[Congressional Record Volume 140, Number 137 (Tuesday, September 27, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: September 27, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           HEALTH CARE REFORM

  Mr. MOYNIHAN. I thank the President. I rise to state that I agree 
with the majority leader's assessment that large-scale health care 
reform cannot be enacted in the final days of this Congress. I further 
agree with Senator Mitchell that we need at least 60 votes in the 
Senate to pass legislation quickly. I believe the record will be that 
this has been my view for a very long while. With those two defining 
facts in mind, I would like to outline four simple provisions that I 
believe could be passed in just a few days.
  This proposal would include basic health insurance reforms to provide 
portability of coverage and to eliminate the denial of health insurance 
due to preexisting conditions. These are familiar matters which have 
passed the House and Senate before. In addition, it would expand health 
care coverage for the self-employed and for children and pregnant 
women. These expanded benefits would be financed by a gradual increase 
in the tobacco tax of the kind we have already reported from the 
Committee on Finance.
  The insurance reforms, again to state, have already passed the Senate 
twice.
  The proposal for expanding benefits is a measured approach using 
existing programs rather than creating new programs, with all the 
organizational paraphernalia that goes with new programs. The expansion 
of existing programs will be financed by a gradual increase in an 
existing tax. We are not inventing anything new.
  This proposal will not foreclose or prejudge the direction of future 
reforms in the health care system. It is consistent with reforms that 
stress private or public, Federal and/or State initiatives.
  The proposal is deficit neutral; expanded benefits for the self 
employed and children and pregnant women will cost $59 billion over 10 
years and will be fully financed by a quite modest increase in the 
tobacco tax.
  Under the four major elements of the proposal:
  First, insurance reforms would guarantee that insurers could not deny 
coverage based on health status, medical condition, or anticipated need 
for health services. One of the things we learned in the course of the 
years of inquiring into the issue of who are the uninsured, we find 
persons with high professional standing and good incomes who are 
uninsured because of a previous medical condition, which is absurd.
  Second, self-employed persons could deduct 100 percent of the cost of 
their health insurance premiums, which is effectively the case for 
persons insured by their employer.
  Third, millions of children in families with incomes below 185 
percent of the poverty level could become eligible for Medicaid through 
enhanced matching grants to States.
  Fourth, a gradual increase in the tobacco tax would fully fund the 
expansion of health care benefits for the self-employed and for 
children and pregnant women.
  Under my insurance reform proposal, insurers would be prohibited from 
imposing a preexisting condition exclusion for individuals who maintain 
continuous insurance coverage. The intent of this provision is to 
prohibit insurers from requiring individuals who change jobs from 
having to meet a new preexisting condition whenever this type of change 
occurs.
  In addition, a limitation would be placed on the length of time 
insurers could exclude individuals who have preexisting conditions. 
Under the proposal, insurers would only be permitted to exclude 
conditions which were diagnosed or treated within the 3 months previous 
to enrollment for a maximum of 6 months after the date of enrollment.
  Identical provisions, as I have said, passed the Senate twice in 1992 
but were dropped in conference.
  The provisions were included in H.R. 4210--the Family Tax Fairness, 
Economic Growth, Health Care Access Act of 1992--which was reported by 
the Finance Committee, and passed by the Senate on March 13, 1992.
  In addition, Secretary--then Senator--Bentsen, along with 15 
Republicans and 5 Democratic cosponsors, proposed these reforms on the 
floor of the Senate as part of a package of amendments to H.R. 11, the 
Revenue Act of 1992. Sixteen Republicans and seven Democrats spoke on 
the floor in favor of this bipartisan set of reforms. No one in the 
Senate spoke against it. No one opposed it. And in that spirit, I hope 
we can proceed, even at this late hour. The reforms passed by a voice 
vote on September 23, 1992, and there is no reason why these insurance 
reforms should not enjoy the same support in the Senate today.
  My proposal would make health insurance more affordable for self-
employed individuals by permitting the self-employed to deduct 100 
percent of their insurance premiums. This is a simple matter of tax 
fairness. It would put self-employed individuals on the same footing as 
employees who can exclude from income health care insurance premiums 
paid for by their employers.
  The deduction would be gradually phased in starting at 25 percent in 
1994. A 25-percent deduction for the self-employed expired on December 
31, 1993. Indeed, we allowed it to expire in last year's reconciliation 
bill only with the full expectation that we would tend to this item as 
part of health care reform legislation this year. If we do not take 
action in this Congress, the self-employed will have no deduction for 
health insurance on their next tax return. I know that no one in this 
Congress has intended this to happen to the self-employed.
  My proposal would expand Medicaid coverage for children and for 
pregnant women. Currently 10 million children lack health insurance 
coverage. Under my proposal two-thirds of these children could become 
eligible for Medicaid coverage.
  For children, the proposal would encourage States to expand Medicaid 
eligibility by giving States an enhanced Federal matching rate for the 
costs of covering children who they are not now required to cover. This 
would make eligible for coverage all children up to age 19 with family 
incomes up to 185 percent of the Federal poverty level.
  Current Medicaid law has an extraordinarily complicated formula for 
coverage of children. States are now required to provide coverage of 
infants (up to age 1) and children up to age 6 with family incomes 
under 133 percent of the Federal poverty level. They have the option of 
covering infants with family incomes up to 185 percent of poverty. And 
finally, States must also cover all other children born after September 
30, 1983 with family incomes up to 100 percent of poverty.

  By giving States an option and an incentive to cover all children 
under age 19, with family incomes below 185 percent of the Federal 
poverty level, we will hopefully not only expand coverage significantly 
but more toward a simplification of eligibility rules, as well.
  My proposal would also increase coverage of pregnant women by 
requiring that States cover this group with family incomes up to 150 
percent of the Federal poverty level. Federal law currently requires 
States to cover pregnant women only up to 133 percent of the Federal 
poverty level. Thirty-four States cover pregnant women at income levels 
beyond the minimum of 133 percent of Federal poverty; the majority of 
these States cover this group up to 185 percent of the Federal poverty 
level. The requirement that States increase coverage to 150 percent of 
poverty would also apply to infants.
  The Medicaid changes and the deduction for the self-employed would be 
financed by increasing the excise tax on cigarettes by 45 cents per 
pack, phased in over 5 years, with a proportional increase in the tax 
imposed on other tobacco products--a proposal very similar to the one 
offered by Senator Mitchell.
  Mr. President, as I stated recently, for health care reform 
legislation I have had one clear guideline in mind at every stage of 
our deliberations: the first principle of the Hippocratic oath ``primum 
non nocere''--First Do No Harm. In my view, the proposal I have 
outlined meets this elemental standard. Moreover, it provides expanded 
health insurance coverage that can be paid for without harming 
beneficiaries of existing programs.
  Mr. President, there is so much more that I would like us to do.
  I do wish we could somehow reasonably contain health care costs.
  I do wish we could fund new and greater support for medical education 
and research.
  But, Mr. President, the reality is that with only about 15 days left 
in this Congress, and with so much disagreement on those issues, we 
must target our efforts in health care reform to what we do know how to 
do, and to what a large majority can agree on. The undeniable fact that 
time is running out on this Congress does not mean that we should give 
up but only that we should concentrate intensely on what health care 
reforms are realistically possible in this Congress.

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