[Congressional Record Volume 142, Number 94 (Monday, June 24, 1996)]
[Senate]
[Pages S6754-S6760]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. KENNEDY. Mr. President, I will address the Senate for a few 
moments this evening on an issue that is before the Senate, and really 
before the country, and that is a question of where we are in our 
health care debate and discussion.
  I thought this evening I would just make some brief comments to 
follow those of last Friday about what some of the dangers are with 
medical savings accounts and, in particular, what has been the record 
of the Golden Rule Insurance Co., which is the principal insurance 
company that sells medical savings accounts at the present time. I will 
review, briefly, what the record of that company has been over the 
period of the last couple of years because there have been those who 
have questioned whether we have been giving a fair and accurate 
reflection of this insurance company.
  I will include in the Record, Mr. President, the Indianapolis Star 
article of June 22, just a few days ago. This is the Indianapolis Star, 
the home newspaper for the Golden Rule Insurance Co. I think for those 
that are familiar with the Indianapolis Star, there is no one here that 
would suggest that that was considered to be a liberal newspaper, or 
even a moderate newspaper. It has been one of the newspapers that have 
been part of the Pullian family and has prided itself in supporting 
very conservative candidates, with a very conservative editorial 
policy. This is the hometown newspaper. This is not the Democrats, who 
are opposed, or Republicans who are opposed to medical savings 
accounts. This is their hometown newspaper, blowing the whistle, so to 
speak, on the Golden Rule Insurance Co.
  I ask unanimous consent that this article be printed in the Record.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

              [From the Indianapolis Star, June 22, 1996]

           Golden Rule Has a Keen Interest in Insurance Bill


 inclusion of tax-free medical savings accounts would be a significant 
                    aid to the firm's profitability

                          (By Larry MacIntyre)

       If you ran an insurance business and discovered that fewer 
     and fewer people were

[[Page S6755]]

     buying your policies, you'd probably welcome a federal law 
     that would have the effect of paying some families a $2,000 
     or more bonus to buy them.
       A law like that could turn sinking sales into skyrocketing 
     sales almost overnight.
       In a sense, that is what's at stake for the Indianapolis-
     based Golden Rule Insurance Co. as it watches the White House 
     and Congressional Republicans haggle over putting tax-free 
     medical savings accounts--known as MSAs--into a health-
     insurance reform bill jointly sponsored by Sens. Ted Kennedy, 
     D-Mass., and Nancy Kassebaum, R-Kan.
       The bill is aimed at making it easier for employees to keep 
     health insurance when they change jobs. Until this month, 
     President Clinton had vowed to veto it if it included MSAs, a 
     concept that Golden Rule's former chairman, Pat Rooney, has 
     been lobbying for tirelessly for years.
       Congressional Republicans, who received more than $1 
     million in campaign contributions from Golden Rule and its 
     executives before the last election, are touting MSAs as a 
     way to bring free-market forces to bear on rising health-care 
     costs.
       Opponents of MSAs predict the device will shrink the amount 
     of money needed for health insurance pools by instead giving 
     it to people who stay healthy--or at least don't visit the 
     doctor. Kennedy says MSAs will drive insurance premiums 
     ``through the roof,'' and he singled out Golden Rule as being 
     the ``worst abuser'' of the current system.
       The prospect of MSAs appeared to be at a stalemate until 
     two weeks ago, when the White House signaled it would be 
     willing to include a trial program for small businesses. Now, 
     Clinton's aides and Congressional staffers are trying to 
     agree on how big a population would be served by the trial 
     program.


                           future in question

       The answers they come up with will determine the future of 
     Golden Rule, which is seeing steadily declining sales of 
     individual health-insurance policies in the face of mounting 
     competition from managed-care plans.
       The company's profitability is also being squeezed as it 
     shifts into the highly competitive group health-insurance 
     market, which is now dominated by managed-care plans.
       In its required annual report to the state, Golden Rule 
     cited reduced revenue from health policies as the reason its 
     net gain after taxes fell to $25.8 million in 1995--down 29 
     percent from the previous year.
       Company officials did not return phone calls from The 
     Indianapolis Star and The Indianapolis News seeking comment.
       One reason managed-care plans are growing in popularity is 
     that, unlike holders of Golden Rule's traditional fee-for-
     service policies, users of managed-care plans don't have to 
     pay a $500 or $1,000 deductible out of pocket before the 
     policy kicks in. Most managed-care policies provide what is 
     known as first-dollar coverage.
       The attraction of medical savings accounts is that they go 
     one step better. People who stay healthy would get money 
     back.
       The plan pushed by Congressional Republicans calls for a 
     three-year test. It would allow self-employed individuals and 
     employers with 100 or fewer workers to establish tax-exempt 
     MSAs of up to $2,000 per individual or $4,000 per family.
       The catch is that money in the MSA would be tax exempt only 
     if a companion health-insurance policy for catastrophic 
     illness is also purchased. Deductibles for these policies 
     could be as high as $5,000 for individuals and $7,500 for 
     families. Choose own doctors
       MSA holders could choose their own doctors and spend as 
     much or as little as necessary from the account. At the end 
     of the year, any money left in the MSA could be either rolled 
     over or paid to the employee as taxable income.
       At the end of the three-year test, Congress would vote on 
     whether to expand MSAs to the rest of the nation's workers.
       A RAND Corp. study published in the Journal of the American 
     Medical Association last month estimated that 57 percent of 
     the nation's families would choose MSAs over traditional fee-
     for-service policies or managed care.
       If that estimate were to hold true, it would translate into 
     a potential market of more than 50 million new customers for 
     Golden Rule and other insurers offering catastrophic-care 
     policies.
       Last year, Blue Cross & Blue Shield of Ohio analyzed a 
     year's worth of health claims for 38,729 family policyholders 
     and determined that 68 percent would have qualified for money 
     back if they had MSAs.
       Assuming they had all started with $3,000 in their MSAs, 
     their average payback would have been $2,039.
       But the Ohio insurer isn't a supporter of MSAs. In fact, 
     John Burry Jr., its chairman and chief executive officer, is 
     one of the most outspoken and active opponents of MSAs.
       Burry says the Ohio study--which he presented to the House 
     Ways and Means Committee last year--show that MSAs have the 
     potential to bankrupt the nation's health-care system.
       ``They are tailor-made for identifying healthy persons who 
     may be profitably insured. It makes no sense for a sick 
     person to utilize an MSA,'' Burry said in testimony to the 
     committee.
       The reason is that all the money that healthy people would 
     get back from their MSAs--more than $50 million in the Ohio 
     group--represents money that under current health plans is 
     being paid into the insurance pool for their group coverage.


                         $50 million shortfall

       If that money were taken out of their pool, it would create 
     a shortfall of $50 million needed to cover the health 
     expenses of the 32 percent of families that didn't stay 
     healthy.
       Some of those families spent in excess of $300,000 each for 
     treatment of cancer, pre-term infants or coronary problems.
       While the unhealthy families represented less than a third 
     of the study group, they accounted for 84 percent of the 
     $159.3 million health-care costs. But under an MSA plan, the 
     study calculated there would have been only $109 million 
     available to cover those health costs.
       Thus, the study concluded, employers would ultimately have 
     to pay higher premiums, or sick people would have to pay more 
     of their own costs to make up that $50 million shortfall.
       Extend that economic model across the entire nation, says 
     Burris, and the shortfall could reach $80 billion a year.
       Burris' arguments have not dampened the enthusiasm among 
     Congressional Republicans.
       ``MSAs deserve to become the law of the land because they 
     represent a common-sensical, sound policy for health care,'' 
     says Sen. Dan Coats, R-Ind. Coats is a Republican conferee 
     pushing to keep MSAs in the health-care bill.
       Supporters of MSAs range from the American Medical 
     Association to Rush Limbaugh.
       The most ardent opponent of MSAs in the Senate has been Ted 
     Kennedy, who recently singled out Golden Rule for criticism 
     in his written response explaining why he would not support 
     the MSA amendment to his bill.
       ``It is no accident that the leading proponents of medical 
     savings accounts are insurance companies like Golden Rule, 
     which have been the worst abusers of the current system,`` he 
     wrote, ``They have given millions of dollars to political 
     candidates to try to get this business opportunity into 
     law.''
       Last fall, the nonpartisan American Academy of Actuaries, 
     which studies insurance policy issues, also chimed in with a 
     call for caution on MSAs.
       Its report concluded: ``The greatest savings will be for 
     the employees who have little or no health care expenditures. 
     The greatest losses will be for the employees with 
     substantial health care expenses. Those with high 
     expenditures are primarily older employees and pregnant 
     women.''

  Mr. President, in the last Congress, health care reform became a 
highly partisan issue--and no progress was made. In this Congress, we 
have an opportunity to avoid the failures of the past by moving to 
address some of these problems on a bipartisan basis, even in this 
election year. The Kassebaum-Kennedy bill passed the Senate by a vote 
of 100 to 0. It had 66 cosponsors--with almost equal numbers from both 
parties. If we could send it to the President today, it would be signed 
by him tomorrow.
  But the House Republican leadership is insisting that any health 
reform must be their way or no way. This non-negotiable approach is an 
insult to millions of Americans who want insurance reform. It is time 
for the Republican leadership to stopped trying to turn a bipartisan 
bill that the American people need into a partisan proposal that will 
never be signed into law.
  The Kassebaum-Kennedy insurance reform bill eliminates many of the 
worst abuses of the current system. It will benefit an estimated 25 
million Americans a year. Today, millions of Americans are forced to 
pass up jobs that would improve their standard of living or offer them 
greater opportunities, because they are afraid they will lose their 
health insurance or face unacceptable exclusions for preexisting 
conditions. Many other Americans abandon the goal of starting their own 
business, because health insurance would be unavailable to them or 
members of their families. Still other Americans lose their health 
insurance because they become sick or lose their job or change their 
job, even when they have paid their insurance premiums for many years.
  The Kassebaum-Kennedy bill addresses each of these problems. 
Insurance companies are limited in their power to impose exclusions for 
preexisting conditions. No exclusion can last for more than 12 months. 
Once persons have been covered for 12 months, no new exclusion can be 
imposed as long as there is no gap in coverage, even if they change 
their job, lose their job, or change insurance companies.
  No workers wishing to participate in an insurance plan offered by 
their employer can be turned down or made to pay higher premiums 
because they are in poor health. If someone no longer has access to on-
the-job insurance because they have lost their job or gone to work for 
an employer who does not

[[Page S6756]]

offer coverage, they cannot be denied individual insurance coverage or 
face exclusions for preexisting conditions when they buy a policy. The 
same protection is provided for children who exceed the maximum age 
when they can still be covered under their parents' plan.
  The Kassebaum-Kennedy bill will not solve all the problems of the 
current system. But it will make a significant difference in increased 
health security for millions of Americans.
  The only opposition to the Kassebaum-Kennedy bill came from those who 
profit from the abuses in the current system. That is why it passed the 
Senate unanimously. An amendment by Senators Dole and Roth that added 
assistance for small business, strengthened antifraud provisions--and 
included other useful proposals was also adopted with overwhelming 
bipartisan support.
  But now the bill is stalled, because some Republicans insist on 
adding a partisan poison bill--medical savings accounts. Such accounts 
are a bad idea that will make our insurance system worse instead of 
better. They are too controversial to be included in any consensus 
bill.
  A compromise is possible if our Republican friends are willing to 
have a legitimate test of the idea first, without imposing it full-
blown on the country. But the so-called compromise now being offered on 
medical savings accounts is nothing of this kind. It is a capitulation 
to House Republicans, who are more interested in creating an issue and 
serving a special interest constituency than in passing a needed health 
reform bill.
  Discussions are ongoing to see whether a genuine compromise can be 
reached. If not, we should simply pass the bipartisan bill already 
unanimously approved by the Senate, and consider medical savings 
accounts on separate legislation.
  Most people do not understand what a medical savings account is, or 
why special interest groups are so anxious to see them included in this 
bill. Medical savings accounts have two parts. The first is a 
catastrophic, high-deductible insurance policy that requires people to 
incur substantial medical costs out of their own pocket before 
insurance kicks in. Supporters of medical savings accounts usually mean 
policies with deductibles of about $1,500 to $2,000 per person. There 
is nothing that keeps businesses and individuals from buying such 
policies today.

  The second part of a medical savings account is a tax-free savings 
account that is established by an individual or an employer to pay for 
part of the costs that the insurance does not cover. In theory, the 
lower premium cost for such a policy will make savings available to put 
in these accounts. Proponents of medical savings accounts often present 
this part of the plan as if the premium savings will cover almost the 
whole cost of the deductible. But that's not necessarily the case.
  Medical savings accounts sound too good to be true--and they are. The 
American Academy of Actuaries and the Urban Institute estimate that the 
savings will be only a fraction of the deductible--leaving families 
exposed to high costs they simply cannot pay.
  Last week, I challenged the supporters of medical savings accounts to 
answer some simple questions, so that the American people can 
understand what the flawed Republican proposal really means. Those 
questions have still not been answered, because the Republicans know 
that their medical savings account plan cannot stand the truth in 
advertising test. Here's what their plan provides.
  First, the Republican plan allows deductibles as high as $5,000 per 
individual and $7,500 per family. A family needing medical care must 
spend $7,500 out of their own pocket before their insurance pays a 
dime. I ask my Republican friends how many families can afford to pay 
this much for medical care, and why in the world would you give a 
special tax break for a policy providing such minimal protection?
  Medical savings accounts are described by the advocates as providing 
catastrophic protection. Once you hit the cap, they say you have 
complete protection. Actually, almost all conventional insurance 
policies already have a feature like this, called a stop-loss, which 
caps the policyholder's out-of-pocket spending for covered services. 
Even among policies offered by small businesses, which are typically 
less generous than those provided by large companies, 90 percent have a 
stop-loss. And for virtually all of these plans, the stop-loss is less 
than $2,000.
  Contrast that to the Republican plan. Protection does not even start 
until you have spent $5,000, and there is no stop-loss. None 
whatsoever. The plan allows the insurer to charge a 30-percent 
copayment for charges in excess of the deductible. A $40,000 doctor and 
hospital bill is not unusual for a significant illness or surgery. A 
person needing such care would owe $15,500 for bills the policy would 
not pay. Under the conventional plan, their costs would be limited to 
$2,000 or less.
  Can the Republicans explain to the American people why their plan has 
no stop-loss provision? Can they describe the logic that says it is all 
right to make a family pay $7,500 before their insurance covers them at 
all--and then leave them exposed to unlimited additional expenses even 
after they have paid the first $7,500? When you ask these questions, 
the Republicans have no answer.
  The Republicans claim that people can cover these huge gaps in their 
insurance protection out of their medical savings accounts. Perhaps the 
wealthy, who get the bulk of the tax breaks under this plan, will be 
able to afford high medical costs--but how are working families to set 
aside the $5,000, $10,000, $20,000, or more that they would need for 
protection in the event of a serious illness?
  There is nothing in the Republican plan that requires employers to 
contribute even one thin dime to a medical savings account for their 
employees. I've asked the Republican sponsors of this provision if 
their plan requires employers to make any contribution to the medical 
savings accounts of their employees, but there has been no answer--
because a truthful answer is too embarrassing.

  The Republican plan has other basic flaws. Today, most insurance 
companies have fee schedules limiting the amount that doctors and 
hospitals can charge for covered services. These fee schedules 
generally pay less--sometimes only half as much--as the actual charges. 
But providers generally accept these reduced fees as payment in full.
  Under a medical savings account there is no such protection. In fact, 
patients could find themselves in the situation of having spent $9,000 
on physician and hospital care and still not have met their $5,000 
deductible, because the charges the patient has to pay are higher than 
the insurance company's fee schedule. No wonder some doctors and 
hospitals love the idea of medical savings accounts.
  The driving force behind medical savings accounts is the Golden Rule 
Insurance Co. It made more than $1 million in campaign contributions 
before the last election alone. In October 1994, Golden Rule delivered 
$416,000 in soft money to the GOP. Only two other companies gave more 
to Republicans during the last election cycle. Golden Rule has 
contributed lavishly to Newt Gingrich's GOPAC political action fund. No 
one should be under any illusions. If it were not for Golden Rule, its 
chairman, Patrick Rooney, and its lavish contributions, medical savings 
accounts would not be an issue before this Congress--and it would not 
be the poison pill that threatens to sink health reform legislation 
again.
  Why does the Golden Rule Insurance Co. want this legislation? The 
answer is simple. Golden Rule profits by abusing the current system. 
They make their money by insuring the healthy and avoiding those who 
need coverage the most. The company is notorious for offering policies 
with inadequate coverage, for dropping people when they get sick, for 
excluding parts of the body most likely to result in an illness, and 
for invoking exclusions for preexisting conditions when costly claims 
are filed.
  Insurance reform that forces companies like Golden Rule to compete 
fairly by providing good services at a reasonable price would put them 
out of business. As the Indianapolis Star said on Saturday, ``[MSAs] 
will determine the future of Golden Rule, which is seeing steadily 
declining sales of individual health insurance policies * * * In its 
required annual report to the State, Golden Rule cited reduced revenue

[[Page S6757]]

from health policies as the reason its net gain after taxes fell to 
$25.8 million in 1995--down 29% from the previous year.''
  Golden Rule knows that its future depends on a multibillion dollar 
tax giveaway in the form of medical savings accounts. That is why their 
Republican friends in Congress are trying to force this partisan 
special interest proposal into the health reform bill--even at the risk 
of sinking the bill.
  Let's look at the dishonor roll of Golden Rule policies. Like the 
Republican plan, MSA policies sound good until you read the fine print. 
Here is a policy offered by Golden Rule in Massachusetts through 
Americans for Tax Reform. It has no coverage for prenatal care or 
postnatal care. It has no coverage for most preventive services. It 
does not cover an emergency room visit unless you are admitted to the 
hospital. It does not even cover outpatient physician services, except 
for outpatient surgery. It does not cover outpatient prescription 
drugs. It does not even cover diagnostic tests unless the patient is 
hospitalized within 3 days.
  Here is another Golden Rule policy, from Virginia. It has all the 
exclusions in the Massachusetts policy and adds even more gaps. There 
is no coverage for mental health. There is no coverage for substance 
abuse. There is no coverage for pregnancy and delivery--none at all. 
All routine and preventive care is excluded.
  But even worse than the things Golden Rule explicitly does not cover 
is the things that it will not cover for you if they think you might 
get sick--or if you actually do. Here is what the policy says on page 6 
of the Massachusetts policy under the heading ``pre-existing 
conditions.'' It says ``Pre-existing conditions will not be covered 
during the first 12 months after an individual becomes a covered 
person.'' This sounds reasonable. But listen to the fine print. ``This 
exclusion will not apply to conditions which are both: (a) fully 
disclosed to Golden Rule in the individual's application; and (b) not 
excluded or limited by our underwriters.''

  What does this mean? It means that if, in the judgment of Golden 
Rule, you have not disclosed a pre-existing condition, they are not 
obligated to cover it after 12 months, and they reserve the option to 
exclude a condition from coverage forever--not just for 12 months. What 
does that mean in practice? It means that the protection Golden Rule 
promises is often a sham.
  Let me read some of the cases of consumers who bought Golden Rule 
policies, faithfully paid their premiums, and then were told their 
insurance did not cover them, just when they needed it the most.
  Daniel Brokaw of Roanoke, VA, was covered under a Golden Rule policy, 
although the policy excluded any coverage for care related to Mr. 
Brokaw's Tourette's disorder. Golden Rule also refused to cover Mr. 
Brokaw's 4-year-old son, even with a similar exclusion, because he 
occasionally shook his fist. Golden Rule canceled even this limited 
coverage when Mr. Brokaw submitted a claim for a broken arm.
  Louise Mampe of suburban Chicago was diagnosed with breast cancer 
after having been covered by Golden Rule for 11 months. Golden Rule 
denied payment for $60,000 of bills and canceled her policy, saying 
that the breast cancer was a pre-existing condition. Mrs. Mampe had 
felt a ``bump'' but did not get treatment for years because she did not 
think it was anything serious--she had been getting similar bumps for 
years. Golden Rule wrote to Mrs. Mampe's widowed husband, Howard, that 
``Obviously, Mrs. Mampe was the author of her own misfortune.'' Pat 
Rooney, head of Golden Rule, himself stated that, ``If my sister 
applied for her own insurance and she knew that she had felt a lump in 
her breast, she is not an insurable risk.''
  Gwendolyn Hughes of Utah had claims relating to injuries suffered in 
an automobile accident denied because she had failed to list a 
digestive problem on her Golden Rule insurance application.
  James Clark of Keithville, LA, was forced to pay for his heart by-
pass surgery after Golden Rule denied his claim, saying he had not 
disclosed cholesterol and triglyceride levels on his insurance 
application.
  Linda Shafer of Ramsey, IN, had her Golden Rule policy canceled after 
she was diagnosed with Parkinson's. The Golden Rule underwriter said 
Ms. Shafer failed to disclose on her application that her hands 
sometimes shook. Ms. Shafer said she thought this was due to the stress 
of going through a divorce, not ``a disorder of the nervous system such 
as epilepsy, convulsion, frequent headaches or mental or nervous 
disorders'' as listed on the application. ``Since I am not in the 
medical profession and could not diagnose my symptoms, I didn't even 
consider that I had any type of nervous disorder,'' she wrote.
  Sharon Tate of Kansas City, MO, had her claim for removal of a sinus 
cyst denied because Golden Rule said she had to have known about the 
problem before taking out her policy. A court ruled against Golden Rule 
when it found that the company's doctor had not even looked at Ms. 
Tate's x-ray, although that was supposedly the justification for the 
claim denial.
  Ana Painter of Chesterfield, IL, had her hospital bill relating to 
stem-cell infusion treatment for malignant ovarian cancer rejected on 
grounds that the treatment was ``experimental.'' Golden Rule filed a 
suit against Ms. Painter 5 days later--without even waiting for her to 
appeal the decision--asking for a legal ruling that the company did not 
have to pay the bill. Ms. Painter had to retain a lawyer.
  James Anderle of Milwaukee, WI, had his claim for medical bills 
resulting from a stroke denied by Golden Rule. Golden Rule claimed Mr. 
Anderle had a pre-existing condition--the flu.
  Carol Schreul of Aurora, IL, suffered a brain tumor, resulting in 
medical bills of $39,000. Golden Rule refused to pay, claiming that Ms. 
Schreul misrepresented her health status by listing her weight as 190 
pounds when it was actually 210.
  Harry Baglayan had his claim for the $49,000 in costs for heart by-
pass rejected. Golden Rule argued that Mr. Baglayan had failed to 
disclose that he had nausea four months earlier, a pre-existing 
condition.
  Golden Rule has adamantly opposed insurance reforms, because they 
know they cannot compete on a level playing field where these abusive 
practices are outlawed. In Vermont, they vigorously and tenaciously 
opposed insurance reform--and then pulled out of the State when reform 
was finally enacted. Golden Rule refuses to give information on their 
experience with MSA's that they currently offer--and it's no wonder, 
given what turned up in Vermont.
  Here is how the State insurance commissioner described what they 
found when Golden Rule turned over its policies to the Blue Cross plan, 
which assumed responsibility for Golden Rule policyholders when it 
pulled out of the State.
       What are the tools of an aggressive underwriter [like 
     Golden Rule]? The first is the initial application form 
     filled out by the consumer. Let me briefly review its scope. 
     Item 15 of the application asks for information about health 
     status over a 10 year period. The questions asked are very 
     broad and refer to any disorder that the applicant may have 
     had. How many of us have not had a headache or diarrhea or a 
     bad stomach ache over the past ten years?
       Another tool used more aggressively by Golden Rule than by 
     other insurers is the exclusion. This is a limitation placed 
     on the policy to exclude coverage for a particular 
     individual, condition, disease, etc. When Golden Rule 
     withdrew from Vermont, most of its insured elected to become 
     members of Blue Cross and Blue Shield of Vermont under the 
     safety net program I discussed earlier. As a result, the 
     safety-net program allows unique access to information about 
     the Golden Rule Policies.
       Of the approximately 5,000 Vermont Golden Rule 
     policyholders who joined the safety-net, approximately 25 
     percent had some type of exclusion under their Golden Rule 
     policies. In the initial study done by Blue Cross and Blue 
     Shield, 1,024 Golden Rule policies have 1,245 separate 
     exclusions added to their policies.
       Blue Cross and Blue Shield also compiled a list of more 
     than 81 exclusions used by Golden Rule. These include the 
     exclusion of whole body parts, such as arms, backs, breasts, 
     knees, legs, hands, skin.
       A particularly disturbing practice of Golden Rule was to 
     selectively underwrite newborn children of individuals 
     holding individual rather than family policies. After 
     providing the 30 day coverage of newborn children mandated by 
     Vermont law, Golden Rule would only extend coverage if the 
     newborn was healthy.

  Mr. President, I ask that the full text of this letter be entered in 
the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:


[[Page S6758]]


                                                 State of Vermont,


                                        Department of Banking,

                                         Insurance and Securities.

                              [Memorandum]

     To: John D. Dingell, Chairman, Subcommittee on Oversight and 
         Investigations.
     From: Thomas R. Van Cooper, Director of Insurance Regulation.
     Date: June 27, 1994.
     Subject: Vermont Health Care Reform Initiatives.


                              Introduction

       Good morning. My name is Thomas Van Cooper. I am the 
     Director of Insurance Regulation for the state of Vermont. I 
     want to thank you, Mr. Chairman and members of the 
     subcommittee, for the opportunity to discuss Vermont's health 
     insurance reforms. In particular, the requirements that 
     health insurers use community rating and that they guarantee 
     acceptance of all applicants, in the small group (1-49 
     employees) market as of July 1, 1992, and in the individual 
     market as of July 1, 1993. I understand that the committee is 
     interested in Golden Rule Insurance Company. Many of the 
     issues surrounding Golden Rule, regarding both its conduct 
     and its positions on health insurance, can probably be best 
     addressed by reviewing more generally the issues Vermont 
     faced in its individual and small group markets.
       An important finance issue that Vermont confronted in its 
     effort to obtain health care reform involved the impact of 
     insurers employing aggressive underwriting techniques that 
     either explicitly excluded some Vermonters from the 
     marketplace or effectively did so by pricing such individuals 
     out of the marketplace. The cost of care for individuals 
     forced out of the marketplace is borne by other taxpayers and 
     insureds, whether through tax based social programs or by 
     less easily identified shifts of uninsured and underinsured 
     costs to the private insurance marketplace. Since Vermont had 
     a social contract to provide health care to all citizens 
     regardless of their ability to pay, it needed a fair 
     insurance mechanism for financing health care.

                           *   *   *   *   *

       Did insurers leave the state as a result of the reforms? 
     Sure, some chose to leave, including Golden Rule. However, 
     other insurers took their place, recognizing the opportunity 
     to do business and make a fair profit in Vermont. Today 
     Vermont has 17 carriers competing in the small group market 
     and 9 carriers in the individual market. Now that may not 
     sound like a lot, but Vermont only has 560,000 citizens and 
     in fact, we now have more carriers actively competing for 
     business than before the reform measures. More significantly, 
     we now have much more capacity, since every one of these 
     carriers will take all comers. I have attached a list of the 
     companies doing business and some of the prices for products 
     they are selling. See Attachment D.
       In sum, the reforms in Vermont have been a success. The 
     consumer can have confidence in a stable and rationale 
     marketplace in which coverage is guaranteed and available at 
     a fair price. In fact, prices are low, and competition among 
     insurers for business is high. During the legislative debate, 
     the HIAA and Golden Rule rolled out their actuaries and 
     experts to explain why the reforms would not work. But rather 
     than fall prey to the numbers game in which one actuary 
     battles another, we relied on common sense and looked to the 
     definition of insurance for guidance. Insurance is not about 
     risk avoidance. It is about the pooling of risk.


                              golden rule

       Before discussing Golden Rule and its behavior in Vermont, 
     I want to state that the company did not violate any Vermont 
     laws by its conduct. I believe that its underwriting 
     practices, however, were instrumental in creating the support 
     that led to the passage of reform legislation in Vermont that 
     rendered its type of underwriting illegal.
       What are the tools of an aggressive underwriter? The first 
     is the initial application form filled out by a consumer. I 
     have attached a copy of a Golden Rule form. See Attachment E. 
     Let me briefly review its scope. Item 15 of the application 
     asks for information about health status over a ten-year 
     period. The questions asked are very broad and refer to any 
     disorder that the applicant may have had. How many of us have 
     not had a headache or diarrhea or a bad stomach ache over the 
     past ten years?
       Another tool used more extensively by Golden Rule than by 
     other insurers is the exclusion. This is a limitation placed 
     on the policy to exclude coverage for a particular 
     individual, condition, disease, etc. When Golden Rule 
     withdrew from Vermont, most of its insureds elected to become 
     members of Blue Cross and Blue Shield of Vermont under the 
     safety-net program I discussed earlier. As a result, the 
     safety-net program allows unique access to information about 
     Golden Rule policies.
       Of the approximately 5,000 Vermont Golden Rule coverage 
     policyholders who joined the safety-net, approximately 25 
     percent of them had some type of exclusion under their Golden 
     Rule policies. In an initial study done by Blue Cross and 
     Blue Shield, 1,024 Golden Rule policyholders had 1,245 
     separate exclusions added to their policies. I have attached 
     some examples of these policy exclusions. See Attachment F. I 
     will review a few of them.
       Subscriber B applied for health insurance from Golden Rule 
     on September 18, 1991. The subscriber had been treated by a 
     physician in June of 1991 for bumps on the skin that were 
     determined to be fatty deposits of no concern. Golden Rule 
     excluded any loss incurred resulting from any form of tumor 
     or tumorous growth, including complications therefrom or 
     operation therefor. The exclusion was in force at the time 
     Golden Rule terminated coverage on November 1, 1992.
       Subscriber C also treated with aspiration of fluid in 
     benign cysts located in breasts. Golden Rule excluded any 
     loss incurred resulting from any disease or disorder of the 
     breasts, including complications therefor. This included any 
     reconstructive surgery or complications of reconstruction 
     surgery. The exclusion was in force at the time Golden Rule 
     terminated coverage on July 19, 1993.
       Subscriber F applied for health insurance from Golden Rule 
     on January 15, 1992. The subscriber, a self-employed 
     commercial painting contractor, indicated no experience with 
     back problems. Golden Rule excluded any loss incurred 
     resulting from any injury to, disease or disorder of the 
     spinal column, including vertebrae, intervertebral discs, 
     spinal cord, nerves, surrounding ligaments and muscles, 
     including complications therefrom or operation therefor. The 
     exclusion was in force at the time Golden Rule terminated 
     coverage on March 1, 1993.
       Blue Cross and Blue Shield also compiled a list of more 
     than 81 exclusions used by Golden Rule. These include the 
     exclusion of whole body parts, such as arms, backs, breasts, 
     hips, knees, legs, hands, skin, testes and so on. I think the 
     list speaks for itself. See Attachment G.
       A particularly disturbing practice of Golden Rule was to 
     selectively underwrite newborn children of individuals 
     holding individual rather than family policies. After 
     providing the 30 day coverage of newborn children mandated by 
     Vermont law, Golden Rule would only extend coverage if the 
     newborn was healthy.


                                summary

       Community rating and guarantee issuance represent good 
     social policy, good insurance policy and good business 
     policy. The Vermont legislature quickly saw through the self-
     interested doomsday prophesies of the commercial industry 
     about radical price increases and the destruction of 
     Vermont's insurance market, and instead recognized that there 
     was no reason insurers could not make a fair profit playing 
     on a level playing field, where they could compete on the 
     quality of service they provided and the management of costs 
     rather than the avoidance of risk. Vermont consumers need no 
     longer worry about whether they will be able to have access 
     to this essential product.

  Mr. KENNEDY. Mr. President, these shameful practices are not unique 
to Vermont. In Kentucky, consumer complaints against Golden Rule were 
twice as high as against other companies. In New Hampshire, where no 
systematic survey was done, a State legislator reported his son had a 
foot injury as a small child and Golden Rule's coverage of him as a 
young adult excludes everything on the right leg before the knee. In 
Florida, the insurance department reported that Golden Rule's rate 
increases exceeded those of other carriers by a wide margin. People 
were insured at a low rate when they were healthy, and then their 
premiums were raised through the roof when they became sick. And 
Consumer Reports ranked Golden Rule near the bottom in a nationwide 
survey of insurance companies.
  No wonder Golden Rule wants medical savings accounts. They can only 
compete when the rules of the game are rigged against consumers. They 
can only profit by perverting insurance into a method of taking premium 
dollars from the healthy and avoiding paying benefits to the sick. The 
American public is coming to understand why a company like Golden Rule 
favors medical savings accounts, and why they have no place in 
legislation that is designed to make health insurance work better for 
consumers, not worse.
  I have placed into the Record editorials from a number of leading 
newspapers around the country pointing out the dangers of medical 
savings accounts and urging the passage of a bipartisan insurance 
reform bill without this poison pill. The editorials included the 
Washington Post, May 8, 1996, ``Dubious Crusade for Medical Savings 
Accounts''; the Los Angeles Times, June 6, 1996, ``U.S. Deserves This 
Health Reform''; the New York Times, May 30, 1996, ``Mr. Dole's Health-
Care Task''; the Dallas Morning News, April 21, 1996, ``No Cure-All, 
Medical savings accounts present a flawed solution''; the Baltimore 
Sun, April 25, 1996, ``Another Chance for health care reform''; the 
Washington Post, June 3, 1996, ``Senator Dole's Final Business''; the 
News Tribune (Tacoma, WA), June 13, 1996, Stick to Basics in New Health 
Bill''; the San Francisco Chronicle, June 10, 1996, ``Health Care 
Reform/Key Test for Dole''; the Harrisburg Patriot, April 3, 1996, 
``Too Much Reform''; the Columbus Dispatch, June 12, 1996, `` `Clean'

[[Page S6759]]

Health Bill; Get Rid of Those Two Killer Amendments''.
  Today, I would like to place additional editorials in the Record 
demonstrating the broad public opposition to MSA's and the desire for 
people across the country for passage of a clean, bipartisan insurance 
reform bill.
  There being no objection, the editorials were ordered to be printed 
in the Record, as follows:

                [From the Seattle Times, June 17, 1996]

           Pointless Stalemate Halts Health-Insurance Reform

       The near demise of the Kennedy-Kassebaum health-insurance 
     bill shows how little Congress now cares about solving the 
     real-life problems of millions of working Americans.
       The Kennedy-Kassebaum bill, a modest piece of legislation, 
     would allow people moving from one job to another the right 
     to transfer their insurance coverage and provide more 
     protection for individuals with pre-existing medical 
     conditions. It is an incremental step toward broadening and 
     stabilizing health care access.
       At one time, the bill's enactment was cheered on by both 
     Democrats and Republicans. President Clinton endorsed the 
     bill in his State of the Union address. The Senate passed it 
     unanimously; the House's version sailed through too.
       Now, this plan is about to be sacrificed to politics of the 
     crassest sort. Both Sens. Edward Kennedy and Nancy Kassebaum 
     were adamant from the beginning that their bill would win 
     passage only if it were limited to the noncontroversial 
     portability and pre-existing provisions. And yet, both Senate 
     and House versions were eventually loaded with dubious 
     amendments.
       After weeks of negotiations, most of those add-ons have 
     been stripped off. Now, medical savings accounts (MSAs) 
     allowed in the House version but not in the Senate bill 
     remain the heart of the controversy.
       Kennedy, a strong opponent of the MSA concept, will agree 
     only to a pilot program to test the impact of MSAs on health-
     insurance rates. The Republicans, however, insist on making 
     MSAs available immediately to roughly 30 million Americans 
     working in small businesses, with all others becoming 
     eligible in 2000 unless Congress votes to stop the expansion. 
     The Clinton administration opposes immediate, broad MSA 
     implementation.
       The MSA issue is highly controversial and has nothing to do 
     with insurance reform. Some claim these tax-free savings 
     accounts will help control overall health-care spending. 
     Others argue MSAs would siphon healthy people out of the 
     traditional insurance market, thereby leaving sicker people 
     with higher insurance premiums.
       Congress will have every opportunity to wrestle with MSAs 
     in coming months; the issue could even pop up in the 
     presidential campaign. If MSAs are good innovations, Congress 
     can pass them on a separate track.
       There is absolutely no reason to hold the Kennedy-Kassebaum 
     bill hostage to MSAs. Let a good, widely supported insurance-
     reform measure pass standing alone.
                                                                    ____


            [From the St. Louis Post-Dispatch, June 1, 1996]

                   Revive the Health Insurance Debate

       President Bill Clinton's promise to put health insurance 
     issues back on the national agenda, perhaps during his re-
     election campaign, is welcome. Since Congress killed his 
     initial health-care proposal, the president has shied away 
     from the issue even though the ranks of uninsured Americans 
     have eclipsed the 40-million mark.
       Voter concern about health costs is high, judging from 
     findings of a Louis Harris survey commissioned by the Robert 
     Wood Johnson Foundation. The survey included separate polls 
     in 15 cities, including St. Louis, as well as a national 
     poll.
       Though giving managed care high marks for containing 
     medical costs, 90 percent of St. Louisians predict 
     nevertheless that their own out-of-pocket costs for medical 
     expenses will continue to rise. Moreover, they expect 
     taxpayers to pay more than they do now to cover medical costs 
     for the elderly and the indigent. Another 44 percent express 
     worry about being hit with expensive medical bills that their 
     health insurance won't cover.
       Overall, the views of the 300 St. Louis households in the 
     survey mirrored those of the 605 households in the national 
     sample. St. Louisians did have more misgivings about health 
     care in some key areas. Only 40 percent, compared to 48 
     percent in the national sample, felt that managed care would 
     improve the quality of health care. Another 45 percent 
     reported worrying that they won't be able to pay for nursing-
     home care when they or a family member needed it, compared 
     with 38 percent in the national sample.
       Some of these numbers suggest that Congress is tackling the 
     wrong health-insurance issues. The Kennedy-Kassebaum bill to 
     protect health benefits of workers who change jobs or face a 
     serious illness is a good one. A House bill also includes 
     these provisions, along with the misguided plan to give 
     Americans the choice of opening so-called medical savings 
     accounts to cover some of their health expenses.
       In fact, these accounts generally would give tax breaks to 
     wealthy Americans, who need them least; moreover, the 
     accounts would do nothing to help the uninsured, 
     notwithstanding claims by GOP leaders. If many working 
     Americans are too poor to buy health insurance, what makes 
     the party think these workers would be able to put aside 
     money for a medical savings account?
       The Harris poll results show that voters deserve some 
     plausible answers to this question. They also deserve to know 
     what each party intends to do not only to protect the health 
     benefits of the insured but to extend benefits to those who 
     are not.
                                                                    ____


            [From the Pittsburgh Post-Gazette, May 7, 1996]

 Modest or Revolutionary? The Kennedy-Kassebaum Health Legislation May 
                                Be Both

       Depending on who is doing the talking, the Kennedy-
     Kassebaum health reform proposal is either so minimalist it 
     is meaningless, or so enormous it's revolutionary.
       Both assertions may be true.
       On the face of it, the bill makes it legally possible for 
     people to change jobs or lose their job and still maintain 
     health coverage. The bill, separate versions of which have 
     passed the House and Senate, ensures that workers who change 
     jobs will not have to wait around for years before being 
     covered under their new employers' insurer.
       Gone would be exclusions based on pre-existing medical 
     conditions. Also, workers who lose their jobs or move to new 
     jobs without health benefits would be guaranteed the 
     opportunity to purchase an individual policy through their 
     previous insurer.
       The bill does not cap premiums, however, so it is possible 
     that the individual coverage that is legally available may be 
     financially out of reach, particularly for people with a pre-
     existing condition.
       The Kennedy-Kassebaum tinkering could free millions of 
     people who are currently in job-lock because of their 
     dependence on health coverage. And it opens up the insurance 
     pool to millions more who are now closed out due to some 
     illness. But because of the costs involved, it seems unlikely 
     that it would have much of an impact on the 40 million 
     Americans without coverage.
       That's why many analysts consider it all but insignificant.
       Those who believe the contrary, that this proposal is 
     revolutionary, do not think the bill itself will turn the 
     world upside down. Rather, they believe that it will lead 
     inexorably to massive government involvement in writing the 
     rules for health care.
       In their scenario, throwing coverage open to sick people 
     will learn to sharply higher premiums and result in a public 
     backlash. Voters will turn up the heat on Congress to further 
     regulate the insurance market. What started out as a 
     piecemeal reform will, in the long-run, lead to systemic 
     change.
       We do not imagine that the 100 senators who voted in favor 
     of the bill foresee revolution as a consequence. But even if 
     that analysis is on target, it does not argue against the 
     proposal.
       Everyone agrees that being sick should not preclude an 
     individual from obtaining health coverage. Indeed, sick 
     people have the most immediate need for insurance. If it is 
     impossible for the nation's health-care system to extend 
     coverage to that group, then there is something deeply wrong 
     with the system.
       If the bill sponsored by Kansas Republican Nancy Kassebaum 
     and Massachusetts Democrat Edward M. Kennedy plugs the hole, 
     great. If it exposes a more widespread problem. Congress 
     should be grateful for the knowledge and then move to fix it.
       All that said, and despite the massive bipartisan support 
     for the bill, it is not a sure thing. The conference 
     committee must first deal with three potential deal-breakers.
       The House version includes tax-exemption for Medical 
     Savings Accounts, which are sort of a health-care IRA, and 
     for a cap on medical malpractice awards. If these measures 
     find their way into the final bill, President Clinton has 
     threatened a veto. The Senate version includes a requirement 
     to raise the caps on mental health treatment to provide the 
     same lifetime limits as other forms of treatment. Many in the 
     business community fear the cost ramifications of this 
     proposal.
       We have mixed feelings about the three proposals--thumbs 
     down on Medical Savings Accounts, proceed cautiously with 
     malpractice reform, thumbs up for treatment parity--but we 
     don't believe any of them should be allowed to block passage 
     of the more modest first step originally promised by Kennedy-
     Kassebaum.
       Whether it's a revolution or a tentative first step, it's 
     the most Congress has been able to manage and the least the 
     American public deserves.
                                                                    ____


                [From the New York Times, June 22, 1996]

                     White House Waffling on Health

       The White House and Congressional Republicans are 
     negotiating over the G.O.P.'s demand to include medical 
     savings accounts as part of healthcare reform. The White 
     House once threatened to veto a bill that included these 
     accounts. But now it is merely quibbling over details. The 
     Administration needs to regain its sense of principle. The 
     fight over medical savings accounts goes to the heart of the 
     health-care debate. No one can say for sure what damage the 
     accounts would cause. But they threaten to divide rich from 
     poor, healthy from sick, young from old.
       The Republicans propose to permit families who buy 
     catastrophic coverage--policies with high deductibles--to 
     make tax-free deposits to a savings account. The account

[[Page S6760]]

     would be used to pay routine bills. Savings could be 
     withdrawn after age 59\1/2\ and taxed as ordinary income.
       Proponents say the accounts would discourage waste because 
     initial outlays would come from personal savings. The 
     accounts would also provide coverage without herding people 
     into managed care or government coverage. But critics point 
     out that the accounts will appeal mostly to wealthy people 
     because they can afford steep deductibles, and healthy people 
     because they can expect to save money on a tax-free basis. 
     The accounts would encourage healthy people to split off from 
     traditional coverage, leaving the chronically ill to buy 
     coverage at sky-high rates.
       Yet good health can be transitory, giving holders of 
     medical savings accounts a false security. Once they become 
     ill, they may regret having given up traditional coverage. 
     Indeed, they may try to manipulate the system by hopping back 
     into traditional coverage when they expect large bills. The 
     better alternative is for all Americans to buy coverage 
     together, creating a vast pool of customers that will 
     guarantee affordable premiums for everyone regardless of 
     medical condition.
       The Administration understands the problem, but wants to 
     walk into November having signed a health-care bill. It is 
     covering its tracks by saying that all it is negotiating is a 
     pilot program. But the Republicans plan to offer the accounts 
     to tens of millions of employees at small businesses. After 
     three years, Congress will be asked to make the accounts 
     permanent and universal.
       It is thus highly likely that today's experiment will 
     become tomorrow's permanent program. The vast majority of 
     Americans are healthy. Because they will profit from a 
     medical savings account, at least in the short term, they 
     will resist any effort by Congress to strip them of their 
     tax-free benefit. A true test of the savings accounts would 
     be limited in size and require at least six years--enough 
     time to observe what happens when sizable numbers of account-
     holders become chronically ill. A valid test would also 
     experiment with different formulations in order to test what 
     plan works best.
       In 1993, the White House stood for the principle of 
     covering every American through common insurance pools. That 
     was a fine principle, even if the legislation it proposed 
     proved to be a medical monstrosity and a political albatross. 
     Now the Administration seems to be heading in the opposite 
     direction, where fortunate individuals take care of 
     themselves and leave others to do as best they can.

  Mr. KENNEDY. The Seattle Times stated on June 17,

       There is absolutely no reason to hold the Kennedy-Kassebaum 
     bill hostage to MSAs. Let a good widely supported insurance 
     reform measure pass standing alone.

  The St. Louis Post-Dispatch said on June 1,

       The Kennedy-Kassebaum bill to protect health benefits of 
     workers who change jobs or face a serious illness is a good 
     one. A House bill also includes these provisions, along with 
     the misguided plan to give Americans the choice of opening 
     so-called medical savings accounts to cover some of their 
     health expenses. In fact, these accounts would give tax 
     breaks to wealthy Americans, who need them least; moreover, 
     the accounts would do nothing to help the uninsured, 
     notwithstanding claims by GOP leaders. If many working 
     Americans are too poor to buy health insurance, what makes 
     the party think these workers would be able to put aside 
     money for a medical savings account?

  The Pittsburgh Post-Gazette said on May 7,

       Thumbs down on Medical Savings accounts . . . [They] should 
     not be allowed to block passage of . . . Kennedy-Kassebaum.''
  The Star-Ledger of Newark, NJ, said on May 29,

       Kennedy-Kassebaum was supposed to guarantee that workers 
     can take their employee health benefits with them when they 
     are downsized, out-sourced, or otherwise put out of a job. 
     Since then, a horde of amendments have been added . . . Some 
     are bad, such as the proposal for medical savings accounts, a 
     new tax shelter for the wealthy. None of them . . . should 
     have been tagged on to the Kennedy-Kassebaum bill, and you 
     have to wonder whether some of those supporting these add-ons 
     might not be out to sink the measure under the weight of the 
     amendments.

  The St. Petersburg Times said on June 11,

       Dole claims to support the major provisions of the 
     Kassebaum-Kennedy legislation . . . However, Dole and other 
     Republicans have insisted on weighing the bill down with a 
     provision that would create tax-deductible Medical Savings 
     Accounts--a radical plan to subsidize wealthy taxpayers that 
     could threaten the solvency of insurance plans for less 
     affluent Americans.

  And just last Saturday, the New York Times wrote,

       The fight over medical savings accounts goes to the heart 
     of the health care debate. No one can say for sure what 
     damage the accounts would cause. But they are threatening to 
     divide rich from poor, healthy from sick, young from old.

  These editorials are just a sampling of commentary around the Nation. 
There is no clamor for medical savings accounts, except from the 
special interests who see yet another opportunity to profit at the 
expense of people who need medical care. Indeed, responsible voices 
throughout the country urge rejection of this dangerous and untested 
idea. It is time for Republicans to stop playing special interest 
politics with health insurance reform. The Kassebaum-Kennedy bill 
passed by a bipartisan vote of 100 to 0. It should not be blocked 
because some Republicans want to line the pockets of their campaign 
contributors. Health insurance reform is too important to become just 
another election year casualty of extremist Republican political 
tactics.
  Mr. President, the MSA's are a golden lifeboat for Golden Rule's 
sinking ship. If we have ever had a classic bailout for private special 
interests, this is it. This is not what I am saying here tonight. It is 
what the hometown newspaper of Golden Rule, a conservative newspaper, 
has described it as, and in the meantime, the Republican leadership is 
refusing to let us get what has been agreed on, a bipartisan program 
signed by the President of the United States into law, because we are 
being held hostage to Golden Rule Insurance Co. That is the fact of the 
matter. Of course, they want their hand in the Federal Treasury. Of 
course, they want the American taxpayers to bail them out. Who would 
not, with declining sales in this market, and you can understand why 
they have declining sales.
  It is time for Republicans to stop playing special interest politics 
with health insurance reform. The Kassebaum-Kennedy bill passed by a 
bipartisan vote of 100 to nothing. It should not be blocked because 
some Republicans want to line their pockets with campaign 
contributions. Health insurance reform is too important to become just 
another election year issue.
  Mr. President, I hope that we are going to be able to see that this 
legislation is passed. We welcome the opportunity, as we did last 
Friday and this evening, to point out the flaws both of the companies 
that have been receiving and would receive the benefits from this 
effective tax giveaway.
  The Joint Economic Committee estimated that if there was going to be 
a million Americans who were going to participate in this program, the 
costs to the Federal Treasury in 10 years is $3 billion--for 1 million 
people. And you have 120 million Americans who are working and you have 
their family members. The Republican proposals would include all the 
companies with employees of less than 100, some 47 million working, a 
third of all Americans, in a program that is untested, untried. You can 
imagine what that would mean in terms of opening up the Federal 
Treasury.
  There is no justification, there is no rationale, there is no reason, 
there is no meaning to deny 25 million Americans who have these 
preexisting conditions the protection that they need and their families 
deserve. We have a responsibility to do it. We have developed 
bipartisan legislation. Release the hold that these insurance companies 
have on the Republican leadership and let us do something decent for 
the American people and for hard-working families across this country.
  Mr. President, I yield the floor.

                          ____________________