[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.

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