[Congressional Record Volume 142, Number 116 (Thursday, August 1, 1996)]
[House]
[Pages H9801-H9809]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  CONFERENCE REPORT ON H.R. 3845, DISTRICT OF COLUMBIA APPROPRIATIONS 
                               ACT, 1997

  Mr. WALSH. Mr. Speaker, pursuant to the previous order of the House, 
I call up the conference report on the bill (H.R. 3845) making 
appropriations for the government of the District of Columbia and other 
activities chargeable in whole or in part against the revenues of said 
District for the fiscal year ending September 30, 1997, and for other 
purposes, and ask for its immediate consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to the order of the House of today, 
the conference report is considered as having been read.
  (For conference report and statement, see proceedings of the House of 
earlier today.)
  The SPEAKER pro tempore. The gentleman from New York [Mr. Walsh] and 
the gentleman from California [Mr. Dixon] each will control 30 minutes.
  The Chair recognizes the gentleman from New York [Mr. Walsh].


                             general leave

  Mr. WALSH. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
on the conference report to accompany H.R. 3845, and that I may include 
tabular and extraneous material.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New York?
  There was no objection.
  Mr. WALSH. Mr. Speaker, i yield myself such time as I may consume.
  (Mr. WALSH asked and was given permission to revise and extend his 
remarks.)
  Mr. WALSH. Mr. Speaker, I will be very brief. The conference 
agreement we bring to the House this evening is essentially the same 
bill that was passed by this House 2 weeks ago. Our conference 
agreement includes $719 million in Federal funds and is within our 
602(b) allocation in both budget authority and outlays. In District 
funds, we retain the ceiling of $5.108 billion on total operating 
expenses, and we were successful in getting a deficit cap reduced to 
$74 million instead of $99 million, as proposed by the consensus in the 
Senate bill.
  Mr. Speaker, I want to thank the members of the subcommittee for 
their hard work. This is a good conference agreement. I urge the 
Members to support it.
  Mr. Speaker, this evening we have before the House the conference 
agreement on H.R. 3845, the District of Columbia Appropriations Act for 
fiscal year 1997. It is essentially the same bill that was passed by 
this House 2 weeks ago with a few exceptions that I will highlight in a 
moment.
  Our conference agreement includes $719 million in federal funds and 
is within our 602(b) allocation in both budget authority and outlays.
  In Federal funds, the $719 million agreed to by the conferees is $1 
million above the amounts recommended in the bill as passed by the 
House and Senate. The efforts of the gentleman from California [Mr. 
Dixon], the ranking member on our subcommittee, resulted in this $1 
million being added to our bill for the control board to contract with 
private entities to inspect, flush, and repair the drinking water 
distribution system in the District. There is a strong Federal interest 
in assuring that those who visit, live, and work in the Nation's 
Capital have safe water to drink.
  In District funds, we retain the ceiling of $5.108 billion on total 
operating expenses for fiscal year 1997, and we were successful in 
getting the deficit cap reduced to $74 million instead of $99 
million as proposed in the consensus budget and the Senate bill.

  Mr. Speaker, there are four items I want to mention briefly.
  First, on the abortion issue, the Senate receded to the House 
language that no appropriated funds, Federal or local, are available 
for abortions except to save the mother's life, or in cases of rape or 
incest.
  Regarding the domestic partners provision, the House language was 
agreed to by the conferees and provides that no funds, Federal or 
local, are to be used for a registration system or to implement or 
enforce the District's Domestic Partners Act.
  Mr. Speaker, our subcommittee is concerned about deficit spending by 
the District government and borrowing long term to finance those 
deficits. We are urging the Mayor, the Council, and the control board 
to hold spending to the level of revenues collected. The District 
cannot spend its way to prosperity; nor can it borrow its way to 
prosperity.
  And lastly, we have included an important provision regarding the 
Chief Financial Officer. Language in section 142 makes clear that all 
financial personnel in the executive branch of the District government, 
including all independent agencies and excluding the legislative and 
judicial branches, are under the exclusive control of the CFO. The CFO 
is making progress. It has been reported that the time delay in making 
vendor payments has been reduced from months to between 30 to 45 days. 
This is good progress.
  I would like to thank the members of the sbucommittee for their hard 
work on this bill--the gentleman from Texas [Mr. Bonilla], the 
gentleman from Georgia [Mr. Kingston], the gentleman from New Jersey 
[Mr. Frelinghuysen], the gentleman from Wisconsin [Mr. Neumann], the 
gentleman from Mississippi [Mr. Parker], the gentleman from California 
[Mr. Dixon], the ranking member on our subcommittee and my predecessor 
as subcommittee chairman, the gentleman from New York [Mr. Serrano], 
the gentlelady from Ohio [Ms. Kaptur], and the ranking member of the 
committee, the gentleman from Wisconsin [Mr. Obey].
  I want to especially thank the full committee chairman, the gentleman 
from Louisiana [Mr. Livingston], for his extraordinary efforts on this 
bill. He took time to participate in our markups and meetings while 
still tending to other important appropriations matters.
  Each of these Members is to be commended. I also want to thank the 
House and Senate staff as well as my personal staff for their hard 
work.
  Mr. Speaker, at this point in the Record, I will insert a tabulation 
summarizing the conference action.
  [The tabulation referred to follows:]

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[[Page H9804]]


  Mr. WALSH. Mr. Speaker, I reserve the balance of my time.
  Mr. DIXON. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. DIXON asked and was given permission to revise and extend his 
remarks.)
  Mr. DIXON. Mr. Speaker, the gentleman from New York is correct. This 
bill is substantially the same that left the House. I can certainly 
support it. I would like to thank the gentleman from New York and the 
Senator from Vermont for their cooperation in this matter. It made the 
bill and the conference go smoothly. I pay particular thanks to the 
gentleman from Louisiana [Mr. Livingston], the chairman of the full 
Committee on Appropriations, for we were able to provide another $1 
million for the District of Columbia to clean the water pipes. This is 
an issue that not only affects the residents of the District and 
Federal employees, but tourists and citizens that come from around the 
country. I want to thank the gentleman from Louisiana [Mr. Livingston] 
for that effort.
  Mr. Speaker, I rise in support of the conference agreement on the 
fiscal year 1997 District of Columbia appropriations bill.
  I want to congratulate the gentleman from New York, Mr. Walsh, and 
Senator Jeffords who chairs the D.C. Appropriations Subcommittee in the 
Senate, for their fine work in moving this bill in record time. Unlike 
last year when agreement on the 1996 bill was not reached until 7 
months after the start of the fiscal year, this year we have reached a 
bipartisan agreement 2 months before the start of the 1997 fiscal year.
  This conference agreement is a fair and balanced agreement on the 14 
differing items between the House and Senate bills. The agreement 
adopts the $5.1 billion consensus budget submitted by the District and 
the Control Board, but also caps the projected budget deficit at $74 
million. This cap will put the District on a faster path toward a 
balanced budget, while giving the District and the Control Board the 
flexibility to determine precisely what additional spending reductions 
can be made without disrupting vital city services.
  The conference agreement also strengthen's the ability of the 
District's chief financial officer to supervise and reorganize the 
financial personnel of the District's executive and independent 
agencies. These are the individuals who will be responsible for 
maintaining strong financial controls and accountability within the 
District's bureaucracy. The conference agreement makes it clear that 
Congress intends that these individuals serve under the direction of 
the chief financial officer.
  Mr. Speaker, with regard to the funding restrictions on abortion and 
domestic partners, the agreement continues the restrictions implemented 
in the fiscal year 1996 bill without change. I continue to believe that 
these provisions abridge the rights of the citizens of the District to 
make their own judgments about these matters through their own elected 
representatives. I hope that we can remove this intrusion into home 
rule in the future.
  I am delighted that the conference agreement also includes $1 million 
in funding to comply with the Environmental Protection Agency's 
recommendation that the District move swiftly to address the causes of 
elevated bacteria levels in the District's drinking water. The District 
has had five violations of Federal water quality standards in the past 
year, and simply does not have the staff or resources to address this 
problem in a timely fashion. The funds in this bill will enable the 
Control Board to move swiftly to hire a private contractor to flush the 
District's drinking water system of bacteria and other pollutants, 
while the city develops a longer term plan to ensure that drinking 
water in the District remains safe.
  Mr. Speaker, overall, this conference agreement is a good agreement. 
I support it and urge its adoption.
  Mr. Speaker, I have no requests for time, and I yield back the 
balance of my time.
  Mr. WALSH. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I would also like to thank the gentleman from California 
[Mr. Dixon], who served as chairman of this subcommittee, now serves as 
ranking member, for his cooperation, for his staff's cooperation. It 
was a remarkable feat to complete this bill in less than 3 weeks. It is 
due in no small part to the cooperation we received from the Democrat 
side and from the Senate.
  Mr. TORKILDSEN. Mr. Speaker, I rise today to urge my colleagues from 
both sides of the aisle to join me in support of the Health Coverage 
Availability and Affordability Conference Report.
  Statistics show that under current law, up to 25 million Americans 
across the country are denied health insurance coverage because of pre-
existing conditions. Additionally, some 4 million workers remain ``job-
locked'' because of the lack of health insurance portability. This is 
unacceptable.
  It is inconceivable that, under current law, people with pre-existing 
medical conditions--whose need for quality health care can be 
immediate--can be denied health insurance. People should not have to 
live in fear that a change in jobs, or job loss, could deny them 
continued health coverage.
  This bill is a bipartisan and common-sense solution. It doesn't solve 
every problem, but it is a shining example of what can be accomplished 
through compromise.
  The key to health care reform is choice. Americans should be free to 
choose what type of insurance they want--and which doctors they wish to 
see. Medical Savings Accounts are one of the most innovative new 
choices in health care, and it is encouraging that the House and Senate 
were able to reach a compromise to institute MSA's on a 4-year trial 
basis. While MSA's clearly are not right for everyone, they are a bold 
new approach to health care reform. MSA's are one more choice for 
people who need health insurance.
  This Conference Report is also a major win for the self-employed, in 
that it increases the percentage of their health insurance expenses 
that they can deduct from 30 percent to 80 percent. Under current law, 
the self-employed are permitted to deduct a mere 30 percent of their 
health insurance costs, while corporations can deduct 100 percent. This 
is unfair. People who are self-employed should not be discouraged from 
buying insurance because they are forced to pay a de facto tax penalty. 
We must eventually increase this deduction to the 100 percent enjoyed 
by corporations, but for now, 80 percent is a great improvement.
  The Health Coverage Availability and Affordability Act does not 
involve a government take-over of health care. It does, however, solve 
specific problems in the current system and institutes new ideas to 
help all Americans--young and old--obtain health coverage.
  I urge my colleagues on both sides of the aisle to support the bill 
and pass this much-needed reform.
  Mr. FAZIO of California. Mr. Speaker, I rise to express my strong 
support for the conference agreement before us.
  The health insurance reform conference agreement will help tens of 
millions of Americans keep their health insurance when they switch 
jobs, regardless of their health condition. In addition, the conference 
agreement contains an increase in the deductibility of health insurance 
for the self-employed.
  This conference agreement addresses several fundamental problems in 
our Nation's health insurance system. First, if an employee who has 
been covered by an employer's health plan for at least 18 months loses 
his or her job, or switches to a job that doesn't provide insurance 
coverage, that employee will be able to buy insurance without 
exclusions for pre-existing medical conditions from any firm in the 
state that sells insurance.
  I believe that this agreement represents an important first step in 
reforming our Nation's health care system. The General Accounting 
Office has found that about 21 million Americans are uninsured because 
of pre-existing conditions. The common-sense portability provisions 
contained in this bill will make a real difference in the lives of 
these uninsured workers.
  So, too, will the provisions governing the deductibility of health 
insurance costs for the self-employed. Greater deductibility means that 
those who already are insured will find it more affordable. Those who 
lack coverage will more easily be able to budget for this necessary 
expense.
  Greater deductibility also ensures greater fairness in our tax code. 
Corporations have long enjoyed full deductibility for their employee's 
health insurance. This provisions will narrow the gap between the self-
employed and corporate employers, thereby reducing operating expenses 
for America's small business men and women and increasing the number of 
working families covered by health insurance.
  I am glad that the conferees, particularly Senator Kennedy and 
Congressman Archer, were able to negotiate a compromise on the medical 
savings accounts (MSA's) issue. The compromise agreement on MSAs 
reflects the concerns that I, and many others, had about the scope of 
MSA coverage. In addition, the compromise requires that Congress re-
visit the MSA issue in four years to determined whether it should be 
extended or curtailed.
  This conference agreement presents us with an opportunity to enact 
health care insurance reform legislation that will benefit millions of 
hard-working Americans. I urge my colleagues to vote YES on the 
conference agreement.
  Mr. REED. Mr. Speaker, I rise in support of passing meaningful and 
essential health care reform today.
  The conference agreement on H.R. 3103 is a positive first step to 
expanding access to health insurance for Rhode Islanders and

[[Page H9805]]

Americans across the nation. This legislation prohibits insurance 
companies from dropping coverage when an individual changes jobs or 
denying coverage because of a pre-existing condition. In addition, this 
bill increases the tax deduction for the self-employed from 30 percent 
to 80 percent by 2006.
  Enactment of this common-sense health reform legislation has been 
delayed several months due to the insistence by the Republican Majority 
to attach many controversial provisions, including Medical Savings 
Accounts (MSA's), to the bill. The conference agreement contains a 
compromise that would make MSA's available to a limited population for 
four years. While I am concerned about the potential impact of this 
provision on our health care system, I am pleased that Congress must 
pass new legislation to continue or expand this MSA demonstration 
project.
  I am also disappointed that the conference agreement does not contain 
the Domenici-Wellstone amendment adopted during Senate consideration of 
this legislation. This amendment would have required insurers and 
health plans to provide coverage for mental illness equal to that 
provided for physical health conditions. It is my hope that future 
Congresses will address this essential issue.
  The steps to correct our health care system in H.R. 3103 is minimal, 
but needed reform which will alleviate the anxiety and suffering of 
many hard working families. However, more needs to be done to make 
health coverage affordable and available to more Americans. I remain 
committed to enacting comprehensive, systemic health care reforms in 
order to slow cost increases in health care services and ensure that 
all Americans have access to the quality health care they need.
  Ms. PELOSI. Mr. Speaker, I rise in support of the conference report 
on the Kennedy-Kassebaum health care legislation. While I would have 
much preferred the bill adopted by the Senate, the advantages of this 
conference agreement outweigh the drawbacks.
  This bill will be very helpful to Americans with preexisting 
conditions who may need to change jobs. It will allow them to move from 
one group insurance plan to another without coverage being excluded 
because of a preexisting condition. It will also allow people who lose 
their jobs to buy individual insurance without exclusion because of a 
preexisting condition.
  The bill contains an important provision which states that the 
results of genetic testing cannot be used as a finding of a preexisting 
condition. This is an important first step in protecting individuals 
from discrimination based on new genetic testing made possible by 
advances in biomedical research.
  The bill also expands on a provision important to me and my district. 
Several years ago, I introduced legislation which became law extending 
continuation group health coverage under COBRA to individuals found to 
be disabled at the time that they stopped working. Under the provision, 
these disabled individuals could remain in group coverage for 29 
months--the time it takes to qualify for Medicare coverage. This bill 
improves this benefit by extending continuation coverage for those that 
become disabled during their initial COBRA coverage until they are 
covered under Medicare.
  In addition, this bill includes an important provision which allows 
individuals with terminal illness to receive accelerated death 
benefits--often called viatical settlements--as tax-exempt benefits 
rather than income. This provision would apply to settlements received 
after December 31, 1996.
  I am disappointed in the conference agreement for what this bill does 
not do. It does not make health insurance more affordable. In fact, the 
medical savings accounts portion of the bill--by taking the healthy and 
wealthy out of the insurance pool--may make health insurance more 
expensive.
  In addition, this bill does nothing about the ability of insurance 
companies to exclude types of treatment or cap coverage. The bill also 
eliminates the Domenici-Wellstone mental health parity provision and 
even a scaled-back compromise to expand mental health coverage. 
Responding to these needs is also part of what should be done to 
provide health care security.
  While this bill will help about 400,000 Americans with preexisting 
conditions who will benefit from the portability provisions, it will do 
nothing for uninsured Americans. The number of uninsured is projected 
to increase by another million in the next year. The welfare bill, 
passed by the House yesterday, will add even more people to the ranks 
of the uninsured.
  Mr. Speaker, I urge a ``yes'' vote. Yet I am also compelled to 
comment on how much this bill has been weakened from the Kennedy-
Kassebaum bill adopted by the Senate. We have a long way to go before 
achieving true health care reform.
  Mr. MATSUI. Mr. Speaker, I would like to express my disappointment 
with the failure of the conferees to include a provision addressing the 
ongoing blatant insurance discrimination against the treatment of 
mental illness.
  Millions of American men, women, and children, from every ethnic, 
economic, and age group, suffer from mental illness. We have made great 
progress in recent years in diagnosis and effective treatment of these 
debilitating and sometimes life-threatening illnesses. Yet persons with 
mental illness must struggle every day not just with their illness 
itself, but also with the refusal of the Nation's insurance industry to 
end discriminatory coverage of their treatment.
  There is no reason for this discrimination, other than stigma and 
ignorance. Study after study has shown that parity coverage would save 
lives and money. The National Mental Health Advisory Council reported 
to Congress in 1993 that parallel treatment of severe mental and 
physical illness would actually save the national economy more than $2 
billion every year.
  In April, the Senate adopted by a vote of 68-30 an amendment offered 
by Senator Domenici and Senator Wellstone which specified that 
insurance plans had to impose the same limits on mental illness as 
physical illness in areas such as patient cost sharing, drug coverage, 
hospital stay duration, and annual and lifetime caps. It did not 
prevent businesses from managing mental or physical health care. All it 
said was that insurers must apply the same restrictions on mental 
health care as they do to physical health care.
  During conference, Senators Domenici and WEllstone scaled back their 
proposal to require equal coverage only for lifetime and annual caps. 
The Congressional Budget Office estimated that the revised proposal 
would cost employers no more than .16 percent in additional premiums--
literally pennies per day. This cost amounts to 3 cents per day per 
employee, or about $7 per year. It could have been completely offset by 
a negligible increase in the annual deductible, so that businesses 
would have paid nothing.
  Unfortunately, House Republican conferees rejected even the modest 
proposal for parity on annual and lifetime caps. There is, as a result, 
nothing in the conference agreement to specifically address the fair 
treatment of persons with mental illness. This is unacceptable. More 
than two-thirds of the Senate voted for mental illness parity, and 116 
Representatives endorsed the Senate amendment.
  Mr. Speaker, this Congress and the Republican conferees had a real 
opportunity to make a modest but meaningful effort to reduce insurance 
discrimination against persons with mental illness. That they chose to 
do nothing at all is a lamentable rebuff to the millions of Americans 
who suffer from mental illness. We have to do better.
  Ms. HARMAN. Mr. Speaker, I rise today on behalf of moderation and 
bipartisan cooperation and in strong support of the Health Coverage 
Availability conference report.
  After months and months of gridlock, we finally have before us a 
solid health care compromise. This legislation shows what is possible 
if we put partisanship behind us and work from the sensible center for 
the betterment of our country.
  Over the last decade, thousands of high-skill, high-wage workers in 
California's South Bay have lost their jobs because of defense 
downsizing. While many successfully found new employment, some cannot 
obtain medical insurance for themselves and their families because of 
preexisting health conditions. This bill generally prohibits insurers 
from excluding coverage of preexisting conditions and ensures that 
individuals would not lose their health insurance coverage when they 
move from one job to another.
  The conference report's bipartisan character is particularly apparent 
in the section authorizing medical savings accounts. I'm pleased with 
the language establishing an MSA trial program. This way we can collect 
accurate evidence on how MAS's affect the quality and scope of health 
coverage for everyone.
  Mr. Speaker, if we govern together from the sensible center, we will 
be successful. If we resort to partisan bickering, we are doomed to 
failure. Americans want and deserve a Congress that works. This 
conference report is evidence that it can.
  Mrs. LOWEY. Mr. Speaker, I rise in support of the Kennedy-Kassebaum 
health insurance reform bill. While not perfect, this bill is a major 
step toward improving the health security of hard-working Americans and 
their families.
  Mr. Speaker, Democrats have been working on this issue for a long 
time. Senator Kennedy and his colleague, Senator Kassebaum, introduced 
their bill nearly a year ago today. The President endorsed the plan in 
his State of the Union address in January. Democrats in both Houses 
have been fighting for it ever since. The time has come to finally 
enact these reforms.
  Mr. Speaker, we all know that the days of having a 40-year career at 
a single company are over. Americans today change their jobs often, but 
can't take their health insurance with them. Too many hard-working 
Americans and

[[Page H9806]]

their families have faced a troubling threat--if they change or lose 
their job, they lose their health insurance. That is wrong. This bill 
will give more Americans the peace of mind that they will continue to 
have access to health insurance, regardless of their job situation.
  In addition, this health reform bill will: prevent insurance 
companies from denying coverage to Americans because they are sick; 
help seniors suffering from Alzheimer's and other chronic illnesses to 
afford the cost of long-term care; allow the self-employed to deduct 
more of their health insurance costs; and create a demonstration 
project to determine whether tax-preferred medical savings accounts are 
a promising way to control costs and protect patients' choice of 
doctor.
  While I strongly support this bill, I am extremely disappointed that 
it does not ensure that mental health benefits are treated like other 
health benefits. The Senate unanimously supported mental health parity 
and nearly 100 of my colleagues in the House expressed their strong 
agreement. Sadly, it is not included in this bill. Mental illness is no 
different from physical illness. It should no longer be stigmatized.
  I hope we can work to end discrimination against mental illness. For 
now, we must pass this bill--for it is a step forward for millions of 
American families. I urge my colleagues to support this health 
insurance reform bill.
  Mr. BUNNING. Mr. Speaker, I rise in support of the Health Coverage 
Availability and Affordability Act and urge my colleagues to vote for 
it. It is a good bill.
  Two years ago, when the First Lady's massive health care reform 
proposal was being considered and rejected by Congress, two things 
became clear. It was obvious that there was virtually no public support 
for a dramatic increase in the Government's involvement in our health 
care system. But it also became clear that there were quite a few 
health care issues on which there was widespread agreement.
  This bill is the result of that consensus. It contains many of the 
reforms that are really needed in our health care system--reforms that 
people really want. It contains the reforms that we can all agree on. 
This bill does what is doable in health care reform.
  The key element of this bill is something I have been working on for 
several years--legislation to ensure portability of health care 
insurance. Currently, too many people are locked out of health coverage 
because they have some sort of chronic health problem or preexisting 
condition. Our bill will solve the problem by eliminating preexisting 
condition exclusions for people with prior health insurance coverage. 
This is a long overdue change.
  The Health Care Availability and Affordability Act does some other 
worthwhile things too. It will also improve access to health insurance 
by raising the health care deduction for self-employed from 30 to 80 
percent, and by allowing small businesses to form insurance pools to 
get better rates for their employees. It will allow tax deductions for 
long-term health care coverage; allow terminally ill patients to 
receive tax-free accelerated death benefits from their insurance 
companies and create an exciting new concept called medical savings 
accounts.
  I'm very excited about the potential for medical savings accounts. 
These accounts will allow people to set money aside in tax exempt 
accounts to use for medical expenses. Later, unused funds remaining in 
the accounts could be used for other purposes. What better incentive 
could you ask for to make people better shoppers and wiser users of 
health care? The medical savings account is a great idea.
  Unfortunately, because the President objected to the MSA concept, we 
had to scale back the availability of these accounts in this bill. In 
the final bill, MSA's will be allowed on a 4-year test basis and be 
limited to 750,000 policies. But I am confident that in less than 4 
years, medical savings accounts will prove themselves and Congress will 
clearly recognize their value and expand their availability.
  This is a good bill. It doesn't solve all our health care problems 
but it contains many worthwhile reforms and it is doable. I urge my 
colleagues to vote for it.
  Mrs. COLLINS of Illinois. Mr. Speaker, HIPAA, HIPAA, Hurray. HIPAA 
stands for the Health Insurance Portability and Accountability Act, the 
short title of H.R. 3103 for which we now consider a conference report. 
Hurray. We finally have some health care reform. I say ``some,'' 
because we still have a long way to go, but in this week of the 1996 
summer Olympics, we at least have gotten out of the starting blocks to 
provide improved access to health case financing for more Americans.
  The portability provisions agreed upon in this conference report of 
H.R. 3103, will allow people who lose or change jobs to continue their 
health insurance coverage. Now, even with some preexisting condition, 
health insurance plans can only limit for so long a person's waiting 
period before treatment for a preexisting condition could be covered--
and, no longer can pregnancy, birth, and adoption be considered 
prohibitions to immediate coverage. These are good steps toward 
universal access and health insurance coverage for all Americans, which 
I have long advocated.
  It looks like we finally have some relief from the special interests 
that control the health care delivery and financing system in this 
country that left over 37 million American uninsured for health care. 
It has been well documented that it is hard-working middle-income 
families who were being squeezed out of decent health coverage. In this 
time of rampant corporate layoffs, losing your job or even changing 
jobs can mean a devasting loss of health insurance coverage for you and 
your family.
  Small businesses with 25 employees or less often found group coverage 
either unaffordable or unavailable if any of their workers were 
determined to be part of a high-risk category. Under this agreement, 
the small group employer market will be opened up. Title I of this 
conference bill provides for guaranteed availability of coverage to 
employees in the small group market. In layperson language, that means 
that each insurer that offers coverage in a small group market will 
have to make all health insurance policies available to all small 
employers and will have to accept for enrollment every eligible 
individual within the same employer--no longer will health insurance 
companies be able to pick and choose, or discriminate, who will be 
allowed to have health insurance.
  Especially at a time of growing economic insecurity and instability, 
we have been challenged to find ways to address these problems--to make 
health coverage easier to buy and keep. That has been my primary goal 
in my efforts to reform the health care financing system in America 
today. I believe that we must be vigilant on a wide variety of concerns 
to help ensure that any health care reform product that is passed by 
Congress satisfies certain criteria. Some of the important objectives 
include universal coverage, comprehensive benefits, strong cost 
containment, and guaranteed access to high quality care for low-income, 
unemployed, and part-time employed people. Also, it is critical that 
the unique health needs of women, minority, and elderly populations are 
addressed. There should additionally be some expansion of long-term 
care insurance market.
  So, there is more work to be done to provide fair and open access to 
health care for all children, individuals, and families. Until and 
unless Congress can achieve meaningful health care reform to provide 
for universal access to health care financing, there must be Medicaid 
eligibility for the unemployed, uninsured families who receive public 
assistance.
  Mr. Speaker, I am disappointed that the provisions for mental health 
parity did not survive the conference because I believe that every 
person has a right to receive comprehensive physical and mental care 
under health care financing. Many States provide for mental health care 
coverage in their health insurance plans and I believe that the Federal 
Government will eventually recognize the value for it and will ensure 
national uniformity in that area.
  The health care reform covered in this conference agreement is a good 
start. I urge my colleagues to support this conference agreement.
  Mr. COLLINS of Georgia. Mr. Speaker, I rise to support this health 
care bill that will make health care more available and affordable for 
millions of Americans.
  This is a health care bill the American people have wanted for years. 
And this Congress was able to accomplish this without a Government 
takeover of health care.
  Two key provisions of this reform bill will eliminate health coverage 
exclusions based on pre-existing conditions and expand the portability 
of health care insurance plans for workers.
  American workers will no longer have to fear losing their health care 
coverage if they change jobs. And, people can change jobs without 
losing their health insurance even if they have a pre-existing 
condition. These are major breakthroughs in health care.
  We created Medical Savings Accounts to allow small business employees 
and the self-employed to make tax deductible contributions to a savings 
account if they choose to purchase a high deductible health plan.
  We increased to 80 percent the tax deduction self-employed 
individuals can claim for health insurance. We included tax deductions 
for nursing home and home health care insurance and approved 
accelerated death benefits which will provide Americans more access to 
health care.
  Finally, the legislation fights fraud and abuse in the health care 
industry by creating new criminal penalties and by increasing funding 
for prosecutions and investigations.
  I am pleased to learn that President Clinton announced he will sign 
this historic health reform legislation even though he had previously 
threatened to veto the measure.
  This legislation is good, sound health care policy. It provides a 
comprehensive approach

[[Page H9807]]

to providing market-based health care reform that avoids the explosion 
of government bureaucracy.
  Mr. COSTELLO. Mr. Speaker, I rise in support of the conference 
agreement on the Health Coverage Availability and Affordability Act. 
While this bill is not perfect, I am pleased we have reached a 
bipartisan compromise on this important legislation. The conferees 
improved the House-passed bill and I am hopeful this body will now pass 
this conference report so it may be sent to the President. By passing 
this bill, we will help millions of Americans relieve their anxiety 
about maintaining health insurance if they become unemployed or change 
jobs.
  This bill makes great strides toward protecting the health insurance 
converge of workers who face job-lock because of a fear of losing 
medical benefits. By increasing portability, the Congress is extending 
coverage to millions of working Americans who might otherwise lose 
their health care benefits.
  This bill makes modest, basic changes to our health care system. It 
increases the portability of health insurance by prohibiting insurance 
companies and Health Maintenance Organizations [HMO's] from denying 
health care coverage to workers who move to another company or lose 
their jobs. Under the legislation, insurers may not exclude coverage 
for pre-existing medical conditions for more than 1 year.
  The bill also raises from 30 percent to 80 percent the share of 
health insurance costs that the self-employed could deduct for tax 
purposes. While I believe that health insurance costs for the self-
employed should be 100-percent deductible, this provision is an 
important step in giving small business entrepreneurs and family 
farmers more economic security.
  In addition, the legislation establishes a test pool of Medical 
Savings Accounts where for 4 years up to 750,000 Americans who usually 
have high-deductible insurance policies could instead contribute to 
these accounts. These contributions could be used to pay medical 
expenses, but unused funds could accumulate or remain the property of 
the contributor. I am pleased we are giving MSA's a test run to see if, 
in fact, such savings accounts are equitable to everyone in insurance 
pools. I have strong reservation about jumping to such a large scale 
program without knowing if MSA's will work.
  These incremental yet important reforms are the first step in fixing 
our health care system. We must next work on providing adequate and 
affordable health care for the uninsured and underinsured. This bill 
will help reduce the number of uninsured Americans and allow Congress 
to better target insurance reform in the future.
  Mr. CASTLE. Mr. Speaker, I rise in strong support of the Health 
Coverage Availability and Affordability Act. This historic agreement 
will address the health insurance needs of millions of Americans. Those 
who want to change jobs, or who find themselves stricken with a costly 
illness, or who find themselves unemployed, will still be able to 
purchase affordable health insurance for themselves and their families.
  The magnitude of the health insurance problem today is substantial--
millions of Americans are without health insurance--39.7 million non-
elderly Americans, or 17 percent of non-elderly Americans, were without 
health insurance in 1994. This is in spite of the fact that the United 
States spends far more per capita on health care than any other major 
nation--according to 1993 estimates, national health expenditures 
totaled $884 billion, or 13.4 percent of the gross domestic product.
  There are many reasons for this high rate of uninsurance. Increasing 
numbers of health insurance companies refuse to insure those with pre-
existing medical conditions or who work in high-risk jobs. Health care 
costs have driven up the cost of insurance, making it unaffordable. 
Rates for small businesses and the self-employed are extremely high due 
to their small risk pools. State mandates sometimes load up policies 
with unnecessary or unwanted benefits. Medical malpractice laws drive 
up the need for defensive medicine and expensive liability insurance 
for doctors.
  I am delighted that the Congress was able to work in a bipartisan way 
to achieve important health insurance reforms to address some of these 
problems. This bill is a composite of sensible ideas which will have a 
substantial impact on hard working Americans who seek to retain or 
obtain health insurance coverage.
  The conference report retains the best of the House and Senate 
proposals. It addresses the availability of health insurance by making 
sure health insurance is available for individuals moving from group to 
group or group to individual coverage. These portability provisions 
will provide important protections for the American people. It also 
guarantees the availability of insurance coverage to employees in the 
small group market, and assures people in group health plans that they 
cannot be excluded from coverage or from renewing their coverage based 
on their health status.

  The issue of affordability is addressed by strong anti-fraud and 
abuse provisions--which are particularly important given that an 
estimated 1 in every 10 health care dollars is spent on fraud or abuse. 
Some of the reforms include establishing a national health care fraud 
and abuse control program to coordinate Federal, State, and local law 
enforcement to combat fraud with respect to health plans; establish a 
Medicare Integrity program; increase criminal penalties for fraud and 
abuse violations under Medicare and Medicaid; establish a program to 
encourage individuals to report suspected cases of fraud and abuse in 
the Medicare Program; among others
  In addition, the bill includes administrative simplification 
provisions which should also reduce costs. Uniform standards for health 
information would enable the private sector to reduce paperwork--which 
accounts for an estimated 1 in every 10 health care dollars spend--make 
it easier to identify fraudulent claims, and make it easier for 
consumers to compare health plans and services. And it raises the 
health insurance deduction for self-employed individuals form 30 
percent to 80 percent by the year 2006, and provides tax incentives for 
the purchase of long term care.
  The conference report also includes an important innovation--Medical 
Savings Accounts. I am extremely pleased that the conferees agreed to a 
demonstration program. Medical Savings Accounts hold considerable 
promise, as they can make consumers more cost-conscious and thereby 
reduce health care costs. MSA's give consumers a clear inventive to 
take a more active role in their health care.
  But before MSA's should be implemented on a grand scale, I think it 
makes sense to ensure MSA's don't have negative unintended consequences 
regarding the health insurance market or the health care choices that 
consumers make. For example, I imagine that none of us wants to see 
consumers forgoing all preventive care in order to build up their 
medical savings accounts. That is why the idea of a demonstration 
program is such a reasonable one.
  This bill will make health insurance more affordable for millions of 
Americans. It will expand the opportunities Americans have to secure 
health care for their families, and will provide protection in these 
uncertain economic times. Health insurance reform is an idea whose time 
has finally come, and I hope this bill will pass with a wide bipartisan 
margin.
  Mr. POSHARD. Mr. Speaker, I rise in strong support of the Kennedy-
Kassebaum health insurance portability conference agreement, because 
this bill represents a bipartisan approach to providing health 
insurance portability to millions of Americans. For too long, workers 
and their families have been denied continued access to affordable and 
quality health insurance coverage simply because they lose their job or 
are found to be suffering from a pre-existing illness. This bill 
guarantees those individuals health coverage.
  The bill also provides a long overdue increase in the deductibility 
of health insurance costs for this Nation's self-employed. I know that 
in my very rural congressional district, hundreds of farmers and their 
families have been shut out of being able to afford health insurance, 
because they were not able to deduct the cost of insurance at the same 
rate as corporations. While this bill does not level the deduction, it 
does move the deduction from 30 to 80 percent. This increase will 
provide the financial incentive to give farmers, the self-employed, and 
their families the ability to afford quality health care insurance.
  Additionally, Americans have not had the opportunity to enroll in 
medical savings accounts. Coupled with catastrophic insurance to cover 
serious illnesses, these private, tax deductible accounts will pay for 
routine medical expenses. Medical savings accounts will encourage 
prudent choice by individuals in selection more cost-effective health 
care services. I believe the agreement's medical savings account pilot 
program will demonstrate the necessity of providing not only small 
business owners and employees with this choice, but all Americans.
  For those living and working in the 19th Congressional District, this 
bill will:
  Make it easier for people to keep their health insurance coverage 
should they leave or lose their job;
  Prohibit health insurance companies from denying health coverage to 
individual with a pre-existing illness;

[[Page H9808]]

  Require insurance companies to offer at least two health insurance 
plans comparable to that of the companies' other plans to people 
shifting from group to individual coverage;
  Create a 4-year pilot program to test medical savings accounts on 
small business owners and employees;
  Increase the deductibility of health insurance premiums for the self-
employed to 80 percent from 30 percent;
  Establish tax incentives to encourage the purchase of insurance for 
long-term care; and
  Tackles fraud and abuse within the health care system.
  As Co-Chair of the House Rural Health Care Coalition, I know this 
bill addresses many of the challenges we are facing in rural 
communities throughout America. I think our families and our businesses 
can look forward to meaningful changes in the way they purchase and use 
health insurance. This is a major step forward--but we must not forget 
the fact that millions of Americans are still without health insurance, 
and health care costs continue to climb.
  We have demonstrated here today that by working together we can 
accomplish what many believe are far off goals. I encourage my 
colleagues on both sides of the aisle to use this bipartisan agreement 
as an example as we continue to overcome the many other challenges 
facing our nation's health care system, this Congress and the American 
people.
  Mr. HALL of Texas. Mr. Speaker, I rise today in support of H.R. 3103, 
a health care reform bill that represents more than 6 years of hard 
work on the part of many Members of Congress, beginning with Senator 
Bentsen in the 102d Congress and continuing through the 103d Congress 
and now the 104th.
  I've had the opportunity to work on health care reform over the past 
4 years through the Commerce Committee and through The Coalition. Many 
of the provisions in the bill that we are considering today were 
included in previous work, and I want to commend my colleagues for 
finally bringing this legislation to the floor of the House for 
consideration.
  Health care is one of the most important concerns of Americans, and 
this bill will help alleviate some of their greatest fears. Americans 
who want to pursue other job opportunities or who lose their job are 
now free from the worry of losing their health insurance, and those 
with pre-existing conditions are no longer faced with the nightmare of 
being unable to secure insurance coverage.
  In addition, taxpayers will be able to purchase long-term care 
insurance and deduct this as a medical expense. Terminally and 
chronically ill citizens will be able to receive life insurance 
benefits prior to death without paying taxes on them. And some citizens 
will have the opportunity to try an alternative to traditional health 
insurance in the form of medical savings accounts, which I support.
  Mr. Speaker, these are important reforms that will offer much-needed 
relief to all Americans. I believe that it will be one of the most 
important accomplishments of this Congress, and I urge my colleagues' 
support.
  Mr. STOKES. Mr. Speaker, I rise in support of the long-awaited health 
insurance reform bill, H.R. 3103, entitled the Health Care Coverage 
Availability and Affordability Act. This measure was first introduced 
in the Senate by our colleagues, Senators Kennedy and Kassebaum, over a 
year ago, on July 13, 1995. Yet, for political reasons, the majority 
would not let the measure move through the legislative process.
  In fact, it is possible that the measure would not have moved at 
all--if it had not been for President Clinton's leadership and 
commitment to meaningful health care reform. Each of us in this Chamber 
and in the Senate recalls President Clinton calling for the passage of 
the bill in his State of the Union Address in January.
  While the majority acknowledged the President's instruction, their 
choke hold on the bill continued. In fact, because of continuing 
unnecessary roadblocks, the bill was not even voted on until late 
March.
  It is because of the President's and the Democrats' continued 
pressure and steadfast commitment to meaningful reform that we can 
stand here today to vote on the conference to the health insurance 
bill.
  While I am extremely concerned that H.R. 3103 does not include the 
mental health parity provisions which were in the Senate bill and which 
we know the American people want, and desperately need, and in fact 
which many of us had fought hard to have included in the measure for, 
we can be pleased that the bill increases the portability of health 
insurance, and gives families increased security with regard to 
maintaining their health care coverage. We can also be pleased that 
H.R. 3103 does address pre-existing health conditions. H.R. 3103 frees 
the American people from job lock, as the measure denies health 
insurance companies and HMO's from denying health care coverage to 
workers who change jobs and/or lose their jobs. These are critical 
provisions which those of us on this side of the aisle have worked 
tirelessly to secure.
  More specifically, with regard to ``group-to-group portability,'' the 
bill prohibits health insurance companies and HMO's from excluding 
coverage for pre-existing conditions for more than 1 year for 
individuals with a health condition for which medical advice, 
diagnosis, or treatment was given within 6 months prior to the 
individual becoming insured. The bill provides that this 12-month 
period be reduced by the period of time the individual was continuously 
covered by a group health plan in their previous job.
  With regard to ``group-to-individual portability'', the conference 
agreement provides that certain individuals who previously had group 
coverage would be able to obtain individual health coverage. Under the 
agreement, insurance companies would be required to offer a choice of 
the two most popular policies they sell, or a choice of two policies 
that spread the risk.

  With respect to long-term care, H.R. 3103 permits a tax deductibility 
of long-term care expenses, and allows those suffering from terminal 
and chronic illnesses to receive life insurance benefits prior to death 
without paying any taxes on such benefits.
  However, with regard to the medical savings account provision, I 
remain extremely concerned as well. While I and many of my colleagues 
on this side of the aisle agreed with the Senate position that the 
measure should not include MSA's, the conference report does include a 
trimmed-back House proposal.
  Instead of allowing for blanketed MSA's as the majority in the House 
had hoped, H.R. 3103 instead provides for a 4-year test period for 
medical savings accounts, and sets the number of participants allowed 
in the program to not exceed 750,000. Only businesses of no more than 
50 employees and/or the self-employed individuals are permitted to 
participate in the program.
  This is definitely one of those provisions where the phase ``buyers 
beware'' must be taken literally. After the 4-year period expires, 
people who participated in the MSA project could continue. However, no 
new accounts could be permitted unless new legislation was enacted to 
expand the time limit or to increase eligibility.
  While I understand that the President is expected to sign the bill, 
it is incumbent upon each of us to follow the MSA provision very 
carefully, as it is expected to increase the cost of health care not 
reduce it. It is also incumbent upon each of us to continue to work to 
ensure adequate coverage for mental health.
  Mr. Speaker, while H.R. 3103 definitely is not comprehensive health 
insurance reform, millions of Americans will benefit from the measure 
including small businesses and the self-employed. Serving as the line 
in the sand from where we can begin to make real inroads to meaningful 
health care reform, H.R. 3103 jump starts meaningful reform which is 
critically needed to ensure millions of Americans health care coverage 
that is accessible, affordable, and secure. While H.R. 3103 is not 
perfect, it is workable and I look forward to working with my 
colleagues to help further the enactment of meaningful health insurance 
reform. Vote ``yes'' on H.R. 3103.
  Mrs. LINCOLN. Mr. Speaker, I rise today in support of the conference 
report for the Health Coverage Availability Act. This important 
legislation will address the millions of Americans who lose their 
insurance coverage because of job loss or because they suffer from a 
preexisting condition.
  Families in my home State of Arkansas have grown increasingly anxious 
about the availability, portability, and cost of their own private 
health coverage. And who would blame them? Consider these staggering 
statistics:
  There are over 40 million Americans without health insurance.
  Over 1 million working Americans have lost health insurance in the 
last 2 years alone.
  Over 80 million Americans have preexisting conditions that could make 
it difficult for them to maintain health coverage when they change 
jobs.
  The legislation before us today will help ease some of the fears and 
concerns our constituents face. The bill would prohibit insurance 
companies from denying health care coverage to workers who move to 
another company, or who lose their jobs or become self-employed. The 
conference report also bars insurers from excluding coverage for 
preexisting illnesses for more than a year.
  And I am extremely pleased to see that it would raise the amount of 
health insurance premiums self-employed people can deduct from their 
Federal income taxes from the current 30 percent to 80 percent. As many 
of you may know, I introduced the Health Insurance Equity Act which 
increases this deduction to 100 percent. Although the increase to 80 
percent is substantial, I will continue to work to see this deduction 
increased to 100 percent. I believe that the small businessmen and 
farmers, who are the backbone of the district I represent, deserve the 
same tax benefits allowed larger businesses.

[[Page H9809]]

  I am proud that this body has come together in a bipartisan fashion 
to produce this legislation that is worthy of our support. This 
conference report before us makes positive steps towards ensuring that 
the millions of Americans who are in need of health insurance will be 
able to afford and keep it.
  Mr. CRANE. Mr. Speaker, in the last Congress, President Clinton set 
out to reform health care by taking decision making power away from the 
individual and placing it in the hands of a centralized bureaucracy. As 
a member of the Ways and Means Health Subcommittee, I am proud to be a 
part of the Congress that today is taking important steps towards 
reforming our health care system by taking power away from the 
bureaucrats and giving it back to individuals.
  For example, the creation of Medical Savings Accounts [MSA's] will 
give individuals more rights and more responsibilities regarding their 
health care. I have been a strong supporter of MSA's, and I am pleased 
that Senate Democrats have agreed with the House and included MSA's in 
the conference report.
  It should be noted that this is not a perfect bill by any means. I 
find it unfortunate that malpractice reform was dropped, I believe the 
MSA experiment is too restrictive, and I am concerned about the impact 
that guaranteed issue will have on the market as a whole. While there 
are unquestionably further improvements that can be made in our system 
and even in this bill, we are taking a major step forward.
  When coupled with preexisting condition and portability reform, I 
believe MSA's and other provisions in this compromise represent a 
dramatic, but carefully measured reform of our health care delivery 
system. It is one that should be approved by Congress, applauded by 
pundits, welcomed by the American public, and signed by the President.
  Mr. LAZIO of New York. Mr. Speaker, I rise today in strong support of 
the conference report to H.R. 3103, the Health Coverage and 
Affordability Act of 1996, of which I am a cosponsor.
  Today, we are taking a long overdue step to help working class 
families across America, and in my home district of Long Island to 
acquire and keep their health care coverage.
  For far too long, many Americans have worried that losing a job or 
having a preexisting condition would jeopardize the portability of 
their health insurance.
  Because of this bill, workers will continue to have coverage if they 
change or lose their job--even with preexisting conditions.
  As a result of our efforts today, health care will become more 
affordable. H.R. 3103 tackles the problem created by rampant fraud and 
lawsuit abuse that drives up the cost, and will increase penalties for 
those who commit fraud and abuse. Importantly, this bill also increases 
the health insurance deduction for self-employed individuals from 30 
percent to 80 percent by 2006, and allows taxpayers to make tax-
deductible contributions to a medical savings account.
  An important feature of H.R. 3103 which Representative Nancy Johnson 
and myself championed, is a provision which will eliminate 
discrimination based on genetic information. This would allow thousands 
of men and women to undergo genetic testing needed to preserve their 
health without fear of losing their health insurance or not being able 
to acquire it. This protection is essential for the women of Long 
Island, where instances of breast cancer are among the highest in the 
country. With H.R. 3103 in place, these women can be tested for BRCA-1, 
a gene linked to the disease, without fear of losing the insurance 
needed to meet their medical needs. Hopefully some of this testing may 
provide information regarding the cause of this disease, or a potential 
cure.
  I urge my colleagues to support this bill and these reforms which 
will ease some of those worries of families who are already being 
squeezed by high taxes and falling wages by ensuring availability, 
affordability, and accountability to those who received health care 
through their jobs. The American people deserve this and we owe it to 
them to pass it by a wide bipartisan margin.
  Mr. WALSH. Mr. Speaker, I have no requests for time, and I yield back 
the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the conference report.
  There was no objection.
  The SPEAKER pro tempore. The question is on the conference report.
  Pursuant to the provisions of clause 7 of rule XV, the yeas and nays 
are ordered.
  Pursuant to clause 5 of the rule I, further proceedings on this 
question are postponed until the end of the vote on the conference 
report on H.R. 3517.

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