[Congressional Record Volume 140, Number 116 (Wednesday, August 17, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 17, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                          HEALTH SECURITY ACT

  The Senate continued with the consideration of the bill.
  The PRESIDING OFFICER. The Chair recognizes the Senator from Idaho 
[Mr. Kempthorne].
  Mr. KEMPTHORNE. Thank you very much, Mr. President.
  May I also acknowledge and thank for his courtesy the Senator from 
South Dakota, who is always a gentleman in all floor debate I have ever 
seen. I appreciate that.
  I often read comments from Idahoans here on the Senate floor, because 
they reflect down-to-earth common sense. This is such a case. I am 
going to share with you three quotes from Idahoans relating to this 
current health care debate:

       I do not believe that we have a crisis in the health care 
     system. We have a good system, it just needs to be amended, 
     says Missy Hunsucker of Boise.

  Dr. Andrew McRoberts of Pocatello says:

       What I fear now is they're going to rush something through 
     with very little thought or planning and when it's done 
     they're going to say, `Oh, my God, what did we do'

  And Jim Guthrie, a small business owner in McCammon says,

       When you look at what the government is doing with some of 
     the other things they've got their hand in, it's scary. I 
     think something needs to be done, but I don't think this is 
     it.

  These are comments from hard-working, thoughtful and practical 
Idahoans. Real people, not policy wonks or ``inside-the-beltway'' 
analysts. These are the thoughts of the people whose lives will be 
impacted by the decisions we make in Congress. I hope we keep their 
comments in mind when we examine the whole question of health care 
reform.
  The mail, faxes, and phone calls that come into my State offices and 
to my Washington office are almost unanimous in opposition to 
government-run health care and the Clinton-Mitchell bill. These are not 
part of any organized campaign, they are honest comments from concerned 
Americans.
  There is no dispute that our country's health care system is the best 
in the world. Americans enjoy the best physicians, the best hospitals, 
and the best research facilities. There are changes that need to be 
made, but not a complete overhaul in our health care delivery system.

  Is the Clinton-Mitchell plan, all 14-hundred-plus pages, the way to 
go? I do not think so. Veteran Senators tell me this is one of the most 
complex pieces of legislation they have ever seen. And what compounds 
the problem is the fact that we are now working on the third version of 
the bill--a bill that has not had the benefit of a complete committee 
markup and review, and a bill that frankly, not many people totally 
understand. The non-partisan Congressional Budget Office says this bill 
will cost more than $1.1 trillion over 8 years. In 1998 alone, it would 
cost nearly $104 billion, making it the third largest program in the 
budget.
  My personal preference is to have Congress do what Idahoans tell me 
they would do: Implement local innovations and ideas, reform elements 
of the system, and let the private sector work.
  When I first looked at the Clinton-Mitchell bill, one of the first 
phrases I saw was, ``A participating State shall.'' A version of that 
phrase is repeated at least 85 times in the bill. What does that mean? 
Does it mean a State can opt out of the program? Far from it.
  Under the Clinton-Mitchell bill, States would have to choose one of 
three options: Comply with the bill entirely, including the mountains 
of new rules and regulations; become a single-payer socialized medicine 
State; or let the Federal Government totally control health care in the 
State. None of these are attractive options.
  State governments should not be forced to comply with the overly 
restrictive nature of this bill when they are doing a lot on their own, 
right now--and without Federal intervention.

  The State of Idaho is not immune to the problems in health care. 
While Idahoans pay less for care than others, costs are going up and 
there are not enough doctors. That is making health care more difficult 
to get than in the past. Mr. President, 84 percent of Idahoans have 
health care coverage, but there are still more than 100,000 without 
coverage. Of those with coverage, 15 percent still do not have access 
to a primary care physician. That is because in a State with a large 
land mass and a small population, doctors tend to live in population 
centers, not in small, remote towns.
  The Clinton-Mitchell bill makes provisions for rural communities. But 
that does not go far enough to meet the needs of a lot of towns in 
Idaho.
  There are communities like Warren or Atlanta, ID--I could name 
dozens--that have no doctors or health care facilities. They are truly 
western frontier towns. They may be 25 miles or 100 miles from the 
nearest doctor, often isolated in the mountains and accessible by, at 
best, a gravel road. In the winter, they are lucky if that road is even 
plowed. They do not fit within the definitions of the Clinton-Mitchell 
health care bill for rural communities. We need to acknowledge these 
towns and their conditions and make allowances for them.
  How important is a hospital to small town Idaho? It is often the 
difference between life and death, and is critical if there is an 
accident or sudden illness. Larry Lee, chief financial officer at Harms 
Memorial Hospital in American Falls is scared of the Clinton-Mitchell 
plan. He says isolated hospitals without cost efficiencies found in 
more urban areas are at risk. He says his greatest fear is that, ``this 
small hospital will cease to exist--everything will be centered around 
the large hospitals with no consideration given to distance. Everything 
will be based on cost.'' In Emmett, a farming community northwest of 
Boise, the emergency room at Walter Knox Hospital treated 4,292 
patients last year. That is roughly equal to the population of the 
town, and about one-third of the total number of people living in the 
entire county. The community can ill afford to lose its immediate care. 
There are other advantages of a hometown hospital beyond the medical 
needs of the community. An economic impact report presented to the 
local officials found that the hospital attracted three physicians to 
the valley, employs 92 people, and contributes more than $2 million 
annually to the economy. The report also stressed the importance of 
indirect revenues from related medical and service industries. So you 
can see that if small towns like Emmett, ID, lose their hospitals, they 
lose much more than health care--their economic health is also 
jeopardized. I do not want any part of a plan that causes rural 
hospitals and doctors to close their doors and abandon small towns. I 
doubt very much whether my colleagues do either.

  Will the farmer in Idaho benefit from the Clinton-Mitchell plan? I 
mentioned that Idaho does not have enough health care providers. While 
the Clinton-Mitchell bill contains funding for outreach into rural 
underserved areas, it also creates disincentives to practice there. One 
example of such a disincentive may be the 25-percent tax for 
noncompetitive areas. The tax on so-called high cost plans is to be 
paid, partially, by physicians.
  Rural doctors already face low reimbursement rates--the additional 
burden may force some into more urban areas where there is a larger 
patient base and reimbursements are higher.
  The 25-percent premium tax on high cost plans is such a disincentive. 
My staff has prepared an analysis. This is how it works.
  Your insurance policy will be taxed if your WAP is greater than the 
WARP. That is, if your Weighted Average Premium is greater than the 
Weighted Average Reference Premium. This is from the Clinton-Mitchell 
bill. The WARP is figured out this way: You take the total of all U.S. 
health care payments and subtract from that the Medicare beneficiaries, 
Supplemental Security Income recipients, worker's compensation, 
automobile or other liability insurance. To that amount you add the 
projected expenditures for underinsured and uninsured people and 
increase that amount by the estimated percentage reflecting the 
proportion of premiums required for administration and State premium 
taxes. Decrease that amount by a percentage that reflects the estimated 
average percentage to total amount payable for items and services 
covered under the standard benefits package that will be payments in 
the form of cost sharing under a certified standard benefit plan with a 
high-cost option. Then, divide that amount by your community rating 
area difference--which is actually the percentage of difference in 
health car expenditures, in rates of uninsurance and underinsurance and 
in the proportion of expenditures for services provided by academic 
health centers.

  Sound simple? Not at all.
  It will require an army of Washington bureaucrats to figure all this 
out, and this is just one small section of the Mitchell bill. The bill 
is a jobs bill for bureaucrats.
  There are other complexities of this provision. The fact that you 
will not know when you buy insurance if your policy is going to be 
taxed. The fact that your doctor might very well be getting a bill for 
half of the tax at the end of the year. We all know who ends up paying 
this tax. Individuals and small businesses.
  Is it so important that we enact this type of legislation and cause 
such disruption in the lives of many Americans? Isn't there a better 
way to improve health care? I think there is, and it is being done by 
the States and private sector already.
  The Idaho legislature adopted health care reforms the last two 
sessions.
  These are State, not Federal solutions.
  Idaho has enacted legislation which guarantees access to health 
insurance, regardless of preexisting conditions or current health 
status.
  At the same time, the legislature created true portability of 
insurance by allowing the insured to transfer coverage from one plan to 
another without a loss of coverage.
  Administrative simplification was next on the list. Idaho now 
requires insurance companies to use a uniform claim form to reduce 
administrative costs and simplify the insurance process for the 
patient, the doctor, and the insurance companies.
  Finally, the lawmakers took a step toward increasing the 
affordability of insurance by establishing Medical Savings Accounts. 
Contributions to these accounts are tax deductible form State income 
tax and may be used tax-free for medical expenses.
  Idaho State Senator Dean Cameron says lawmakers recognized the need 
to do something, and he added, ``We've accomplished everything they 
(the Federal Government) are trying to accomplish.''
  The private sector has also acted on its own. Moscow, Idaho, and 
Pullman, WA, are towns only 8 miles apart. They face a rural health 
care delivery problem, and they are doing something about it. Pullman 
Memorial Hospital and Gritman Medical Center have formed an alliance to 
keep costs down, improve care, and keep doctors and services available 
to the Palouse region.

  The physician hospital organization, called a PHO, is voluntary--not 
mandated. Gritman's administrator, Robert Colvin, says, ``We think 
we're doing this ahead of the curve, before it's do or die.'' This 
arrangement should be able to reduce costs and improve service by 
reducing the amount of duplicated services. Again, this is something 
these two communities, their hospitals, and doctors decided to do. The 
Federal Government did not tell them to do it.
  I might add with no small amount of pride that I was an orderly at 
Gritman Medical Center when I was a student at the University of Idaho.
  Because of the actions taken by the Idaho legislature, and 
innovations by private-sector health care providers, health care 
insurance and coverage in the State will be more affordable and 
accessible to many people. This was done without increasing taxes or 
more bureaucracy. The U.S. Congress could learn a lot from the Idaho 
State legislature.
  Instead, the Senate is now debating a piece of legislation which will 
increase our taxes and dramatically increase the health care 
bureaucracy. Early reports indicate the Clinton-Mitchell bill will 
impose 17 new taxes and create 25 new bureaucratic regimes.
  Over 90 percent of all employers in Idaho are small businesses. They 
employ almost two-thirds of the State's workers. People who currently 
receive their insurance through their employer, a small business, would 
be forced to change their current health plan. The business would be 
required to purchase a plan through the proposed Health Insurance 
Purchasing Cooperative, and the plan would have to provide the standard 
benefits package. Even if the worker preferred the old plan, he or she 
could easily be stuck paying for a plan that contains unneeded items or 
does not provide benefits that fit the worker.
  Employees would suffer, and so would employers. Businesses would be 
negatively impacted by the Clinton-Mitchell plan. We are all aware of 
the serious impact the so called employer mandates will have on small 
business. Under this bill, there is little doubt that the mandate would 
likely be enacted. Willard Wood was in the restaurant business in Idaho 
for 58 years before retiring. He's managed both large and small 
restaurants, and he says employer mandates could be lethal to mom-and-
pop businesses. ``If health care reform goes through and the employer 
has to pay for all the employees, it will mean the loss of thousands of 
small business. I am talking about where the owners are working long 
hours just to make a living.'' After 58 years in business, I think Mr. 
Wood could be considered an expert in the field.
  Chris Nye, who manages a business in Pocatello, says if employer 
mandates are forced onto his business, he will have to change his 
hiring practices because he won't be able to hire part-time help.
  With examples like that, I can foresee where this bill will only 
serve to increase welfare rolls and lengthen unemployment lines because 
this health care bill will put people out of work.
  Even before the mandates kick in, this bill is bad for a number of 
businesses--the small companies that have chosen to self-insure. They 
have taken the time and often the investment to carefully study their 
insurance needs and options and have decided that self-insuring 
provides them with the most efficient and most cost-effective way of 
providing coverage for their employees. Under the Clinton-Mitchell 
proposal, this would no longer be an option. The businesses would 
either have to buy insurance through those purchasing cooperatives I 
mentioned earlier or not provide insurance for their workers. I doubt 
we want to create a situation where a company is discouraged from 
providing coverage for its employees.

  So how do we help small businesses across this country? What areas of 
reform are important to address right now?
  There are insurance market reforms, providing portability, so a 
person can take insurance with them even between jobs.
  Such reforms would also do away with limitations on insurance caused 
by preexisting conditions.
  Antitrust reform is needed to allow hospitals and doctors to 
communicate and cooperate to provide the best care for a community.
  St. Alphonsus Regional Medical Center and St. Luke's Regional Medical 
Center in Boise are only about 3 miles apart. Boiseans are truly 
fortunate to have two such fine facilities in their community. There 
have been times when people in Boise have wondered why each hospital 
provides the same specialized treatment or service. Would it not make 
sense to combine efforts? Normally, yes. But current antitrust laws 
make cooperation difficult. However, the hospitals have decided to push 
the edge of those laws and have combined their diabetes treatment 
centers. In doing so, the hospitals decided that several factors are 
more important than possibly risking violation of antitrust.
  Both hospitals have diabetes centers. Both centers lose money or 
barely break even. So instead of passing the losses on to their 
patients in the cost of other services, the hospitals have combined 
efforts to improve delivery and cut costs. In the end, the community 
wins with a better quality of service in a facility that does not run 
the risk of closing down because it is losing money. It is a small step 
with two small programs, but could lead to more. Administrators at both 
hospitals say it could mark the beginning of more cooperative efforts. 
But they are nervous that the cooperation could run afoul of antitrust 
provisions. Enactment of antitrust reforms could remove the hurdles and 
provide incentive for the two hospitals to work together, not against 
each other, for the good of the community. Antitrust reform is not 
included in the Clinton-Mitchell bill.
  One hundred-percent deductibility of health care premiums would give 
farmers, ranchers, and small business owners the same kind of 
advantages large corporations get. If you want to help rural and 
frontier areas, this would go a long way.
  Congress should enact medical malpractice insurance reform. Bob 
Seeheusen, executive director of the Idaho Medical Association, says 
the current Clinton-Mitchell bill would preempt State laws on medical 
malpractice. In Idaho's case, he says this would undo what the State 
has already accomplished, and would likely push malpractice premiums up 
in price. It is unfortunate that even hospital equipment manufacturers 
need to buy malpractice insurance. Hospital administrators tell me that 
is what increases the cost of equipment, and the cost of care. If a 
hospital or doctor has to pay more for equipment, the cost is passed to 
the patient.

  We need to enact anti-fraud and abuse control provisions; and 
administrative simplification. Nurses spend too much time filling out 
forms, taking away from the time they would like to spend with the 
patients.
  I introduced a health care reform bill earlier this year that 
contained these reforms. I do not claim total authorship of the 
measure--I was able to take these items that are common to a variety of 
health care bills that had been introduced, and put them in one bill. I 
believed then, and I believe now, that there are reforms that most of 
us agree on and put in one bill and enact immediately and begin the 
reform of health care in America. Those should be put in a bill and 
enacted now so we can get started on the real reform Americans want.
  Finally, it seems appropriate to remind everyone of the old adage, 
``Haste makes waste.'' It may seem trite, but it fits. With issues as 
detailed and complex as health care, it is vital that we not proceed 
too rapidly. We should not pass any piece of health-related legislation 
until we are sure we fully understand the consequences of our actions. 
Otherwise, we may find that we create more problems than we solve.
  Larry Lee at Harms Memorial Hospital in American Falls has an 
interesting suggestion. He believes that before Congress jumps into 
something that is unproven, we should authorize pilot programs and test 
these theories. He says the health care reform proposals should go 
through the same kind of scrutiny, testing, retesting, and sampling 
that drugs undergo by the Food and Drug Administration.
  There are many aspects of health care reform that I have not talked 
about today. They will be discussed by my colleagues on both sides of 
the aisle. But I look forward to that exchange. Only through extensive 
and thorough debate of the issues will we be able to unravel all the 
questions facing us, and only then will we hope to be able to pass 
legislation that Americans say they want and need.
  The Clinton-Mitchell bill is not the right prescription for Idaho. 
Health care is too important an issue to pursue in this manner.
  We would be wise to follow the advice of Missy Hunsacker, Dr. Andrew 
McRoberts, and Jim Guthrie when they say Congress should not move 
toward a hasty, big-government solution to our Nation's health care.
  Mr. President, that completes my remarks. I thank you for your 
courtesy and the courtesy of all who have remained here this evening. I 
yield the floor.

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