[Congressional Record Volume 143, Number 154 (Thursday, November 6, 1997)]
[Senate]
[Pages S11868-S11869]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DASCHLE:
  S. 1384. A bill to amend title 5, United States Code, to make the 
Federal Employees Health Benefits Program available to the general 
public, and for other purposes; to the Committee on Governmental 
Affairs.


                   THE ACCESSIBLE HEALTH COVERAGE ACT

  Mr. DASCHLE. Mr. President, when comprehensive health reform failed 
in 1994, we were left with the legacy of a major unmet challenge--
providing secure health care coverage to millions of uninsured 
Americans. Despite the inability of Congress to enact comprehensive 
health reform, many of my colleagues and I continue to work to achieve 
that goal, albeit incrementally. The Kennedy-Kassebaum bill was part of 
that effort, as were the provisions of the recent budget agreement that 
made $24 billion available to states to cover uninsured children.
  As part of this ongoing effort, last week I introduced legislation 
that would restore rights and protections to early retirees who are 
abruptly dropped from their employer's health plan. Today I am 
introducing legislation to help individuals who do not have employer-
sponsored coverage and who, because of a previous or current health 
condition, are unable to obtain private non-group health insurance.
  While today many people without employer-sponsored insurance can 
purchase health coverage in the individual insurance market, those with 
health problems --conditions as common as asthma or migraine headaches 
and as controllable as hypertension or allergies--may not be able to 
find an insurer willing to cover them at any price. As many as 4 
million Americans fall into this abyss, known by the insurance industry 
as the ``medically uninsurable.''
  Many Americans felt that we had solved that problem when we enacted 
the Kennedy-Kassebaum bill. I have received phone calls and letters 
from men and women in South Dakota and around the country who thought 
that enactment of the Kennedy/Kassebaum legislation meant they could 
not be denied private health insurance. Unfortunately, that is not the 
case. While the Kennedy/Kassebaum bill makes it easier for some groups 
to maintain their coverage if they switch jobs or become unemployed, it 
does not improve health insurance affordability or access to coverage 
for individuals who have not been part of the employer-sponsored 
insurance system. Kennedy-Kassebaum does not require insurers to cover 
self-employed individuals unless they were previously enrolled under a 
group health plan. Moreover, insurance companies still can deny 
coverage to workers whose employers do not provide employee health 
benefits. The reality is that if you do not have employer-sponsored 
insurance and have, or have had, any of a number of health problems, 
you're probably out of luck.
  Too many insurance companies continue to cherry-pick the healthiest 
of us and leave unprotected those most in need of insurance. This is 
not only regrettable for those left without coverage, it is 
shortsighted. Uninsured individuals often end up needing expensive 
emergency room care and extended inpatient convalescence because they 
were unable to afford the early, relatively inexpensive care necessary 
to prevent these serious problems. The unnecessary costs associated 
with the treatment of preventable diseases are passed on to the insured 
population through higher hospital charges and insurance premiums. The 
uninsured suffer needless health problems, while the insured pay more 
for everyone's health care. Ironically, insurers then point to these 
higher premiums when they try to justify their exclusionary 
underwriting practices, compounding the problem.
  This is the unfortunate legacy of our inability to enact 
comprehensive reform and it is why we need to continue to pursue every 
means available to provide reasonably priced health insurance to all 
Americans, even if we have to do it one step at a time.
  The legislation I am introducing today would allow individuals who 
have been denied coverage for medical reasons to purchase private 
coverage through the Federal Employees Health Benefits Plan. While 
FEHBP insurers could charge high-risk individuals up to 150 percent of 
the premium paid by federal employees--to account for differences in 
the risk of insuring the two populations--these previously uninsured 
individuals would have access to insurance and in every other respect 
would be treated the same as federal employees.
  The bill is structured to prevent any cost shifting to Federal 
employees. The two populations would be accounted for separately, while 
eligible non-Federal individuals would be able to enroll in the program 
without jumping through elaborate administrative hoops.
  To allay the concerns of those who may fear the creation of a new 
entitlement, despite the fact that we're talking about private coverage 
paid for by private citizens, the FEHBP buy-in will sunset after 10 
years. I'm confident that what we'll learn from this demonstration is 
that private insurers can cover high-risk individuals without 
disrupting the private insurance market.
  One thing is certain. The status quo isn't working. When health 
insurance is reserved for only the healthy, the system is not working 
efficiently for any of us.
  We must stop perpetuating a system that relegates certain individuals 
to permanently uninsured status if they are unlucky enough to become 
sick at a time when coverage was not in their name or was beyond their 
financial reach.
  This bill empowers a disenfranchised group of individuals to purchase 
private health insurance. They are willing to pay a fair price for it--
all they need is an insurer who will offer it. Through FEHBP this 
legislation provides that opportunity.
  This legislation is not a comprehensive solution to our health 
insurance challenges. Filling this gap won't bring health care costs 
under long-term control; it won't eliminate the billions of dollars 
lost to waste, fraud and abuse; and it won't create a system that 
uniformly reflects consumers' values regarding disease prevention, high 
quality care, privacy and access to treatment. Ultimately, we still 
need a critical and comprehensive reevaluation and reform of the two-
tiered, patchwork health care financing and delivery system we've 
erected over the years. However, this bill represents one long overdue 
step, and I hope Congress will enact it in the near future.
  There is no excuse for sitting on our heels while the health 
insurance system excludes the very people who need coverage most. If 
filling gaps is the only way we can move forward at this time to help 
early retirees and individuals with health problems gain access to 
coverage, then let's get on with it and begin to fill in those gaps.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.

[[Page S11869]]

  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1384

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Accessible Health Coverage 
     Act''.

     SEC. 2. PROVISIONS TO MAKE FEHBP AVAILABLE TO THE GENERAL 
                   PUBLIC.

       (a) In General.--Chapter 89 of title 5, United States Code, 
     is amended by adding at the end the following:

     ``Sec. 8915. Individual access to coverage

       ``(a) In General.--A contract may not be made or a plan 
     approved unless the carrier agrees to offer to eligible 
     individuals, throughout each term for which the contract or 
     approval remains effective, the same benefits (subject to the 
     same maximums, limitations, exclusions, and other similar 
     terms or conditions) as would be offered under such contract 
     or plan to employees and annuitants and their family members.
       ``(b) Eligible Individuals.--An individual shall be 
     eligible to enroll under a plan or contract under this 
     chapter if such individual--
       ``(1) is not eligible to be enrolled in a group health plan 
     (as such term is defined in section 2791(a) of the Public 
     Health Service Act (42 U.S.C. 300gg-91(a));
       ``(2) provides the Office with documentation that such 
     individual has been denied individual health insurance 
     coverage (as such term is defined in section 2791(b)(5) of 
     the Public Health Service Act (42 U.S.C. 300gg-91(b)(5));
       ``(3) during the 6-month period prior to the date on which 
     such individual attempts to enroll under such plan or 
     contract, was not eligible for coverage through a State high-
     risk health insurance pool or coverage through a health 
     insurer of last resort;
       ``(4) is not eligible for medical assistance under title 
     XIX of the Social Security Act (42 U.S.C. 1396 et. seq.); and
       ``(5) meets such other requirements as the Office, by 
     regulation, may impose.
       ``(c) Enrollment.--The Office shall provide for the 
     implementation of procedures to provide for an annual open 
     enrollment period during which individuals may enroll with a 
     plan or contract for coverage under this section.
       ``(d) Premiums.--
       ``(1) In general.--Premiums for coverage under this section 
     shall be established in conformance with such requirements as 
     the Office shall by regulation prescribe, including 
     provisions to ensure conformance with generally accepted 
     standards and practices associated with community rating.
       ``(2) Limitation.--With respect to coverage under a health 
     plan or contract under this section, the Office, in 
     establishing premiums under paragraph (1), shall ensure that 
     the monthly premium for coverage under this section does not 
     exceed 200 percent of the monthly premium otherwise 
     applicable for the coverage of employees and annuitants and 
     their family members under such health plan or contract under 
     this chapter.
       ``(e) Adjustment in Agency Contributions.--
       ``(1) Annual reporting.--Each carrier shall maintain 
     separate records with respect to individuals covered under 
     this section and employees and annuitants (and their family 
     members) otherwise covered under this chapter, and shall 
     annually report to the Office the amount which the carrier 
     paid (including claims and administrative costs) with respect 
     to coverage provided to individuals under this section.
       ``(2) Determination by office.--If, based on the reports 
     received under paragraph (1), the Office determines that the 
     average cost of providing coverage to individuals under this 
     section exceeds 200 percent of the premiums paid by such 
     individuals for such coverage, the Office shall increase the 
     biweekly Government contribution for coverage otherwise 
     provided under this chapter by an amount equal to such excess 
     amount.
       ``(f) Contributions and Benefits.--
       ``(1) In general.--In no event shall the enactment of this 
     section result in--
       ``(A) any increase in the level of individual contributions 
     by employees or annuitants as required under section 8906 or 
     under any other provision of this chapter, including 
     copayments or deductibles;
       ``(B) the payment by the Government of any premiums 
     associated with coverage under this section except for the 
     increase described in subsection (e)(2);
       ``(C) any decrease in the types of benefits offered under 
     this chapter; or
       ``(D) any other change that would adversely affect the 
     coverage afforded under this chapter to employees and 
     annuitants and their family members.
       ``(2) Limitation.--Coverage under this section shall be 
     provided on an individual, not a family basis.
       ``(g) Individuals Eligible for Medicare.--Benefits under 
     this section shall, with respect to an individual who is 
     entitled to benefits under part A of title XVIII of the 
     Social Security Act (42 U.S.C. 1395 et. seq.), be offered 
     (for use in coordination with those Social Security benefits) 
     to the same extent and in the same manner as if coverage were 
     under the preceding provisions of this chapter, rather than 
     under this section.
       ``(h) Exclusion of Certain Carriers.--
       ``(1) In general.--A carrier may file an application with 
     the Office setting forth reasons why such carrier, or a plan 
     provided by such carrier, should be excluded from the 
     requirements of this section.
       ``(2) Consideration of factors.--In reviewing an 
     application under paragraph (1), the Office may consider such 
     factors as--
       ``(A) any bona fide enrollment restrictions which would 
     make the application of this section inappropriate, including 
     those common to plans which are limited to individuals having 
     a past or current employment relationship with a particular 
     agency or other authority of the Government;
       ``(B) whether compliance with this section would jeopardize 
     the financial solvency of the plan or carrier, or otherwise 
     compromise its ability to offer health benefits under the 
     preceding provisions of this chapter; and
       ``(C) the anticipated duration of the requested exclusion, 
     and what efforts the plan or carrier proposes to take in 
     order to be able to comply with this section.
       ``(i) Application of Section.--Except as the Office may by 
     regulation prescribe, any reference to this chapter (or any 
     requirement of this chapter), made in any provision of law, 
     shall not be considered to include this section (or any 
     requirement of this section).
       ``(j) Termination.--This section shall terminate on the 
     date that is 10 years after the date of enactment of this 
     section.''.
       (b) Conforming Amendment.--The table of sections for 
     chapter 89 of title 5, United States Code, is amended by 
     adding at the end the following:

``8915. Individual access to coverage.''.
                                 ______