Health Care Act; and the State health 
insurance program, which has since been improved into our Health Quest 
program.
  In other words, we have gone from 1974 with the Prepaid Health Care 
Act 20 years ago to 1994, and our Health Quest Act, which brings our 
health coverage in Hawaii up to date literally up to the minute. The 
Health Quest program will be completed September 9, 6 weeks after its 
inauguration.
  In the 1970s, Hawaii had pursued four goals: workers compensation, 
unemployment compensation, temporary disability insurance, and 
universal health coverage. Workers compensation had been passed in 1915 
and expanded in 1963. Unemployment compensation in 1939, later also 
amended. Temporary disability insurance in 1969. What remained in the 
early 1970's then was to accomplish universal health care insurance for 
all.

  This set the stage for the passing of the Prepaid Health Care Act of 
1934. I know there are lots of names for what we are trying to do right 
now, universal coverage, Health Security Act.
  Mr. Speaker, for all the people of the United States, all the 
taxpayers, all the citizens out there in the United States, this is 
prepaid health care. That is all it is. No more, but certainly no less. 
This is not some strange idea.
  Mr. Speaker, $124 million has been spent on advertising, eagerly 
seized by the networks, I might add, all of which blurs, masks, and 
creates a fog of fear, suspicion and disinformation in the body public 
and in the body politic here in our country.
  When you see, Mr. Speaker, advertisements where you have people 
pretending to have health insurance, worrying about government programs 
or government rationing of health care or government taking over the 
health care system, remember, just as there was an ad, an advertisement 
that many of us know about, ``I am not a doctor, but I play one on 
TV,'' well, we have people on television now saying, ``I do not really 
have health insurance. I do not really have health insurance that I can 
count on being there every day, but I pretend that I do on 
television.''
  There are actors. And most actors do not have health care insurance 
beyond the job possibly that they have that day. The second that they 
are off the set, they are out of the health care picture. Do not be 
fooled by all of the corporate/private interests that are on television 
today, spending an unprecedented amount of money to try to pretend that 
a health care system that covers every one, that meets some fundamental 
principles, all of which the President has addressed in his bill, all 
of which Mr. Gephardt has addressed in the Democratic bill that will be 
coming forward, all of which are addressed in the single-payer bill, 
for that matter, all of these principles are embodied, all of them 
exist already in Hawaii, all of them have existed for 20 years.
  Two studies were done in the late 1960's. One resulted in the passage 
of that which I previously mentioned, temporary disability insurance. 
The second study was on the health insurance plan.
  The author of the principle study was Prof. Stefan Riesenfeld of the 
University of California at Berkeley. He had drafted workers 
compensation legislation in Hawaii. We were familiar with him in 
Hawaii. He had done a lot of work. He was familiar with our political, 
our legislative leaders in Hawaii and had done good work on the 
temporary disability system and so he was asked to do the study.
  Very, very interestingly, Professor Riesenfeld concurred with the 
funding of the Hawaii Medical Service Association, which is, for 
purposes of reference, is the equivalent of the Blue Cross-Blue Shield 
that you may be familiar with here on the mainland. They found, 
Professor Riesenfeld and the Hawaii Medical Services Association found 
Hawaii an ideal experimental site for universal employee coverage 
because we already had out there at that time the Kaiser Permanente 
system, the health maintenance organization, and the Blue Cross-Blue 
Shield in the institution of the Hawaii Medical Services Association.
  The only people who objected vociferously, as Professor Riesenfeld 
says, ``the commercial insurers hated me.'' I will repeat that again, 
``the commercial insurers hated me.''
  There was a very good reason. He was not there operating on behalf of 
the commercial insurance companies whose business it is to take the 
maximum amount of premiums away from you as an individual, away from 
us, and to retain the maximum profit and return as little as possible 
in services. That second Riesenfeld report was called the ``Prepaid 
Health Care in Hawaii'' report. It was submitted to the legislature, 
the Hawaii legislature in January 1971.
  Professor Riesenfeld concluded, and I am quoting ``at present 
voluntary prepayment plan coverage does not extend to a substantial 
portion of the population.''
  The report, Mr. Speaker, discussed a full spectrum of options from no 
action at all on to a health care system based on the British model.
  The report, however, settled on two alternatives: expanding Medicaid 
to cover more of the population or, and I am quoting, ``extension of 
the existing system of prepayment plan coverage to additional 
categories of employees on a contributory basis, with or without a 
premium supplementation scheme.''
  The report recommended that last. Mr. Speaker, the essence of the 
plan, Democratic plan is coming forward in-corporates that same 
principle, that same underlying foundation principle. That principle is 
in President Clinton's plan. That principle is in the Democratic plan.
  Basic principles were added then to that foundation, and they are as 
follows.
  Every regular employee in private employment should be protected by a 
prepaid plan providing for hospital, surgical, and medical benefits. 
The level of benefits should conform with the prevailing community 
standards. Unless a collective bargaining agreement or self-initiated 
employer's policy provided for an allocation of the costs should be 
shared equally by the employer and the employee. The prescribed 
coverage was to be provided to any of the existing prepayment plan 
operators regardless of whether they provided services such as the 
Kaiser system or other medical group plans as the Kaiser system or 
other medical group plans such as the Hawaii Medical Services 
Association, either on a nonprofit principle, like HMSA, or a similar 
organization or the profit principle such as the commercial carriers.

                              {time}  2200

  They had their chance. The scheme and the plan was not intended to 
interfere with the collective bargaining process or interfere with any 
agreements that had already been made, or any collective bargaining 
agreements that might be achieved in the future. The free choice of 
physician was protected.
  Finally, Mr. Speaker, in order to avoid any oppressive burden on low-
wage earners or their employers, the mandatory plan in Hawaii was 
coupled with a plan for premium supplementation from general revenues. 
This was to enable the small employer, the employer of a small number 
of employees, to be able to afford the insurance 20 years ago.
  If there is a sense of urgency on our part, I think it is well 
founded. I assure you my colleague, the gentlewoman from Hawaii [Mrs. 
Mink] and I find it passing strange that we should have to explain over 
and over and over again to our colleagues that what is being proposed 
has already been in existence for all intents and purposes in Hawaii 
for 20 years, 20 years; that the coverage of those who are not 
otherwise eligible for participation with their employers--because they 
may be unemployed, because they may be on general assistance, because 
they may have other difficulties or disability which prevent them from 
working and otherwise be eligible, perhaps they are in a gap group 
where they earn a certain amount of money and their eligibility under 
Medicare is not quite clear--all those particular factors that may 
affect an individual or a group of people or a family we have now taken 
care of with our Health Quest program, which grew out of our State 
insurance plan that we put into effect in the late 1980's. So that we 
have, again, contrary to the propaganda that comes forward, whether 
intentionally or on the basis of misinformation or uninformed opinion 
or judgment, both in this body and in newspapers of general circulation 
and elsewhere, that somehow we do not have 100-percent coverage in 
Hawaii, we have 100-percent coverage in Hawaii. We have had it for the 
past 20 years.
  Mr. Speaker, those principles that I have just enunciated have been 
put forward in our plan. It was not easy to pass. Again, if we have a 
sense of urgency, we have been through this already. We are happy to 
make available to anyone here in the Congress the benefit of our 
experience in these reports, and I have here from the Journal of the 
State of Hawaii the actual discussion and passage of the bills; again, 
not very lengthy, because we had done the homework. We have been doing 
the homework for a number of years.
  Mr. WALKER. Will the gentleman yield?
  Mr. ABERCROMBIE. Yes, of course, I yield to the gentleman from 
Pennsylvania.
  Mr. WALKER. I just wanted to ascertain, Mr. Speaker, based upon the 
discussion that I was hearing from the gentleman, whether or not the 
reasons that he is giving for the Hawaii bill or for the Hawaii program 
are the reasons why Hawaii chose to opt out of the national health care 
plan that we are in the process of developing.
  Mr. ABERCROMBIE. I would be happy to answer that, but I yield to my 
colleague, the gentlewoman from Hawaii [Mrs. Mink], because I am afraid 
the gentleman has mischaracterized the Hawaii position. We will be 
happy to elucidate the issue for you, because I know you are eager to 
have the proper information.
  Mrs. MINK of Hawaii. If the gentleman will yield, that issue has been 
raised a number of times by not only Members on the gentleman's side 
but by the general public that has heard that statement repeated in 
talk shows and other television programs.

  As the author of the provision in the bill that came out of the 
Committee on Education and Labor with respect to the opportunity for my 
State to obtain an exemption, that is not properly characterized as an 
automatic opt out.
  As a matter of fact, what is required under the amendment which I 
presented to the committee, which was adopted, is that the five basic 
elements of the legislation--and I hope those elements will be retained 
upon final enactment--must first be secured by the State of Hawaii 
before it can even apply for an exemption. There is not an automatic 
opt out. There must be an application which asks the Secretary to 
determine whether those things which we would like to be released from, 
because of 20 years of experience, are appropriate.
  Mr. WALKER. Would my State be eligible?
  Mrs. MINK of Hawaii. Before we can do that, we have to have the same 
benefit package, we have to have the same cost containment, we have to 
have the same data collection, we have to have the same quality 
control, and we have to have the same employer mandate.
  Mr. WALKER. Would my State be eligible?
  Mrs. MINK of Hawaii. I don't know whether your State would be 
interested in such a requirement.
  Mr. WALKER. Mr. Speaker, I am asking the question, if we were, would 
we be eligible under your amendment?
  Mrs. MINK of Hawaii. Under my amendment, I only sought the 
opportunity for my State to make such an application.
  Mr. WALKER. It was only for one?
  Mr. ABERCROMBIE. Reclaiming my time, if the gentleman will give me 
the opportunity to continue with my presentation, I will point out why 
Hawaii is in this position. I will get to the ERISA waivers.
  Mr. WALKER. I just had one more question, if I could, Mr. Speaker.
  Mr. ABERCROMBIE. I would answer the gentleman's question about 
whether he would be eligible or not. If you would help us pass national 
health care, it would be a moot point.
  Mr. WALKER. If the gentleman would just answer one more question.
  Mr. ABERCROMBIE. Certainly.
  Mr. WALKER. Is the same exemption provision likely to be part of the 
Gephardt bill?
  Mr. ABERCROMBIE. When you say ``exemption provision'', I'm not sure 
what you are talking about.
  Mr. WALKER. The gentlewoman has just explained that she had an 
exemption provision, but in the Committee on Education and Labor bill.
  Mrs. MINK of Hawaii. It is an application to the Secretary to ask for 
exemptions for certain----
  Mr. WALKER. It only applies to Hawaii.
  Mrs. MINK of Hawaii. For certain procedural aspects where it would be 
redundant and unfair to apply to a State that has already had 20 years 
of experience in a prepaid plan.
  Mr. WALKER. I understand that, but it only applies to Hawaii.
  Mr. ABERCROMBIE. Yes.
  Mrs. MINK of Hawaii. Because no other State has such an employer 
mandate.
  Mr. ABERCROMBIE. The answer, of course, is to the degree it does 
apply to Hawaii, I wish it would apply to Pennsylvania. If you would 
enact a health care plan in Pennsylvania that at least meets the 
minimum standards of Hawaii, you would not have to ask the question.
  Mr. WALKER. We are reasonably proud of our health care plan in 
Pennsylvania, too.
  Mr. ABERCROMBIE. We are very proud of ours.
  Mr. WALKER. I understand that. We would like the same kind of 
treatment, the same kind of ability to go for an exemption.
  Mr. ABERCROMBIE. You need only, I assure the gentleman, pass the 
Democratic plan and you will have it. That is true bipartisan 
cooperation.
  Mr. WALKER. I would say to the gentleman, that is not the case. We do 
not know what the Democratic health plan is. We have yet to see it.
  Mr. ABERCROMBIE. Reclaiming my time, I will be happy to explain it to 
you.
  Mr. WALKER. Has the gentleman had a chance to see it?
  Mr. ABERCROMBIE. Yes, of course I have.
  Mr. WALKER. You have had a chance to read the Gephardt plan?
  Mr. ABERCROMBIE. I have had a chance to understand completely what is 
in the Gephardt plan.
  Mr. WALKER. You have actually seen the Gephardt plan and have had a 
chance to read it?
  Mr. ABERCROMBIE. I have had an opportunity to see all of the 
elements, as you have, Mr. Walker.
  Mr. WALKER. No, have you seen the Gephardt plan? Have you had a 
chance to read it, and does it contain the Hawaii exemption?
  Mr. ABERCROMBIE. I will reclaim my time and answer the question, Mr. 
Speaker.
  The answer to the gentleman's question is that we will be able to 
provide, with the Gephardt plan, a health care system equal to that of 
Hawaii for Pennsylvania as well. I realize that the gentleman----
  Mr. WALKER. That does not answer the question.
  Mr. ABERCROMBIE. I have reclaimed my time, and I am sure the 
gentleman has had ample opportunity in other times during special 
orders to make his points known. If you will give me the opportunity, 
kindly cede me the opportunity to more fully answer your question, I 
will, and so will the gentlewoman from Hawaii.
  Mr. WALKER. Yes, Mr. Speaker.
  Mr. ABERCROMBIE. Thank you. The principles enunciated in the 
Democratic plan, which will be forthcoming, in detail; you cannot have, 
after all, the printing of the Ten Commandments before they are brought 
down from the mountain by Moses.
  I do not think the gentleman from Missouri [Mr. Gephardt] would claim 
the mantle of Moses. He does not resemble Mr. Heston very much in that 
regard, but the process is the same.
  Mr. Speaker, every essence, everything associated with the plan, has 
been discussed in great detail. The actual embodiment of those 
principles, proposals, and plans in bill form I understand will be 
available as early as tomorrow.
  Mrs. MINK of Hawaii. Will my colleague yield?
  Mr. ABERCROMBIE. Yes, of course, I yield to the gentlewoman from 
Hawaii.
  Mrs. MINK of Hawaii. In listening to the discussion that preceded 
ours, I am sure the audience is left with an impression that Members of 
the Congress have not had an opportunity to study and deliberate and 
consider all the various ramifications of the health reform plan.
  As a matter of fact, the Congress has had almost a year to deal with 
all of the essential features that are still on the table, that are 
still up for discussion, and will obviously be a part of the leadership 
presentation which we hope to get tomorrow.

                              {time}  2210

  My own Committee on Education and Labor has had the bill in our 
committee for almost 4 months. Every day we went to the committee 
meetings, and page by page that bill was read and it was discussed. We 
had experts there to explain all of the provisions. We did that not 
only once in the subcommittee but again in the full committee. Besides 
all the deliberations of dozens and dozens of amendments that were 
proposed and debated, certainly the members of that committee had an 
ample opportunity to understand all the features not only of the 
Clinton plan but also the ultimate mark that our chairman, the 
gentleman from Montana [Mr. Williams] produced, which was quite 
different. The Committee on Ways and Means did essentially the same 
thing. I watched much of it on television, where the gentleman from 
California [Mr. Stark] was presiding as the chair of the subcommittee 
and they read the bill page by page. It was a tedious process, but I 
defy Members who are interested in the process, why were they not 
watching? If they were not members of the subcommittee, they could have 
done what I did. I stayed up and I watched the discussion that went on 
in the Committee on Ways and Means. Because I was interested to hear 
all the different points that were being made with respect to all of 
these different provisions.
  I submit that the Committee on Energy and Commerce probably did the 
same thing. We had opportunities to hear some of the debate over on the 
Senate side. We have had an ample opportunity, and we should have taken 
those opportunities to study the legislation as it were being presented 
to us, first the Clinton bill, then the bill that came out of Education 
and Labor, then the bill that came out of Ways and Means. And it is the 
leadership's responsibility now to produce the 218 votes. I cannot do 
that. I do not have that magic wand that can suddenly produce a 
compromise piece of legislation that is going to be able to garner the 
majority votes of this body. That is a complicated thing. But certainly 
we are not starting from scratch, Mr. Speaker. We have had this bill 
here for consideration for over a year, and those of us who have taken 
the time to study the various issues, employer mandates and alliances 
and all these other features, have been able to understand how this 
process has finally brought us to the point where we are.
  We are here tonight, my colleague the gentleman from Hawaii [Mr. 
Abercrombie] and myself, because basically I am thrilled that over the 
last month and a half or so on television, nightly, sometimes 4 or 5 
times a night on television, the major networks, I see the floating 
palm trees of Hawaii and a discussion about our Hawaii plan. ``If 
Hawaii can do it, why can't the Nation?''
  That is really why we are here tonight, to try to explain to those 
who are interested, to find out that yes, indeed, the State of Hawaii 
20 years ago did enact an employer mandate legislation.
  Admittedly a lot of the materials that we have disseminated and 
distributed come from our State. I have heard Members of the opposite 
side disparage the fact that I am constantly talking about the Hawaii 
plan, constantly using it as an illustration. But the point of fact is, 
is that my State is the only one thus far that has enacted an employer 
mandate program, and, therefore, it is important to know what happened. 
We do not need to just listen to the agonies and despairing comments 
about what would happen if we had an employer mandate? We have had one 
for 20 years in the State of Hawaii and it has worked.
  Members do not have to take my word for it. If my colleague will 
yield further, because there was such an interest in the Hawaii prepaid 
health plan in Hawaii, the GAO was summoned to do a study. Certainly I 
had nothing to do with the conclusions the GAO report found, I had no 
part in writing it. I did not know what conclusions were going to come 
out of such a study in advance, but the GAO was requested by the 
gentleman from Michigan [Mr. Dingell] to conduct a study. The 
conclusions there are dramatic. It says, ``Hawaii has the highest level 
of insurance coverage of any State.'' And it comes out with a 
percentage, of something like 3.75 percent only are not covered.
  If we listened to what my colleague said, since this study was taken 
from the 1991 figures, since then, with the implementation of SHIP and 
QUEST, we now can very comfortably say 100 percent of the people of my 
State are in some program or another if not in the employer mandate 
part which is private insurance.
  Mr. WALKER. Will the gentlewoman yield for a question on the study?
  Mrs. MINK of Hawaii. I would be happy to yield.
  Mr. WALKER. Could you tell me what the study said in terms of your 
coverage?
  Mrs. MINK of Hawaii. The coverage, it says here, I will read exactly. 
``Estimates of the percentage of Hawaii's residents lacking health 
insurance in 1991 ranged from 3.75 to 7 percent in comparison to the 
national average of about 14 percent.''
  Mr. WALKER. That is still less than the 100 percent that the 
gentleman talked about.
  Mrs. MINK of Hawaii. If you had listened to what I had said, you will 
hear that what has happened subsequent to 1991 is the collaborative 
agreement which was permitted to take Medicaid funds and to incorporate 
it into a program that covered everybody.
  Mr. WALKER. So this study is only as good as the portions of it which 
you happen to agree with?
  Mrs. MINK of Hawaii. No.
  Mr. ABERCROMBIE. Mr. Speaker, I will reclaim the time, I will answer 
the question, and I think that we should move on from this.
  If the gentleman persists in mischaracterizing the answers, we are 
not going to really accomplish anything here, other than to demonstrate 
to the people of this Nation and to our colleagues who are watching 
that there is less interest in achieving a bipartisan resolution of 
this issue than there is in trying to score points, points which I may 
tell the gentleman can be easily refuted.
  The General Accounting Office report states very, very clearly that 
this is a result of the employer mandate bill which we have had in 
effect since 1974. It was never expected that this passage of the 
prepaid health care bill would be able to cover everyone in the State 
who was not eligible under the original law. The fact that we have 
achieved this incredibly high ratio on a law 20 years old which did not 
apply as I indicated to those who were not otherwise eligible under it 
I think is absolutely remarkable.
  What it shows is that 100 percent of those who were eligible to be 
covered under our law in the first place were covered. Those who are 
not otherwise eligible have been covered, either by Medicaid or by 
other such plans that were federally imposed. What we are saying is 
that we have as a result of the Medicaid waiver been given the 
flexibility to put together a State plan which operates complimentarily 
with those already in existence, and they are private insurers. The 
same companies, the same health providers, the same insurers that 
operate with our employers and our employees rushed eagerly to bid for 
and be appointed those who would implement the rest of the plan to 
cover 100 percent of all the people, regardless of those who would 
otherwise be ineligible under the prepaid health care plan of 1974. We 
never amended the bill, except for certain benefits that were put in 
other than for administrative purposes.

  There is no bureaucracy. As a matter of fact, I will pursue at this 
time, then, the rest of my presentation. There is no government 
bureaucracy. In fact, the bill itself, as I said, less than 10 pages 
long, the bill itself indicates that the act is meant to be for the 
most part self-administering. And that is what it has been.
  Mrs. MINK of Hawaii. Will my colleague yield on that point, which I 
think is really the telling point on the success of the Hawaii plan.
  In the 20 years, and my colleague will agree, in the 20 years of the 
existence of this prepaid health plan, the State of Hawaii has had to 
add only 2 employees in the Department of Labor to administer this 
program. Two positions. That is it. So to talk about employer mandates 
and the enactment of a health reform bill is going to create a huge, 
monstrous bureaucracy is absolutely not so.
  We have been able to accomplish our universal coverage literally 
without the addition of any government personnel whatsoever, just two, 
to handle the routine paperwork.
  Mr. ABERCROMBIE. All of the opposition, Mr. Speaker, at that time, in 
1974, the tenor of the opposition, the origin of the opposition, has 
all manifested itself again in this debate.

                              {time}  2220

  The same business entities and institutions, sometimes using the same 
words almost exactly, some of those of the major employers, the major 
industrial employers, what were known as the Big Five, the great 
companies that controlled the plantations, that controlled the 
importing and exporting business in Hawaii, who were already offering 
some form of insurance to their employees at that time, they opposed 
it, as they said, and I will quote here, ``Even though they covered 
their own they were opposed to it ideologically.''
  This comes down not to a question of practicality it comes down not 
to a question of whether something is being presented too quickly. It 
comes down to a matter of ideology. Either you are in favor of 
universal coverage that cannot be taken away from people, or you are 
not. And if you are in favor of it, you have to go through a process 
that enables us to fund it, and to move it forward, and to make it 
fair, and that is what we have done. This study again written by 
someone who lives in Chicago, IL., who is self-employed, as a matter of 
fact, who has to have her own insurance, and I have talked with Ms. 
Friedman on several occasions, she was the contract employee. By the 
way, the study that I am citing I want to point out is from the Blue 
Cross/Blue Shield Hawaii Medical Association, the Health Care 
Association of Hawaii, Kaiser Permanente Foundation, Hawaii Medical 
Association made of up the medical doctors in Hawaii, the Hawaii 
department of health of the State of Hawaii and the Hawaii Community 
Private Foundation. So the publication and the hiring of Ms. Friedman 
to do this analysis and history of the Hawaii plan comes from a broad 
spectrum of State, private, and nonprofit organizations and 
individuals.

  Her study indicates then to us that there was the opposition. The 
study also then indicates that one of the reasons that the Hawaii 
Medical Services Association, the Blue Cross/Blue Shield organization 
eventually supported the legislation in the legislature was, and I am 
quoting now as one observer says, ``It's nice to have a law around that 
says people have to buy your product.'' That is what we are doing here. 
This is private insurance that is being offered, not whether there can 
be an argument for other forms of insurance. I do not know. One of the 
litmus tests, if you will, of whether or not we can move forward with 
health insurance at this time for everyone in America has been whether 
we can incorporate the private system.
  Now I will grant you, and as a matter of fact not only grant to you, 
Mr. Speaker, and grant to those who bring up the question, but in fact 
I invite them. There is competition for this, and what happens is that 
commercial insurers are the ones who opt out. The commercial insurers 
who are interested primarily in being able to extract premiums, high 
premiums, and pay back very little in the way of services, or perhaps 
even remove insurance from people. What happened was that upon the 
passage of this bill, and by the way, it did not take 6 months to 
implement it. It was 6 months from the signing of the bill, from June 
1974 to January 1, 1975. January 1, 1975, we implemented the bill. We 
implemented universal care, universal insurance in Hawaii, in 6 months' 
time. That is all it took. Now, we did this. This is not a proposal. 
This is not something we dreamed up. It is not a novel. It is not 
fiction. It is history. This is the reality. This is what was done.
  In that 6-month period what happened was very, very simple. Those 
insurance companies who had no real interest in actually providing 
insurance at the lowest possible rate to the maximum number of people, 
and actually engage in providing health insurance that worked, left the 
marketplace. They left the marketplace. They chose not to compete. And 
those that were left did of course compete. And what we have in Hawaii 
today, and I think this is very, very important for our colleagues to 
understand, and for the people across the Nation to understand, what we 
have now is competing private insurance in Hawaii that strives to give 
people the lowest possible price for the insurance.
  Now Hawaii, as everyone knows, is a series of islands in the middle 
of the Pacific Ocean. We cannot get from island to island in our 
counties. Representative Mink represents, I represent urban Honolulu 
and she represents what could be called rural Honolulu, rural Oahu, the 
island of Oahu, all of the island of Oahu that is not constituted in 
the First District that I have the honor to represent, all of the 
neighboring islands. We cannot drive to the neighboring islands. Some 
of us are strong enough to swim, but not very many. But it takes crews 
of very strong paddlers to be able to get an outrigger canoe and get 
between some of the islands, so we have to fly. In other words, it is 
very, very difficult so our expenses are high in Hawaii, because we 
have to ship everything in either by air or by long distance in the 
sea, and then we have to transship by barges to what we call the 
neighbor islands, to our friends and neighbors on the neighbor islands. 
So our expenses are very high.

  The one thing that is lower, in fact lower than all of the expenses 
of all of the rest of the Nation is health care, despite all of the 
difficulties in delivery. And I can assure you that Mrs. Mink spends a 
good deal of time in an airplane after she gets to Oahu, and a good 
deal more time after that in an automobile traveling around the 
hundreds and hundreds of miles that are required to get around the rest 
of the Second Congressional District of Hawaii.
  So we have great distances to cover. We have great expenses to cover. 
Yet, the cost of our health care plans remains significantly lower than 
the rest of the United States, the rest of those States on the 
mainland.
  So the opposition, which was quite vociferous at the time, indicated 
among other things, and this is an ironic note to add at this point, 
that the Hawaii Medical Association in the end was opposed to the bill 
because, as they said, the chairman of the Hawaii Medical Association 
Legislative Committee in the National Government, and this is of course 
1973, said,

       The National Government is already moving in the direction 
     of a national health insurance program which seems likely to 
     become law within the next year or two. It would seem foolish 
     for the State of Hawaii to embark on a program that perhaps 
     would be superseded by Federal regulations within a short 
     period of time.

  So you see, as far back as 1973 the Medical Association, the 
Association of Physicians was anticipating the passage of this 
legislation, saying that we would not have to have this program. So 
when we are asked well, why is Hawaii in the position of trying to make 
certain that the national bill that we are proposing is going to 
incorporate that which Hawaii already has, you can see that we have 
anticipated again and again, and I will be able to give further quotes, 
Mr. Speaker, where it was anticipated when we made some changes in our 
health care approach that again that the Congress would be passing 
national health care legislation, and so it was not necessary for us to 
move in this direction.
  After a while we got the message that it was going to take perhaps 
the experience of a demonstration project to show that it was possible 
to have national health care. So if anything, we do not stand here 
tonight in some superior attitude or in some patronizing kind of 
attitude towards the rest of the country and say look, did we not do a 
terrific job, and why do you not just follow in our wake. On the 
contrary, what we think is that to the degree as happens often in the 
Congress a demonstration project is commanded or is needed or is found 
to be useful that please, look upon the Hawaii experience and 
experiment, because that is what it has been, both an experience and an 
experiment, look upon it as a demonstration project that has worked 
and, as a result, perhaps then we can utilize this experience and the 
result of this experiment in a way that manifests itself in the bill 
that will be coming forward.

                              {time}  2230

  Mr. WALKER. If the gentleman will yield, I thank the gentleman for 
yielding. He has been very generous. I appreciate that.
  Did Hawaii, in their demonstration project, have any experience with 
people who wanted to opt out of the plan for religious reasons?
  Mrs. MINK of Hawaii. No. Not that I am aware of.
  Mr. ABERCROMBIE. Not that I am aware of. I will tell you who was 
exempted at the beginning if you will give me a moment to find it.
  Mr. WALKER. The reason why I raised the question is that----
  Mr. ABERCROMBIE. There were some Federal employees and others were 
exempted.
  Mr. WALKER. Because they had a plan. But let me just give the 
gentleman a sense of experience from my State that probably would not 
apply in Hawaii. But it probably yet has some relevance to adopting 
universal coverage. I have a large group of Amish in my district. 
Amish, because of their religion, do not believe in insurance. To 
participate in an insurance program is a violation of their strongest 
religious beliefs. If, in fact, we are to pass a national health care 
plan that requires universal coverage, you would have to have the Amish 
coerced into the program against their religious principles. I would 
suggest, I am simply suggesting, that that is a difference out there 
that we will find a number of in the Nation that would not fit the 
demonstration.
  Mr. ABERCROMBIE. I understand. Reclaiming my time, I say to the 
gentleman from Pennsylvania [Mr. Walker], because I believe we only 
have 5 minutes left, and I would like to answer the question and yield, 
in turn, to the gentlewoman from Hawaii [Mrs. Mink] to provide an 
answer.
  Mrs. MINK of Hawaii. The Committee on Education and Labor did provide 
an exclusion for the Amish because of their religious belief.
  Mr. WALKER. Then you do not have universal coverage.
  Mrs. MINK of Hawaii. Well, I think that is a matter of semantic 
debate at this point as to exactly what universal coverage is. If we 
make an exclusion for a certain group, that does not mean that we have 
not made an attempt to include everybody. Including of everybody, we 
decide that because of religious commitments and other kinds of 
reasons, that they should be excluded. It does not mean that we have 
failed to enact a bill that is universal. It is universal. It considers 
everybody, but in doing so, found for other reasons to leave out 
certain people.
  Mr. WALKER. But they have to have some other access to the health 
care system, which means you have to design special exemptions, and 
there are going to be a lot of other people. The only point I was 
making was the demonstration in Hawaii does not exactly apply if you 
take all the rest of the experiences we have around the Nation.
  Mr. ABERCROMBIE. If I can reclaim my time, I am certain there will be 
details to be discussed so we can properly respect the multicultural, 
multiethnic, multireligious, multiracial society we have. We have a 
rainbow of people in Hawaii, and we have a rainbow of people in the 
United States.
  In that context, I assure the gentleman from Pennsylvania that I 
trust all of us will be sensitive to the special needs that might exist 
in that.
  Let me conclude very quickly, Mr. Speaker.
  In the remaining time then, for the moment, I would like to summarize 
then what it is that has been accomplished by the Prepaid Health Care 
Act in Hawaii.
  It has set a floor below which no person in Hawaii will be allowed to 
fall. I think that is fundamental. After all the rhetoric is out of the 
way, we are taken care of in here. We find ourselves in a very good 
position.
  I noticed that many of the people who find themselves commenting on 
it and analyzing it on television, all of them are covered by health 
plans. All of them would be loath to see that health plan to fall away 
from themselves.
  All I am saying is, is it not good enough? I have heard the 
discussion here let us not have a health care plan in America that is 
any less then what Members of Congress provide for themselves. Well, in 
the State of Hawaii, we provide for everyone. No one in this country 
should be allowed to fall. No one in this country should be uncovered. 
It defines a basic benefits package. Long before the idea was 
fashionable, we had it in Hawaii.
  It enfranchised thousands of people. It gave them confidence. It gave 
them security. It gave them a sense of independence. It gave them 
dignity. Nothing in the world makes you feel more vulnerable than to 
think that you cannot provide for your own, that you are not able to 
provide those things that are necessary to sustain the basic dignity of 
the individual, and your health is the most fundamental element in that 
dignity. We enfranchised that, and it has not been misused. It has not 
been misused.
  Government here has been the partner of the individual and the 
families of this State and of this country, and it can be with the 
passage of the national health care bill.
  We have simple, predictable claims patterns. We have simple, 
predictable coverage. We have simple, predictable protection in Hawaii, 
and the health care bill that is coming forward on this floor tomorrow, 
as presented by the Democratic majority leader, is meant to provide 
exactly that kind of simple, predictable, certain coverage, and we 
implore and enjoin and request our colleagues on the Republican side of 
the aisle to join with us and pass national health care.
  It will not be a situation in which anyone will be left out. It will 
be a situation in which we are all in this together. Failure to do 
this, as I conclude, Mr. Speaker, would be as follows: We have a 
fundamental choice, and this is what it is. Either we are going to say 
to the American people, ``You are on your own,'' or we are going to say 
to the American people, ``We are all in this together.''
  I implore my Republican colleagues to choose the latter. Let us all 
be in this together. Let us pass national health care.

                          ____________________