[Congressional Record Volume 140, Number 111 (Thursday, August 11, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 11, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

  The SPEAKER pro tempore (Mr. Lehman). Under the Speaker's announced 
policy of February 11, 1994, and June 10, 1994, the gentlewoman from 
Connecticut [Ms. DeLauro] is recognized for 60 minutes as the designee 
of the majority leader.
  Ms. DeLAURO. Mr. Speaker, before I get to my remarks tonight on 
health care reform and a discussion of health care, several of my 
colleagues were just on the floor talking about the economy, several of 
my Republican colleagues. I might just take a minute to note that I do 
not know where they got their facts from in terms of what the state of 
our economy is today, but let me just quote to you from some, if you 
will, nonpartisan folks who look at the economy on a regular basis, 
folks at Lehman Brothers.
  To President Clinton's credit early last year he rejected an either-
or construction for U.S. growth versus deficit reduction. Clinton's 
blueprint for economic revival had as its centerpiece a multiyear 
program of deficit reduction. It promised higher growth in the short, 
it promised higher growth in the short run. A move to restrain deficit 
spending, he wagered, would both lower U.S. long-term interest rates 
and energize U.S. interest-sensitive sectors. He goes on to say lower 
deficits, lower long-term rates and higher real growth was the overall 
promise. With the data now rolling in it seems clear that President 
Clinton delivered on all three counts over this second half of the 
year.
  Allen Sinai of Lehman Brothers, again as reported by the Washington 
Post: This is the healthiest American economy has been in 30 years.
  David Shulman of Salomon Brothers, as reported by the Washington 
Post: The economic recovery is now moving from Wall Street to Main 
Street. There will be less money flowing into the financial--in the 
financial economy and more flowing into real recovery.
  I just felt the need to mention some of these things because in fact 
the economy is recovering, and we have had under President Clinton 2.8 
percent growth 1993, 7.5 percent growth in the fourth quarter, 3.3 
percent projected for this year. Jobs are up 1.7 million. New private 
sector jobs, 60 percent more than during the entire Bush 
administration. The deficit is down. It has been the largest deficit-
reduction package in history. We have seen the lowest deficit numbers 
for the first time since Harry Truman held the office of President.
  So, I do not know where my Republican colleagues are getting their 
data.
  Furthermore, I just make one or two more points here. In this carbon 
Congress the House Democrats passed the largest deficit-reduction plan 
in history cutting $255 billion in spending cuts. Again, I do not know 
where they are getting their economic data, but in fact, I think it is 
more partisan rhetoric, and if you--some of my colleagues who were 
speaking are the same folks, in fact, who did not vote for the budget 
package. As a matter of fact, there was not a Republican vote for the 
budget package in this body last year.
  These are some of the same folks who were telling you that we do not 
need or we cannot have a health care reform and that health care reform 
will, in fact, do in this Nation as the Democrats have proposed it.
  They were wrong last year about the budget, and I might add that in 
fact they are wrong again about health care reform.
  Mr. WISE. Mr. Speaker, if the gentlewoman would yield for just a 
moment.
  Ms. DeLAURO. I yield to the gentleman.
  Mr. WISE. You bring up an excellent point because these are the same 
people that just a year ago in this Chamber were making dire 
predictions about the package, what would happen if the budget package 
passed. Indeed let us look. This is the third year or declining 
deficits, the first time since Harry Truman that we have had that 
situation in this country. The deficit this year is going to be 40 
percent lower than anyone projected last year. The deficit package, 
deficit-reduction package, is working and working more than anyone even 
thought.
  I was on the Committee on the Budget when it held a hearing just a 
couple of months ago with Alan Greenspan, not someone given to 
overeffusive optimism, who was saying the economy was in the strongest 
shape it had been in many years, and he saw the economy being in such 
shape that it could expect to grow in a good fashion for many more 
years. It was in the best shape he had seen it in in a long time.
  Now our colleagues, not just those who just spoke, but many of the 
others on the other side of the aisle, same crowd that a year ago were 
saying that passage of the Clinton budget package would be a job 
killer. That was one of the main words used, and they stood in the well 
and would claim, based on a study they had from some group, Joint Tax 
Foundation or some Washington almost-think tank, that in each district, 
and they would name a district, there would be X thousand number of 
jobs lost because of this package. I had got good news for my district, 
bad news for their foundation. Jobs are only growing in my State and in 
other States, and indeed it has not been a job killed, it has been a 
job creator. They said it would be an immediate recession. Instead we 
have seen job creation at the rate of four times of those halcyon days 
of the Bush administration. We are seeing a recession that is steadily 
moving--seeing an economy that is steadily moving along, not in a 
recessionary mode, even though there has been deficit reduction at the 
same time that the Federal Reserve independently has been hiking 
interest rates, and the economy is still growing.

  Those are all positive signs.
  And finally, to the largest tax increase in history, they warned us 
about that. The fact of the matter is that for the 1,600 West 
Virginians, all over $140,000 a year that did pay more taxes as a 
result of that package, 105,000 working West Virginians families got a 
tax cut, and indeed that is giving them the ability to maybe buy health 
care; that would be nice, but also to be consumers and to be consumers 
and to be fueling this economy.
  So, I think that, as we move to the health care discussion now for 
the special order you have scheduled, I am glad that we just had this 
discussion prior to this because this was the crowd saying no on the 
budget. They are now saying they do not want to do health care. Look at 
the record. Look at the record.

                              {time}  1940

  Ms. DeLAURO. Amen. Let us get on to the discussion for this evening, 
and I am delighted to have my colleague join with me this evening as we 
talk about health care reform.
  More than a year ago, we began our efforts to try to bring affordable 
health care to every American. At long last we have arrived at the 
moment when this House will begin that debate and vote on health care 
reform legislation.
  I am proud to have several of my colleagues join with me tonight, 
people who have been at the forefront of the health care reform battle, 
and who support the plan that has been put forth by the majority leader 
of this House.
  As hard as we have all been working, I think we would all agree that 
no one has worked harder than our majority leader, Dick Gephardt, and I 
would like to take a moment and commend him for his insight, his 
patience, and, most of all, for his persistence in putting together a 
plan that we can all be very, very proud of.
  Let us be clear why we are here. We are here because this country in 
fact has a health care crisis. We are here because 40 million Americans 
are uninsured and 81 million Americans have preexisting conditions. We 
are here because small businesses are paying 20 to 30 percent more than 
their larger competitors. We are here because too many senior citizens 
are forced to make the choice between prescription drugs and their next 
meal. And we are here because we have listened. We have listened to 
these countless health care horror stories from every district and 
every State in this country.
  Every single Saturday, I do office hours in my district. I go to a 
large supermarket in one of the 18 towns that I represent. People are 
notified. They come there and talk to me about what is on their minds, 
what are the issues that are of real concern to them.
  The faces are different every weekend, every Saturday morning, but 
the stories are the same, the exact same stories. Mothers who cannot 
get health care for their children, fathers who lost their jobs, and 
with them the health care benefits that they need for their families.
  So I believe we are going to pass health care reform in the House of 
Representatives. The question is whether or not we are going to pass 
real health care reform that will make things better for people, or are 
we going to pass some half-baked reform that could actually make things 
worse.

  We have a choice to make. We will all be faced with a choice in the 
next several weeks.
  Let us take a look at the health care plans that have been proposed, 
to see which of them begins to solve the problems that brought us to 
this point in the debate.
  Yesterday the largest senior citizens organization in the country 
endorsed the Gephardt bill. The AARP, 33 million members, know what we 
are here to discuss tonight, and that under the Gephardt plan, that 
Medicare is safe, that a new prescription drug benefit will be 
available for seniors, that for the first time we will see the 
beginnings of long-term care and home health care for seniors, and that 
in fact insurance companies will not be able to discriminate against 
seniors because of age or because of preexisting conditions.
  Simply put, what we are talking about here tonight is a program and a 
plan that would guarantee private insurance to every single American, 
that can never be taken away, and that is affordable.
  The other plans that are offered only give us incremental reform, 
insurance reform, and nothing else. They rely on various insurance 
reforms and subsidies for some Americans, but what they do not do is 
guarantee coverage to all Americans. And that is why they are not going 
to work.
  I would be delighted to yield to my colleague from Maryland.
  Mr. CARDIN. I want to thank the gentlewoman for taking this time and 
yielding to me. We very much appreciate the effort you have made to try 
to inform the American people about the debates that have taken place 
here in the House of Representatives.
  It is interesting the bill you are referring to, the bill that the 
majority leader has put together, is a bill that has been carefully 
scrutinized. It has gone through the normal committee process, with 
every committee that has had jurisdiction over any part of health care 
reform having the opportunity to work on the bill, having public 
hearings where the public had an opportunity to comment, where we had 
open markups that were carried live on C-SPAN where the American public 
had an opportunity to see both Democrats and Republicans working 
together on amendments to bills, trying to improve the bill, making 
reports to the House, and then the majority leader bringing together 
the work of the various committees in a coordinated way.
  The gentlewoman is absolutely correct. We have really one option 
before us. That is a comprehensive bill that has been through the 
scrutiny of public comment and the Congressional Budget Office that 
scores all that work. The Gephardt bill, the bill that he has put 
together, is a comprehensive bill that has stood the test of very close 
scrutiny, that will, I think, live up to the objectives that the 
American public will demand, and that is universal coverage, that 
everyone is insured; effective cost containment, that it is fair to all 
of our people, it is affordable, affordable to small business, 
affordable to people who need to buy insurance, whether they work for a 
small company, a large company, whether they are in the work force or 
not in the work force, and that it is well-balanced. I wanted to really 
underscore the point that the leadership bill, the Gephardt bill, has 
been through all that scrutiny, it has been carefully reviewed.
  Last night we received some substitutes that were filed by various 
individuals and groups. Those substitutes on quick review do not even 
come close to dealing with the problems. What I find very disturbing is 
that people, individual Members who have been identified with much more 
comprehensive approaches, it looks like they are backing off of that 
and going forward with a very incremental approach that will not even 
come close to dealing with the problems. It looks to me like we are 
only going to have one choice, the Gephardt leadership bill.
  Ms. DeLAURO. I thank my colleague for his comments. Earlier the 
gentleman from West Virginia made a similar point when he said there 
has been debate, there has been discussion, on a number of pieces that 
find themselves in the Gephardt bill. It has been put together. We have 
discussed these issues in this body.
  The notion that there has been no discussion on health care is so far 
from reality. If people have not had an opportunity to discuss health 
care in this body for the last 18 months, I do not know where they have 
been. They have not been doing their job.
  We have all had ample time, ample debate time, ample review time and 
opportunities to take the closest look at all of the various pieces of 
these health care plans that are being discussed. So it is really 
spurious for people to come forth today and say there has been no 
debate and discussion on these bills.
  We need to point up additionally that the whole notion of universal 
coverage, which is where the Gephardt bill takes us, to make sure that 
all Americans are covered, is key and critical. If you begin to take a 
look just at these incremental pieces, the go-slow, halfway approach 
that has been advocated by the Dole, Michel, and Gingrich bills, they 
fail the American people. The Michel bill, for instance, would only 
require employers to offer, but not to contribute to the cost of 
insurance for their employees.
  What kind of comfort does that give to those currently uninsured 
working Americans? Is it really an improvement over the status quo?
  Clearly the American public, 72 or 75 percent, believe that critical 
to passage of health care reform is universal coverage.
  The Rowland-Republican substitute would also preserve the status quo. 
The poor get health care, the rich buy insurance, and one more time, 
middle class America, middle class families, have got to go it alone.
  Mr. CARDIN. If the gentlewoman would yield, I think that point needs 
to be underscored. We have the Gephardt bill, which will get us to 
universal coverage. No one disputes that. The objective scorekeepers 
have looked at it. The groups that have taken a look at it concede it 
will get us to universal coverage, that everyone, whether they are in 
the work force or not, whether they are wealthy, whether they are 
working people, whether they are middle income, whether they are poor, 
every one will be covered. And we expand private insurance under the 
Gephardt bill. There is no question about that.
  Now, when we started this debate, I thought it was fairly well agreed 
that our goal would be to accomplish 100 percent. We would get every 
one covered by health insurance in our country.
  All of a sudden, some of the people who have been speaking the 
loudest about universal coverage are changing the goals. We heard some 
people say, OK, we can get down to 95 percent and we are OK.
  As I understand what you are saying, it is that the Minority Leader's 
bill and the Rowland-Republican substitute bill do not even get us to 
95 percent by their own projections. They are down to 90 percent, which 
they are claiming, and people are looking at it objectively and doubt 
if they will even accomplish 90 percent. We are at 85 percent today 
with close to 40 million Americans without any health insurance 
benefits.

                              {time}  1950

  If I understand correctly the alternatives that are being brought 
forward, at best we will make very little change in those numbers and 
may, in fact, if I remember listening to you on the floor the other 
day, that if we do the insurance reform, if we increase the cost of 
health insurance for the average person who currently has insurance 
today, because we do not get universal coverage and we do insurance 
reform which brings higher risk to the insurance pools, we may, in 
fact, frighten people out of the insurance market. We may end up with 
less people insured rather than more, just compounding our problems.
  Let me also point out the fact to the American people that if you 
have less people insured or if we do not significantly increase this 85 
percent, if we end up with 30 million people uninsured, that the number 
I heard on the Rowland substitute, that there still will be 30 million 
Americans uninsured when the bill is fully implemented in the year 
2002, that you and I, those who have insurance are going to continue to 
have to pay for those who do not have insurance.
  We are not going to be solving the problems that we were sent here to 
do, to stop this cost-shifting, to have a fair system, a cost-effective 
system. How can we expect health facilities to locate in communities 
where there is a large number of people who do not have insurance? They 
are not there today because they are not getting reimbursed for the 
care.
  If we do not get universal coverage, we cannot work for a more cost-
effective health care system. We cannot bring costs down. So when the 
Republican substitute or the Rowland bill does not bring us to at least 
95 percent, then we are not, I do not know why we should even really 
consider it health care reform.
  Ms. DeLAURO. My colleague is absolutely right. In the Michel bill, 
the minority leader's bill, it leaves more than 38 million Americans, 
most of them hard-working Americans, without insurance. That means that 
more than one in seven Americans, many of them children, most of them 
in working families, will have no health care coverage at all. What 
will we have accomplished?
  If we move back into the same system we have today, which only 
continues to increase the cost to everyone else, who is insured and who 
is paying for their insurance? The whole point of this was to help to 
try to stabilize costs, bring costs down today to those who are 
carrying the largest burden.
  If you only deal with the insurance reform portion of it, you then, 
once again, increase the cost for everyone else. I have a preexisting 
condition. I am a cancer survivor. If I am included in a pool, the risk 
goes up. If we only allow for the insurance reform and not make sure 
everyone else is included, then it will be those at the highest risk 
who will be in the pool; the healthy will opt out. And once that awful 
spiral will continue while the costs will continue to rise and rise.
  Any of the substitutes that are being put forward, the minority 
leader's bill, the Rowland Republican substitute, leave millions and 
millions of Americans uncovered in insurance with everyone else picking 
up the cost.
  Mr. CARDIN. If I could just emphasize one point, this is one area 
where people who have insurance or people who do not have insurance 
should be together on. Whether you are a person who has health care 
insurance today or you are a person who does not have health care 
insurance today, we are together in saying we must have universal 
coverage. The person who does not have insurance needs it, needs it so 
that that person can get access to care today. The person who does have 
insurance should be tired of paying the bills of people who do not have 
insurance. So it is critical that for all Americans that we get 
universal coverage.
  Ms. DeLAURO. I would like to make a point about, in terms of the 
Rowland Republican substitute, I mentioned that the middle class 
families are going to have to go it alone. I will just give an example. 
A typical middle income family earning about $37,000 could face 
premiums of almost $6,175 per year under the plan. The same family 
would pay $1,065 under the House leadership, under the Gephardt plan. 
That is a savings of $5,000 a year for families under the Gephardt 
plan.
  You show me a family in this nation that does not want to save $5,000 
a year.
  I yield to my colleague from Utah, Ms. Shepherd.
  Ms. SHEPHERD. I would like to point out that in my district, in Salt 
Lake County, UT, that as near as we can estimate that all the people 
that earn in between $20,000 and $75,000 a year, basically 
middle income families, each one of these families, and there are 
120,000 of them in my district, each of these families will almost 
certainly pay $600 more a year for their insurance premiums, if we have 
an approach which simply eliminates preexisting conditions and really 
makes it impossible for insurance companies to manage their costs in 
any other way except raising insurance premiums.

  If all we do is tell insurance companies that they can no longer 
exclude people from their policies, and that is the only thing that 
this Congress does, then what we are doing is absolutely guaranteeing 
that every American's insurance policy premium will be greatly 
increased.
  And, at the time that it is increased, they are going to look at 
their checkbooks and decide whether or not they can continue to pay for 
their insurance and, if they cannot, they will drop it. And then when 
they get sick, they go to the hospital. And when they go to the 
hospital, after the hospital has taken their house and their car and 
everything they own, the hospital will pass the remaining costs onto 
the paying insurers and more insurers will drop.
  This has already happened in New York. It happened in New York 
because in New York they decided they would reform insurance. They 
reformed insurance, but they did not ask all New Yorkers to be covered 
with insurance. And as a result, in New York, what is it, nine months 
later, they have fewer people insured. And those who are insured are 
paying a lot more money.
  This is a formula for a disaster in America.
  Mr. WISE. The gentlewoman from Utah makes a case study. Those who 
want to look, for example, at why incremental reform, why insurance 
reform by itself will not cut it need only look to the recent New York 
State experience.
  Also I am fascinated by those who want to create some kind of 
generational war and say they are protecting young people by keeping 
them from having to participate in universal coverage. They are not 
protecting young people.
  What happened in the case of New York State was that by enacting 
insurance reform, mainly saying you cannot deny people coverage because 
of preexisting illness but not making it apply universally, what 
happened is that young people could not afford the premiums any longer 
and opted out.
  Some young people, actually people in general said, then I do not 
need to worry about preexisting coverage because I can get into the 
pool at the point I get sick. But many young people who were on the 
margin, as far as being able to pay premiums found that now premiums 
are rising so sharply, they could not afford it and they are not 
covered anymore.
  We are all for insurance reform but we know, on this side of the 
aisle particularly, that insurance reform can only happen in the 
context of total universal coverage, guaranteed private health 
insurance that cannot be taken away, for everybody. Otherwise, 
insurance reform does not make the problem better; it makes it worse.
  Mr. CARDIN. I think we should stress that both the Michel bill and 
the Rowland so-called bipartisan bill do not provide for universal 
coverage, try to do insurance reform and will lead to the results that 
we are referring to, that the gentleman from West Virginia just 
mentioned. That is, we run the real risk that our constituents who 
currently have insurance are going to find that their premiums will go 
up substantially because both of those substitutes fail is not 
providing universal coverage and try to do insurance reform.

  Ms. SHEPHERD. If the gentlewoman would continue to yield, I would 
like to make a point about business, especially small business, since I 
owned a small publishing company for over a decade.
  I was one of the people who purchased insurance for my employees, 
because I thought it was the right thing to do. I did it as soon as I 
started the business. I did it much in the same way as I signed up for 
the utilities that we had at our company. I really did not notice it, 
that anything was happening, until years later when all of a sudden the 
bills started to rise.
  Then I also started losing bids in my publishing company. And I tried 
to figure out why I was losing these bids. And when I went out and 
investigated it, what I discovered is, I was the only publishing 
company that I bid against that had health care coverage for my 
employees.

                              {time}  2000

  So suddenly I realized we have a public policy which actually 
punishes businesses when they do the right things and carry health 
insurance for their employees.
  Mr. Speaker, I was angry about that, because I thought it was very 
unfair that I should be asked to pay for businesses which chose not to 
cover their employees, and that is precisely what I was doing. It made 
my uncompetitive, and I believe we can actually take that small 
experience that I had in my business, apply it to all of America, and 
say that very same dynamic is making America uncompetitive in the rest 
of the world, because we are the only industrialized country that we 
compete against that does not have 100 percent of its people insured.
  Mrs. UNSOELD. Would the gentlewoman yield?
  Ms. DeLAURO. I yield to the gentlewoman from Washington.
  Mrs. UNSOELD. If your competitors had been required, had had an 
employer mandate so everyone was offering insurance to their employees, 
that would not have been a disadvantage for you, would it have?
  Ms. SHEPHERD. No, No; it would have leveled the playing field, and 
then we would have been competing on level turf.
  Mrs. UNSOELD. Mr. Speaker, in this House we hear over and over again 
the cry that we must cut the deficit, and yet some of the very people 
who are expressing that and say that ``we've got to attack 
entitlements,'' the biggest runaway of entitlements, the only one is 
health care.
  The single thing that would bring the cost of health care down is 
universal coverage, employer mandate. Why should there be 85 percent of 
those who are uninsured work for a living, or are part of a family that 
works for a living, and yet they are not covered.
  Mr. Speaker, the small business employers who give benefits to their 
employees are put at an enormous disadvantage. The gentlewoman has 
illustrated it perfectly.
  Mr. CARDIN. If the gentlewoman would yield again, to compare the 
different approaches we have as to how it would deal with the problem 
that the gentlewoman raised, the Gephardt bill would deal with that by 
putting every company on a level playing field, but even going further 
than that.
  That is, the small businesses that have legitimate affordability 
problems, there is a very significant tax credit program that reduces 
the cost for small businesses that have a large number of employees 
that are of lower wage, where you could run into some of the 
affordability issues. That is provided in the Gephardt bill.
  The problem that the gentlewoman referred to would be answered. Once 
again, looking at the substitute of the Republican leader, the 
gentleman from Illinois [Mr. Michel], looking at the so-called Rowland 
bipartisan bill, neither one of those bills deals with the problem of 
small business.
  You would still be at a terrible disadvantage if you as a small 
business person attempted to insure your employees, and there is no 
help, no help at all to make insurance costs for small businesses more 
affordable. In that case, again, the substitute is----
  Ms. SHEPHERD. It is even worse than that, if the gentleman will 
yield. It is so bad that not only is there no help, if we do simply 
insurance reform, and we keep the system basically as it is today, we 
can guarantee small businesses that their insurance premiums will rise 
and rise and rise, because businesses bear the brunt of this, really.
  Ms. DeLAURO. Mr. Speaker, I think it is interesting to note that with 
the Michel bill, insurance companies will be able to charge small 
businesses more for the same exact coverage, exactly the way it is in 
the current system. Small businesses are likely to face administrative 
costs that are up to 800 percent higher than those that are paid by 
larger businesses.
  In the Rowland substitute, the premiums, once again, will be higher 
for small businesses. Those are the early predictions on what it will 
be. There are no discounts to assist small businesses, which you will 
find in the Gephardt bill, because there is an understanding. There are 
small businesses today that would like to cover their employees, and 
they are having a difficult time doing that.
  Ms. SHEPHERD. Two-thirds of small businesses do, they are doing the 
right thing.
  Ms. DeLAURO. They do. There are some that want to do that and they 
can't. What we want to try to do is to make it as easy as possible for 
small business to do that through a tax credit, to make it possible for 
them not to go out of business, which is what some of the naysayers 
will do, and both of these substitutes that we are talking about 
provide no opportunity for a small business to get the kinds of 
discounts that would allow them to prosper in their business and at the 
same time to be able to provide coverage to their workers that they can 
share responsibility in, and their employees can share part of that 
responsibility for paying the cost of health care.
  Mr. WISE. Will the gentlewoman yield?
  Ms. DeLAURO. I yield to the gentleman from West Virginia.
  Mr. WISE. The gentlewoman from Utah, who ran a small business before 
coming here, has illustrated the problems well, I think. I think what 
might be infuriating to me, had I been in the gentlewoman's situation, 
is that you are doing exactly what people would ask of you. Meanwhile, 
you are also paying for the employees of other businesses, whether they 
be competitors of yours or fast food restaurants or whoever, that are 
not doing it.
  Indeed, what is happening in the premium that you paid is that up to 
30 percent of the insurance premium that the gentlewoman from Utah paid 
for her employees did not go for her employees, it was cost shifting. 
It was picking up the tab for all the other uninsured people who went 
into the hospital and got medical care, usually at four times the cost 
if they had been able to go into a doctor's office.
  Mr. Speaker, I guess what concerns me is that the fast food pizza 
employees, the McDonald's employees, all of those, some of the most 
profitable corporations that we have, who are not covered by their 
employer, they take pride in what they do. The only problem is that 
they eventually have to go get medical care, and when they do, somebody 
else pays the tab. We are not getting off cheaply because McDonald's 
does not provide insurance for its employees. We may save 8 cents or 9 
cents on a happy meal.
  I like the happy meal. My children like the happy meal. We are not so 
happy, though, that the employee behind the counter does not have 
insurance, and we are not so happy that when we go out of that 
McDonald's store, and that employee goes into the hospital, then all of 
us as taxpayers and insurance consumers have to pay that tab.
  Mr. Speaker, I would rather pay up front, and I do not think it is 
going to be very much, and the gentlewoman and I have demonstrated in 
past presentations that the cost to a business is very, very cheap, two 
pepperoni in the case of a $10 pizza. It is very cheap, and yet it 
provides so much of what is needed. It is good economically and it is 
also good morally.

  Ms. DeLAURO. Just one point with regard to that. It really winds up 
with that business that is doing the right thing, that is, helping to 
cover their employees, winds up paying twice. They pay twice.
  Ms. SHEPHERD. Yes.
  Ms. DeLAURO. The Michel bill, the Rowland substitute, does nothing to 
stop that process, where in fact the Gephardt bill ends that process.
  Mr. WISE. The Rowland bill does have a measure in it that indicates a 
recognition that this is the way to go. What it does, though, is it is 
a hollow statement.
  It says that all employers are required to offer insurance, and 
indeed, offer a choice between a fee for service plan or a managed care 
plan. However, the employer is not required to pay for it. There are no 
subsidies to help the employee, so what you have got is this hollow 
promise out there.
  The significant thing about the Gephardt House leadership plan is 
that it has in place, for businesses under 100 employees whose annual 
income is below a certain amount, that they can receive a tax credit, 
as the gentleman from Maryland [Mr. Cardin] points out, of up to 50 
percent. They are paying 40 percent of the premium, and the low-income 
employees can also get assistance based on their income.
  Mr. CARDIN. If the gentlewoman will continue to yield, the Rowland 
bill makes it worse. Many employers will say ``All we have to do is 
offer.'' So I may be providing the benefits today as an employer, so I 
say, ``The law only requires me to offer it, and since everybody has 
the chance to buy insurance, and since my competitor is not required to 
buy insurance, why should I pay for its? You do it with your own 
money.''
  Let me just give a concrete amount of money we are talking about from 
Maryland. At the University of Maryland Medical Center, a fine 
institution in my district, the uncompensated care equals 16 percent of 
their total revenues.
  That means the premiums, the rates that they have to charge for 
services at that facility are 16 percent higher in order to pay for the 
people who have no insurance. Those of us who have insurance, the 
premiums we pay for the rates at that hospital are that much higher to 
cover those higher rates.
  So now you as a publisher, as a small business person, you had to 
compete with companies that did not provide health benefits. You were 
not only being asked to pay the cost of your own employees and compete, 
but you were being asked to pay for your competitor's employees and 
then compete against your competitor.
  That is what the current system does, and the Rowland bill will not 
change that. It may make it worse. The Michel bill won't change that. 
It may make it worse.

                              {time}  2010

  Small business has a direct interest in health care reform and only 
the Gephardt bill addresses their problems.
  Ms. DeLAURO. I would like to also talk about what happens with 
another group of individuals in this Nation who are very, very 
concerned about health care and health care coverage and what it means 
to them, and that is our senior citizens. The Gephardt bill includes a 
new Medicare prescription drug benefit, the new beginnings of a long-
term home health care program. The Michel and Rowland Republican bills 
both raid Medicare to pay other bills, or to bring other groups in. It 
does not turn anything back over to providing prescription drug 
benefits for seniors or any other services to seniors. So there is no 
benefits at all in terms of the older American population. In fact, the 
Gephardt bill is the only bill that, in fact, just maintains the 
integrity of the Medicare system.
  I am sure you have the same experience that I do with seniors and 
prescription drugs.
  Mr. CARDIN. If the gentlewoman would yield on that point, because the 
prescription drug issue is a cost-saving issue. There are many seniors 
today that their medicine that they take keeps them out of hospitals, 
keeps them out of more intense health care. Sometimes they do not have 
the money to buy those prescriptions and they do not take their drugs 
and they end up needing more expensive health care needs. So the fact 
that we are providing prescription drug coverage under the Gephardt 
bill to our seniors is not only of interest to our seniors, it is in 
the interest of having a more cost-effective health care system in this 
country. It is a very important expansion of the benefit package.

  I know of many seniors in my district that spend $200, $300, $400, 
$500 a month on prescription drugs and have no protection under the 
current Medicare system. Under the leadership bill, they will be 
protected.
  What does the Rowland bill do? What does the Michel bill do in this 
area? They do not do anything. They do not provide these benefits. But 
worse than that and what the gentlewoman pointed out, they take 
Medicare cuts and take that money and use it to expand the access for 
low-income people. So they are really taking the money that goes to 
providers and goes to our program for Medicare and using it for other 
purposes. At least the earlier drafts of the people who were behind the 
Rowland bill had enough courage to put more revenue in the package in 
order to use it for the purpose of expanding access, but now I am 
afraid that the option they have brought forward takes money from under 
Medicare and uses it to try to expand access and it should be used to 
expand the prescription drugs.
  Mr. WISE. If the gentlewoman would yield, the gentleman from Maryland 
brings up a point, and it gets even more incongruous from that, because 
what the Rowland, or bipartisan bill does, it not only cuts Medicare 
without giving any increase in benefits from those cuts, but 
furthermore it cuts Medicaid and then says it is going to expand 
coverage for low-income persons after it just cut the program that 
covers low-income persons.
  The Gephardt bill does not get into those kind of cuts with Medicaid 
and it does cut for Medicare but the savings from administrative 
efficiencies go to long-term care and prescription drugs. Senior 
citizens on the average pay about 65 percent of their prescription drug 
costs out of pocket, but there is another aspect to this long-term 
care. Any senior citizen or family who has come to grips with this 
knows that the average family of just a couple of years ago, the 
statistic was the average family putting somebody into a nursing home 
will be bankrupted in 13 weeks, at an average of $3,000 per month. This 
was the beginning of significant expansion of long-term care dedicated 
to home, dedicated to keeping people in their homes where they can 
function with care providers and others on a cheaper basis and, 
incidentally, a more therapeutic one. So that is what is covered in the 
House leadership plan.
  The bipartisan bill, nothing. The Michel bill, nothing. And so 
seniors see Medicare cut under the bipartisan bill and the Michel bill. 
They see Medicaid which does affect some low-income seniors, they do 
not get anything for it, and they lose the benefits that are put into 
the Gephardt/House leadership package of long-term care and outpatient 
prescription drugs.
  Mrs. UNSOELD. More than any other issue, I believe that the fear of 
not being able to pay for the prescription drugs haunts many of the 
seniors. Our colleague, the gentleman from Oregon [Mr. Wyden] and I had 
a hearing on the prescription drug cost and particularly for seniors. 
The tragic stories of seniors who would pay for their prescription 
drugs as long as they could and then when they had to pay the rent or 
they had to replace or do some repair, some other need, they would 
cancel by renewing their prescription drug. Pharmacists said they could 
predict who of their customers was going to end up in the emergency 
room, in the hospital because they had to forego the drugs that were 
going to keep them healthy, functioning and maybe even alive.
  Ms. DeLAURO. I would echo what the gentlewoman said. My experience is 
what seniors do is one of three things when they go to the pharmacy 
with their prescription. They ask for the cost first. If they deem it 
too much, they do not get it filled at all or they may get half filled. 
The third piece is that they get it filled and then because so many are 
on fixed incomes, that what they do is maybe scale back on what they 
are eating in the course of the week. So in all three instances, we 
watch a senior population, older American population, probably the most 
vulnerable population, seeing their health deteriorate further because 
of the cost of prescription drugs.
  What is most incredible is that in terms of this Medicare effort, the 
Michel plan cuts the Medicare reimbursements to hospitals and doctors, 
but without relieving them of the burden of the uncompensated care 
because of the lack of universality, of including everyone, which just 
continues to compound problems.
  Mr. CARDIN. If the gentlewoman would yield, it may be worse than 
that, because they also cut Medicaid. As the gentleman from West 
Virginia was indicating, they are cutting Medicaid. They are cutting 
the program to the poor. Under the Gephardt bill, we reimburse 
hospitals and doctors the same rates on the poor people as we do for 
everyone else. We bring that rate up so that hospitals and doctors are 
not discriminated against who are taking care of poor people. But under 
the Rowland bill, under the Republican bill, what they are doing is 
they are cutting the Medicaid program, reducing it, and it does not pay 
the right fees now, it is paying too little right now, they expect with 
less money they are going to be able to cover more people.
  The original drafts of the managed competition and the people that 
were trying to work in a bipartisan fashion had new revenues in here. 
They had caps on how much you could deduct and they had tobacco taxes, 
they had money in the bill in order to try to deal with some of these 
problems. But it looks like they really have taken the lowest common 
denominator and now they are going to cause more problems for 
hospitals, for doctors, for our elderly, and for our poor.
  Ms. SHEPHERD. If the gentleman would yield, I would like to point out 
that when we talk about Medicaid, we are talking about seniors, that is 
true. But we are most importantly, I think, talking about children. We 
are talking not about small adults, we are talking about children; 
children who need immunizations, children who need to be able to go to 
the doctor when they have an earache; children who may have childhood 
diseases that if they are not treated will become adult disabilities. 
We are talking about the seed corn in America. We are talking about the 
future work force of America. We are talking about the people that we 
most must keep healthy and strong and raise up to replace us. I think 
that the lack of health care to children is absolutely one of the 
greatest tragedies of all of this.
  The Carnegie Foundation recently released a study that said that 
America was dead last among all industrial nations in the quality of 
life lived by its children. This has got to be because of our health 
care.
  They have higher incidences of childhood disease, they have fewer 
immunizations. Obviously those two are very closely connected. They are 
far less likely to have preventative care of all kinds. They are far 
less likely to have check-ups when they need them. This is something 
that I think it is our absolute moral obligation to address.

                              {time}  2020

  Mr. KREIDLER. If the gentlewoman would yield, I would certainly like 
to point out in connection with it argument she has put forward here 
when we deal with children, I was a clinical optometrist before I was 
elected to Congress in 1992. As an optometrist I dealt with patients on 
a one-on-one basis. I dealt with mothers on welfare, and not 
infrequently, if not always invariably they would point out to me the 
reason they could not get off welfare is they needed to keep their 
health insurance, they needed to stay on the Medicaid program, so no 
matter what they did from the standpoint of finding jobs they never 
could find the jobs that would pay the kind of a salary that they could 
purchase their own health insurance. That is presuming it was even 
available to them, much less find a job that would cover it as a part 
of their work.
  So, as a consequence, you saw a situation where it precipitated them 
staying on welfare. If we care about welfare reform, if we really care 
about what happens to children in welfare families, then you have to 
have universal coverage, which brings us back to the point that was 
being made earlier quite eloquently. Those who argue that what we need 
to do is just fix what is broken, meaning just a little bit of 
insurance reform, is so shortsighted. It leaves major gaps. It will 
never achieve universal coverage. It means that we take care of the 
wealthy, making sure we do not step on their rights to make sure that 
they always get health insurance. We may throw some bones to the poor. 
But the middle class is left out in the cold. Increasingly they find it 
difficult to continue to purchase health care, that they are being 
priced out of it, that they do not have the resources to purchase any 
longer. Their salary increases are being eaten up trying to maintain 
their health care benefits, and if they lose their job they find it 
that much more difficult to be able to keep their insurance, if they 
can afford it for the 18 months that they are able to continue it right 
now, much less have any other benefit.
  Mr. WISE. If the gentlewoman will yield on the point the gentleman 
from Washington makes, not only are the middle class left out in the 
cold, they get burned. They get burned because in the recent Lewin-VHI 
study that was done for the Catholic Health Association, we analyzed 
incremental plans or reforms, meaning simply doing an insurance reform 
without universal coverage. What they concluded was for persons between 
$10,000 and $20,000 a year income they would pay annually $201 more, 
for persons between $30,000 and $40,000 a year they would pay $344 
more, and from $40,000 to $50,000, $137 a year more.
  The middle class gets burned if you just do insurance reform. You are 
going to tell them that it is insurance reform, this one is for you, 
and it is really for you, it puts it right to you, and that is why it 
is so important that we have to frame this debate.
  I am glad that these proposals are now in writing, the Michel 
proposal, the bipartisan proposal, the Gephardt proposal. They are out 
there, and now the American public can analyze them and see where they 
come down. But I do not think the middle class are going to be very 
happy knowing they get insurance reform, and when they get that, they 
get reformed right out of their wallets.
  Ms. DeLAURO. The chart over here to my right displays precisely what 
my colleague was talking about and how that working middle class family 
wind up paying increased costs without the advent of 
universal coverage, which is something that I would urge people to take 
a look at these various plans and understand what they are about.

  There is a lot of rhetoric, granted, and these are studies that are 
independent studies of these plans which are making the determination 
of what happens when we do not have every person in this Nation covered 
by insurance.
  There is another issue that I would like to raise. There is a 
contrast between what the Gephardt proposal talks about versus the 
minority leader's plan or the Republican substitute, the Rowland 
Republican substitute, and that is the issue of preexisting condition, 
which is prohibited in the Gephardt plan where insurance companies 
cannot say to you that because you have had the good fortune to survive 
a major illness, or because maybe your child has asthma that therefore 
you can no longer get insurance. That in fact is prohibited in the 
Gephardt bill, and it is not clear what the situation is in the other 
bills. That is of prime importance to the American people.
  Mr. CARDIN. If the gentlewoman will yield, it is my understanding in 
the Rowland substitute there is a 6-month waiting period. I thought 
this was one area that we had agreement on. I mean, we have heard from 
all sides, both parties and all sides of the political spectrum that we 
were going to do insurance reform and eliminate the discrimination 
against people who have preexisting conditions. And it looks like they 
did not even put that in their bill.
  Ms. DeLAURO. Exactly. If you are going to talk only about insurance 
reform, then for heaven's sake make sure we do not continue to put 
people in jeopardy.
  I met a young woman at one of my office hours, a most incredible 
story. She has multiple sclerosis and she is now covered. Her 
neurologist said to her that she ought to be taking as quickly as 
possible the new drug, Betaseron. She said to me, she was asking please 
support health care reform. She said I will not talk to my employer, 
nor will I talk to my insurance company about this because I am 
frightened to death that it will be over, that they will not provide 
any kind of service for me, and that I will not be able to get this.
  It is most incredible. This is a woman with a deteriorating disease, 
and every day that goes by makes it more difficult for her to live her 
life. And she is frightened to death to bring this to the attention of 
anyone who might be able to help her. This is the wrong system.
  Our colleagues have put together programs that say that we are not 
even going to go the full measure on preexisting condition in what they 
characterize as a limited reform in any situation. It really needs to 
be looked at by the American public, and you wonder what these folks 
are trying to accomplish here.
  Mr. CARDIN. We knew it was going to be a limited bill, but I thought 
at least we were going to see that provision in the bill. And it looks 
like they have sort of opted out on the side of the insurance and 
decided to give a way out so insurance companies do not have to pay for 
preexisting conditions.
  Ms. DeLAURO. In addition to that, there are mechanisms within the 
Gerhardt bill to also say to the insurance companies that while they 
maybe accept someone with preexisting condition, they cannot charge any 
price they want for that preexisting condition. What price for heart 
disease? What price for a cancer survivor? So this is critically 
important.
  As I said earlier, I am a survivor of ovarian cancer. If I were to 
try to get insurance it could cost me up to $12,000 to $14,000 a year. 
Who can afford to pay that kind of money for insurance?

  So these plans fall short on even the limited measures that they are 
willing to move forward on.
  Mrs. UNSOELD. The sponsors and proponents of those plans give lip 
service to removing this problem, this burden that hangs over Americans 
and denies to those who work hard for a living and have a right to 
guaranteed insurance, denies them that right while they give lip 
service to remedying their problem.
  You have very well described it.
  Ms. DeLAURO. I think the choice is clear. I think the halfhearted 
approaches in fact do not measure up to the Gephardt bill, and if we 
can, we really need here to summon up the courage to pass the Gephardt 
bill and not be blindsided, if you will, by these limited bills. If we 
do that, then my view is that we will have failed in this mission, and 
my colleague from Maryland was talking about that earlier, we will have 
failed the American public with a year and a half of debate and 
discussion.
  Mr. CARDIN. I was just trying to take some notes here on Gephardt. We 
have universal coverage. In Michel or the Rowland substitute we do not 
get universal coverage. We have been through that. On small business, 
the Gephardt bill helps business, eliminates discrimination in the 
current marketplace, provides help on the affordability to small 
business, whereas the other two bills do not deal with that at all. The 
Gephardt bill helps our seniors by providing prescription drugs and 
long term care which is fully paid for in the legislation. The other 
bills take from the Medicare program and give our seniors nothing in 
return. The Gephardt bill has full insurance reform. We can eliminate 
the preexisting conditions, we live up to a commitment I think we have 
given to the American people on health care reform. The other bills do 
not do that.
  We have not talked cost containment, but we have effective cost 
containment in the Gephardt bill. The other bills do not do anything to 
bring down the overall growth rate of health care costs.

                              {time}  2030

  It seems to me that we do not have any choice. There is only one bill 
that is going to provide meaningful health care reform that we are 
going to have a chance to vote on.
  Mr. WISE. There is another choice, and the choice is to do nothing. 
That is what some are urging us to do, delay, stretch it out, have 
another study, have a good time, do not come back, and the reality is 
doing nothing. Where does that leave each of the categories? You 
mentioned for the senior citizen, on Medicare today, that means they 
are going to have to continue to watch while Medicare gets eroded 
because of deficit-reduction pressures, and yet nothing is done to 
enhance the entire system. There certainly will not be any long-term 
care or prescription drugs for the small business.
  The gentlewoman from Utah was eloquently describing the challenges 
she faced as a business person. I think it is going to mean a lot of 
small businesses having to opt out of health care because they simply 
cannot afford it. They cannot afford to continue to pay for their 
competitors who do not provide it, and they see the rates continuing to 
rise to them.
  The middle-class person, they are the ones getting squeezed all the 
way through.
  Mr. CARDIN. I will respond to the gentleman from West Virginia. As 
the gentleman from Washington pointed out, if we do nothing, how do you 
get to welfare reform? How are you going to reform a welfare system if 
we do not take care of one of the major problems that someone on 
welfare has today of taking a job and losing their health care 
benefits?
  Mr. WISE. Secretary Shalala estimates that 1 million people come off 
the welfare rolls over the next few years if you pass comprehensive 
health care for the reason the gentleman says, because now people do 
not lose their medical card, low-income medical card, by going to work. 
We penalize a lot of people by not acting. You do not help anybody. You 
penalize them.
  Mr. KREIDLER. I would like to point out that listening to the 
arguments that are coming forward right now are really disappointing 
from the standpoint of what the gentleman from Maryland pointed out. 
There are those who are arguing right now to do nothing, to delay, to 
postpone, take another year.
  The longer we take, the worse the problem gets, more people that are 
denied access to health care, the more difficult it becomes to make a 
correction in the system. What are we talking about for change?
  You know, those that will talk about government takeover of health 
care, it is so ridiculous that it is patently almost humorous in its 
own way, because we are talking about private insurance, private 
insurance. All you are doing is trying to establish some game rules so 
that there is some kind of understanding so that some people over here 
do not kind of game the system and others over here have to pick up the 
tab.
  It is kind of like the airline industry in a way. You can sit in a 
seat on an airplane and maybe you have gotten the rock-bottom price and 
so forth, and the next person over is paying the maximum price. It is 
much like that today in the kind of cost-shifting that takes place in 
our health care system.
  If we want to get a handle on our health care so we bring about some 
rules so we eliminate the cost-shifting, we get rid of all the 
bureaucratic overhead that is built into it, administrative overhead, 
the overcapitalization that has taken place in high-specialty medical 
equipment, the over-specialization that has taken place in medical 
specialties; if we want to get back to where people really get the 
health care they need, then it means setting up some rules, but keeping 
it private. Keep Government out of it; minimize Government's impact, 
and it will not happen overnight.
  We are talking about a system phased in over a number of years.
  Mrs. UNSOELD. Not only are we talking about private insurance, but we 
are talking about giving people the choice of what doctor they go to, 
what hospital they go to, not their employer making that decision, not 
the Government making that decision, not politicians making that 
decisions, but the individual selecting their health care, their 
doctor.
  Mr. KREIDLER. How frequently now, if most workers out their find that 
their choices with their employer have been continually narrowing, 
there have been fewer and fewer choices, that they have had less 
quality options, they have been more or less dictated to what they are 
going to receive. We are giving them some real opportunities.
  Ms. DeLAURO. If I might summarize. Our time is coming to a close.

  I think what we have all talked about here is the effect of the 
substitutes and what they offer, and on all scores the Rowland 
Republican substitute, the minority leader, the Michel substitute 
shortchange, if you will, middle-income families, older Americans, 
small businesses. They do not get near to controlling costs, and, in 
fact, leave the insurance companies in charge and do not meet the first 
test of any health care reform, and that is to make sure that every 
single American is covered under private guaranteed health insurance 
that can never be taken away, and that is affordable.
  The only bill, the only proposal that addresses all of those problems 
is the Gephardt bill.
  I know I have said to many groups, my colleagues have said to many 
groups that they are meeting back home with, that the most important 
piece of legislation that we are going to work on in this body is 
passing health care reform. If we do not pass the Gephardt bill, we are 
not going to be able to face those mothers and fathers that I talked 
about earlier on who are frightened to death that they are not going to 
be able to afford health insurance for themselves or their kids or that 
they are going to be trapped in their jobs without having the 
opportunity to have health care benefits.
  We cannot go home from this Congress and not pass the Gephardt 
proposal and pass guaranteed health insurance for everyone in this 
Nation.
  I want to say ``Thank you'' to my colleagues for joining with me in 
this special order tonight. I am sure we will find ourselves on this 
floor again several nights to come in the next several weeks.

                          ____________________