[Congressional Record Volume 140, Number 110 (Wednesday, August 10, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 10, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                     HEALTH CARE REFORM FOR AMERICA

  The SPEAKER pro tempore (Ms. McKinney.) Under the Speaker's announced 
policy of February 11, 1994, and June 10, 1994, the gentleman from 
South Carolina [Mr. Clyburn] is recognized for 60 minutes as the 
designee of the majority leader.
  Mr. CLYBURN. Madam Speaker, I would like to thank you on behalf of 
our fellow freshmen colleagues for allowing us to participate in 
special orders tonight. Joining us tonight are our colleagues from 
Georgia--Congressman Bishop and Congresswoman McKinney, from 
California--Congresswoman Eshoo, our colleague--Congresswoman Clayton 
from North Carolina, and from Mississippi, our distinguished colleague, 
Congressman Thompson.
  Since we were elected almost 2 years ago, we have learned many 
things. We have voted on many significant pieces of legislation. And we 
have listened to many debates. However, few of these are as important 
as the debate raging today over health care reform legislation and what 
is right for our country. Just yesterday, I was in my district in South 
Carolina for the primary elections. As most of my colleagues probably 
do, I got up early and visited voting precincts throughout the 
district.
  As I did, I noticed the large number of people who had come to cast 
their votes, some before going to work. There were people in uniforms 
belonging to the local utility company, there were nurses on their way 
to hospitals, there were business men and women heading to their 
offices and to their plants.
  These people are no different from the millions of others in our 
country who work hard to make a living for themselves and their 
families. These people are no different from others in that they 
deserve affordable health care insurance that can never be taken away.
  While greeting these voters as they slowly moved through the lines, I 
was reminded of some recent figures on uninsured Americans. In my 
district alone, there are 94,000 people from working families who have 
no health insurance and 4,000 people living in the Columbia area alone 
who lose their health insurance each month.
  Twenty-six thousand of these uninsured in my district are children. 
The uninsured are the people who have unexpected medical emergencies 
and need preventive care, they are children who have ear infections and 
need childhood immunizations that should be covered under their 
families' health insurance plans.
  Last night, during his evening health care message, President Clinton 
mentioned the studies recently done for the Catholic Health 
Association. I would like to commend the association for compiling this 
nonpartisan, up-to-the-minute information about the state of health 
care insurance in our country, and my colleagues and I would like to 
share some of this information with you tonight.
  Currently, there are 37 million uninsured people in the United 
States. If we pass health care legislation without universal coverage, 
there is no way to guarantee that these middle-class, working Americans 
and their families will have health coverage they can never lose.
  Take a look at this pie chart. It is a very simple chart and the 
message is very clear. The gold portion represents the 1.1 million 
currently uninsured Americans that will receive coverage under a plan 
with insurance market reforms. That's a very small piece of the pie.
  If you look at the blue portion, you will see about 40 percent or 
13.8 million of the uninsured Americans who will receive insurance when 
subsidies are added for low-income populations.
  After taking these 2 pieces of the pie, there is still an enormous 
red slice containing 22.3 million Americans who will remain without 
health care coverage. This piece of the pie is too big to think we can 
get away with passing any kind of legislation with less than universal 
coverage.
  Madam Speaker, I yield to my distinguished colleague, the gentlewoman 
from California [Ms. Eshoo].
  Ms. ESHOO. Madam Speaker, I thank the gentleman from South Carolina, 
who, in addition to the great service that he renders on behalf of his 
constituents here in the House of Representatives, also serves as the 
president of the freshman class of the second year of the 103d 
Congress. Actually, this evening, Madam Speaker we have our president 
from the first year of the 103d Congress, and you will be hearing from 
her shortly.
  Madam Speaker, we have heard a lot in the last several days about the 
problems with reforming our health care system incrementally. That 
means step-by-step, piece-by-piece, the piecemeal, slow step approach. 
Yet many of our colleagues continue to insist that we should only 
tinker with the system, rather than pass meaningful reform.
  Therefore, tonight, I want to spend my time talking about what the 
differences are if in fact we tinker with the system and take an 
incremental approach, versus what most Americans have heard about and 
talk about themselves, and that is universal coverage, wherein all 
Americans would be brought in under the tent and be covered, and what 
the financial consequences are under both scenarios.
  Madam Speaker, let me pose a question to all of my colleagues. That 
is, do any of us want to go home to our constituents and tell them that 
they have to pay more for health care? I don't think so. I sure as heck 
don't want to go home and tell my constituents that.
  I don't want to have to pay more. I don't want my constituents to 
have to do that. That is why I support comprehensive reform, which 
guarantees private health coverage for every United States citizen, and 
will reduce the average health care costs for the middle class.
  Madam Speaker, what seems counter intuitive to most people is that by 
bringing everyone in, that it would supposedly cost more. However, I 
would like to pull from a recent study. These are not my numbers, these 
are the numbers that were produced, as I said, very recently by the 
Lewin-VHI, the largest nonpartisan health care research organization in 
our country.
  Their study confirms that incremental reform is a short-term, short-
sighted solution. Madam Speaker, while it may seem politically 
palatable for some, it would hurt the very people we are trying to help 
the most, and that is the middle class of our Nation.
  As this chart illustrates, Madam Speaker, the study shows that 
incremental reform would force families making between $20,000 and 
$30,000 a year, and there are many families where that is the income, 
to pay more than $200 more a year, not just $200, but $200 more a year 
than what they are paying now in their annual health care costs. 
Families making between $30,000 and $40,000 a year would have to pay 
almost $345 more a year for their family premium.
  Madam Speaker, you can see this very well on the chart. It is not a 
complicated chart. I think Johnny Carson could have used this, because 
it has a lot of clarity; not to make jokes with, but because it is very 
clear in terms of what it is stating.

                              {time}  2010

  Those making between $40,000 and $50,000 a year would pay almost $140 
a year more for their premium, and those making between $50,000 and 
$75,000 a year would pay $75 a year more on health care costs. Maybe it 
does not mean that much to them because they are way up there in terms 
of their annual income, but suffice it to say that it is more than 
less.
  In other words, if we pass an incremental health care reform plan, 
more than half of all the families in the United States will spend more 
on health care and it will hit the middle class the hardest. The middle 
class is usually the group that picks up the brunt of most things, 
anyway, and I do not think the 1990's is the time to do that. I think 
that we stand tall and stand next to the middle class and say enough is 
enough and let us bring everyone in under the tent.
  In contrast, if, in fact, we bring everyone in, the universal 
coverage approach linked to cost controls, which is very important in 
our system and employer/employee contributions, I believe that everyone 
needs to pay something--no one should get off for free--this would 
lower spending on health care for every family making less than 
$100,000 a year. That takes in a lot of families in the United States 
of America.
  As the chart shows, those families making between $20,000 and $30,000 
a year would pay approximately $40 less, those making between $30,000 
and $40,000 would pay $165 a year less, those making between $40,000 
and $50,000 a year would pay almost $150 less per year, and families 
earning between $50,000 and $75,000 per year would pay $115 less. These 
are for the premiums.
  For those who are watching this at home, I know that you have heard 
for more than 2 years so much about the health care debate. It is a 
huge one, it is complex, but if we are wondering why there is so much 
debate about the controversy if comprehensive reform achieves these 
results, I will tell you why: Over $50 million has been spent to date 
by the special interests in this country advertising, advertising, 
advertising, and not only planting the seeds of suspicion in the 
American citizen's mind but to make you fearful. This is the largest 
sum of money that has ever been spent to lobby a single issue before 
the Congress of the United States in the history of the Congress. This 
is not called the health care industry for nothing. So what we need to 
look at and why I brought onto the floor this evening indisputable 
numbers by the most respected, nonpartisan health organization, and 
these numbers I present to you.
  I believe that we need to have guaranteed private health insurance 
coverage that cannot be taken away. There are those that will tell you 
that Congress should proceed cautiously and not attempt to cover 
everyone. But who is that ``not everyone''? Is that you? Is it your 
family? Is it your child?
  In my district, there are 88,000 working individuals from families, 
88,000 workers, not welfare individuals, but workers. Of that 88,000, 
13,000 are children. None of them are covered. They either cannot 
afford it, it is not made accessible to them through their employment, 
or they have a preexisting condition or someone does in their family 
and they simply are not eligible. I do not really think that is the 
American way. That simply is not fair and I know that we can do better.
  While this again seems counter intuitive to bring everyone 
in and the costs go down, let me explain this for a moment.
  Higher costs drive younger, healthier people out of an insurance 
pool. We have seen that happen. It has been demonstrated in many 
States. If, in fact, we bring in those that are more vulnerable and 
keep the younger, healthier people in the mix, it lessens the risk pool 
of those that are being insured and, therefore, the premium comes down.

  In contrast, if all of us cannot be covered, obviously the premiums 
will go up. I believe, along with so many others, and poll after poll 
shows that the American people want everyone covered. I think it is 
time for Congress to act. I think the moment of truth has arrived. We 
have debated, we have had our public hearings, we have certainly heard 
much from our constituents. I urge my colleagues to deliver what the 
American people really want. They do not want a $50,000 ad campaign. 
Instead, they want us to stand next to them, to the middle class, to 
the workers of this country and their families and once and for all say 
to them that no insurance company can take your insurance away from 
you, that we will all be covered by private insurance plans, a solid, 
good plan for the solid, good citizens of this country.
  Mr. Speaker, I would like to thank the president of our freshman 
class, the gentleman from South Carolina [Mr. Clyburn], who serves with 
great distinction for bringing us together once again on this I think 
one of the greatest domestic issues facing our Nation and as freshmen I 
think we are going to help make history, not just shape the bill, but 
make history by passing legislation that is truly meaningful, 
worthwhile and noble for the American people.
  Mr. CLYBURN. Madam Speaker, I thank the gentlewoman from California 
[Ms. Eshoo] for giving us such a concise and clear picture of what is 
going to happen with the people of the middle class if we fail to do 
universal coverage with our health care reform.
  Madam Speaker, I yield 8 minutes to the gentleman from Georgia [Mr. 
Bishop].
  Mr. BISHOP. Madam Speaker, I thank my colleague, the gentleman from 
South Carolina [Mr. Clyburn] for organizing this special order on 
health reform and the need for universal coverage.
  I would like to thank my colleague, the gentlewoman from California 
[Ms. Eshoo] for helping to explain how health care reform will fail 
without universal coverage. Not only will premiums be driven up so that 
they are unaffordable for even middle class Americans, but reform 
without universal coverage will fail because it will destabilize our 
insurance markets and it will make insurance unaffordable for many of 
America's businesses and families.

  This is what I would like to discuss tonight. If Congress passes a 
health care reform bill that attempts to provide universal coverage 
incrementally rather than immediately, we will not be providing a 
prolific health care reform measure that will grow to cover all 
Americans. Rather, we will be providing a sparse reform measure that 
will increase premiums and decrease the collective number of insured 
individuals.
  In a recent study prepared for the Catholic Health Association, Lewin 
VHI, which undertook the study, said that universal coverage reduces 
consumer exit and entry into health insurance markets because if people 
can move freely in and out of the system, the healthy will tend to 
avoid insurance coverage until they get sick.
  To the extent that this issue is not addressed in a real reform 
proposal, premiums are driven up, encouraging more people to become 
uninsured. The result is the vicious, upward spiral that is shown on 
this illustration.
  Step one. Under reform plans that attain universal coverage 
incrementally, by certain dates and with so-called triggers, insurance 
reforms will extend coverage to sick and high users of health care. 
This will allow many people currently without coverage to become 
covered. I applaud that result. That is great. However, there is an 
inescapable reality that will occur when we include the sick and the 
high users of medical care without providing 100 percent universal 
coverage.

                              {time}  2020

  Under this plan, utilizing community rating, the newly insured sick 
will drive up average premiums for the currently insured. This is the 
beginning of the vicious upward spiral. These higher premiums will 
naturally cause healthy individuals and firms currently with plans to 
drop their coverage.
  Why? Because under a plan that requires coverage for those in need, 
there is no reason to pay for it when you are healthy. Under an 
incremental plan, it is fiscally illogical for a healthy individual to 
continue to pay escalating health insurance premiums and stay on a 
plan. The reform system will allow them to reenter the insurance pool 
when they need health care, when they are sick, when paying for health 
care makes no sense to them. For healthy people to continue paying for 
insurance when it is in fact guaranteed later when they might need it 
would be merely earning more and more of their own money by buying an 
insurance plan with rising costs.
  What happens next? When these healthy people and companies begin to 
leave their plans, the insurance resource pools will shrink and the 
average cost per customer will increase. This will cause premiums to 
rise yet again, the upward spiral caused by incremental reform. Fewer 
and fewer healthy people will remain on plans, premiums will continue 
to skyrocket, and insurance pools will shrink while the average cost 
per customer rises.
  Do not think for a moment that this will die down, because it will 
not. The spiral will be perennial and will be as damaging to the 
insurance markets as a tornado is to a home in its path. The goal of 
universal coverage will be nothing but a pipe dream because healthy 
people will never spend money on expensive premiums to join a plan. 
Only when they become ill or in need of medical assistance will they 
join.
  This is the ironic impact of expanded insurance availability without 
universal coverage.
  Universal coverage, Mr. Speaker, is the only way to avert this 
problem by including healthier, lower cost individuals in the insurance 
pool, thereby holding down average premiums.
  In a June 15 study that explains this phenomenon, the Wall Street 
Journal called the notion of a reform plan that prohibits insurance 
companies from increasing rates for the sick who are at risk of 
accumulating stacks of medical bills, ``the health care proposal 
everyone loves. There's just one problem with the idea,'' the Journal 
continues, ``Experts insist and real life evidence shows it probably 
won't work without universal coverage.''
  This is not just theory, but it is reality. Let us look at facts.
  Signs of this impact are already evident in the State of New York. 
According to the State's insurance department's own data, 25,477 fewer 
people, fewer people had insurance in the individual and small group 
market at the beginning of this year than when community rating and 
other nonuniversal coverage reforms took place 9 months earlier.
  Why? According to the Journal, New York tried community rating 
without a law requiring everyone to have health insurance. The result 
has been a rise in insurance premiums for healthier individuals. 
Consequently, those healthy people left their health care plans 
figuring they either will not need to have coverage or they will be 
able to get it at a reasonable rate when they do.
  Mr. Speaker, our attempt to reform health care will be not only 
fruitless and senseless without immediate universal coverage, but 
harmful to insurance markets as well. We need universal coverage, and 
we need it immediately upon passage of any health reform measure.
  In Georgia, in the Second Congressional District that I represent, 
our people need health insurance coverage desperately. We are 
determined to do whatever is necessary to fairly and impartially and 
rightfully provide for decent Americans' health insurance. If every 
criminal can be afforded a lawyer regardless of ability to pay, 
certainly every decent, hardworking American can be guaranteed 
universal health insurance coverage.
  I thank the gentleman from South Carolina for organizing these 
special orders.
  Mr. CLYBURN. Mr. Speaker, I thank the gentleman from Georgia [Mr. 
Bishop] for giving us such a good, comprehensive statement of what can 
be expected to happen with our insurance markets if we fail to have 
universal coverage as we move to reform our health care financing 
business.
  Mr. Speaker, I yield to our distinguished colleague, the gentlewoman 
from North Carolina [Mrs. Eva Clayton] the first-year president of the 
freshman class.
  Mrs. CLAYTON. Mr. Speaker, I thank you for allowing me this 
opportunity to address my colleagues in the House about the importance 
of universal coverage in any health care reform bill that we consider, 
and hopefully pass. I also, want to extend my appreciation to the 
distinguished gentleman from South Carolina and president of the 
freshman class for his leadership in organizing this debate on health 
care reform.
  I am confident of the fact that without universal coverage, any 
health care reform legislation we adopt will not solve the problem. At 
the very core of requiring all Americans to be covered, is the argument 
that universal coverage will improve the quality of health care and 
control cost-shifting. Universal coverage will correct the imbalance 
that currently exists between those who pay for health coverage and 
those who obtain coverage without paying.
  Right now, individuals farmers, small and big businesses, and rural 
hospitals all pay a very high price when someone without coverage 
obtains emergency care rather than primary care from a doctor's office. 
The cost of this expensive care is passed on to those individuals who 
pay for health coverage. Hospital prices go up when they provide 
uncompensated care which increases rates. How many of us have 
experienced paying $5 for aspirins at hospitals?
  Small businesses that currently provide health coverage for their 
employees are affected with these rate increases. In fact, in recent 
years small businesses that provide coverage for their employees have 
experienced rate increases far higher than those of large businesses, 
rising by 10 percent to thirty percent each year. This can be 
devastating to small businesses which are trying to do the right thing 
by providing this essential coverage. Without employer participation 
which I prefer to think of as an employer-based system of shared 
responsibility instead of a mandate, it is unlikely we will get to 
universal coverage. Without universal coverage, those who currently pay 
the price will continue to do so, and they will pay even more in the 
future.
  Contrary to what we have heard on TV or read from special interest 
organizations, a majority of small businesses, 58 percent, provide 
health insurance for their workers. Those who do not provide coverage 
are in the minority. Should we allow this minority of businesses to 
block passage of a universal health care system that upholds their own 
interests? Can we continue to allow them a free ride on the backs of 
the majority of small businessowners who do provide health coverage for 
their employees?
  We must recognize that there are small businesses who are not now 
providing health coverage who will have difficulty in providing 
coverage without assistance. Any health care proposal should provide 
assistance. In fact, the House health bill provides subsidies and tax 
credits for small businesses with fewer than 50 employees.
  However, the responsible small businesses that now provide coverage 
for their employees pay three times higher than they need to. This 
chart illustrates this unfair overpayment by those who can least afford 
it: First, they provide coverage for their own employees; second, they 
pay for the dependents of their employees who may work but don't get 
health care from their own jobs, and third, they pay for those 
uninsured--most of them working people--who receive health coverage in 
America's emergency rooms, whose costs are borne by the insured. I 
argue that this cost shifting is a hidden tax on small businesses that 
do provide insurance.
  I have heard from small employers in my First Congressional District 
of North Carolina that provide health insurance coverage for their 
workers. I have heard from pharmacy owners, dry-cleaner operators, and 
homebuilders among others who support universal coverage. They not only 
see the problem, they feel the problem in their pocketbook.
  Small businesses cannot be required to pay a much higher rate than 
large businesses, just because they recognize the value of insuring 
their workers and don't have the economy of scale in purchasing health 
insurance. These small businesses, realize that with the passage of 
universal coverage their rates will decrease if everyone participates 
in the health care system. No longer will some citizens be able to 
participate in America's great health care system without paying their 
fair share, without shouldering some responsibility for their care.
  We cannot allow this cost shifting situation to continue. We have the 
power in this legislative body to make a real difference, to provide 
health coverage for all Americans. I for one intend to take a stand for 
my constituents, and for all those citizens who have suffered because 
we have allowed them to slip through the cracks without a safety net to 
ensure their care.
  In my rural district in North Carolina, some 75,000 people in working 
families, largely employed by small businesses, have no health 
coverage. Of these families--there are 27,000 children--this is a 
despicable statistic. These are the individuals who will be the winners 
with a health care plan that provides for universal coverage.
  I submit to you Mr. Speaker, that health care reform that does not 
provide for universal coverage will not improve the quality of health 
for many in my district and in many areas across the nation. Without 
universal coverage we will not stop or contain cost shifting. Without 
universal coverage Mr. Speaker, we will not have health care reform.

                              {time}  2030

  Mr. CLYBURN. I thank the gentlewoman from North Carolina so much for 
giving us that very comprehensive view on what is going to happen with 
cost shifting. I think that what you have shown to us with your 
presentation is that for the middle class, if we pass health care 
reform legislation which provides universal coverage, what we will have 
is, in fact, a middle-class tax cut that everybody has been asking 
about.
  So thank you very much for pointing that out so clearly to us.
  Mr. Speaker, I would now like to yield to our distinguished 
colleague, the gentlewoman from Georgia [Ms. McKinney].
  Ms. McKINNEY. Mr. Speaker, I thank the gentleman from South Carolina 
[Mr. Clyburn] for yielding and also for organizing this special order 
tonight.
  Mr. Speaker, let me just say that health care reform is no reform at 
all without universal coverage.
  I am happy to join my freshman class members this evening as we 
underscore the need for universal coverage for everyone.
  I want to give a snapshot of the 11th Congressional District of 
Georgia tonight and to tell why Georgia's 11th Congressional District 
needs universal coverage. Presently under the current system 98,000 
people in working families have no health coverage; 82 percent of all 
people without health coverage are in working families, and, of course, 
that means that 37,000 children in Georgia's 11th Congressional 
District have no health coverage.
  With universal coverage, that means that 98,000 people in working 
families will have health coverage, 37,000 children will have health 
coverage, 33,000 women will have improved coverage for breast cancer 
screening, 5,000 2-year-olds will have improved coverage for 
immunization, 170,000 people will no longer have lifetime limits on 
their coverage, 89,000 people will no longer have preexisting-condition 
exclusions on their insurance.
  With nonuniversal reform, every middle-class family earning between 
$20,000 and $75,000 will be forced to pay on average $622 more each 
year on insurance premiums. That is 110,000 families in Georgia's 11th 
Congressional District.
  Now, in the health care reform bill that Congress will be voting on, 
there are six principles that are contained there: Security, 
simplicity, savings, quality, choice, responsibility, and after waiting 
so long and so hard, hard-working families from Georgia's 11th 
Congressional District and, quite frankly, hard-working families 
throughout America, just do not need to wait any longer for health 
security.
  The interests of the 11th Congressional District and the interests of 
this country will not be served by tinkering on the margins. Mr. 
Speaker, I believe we were sent here to Washington with a mandate from 
the people to change business-as-usual politics. We want a Government 
that looks after the needs of people.
  We anticipated resistance from the obstructionist, divisive, 
Republican gridlock gang, and quite frankly we have to fight every day 
with full force at every step of the way. Politics, gridlock, partisan 
positioning should not keep us from doing what we must do, and that is 
to perfect a health care reform bill that guarantees that health care 
will always be there when Americans need it.
  Without universal coverage, health care reform is just a meaningless 
phrase. We cannot fall short of the promise.
  Mr. Clyburn and Mr. Speaker, I would like to thank all of you who are 
participating in tonight's special order. I would also like to thank my 
staff for allowing me to be able to participate tonight. I would like 
to thank the information that came to us from various sources, 
particularly the Catholic Health Association of the United States, and 
I would just like to close by reminding you that health care reform is 
no reform at all if it does not include universal coverage.
  Mr. CLYBURN. I thank the gentlewoman from Georgia [Ms. McKinney]. I 
think that what you have shared with us about the conditions which 
could be expected in your congressional district if we fail to do 
universal coverage is something that can be repeated over and over 
again as we look at the congressional districts across the Nation.
  Now, Mr. Speaker, we want to close out this special order this 
evening by calling upon our colleague, the gentleman from Mississippi 
[Mr. Thompson], who will share with us some insight as to what we can 
expect to happen with access if we fail to do universal coverage.
  Mr. THOMPSON. Mr. Speaker, I want to thank my colleague, the 
gentleman from South Carolina, for chairing this special order this 
evening dealing with health care.
  The topic that I have is one that I think is absolutely key to the 
whole issue of health care reform in this country, and it is the notion 
that reform will fail without universal coverage. Without universal 
coverage, hospitals and physicians that serve the uninsured, the poor, 
and the elderly will be put most at risk.
  One of the things that I share often with a number of my colleagues, 
Mr. Speaker, is that I represent one of the poorest districts in the 
country, and in that district we have a number of uninsured 
individuals. I hear from hospital administrators as well as physicians 
who feel that they are bearing an undue burden on servicing the poor 
and uninsured in my district. I agree with them.
  I support the notion that in the richest country in the world that 
individuals should not have to make the choice between buying medicine 
and paying the rent or paying utility bills and going to the doctor. So 
many of the issues around universal coverage are addressed in the whole 
notion of health care reform.

                              {time}  2040

  As we talk about this, my chart will explain this to those of us 
here. It is comparing the uninsured counterparts with the insured. The 
uninsured are twice as likely to have no regular source of care. That 
means that those individuals who are without coverage basically do not 
have a doctor, do not have anybody to call when they are feeling bad, 
and consequently they are the ones that are falling through the system.
  In my district alone there are 94,000 working people who have no 
coverage at all. Of that number, 83 percent of those individuals 
without coverage are from working families.
  So what am I saying to my colleagues? Mr. Speaker, that even a number 
of the people who are without coverage are working, but they cannot 
afford the care.
  So, we have almost 100,000 people in my congressional district alone 
who are working, but who cannot afford the coverage. Of that number, 
37,000 are children, and my colleagues and I know that, as preventative 
health goes, those formative years are the years that are very 
important, even on through adulthood, but if 37,000 children in my 
district alone have no form of health coverage, then my colleagues can 
understand why infant mortality rates and other things are higher 
simply because they are not getting the prenatal and other care.
  Also the uninsured are twice as likely to use the emergency room as a 
regular source of care, and there is no question that billions of 
dollars are written off every year in this country by emergency rooms 
and hospitals because individuals are using those facilities as 
doctors' offices because, as we said earlier, they do not have a 
physician, and generally they wait until it is too late to go anywhere 
other than the emergency room, and consequently they get an $800, $900 
office visit in the emergency room.
  In my district alone, $67 million was written off last year as bad 
debt, debt that could have been paid for had we had universal coverage, 
and I say:

       Mind you, that debt is still picked up by the taxpayers 
     whether we pay for it in the emergency room or we pay for it 
     with universal coverage.

  We will pay, so I think it is clear we will have to understand that 
the notion of universal coverage is also the notion of paying for 
health care, but at a different rate. So, it is important.

  Also the uninsured are over 3 times as likely to report that there 
was a time that they needed medical care and did not get it for 
financial reasons.
  What am I saying? These individuals cannot afford it.
  So we asked them, ``The last time that you had a headache, did you go 
to the doctor?''
  They said, ``No, I couldn't afford it.''
  So any time people have to make the choices between affordability and 
how they feel, then we know that they are seriously jeopardizing their 
health.
  But also 72 to 100 percent of the uninsured are most likely to go 
without a physician visit for acute earache, recurring ear infections, 
or asthma, and that is young people. So, most of us who have children 
know that they get sick, and I ask my colleagues:

       Can you imagine in the richest country in the world, when 
     children are sick, they can't go to the doctor? Or if they 
     go, they go to the most expensive provider, which is the 
     emergency room?

  We can do better if we have universal coverage.
  One in 3 poor adolescents are not covered by Medicaid, and private 
insurance coverage for adolescents is increasingly restrictive; 42 to 
60 percent are less likely, specially among women, to receive adequate 
preventive screening of hypertension, cervical cancer, breast cancer, 
and glaucoma.
  The basic issue is that the majority of the people in my district who 
are without coverage are also women, and because of this the incidences 
of illnesses related to screening that is not taking place is greater, 
and also those illnesses, for the most part, are the ones that cost 
more money.
  And I guess in summing it up, the tragedy is that 25 percent of those 
individuals who are without insurance die prematurely. In my district 
163 infants die per 1,000 live births. We had the third highest infant 
mortality rate in the United States.
  So, in conclusion, Mr. Speaker, I offer this chart to justify having 
universal coverage. But also we have to have increased competition, and 
to have that without universal coverage can only worsen the patterns 
that presently are going on in this country.
  Lastly, I implore my colleagues that, as we discuss health care 
reform, let us make one of the main tenets of it universal coverage. If 
we do not have universal coverage, then indeed, Mr. Speaker, we do not 
have health reform.
  Ms. McKINNEY. Mr. Speaker, I think the gentleman has very eloquently 
reminded us that we are down here to do the business for the people, 
and through what he has talked about just now he reminded us that 
behind all of the statistics are very real people. We are talking about 
working people, we are talking about babies, we are talking about 
children, and this, quite frankly, is very serious business.
  We are not here to do the business of special interests. We are not 
here to do the business for special businesses. We are not here to do 
the business of particular industries. We are here to do the people's 
business, and I thank the gentleman for such a touching and eloquent 
delivery, and a reminder really for why we are here.
  Mr. CLYBURN. Mr. Speaker, I thank the gentleman from Mississippi [Mr. 
Thompson] for that very comprehensive overview of exactly what 
universal coverage is all about.
  Mr. Speaker, I thank you for allowing us the time to participate 
tonight and I thank my freshman colleagues for all of the work they 
have put into the health care reform legislation that will come to the 
House floor in a few days.
  On radios and televisions, in newspapers, and dinner conversations 
across the country--the hot topic right now is health care reform. As 
we contribute to this ongoing conversation from the Chamber where 
decisions affecting each and every one of us will be made in the coming 
days, Mr. Speaker, I remind you and my colleagues universal health care 
coverage which can never be lost should be guaranteed to every 
American, because there is no such thing as a lifetime guarantee of 
good health.

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