Congressional Record, Volume 142 Issue 116 (Thursday, August 1, 1996)

[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:]

[[Page H9802]]

[GRAPHIC] [TIFF OMITTED] TH01AU96.027

[[Page H9803]]

[GRAPHIC] [TIFF OMITTED] TH01AU96.028

[[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.

____________________