[Congressional Record Volume 143, Number 4 (Tuesday, January 21, 1997)]
[Senate]
[Pages S376-S379]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





                   THE NEED FOR A BIPARTISAN APPROACH

  Given the importance of succeeding in enacting this type of 
legislation, it is worth reviewing recent history. In particular, the 
debate over President Clinton's Health Security Act during the 103d 
Congress is replete with lessons concerning the pitfalls and obstacles 
that inevitably lead to legislative failure. Several times during the 
103d Congress, I spoke on the Senate floor to address what seemed 
obvious to me to be the wisest course--to pass incremental health care 
reforms with which we could all agree. Unfortunately, what seemed 
obvious to me, based on comments and suggestions by a majority of 
Senators who favored a moderate approach, was not obvious at the time 
to the Senate's Democratic leadership.
  This failure to understand the merits of an incremental approach was 
demonstrated during my attempts in April 1993 to offer a health care 
reform amendment based on the text of S. 631, an incremental reform 
bill I had introduced earlier in the session incorporating moderate, 
consensus principles. First, I attempted to offer the bill as an 
amendment to debt ceiling legislation. Subsequently, I was informed 
that the consideration of this bill would be structured in a way that 
my offering an amendment would be impossible. Therefore, I prepared to 
offer my health care bill as an amendment to the fiscal year 1993 
emergency supplemental appropriations bill. The majority leader, 
Senator Mitchell, and Senator Byrd worked together to ensure that I 
could not offer my amendment by keeping the Senate in a quorum call, a 
parliamentary tactic used to delay and obstruct. I was unable to obtain 
unanimous consent to end the quorum call, and thus could not proceed 
with my amendment.
  Three years later, well after the behemoth Clinton health care reform 
bill was derailed, the Senate once again endured a lengthy political 
battle concerning the Kassebaum-Kennedy bill. We achieved a 
breakthrough in August 1996, when enough Senators sensed the growing 
frustration of the American people and finally passed health care 
insurance market reforms such as increased portability. I would note 
that the final version of the Health Insurance Portability and 
Accountability Act of 1996 contained many elements which were in S. 18, 
the incremental health care reform bill I had introduced when the 104th 
session of Congress began on January 4, 1995.
  In retrospect, I urge my colleagues to note a most important fact--
the Kassebaum-Kennedy bill was enacted only after the most liberal 
Democrats abandoned their hopes for passing a nationalized, big 
government health care scheme, and the most conservative Republicans 
abandoned their position that access to health care is really not a 
major problem in the United States demanding Federal action.
  Although we succeeded in enacting incremental insurance market 
reforms,

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there is still much we need to do to improve our health care system. 
Additional reforms must be enacted if we are serious about our 
commitment to meet the needs of the American people. The bill I am 
introducing today is an updated version of the proposals I have 
introduced in the 102d, 103d, and 104th Congresses. I am hopeful that 
my colleagues understand how important it is to our constituents that 
we continue to reform the health care system. Looking back at our 
success with the Kassebaum-Kennedy bill, I am equally hopeful that my 
colleagues have come to realize that if we are to continue to be 
successful in meeting our constituents' needs, the solutions to our 
Nation's health care problems must come from the political center, not 
from the extremes.
  Mr. President, there is no time to waste. Many of our Nation's health 
care problems are getting worse, not better. There is as much need now 
as ever before to correct the problems in our health care system for 
the 40.3 million or 17.4 percent of Americans for whom the system is 
not working. This is a group which, according to the Census Bureau, 
contained 900,000 more uninsured individuals in 1995 than the previous 
year. As I have said many times, we can fix the problem for these 40.3 
million Americans without resorting to big government and turning the 
best health care system in the world, serving 82.6 percent of all 
Americans, on its head. The recent November elections reaffirmed the 
basic principle of limited government. Limited government, however, 
does not mean an uncaring or do-nothing government. Consistent with 
this principle, my legislation will fix the problem for many of the 
uninsured and underinsured while leaving intact what already works for 
those Americans with health insurance coverage.
  To be sure, health care reform remains a very complex issue for 
Congress to address. But it is not so complex that we cannot act now 
and in a bipartisan way. As many of my colleagues will recall, in 1990 
Congress passed Clean Air Act amendments that many said could not be 
achieved. That issue was brought to the Senate floor, and task forces 
were formed which took up the complex question of sulfuric acid in the 
air. We targeted the removal of 10 million tons in a year. We made 
significant changes in industrial pollution and in tailpipe emissions. 
We produced a balanced bill which protected the environment and 
retained jobs. Last year's enactment of Kassebaum-Kennedy is another 
example of such bipartisan success.


          PREVIOUS EFFORTS ON REFORMING THE HEALTH CARE SYSTEM

  I have advocated health care reform in one form or another throughout 
my 16 years in the Senate. My strong interest in health care dates back 
to my first term, when I sponsored the Health Care Cost Containment Act 
of 1983, S. 2051, which would have granted a limited antitrust 
exemption to health insurers, permitting them to engage in certain 
joint activities such as acquiring or processing information, and 
collecting and distributing insurance claims for health care services 
aimed at curtailing then escalating health care costs. In 1985, I 
introduced the Community Based Disease Prevention and Health Promotion 
Projects Act of 1985, S. 1873, directed at reducing the human tragedy 
of low birth weight babies and infant mortality. Since 1983, I have 
introduced and cosponsored numerous other bills concerning health care 
in our country. A complete list of the 21 health care bills that I have 
sponsored since 1983 is included for the Record.
  During the 102d Congress, I pressed the Senate to take action on this 
issue. On July 29, 1992, I offered a health care amendment to 
legislation then pending on the Senate floor. This amendment included 
provisions from legislation introduced by Senator Chafee, which I 
cosponsored and which was previously proposed by Senators Bentsen and 
Durenberger. The amendment included a change from 25-percent to 100-
percent deductibility for health insurance purchased by self-employed 
persons and small business insurance market reform to make health 
coverage more affordable for small businesses. When then-Majority 
Leader George Mitchell argued that the health care amendment I was 
proposing did not belong on that bill, I offered to withdraw the 
amendment if he would set a date certain to take up health care, just 
as product liability legislation had been placed on the calendar for 
September 8, 1992. The Majority Leader rejected that suggestion and the 
Senate did not consider comprehensive health care legislation during 
the balance of the 102d Congress. My July 29, 1992, amendment was 
defeated on a procedural motion by a vote of 35 to 60, along party 
lines.

  The substance of that amendment, however, was adopted later by the 
Senate on September 23, 1992, when it was included in an amendment to 
broader tax legislation (H.R. 11), offered by Senators Bentsen and 
Durenberger and which I cosponsored. This amendment, which included 
substantially the same self-employed deductibility and small group 
reforms that I had proposed on July 29, passed the Senate by voice 
vote. Unfortunately, these provisions were later dropped from H.R. 11 
in the House-Senate conference. It is worth noting for the Record that 
on January 23, 1994, when Senator Mitchell was asked on the television 
program ``Face The Nation'' about Senator Bentsen's bill from 1992, he 
stated that President Bush vetoed that provision as part of a broader 
bill. In fact, the legislation sent to President Bush never included 
that provision.
  On August 12, 1992, I introduced legislation entitled the Health Care 
Affordability and Quality Improvement Act of 1992, S. 3176, that would 
have enhanced informed individual choice regarding health care services 
by providing certain information to health care recipients, lowered the 
cost of health care through use of the most appropriate provider, and 
improved the quality of health care.
  On January 21, 1993, the first day of the 103d Congress, I introduced 
the Comprehensive Health Care Act of 1993, S. 18. This legislation was 
comprised of reform initiatives that our health care system could have 
adopted immediately. These reforms would have both improved access and 
affordability of insurance coverage and would have implemented systemic 
changes to lower the escalating cost of care in this country. S. 18, 
which is the principal basis of the legislation I am introducing today, 
melded the two health care reform bills I introduced and the one bill 
that I cosponsored in the 102d Congress, and contained several new 
provisions.
  On March 23, 1993, I introduced the Comprehensive Access and 
Affordability Health Care Act of 1993, S. 631, which was a composite of 
health care legislation introduced by Senators Cohen, Kassebaum, Bond, 
and McCain, as well as my bill, S. 18. I introduced this legislation in 
an attempt to move ahead on the consideration of health care 
legislation and provide a critical mass as a starting point. As I noted 
earlier, I was precluded by Majority Leader Mitchell from obtaining 
Senate consideration of my legislation as a floor amendment on several 
occasions. Finally, on April 28, 1993, I offered the text of S. 631 as 
an amendment to the pending Department of Environment Act (S. 171) in 
an attempt to urge the Senate to act on health care reform. My 
amendment was defeated 65 to 33 on a procedural motion, but the Senate 
had finally been forced to contemplate action on health care reform.
  On the first day of the 104th Congress, January 4, 1995, I introduced 
a slightly modified version of S. 18, the Health Care Assurance Act of 
1995 (also S. 18), which contained provisions similar to those 
ultimately enacted in Kassebaum-Kennedy, including insurance market 
reforms, an extension of the tax deductibility of health insurance for 
the self employed, and deductibility of long term care insurance for 
employers.
  In total, I have taken to this floor on 16 occasions over the past 4 
years to urge the Senate to address health care reform and on two 
occasions, I offered health care reform amendments which were voted on 
by the Senate.
  As my colleagues are aware, I can personally report on the miracles 
of modern medicine. Three years ago, an MRI detected a benign tumor 
(meningioma) at the outer edge of my brain. It was removed by 
conventional surgery, with five days of hospitalization and five more 
weeks of recuperation.
  When a small regrowth was detected by a follow-up MRI in June 1996, 
it was treated with high powered radiation from the ``Gamma Knife.'' I 
entered the

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hospital in the morning of October 11 and left the same afternoon, 
ready to resume my regular schedule. Like the MRI, the Gamma Knife is a 
recent invention, coming into widespread use in the past decade. I ask 
unanimous consent to insert in the Record an article from the 
Pittsburgh Post-Gazzette about my experience with the Gamma Knife as 
well as an essay I wrote for several Pennsylvania newspapers on this 
subject.
  My own experience as a patient has given me deeper insights into the 
American health care system beyond the U.S. Senate hearings where I 
preside as chairman of the Appropriations Subcommittee with 
jurisdiction over the Department of Health and Human Services. I have 
learned: First, our health care system, the best in the world, is worth 
every cent we pay for it; second, patients sometimes have to press 
their own cases beyond the doctors' standard advice; third, greater 
flexibility must be provided on testing and treatment; fourth, our 
system has the resources to treat the 39 million Americans not now 
covered, but we must find the way to pay for it; and fifth, all 
Americans deserve the access to health care from which I and others 
with coverage have benefited.
  I share the American people's frustration with government and their 
desire to have the problems addressed. Over the past four years, I 
believe we have learned a great deal about our health care system and 
what the American people are willing to accept from the Federal 
Government. The message we heard loudest was that Americans did not 
want a massive overhaul of the health care system. Instead, our 
constituents want Congress to proceed more slowly and to target what 
isn't working in the health care system while leaving in place what is 
working.


                        THE CLINTON HEALTH PLAN

  As I have said both publicly and privately, I am willing to cooperate 
with President Clinton in solving the problems facing our country. 
However, in the past I have found many important areas where I differed 
with the President's approach and I did so because I believed that they 
were proposals that would have been deleterious to my fellow 
Pennsylvanians, to the American people, and to our health care system. 
Most importantly, I did not support creating a large new government 
bureaucracy because I believe that savings should go to health care 
services and not bureaucracies.
  On this latter issue, I first became concerned about the potential 
growth in bureaucracy in September 1993 after reading the President's 
239-page preliminary health care reform proposal. I was surprised by 
the number of new boards, agencies, and commissions, so I asked my 
legislative assistant to make me a list of all of them. Instead, she 
decided to make a chart. The initial chart depicted 77 new entities and 
54 existing entities with new or additional responsibilities.
  When the President's 1,342-page Health Security Act was transmitted 
to Congress on October 27, 1993, my staff reviewed it and found an 
increase to 105 new agencies, boards, and commissions and 47 existing 
departments, programs, and agencies with new or expanded jobs. This 
chart received national attention after being used by Senator Bob Dole 
in his response to the President's State of the Union Address on 
January 24, 1994.
  The response to the chart was tremendous, with more than 12,000 
people from across the country contacting my office for a copy. 
Numerous groups and associations, such as United We Stand America, the 
American Small Business Association, the National Federation of 
Republican Women, and the Christian Coalition, reprinted the chart in 
their publications--amounting to hundreds of thousands more in 
distribution. Bob Woodward of the Washington Post later stated that he 
thought the chart was the single biggest factor contributing to the 
demise of the Clinton health care plan. And, as recently as the 
November 1996 election, my chart was used by Senator Dole in his 
Presidential campaign to illustrate the need for incremental health 
care reform as opposed to a big government solution.


          COMPONENTS OF THE HEALTH CARE ASSURANCE ACT OF 1997

  As I begin to describe my new proposal, the Health Care Assurance Act 
of 1997, in greater detail, I want to reiterate that in creating 
solutions, it is imperative that we do not adversely affect the many 
positive aspects of our health care system which works for 82.6 percent 
of all Americans. It is more prudent to implement targeted reforms and 
then act later to improve upon what we have done. I call this trial and 
modification. We must be careful not to damage the positive aspects of 
our health care system upon which more than 224 million Americans 
justifiably rely.
  The legislation I am introducing today has three objectives: First, 
to provide affordable health insurance for the 40.3 million Americans 
now not covered; second, to reduce health care costs for all Americans; 
and (3) to improve coverage for underinsured individuals and families. 
This legislation is comprised of initiatives that our health care 
system can readily adopt in order to meet these objectives, and it does 
not create an enormous new bureaucracy to meet them.

  This bill builds and improves upon provisions put forth in my 
legislation from the 104th Congress, S. 18. That legislation included 
provisions to encourage the formation of small group purchasing 
arrangements, increase access to prenatal care and outreach for the 
prevention of low birth weight babies, facilitate the implementation of 
patients' rights regarding medical care at the end of life, improve 
health education, place greater emphasis on and expanded access to 
primary and preventive health services, utilize non-physician 
providers, reform the COBRA law to extend the time period for employees 
who leave their jobs to maintain their health benefits until 
alternative coverage becomes available, and increase the availability 
and use of consumer information and outcomes research.
  This year, I have added a new title I to provide vouchers to cover 
children who lack health insurance coverage. Preliminary data from the 
Census Bureau shows that in 1995, there were 10 million uninsured 
Americans under the age of 18 in the United States, representing 14 
percent of all children. According to a July, 1996, General Accounting 
Office report, this vulnerable population reached an all time high 
number of uninsured in 1994. The number of children without health 
insurance coverage was greater in 1994 than any other time in the last 
8 years. This is partly because the proportion of children with private 
insurance is decreasing as companies increasingly are covering only 
workers and not their spouses and children.
  Children are our Nation's greatest resource and our most vulnerable 
population, along with our Nation's seniors. In 1965, we ensured that 
our Nation's seniors would have access to health care. In 1997, we 
should do no less for our Nation's children.
  My approach is to give minimum federal directives and leave it to the 
States to determine how this health coverage would be delivered. The 
size of the benefits package would be keyed to the average cost in each 
State of providing insurance coverage for three basic types of 
services: First, preventive care; second, primary care; and third, 
acute care services. Full Federal subsidies would be provided to 
uninsured children living in families with incomes up to 185 percent of 
the poverty line. On average, a family of four living at 185 percent of 
the poverty level lives on $28,860 a year. Partial subsidies would be 
provided to uninsured children living in families with incomes between 
185 and 235 percent of the poverty line. On average, a family of four 
living at 235 percent of the poverty level lives on $36,660 a year. 
Under this plan, more than 7.5 million children or 77 percent of all 
uninsured children would receive health care coverage.
  The subsidy levels in my plan are modeled after our excellent 
programs in Pennsylvania that provide health care for needy children. A 
unique public-private partnership has enabled approximately 60,000 
children to receive basic health care coverage under one of two 
programs: The Children's Health Insurance Program of Pennsylvania and 
the Caring Program for Children sponsored by Highmark Blue Cross/Blue 
Shield and Independence Blue Cross.
  States have traditionally been the great laboratories for 
experimentation. Accordingly, I leave it to the States to work out the 
detail on how this program should be run. My hope is that

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the subsidy program will be so successful it will be used as a model 
for reform of the Medicaid program. Savings through other health care 
reforms detailed later in this statement will provide the funds needed 
to implement the essential effort to take care of the health of our 
Nation's children.
  I have also added a new title VIII to establish a national fund for 
health research within the Department of Treasury. This fund will 
supplement the moneys appropriated for the National Institutes of 
Health. It is to be on budget, but the financing mechanism is not 
specified. This proposal was first developed by my distinguished 
colleagues, Senators Mark Hatfield and Tom Harkin. Senator Hatfield, 
who retired after the 104th Congress, worked closely with me on medical 
research funding issues. The concept of a national fund for health 
research was incorporated into the National Institutes of Health 
Revitalization Act of 1996, which was passed by the Senate, but not by 
the House.
  Responding to decreases in discretionary funding, in the 104th 
Congress, Senators Hatfield and Harkin introduced S. 1251, the National 
Fund for Health Research Act. They wisely anticipated that we cannot 
continue to look solely to the appropriations process for the necessary 
resources to sustain sufficient growth in biomedical research. The 
great advancements made by the United States in biomedical research are 
part of what makes this country among the best in the world when it 
comes to medical care. Their idea is a sound one and ought to be 
adopted. I look forward to working together with Senator Harkin to 
enact a biomedical research fund this Congress.
  Taken together, I believe the reforms proposed in this bill will both 
improve the quality of health care delivery and will bring down the 
escalating costs of health care in this country. These proposals 
represent a blueprint which can be modified, improved and expanded. In 
total, I believe this bill can significantly reduce the number of 
uninsured Americans, improve the affordability of care, ensure the 
portability and security of coverage between jobs, and yield cost 
savings of billions of dollars to the Federal Government, which can be 
used to cover the remaining uninsured and underinsured Americans.

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