[Congressional Record Volume 142, Number 53 (Tuesday, April 23, 1996)]
[Senate]
[Pages S3827-S3833]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH INSURANCE REFORM ACT
The Senate continued with the consideration of the bill.
Mrs. KASSEBAUM. Mr. President, first before we go to the closing
statements on the health insurance reform bill, I would like to yield
the floor 5 minutes to the Senator from Minnesota.
The PRESIDING OFFICER. The Senator from Minnesota, [Mr. Grams] is
recognized for 5 minutes.
Mr. GRAMS. Thank you very much, Mr. President.
Mr. President, I rise today to offer my strong support for the Health
Insurance Reform Act, and I commend the distinguished chairman from
Kansas and the Senator from Massachusetts for drafting legislation
which seeks to ensure affordable, accessible health insurance for all
Americans.
In September of 1993, President Clinton and the First Lady presented
a sweeping health care reform proposal which they believed would
resolve the health care problems facing many in our country. They said
we needed to make insurance portable . . . they said we needed to
protect individuals with pre-existing conditions . . . and they said we
needed to bring down the rising costs of health insurance. I agreed
with the problems identified by the President, however, I strongly
disagreed with the solutions he proposed.
Crafted during a year of closed-door meetings by the White House's
Health Care Task Force, the Clinton plan set in place global budgets,
price controls, tax increases, reduced choice and rationing--all housed
within a massive, new layer of Federal bureaucracy. Fortunately,
Americans recognized the President's plan for what it really was--a
government takeover of the Nation's health care system, and they had
the good sense to reject it.
Mr. President, I believe government-controlled health care failed in
1994 because the President underestimated the ability and desire of
Americans to make their own health care choices, free from government
intrusion or control. Only by empowering consumers, rather than the
Government, will we allow the marketplace to evolve into a quality,
cost-effective, and responsive health care provider, able to offer
affordable insurance to all Americans.
While socialized medicine failed in 1994, Americans did embrace four
important concepts which emerged from the health care debate: health
insurance should be accessible, it should be affordable, it should be
portable, and pre-existing conditions shouldn't disqualify anyone from
obtaining health insurance. Those principles lie at the heart of the
Health Insurance Reform Act.
It is estimated that 43 million Americans went without health
insurance in 1995. According to the Minnesota Health Care Commission,
the number of uninsured Minnesotans has remained stable for the last 5
years at approximately 400,000 individuals, or nearly 9 percent of the
State's population. That is below the national average of close to 15
percent uninsured but still too high.
Mr. President, what keeps health insurance out of the reach of so
many? The two main barriers are access and affordability.
A majority of Americans under the age of 65 are insured through their
workplace. Many job providers, however--small employers in particular--
find themselves shut out of the health insurance market when it comes
to obtaining affordable coverage for their employees.
And even insurance obtained through a job doesn't last forever,
because few Americans stay with a single employer throughout their
entire work career. Each year, 18 million Americans change insurance
when a family member moves between jobs, often stranding them without
insurance and usually forcing them to find new coverage. Many who are
unwilling or unable to risk going without insurance just stay put. A
Washington Post/CBS News survey found that one quarter of all American
workers experience ``job lock''--they are staying in jobs they would
otherwise leave because they are afraid of losing their health
coverage.
Another flaw of our insurance system is that it offers little
protection to individuals or their family members suffering from major
health disorders. Because they are victims of what are known as
``preexisting conditions,'' these Americans are denied insurance
because of the cost they represent to the system.
Americans who play by the rules, who buy health insurance when they
are healthy, should be allowed to keep it when they get sick. This is
why I supported Senator Jeffords' amendment which would have raised the
lifetime cap on insurance policies.
Individuals buy health insurance to not only ensure treatment for
relatively minor medical problems--strep throat and the occasional
broken bone, for example--but also to protect themselves against
crippling accidents or catastrophic illness. It is important that these
individuals continue to be covered by their private insurance company.
If they are dropped, their only alternative is to spend-down their
assets in order to qualify for Medicaid.
This moves more patients into the Medicaid program, overloading the
taxpayers and a system that is already buckling under heavy costs.
This is unfair to those individuals who have played by the rules, and
I will continue to work with the Senator from Vermont to address this
issue.
Expanding access to insurance, allowing individuals to move between
jobs with insurance policies that can move with them, and preventing
insurance companies from denying coverage based on a preexisting
condition, is precisely what the Health Insurance Reform Act attempts
to provide.
The Federal Government's General Accounting Office estimates this
legislation would open the door to health insurance for 25 million more
Americans.
Americans will no longer be forced to decide between taking a new job
or losing their medical coverage--the Health Insurance Reform Act
guarantees health care that is always there, regardless of where an
employee works or even if they work at all.
My own State of Minnesota embarked on reforming its health care
delivery system long before most of the rest of the country.
For three decades, we have debated these very same issues and worked
long and hard to achieve portability, renewability, and the elimination
of preexisting condition exclusions, thereby increasing the number of
insured.
Minnesotans have been innovative and progressive in reform of our
health care marketplace.
We have celebrated success and we have endured failure.
While our system is far from perfect, our legislators, our health
care community, and our constituents continue
[[Page S3828]]
to work to improve the delivery of quality health care and guarantee
its affordability in Minnesota.
One of this bill's most beneficial aspects is the flexibility it
gives States to create and administer their own health insurance reform
programs--away from Washington's control.
Under this legislation, States such as Minnesota, which have already
implemented reforms, are exempted from any changes established by the
Kassebaum-Kennedy bill.
Furthermore, Minnesota has already enacted laws in the large group,
small group, and individual markets which go beyond what is laid out in
the Kassebaum-Kennedy legislation.
That includes guarantee issue, guaranteed renewability, limits on
pre-existing condition exclusions, a State risk pool for uninsurable
individuals, and reforms to enhance and encourage the bargaining power
of small businesses.
The Kassebaum bill will have minimal effect on most of my
constituents, but it will provide new portability and access
protections for Minnesota employees and their dependents.
It does so by requiring insurers to guarantee issue coverage to plans
with 50 or more employees, which includes self-insured plans not
currently providing these protections.
I am disappointed that medical savings accounts are not part of the
Senate bill.
I am encouraged, however, by the large number of my colleagues who
share the majority leader's commitment to including MSA's in the
conference report. I believe MSA's would substantially enhance the
legislation before us.
While this legislation will go a long way toward expanding access to
health insurance, I am still concerned that the bill does not provide
enough affordable access. Keep in mind that health insurance which is
accessible yet unaffordable will not improve the current problems in
our marketplace.
The inclusion of MSA's in this legislation is not a Republican issue
or a Democrat issue--it is a Main Street issue. MSA's enhance
portability and promote consumer choice, while they empower individuals
with the same tax equity large corporations receive under our Tax Code.
I am deeply concerned that many of those who claim to be advocates
for the so-called little guy want to deny lower income Americans the
choice of medical savings accounts.
I believe MSA's are the best way we can put low-income wage earners
on an equal footing with their corporate cousins in the health care
marketplace.
I received a letter last week from a coalition of rural Minnesotans
based in Fergus Falls called Communicating for Agriculture.
Comprised of farmers, ranchers, and agribusinesses, and boasting a
national membership of 80,000, Communicating for Agriculture has been
advocating an MSA-type plan since 1978.
They write;
Managed care is not an option to hold down health care
costs since [rural Minnesota] has little or no competition in
health care. Without competition, you can't have managed
care. MSA's allow us to spend our medical dollars where it is
most convenient.
It also eliminates a great amount of administrative expense
which is a major contributor to health inflation over the
years.
A recent study by Blue Cross and Blue Shield revealed that 43 percent
of employees would definitely or probably switch to an MSA if given the
opportunity. In light of this broad, public support for MSA's, we
should at the very least allow individuals this choice. While the
Kassebaum legislation is good and worth passing on its own merits, I
certainly hope that the conference committee will adopt MSA's as part
of the final version of our health insurance reform efforts this year.
As I conclude, I want to assure my colleagues and my constituents
that my position on the issues before us has not wavered since I first
ran for public office in 1992:
I strongly support legislation ensuring portability.
I strongly support legislation ensuring limiting preexisting
condition exclusions.
I strongly support legislation providing tax equity for all Americans
through medical savings accounts, and increasing deductibility to 100
percent.
And I strongly support the efforts of this Congress to deliver these
desperately needed reforms to the American people.
As Congress prepares a final bill to send to the President, I will be
working to ensure that provisions promoting greater access and
affordability are incorporated into the final bill.
Only through such comprehensive reforms will we encourage more
Americans to purchase health insurance, thereby expanding the ranks of
those with coverage and eventually making health insurance more
accessible and affordable for all.
Again, Mr. President, I strongly support this bill. I thank the
Chair.
The PRESIDING OFFICER (Mr. Campbell). Who yields time?
Mrs. KASSEBAUM addressed the Chair.
The PRESIDING OFFICER. The Senator from Kansas, [Mrs. Kassebaum].
Mrs. KASSEBAUM. I thank the Senator from Minnesota for his support on
this legislation.
If I may speak for a few moments in closing before our vote this
afternoon on the health insurance legislation. For a bill that is a
very modest bill with a broad consensus of support, the Health
Insurance Reform Act certainly has attracted a lot of controversy. It
is not a Trojan pony. It is a bill that was carefully put together,
learning from the mistakes of the past and building together in the
Labor and Human Resources Committee legislation that we believed could
garner the broadest possible support and yet represent a meaningful
step forward in health care legislation.
During the debate in the last Congress on health care, there were
many questions raised of particular concern to most people. One was
portability, a sense of insecurity where many Americans found they were
not able to maintain health insurance if they lost their job or changed
jobs. That is what we started with--something that is clearly, I
believe, a small but important step forward. It is what I believe will
be very valuable to many people in this country. We recognized we were
only going to be able to achieve success if the bill had the broadest
support possible. And indeed, the legislation has garnered over 60
cosponsors. From there, of course, the legislation has grown to be more
expansive than what we initially started with.
It has been our goal all along, Senator Kennedy as the ranking member
of the Labor and Human Resources Committee and myself, to say that
amendments which did not have broad-based support--amendments which
were controversial--were ones that we would have to object to, whether
we favored them individually or opposed them individually. And that is
what we have tried to do throughout this debate.
This legislation now reflects, I think, two very positive amendments
that had unanimous support here on the Senate floor and that were
offered by the chairman of the Finance Committee, Senator Roth, and
Senator Dole, who has been a long supporter of these two initiatives.
One was to increase the percentage of deduction that would be allowed
to those who are self-employed from 30 to 80 percent. The second was to
provide tax deductions for long-term care coverage, an issue which many
of us have believed was very important and of which Senator Dole has
long been a leader. Those were valuable additions to the underlying
bill.
As my colleagues know, Senator Kennedy has for many years in his
legislative career in the Senate, both as chairman of the Labor
Committee and as ranking member, been a strong advocate of improving
the health care system. This bill certainly does not go as far as
Senator Kennedy would like it to go, but he was realistic about the
possibilities of what we could achieve with a more limited bill.
Whether this legislation helps 25 million people, as has been
estimated by the General Accounting Office, or whether it only helps 10
million people or if it helps 50 million people, the important fact is
that the Health Insurance Reform Act does provide some peace of mind
for those who desperately want to have some assurance that they will
not be excluded from coverage because of a preexisting medical
condition if they lose their job or change their job.
That is an important sense of security for many Americans, and I
believe one of the main reasons this legislation has garnered such
strong support.
[[Page S3829]]
It is my hope, Mr. President, that out of this bipartisan effort we
can go to conference and we can come through conference with a bill
that will be acceptable to everyone, because what we can accomplish
with this more limited legislation will be of value and far better to
have accomplished than to try for too much and to fail again.
Other aspects that have been added as amendments in both the House
and the Senate, may have some value. But because they are extremely
controversial, I would suggest that they need to be debated on their
own merits at another time. The clear danger is that if we add too
much, we will again fail to deliver real reform for the American
people.
Mr. President, this is an effort that has had a great deal of help
along the way from all sides--from consumers, from the medical
community, from the insurance community, from employers, and certainly
from colleagues in the Senate and in the House of Representatives. I
particularly thank staff members who have worked tirelessly on this
effort, certainly on my own staff, Dean Rosen, who has spent months and
months trying to pull together a consensus of support, as well as Susan
Hattan, Rebecca Jones, and Ann Rufo, and all of the staff of the
Republican members of the Labor and Human Resources Committee. I also
thank David Nexon and Lauren Ewers of Senator Kennedy's staff for their
hard work and dedication on this issue as well.
I do not think today's vote would have been possible without the
efforts of Senator Kennedy, who has championed this legislation even
though, as I said earlier, his own interests would have been more
expansive than what we would have been able to achieve. It also would
not have been possible without the support of those on my side of the
aisle, as well, who have been willing to settle for what is possible
and of greatest value to most people.
So it has been a collaborative effort. It has been an effort that
garnered unanimous support when it came out of the committee in August,
and I believe will have if not unanimous support here in the U.S.
Senate, close to that. I think it will be an important moment in
advancing health care efforts on the part of the U.S. Government today.
I want to thank the staff who worked countless hours on this
legislation. I want to thank Susan Hattan, Dean Rosen, Rebecca Jones,
and Anne Rufo of my staff for their contributions and persistence in
helping to make this legislation a reality. I want to thank David Nexon
and Lauren Ewers of Senator Kennedy's staff for their hard work and
dedication. And I want to commend the Republican staff of the Senate
Labor and Human Resources Committee: Elaina Goldstein of Senator
Jefford's staff, Vince Ventimiglia of Senator Coat's staff, Kimberly
Spaulding with Senator Gregg, Susan Ramthun with Senator Frist, Saira
Sultan of Senator DeWine's staff, Annie Billings of Senator Ashcroft's
staff. Greg Willhauck with Senator Abraham, and Tammi Brueske with
Senator Gorton. I also want to thank Bill Baird with legislative
counsel for his patience and hard work, and Beth Fuchs of the
Congressional Research Service for her invaluable guidance. Finally, I
would like thank Michael Gutowski and Mark Nadel of the General
Accounting Office for their analysis of the impact of S. 1028.
I yield the floor.
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts has 10 minutes
30 seconds.
Mr. KENNEDY. Mr. President, I ask unanimous consent that Senator
Pryor be able to speak for not to exceed 10 minutes at the conclusion
of my remarks.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. KENNEDY. Mr. President, first of all, I would like to express my
appreciation to a number of our colleagues. I start with our chairman
of the Labor and Human Resources Committee, the leading sponsor of the
bill, Senator Kassebaum. I think that when this legislation becomes
law--and I believe that it will become law--the American people will
owe her a debt of gratitude. I am proud to have joined her in
recommending to the Senate this legislation and to join her in
recommending the passage of the legislation, as well.
I think the entire Senate understands the extraordinary leadership
that she has provided on this legislation, and it is important, I
believe, that the American people do as well.
When the Senate votes on the Health Insurance Reform Act today, the
bill will pass overwhelmingly for many reasons. It will pass because it
is broadly bipartisan. It will pass because it is solidly supported by
over 200 organizations and a coalition of consumer groups, business and
labor and responsible insurance companies. It will pass because the
Senate acted responsibly last week in rejecting a killer amendment that
would serve special interests rather than the public interest.
Senators have made important contributions to the construction of
this legislation, and I would like to mention several of my colleagues.
This is not a complete list, but those who I have had the chance to
work with most closely.
First of all, Senator Harkin, who was a leader in the effort to
protect people against health insurance discrimination based on genetic
information.
Senator Wellstone worked hard to assure similar protections for
victims of domestic violence.
Senator Jeffords was a key leader on the provisions of the bill
enabling small business to create purchasing pools to increase their
bargaining power.
Senator Frist contributed key ideas to address the special needs of
the disabled.
Senator Dodd worked with the responsible insurance companies to see
that their concerns were addressed while protecting the interests of
consumers and gathering considerable support within the insurance
industry for this proposal on the basis of its merits.
Senator Abraham contributed to the State flexibility provisions which
was a matter of considerable concern and interest to many different
Members of this body.
Senator Rockefeller was an early supporter of this effort and
provided enormous assistance during the floor debate.
Senator Bennett worked hard to bring this bill to the floor and to
build a consensus behind it.
Others contributed as well.
We are grateful for the additions that were made by Senator Dole and
Senator Roth focusing on making the availability of insurance more
attractive to small businesses, that provided the support for extended
care for many of our seniors, which is the great gap in the Medicare
system today, and also for the initiatives for terminally ill patients
to permit them greater flexibility to deal with some of their
particular financial interests.
So we are grateful for all of their support and for many others. For
Senator Domenici and Senator Wellstone who offered their amendment
dealing with mental health, that was accepted by the Senate. Senator
Kassebaum and I resisted that amendment on the basis of our earlier
understandings and agreements that we would resist all amendments. But,
nonetheless, I think there is great value of that particular provision
as well.
The Kassebaum-Kennedy bill will end many of the most serious health
insurance abuses and provide greater protections to millions of
families. It is an opportunity that we cannot afford to miss.
Before some final brief remarks about the legislation, I want to
recognize some of our very good staff people for their hard work.
On our side, my staff, Nick Littlefield, Dave Nexon, and Lauren Ewers
were particularly active; Susan Castleberry, Sara Thom, Brian Moran,
Ron Weich, and Melody Barnes.
For Senator Harkin: Peter Reineke and Anne Ford.
For Senator Wellstone: Alex Clyde.
For Senator Dodd: Jane Lowenson.
For Senator Pryor: Bonnie Hoque.
For Senator Rockefeller: Ellen Doneski and also Mary Ella Payne.
For Senator Daschle: Rima Cohen and Cybele Bjorklund. All of them
were involved and helpful.
Senator Kassebaum has mentioned those Republican staff who have been
involved and worked very closely with us. But in this instance, as in
many others, some of them worked very closely with all of us, the
Members of the Senate, as well as our staffs: Susan Hattan; Dean Rosen,
Anne Rufo, and Rebecca Jones.
[[Page S3830]]
For Senator Jeffords: Elaine Goldstein.
And for Senator Frist: Sue Ramthun.
We are grateful to all of them. They have a remarkable sense of
knowledge and awareness in very special segments of this legislation,
and their experience and knowledge and understanding of these nuances
were valuable to all of us. We are grateful for their help.
Finally, Mr. President, briefly, the abusive practices addressed by
this bill create endless, unnecessary suffering. It was our attempt to
address that unnecessary suffering by focusing on language to provide
millions of Americans with a new sense of hope in the workplace,
Americans who are today forced to pass up jobs that would improve their
standard of living or offer greater opportunities because they are
afraid they will lose their health insurance.
Many others have to abandon the goal of starting their own business
because health insurance would be unavailable to them or members of
their families. We have tried to provide ways in which they can come
together to provide coverage for their families and for the families of
those who work in many of the mom-and-pop stores and smaller businesses
of this country.
Children who ``age out'' of their parents policies often find
themselves unable to obtain their own insurance if they have
significant health problems. We have addressed that.
Early retirees can find themselves uninsured just when they are
entering the years of highest health risks. We tried to address those
issues.
Many other Americans lose their health insurance because they become
sick or lose their job or change their job, even when they have
faithfully paid their insurance premiums for many years. This is
perhaps the most difficult concept for people to understand, where they
have paid their premiums for 20, 25 years, suddenly have an illness and
they are either dropped from coverage or their premiums go up
extraordinarily to the point where they cannot effectively afford it.
We have really provided some important reassurances to families.
More than half of all insurance policies impose exclusions for
preexisting conditions and, as a result, insurance is often denied for
the very illness 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, and no matter how faithfully people pay their
premiums, they have to start all over again with new exclusions if they
change jobs or lose their coverage.
The Health Insurance Reform Act is a modest, responsible bipartisan
solution to many of the most obvious abuses in the health insurance
market today. In fact, the only active opposition to the legislation
comes from those who profit from the abuses in the current system. In
his State of the Union Address last January, President Clinton
challenged the Congress to pass this bill. Now the Senate is poised to
fulfill that pledge.
Mr. President, the only thing that stands between this bill and the
President's signature are controversial provisions added in the House
of Representatives. These objectionable provisions include the medical
savings accounts which we have debated----
Mr. President, I ask for 3 more minutes.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
Mr. KENNEDY. The federalization of multiple employer welfare
arrangements. A number of years ago we provided the States the power
regulate these arrangements. It is rather strange now that those
provisions which permit the States to enforce these regulations are
effectively being preempted so that the Federal Government will
regulate them.
Repeal of the MediGap rules protecting senior citizens against
profiteers. That is a very dangerous provision. Up until 1984, we found
that many elderly people would buy 2, 3, 4, 5, 10 different programs
which people thought would cover various gaps in their insurance--
instead the policies duplicated one another with no additional benefit
to the individual. We found all kinds of abuses. We passed legislation
to protect seniors against these abuses. It has been effective. We
should not go back to the earlier period.
The provisions making it more difficult to combat waste, fraud, and
abuse in the current Medicare-Medicaid programs. I think that issue is
one that is not going to go away. There are many concerns that some of
the provisions that have been made in the House bill will lower the
standard, make it more difficult to prove the abuse and waste and
fraud. I am not sure we want to go in those directions.
The malpractice issues were debated earlier in the Congress. I think
they ought to be addressed outside of this legislation.
We go to conference in a bipartisan spirit, committed to trying to
get this legislation passed--obviously they have a right to pass their
bills and we have a responsibility to work through the differences--but
we hope that, given the spirit with which this legislation started,
both in the House and the Senate, that we will be able to do it. Every
day that is delayed, there are millions of our fellow citizens who are
denied the kinds of protections that this legislation will provide for
them. It is an extremely important piece of legislation, in many
respects I think maybe the most important piece of legislation that we
will pass in this Congress.
When the Senate votes on the Health Insurance Reform Act today, the
bill will pass overwhelmingly for many reasons. It will pass because it
is broadly bipartisan. It will pass because it is solidly supported by
over 200 organizations in a coalition of consumer groups, business and
labor, and responsible insurance companies. It will pass because the
Senate acted responsibly last week in rejecting killer amendments that
serve special interests rather than the public interest.
I commend the chairman of the Labor Committee and the leading sponsor
of the bill, Senator Kassebaum. She worked long and well to make this
day a reality. Her leadership resulted in a unanimous vote for this
bill in our committee. Her courage and commitment made it possible for
this bill to pass the Senate without crippling amendments. The American
people owe her a debt of gratitude, and I am proud to serve with her
and join her and recommend passage of this legislation.
Other Senators have also made important contributions. Senator Harkin
was a leader in the effort to protect people against health insurance
discrimination based on genetic information. Senator Wellstone worked
hard to assure similar protection for victims of domestic violence.
Senator Jeffords was a key leader on the provisions of the bill
enabling small businesses to create purchasing pools to increase their
bargaining power. Senator Frist contributed key ideas to address the
special needs of the disabled. Senator Dodd worked with the responsible
insurance companies to see that their concerns were addressed while
protecting the interests of consumers.
Senator Abraham contributed to the State flexibility provisions.
Senator Rockefeller was an early supporter of this effort and provided
enormous assistance during the floor debate. Senator Bennett worked
hard to bring this bill to the floor and to build consensus behind it.
Others contributed as well.
The Kassebaum-Kennedy bill will end many of the most serious health
insurance abuses and provide greater protection to millions of
families. It is an opportunity we cannot afford to miss.
The abusive practices addressed by this bill create endless
unnecessary suffering:
Millions of Americans are forced to pass up jobs that would improve
their standard of living or offer greater opportunities because they
are afraid they will lose their health insurance.
Many others have to abandon the goal of starting their own business,
because health insurance would be unavailable to them or members of
their families.
Children who age out of their parent's policies often find themselves
unable to obtain their own insurance if they have any significant
health problems.
Early retirees can find themselves uninsured just when they are
entering the years of highest health risks.
Many other Americans lose their health insurance because they become
sick, or lose their job, or change their job--even when they have
faithfully
[[Page S3831]]
paid their insurance premiums for many years.
Each year, the flaws in the private health insurance market become
more serious. 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 over 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.
Insurers impose exclusions for preexisting conditions on people who
don't deserve to be excluded from the coverage they need. Sometimes,
insurers deny coverage to entire firms if one employee of the firm is
in poor health, or at least exclude that employee from coverage. In
other cases, entire categories of businesses, with millions of
employees, are redlined out of coverage.
Even if people are fortunate enough to gain coverage and have no pre-
existing condition, their insurance can be canceled if they have the
misfortune to become sick--even after paying premiums for years.
One of the most serious consequences of the current system is job
lock. Workers who want to change jobs must often 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.
During the debate on this legislation, we have heard from Americans
who have been victimized by the abuses in the current system.
Robert Frasher, of Mansfield, OH, works for an employer who offers
health coverage to employees, but the insurance company won't cover
him. Why? Because he has Crohn's disease.
Jean Meredith of Harriman TN, and her husband Tom owned Fruitland
USA, a mom and pop convenience store. They had insurance through their
small business for 8 years, until Tom was diagnosed with non-Hodgkin's
lymphoma and their insurance company dropped them. When the Merediths
asked why, they were told they were no longer profitable insurance
risks. Without health insurance, Tom Meredith had to wait a year to get
the surgery he needed. After spending $60,000 of his own funds, his
cancer recurred and he died about a year ago. Tom Meredith might still
be alive today if he had not been forced to wait that year.
Diane Bratten, of Grove Heights, MN, and her family have insurance
through Diane's employer. Because of a history of breast cancer now in
remission, Diane and her family would not be able to get decent
coverage if she decided to change jobs or was laid off.
Nancy Cummins, of Louisville, KY, lost her health insurance when her
husband's employer went bankrupt. When their COBRA coverage expired,
they were uninsured for 3 years, until they qualified for Medicare.
During this period, she suffered three heart attacks, which left their
family with $80,000 in debts.
Jennifer Waldrup, of Massachusetts, was covered by her husband's
health insurance until his employer went out of business. When she
applied for coverage under her own employer, she was turned down
because she had multiple sclerosis. Her employer tried to help, but
could not find an insurer who would offer coverage. Her husband had to
cash in his life insurance to pay her medical bills.
Tom Hall, of Oklahoma City, faithfully paid his premiums for 30 years
under the group insurance policy of the construction business that he
co-owned. When the company dissolved and he became self-employed, the
insurer refused to give him coverage because he had a heart condition.
He lives in fear that his life savings will be wiped out.
The legislation we will pass this afternoon will address these
problems effectively. The 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 bi-partisan 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 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 when they change jobs and
join another group policy, or when they need to purchase coverage in
the individual market. Businesses--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 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 plan will not be locked into their job for fear
that they will be denied coverage or face a new exclusion for a
preexisting condition. These provisions will benefit at least 25
million Americans annually, according to the General Accounting Office.
In addition, the 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.
The bottom line is that this legislation guarantees that those who
faithfully pay their premiums will not have their insurance taken away
or preexisting conditions imposed, even if they change jobs or lose
their job.
The Health Insurance Reform Act is a modest, responsible, bipartisan
solution to many of the most obvious abuses in the health insurance
marketplace 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
similar to proposals made by President Clinton in his recent balanced
budget plan.
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 last January, President Clinton
challenged Congress to pass this bill. Now the Senate is poised to
fulfill that pledge.
The only thing that stands between this bill and the President's
signature are controversial and harmful provisions added by the
Republican majority in the House of Representatives to their version of
the bill. These objectionable provisions include medical savings
accounts, federalization of multiple employer welfare arrangements,
Federal caps on malpractice awards, repeal of MediGap rules protecting
senior citizens against profiteers, and provisions making it more
[[Page S3832]]
difficult to combat the waste, fraud, and abuse in the current Medicare
and Medicaid programs. Almost all of the 200 groups that support the
legislation have urged Congress to pass a clean bill, without these
controversial amendments.
Each of these provisions represents a special interest agenda that
has no place in this legislation. Medical savings accounts are a $3.2
billion Federal giveaway that provides special tax breaks for the
healthy and the wealthy at the expense of the average taxpayer. They
raise premiums for the vast majority of Americans, by siphoning the
healthiest people out of the insurance pool. As premiums rise for those
remaining in the pool, the number of the uninsured grows.
In fact, in the words of the Congressional Budget Office, medical
savings accounts ``could threaten the existence of standard health
insurance.'' They discourage the use of preventive care and raise
health costs in this way as well. The House provision is also the first
step toward similar accounts for Medicare--a key part of the Republican
plan to undermine Medicare by privatizing it.
Impartial health analysts agree that medical savings accounts are a
bad idea. They have nothing to do with genuine insurance reform or
health security for American families. They are in the House bill as a
reward to Golden Rule Insurance Co. and other insurance companies that
profit from the worst abuses of the current system. Golden Rule alone
has made over $1.6 million in political contributions over the last 5
years. Medical savings accounts should be dropped in conference, so
that this bill can be quickly signed into law.
Several other special interest provisions in the House bill also
jeopardize the hopes of American families for genuine insurance reform.
The House provision to exempt multiple employer welfare plans, or
MEWA's from State regulation will turn back the clock to a time when
these arrangements were rife with fraud and abuse and millions of
workers and their employers were victimized. Inclusion of this
provision would seriously weaken the constructive small business
insurance reforms enacted by many States in recent years.
The other House provisions, such as those imposing Federal caps on
malpractice awards, opening new opportunities to defraud senior
citizens by unscrupulous insurance companies, and weakening Medicare
protections against fraud and abuse are equally counterproductive and
controversial, and they have no place in this consensus bill.
Because of the importance of enacting the broad-based insurance
reforms included in this bill, Senator Kassebaum and I announced early
in the process that we would oppose all controversial amendments to our
legislation. Along with almost all of the more than 200 groups
supporting the legislation, we urge our colleagues in the House to
support this approach.
The Senate has acted responsibility. None of these controversial
amendments are included in the bill that we will pass later this
afternoon. Some were rejected but most were never even offered.
If the Republican majority in the House insists on including these
controversial provisions they will kill this bill, and destroy the
hopes of millions of Americans for the kind of modest but effective
reform that is now well within our grasp, and that leaders and member
of both parties have supported in the past. This measure is a test of
the Congress' seriousness and its ability to put the interests of the
American people ahead of the special interests.
Finally, this legislation is not comprehensive health reform. It will
not solve all the problems in the current system. But it is a
constructive step forward--a step that will help millions of Americans.
Above all, it is proof positive that progress is again possible on
health reform, and that the ghosts of gridlock for the 1994 debate no
longer haunt our work on health care.
I urge the Senate to pass this bill by the largest margin possible.
The larger the margin, the louder the message, and the more likely the
Senate-House conferees will send this bill to the President
expeditiously, without controversial amendments, and ready for his
signature. On this issue, every day we delay is a day that brings
unnecessary misery to large numbers of our fellow citizens.
Mr. President, I would like to discuss with the Senator from Kansas
how H.R. 3103 treats association plans which arrange to provide their
members the option to buy group health insurance. These association
plans frequently are made up of self-employed individuals or small
businesses. Is it not correct that our legislation imposes no new
regulatory requirements on association plans, other than the general
requirements affecting other health plans?
Mrs. KASSEBAUM. The bill establishes standards regarding portability,
renewability, and pre-existing conditions, but does not otherwise
disturb the association plan world. States will still regulate and
certify insured plans, and the Secretary of Labor will continue to
regulate self-insured plans that are currently exempt from State
regulation.
Mr. KENNEDY. It is my understanding that the bill authorizes creation
of health plan purchasing cooperatives, a concept discussed frequently
in Congress over the past few years. The purpose of these cooperative
provisions is to provide clear statutory authorization and guidance to
groups of small employers and individuals who want to join together to
buy health insurance at a lower cost. Is there any provision that
requires these groups to join or create mandatory purchasing
cooperatives?
Mrs. KASSEBAUM. No. Health purchasing cooperatives are purely
voluntary. Subtitle D is intended to create special benefits for
cooperatives that meet the standards in the bill. Congress does not
intend that these provisions in any way affect the legal status or
rights of purchasing cooperatives, employer coalitions, multiemployer
plans, MEWA's, association plans, or other similar arrangements that do
not meet the standards of this subtitle. The statute clearly states
this intent.
Mr. KENNEDY. For example, could association plans sponsored by
professional organizations or local chambers of commerce be forced to
form or join a purchasing cooperative as the result of this bill?
Mrs. KASSEBAUM. No. The bill does not require groups to form or join
a purchasing cooperative. Nor does the legislation preclude any other
type of groups purchasing arrangements from existing.
Mr. KENNEDY. So aside from having to meet the insurance reforms
contained in the bill and standards like portability, renewability, and
preexisting conditions, your bill does not disturb association plans at
all?
Mrs. KASSEBAUM. That is correct. Congress intends that association
plans may continue to do business as they always have, except that they
must meet the same insurance reform standards as other health plans
under the bill.
Mr. KENNEDY. An additional matter that I would like to discuss is the
provisions under the bill forbidding discrimination in the provision of
health insurance in the group market. Section 101(a)(1)(B) forbids an
employee health benefit plan or a health plan issuer from conditioning
eligibility, enrollment, or premium contributions for individual
participants or beneficiaries on health status, medical condition,
claims experience, receipt of health care, medical history, evidence of
insurability, genetic information, or disability. The purpose of this
provision is to prevent health plans from denying coverage to
individuals or charging them higher premiums because the plan believes
they may have higher than average health costs. Is this correct?
Mrs. KASSEBAUM. Yes. This provision is meant to prohibit insurers or
employers from excluding employees in a group from coverage or charging
them higher premiums based on their health status and other related
factors that could lead to higher health costs. This does not mean that
an entire group cannot be charged more. But it does preclude health
plans from singling out individuals in the group for higher premiums or
dropping them from coverage altogether.
Mr. KENNEDY. We intend the words ``health status, medical condition,
claims experience, receipt of health care, medical history, evidence of
insurability, genetic information, or disability'' to have a broad
meaning, do we not?
[[Page S3833]]
Mrs. KASSEBAUM. Yes. These words are meant to broadly preclude the
use of any of the categories insurance companies have historically used
to deny people coverage based on health status and related factors--
that reasonably could lead a health plan to believe that an individual
would incur high health costs or be uninsurable. They are meant to
preclude use of any of the categories insurance companies have
historically used to deny people coverage based on their expected
health costs--not only medical history or the presence of preexisting
conditions, but also including such factors as family history,
likelihood of experiencing domestic violence--or actual experience of
domestic violence, genetic predispositions or other genetic
information, or residence in a low-income neighborhood.
I want to just mention a few measures that we will have to address in
the conference. The Health Insurance Reform Act is a modest,
responsible bipartisan solution to many of the most obvious abuses in
the health insurance market today. In fact, the only active opposition
to the legislation comes from those who profit from the abuses in the
current system. In his State of the Union Address last January,
President Clinton challenged the Congress to pass this bill. Now the
Senate is poised to fulfill that pledge.
Mr. President, the only thing that stands between this bill and the
President's signature are controversial provisions added in the House
of Representatives. These objectionable provisions include, again, the
medical savings accounts which we have debated, the federalization of
multiple employer welfare arrangements--Mr. President, I ask for 3 more
minutes.
The PRESIDING OFFICER. Is there objection? Without objection, it is
so ordered.
Mr. KENNEDY. The federalization of multiple employer welfare
arrangements. A number of years ago we provided the States the power
for the enforcement of those arrangements. It is rather strange now
that those provisions which permit the States to enforce it are
effectively being preempted so that the Federal Government will support
it.
Repeal of the MediGap rules protecting senior citizens against
profiteers. That is a very dangerous provision. Up to 1984 we found
that many elderly people would buy 2, 3, 4, 5, 10 different programs to
cover various gaps in their insurance. We found all kinds of abuses. We
passed legislation to deal with that. It has been effective. I am not
sure that we ought to go back to the earlier period.
The provisions making it more difficult to combat waste, fraud and
abuse in the current Medicare-Medicaid programs, I think that issue is
one that is not going to go away. There are many concerns that the
provisions that have been made in the House bill will lower the
standard, make it more difficult to prove the abuse and waste and
fraud. I am not sure we want to go in those directions.
I think the malpractice issues have been debated earlier in the
Congress. I think they ought to be addressed outside of this
legislation.
We go to that conference in a bipartisan spirit, committed to trying
to get this legislation--obviously they have a right to pass their
bills and we have a responsibility to work through the differences--but
we hope that, given the spirit with which this legislation started,
both in the House and the Senate, that we will be able to do it. Every
day that is delayed, there are millions of our fellow citizens who are
denied the kinds of protections that this legislation will provide for
them. It is an extremely important piece of legislation, in many
respects I think maybe the most important piece of legislation that we
will pass in this Congress.
Mr. President, I urge the passage of the legislation when the Senate
votes on it this afternoon.
The PRESIDING OFFICER. Under the previous order, a vote on passage of
H.R. 3103, as amended, will occur at 2:15. All time has expired.
Mrs. KASSEBAUM. Mr. President, I ask for the yeas and nays on final
passage of H.R. 3103.
The yeas and nays were ordered.
Mr. PRYOR addressed the Chair.
The PRESIDING OFFICER. The Senator from Arkansas is recognized for 10
minutes.
Mr. PRYOR. Mr. President, I thank the Chair for recognizing me.
Before I speak, Mr. President, on the subject that I have chosen here
for the next few minutes, I compliment my colleagues from Massachusetts
and Kansas for the tremendously fine work they have done in this whole
field of health care over a long period of time. This, today, I think
is the culmination of their sincere effort, their tedious effort, and
certainly demonstrates their commitment to improving the health care
available in our country. So, Mr. President, this Senator certainly
congratulates these two fine Senators for their commitment and their
work.
____________________