[Congressional Record Volume 144, Number 35 (Wednesday, March 25, 1998)]
[Senate]
[Pages S2583-S2585]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      SUPPLEMENTAL APPROPRIATIONS

  Mr. KENNEDY. Mr. President, I will just take a few moments of time to 
revisit the proposal of the Senator from Oklahoma, Senator Nickles, to 
strike the funding that would be available under this legislation to 
implement the Kassebaum-Kennedy bill. According to GAO that legislation 
benefited some 25 million Americans who change or lose their job every 
year and could face preexisting condition exclusions or denial of 
coverage. That legislation passed 100-0 in the Senate; the conference 
report passed 98 to 0.
  We know there are gaps in terms of the implementation for providing 
these critical protections to those in the disability community and 
really for any American who has a condition that could make it 
difficult for them to get or keep insurance. HCFA asked the 
Appropriations Committee to reallocate resources to give them the 
ability to hire the necessary skilled staff, primarily with expertise 
in the insurance business, who would be able to assist them to carry 
forward these protections for the disabled community, the mental health 
community, and for all Americans. That is very, very important, Mr. 
President. We had some debate and discussion about this earlier today.
  At this time, I want to read into the Record a very fine letter from 
Nancy-Ann Min DeParle, who is the head of HCFA. She writes:

       Dear Senator Kennedy: I am writing to request your 
     assistance in securing funding for HCFA to implement the 
     insurance reform provisions of HIPAA. The $6 billion and 65 
     FTEs that we have requested for this purpose will allow us to 
     implement the HIPAA provisions as well as those enacted 
     subsequently in the Newborns' and Mothers' Health Protection 
     Act and the Mental Health Parity Act in those states that 
     have not fully implemented HIPAA. As you know, currently, 5 
     states are not implementing HIPAA. HCFA is requesting these 
     resources to guarantee these protections to the 54 million 
     people--or one in five Americans--that live in these five 
     states where under HIPAA, HCFA is the backup federal 
     enforcement agency.
       Moreover, we understand that as many as 30 states may not 
     have standards that comply with the Mental Health Parity Act 
     and as many as 10 states may not have standards that comply 
     with the Newborns' and Mothers' Health Protection Act. We 
     don't have precise numbers because states are not required to 
     notify HCFA about their intentions to implement these two 
     laws. In addition, we believe that many states may not have 
     implemented other parts of HIPAA. For example, some states 
     have not implemented guaranteed availability in the group 
     market or certificates of creditable coverage. Moreover, HCFA 
     also has enforcement authority over non-Federal governmental 
     plans.

  Mr. President, I ask unanimous consent to have printed in the Record 
this

[[Page S2584]]

letter from Nancy-Ann Min DeParle, Administrator of HCFA.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                                     Department of


                                      Health & Human Services,

                                   Washington, DC, March 25, 1998.
     Hon. Edward Kennedy,
     U.S. Senate,
     Washington, DC.
       Dear Senator Kennedy: I am writing to request your 
     assistance in securing funding for HCFA to implement the 
     insurance reform provisions of HIPAA. The $6 million and 65 
     FTEs that we have requested for this purpose will allow us to 
     implement the HIPAA provisions as well as those enacted 
     subsequently in the Newborns' and Mothers' Health Protection 
     Act and the Mental Health Parity Act in those states that 
     have not fully implemented HIPAA. As you know, currently 5 
     states are not implementing HIPAA (CA, RI, MI, MA, MO). HCFA 
     is requesting these resources to guarantee these protections 
     to the 54 million people--or one in five Americans--that live 
     in these five states where under HIPAA, HCFA is the backup 
     federal enforcement agency.
       Moreover, we understand that as many 30 states may not have 
     standards that comply with the Mental Health Parity Act and 
     as many as 10 states may not have standards that comply with 
     the Newborns' and Mothers' Health Protection Act. We don't 
     have precise numbers because States are not required to 
     notify HCFA about their intention to implement these two 
     laws. In addition, we believe that many other states may not 
     have implemented other parts of HIPAA. For example, some 
     states have not implemented guaranteed availability in the 
     group market or certificates of crediable coverage. Moreover, 
     HCFA also has enforcement authority over non-federal 
     governmental plans (e.g., state and local governments).
           Sincerely,
                                            Nancy-Ann Min DeParle.

  Mr. KENNEDY. Mr. President, I will also have printed in the Record 
the various letters that support our position in opposition to the 
Nickles amendment:
  Families USA hopes that the Nickles amendment will be defeated;
  The Consortium for Citizens with Disabilities, more than 20 different 
organizations that have been in the vanguard of protecting and 
advancing the cause of those disabled Americans. They are in strong 
opposition to the Nickles amendment;
  The National Alliance for the Mentally Ill is in strong opposition to 
the Nickles amendment.
  These are only some of the organizations, but they represent the 
leading organizations that have over the past years been the most 
involved and active in protecting the rights of the disabled and of 
consumers--all in opposition to the Nickles amendment. We are not 
talking about adding more money. We are talking about reprogramming 
existing money.
  I ask unanimous consent that those letters be printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                                    Consortium for


                                   Citizens With Disabilities,

                                                   March 25, 1998.
     Hon. Edward M. Kennedy,
     U.S. Senate,
     Washington, DC.
       Dear Senator Kennedy: The Consortium for Citizens with 
     Disabilities, which represents almost 100 national disability 
     organizations, strongly opposes the Nickles' Amendment which 
     would deprive the Health Care Financing Administration (HCFA) 
     of sufficient funds to enforce the Health Insurance 
     Portability and Accountability Act (P.L. 104-191). The HIPPA 
     legislation--also known as the Kassebaum-Kennedy Act--is a 
     stellar example of bipartisan legislation that would benefit 
     individuals of all ages, including people with disabilities.
       The provisions in HIPPA related to pre-existing condition 
     exclusions and portability of health insurance are working to 
     open the doors to many individuals with disabilities and 
     their families who could not previously access appropriate 
     health insurance or who were imprisoned by ``job lock''.
       We urge all Senators to oppose the Nickles' Amendment.
           Sincerely,
         The Arc; National Association of Protection and Advocacy 
           Systems; National Easter Seal Society; American 
           Association on Mental Retardation; Association for 
           Persons in Supported Employment; LDA, the Learning 
           Disabilities Association of America; RESNA, the 
           Rehabilitation Engineering and Assistive Technology 
           Society of North America; National Alliance for the 
           Mentally Ill; Bazelon Center for Mental Health Law; 
           NISH; Paralyzed Veterans of America; Inter-National 
           Association of Business, Industry & Rehabilitation; 
           Council for Exceptional Children; National Association 
           of Developmental Disabilities Councils; United Cerebral 
           Palsy Association; American Congress of Community 
           Supports and Employment Services; American Network of 
           Community Options and Resources; National Association 
           of People with AIDS; Center for Disability and Health.
                                                                    ____

                                   Disability Rights Education and


                                           Defense Fund, Inc.,

                                                   March 25, 1998.
     Senator Edward M. Kennedy,
     Russell Senate Building
     Washington, DC.
       Dear Senator Kennedy: The Disability Rights Education and 
     Defense Fund (DREDF) strongly opposes the Nickles Amendment 
     to S. 1716, the Emergency Supplemental Appropriations Bill.
       Passage of the Nickles Amendment would stop the civil 
     rights protections guaranteed by the Health Insurance 
     Portability and Accountability Act (PL 105-191) and the only 
     accountability left would be the fox guarding the chickens.
       Without these provisions in HIPPA, the doors to health 
     insurance for millions of people with disabilities will be 
     forever locked.
       Please, as you have done so many times before, oppose the 
     Nickles Amendment and open the doors to employment, vote no 
     on the Nickles Amendment.
           Sincerely,
                                                  Patrisha Wright,
     Director of Governmental Affairs.
                                                                    ____

                                         National Alliance for the


                                                 Mentally Ill,

                                    Arlington, VA, March 25, 1998.
     Senator Edward M. Kennedy,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Kennedy: As you know, the National Alliance 
     for the Mentally Ill (NAMI) has been a leading voice in 
     advocating for parity coverage in health insurance policies 
     for people who suffer from schizophrenia, manic-depressive 
     illness or other severe mental illnesses. Enactment of the 
     Domenici-Wellstone Mental Health Parity Act of 1996 was a 
     significant but incomplete step towards ending pervasive 
     discrimination against people with these severe brain 
     disorders in health insurance and other aspects of their 
     lives.
       Because of the importance we attach to parity and other 
     protections for vulnerable consumers in health care, we have 
     been concerned that the Health Care Financing Administration 
     (HCFA) may not have sufficient resources to carry out 
     adequately its important role in enforcing mental health 
     parity and other consumer protections embedded in the Health 
     Insurance Portability and Accountability Act (HIPAA). 
     Consequently, on behalf of NAMI's 172,000 members nationwide, 
     I am writing to express my strong appreciation of your 
     leadership in advocating for adequate funding to support 
     HCFA's enforcement responsibilities under HIPAA. We stand 
     ready to work with you and HCFA to ensure that the mental 
     health parity provisions and other consumer protections 
     contained in HIPAA are aggressively and effectively enforced.
       Please do not hesitate to call upon us if we can provide 
     further assistance to you on this important effort.
           Sincerely,
                                                  Laurie M. Flynn,
     Executive Director.
                                                                    ____



                                              Consumers Union,

                                   Washington, DC, March 25, 1998.
     Hon. Edward Kennedy,
     Ranking Minority Member, Committee on Labor & Human 
         Resources, U.S. Senate, Washington, DC.
       Dear Senator Kennedy: We are writing in opposition to the 
     Nickles' amendment which would strip $16 million allocated to 
     enforcement efforts by the Department of Health and Human 
     Services of the Health Insurance Portability and 
     Accountability Act (HIPAA).
       As you know, HIPAA was enacted in 1996 to help make health 
     insurance more accessible to people who lose their 
     employment-based coverage. Implementation is still at its 
     early stages. The legislation spells out important functions 
     for the Department of Health and Human Services. In addition, 
     several states (including California) have opted for federal 
     enforcement instead of state enforcement. This necessitates 
     federal funding level to ensure that consumers in these 
     states are protected by the legislation.
       Only through adequate funding, will people with pre-
     existing health conditions be assured they can change jobs 
     without facing new pre-existing condition exclusions from 
     coverage. Only through adequate funding, will people who 
     leave group coverage for the individual market be assured 
     that health insurance will be accessible to them.
       Consumers Union urges the Senate to oppose the Nickles' 
     amendment.
           Sincerely,
     Gail Shearer,
       Director, Health Policy Analysis.
     Adrienne Mitchem,
       Legislative Counsel.
                                                                    ____



                                      Families USA Foundation,

                                   Washington, DC, March 25, 1998.
     Senator Kennedy,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Kennedy: Families USA supports the 
     Administration's request for supplemental enforcement money 
     for the ``Health Insurance Portability and Accountability Act 
     of 1996.''

[[Page S2585]]

       HIPAA provides needed protection to Americans who otherwise 
     could not purchase health insurance when they change or lose 
     jobs. Approximately one in four Americans are caught in ``job 
     lock,'' afraid to change jobs or start their own businesses 
     because of preexisting conditions that could prevent them 
     from obtaining new health insurance coverage. Americans like 
     these who lose their jobs involuntarily often find themselves 
     in an even more serious predicament: They join the growing 
     number of individuals without health insurance coverage.
       Implementing HIPAA requires the Health Care Financing 
     Administration to assume new responsibilities. If HCFA lacks 
     the resources to carry out its duties, HIPAA is meaningless. 
     Without the funds to enforce HIPAA, millions of Americans 
     will be deprived of these important protections. Therefore, 
     we urge the defeat of the Nickles Amendment to strike the 
     President's request for HIPAA enforcement funds.
           Sincerely yours,
                                                      Ron Pollack,
                                               Executive Director.

  Mr. KENNEDY. Mr. President, I will also mention a direct quote from 
the testimony of the National Association of Insurance Commissioners. 
They are the State commissioners. They appeared before the Ways and 
Means Committee last September. When they were talking about enacting 
HIPAA----
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. KENNEDY. I ask unanimous consent for 5 more minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KENNEDY. Mr. President, this is the exact quote:

       Moreover, in enacting HIPAA, Congress may not have 
     anticipated that certain States would choose not to implement 
     and enforce its provisions and would instead place that 
     responsibility in the hands of the federal government. This 
     is now the situation in Missouri, Rhode Island and 
     California. The Federal Government has new and significant 
     responsibilities to protect consumers in these States. 
     Fulfilling these responsibilities will require significant 
     Federal resources.

  This is not HCFA, this is not the Senator from Massachusetts. These 
are the commissioners of the States that have indicated that HCFA would 
need additional funding to make sure that the Kassebaum-Kennedy 
legislation to protect portability for those individuals who have 
preexisting conditions would be implemented.
  Wisely, the chairman of our committee asked the GAO to do a report on 
how this program was going. The GAO report made the recommendations 
which the Appropriations Committee has followed in terms of the 
allocation of resources. It is only $16 million, Mr. President--and the 
most important aspect of that provision is the $6 million which HCFA 
has related to the enforcement provisions. The others, I think, are 
desirable to make the program of Administration proceed more 
efficiently, effectively. We are going to be faced tomorrow, or at 
least sometime, with the amendment of the Senator from Oklahoma to 
effectively wipe out that Federal enforcement.
  Mr. President, I think that is unacceptable. That is unacceptable.
  I have in my hand--and I will get into this more tomorrow--but the 
National Association of Insurance Commissioners, as of December 3, 
1997, indicated that 30 States have failed to implement the mental 
health provisions. Thirty States as of December have failed to 
implement the mental health protections.
  We were arguing out here, debating whether they had, and Senator 
Nickles said, ``Oh, they have implemented.'' We have the GAO report and 
through the afternoon we have been able to come up with this 
information, Mr. President.
  What about the maternity provisions? Remember we had the drive-by 
deliveries just a few years ago where expectant mothers were in the 
hospital for 24 hours and then out the door they went and the tragedies 
that ensued. We took action in order to protect those mothers.
  Through the legislative process, that became a part of the HIPAA 
program. We find out that, with regard to the States that have not 
enacted the provisions in terms of protecting mothers, eight States 
have not provided those protections--eight States. Eight States have 
not done that.
  We were all around here at the time, Republicans and Democrats alike, 
commending ourselves about how we enforced that and protected the 
mothers, and we have this. The list goes on. We will have more of a 
chance to go into this in greater detail on the morrow.
  But I hope that our colleagues will at least take the time to review 
the excellent letters that have been sent to them this afternoon that 
indicate strong opposition to the Nickles amendment by the leaders in 
the mental health community, in the disability community, as well as in 
other groups that are most affected. We will have others to refer to 
tomorrow, Mr. President.
  I hope that we will, if we are serious about this issue--and I 
believe that we are--at least give the opportunity for the enforcement 
of these rights and protecting these families from the kinds of 
discrimination which has taken place.
  I will go through tomorrow again briefly some of these stories, real 
life stories with real life families that had some tragic experiences 
that motivated us into making this change with Senator Kassebaum. I 
will go through those tomorrow, Mr. President. We were trying to remedy 
the kinds of harsh experiences that took place and devastatingly wiped 
out different families. I will have an opportunity to go through them 
in some detail on tomorrow.
  So, Mr. President, we are looking forward to the continued debate on 
this issue. This is a very, very important matter. We are not going to 
take it lightly. We are all in favor of moving this legislation forward 
and having a final conclusion, but not with this unacceptable amendment 
that would break the promise we have made to millions of American 
families.
  I thank the Chair and yield the floor.
  Mr. ENZI addressed the Chair.
  The PRESIDING OFFICER. The Senator from Wyoming.

                          ____________________