[Congressional Record Volume 140, Number 118 (Friday, August 19, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 19, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
        A FOCUS ON THE SUCCESS OF HAWAII WITH HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994, and June 10, 1994, the gentleman from Hawaii [Mr. 
Abercrombie] is recognized for 60 minutes as the designee of the 
majority leader.
  Mr. ABERCROMBIE. Mr. Speaker, the State of Hawaii has found itself 
the object of a continuing attack by Members of the other party in 1-
minutes, in some of these special-order colloquies and discussions, 
particularly over the last several days.
  On the one hand, I suppose I might find this amusing that our little 
State, in the middle of the Pacific, suddenly becomes the focus of all 
of this national Republican Party attention, because we are succeeding 
at doing something, and we have succeeded on the local level, we have 
succeeded at the State level, and I was under the impression that 
ideologically speaking the Republican Party at least claims in some 
respects some corner on the capacity for having local solutions to 
problems. This is generally the way they put it forward when 
philosophical discussions take place, campaign rhetoric is being 
spouted.
  Now, why should we be picked on because we have succeeded? And why 
should Members from other States who perhaps do not have what we have 
in Hawaii be picking on us because we have succeeded in achieving 
virtually universal health care for our people?
  In fact, if they feel that this universal care is unable to be 
achieved in their own States, perhaps they want to move to Hawaii and 
they can give a contribution of their talents and skills out in Hawaii, 
or perhaps they feel the people in their constituencies do not need to 
have health care. Perhaps they do not need this interference, as they 
say, by government, whether State or Federal; perhaps they want to get 
rid of Medicare. If they want, there is nothing to prevent anybody here 
on the other side of the aisle from putting in amendments to the health 
care bills that we are putting forward to get rid of Medicare. That 
will get the Government out of business; that will get the Government 
out of the health care proposals.
  Let us get rid of Medicare, if that is what they want to do. But why 
do they want to take away universal health care that we have in Hawaii?
  Well, just so we can get past all of this and so that the public that 
does not have some of the material in front of them, obviously, that 
ostensibly is being cited by the Republican opposition to health care 
for people, to health security for people, again, parenthetically, Mr. 
Speaker, I have to add, I do not know why anybody would be against 
health care security for people. I certainly do not know why they would 
be against people taking the initiative in any given State or 
jurisdiction to see to it that we have health care security. But that 
is something that they will have to answer for themselves.
  Of course, if they want to come down on the floor and defend 
predatory insurance companies, they can do that. I understand in the 
crime bill there is great concern that we label sexual predators in a 
manner that allows the entire community to know who they are and where 
they are. Well, why do we not put in a predator section for insurance 
companies where health care is concerned? Let us do that. Why do we not 
name all the insurance companies that are preying upon the American 
people and keeping them from having health security?
  Now, one of the items that was cited by some of our learned friends 
on the other side is a General Accounting Office report entitled, 
``Health Care in Hawaii.'' I will hold it up here and let our good 
friends on C-SPAN zero right in on that so that they can see that this 
is a report to the chairman, Subcommittee on Oversight and 
Investigations, Committee on Energy and Commerce, House of 
Representatives, February 1994: ``Health Care in Hawaii; Implications 
for National Reform.''
  Now, this has been cited by some of our good friends on the other 
side, I should say cited in part, cited out of context, a few sentences 
left out here and there that might have illuminated the question.
  So I am going to try and fill in some of those blanks that have been 
left because this report from the General Accounting Office does say, 
as I indicated, ``Implications for National Reform.''

                              {time}  1500

  Let us go to the results in brief. Hawaii has the highest level of 
insurance coverage of any State in the Nation. Now, that is the first 
sentence. I will repeat it: Hawaii has the highest level of insurance 
coverage of any State in the Nation.
  Now, are we supposed to apologize for that? Are we supposed to 
somehow back off and say, ``Well, let's have less coverage''? I think 
not.
  The reason that we have, as the General Accounting Office says, the 
highest level of insurance coverage of any State in the Nation is, we 
enacted the prepaid Health Care Act of 1974, not 1994, Mr. Speaker, 
1974. We have 20 years of experience.
  You know, I find it very illuminating to stand here on the floor and 
be lectured about health care and provision of health insurance 
security from people who do not have 20 seconds' worth of experience 
with health care, when I have 20 years of it.
  I was elected to the House of Representatives in the State of Hawaii 
in 1974. I have been the chairman of the Health and Human Services 
Committee in the Hawaii State Senate, with direct responsibility and 
authority over the Medicaid system legislation in the State of Hawaii. 
I have had 20 years of experience, and I have to deal with people on 
this floor who are explaining to me about health security insurance, 
health care insurance, who do not have 20 seconds, 20 minutes, 20 weeks 
of experience, explaining to their people week in and week out, month 
in and month out, year in and year out, why they cannot have health 
care insurance and Hawaii can.
  We have heard on this floor that people want to have insurance at 
least equal to that of Members of Congress. I would be delighted if 
some of the Members of Congress who come down here on the floor and try 
to say to the American people that our plan does not work in Hawaii, 
have them explain to the people of the United States, have them explain 
to the people who are listening in to our conversations here today, 
have them explain to the people who are observing the action on the 
floor of the U.S. House of Representatives, what insurance do they 
have?
  I would like to have members of the opposition, who are ready to 
criticize Hawaii, to come down here and explain why their constituents 
cannot have health care insurance while the Member who is explaining 
that to them has health care insurance.
  Every single Member who comes down here and complains about Hawaii 
providing universal health care security for the people in our State 
has health care insurance himself or herself; but is quite willing to 
see that other people in their own States, and in their own districts, 
do not have it.
  In fact, if anybody wants to come down and explain in detail right 
now, I will yield time, I would be delighted to do so, to have them 
come down and explain in detail. However, before you start telling me 
why my people cannot have health care insurance, and why the people of 
the United States cannot have health care insurance, how come they have 
it? What exactly is their coverage? How much do they pay for it?
  I would be glad to go into what Hawaii has. I have the real figures 
here, not the figures cited from previous commentary on this floor. I 
would be glad to go into it. I would go into it in detail, in massive 
detail, I will go it into detail beyond massive detail. After all, we 
have the experience, we have the health care insurance. And of course, 
Members who come down to the floor and say that the rest of America 
cannot have health care insurance, they will have insurance for 
themselves and their families, of course. But that is only right, I 
suppose.
  Yes, Hawaii has the highest level of insurance coverage of any State 
in the Union. And yet people have come to this floor who have no 
knowledge whatsoever of the Hawaiian health care system--and I am going 
to take a moment, Mr. Speaker, to refer to another document, the 
``Aloha Way, Health Care Structure and Finance in Hawaii,'' by Emily 
Freedman. Emily Freedman is one of the foremost health policy experts 
in the United States. She compiled a history of health care in Hawaii, 
sponsored by private nonprofit foundations, Blue Cross and Blue Shield, 
Kaiser Permanente, a health maintenance organization, by the State of 
Hawaii and by the Hawaii Medical Association, the Association of 
Physicians in Hawaii, which is the Hawaiian branch of the American 
Medical Association.
  In other words, the full spectrum of health care providers, private 
and public, institutional, both private and public, in the United 
States and in Hawaii.
  In this document, in this history, Mr. Speaker, you will find in 
appendix A--and I will hold it up for our friends on television to 
see--the Prepaid Health Care Act of 1974. Now, I doubt that anybody who 
comes down here to complain about our 20-year-old system has ever 
bothered to read the Prepaid Health Care Act of 1974, and not only have 
I read it, but I have helped to enforce it and implement it.

  As I said, we have 20 years of experience. One of the accusations 
that comes out on the floor is that the employer mandate, which is 
required in our Prepaid Health Care Act of 1974, has not provided 
universal coverage. Well, that comes as no surprise to me, Mr. Speaker, 
because it was never intended to. No one has heard me, on this floor, 
say the employer mandate, in and of itself, either in 1974, when it was 
put into effect in Hawaii, or in any of the proposed bills before the 
body now here in the House, is in and of itself intended to provide or 
could provide under any conceivable logistical circumstances for 
universal coverage.
  The employer mandate, in and of itself, will not do that. It has not 
done it in Hawaii. It was never intended to do it in Hawaii.
  Now, what are some of the factors involved in seeing that universal 
coverage does not come out of it; not everybody is employed.
  You see--Mr. Speaker, I am asking you and I am asking the people in 
the public to use some common sense in this. When you see people come 
down to the floor, go into these towering rhetorical rages about the 
inability of the employer mandate to provide universal coverage when 
they have these apocalyptic, Gotterdamerung scenarios laid out, that 
somehow vast numbers of people will become unemployed as a result of 
the employer mandate, businesses will crash, the United States is 
doomed, the sky is falling. Think about Chicken Little. Chicken Little 
ran around saying the sky was falling. That does not make it so.
  In this particular instance I think we need to stand back a little, 
take a deep breath and let us try to account for some of the factors 
that may be involved. You do not necessarily have to take my word for 
it, although I am perfectly willing to have anything I say stand the 
light of the closest possible scrutiny. But I will refer to an entirely 
neutral body, the General Accounting Office or the newspapers. The 
newspapers? They are not neutral, of course. The newspapers in my town 
are opposed to me. They spent the last 20 years trying to get me out of 
office. Even they sometimes have to print the truth. So if I am quoting 
the newspapers back in Honolulu, it is not as if I am quoting someone 
who spends all day trying to figure out how he can make me look good. 
They pay a lot of editorial people in Honolulu good money to try to 
figure out how to get me out of office. They have not succeeded yet, 
and they are not going to succeed this year.

  So I can go to the newspapers, that is what is quoted on the floor 
down here, what the newspapers say. Let us see what the newspapers say. 
Let us see what newspapers say. for example, from the Honolulu Star 
Bulletin. Heck, the Star Bulletin in Hawaii is owned by people on the 
mainland. They just kept up a longstanding tradition in trying to get 
me out of office.
  Here we go, from the 12th of August this year. The headline, ``Our 
Health Care Costs Slow Down.'' Although inflation for medical costs 
leads other categories in Honolulu, the rising cost of health care here 
is slowing. It is slowing in Hawaii. For everybody else it is going 
right off the charts, but it is going down in Hawaii.
  Now, we do not have the universal coverage, but our costs are down. 
How is that possible? Why do we not have universal coverage from our 
employer mandates?
  Some people get unemployed, some people are not eligible. In our 
original bill, in our original law, which we have amended only in terms 
of benefits, if one worked less than 20 hours a week, you were not 
required to be covered. So the employer mandate only went to those 
people in terms of requirements for providing coverage to those who 
were working 20 hours a week or more.

                              {time}  1510

  There was no requirement for dependents to be covered, no requirement 
for dependents to be covered. Think about it, those of you who are 
really interested, and you know you are. We get inquiries in our office 
all the time. Think about it.
  Think about Hawaii's plan, only people 20 hours a week or more to be 
covered, dependents not required to be covered, the unemployed or 
others, which I will go into in a little bit of time, not required to 
be covered, and yet, even with all of that, Hawaii has the highest 
level of insurance coverage anywhere in the Nation.
  How is it possible?
  Well, of course it was possible because virtually immediately we got 
to the serious insurance providers as opposed to those who were merely 
looking to extract the highest amount of premiums out of the most 
people and give the least service and recompense back. We got rid of 
those people. Those companies left the State of Hawaii in 1974.
  Mr. Speaker, I want to point out that our bill passed in 1974, and it 
was implemented on January 1, 1975; in other words, 6 months, was 
passed in June, signed in June in 1974. We put it into effect, not in 6 
years, as is being contemplated here in the House and Senate, but in 6 
months, and I will go on later to explain how, when we take care of 
those on Medicaid, when we take care of those who are not otherwise 
eligible for insurance coverage, that we have implemented that program 
in 6 weeks. We started August 1. We are going to be finished by 
September 9. All done with private insurance, all done with private 
insurance.
  That is another thing they talk about getting, the Government. You 
are going to have the Government involved in the health care provision. 
Mr. Speaker, just think about it for a moment. Our act, and I can quote 
it to you in here, this act is intended to be self-administering, self-
administering.
  We have more than a million, 1.2 million, people in the State of 
Hawaii. We have more than a million permanent residents in the State of 
Hawaii. We have had mandatory employer mandated health insurance for 20 
years. We have had health insurance companies providing insurance under 
our prepaid health care law for 20 years, and it is entirely self-
administered. Where are all these bureaucrats that they are talking 
about?
  You see it on the ads on television. Why would anybody believe an ad 
on television? I mean it astounds me that people could take seriously 
an advertisement, a commercial advertisement, coming from the insurance 
companies of America seriously. I mean how can you take--let me make an 
analogy to the crime bill:
  You got Charlton Heston. He is an actor, boys and girls. He is an 
actor, not a real person. There is no Charlton Heston. We know that. 
Charlton Heston belongs to the Screen Actors Guild. He has got 
insurance. He does not have to worry about it. He has it made. He is 
rich. He has got rich pals. He is an actor who works.
  Most actors do not work. Some of the actors that we have seen in the 
health care routine, except for the actors here on the floor, on these 
commercials--let me draw a parallel.
  You know they get some young guy on there with too much hair and too 
few brains. I mean I ought to know about that one. I do not know about 
the second part, but the first part I have some experience with. And he 
stands up there and says, ``I'm not a doctor, but I play one on TV.'' 
Then he tells you to, you know, buy aspirin, or whatever it is that he 
is hawking. He is an actor. He even tells you. I suppose this is a 
variation on the truth in advertising kind of thing.
  ``I'm not really a doctor.'' Somehow I guessed that he really was not 
a doctor. I knew that. I imagine most people in the United States know 
it, that this clown is not really a doctor. But he says so just in case 
some of us out there are fooled by his little smock that he has on. 
``I'm not a doctor, but I play one on TV.''
  Well, you get people on television now. You can see it everywhere. I 
mean after the news, before the news, before Donahue comes on, there is 
a lot of actors come on, and they look, oh my goodness, that they are 
trying to take our insurance away; oh, the Government is going to get 
involved in insurance. And in health insurance; you mean like Medicare? 
The Government is involved in Medicare.
  Now does anybody want to come on the floor and say they want to take 
Medicare away? I invite them. You do? You have noticed, Mr. Speaker, I 
handed out the invitation here for quite some time now. I do not see a 
rush of people coming down here to get into a dispute with me, 
particularly inasmuch as I have invited them to explain what their 
health care coverage is before they start telling other people that 
they cannot have any. They have not come down here.

  Now what you have is actors. What they should be saying is, ``I don't 
really have health insurance, but I pretend I do on TV.'' That is what 
it really is. They do not have any health insurance. They are actors.
  You know, it is real interesting. I tried to find out who some of the 
actors were. I mean they play people on television with health care 
insurance. I thought I would just make little inquiry. What I did was I 
said, ``Well, why don't we find out who they are and find out if they 
actually have health insurance?''
  You want to know something? We found out who those folks were. I mean 
I do not want to expose them, I do not mean in the sense of getting 
their names and addresses and publicizing them on television or any 
other area. I just wanted to find out do they have insurance.
  Well, it turns out that the insurance companies have hired these 
folks, and of course they are actors, and they are out of work all the 
time, which means they do not have any regular health insurance, or 
when they are out of work they lose their health insurance; but one of 
the stipulations for these poor folks is they cannot talk about it. Ha, 
ha, ha. The insurance companies do not want you to know that these are 
folks who otherwise would not have health health insurance, and they 
are on television pretending that they are worried about the rest of 
us.
  And this is what is happening down here on the floor day after day 
when Hawaii gets attacked for the crime apparently of seeing to it that 
all our people have health insurance. I mean it stuns me. I thought we 
were supposed to be acting on people's behalf. I do not feel bad that 
everybody in Hawaii has access to health insurance. I think it is a 
good thing. I happen to think it is one of the reasons that I get 
elected.
  In fact, I would be delighted to have anybody who is against health 
care insurance, against health care security for everybody, to come out 
to Hawaii and run for office. I would be delighted to have someone run 
for office against me who says, ``Well, Abercrombie is for you having 
health care insurance, and I'm against it. Vote for me.'' I mean, how 
dumb can you get?
  In fact, we have a situation right now where we have a Republican 
candidate for Governor who is on her way to losing what was at one 
point a 20-25 point lead and is going to lose the governorship because 
she associated herself with people from Hawaii who came to Washington, 
who said they are going to try and get rid of the health care system we 
have in Hawaii.
  So, the Republican opposition to health care is now practicing what 
they preach. I give them credit for that. I will give credit for that. 
The Republican candidate for Governor out in Hawaii is presently 
associated with those in her party who want to end health care in 
Hawaii as we have it in our prepaid health care plan. They want to go 
back to the old system. They want to go back to the system that many of 
the people here visiting our Capital and many of the people in the 
United States, other than Hawaii, have right now--namely, you are a 
complete victim of predator insurance companies. It is interesting they 
say they want the government out, but it is apparently OK for an 
insurance agent to tell you whether you can have care or not, to tell 
you whether you can have health insurance or not.

                              {time}  1520

  What happens if you get sick? What happens if you have a heart 
condition arise? What happens if some other wasting disease comes into 
your family? You can find your health care taken away, your insurance 
taken away.
  That does not happen in Hawaii. You cannot take any one's health care 
insurance away in Hawaii. You can do it if you legislative it. We have 
a candidate who actually associated herself with people who wanted to 
take health care away, and as a result she is now, as people find that 
out, her lead in the polls, presumed lead, if you are to believe these 
polling people, is now evaporating. The election will be lost. Of 
course, one of the reasons, I believe the principal reason, will be 
that when people find out that there is demonstrated across-the-board 
hostility on the part of the Republican Party, in this instance in 
Hawaii, to health care security as we have in the State, they, of 
course, are going to lose.
  I understand what they are doing. Do not get me wrong, Mr. Speaker. 
They believe this. This is an ideological belief. This is a principal 
part of the belief system of some of the prominent people in the 
Republican Party in Hawaii.
  They are entitled to that. I do not object to them having that. On 
the contrary, I am delighted that they do, because obviously it makes 
our job a lot easier as Democrats to stand for health care security and 
making sure that everybody has health care insurance in Hawaii.
  Let me give you another reason why we do not have necessarily 
universal health care as a result of the employer mandate, which I 
indicate, once again, was never intended to be provided from the 
employer mandate.
  GAO itself gives an example. For example, private providers are not 
always willing to serve Medicaid patients. Some people are on Medicaid. 
They do not want to serve these people. So obviously the law with 
respect to employer mandate cannot take care of that. It never was 
intended to.
  Let's go on into some of the other results in Hawaii according to the 
GAO. Health insurance premiums are lower than in the nation as a whole 
and in the last decade have risen more slowly in Hawaii than 
nationally.
  I will repeat. Insurance premiums are lower than in the nation as a 
whole and in the last decade, the last 10 years, have risen more slowly 
in Hawaii than nationally.
  We identify two factors that contribute to lower premiums in Hawaii. 
Reduced cost shifting, which, of course, is one of the principal 
reasons we have the universal employer mandate, so that some businesses 
are paying into the insurance plans of their employees, and others are 
not. You see, if some businesses are paying in and others are not, the 
others who are not have an advantage over those who do. They are free 
riders.
  The cost is shifted. Somebody has to pay for insurance. When we hear 
the phrase who is going to pay for it. Mr. Speaker, you and I both know 
we are already paying for it. The question is some of us are paying for 
it and some of us are getting away with not paying. And you will find 
that those who are most vociferous, those who most loudly proclaim 
their right, quote-unquote, not to participate in an employer mandate, 
are those who do not want to pay. But they are perfectly willing to let 
others do so. They want to ride on the backs of those who are trying to 
do the right thing.
  In Hawaii, because this law covered everyone in the State, everybody 
started from the same starting line, everybody started at once from the 
same position, and therefore nobody was put at a disadvantage. So there 
is, as the General Accounting Office says, reduced cost shifting, and 
insurance companies' use of modified community rating for small 
businesses. This is not me speaking, this is the Government Accounting 
Office.
  The insurance companies' use of community rating for small 
businesses. Actually, what happened when our law was passed 20 years is 
small businesses got a break. Previously, and this happens all over the 
United States now, it happens to virtually everybody who is visiting 
the Capitol, everybody who is viewing the proceedings here today on 
television, they are in a situation in which large companies, those 
with very high numbers of employees, are able to get favorable 
insurance treatment because they have a group rate based on their 
numbers, whereas a small business with 1, 2, 5, 10, or 20 employees, 
does not get that rate, because they are small and because the 
insurance company does not have to give them a good rate. The insurance 
company can beat them up.
  I feel for the small businesses in this regard. We are looking out 
for them. That is why we passed the bill that we did. Small businesses 
do not take a beating in Hawaii on insurance because they are not 
allowed to be discriminated against by predator insurance companies.
  Next sentence: ``Hawaii's requirement that employers provide health 
insurance has not resulted in large disruptions in Hawaii's small 
business sector.''
  Again, Mr. Speaker, believe me. I could quote page after page after 
page in context here of the General Accounting Office report, and will 
come up with the same kinds of things, the exact opposite of what has 
been said on this floor with respect to what has happened to small 
businesses.
  Obviously, there are people in Hawaii, businesses in Hawaii, who 
would prefer not to pay. Does this strike anyone as strange? Does 
anyone want to pay more taxes than they actually have to pay on their 
income?
  No. We are at great pains to make sure that yes, we are being 
straightforward and honest about our incomes. But, by golly, if there 
is an opportunity for an exemption or an opportunity for a deduction 
that we are entitled to, why, we want to take it. Not only is it our 
right, I am sure it is your obligation. You want to retain the maximum 
amount of income for yourself and your family. Of course you do that.
  Well, naturally if businesses could get out of paying, many of them 
would like to do so. Not all, because many of them do recognize their 
social and economic responsibilities. They understand what cost 
shifting is all about. They understand that we all have to pay in the 
end. They understand that this is the most sensible way in order to get 
a broad-based community-based statewide and hopefully nationally based 
health care system underway.
  But the principal argument that has been made by business, according, 
again, to the GAO, really is not to get out of the employer mandate, 
but they have concern about the cost, and that is a perfectly 
legitimate item. They have expressed concern, business owners have 
expressed concern, about the cost and inflexibility of the employer 
mandate. Not the employer mandate itself, they have expressed concerns 
about the cost, which again I will say is not only perfectly natural, 
but I would expect that people would be concerned about costs. I will 
get to that, how our costs have been lower than they were on the 
mainland and continue to be lower, despite the fact that we are subject 
to the same kinds of pressures that have caused a general rise in 
expenditures and costs for health care elsewhere on the mainland. We 
are subject to the same kinds of things.
  As a matter of fact, one of the points I would like to raise at this 
juncture is we have even more pressures on us. Our State, after all, is 
made up of islands. We cannot travel as you can, say, from the District 
here into Maryland and Virginia by car or by bus on by foot, for that 
matter. Unless you are very strong and practice almost all year long, 
you cannot even get between islands by canoe. We have special races for 
the canoes. Only the best athletes can do that. We have to fly. And we 
have remote parts on our islands, rural sections on our islands.
  My colleague in the House, Mrs. Mink, Patsy Mink, who serves the 
Second District, as you know, Mr. Speaker, I serve urban Honolulu, the 
Honolulu that maybe many people are familiar with, with the outline of 
Diamond Head against a beautiful blue sky and Waikiki and its beautiful 
beaches, and all of which I am privileged to represent and invite 
everybody to and hope you will come out and help improve our economy so 
we can keep our health care insurance premiums low. We would be 
delighted to have you come out. We will take care of you, by the way, 
if you get sick while you are out there.
  You are familiar with that. The friendly skies will take you there to 
Hawaii. Mrs. Mink has the rest of Oahu, on which Honolulu is located, 
and all the other islands. In other words, when her plane lands from 
the friendly skies in Honolulu, at Honolulu International Airport, she 
has to get on a plane again and fly to Kaui, Molokai, Niihau, the big 
island of Hawaii, fly to both sides of the island of Hawaii, to the 
Kona or Hilo side. When she is there, she has to drive 1, 2, or 3, 
hours to Hana on Maui. We invite you there, too. It is a small quiet 
community if you want to get away from it all. We have universal health 
care coverage in Hana.

                              {time}  1530

  It will take 2 to 3 hours to drive there. So naturally we have some 
difficulties in actually putting the providers, the physical capacity 
to provide the health care that we have on paper, that is to say what 
the law requires in terms of coverage, every one has that. But actually 
physically providing it is difficult. It is costly. And yet with all of 
these cost factors which drive our figures up, we still are below the 
costs associated with the rest of the United States.
  Mr. Speaker, I have enjoyed this discussion with you and those who 
are observing and listening today so much, I know my good friend Mr. 
Dornan has some things he wants to share with us. I am going to let him 
know that I will not be taking the full 25 minutes. I am anxious to 
hear what he has to say. In fact, I cannot cover all the material in 
this particular segment, but I will come back; I am sure that people 
want to know, now that the issue has been raised, that we do, in fact, 
have universal health care coverage in Hawaii.
  We are not saying and never have said, by the way, Mr. Speaker, as 
you well know, that we seek merely to duplicate the Hawaii system in 
the rest of the country. Mrs. Mink and myself have never said that. We 
have never indicated that. I think that our law, as I said was 20 years 
old, it has been very effective. I would think it forms a good 
foundation. We think that it offers an opportunity for objective 
people, for people of good will and good faith to take a look at what 
we do and how we do it and how we have modified, how we have modified 
it and what we would like to see changed. Certainly, we see that. But 
we do believe that there has to be more than a coincidence involved.
  When our little State in the middle of the Pacific, just two 
Representatives here in this vast body, 435 people, suddenly is zeroed 
in on as somehow misrepresenting what it is that takes place in our 
State or somehow trying to foist off on the rest of the Nation that 
which we do, on the contrary. What we have said, and in fact I note 
that there are some Members in the Senate now, am I allowed to mention 
the Senate, by the way, during special orders or do I have to say the 
other body. I do not mean any disrespect.
  I understand there is some concern in the Senate that has been 
expressed at least by newspaper reports, although I wish some of these 
folks would actually get in touch with us and speak to us personally 
about it, about Hawaii possibly having a waiver in whatever results in 
health care. Well, it is of no concern to me, Mr. Speaker, at all.
  If Members of the House of Representatives in the U.S. Senate want to 
pass a health care bill that provides for health care less than that 
which is already in effect in the State of Hawaii, I would presume that 
no one would object if Mrs. Mink and myself and our good Senators 
across the way, Mr. Inouye and Mr. Akaka would like to have the people 
of Hawaii not have health care coverage taken away from them. It only 
makes sense. I am not worried about waivers or changes. We have one of 
those already. We have a waiver that we have been given. Of course, the 
reason was we are the only one that has the national health care plan.
  The waiver we have is from the Employment Retirement Income Security 
Act of 1974, commonly known as ERISA. If I use that acronym, what it 
means is the Employee Retirement Income Security Act. That is a Federal 
law. And we have limited exemption from it. Why? The ERISA, the 
Employee Retirement Security Act, preempts State authority in terms of 
regulating self insured employer health plans. It preempts our State 
authority.
  Inasmuch as we already passed a universal health care bill before the 
enactment of the ERISA, we wanted to make certain that our act, our 
ability to take care of our people was not impaired. So we have a 
limited exemption.
  In fact, our exemption is so limited it is virtually impossible for 
us to amend our act. Believe me, Mr. Speaker, we would be delighted in 
the State of Hawaii to amend the prepaid health care plan that was 
written 20 years ago in some administrative ways that we think would 
advance the case, the kinds of things that are now being proposed in 
the national health care bill in 1994, but we are disenabled from doing 
that because of the restrictions about preemption on the Federal level.
  So we find ourselves, then, in a situation where we are able to 
provide health care insurance at a lower rate than anybody else in the 
rest of the Nation, despite disquisitions here on the floor of the 
House and pronouncements on the floor of the House to the contrary. I 
do not know where all these statistics come from. I can tell you what 
the statistics actually are. I have the Hawaii Medical Service 
Association's statistics here. I have the Kaiser Permanente Health 
Maintenance Organization plans here, prices here that we pay in Hawaii. 
I have all of it.

  I want to indicate one other thing that comes up with respect to the, 
I will not say false but misleading, the misleading statement that our 
employer-based mandate for insurance somehow is supposed to provide 
total coverage. For those who are low-income residents, the gap group 
that were not covered by our insurance plan were not otherwise eligible 
for Medicaid, we had what was called the State health insurance plan, 
which we put into effect. Enrollment is voluntary, you cannot force 
everybody into it.
  So I think that for my purposes today, Mr. Speaker, I would like to 
wind down my remarks and allow Mr. Dornan to launch into his remarks 
for the day by repeating, then, an obvious point to us that, and this 
is highlighted in the General Accounting Office report, Hawaii has the 
highest rate of coverage but not universal care. I will repeat what is 
in the report: Hawaii has the highest rate of coverage of any State, 
does not have universal coverage. This widespread coverage is the 
result of State's employer mandate, the Medicaid Program, and SHIP, the 
State health insurance plan coverage for the gap group. Estimates of 
Hawaii's uninsured rate range from 3.75 percent in 1991, survey to a 7-
percent determined by data from the current population survey.
  In other words, that is done strictly by statistics. So you can come 
up, anybody can come up with something that says, it is 3 percent, 
somebody else says it is 7 percent, but with our new program, which we 
have put into effect called the Healthquest Program. We came up to the 
Congress. We came up to the new administration and we said, look, we 
are quite aware of the fact that because we have not been able to amend 
our law the way we want to as a result of Federal preemption, that we 
do not cover 100 percent of our people the way we want to.

                              {time}  1530

  We want to make more certain of that. So this year we were able to 
get another small waiver enabling us to put together what is called 
health quest, and improvement on the State health insurance plan known 
as SHIP. We have the Health Quest Program. That is going to be fully in 
place, as I said, by September 9 of this year.
  The Health Quest Program, Mr. Speaker, I want to indicate to you, is 
again not a government program in the sense that it has been portrayed 
here on the floor of the House. It is again self-administering. It was 
competed for. We have five different groups.
  I have heard down here on the floor our Hawaiian Medical Services 
Association, and I suppose even Kaiser, I do not know if lambasting is 
exactly the word, but let me put it this way: The implication of the 
discussion on the floor was that somehow the choice of our people was 
limited as a result of these two providers having the major share of 
employees and others in the State of Hawaii.
  Mr. Speaker, they have competed for 20 years. They have a major share 
because they have provided good service. I am astounded by people who 
tout the private care system, the private sector system, who then 
complain when it works.
  Mr. Speaker, are those of us who are satisfied--I have been a member 
of the Kaiser system, the Kaiser Health Maintenance Organization, for 
35 years, 35 years. The reason that I have been associated with them 
for 35 years is that I am satisfied with the service that I get. Does 
it sound strange, then, that I would continue to be a member?
  I have good friends who are members of the Hawaii Medical Services 
Association, the HMSA, and they have been there for 35 years. Why? 
Because they are satisfied with it.
  I happened to start with Kaiser. I suppose I could have picked the 
HMSA at the time. I was a student at the University of Hawaii at the 
time. That is the way we got started. I could have changed.
  There are other plans out there now. There are three or four other 
plans that are available to us in Hawaii, all competitive with one 
another. I am not compelled to stay with any one system. I can change.
  Every year, I want to point out, every year those who are not 
satisfied with their health plan can change the plan that is provided. 
We are not stuck. We have nobody there that makes us stay there.

  As a matter of fact, Mr. Speaker, I have indicated that our plan is 
self-administering. The other gentlewoman from Hawaii [Mrs. Mink] has 
told me she believes there are two clerks in the Department of Labor 
and Industrial Relations that monitor the health care plan system in 
Hawaii. I am not certain and she is not certain. She believes there are 
two clerks.
  Two clerks for 20 years is not bad. We are not sure where they 
actually are, but if we find them I will bring them in, their names and 
where their desks are in the State. I am not sure where they are; I 
will have to look real hard.
  That is the sum total of the bureaucracy associated with our health 
plan. It is all self-administered. After all, does anybody think that 
the health providers are going to let a member disappear and not pay? 
Of course they are not. It is in their interest to do it. That is why 
it is self-administered.
  Mr. Speaker, I want to conclude by saying that we have taken care not 
only of those who are employed, but we have taken care of the gap 
group, we have taken care of those on Medicaid, we have taken care of 
everybody to provide what for all intents and purposes is 100 percent 
coverage. I will go into the costs of that coverage in another special 
order.
  I will be happy to discuss Hawaii's health care system with any of 
the opposition to national health care reform. I will be happy to share 
with them what our experiences have been, and hopefully convince them 
that if they keep an open mind, if they are willing to discuss it in 
good faith and with a modicum of good will, that perhaps we can arrive 
at a proposal and a plan that will allow all of us here, regardless of 
our party affiliations, to act on a nonideological basis on behalf of 
the interests of all the people of the United States.

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