[Congressional Record Volume 143, Number 4 (Tuesday, January 21, 1997)]
[Senate]
[Pages S132-S134]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   HEALTH CARE IN THE 105TH CONGRESS

  Mr. KENNEDY. Mr. President, if we act on health care in a spirit of 
bipartisanship this year and build on the accomplishments of last year, 
the new Congress can be the Health Care Congress.
  There are several significant health care goals that this Congress 
can and should accomplish:
  We should expand health insurance coverage for children and the 
unemployed.
  We should deal with the serious problem of abuses by HMO's by 
adopting needed patient protections and standards for care.
  We should put Medicare on a sound fiscal footing for the next decade, 
without dismantling the program or adding to the already high health 
care costs that burden senior citizens.
  We should protect Medicaid, as we did last year, against any attempts 
to undermine protections for children, senior citizens, and the 
disabled.
  The final months of the last Congress were a period of considerable 
accomplishment. We finally broke the long stalemate over health care 
reform. We passed a health insurance reform act. We made a start toward 
long-overdue parity for mental health coverage. We put an end to the 
insidious practice of drive-through deliveries, by guaranteeing newborn 
infants and their mothers a 48-hour stay in the hospital if they need 
it.
  The Health Insurance Portability and Accountability Act of 1996 ends 
some of the worst abuses in the current insurance system. It guarantees 
that, as long as you faithfully pay your premiums, your insurance 
cannot be taken away--even if you become seriously ill, or change your 
job, or lose your job. In addition, insurance companies can no longer 
impose new exclusions for pre-existing conditions, as long as you do 
not let your insurance lapse.
  The legislation on mental health parity was a first step toward the 
day when those who suffer from mental illness will receive the care 
they need and deserve. The ban on drive-through deliveries is a wake-up 
call to unscrupulous health plans that exalt profits over patients' 
needs.
  Now, we have a new Congress and a new opportunity to build on these 
achievements. The crisis that put health care on the front-burner of 
public policy has not gone away. In fact, it has become worse. Between 
1990 and 1994, the number of uninsured Americans rose from 34 to 40 
million, and it continues to climb.
  A quarter of the uninsured--over 10 million--are children. One in 
every seven children in America today have no health insurance. Almost 
all of these children have parents who work. Cutbacks in employer 
coverage are worsening this problem, as more and more employers decide 
to cut costs.
  Many firms are shifting from full-time to part-time employees. Others 
are contracting out work to firms that typically don't provide 
benefits. Large employers with generous benefits are reducing the 
number of employees eligible for the benefits. Other employers are 
dropping coverage for early retirees, or even all retirees. Cost-
sharing is going up, and coverage of spouses and children is going 
down. Every 35 seconds another child loses private insurance. Parents 
should not have to live in fear that their employer's failure to 
provide coverage will deny their children good health care.

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  Every Member of Congress knows that those who are uninsured or 
underinsured can see the savings of a lifetime swept away by a single 
serious illness. Every Member of Congress knows that those who are 
uninsured are vulnerable to financial catastrophe, and are too often 
denied the timely, quality care they need to avoid disability or death. 
Children in particular often suffer premature death or a lifetime of 
unnecessary suffering because they lack the access to quality care that 
insurance provides.
  All children deserve the health care they need for a healthy start in 
life. Every family deserves the security of knowing their children will 
get the health care they need. Unfortunately, too many American 
children lack that care, and too many families lack that security.
  Uninsured children are less likely to see a doctor regularly. As they 
grow, they tend to receive little or no treatment, even when they need 
it for injury or illness. If the case is serious enough, they go to the 
hospital. The only family doctor they know is the hospital emergency 
room.
  More than half of uninsured children with asthma never see a doctor. 
A third of uninsured children with recurring ear infections never see a 
doctor, and many suffer permanent hearing loss.
  Providing health care for children is sound public policy and also 
sound economics. It's an investment in the future. Dollars spent 
immunizing a child or providing prenatal care can save hundreds or even 
thousands of dollars in future medical costs.
  At the end of the last Congress, Senator John Kerry and I introduced 
a program to make private health insurance coverage accessible and 
affordable for all children through age 18. Working families will have 
the financial assistance they need to purchase such coverage, including 
care for pregnant women, so that every baby has a healthy start in 
life. We intend to reintroduce this legislation with other Members of 
the Senate early this year. A similar plan is being introduced today by 
Senator Daschle, and I am hopeful action in this area will be high on 
the agenda of both parties.
  The legislation that Senator Kerry and I intend to offer will make 
Federal assistance available to the States on a sliding scale to help 
families purchase health insurance for their children at group rates, 
if they do not already have coverage under an employment-based plan or 
an existing public program. The covered benefits will include in-
patient, out-patient, and preventive care--all comparable to the 
coverage available under good group health plans.
  The plan does not guarantee that every child will have insurance 
coverage. But it will give every family the opportunity to cover their 
children at a cost the family can afford.
  I hope this program will receive broad bipartisan support. The Health 
Insurance Reform Act passed by the last Congress was based on the 
common elements of proposals that had previously been introduced by 
Republicans and Democrats alike. Our current plan for coverage of 
children also meets that test. Every Republican proposal and every 
Democratic proposal introduced in the first 2 years of the Clinton 
administration expanded coverage by providing financial assistance to 
low and moderate income families to purchase private insurance. Almost 
all of these proposals included extra assistance to purchase children's 
coverage. Members of Congress on both sides of the aisle recognize the 
importance and priority of covering children.
  Our legislation establishes no Government mandates. It relies on the 
private sector to provide insurance and deliver care. It imposes no 
price controls. It builds on the efforts of 14 States that already have 
similar programs in place.
  Our plan will be financed by an increase in the tobacco tax, because 
that tax is an especially appropriate means of funding children's 
health coverage. Society pays dearly for the health costs of smoking. 
We know that the tobacco industry is targeting children. If children 
start smoking, the industry will live. If children stop smoking, the 
industry will ultimately die. It's as simple as that.
  According to the Centers for Disease Control and Prevention, if 
nothing more is done, 5 million of today's children will die 
prematurely as the result of smoking. An increase in the tobacco tax is 
the most important single step we can take to reduce childhood smoking, 
save lives, and lower the health costs of smoking over the long run.
  In addition, we must do more to provide health care for the 
unemployed. For too many workers between jobs, coverage is difficult or 
impossible to afford. Too often, they are forced to let their insurance 
lapse in order to meet other needs. Modest financial assistance can 
make all the difference in making coverage available and affordable. 
Massachusetts has already shown that such coverage can be provided at 
reasonable cost.
  Another key area to address is managed care. In many ways, its 
current growth is a positive development. Managed care offers the 
opportunity to extend the best medical practice to all medical 
practice. Good managed care plans provide more coordinated care and 
more cost-effective care for people with multiple medical needs.
  It compares favorably with fee-for-service medicine in a variety of 
ways, especially preventive care and early diagnosis of illness. But 
the same financial incentives that make HMO's and other managed care 
organizations so cost-effective can also lead to under-treatment or 
excessive restrictions. Some managed care plans put their bottom line 
ahead of their patients' well-being--and pressure physicians in their 
networks to do the same.
  Some of the worst abuses include failure to inform patients of 
treatment options; excessive barriers against referrals to specialists; 
irresponsible attempts to slash hospital care; unwillingness to order 
appropriate diagnostic tests; inadequate support for clinical trials 
and academic health centers; refusal to pay for potentially lifesaving 
treatment; and lack of fair ways to resolve disputes or redress 
grievances. Some of these problems affect conventional insurance as 
well. In many cases, these failures have tragic consequences.
  The ban adopted in the last Congress on drive through deliveries was 
a first step in dealing with these problems. We also attempted to deal 
with another flagrant HMO abuse--the so-called gag rules that prohibit 
doctors from mentioning certain treatment options with patients. Time 
ran out before we could complete action, but the issue is high on our 
agenda for 1997. Managed care plans themselves have recently taken a 
strong position against this abuse. But there continues to be strong 
bipartisan support for additional steps to guarantee consumer 
protections and adequate care--and this Congress should be the Congress 
that enacts needed legislation in this area.
  As we try to pass measures to improve the health of the American 
people, we must not undermine effective programs already in place. In 
the last Congress, a destructive proposal to slash Medicaid and convert 
it to block grants to the States threatened to strip children and 
parents, senior citizens, and disabled of needed coverage. Senior 
citizens in nursing homes could have lost their protection of quality 
of care, and their families would have been increasingly burdened by 
the high cost of long term care. Fortunately, that assault on Medicaid 
failed. In this new Congress, I hope that a bipartisan approach will 
keep such extreme measures from serious consideration.
  Finally, we need to act responsibly on Medicare. President Clinton 
has proposed responsible steps to protect patients while extending the 
life of the trust fund for a decade. Senior citizens deserve fair 
action by this Congress on Medicare. But we should continue to reject 
proposals to slash Medicare to pay for tax cuts for the wealthy, or to 
force senior citizens to give up their own doctor and join private 
insurance plans under the guise of expanding patient choice, or to pile 
additional out-of-pocket costs on hard-pressed senior citizens.
  This Congress can be the Congress that puts Medicare and Medicaid on 
a stable basis for the next decade. This can be the Congress that 
guarantees quality and consumer protection in managed care. This can be 
the Congress that gives every family health security for their children 
and every child the opportunity for a healthy start in life. This can 
be the Congress that grants the unemployed needed protection for health 
insurance. If we

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work hard together, this Congress can achieve these goals, and both 
Republicans and Democrats will deserve a real vote of thanks from the 
American people.

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