[Congressional Record Volume 144, Number 31 (Thursday, March 19, 1998)]
[House]
[Pages H1324-H1327]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      AFFORDABLE HEALTH INSURANCE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, next week I plan to introduce the 
Affordable Health Insurance Act of 1998. This is the House companion 
bill to Senator Kennedy's legislation that he will also shortly 
introduce.
  Mr. Speaker, in 1996, 2 years ago, Senators Kennedy and Kassebaum 
introduced the Health Insurance Portability and Accountability Act of 
1996, which became known as the Kennedy-Kassebaum bill. The Kennedy-
Kassebaum bill sought to improve portability and continuity of health 
insurance coverage and to limit preexisting conditions exclusions. This 
was part of our overall effort to reform health care and health 
insurance and try to make it easier for people to transfer their health 
insurance when they moved from job to job and to make sure that people 
who had preexisting conditions were not excluded from being able to 
obtain health insurance because they lost their job or changed their 
job or decided that they needed health insurance.
  At the time, 2 years ago, as cochair of our Democratic Health Care 
Task Force, I worked with a majority of Democrats and some moderate 
Republicans to push for passage of the Kennedy-Kassebaum bill. On 
August 21, 1996, it was signed into law by President Clinton as Public 
Law 104-191. Those of us who pushed for the Kennedy-Kassebaum 
legislation were hopeful that what we set out to do would be 
accomplished in the 2 years since it was enacted into law. However, the 
General Accounting Office recently issued a report. The GAO is the 
nonpartisan investigative arm of Congress. They recently, just this 
past week, issued a report that said that many people who tried to move 
from the group health insurance market to the individual health 
insurance market under the Kennedy-Kassebaum law may, and I quote, 
``may be effectively priced out of the market.''
  Those who fought for the original Kennedy-Kassebaum legislation 
thought that people who left the group market would be provided access 
to the individual health insurance market. Unfortunately, what the GAO 
found is that consumers who either leave their job or for other reasons 
leave the group market are being charged between 140 percent to 600 
percent of the standard premiums when invoking Kennedy-Kassebaum to 
obtain insurance in the individual market.
  Kennedy-Kassebaum was intended to provide access for people, for 
Americans, to health insurance. Unfortunately, when the price of the 
premiums becomes so outrageously unaffordable, essentially that access 
is denied. And so the promise of Kennedy-Kassebaum to provide access is 
essentially denied because the health insurance is unaffordable.
  I wanted to, if I could, Mr. Speaker, talk a little bit more about 
the recommendations and the concerns that came out of this GAO report. 
As I said, the main concern was that the high rates that are being 
charged individuals basically make the guarantee of health insurance in 
Kennedy-Kassebaum not real. But the GAO mentioned a number of things in 
addition to the high rates which I think should be brought to my 
colleagues' attention and to the American people.
  The GAO identified these problems. They said, first, that some 
States, including California, have not passed all the laws needed to 
carry out the Federal statute. And the Federal Government does not have 
enough money or personnel to fill the breach.
  I am reading, I should say, Mr. Speaker, from a New York Times 
article from this past Tuesday, March 17, on the front page, which went 
into some of the recommendations and some of the concerns expressed in 
the GAO report.
  The second thing that the GAO mentioned was that the regulations are 
vague and ambiguous, so insurers do not fully understand their 
obligations. Then they said the consumers lose most of their rights if 
they do not buy an individual insurance policy within 63 days of losing 
group coverage, but they are often unaware of this time line.
  The GAO also said that some insurers have redesigned their benefits 
in ways that exclude coverage of particular illnesses or costly 
procedures for a specified period of time and that these tactics may 
not be illegal, but defeat the purpose of the law.
  Finally, the GAO report says that some companies have told insurance 
agents that they will not get commissions for selling policies to 
individuals with medical problems; in other words, those with the 
preexisting conditions that we were concerned about.
  President Clinton has said that he will address one problem this week 
by notifying State officials that it was against the law for insurers 
to penalize agents who sell policies to high-risk individuals. These 
are all concerns that we certainly need to address in Congress or that 
need to be addressed through agency action by the executive branch.

                              {time}  1330

  But really, the whole focus of the law and the main concern that I 
have is the issue of affordability. A lot of consumers I think may be 
disappointed because they cannot buy affordable policies pursuant to 
Kennedy-Kassebaum, and in The New York Times article it actually 
mentions that one insurer, American Medical Security of Green Bay, 
Wisconsin, a subsidiary of United Wisconsin Services, said it reserved 
the right to charge high-risk individuals 5 times the rates charged to 
healthy people.
  Now, the law does not restrict the premiums that a company may charge 
for individual health insurance coverage. I think our feeling was, 
those of us who voted for this bill, was that we were hopeful that the 
insurance companies, even if it was not required by law, that there be 
a limit on how much they could charge, that they would voluntarily 
exercise some restraint in how much they would charge high-risk people 
or those with preexisting conditions. Obviously, the GAO report says 
that that is not necessarily happening, and I think, therefore, it 
means that the Federal Government must, and this Congress must, 
intervene to pass legislation that would limit how much could be 
charged these high-risk or these people with preexisting conditions.
  The legislation that Senator Kennedy and I will be introducing will 
end this price-gouging practice. It will ensure that the true intent of 
the original Kennedy-Kassebaum legislation will be guaranteed. Those 
who enter the individual market should not be denied health care for 
being responsible citizens by seeking to maintain health care coverage.
  The Affordable Health Insurance Act of 1998 is responsible 
legislation, and I would urge my colleagues that they cosponsor the 
bill before we put it in next week, and that we see action swiftly to 
pass the legislation. Congress, I do not believe, can allow these 
excessive premium increases to go unchecked.
  Mr. Speaker, I wanted to say that in many ways, the issue of 
affordability and the denial of access because of the lack of 
affordability that I mentioned in the context of Kennedy-Kassebaum 
makes me also feel that we should address the issue of affordability in 
the

[[Page H1325]]

context of the Medicare expansion legislation that has been proposed by 
President Clinton and that I support 100 percent. Democrats earlier 
this week announced expansion of health coverage for Americans aged 55 
to 65, basically putting in legislation that would enact into law what 
the President has articulated.
  The President has been saying for the near elderly, the people 
between 55 and 65 that are not yet eligible for Medicare, that they 
should be able to buy into the Medicare system in certain 
circumstances, depending upon their age or circumstances, because what 
we find is that increasingly, this group of people in that 10-year, 
from 55 to 65, are the ones who lose their job or whose spouse loses 
their job or loses their coverage and cannot find health insurance, 
affordable health insurance, on the private market. And so what we are 
saying, let us expand Medicare in certain circumstances so that they 
can buy into Medicare without additional cost to the Medicare program.
  The President's bill that is now supported by the Democratic 
leadership both in the House and in the Senate, presents three options 
to this age group to obtain insurance, and I will just briefly mention 
it. It says, individuals 62 to 65 years old with no access to health 
insurance may buy into Medicare by paying a base premium now and 
deferred premium during their post-65 Medicare enrollment. Individuals 
in the second category from 55 to 62 who have been laid off and have no 
access to health insurance, as well as their spouse, may buy into 
Medicare by paying a monthly premium of about $400. Now, $400 generally 
is about what the cost would be to buy into the Medicare program.
  Then the third category, retirees age 55 or older whose employer-
sponsored coverage is terminated may buy into their employer's health 
insurance for active workers at 125 percent of the group rate.
  I wanted to say, though, again, going back to the issue of 
affordability and how it may impact the Kennedy-Kassebaum legislation, 
I think again we may face a situation where the President's buy-into 
Medicare provides access, but for many people who cannot afford the 
$400 a month or can only afford to pay part of the $400 a month, they 
may be still denied access to Medicare and to health insurance because 
of the cost. So while I applaud the President's buy-into Medicare 
proposal as a means to provide additional access, I believe that 
providing some financial assistance to the near elderly will address 
issues surrounding its affordability.
  I am working on legislation that will provide economic assistance for 
those aged 62 to 64 who choose to buy into the Medicare program and for 
those age 55 to 64 who have been laid off or displaced. As is the 
President, I am not necessarily seeking to increase Medicare costs, but 
am seeking to make one of the best health care programs in the world 
accessible and affordable to an important segment of the uninsured 
population. My idea, which would be to create a sliding scale of 
assistance in which any near elderly who chose to participate into the 
buy-into Medicare would still pay most of the costs, but would receive 
some assistance, depending on need.
  While Medicare is now at one of its strongest points since its 
inception, I believe that now is not the time to further increase 
Medicare expenditures in an irresponsible manner. Instead, I would seek 
to offset any additional costs associated with this plan over and 
beyond the President's proposal. Potential sources would include 
additional Medicare fraud and abuse provisions and potential monies 
from the tobacco settlement.
  Mr. Speaker, again, for those of us who believe, and I do very 
strongly, that health insurance should be guaranteed to every American, 
we have been, of course, disappointed in the last 4 or 5 years since 
the President proposed his universal health insurance proposal that 
more and more people are now uninsured. The number of Americans who 
have no health insurance continues to grow. And we have tried to 
address this issue by passing the Kennedy-Kassebaum legislation; by 
initiating a health care program for kids on the Federal level last 
year; and now by trying to address managed care reform, patient 
protections, and also by the Medicare expansion that I just spoke 
about.
  The bottom line is that we have to do whatever we can to make health 
insurance more available to those Americans who have do not have 
coverage, because I am very fearful that as time goes on, more and more 
people will enter the ranks of the uninsured, and I see absolutely no 
positive benefit to our society or to our economy if that continues. I 
think in the long run, it will make health insurance in this country 
not only less accessible, but also will ultimately affect the quality 
of our health care as well. So it is something that every American 
needs to be worried about.


               The International Arena: Armenia and India

  Mr. Speaker, I would like to now switch, if I could, to a couple 
issues related to the international arena and focus on two areas where 
I have been very concerned. One is Armenia, and the other is India. I 
am the cochairman of our caucus on Armenia and our other caucus on 
India, and both of these two countries, interestingly enough, recently 
went through elections in a very democratic way, one that I think can 
be emulated, if you will, by the rest of the world.
  If I could turn to Armenia, because of the election, this has been a 
very important week for the Republic of Armenia. On Monday, March 16, 
the first round of elections for the Presidency of Armenia took place. 
The turnout was approximately 66 percent. A runoff election between the 
2 top vote-getters will be held on Monday, March 30.
  Mr. Speaker, this election is an important development in Armenian 
democracy. Since gaining its independence from the Soviet Union in 
1991, Armenia has worked to establish the procedures and institutions 
of civil society while adopting economic reforms. Despite being 
surrounded by hostile neighbors that have imposed economically 
devastating blockades, Armenia has overcome years of oppression and 
dictatorship to become a functioning democracy.
  When former President Levon Ter-Petrosian, who led the Nation through 
the early years of independence, resigned last month, the succession of 
the Prime Minister to the post of acting President was held in a 
peaceful, orderly and lawful way. Although it is disappointing to see 
the extremely critical and often inaccurate portrayal provided by much 
of the media, I am proud to say, Mr. Speaker, that Armenia has become 
one of the true success stories of the former Soviet empire, and this 
week's elections are further proof of that.
  As we celebrate the progress of democracy in Armenia, we cannot 
forget the suffering that has been and continues to be visited upon the 
Armenian people by Turkey. The latest Turkish assault on Armenians 
takes the form of an affront to the history, culture and religion of 
Armenians in Turkish-occupied northern Cyprus. Many Members of this 
body, including myself, have been very critical of the Turkish 
occupation of Cyprus and the fact that Turkey has not been willing to 
heed international calls that it withdraw from Cyprus.
  The latest development is that the ancient Sourp Magar monastery, 
referred to as the ``Armenian Monastery,'' near Kyrenia in the northern 
part of Cyprus, which Turkey illegally occupies, is now to be converted 
into a tourist hotel. That is right, Mr. Speaker. A monastery that 
dates to 1,000 A.D., which was bombed during Turkey's invasion of the 
island 24 years ago, and which has been plundered and neglected, will 
be restored for the purpose of turning the property into a hotel.
  I have to say, Mr. Speaker, that I am pleased to note that this 
desecration of the monastery has not gone unchallenged. The Honorable 
Nikitas Kaklaminis, member of the European Parliament from Greece, has 
officially raised a question with the European Parliament which I would 
like to quote from. He says, ``This plan by the Turks proves that the 
Turkish occupation authorities do not respect the cultural heritage of 
the island, and obviously the monuments of Christianity in the north 
part of Cyprus. I would like the European Commission to inform me about 
the way it intends to react against the practice of a brutal regime, 
which is supported by 40,000 Turkish soldiers who occupy almost 40 
percent

[[Page H1326]]

of Cyprus, something that has lasted for 24 years.''
  Catholicos Aram I of the Armenian Church of Antelias, Lebanon, who I 
had the honor to meet last year when he visited New Jersey, has also 
addressed a letter of complaint to the Executive Director of the U.N. 
Education, Scientific and Cultural Organization, UNESCO, also to the 
Secretary General, the President of Cyprus, the President of Armenia, 
the International Religious Council, the National Assembly of Armenia, 
and the Catholicos of All Armenians and other organizations, calling 
the restoration conversion scheme of this monastery sacrilegious and 
nonhumanitarian and a violation of our religious and cultural values.
  Mr. Speaker, the plans for this monastery are consistent with the 
Turkish disrespect of both Armenian and Greek holy places in Cyprus and 
throughout Asia Minor. Turkey has tried to remove traces of Greek in 
Armenian history, change place names and generally tried to assert 
Turkish supremacy.
  I hope that the European Commission and other international 
organizations will make it clear to Turkey that this type of behavior 
is simply not acceptable. I am also asking my colleagues in this House 
to join me in appealing to UNESCO to take a stand against this wanton 
disregard for a site with great religious, historic and cultural 
significance. I will also be calling to our administration to raise 
this issue with the Government of Turkey. While our list of grievances 
with Turkey is a long one, perhaps this issue can serve to convince the 
Turkish regime that it must have more respect for its neighbors.


                    Tribute to Patriarch Karekin II

  Finally, Mr. Speaker, I wanted to pay tribute this afternoon to a 
great Armenian religious leader who labored for decades under Turkish 
rule, and this is Patriarch Karekin II, the spiritual leader of 
Turkey's Armenian Christians, who died on March 10 of this year at the 
age of 71 after a long illness. An estimated 50,000 ethnic Armenians 
live in Turkey, the majority of them members of the Patriarch's church. 
Karekin II was the 83rd holder of the position of Patriarch of 
Istanbul, obviously a title with a great historical legacy. The 
Armenian Patriarchate will begin the process of electing a successor on 
April 14th.
  Mr. Speaker, Armenia was the first Christian state, and the church 
continues to play an important unifying role in the life of the 
Armenian community, both in Armenia itself and throughout the Armenian 
Diaspora, including here in the United States. I join Armenians 
everywhere in paying tribute to this great leader and mourning his 
passing.


                      AAPI Legislative Conference

  Mr. Speaker, finally this afternoon I would like to mention an issue 
of concern to those of us who are in the India Caucus, and I mentioned 
that I cochair the India Caucus in Congress. Next week the American 
Association of Physicians of Indian Origin, AAPI, will be having a 
legislative conference. They come to Washington every year, and they go 
around and visit various Members of Congress and also Senators to talk 
about the issues that they are concerned about that impact physicians 
of Indian origin.

                              {time}  1345

  This conference will focus a great deal on the issue of health care 
reform, particularly managed care reform. I wanted to say that, with 
approximately 30,000 physicians of Indian origin in the United States 
practicing medicine, AAPI has begun to be heard in Washington, D.C.
  I have a number of Indian physicians and members of AAPI in my 
district and throughout the State of New Jersey. They have become very 
politically active, and this legislative conference is just another 
manifestation of that.
  Two issues of particular importance to the AAPI members that they 
will be discussing next week are managed care reform and International 
Medical Graduate or IMG equity. I would just like to take a little time 
now to talk about these two issues.
  On the issue of managed care reform, AAPI has played an active role 
for pushing for comprehensive managed care reform. At the end of 1996, 
I received a copy of AAPI's policy statement on managed care. This 
statement outlined five basic principles for managed care reform: 
first, to ensure patient choice; second, to provide for contract and 
termination nondiscrimination; third, to limit financial incentives 
that reduce appropriate health care; fourth, to eliminate gag clauses 
that restrict physician-patient communications; and, fifth, to ensure 
that medical decisions are in the hands of physicians and not a managed 
care bureaucrat.
  These positions or these concerns that were outlined by AAPI are, of 
course, also the concerns that many Americans have with regard to 
managed care and HMOs. They are the same concerns, essentially, or 
among the same concerns that the President and the Democratic 
leadership in the House and the Senate have identified in putting 
together patient protection legislation, which is probably the number 
one priority for the President and for the Congress, for the 
congressional Democrats this year.
  Of course, we have been thwarted so far in our efforts to move 
managed care reform legislation by the Republican leadership that has 
refused to move any bill in this regard.
  Let me say that AAPI, after having read AAPI's white paper on managed 
care reform and working with AAPI and the Indian physicians, I 
introduced the Health Care Consumer Protection Act, H.R. 3009, last 
November. It is modeled after the AAPI policy statement and includes 
strong language prohibiting provider discrimination based on race, 
national origin, and place or institution in which a health 
professional's education was received.
  In addition, important due process provisions will work to create 
objective, not subjective, criteria for choosing network physicians. 
This bipartisan legislation has 31 additional cosponsors.
  Since that time, managed care reform has gained momentum. It is 
likely to become one of the biggest issue this year, 1998. I want to 
say that AAPI recognized managed care reform as the key issue years 
ago. I believe that their hard work and determination will ultimately 
lead to results for all physicians and for the benefit of American 
people.
  The second major issue that AAPI is concerned about relates to 
international medical graduates, the so-called IMGs, those physicians 
who went to medical school abroad before they came to the United 
States.
  As a result of the Balanced Budget Act that we passed in Congress and 
that the President signed into law last summer, residency slots at 
medical colleges or medical schools are expected to decline. 
Representing the largest group of international medical graduates, 
physicians of Indian origin are rightly concerned that IMG slots may be 
the ones that see the largest reductions in the context of these 
residency reductions.
  Determining which slots will be reduced, I would say, and AAPI 
certainly says, should not be done in an arbitrary fashion; in other 
words, in deciding who is going to fill the reduced residency slots for 
medical education. It should be done in an objective way so that those 
who are IMGs can compete. The criteria should be objective and 
equitable. Qualifications of physicians, not national origin or 
geographic location of medical education, should be the deciding 
factor.
  The reason why this is important to the average American is because 
approximately 85 percent of the IMGs are in practice serving 
predominantly in urban and underserved areas. They are the ones that go 
into the cities and into the rural areas where other doctors do not 
want to practice, particularly in public hospitals.
  It is very important for us and for those who need health care in 
those urban centers as well as in those rural areas to be able to have 
a physician. If they cannot get a physician who happens to be an IMG, 
then, oftentimes, they are not going to get any physician at all.
  So I am trying to point out why IMGs play a very vital role in the 
health care delivery system in the United States.
  AAPI has been in the lead both on managed care reform to guarantee 
objective due process and then now leading the charge to ensure that 
IMGs are not discriminated against. I will continue to work with AAPI 
and other organizations that continue to fight for the same principles.

[[Page H1327]]

  As this session of Congress moves forward, it is my hope that both 
issues will be addressed. Certainly the Indian physicians who come here 
next week for the legislative conference will go around to the various 
congressional offices and explain why managed care reform and objective 
criteria for international medical graduates is something that they 
should all support in the interests of the American people.

                          ____________________