[Congressional Record Volume 142, Number 117 (Friday, August 2, 1996)]
[Senate]
[Pages S9531-S9532]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      HEALTH INSURANCE LEGISLATION

  Mr. GRASSLEY. Mr. President, Congress has been struggling to address 
the problems of our health care system for at least 4 years now. We 
have a bill before us which constructively addresses some of these 
problems. And the President has indicated that he will sign it.
  The bill preserves the essence of the Kassebaum bill. It provides a 
medical savings account opportunity. It increases the health insurance 
deduction for the self-employed. It will facilitate and encourage the 
purchase of private long-term care insurance. And, it will provide 
major new weapons in the fight against health care fraud and abuse.
  Senator Kassebaum's legislation addresses some of the most 
distressing health insurance problems of Americans. It should increase 
the availability of health insurance by requiring insurers to issue 
health coverage to businesses which want to purchase health insurance 
for their employees.
  It should substantially increase the portability of health insurance 
by limiting the ability of group health plans to impose pre-existing 
condition exclusions on workers moving from one job to another. Workers 
insured in one job will now be able to move to another job without fear 
of losing their health insurance. It will also improve portability for 
individuals moving from the group to the individual health insurance 
market.
  The bill still defers to health insurance reforms passed by the 
states. In my State, we enacted earlier this year a good health 
insurance reform law. The Kassebaum bill defers to State insurance 
reforms which substantially achieve the ends the Kassebaum bill seeks. 
So, my expectation is that Iowans will continue to receive health 
insurance under the terms of the Iowa reforms.
  But many States have not enacted health system reforms. Should those 
States continue without their own reforms, the Kassebaum bill will 
provide their citizens with these protections.
  The bill includes a medical savings account program. As the sponsor 
of one of the major medical savings account proposals in the Senate, I 
am very pleased to see that the conferees agreed to include a modified 
version of the original proposal introduced by Congressman Archer and 
myself.
  The provisions contained in the bill retain the essential structure 
of the MSA concept. I would have preferred to see the maximum annual 
contribution to an MSA account be larger than 65 or 75 percent of the 
deductible for an individual or a family. I would have preferred that 
more than 750,000 be able to participate. I do not see as a major 
limitation the fact that participation will be limited to smaller 
businesses and the self-employed. That's where the problem of the 
uninsured is greatest; hence, MSA's make sense for those individuals.
  If I have any concerns about the MSA provisions, Mr. President, it is 
that I have been given to understand that the those provisions are 
elaborate and complicated. Given this, I can only hope that the MSA 
program laid out in this bill will not fail because of this complexity. 
If we must have a trial of this concept, we have the right to expect 
that it will have a fair chance to succeed, and not hamstrung by overly 
complicated rules and regulations.
  The farm community and the small business community strongly support 
this MSA concept. In my State of Iowa, a great many people are familiar 
with high deductible health insurance policies. I believe that many 
Iowa farmers and small businesspeople will want to participate in this 
program.
  Another feature of the bill that will be welcomed by the small 
business community in my State is an increase in the deductibility of 
health insurance premiums for the self-employed from 30 percent to 80 
percent by the year 2006.
  One of the great inequities in our health care system is that 
businesses that offer health insurance as an employee benefit can 
deduct the cost of that insurance from their Federal taxes. The 
employees of those companies get those benefits, which are a part of 
their earned compensation, tax free. The self-employed, however, get 
only the current law 30 percent deduction for what they must spend for 
health insurance.
  The bill provides a medical expense deduction for payment of 
qualified long-term care insurance premiums and expenses. This should 
give a boost to the use of private long-term care insurance. Given our 
Federal budget deficit problem, and the difficulty we are going to have 
as a government and society paying for the benefits we have already 
promised, we simply must encourage increased use of private long-term 
care insurance. These provisions should help.
  Second, Senator Cohen's waste, fraud and abuse legislation is 
included in the bill. These provisions constitute a substantial 
increase in the remedies available to law enforcement for combatting 
health care fraud and abuse. The General Accounting Office has 
estimated that fraud represents as much as 10 percent of total health 
care spending.
  Perhaps 10 percent does not sound like much. But 10 percent of more 
than $900 billion per year is a huge amount of money. We must do our 
very best to insure that we are not defrauded of any of this money and 
that not a penny is wasted.
  Mr. President, we have been promising these incremental reforms since 
at least 1992. Most of us have been saying, since at least 1992, that 
we could easily enact reforms such as those in this bill. We should 
pass it.
  Mr. President, I feel that I should conclude by making clear to my 
own constituents what this bill is not designed to do. I think we will 
be making a serious mistake if we over-sell what it is designed to do 
and, therefore, what it will accomplish. If we do exaggerate what this 
bill is designed to do,

[[Page S9532]]

the American people will be very disappointed and disillusioned when 
they discover that the bill does not live up to their expectations.
  Therefore, I want to make clear, at least to the people I serve in 
Iowa, what this bill has never been designed to do.
  It does not attempt to make health insurance more affordable;
  It would not completely eliminate denial of coverage for pre-existing 
conditions;
  It would not provide portability between different individual 
policies; and
  It would not necessarily mean that currently uninsured individuals 
would have to be sold a health insurance policy.
  Having said that, let me conclude by saying that this monumental 
piece of legislation is the kind of incremental common sense reform 
individuals and families across the country have been looking for. I am 
proud to support it and I urge the President to sign it.

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