[Congressional Record Volume 142, Number 10 (Thursday, January 25, 1996)]
[Senate]
[Pages S371-S374]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH INSURANCE REFORM
Mrs. KASSEBAUM. Mr. President, I would like to offer just a few
observations on comments that were made by President Clinton in his
State of the Union speech the other evening regarding health insurance
reform. I was pleased that President Clinton mentioned it, because I
think it is a subject of great importance to us.
As we debate the future of the Medicare and Medicaid programs,
American families are growing increasingly anxious about the
availability, portability, and cost of their own private health
coverage.
While the comprehensive health reform debate ended well over a year
ago, the American people continue to rank health reform as a priority
and health care as a top concern. A poll conducted late last year by
Princeton Survey Research Associates found that more Americans are
concerned about their own health coverage than crime, high taxes, the
``political system,'' and the economy. Both the Princeton poll and a
Times Mirror poll also found that health care topped the list of issues
Americans most want the Presidential candidates to address.
The health insurance problem is not merely one of perception. The
number of uninsured and underinsured Americans continues to climb:
First, there are now over 40 million Americans without health
insurance.
Second, over 1 million working Americans have lost health insurance
in the last 2 years alone.
Third, and, over 80 million Americans have preexisting conditions
that could make it difficult for them to maintain health coverage when
they change jobs.
Mr. President, Congress has the opportunity this year to address
middle-class Americans' concerns about the diminishing availability,
portability, and affordability of health coverage in a bipartisan way.
A health insurance reform bill proposed by myself and Senator
Kennedy, S. 1028, passed the Senate Labor and Human Resources Committee
unanimously last August and now awaits action on the Senate Calendar.
Similar measures are pending in the House of Representatives, including
a companion bill introduced by Representative Roukema of New Jersey.
Through sensible, market-based reforms, the Health Insurance Reform
Act would:
First, limit the ability of insurers and employers to impose
preexisting condition exclusions;
Second, prevent insurers from dropping coverage when an individual
changes jobs or a family member becomes ill; and
Third, help small companies gain more purchasing clout in the market.
The General Accounting Office estimates that the Health Insurance
Reform Act would help at least 25 million Americans each year, and the
Congressional Budget Office predicts that it would do so without any
cost to American taxpayers.
support for the health reform act
The Health Insurance Reform Act enjoys broad support. It passed the
Labor and Human Resources by a 16 to 0 vote and has attracted 40
cosponsors--20 Republicans and 20 Democrats--from across the political
spectrum. Moreover, it has been endorsed by a wide range of outside
organizations, including the National Governors' Association, the
National Association of State Insurance Commissioners, the Consortium
for Citizens with Disabilities, Small Business United, the National
Association of Manufacturers, the U.S. Chamber of Commerce, and the
American Medical Association.
I believe the legislation has achieved broad consensus for two main
reasons.
First, it is narrowly focused. It does not contain employer mandates,
mandatory purchasing alliances, new taxes or new bureaucracies. It does
not remake the private health care system in the image of the United
States Post Office. Instead, the legislation focuses only on those
areas where broad, bipartisan agreement existed during the health care
debate in the 104th Congress and where State insurance reforms have
demonstrated the ability to work.
Second, the legislation was crafted with significant input from
consumers, insurers, businesses, hospitals, and doctors. It is
carefully attuned to the rapidly changing private health care market.
As the U.S. Chamber of Commerce and other employers said in a recent
letter, the Health Insurance Reform Act would:
* * * improve health coverage for tens of millions of
American workers and their families * * * through carefully
designed rules that are workable for employers who
voluntarily sponsor health plans and for their employees.
response to concerns
The Health Insurance Reform Act is not without some detractors. We
have worked closely with the health insurance industry, and insurers
generally support the bill. For example, Blue-
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Cross Blue-Shield and the Health Insurance Association of America
submitted testimony in favor of the vast majority of the bill's
provisions. However, some continue to raise concerns about one
provision of the legislation that is designed to help individuals and
families who have played by the rules maintain health coverage if they
lose their job or leave a job to work for an employer that does not
offer coverage.
I believe, however, that this provision strikes a careful balance
between the need to provide consumers some access to individual
coverage and the need to protect the fragile individual insurance
market.
The Health Insurance Reform Act would provide access to individual
insurance only for those who have maintained prior continuous coverage
under an employer-sponsored health plan for at least 1\1/2\ years, who
have exhausted their COBRA benefits, and who are ineligible for
coverage are under another group policy.
Moreover, S. 1028 contains no restrictions on premiums, and it leaves
broader reforms--such as guaranteed issue for individuals who have not
had prior coverage, guaranteed issue for the self-employed, and
portability between individual health plans--to the States. As a
result, the bill requires individuals to pay into the system for years
before being able to gain access to health coverage.
This group-to-individual portability provision is not far-reaching.
It is limited precisely to avoid potential premium increases and
adverse selection problems that could result from broader individual
market reforms. Testimony and analysis by the National Association of
Insurance Commissioners and others has confirmed that this narrow
provision is unlikely to have a significant impact on the cost of
health coverage in the individual market. The most recent estimates
from the American Academy of Actuaries show that this provision would
likely affect premiums by only 2 to 3 percent.
It is true that some insurers who now thrive by refusing to cover
those in poor health may be unable to survive in a market characterized
by competition based on quality, price, and service. In States like New
Hampshire, Vermont, and California that have enacted targeted insurance
market reforms like those in the Health Insurance Reform Act, some
insurers have left the market--but others have replaced them,
competition has flourished, rates have come down, and consumers have
benefited.
I do share the belief that State high-risk pools are one important
way of providing access to insurance for certain individuals. That is
why S. 1028 expressly provides that if a State has adopted, or adopts
in the future, a high-risk pool or other means of allowing individuals
to maintain health coverage, that State law or program will apply in
lieu of the group-to-individual portability provision contained in the
bill. Instead of preempting State reforms that are working or
prescribing a one-size-fits-all solution from Washington, S. 1028
allows each State to fashion individual market solutions that are
appropriate for individuals in that State. This is one of the main
reasons that both the NGA and the NAIC support the bill.
Another argument that is sometimes made is that insurance reform
should be left entirely to the States. This argument also ignores
reality.
While 48 States have enacted insurance reforms targeted to small
companies, over 70 percent of workers with health coverage work for
firms with more than 100 employees. Moreover, the States are prevented
by the broad preemption provisions of the Employee Retirement Income
Security Act from providing portability to workers who receive health
benefits through self-insured, employer-sponsored health plans. I
believe strongly that we should retain ERISA preemption. But as we do,
we must recognized that the vast majority of American workers cannot
carry their insurance from one job to the next unless we enact
portability reforms on the Federal level.
it is time to move forward
Mr. President, I think we all know people in our own States who would
be helped tremendously by this legislation. For nearly a decade,
however, Congress has been unsuccessful in attempts to pass health
insurance reform legislation. We now have a historic opportunity to
move forward. And I believe we should seize that opportunity.
Last Congress, Republicans and the American people rejected the
administration's comprehensive health reform proposal. Instead, every
one of us signed onto market-based health reform legislation that was
more ambitious in almost every respect than the Health Insurance Reform
Act.
Now, the President of the United States has endorsed our approach.
And Senator Kennedy and other Democrats should be commended for working
with us to make positive change a realty, without letting the perfect
become the enemy of the good.
While the political dynamic clearly has changed, I believe strongly
that Republicans' commitment to moving forward with common sense,
market-based health reform legislation should not.
I want to make clear to all of my colleagues that I, for one, am
absolutely committed to passing health insurance reform legislation
this year--either as a freestanding bill or as an amendment to another
vehicle.
The Health Insurance Reform Act does not strike out in a bold, new
direction. But it is a very positive step forward that will reduce
barriers to health coverage for millions of working Americans. It is
also an opportunity to demonstrate to the American people that
Republicans and Democrats can work together to address their most
serious concerns about the health care system. I believe we should
start by passing this legislation at the earliest possible opportunity.
I yield the floor, Mr. President.
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, I yield myself 10 minutes.
I again congratulate Senator Kassebaum for her leadership on this
extremely important issue which can make an extraordinary difference to
the quality of life of millions of Americans who are, as she described,
playing by the rules, working hard, trying to participate in the
workplace, and also trying to fulfill some of their hopes and dreams
for the future.
As Senator Kassebaum has pointed out, our committee, as well as other
committees, dealt with the broad issue of health care for all Americans
in the last Congress. We were unable to pass that legislation. But
during the consideration of our committee, we had some 10 days of
markup, which virtually every Member, Democrat and Republican,
attended. Those were long days which began early in the morning, at 8
or 9 o'clock, and went sometimes until 8 to 10 in the evening with
brief recesses. Our committee delved into the various features of the
health care debate. I thought we reached some important agreements on a
number of those different measures, but there were areas of difference
and we were unable to secure the kind of comprehensive coverage which I
basically support. At some other time, hopefully, we will have another
chance to address it.
During that period of time, Senator Kassebaum provided great
leadership by expressing her concern and also her commitment to try to
address one of the particular challenges in health care coverage that
remains out there and works such an extraordinary hardship on millions
of Americans--lack of guaranteed health insurance.
Millions of working Americans develop some preexisting condition and,
under the current system, often are individually dropped from their
health insurance. Or if they are working in a small company, the
company's health care costs go up enormously if they try to maintain
their coverage, or otherwise all of the members, through no fault of
their own or no fault of this individual, lose that coverage.
Or the individual who works hard and has an opportunity to obtain a
job, maybe move up on the economic ladder, faces a circumstance where
the new opportunity will not provide health care coverage. This
individual is effectively in a position of job lock and is denied that
opportunity again because of some preexisting condition or some ailment
or some disability which is no fault of their own.
As the Senator from Kansas has pointed out, those individuals exist
in the small towns and communities, rural areas, as well as cities in
her own State of Kansas. And they exist in my State of Massachusetts.
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Throughout this last year, very quietly, conscientiously, and
deliberately, Senator Kassebaum reached out, as she mentioned, to the
consumers, to the health care profession, to the business community, to
others, including the insurance industry, to try and fashion
legislation that could address one of the most egregious and serious
aspects of the health care crisis that we are facing.
After a very thorough examination of this issue and listening to a
broad range of interested individuals, as well as different groups, she
fashioned this legislation, and I enjoyed the opportunity to work
closely with her and her staff to introduce this legislation. This
legislation takes into consideration a number of the points that were
raised during the course of the hearings and a number of points that
were raised by Members of our committee. Then, in really a very special
way, Senator Kassebaum was able to gain virtually the unanimous consent
of all of the members of the committee, all 16 members of our Labor and
Human Resources Committee supported that legislation.
When we look today at some of the divisiveness which exists in the
course of our legislative agenda, it always continues to impress me
about the willingness of those members and the various groups that they
represent to come together to try and address something which has such
important meaning to millions of our fellow citizens. And that is what
was done. The best of the ideas that were raised and the hearings were
incorporated, some of the concerns were addressed, and out of the
legislative process came an even stronger bill than was even introduced
by Senator Kassebaum and myself. And this legislation has been reported
out of committee and has been on the agenda for some period of time
now.
During the course of many months we have had the opportunity to talk,
and talk together, about what the possibilities were of getting to
present this to the Senate, to urge our colleagues to support this, as
well as to try to get our friends and colleagues in the House to
address this issue. And the time is moving along.
We are not here today to try and point the finger at individuals or
groups or constituencies that have resisted the opportunities to bring
this up and consider the legislation. But what we are basically
indicating today is that the kind of response we have all received on
this issue is Republican and Democrat alike. The 40 cosponsors reflect
20 Democrats and 20 Republicans with wide, diverse, different
philosophical viewpoints. When we are able to gain that kind of
confidence from our colleagues after they have had a chance to study
the legislation, it is worthwhile for this body to consider the
legislation, to consider any amendments that are directed toward the
legislation, and then to move the process forward.
I hope that we would have that opportunity in a timely way. I think
those of us who have supported the legislation believe that even though
there may be differences with Members on different items that are not
directly related to this, that we can as an institution address this
and see a successful conclusion of the legislation.
This is a modest program but a very important one. I underline both
those words. It does not do the comprehensive job that many of us would
like to do, but it will make an enormous difference in the quality of
life for millions--and I mean millions--of young and old alike. This
legislation will enable more people to live a life in our society where
they participate and pay their fair share of premiums for their
coverage in exchange for at least some degree of security in knowing
that they will have health insurance to provide some protection against
financial devastation.
In terms of their health care situation, they will still, as
individuals, endure the anguish and the pain that comes from many
physical and mental challenges which they may face. They will have that
for the rest of their lives. We cannot pass any legislation to deal
with that. But with this legislation, they will know that they will be
able to at least obtain decent, quality health care and that they will
not put in debt the members of their families and their loved ones with
the extraordinary kinds of costs that may be attendant to the treatment
of some of the illness and sickness.
That kind of relief from the anxiety and the anguish for our fellow
citizens is enormously important. It does not show up on the bottom
line of the expenditure column. But what it does do is it makes an
extraordinary difference to our fellow citizens.
So, Mr. President, I welcome the opportunity to join with Senator
Kassebaum and urge that we consider this legislation. I know from
talking with her that we are prepared to do this in a timely way. We
can enter into various agreements so that individuals who have special
interests or concerns can make sure that they have a full opportunity
for debate and consideration of these views, and then let the Senate
work its will.
This is an extraordinary piece of legislation which includes the
support of the chamber of commerce, the National Small Business United,
the National Association of Manufacturers, the ERISA Industry
Committee, the Association of Private Pension and Welfare Plans, and
the National Governors' Association, the National Association of State
Insurance Commissioners, the insurance companies in the Alliance for
Managed Care, the American Medical Association, and the Consortium for
Citizens with Disabilities. In fact, the only opposition comes from
those who really profit from the abuses in the current system.
So, Mr. President, in the State of the Union Address, the President
challenged Congress to pass this legislation. We are aware that there
are some Senators who place these, what we call, ``holds'' on a bill in
an attempt to kill it. They know if the legislation is brought to the
floor of the Senate, it will pass overwhelmingly.
The only thing blocking action is the scheduling of the floor debate.
So I join Senator Kassebaum in urging our leader to bring this to the
floor. We welcome the opportunity to cooperate with him. With his
responsibilities as the majority leader in scheduling different
measures, we are glad to work out whatever agreement that is necessary.
We are glad to speak to our colleagues. But we do think that it is time
that we address this legislation. It is time to break the logjam. The
American people deserve action, and they deserve it now.
Just finally, Mr. President--and then I will yield what remaining
time we have on this side to the Senator from Texas--I hope that we
might be able, as Senator Kassebaum has stated previously, to consider
this legislation in a forum where we can have the focus and attention
on this legislation.
The majority leader was extremely gracious in working out our job
training program, which basically reorganizes the total training
programs, involving billions and billions of dollars, and provides a
reduction in total funding. But we worked that out in a matter of just
hours, again, in a strong bipartisan way, after reporting the
legislation out of our committee. I believe that in somewhat less than
8 or 10 hours, we were able to consider a few amendments and then take
action.
With the kind of support we have for this, I think we can do it in a
similar timeframe, although we are not interested in cutting off any
legislation. But I hope that if we are not able to work that through,
at least we would have an opportunity to raise this issue in the
foreseeable future, if not as an independent measure, at least as an
amendment to another piece of legislation. I agree with Senator
Kassebaum that that would be a less desirable way to proceed, but I
think we may be forced into that kind of situation.
This year Congress has the opportunity to end many of the most
serious health insurance abuses that victimize millions of Americans
every year. It is an opportunity we cannot afford to miss.
These abuses create endless unnecessary suffering. Millions of
Americans are forced to pass up opportunities to accept jobs that would
improve their standard of living or offer them greater opportunities
because they are afraid they will lose their health insurance if they
leave their current jobs. Many others have to abandon the goal of
starting their own business, because insurance will be unavailable or
unaffordable. Still others lose their health insurance because they
become sick, or lose their job, or change their job--even when they
have faithfully
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paid their insurance premiums for many years.
The private health insurance market in the United States is deeply
flawed. More than half of all insurance policies impose exclusions for
preexisting conditions. As a result, insurance is often denied for the
very illnesses most likely to require medical care. The purpose of such
exclusions is reasonable--to prevent people from gaming the system by
purchasing coverage only when they get sick. But current practices are
indefensible. No matter how faithfully people pay their premiums, they
often have to start again with a new exclusion period if they change
jobs or lose their coverage.
Eighty-one million Americans have conditions that could subject them
to such exclusions if they lose their current coverage. Sometimes, the
exclusions make them completely uninsurable.
Not only do insurers impose exclusions for preexisting conditions on
people who do not deserve to be excluded from the coverage they need,
they can deny coverage to entire firms if one employee of the firm is
in poor health. Sometimes, entire categories of businesses, with
millions of employees, are redlined out of coverage. Even if a firm is
in an acceptable category, coverage may be denied if someone in the
firm--or a member of their family--is in poor health.
Even if people are fortunate enough to gain coverage and have no
preexisting condition, their coverage can be canceled if they have the
misfortune to become sick--even after paying premiums for years.
One consequence of the current system is job lock. Workers who want
to change jobs to improve their careers or provide a better standard of
living for their families must give up the opportunity because it means
losing their health insurance. A quarter of all American workers say
they are forced to stay in a job they otherwise would have left,
because they are afraid of losing their health insurance.
I am proud to have joined Senator Kassebaum in introducing
legislation that will address these problems effectively. The
Kassebaum-Kennedy Health Insurance Reform Act is a health insurance
bill of rights for every American and for every business as well.
The legislation contains many of the provisions from the 1994 health
reform debate which received broad bipartisan support--such as
increased access to health insurance, increased portability, protection
of health benefits for those who lose their jobs or want to start their
own business, and greater purchasing power for individuals and small
businesses.
Those who have insurance deserve the security of knowing that their
coverage cannot be canceled, especially when they need it the most.
They deserve the security of knowing that, if they pay their insurance
premiums for years, they cannot be denied coverage or be subjected to a
new exclusion for a preexisting condition because they change jobs and
join another group policy, or because they need to purchase coverage in
the individual market. Business--especially small businesses--deserve
the right to purchase health insurance for their employees at a
reasonable price.
Our Health Insurance Reform Act addresses these fundamental flaws in
the private insurance system. The bill limits the ability of insurance
companies to impose exclusions for preexisting conditions. Under the
legislation, no such exclusion can last for more than 12 months. Once
someone has been covered for 12 months, no new exclusion can be imposed
as long as there is no gap in coverage--even if someone changes jobs,
loses their job, or changes insurance companies.
The bill requires insurers to sell and renew group health policies
for all employers who want coverage for their employees. It guarantees
renewability of individual policies. it prohibits insurers from denying
insurance to those moving from group coverage to individual coverage.
It prohibits group health plans from excluding any employee based on
health status.
The portability provisions of the bill mean that individuals with
coverage under a group health plan will not be locked into their job
for fear that they will be denied coverage or face a new exclusive for
a preexisting condition. The portability provisions will benefit at
least 25 million Americans annually, according to the General
Accounting Office. In addition, these provisions will provide greater
security for the 131 million Americans currently covered under group
health plans.
The bill will also help small businesses provide better and less
expensive coverage for their employees. Purchasing cooperatives will
enable small groups and individuals to join together to negotiate
better rates in the market. As a result, they can obtain the kind of
clout in the marketplace currently available only to large employers.
The bill also provides great flexibility for States to meet the
objective of access to affordable health care for individuals who leave
their group health plans.
During the debate on health reform in the last Congress, even the
opponents of comprehensive reform urged Congress to pass at least the
reforms that everyone supported--portability of coverage, guaranteed
availability of coverage, and limitations on exclusion for preexisting
conditions. These are exactly the provisions included in this bill.
The Health Insurance Reform Act is a modest, responsible, bipartisan
solution to many of the most obvious abuses in the health insurance
market place today. The bill was approved by the Senate Labor and Human
Resources Committee last August by a unanimous vote of 16 to 0. It is
now cosponsored by 40 Senators--20 Republicans and 20 Democrats. It is
similar to proposals made by President Clinton in his recent balanced
budget plan.
The measures it includes are also virtually identical to provisions
of legislation offered by Senator Dole in the last Congress. Sponsors
range from the most conservative Members of the Senate to the most
liberal--because these reforms represent simple justice. They are not
issues of ideology or partisanship.
Support for the bill by outside groups is equally broad. Those who
have expressed their support for the legislation include the Chamber of
Commerce, National Small Business United, the National Association of
Manufacturers, the ERISA Industry Committee, the Association of Private
Pension and Welfare Plans, the National Governors' Association, the
National Association of State Insurance Commissioners, the insurance
companies in the Alliance for Managed Care, the American Medical
Association, and the Consortium for Citizens with Disabilities.
In fact, the only opposition to this legislation comes from those who
profit from the abuses in the current system.
In his State of the Union address, President Clinton challenged
Congress to pass this bill. A few Senators have placed secret holds on
the bill in an attempt to kill it. They know that if the legislation is
brought to the floor of the Senate, it will pass overwhelmingly. The
only thing blocking action is the scheduling of the floor debate.
So I join Senator Kassebaum in urging Majority Leader Dole to bring
this bill to the floor. It is time to break the log jam. The American
people deserve action--and they deserve it now.
Mr. President, I yield whatever time remains to the Senator from
Texas.
The PRESIDING OFFICER. The Senator from Texas has 10 minutes.
Mrs. HUTCHISON. Thank you, Mr. President.
____________________