[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-

[[Page S372]]
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. 

[[Page S373]]

  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 

[[Page S374]]
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.

                          ____________________