[Congressional Record Volume 140, Number 139 (Thursday, September 29, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: September 29, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
    AMERICANS LOSE AS CONGRESS CLOSES THE BOOK ON HEALTH CARE REFORM

                                 ______


                        HON. MICHAEL A. ANDREWS

                                of texas

                    in the house of representatives

                      Thursday, September 29, 1994

  Mr. ANDREWS of Texas. Mr. Speaker, this week Senate majority Leader 
George Mitchell declared health care reform dead. This is regrettable, 
and it could have been avoided. The 103d Congress made real progress in 
this debate, and it is a shame that it failed to enact health care 
reform legislation this year. Even incremental measures which would not 
have fully accomplished all the worthwhile goals the President set out 
to achieve initially would have started us in the right direction. 
According to an ancient Chinese proverb, ``A journey of a thousand 
miles must begin with a single step.''
  During this session, Congress had a truly historic opportunity that 
may not be repeated soon. Not since the enactment of Medicare nearly 30 
years ago had health care been given such attention in Congress. And 
never has there been so much public information and education about the 
issue. Such a big investment of time, effort, and money should not have 
gone to waste.
  Even though nothing was passed, the current problems of cost and 
access won't vanish; they will continue to worsen. And they will get 
harder and more daunting to solve. By starting now to improve access to 
coverage and to get increasing health care costs under control, 
Congress would have been more able and willing to put forth additional 
effort in the future.
  Most Americans want access to overage at reasonable rates; they want 
their health insurance to cover them without tricky exceptions; and 
they want assurances that they will not lose their coverage if they 
change jobs or become ill.
  There is general agreement in Congress that it should enact insurance 
reforms to solve these problems. And it is possible to do so without 
significant negative consequences. By requiring insurers to accept and 
keep anyone who applies for coverage, by applying preexisting condition 
limitations only if people fail to maintain coverage, and by allowing 
rates within a community to be reasonably adjusted for age, insurance 
reforms can attract young and healthy people into the system, keeping 
costs down.
  In addition, purchasing groups for individual and small employers 
will achieve economies of scale that will bring costs down and help 
compensate for the cost-increasing tendency of sicker people on average 
to purchase insurance in a voluntary system.
  Competition created by empowering consumers with appropriate 
incentives and information will also be a powerful cost containment 
tool. Many employers contribute more on behalf of employees who choose 
more costly plans. Congress could have enacted a rule that requires 
employees who contribute to their employees' coverage to contribute the 
same amount whichever plan an employee chooses. This way, the employee 
would get the savings from choosing a less costly plan.
  In combination with rules for standardized benefits and quality 
reports that will help people compare plans, such reform would provide 
strong incentives for cost containment.

  Incremental reforms could have also expanded options for elderly 
Americans by allowing them to apply their government payment to the 
private sector health plan of their choice. Under this proposal, 
beneficiaries who choose an efficient private sector plan would get 
more value for their money, with less paperwork, and better benefits, 
including prescription drugs, with the savings from more efficient 
care.
  Similarly, changes in rules for Medicaid could have allowed States to 
contract with the most efficient private sector managed care 
organizations without requiring them to jump through bureaucratic hoops 
to obtain a special waiver permitting them to do so.
  Incremental reforms would have improved access and started to bring 
costs down. As a result, fewer people would have been uninsured. For 
those remaining uninsured, there would be some safety net with county 
hospitals. Congress could have monitored this system under incremental 
reform and worked to improve it as necessary.
  While incremental reform is not synonymous with universal coverage 
that can never be taken away, it would have been a valuable and 
important first step in a process of making much-needed improvements in 
our ailing health care system.
  These steps would have been small but important. They would have 
affected millions of Americans and laid a foundation for a larger 
health care debate next year in the Congress and across the country. 
Thoughtful Americans understand fully the importance of reforming our 
Nation's health care system. The 103d Congress, however, did not grasp 
this, and it squandered an important and single opportunity to start 
the job.

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