[Congressional Record Volume 144, Number 60 (Wednesday, May 13, 1998)]
[Senate]
[Pages S4825-S4827]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WELLSTONE:
  S. 2074: A bill to guarantee for all Americans, quality, affordable, 
and comprehensive health care coverage; to the Committee on Finance.


                         healthy americans act

  Mr. WELLSTONE. Mr. President, today I introduce the Healthy Americans 
Act. Colleagues will be hearing more about it because there will be 
amendments that I will offer on this subject here on the floor of the 
Senate; and with every bit of ability I have as a Senator, I will push 
this piece of legislation here and talk about it in my State of 
Minnesota and around the country.
  The Healthy Americans Act insures the uninsured; guarantees 
affordable, comprehensive insurance for all, and ensures quality health 
care through its patient protection provisions.
  Let me start out by providing some context, Mr. President. I have two 
charts beside me to demonstrate my points. In 1987, we had about 32 
million Americans who were uninsured. Today, as you can see from this 
graph beside me, we are up to close to 45 million Americans who are 
uninsured. Mr. President, since we debated the subject of universal 
health care coverage several years ago, a debate both of us were very 
involved in, we have had about a million more people a year who have 
been dropped from coverage.
  Assuming the same economic growth with no economic downturn, which is 
a very rosy assumption, we will continue to see this same kind of a 
profile where we will get up pretty close to 48 million Americans by 
the year 2005 who will have no health insurance coverage.
  So this is still a crisis for many Americans, and this is an issue 
that walks into the living rooms of many families and stares them in 
the face.
  The second chart shows the actual percent of annual family income, on 
average, that goes to premiums and out-of-pocket payments in the form 
of deductibles, copays or other amounts of money that people have to 
spend on health care. It is, I think, very important to look at this.
  First, what you see is that at the bottom end of the income ladder, 
families with annual incomes of $30,000 or less are spending an 
inordinate, and I would say unaffordable, percent of their income for 
their health care. If you look at families with incomes between $10,000 
and $20,000, you can see they are spending on average 8 percent of 
their income on health care expenses. Then when you look at families 
with incomes under $10,000, you can see that the average family is 
paying well over 20 percent of their annual income, and these are the 
people who can least afford to make that kind of payment.
  Next, you can see that for families with annual incomes of $30,000 or 
more, the average amount of that income spent on premiums, deductibles 
and copays drops to below 5 percent on average--I would say a more 
affordable amount. But don't forget these are just averages. Many 
families at every income level are spending more than 10 percent of 
their family income on health care, especially if someone in the family 
has a serious illness. That is not affordable. That is not fair.
  Now if we look back at the same chart we can see what would happen 
under the Healthy Americans Act. All Americans would pay what they can 
afford--people should pay what they can afford--but it will be well 
within their means. For those hardest-pressed families, people would 
pay no more than \1/2\ percent of their income. Those with higher 
incomes would pay no more than 3 or 5 percent; and no family, including 
those with at the highest income levels, would pay above 7 percent of 
their annual income for health care.
  So, Mr. President, as you can see, these two charts demonstrate the 
need to provide coverage for the uninsured and to make health care 
coverage affordable for all.
  The Healthy Americans Act does just that. First of all, it covers the 
uninsured, which I think is the first and most important thing to do. 
It builds, I say to my colleague from Indiana, on existing State 
programs. This is universal coverage with maximum flexibility. In 
addition to covering the uninsured, many of them moderate-income and 
low-income citizens, we are going to make sure that health care 
coverage is affordable for all citizens.
  In other words, we are going to have family protection. So, first, we 
cover the uninsured. Then we have family protection, and we say no 
family pays more than 7 percent of family income on health care, and it 
goes from about

[[Page S4826]]

0.5 percent to 7 percent depending on income. We include Medicare 
recipients as well. The income profile of elderly people is not that 
high and they need income protection, too.
  So, again, first, we cover the uninsured, expanding existing 
programs; second, we have protection for family income; third, we make 
sure there is a good package of benefits comparable to what we have 
here in the Congress; fourth of all, we have strong consumer 
protections, strong patient protections, something we have been talking 
about every day; fifth of all, we expand coverage to include some 
needed benefits that are long overdue.

  In Minnesota, and around the country--it could very well be the case 
in Indiana, Mr. President--a lot of elderly people are paying well over 
30 percent of their monthly income just on prescription drug costs. We 
cover prescription drug costs and add that benefit to Medicare. We have 
good, strong mental health parity, and substance abuse coverage as 
well. And this is, I think, really important.
  The way all of this comes together for the States is to have a 
maximum amount of flexibility. And what we are essentially saying to 
States is, ``Look, here is what we decided in the Senate. We are going 
to make sure the uninsured are covered. That is phase one. The second 
thing, we are going to make sure there is protection of family income. 
The third thing is we are going to make sure there is a good package of 
benefits, at least as good as what we have in the Congress. The fourth 
thing that we are going to do is make sure there is good, strong 
patient protection. If you agree to that, States, there will be Federal 
money that will go to you on a, roughly speaking, 70-30 matching basis. 
And you decide how you want to do it. In other words, the funds are 
there for you to use if you agree to lay out a plan for universal, 
affordable, comprehensive health care and follow it over the next 4 
years. This is a good strategy for going into the next century; it is a 
good strategy for reaching universal coverage in our country.'' We are 
offering the States a carrot; not a stick.
  No State has to do it. There is maximum flexibility. I say to my 
colleague from Indiana--we are friends even though we do not always 
agree on issues--we will not have this ideological debate about single 
payer or ``pay or play'' and all these other things that people do not 
understand. This piece of legislation, the Healthy Americans Act, 
leaves it up to the States.
  This legislation says to Minnesota, let us expand. We are already 
above 90 percent on the number insured in my State. Let us expand the 
coverage for these people who still have no insurance. Let us have some 
protection of family income, a very big issue for a lot of people who 
are covered but they are paying way more than they can afford, 
especially when you include the deductibles and copays and the 
premiums.
  What we are saying to Minnesota or Indiana or California or New York: 
Let us cover the uninsured. We can build on what you are already doing 
with the State Children's Health Insurance Plan, by expanding it to 
adults and more children. Let us make sure there is family income 
protection. Let us make sure there is patient protection and a good 
package of benefits that is comprehensive. And you decide how you want 
to do it. You decide how you want to do it in Indiana. You decide how 
you want to do it in Minnesota or California or New York or North 
Carolina or Florida or New Hampshire or Iowa--you name it. You decide 
how you want to do it.
  But the point is, if a State wants to participate--and I think most 
States will be very interested in participating in this piece of 
legislation--then there will be Federal grant money that will come on, 
roughly speaking, a 70-30 matching basis.
  Mr. President, I would like to talk a little bit about the cost of 
this, because I do not want to introduce a piece of legislation and 
treat people in the United States of America as if they do not have 
intelligence. If we think something is important, then we invest in it. 
This piece of legislation, as we have costed it out and done our 
actuarial estimates, goes like this: In the first year--we are just 
trying to cover the uninsured--it will be $42 billion; year two, it 
gets up to $48 billion; year three, $62 billion; years four and five--
when we include both coverage for the uninsured and now also providing 
the family income protection, it gets up to $85 billion, and then, $98 
billion.

  You would add an additional, roughly speaking, $26 billion to $39 
billion to that estimate in the last 2 years if you are going to cover 
Medicare recipients, making sure they do not pay more than 7 percent of 
annual income for health care coverage and making sure that 
prescription drug costs are covered. Now, I say to colleagues, the 
maximum gets to be above $100 billion--we have estimated this to be 
$137 billion at the very end of this 5 year period.
  How do we pay for this? I will tell you. We have hundreds of billions 
of dollars of what many of us have called corporate welfare, a variety 
of different deductions and tax breaks, many of which I do not believe 
are necessary. In addition, we have some military weaponry that I think 
there is a very legitimate debate as to whether or not we need to be 
spending money on some of these items. And in addition, we take a look 
at some of the domestic programs that I think people can call into 
question as to whether or not they are essential.
  But, Mr. President, my point is that we offset the expenditure. We 
are not talking about taxpayers paying any more money. But what we are 
saying is that this is a worthwhile investment. We have a GDP of over 
$8 trillion, we have an economy at its peak performance, and we are 
being told that we cannot have universal health care coverage in the 
United States of America? We are being told that we cannot afford to 
make sure that every man, woman, and child has decent coverage? That 
there cannot be some protection of family income? That the uninsured 
can't be insured? That elderly people aren't able to get the care they 
need? That some patient protection for the people isn't possible? That 
is not acceptable. Of course it is possible. Of course we can do this. 
Of course we can do better as a nation. And that is what this piece of 
legislation says, Mr. President.
  I just say to colleagues again that I have been disappointed that we 
have put this issue of universal coverage off the table. It should be 
put back on the table. I have had so many conversations with people in 
Minnesota, poignant conversations--it happens in other parts of the 
country, too--which are about health care. I will just give but one 
example. I think I may have given it one time before on the floor. But, 
after all, the legislation we introduce is all about people's lives. 
Why else should we be here? It is all about, hopefully, improving 
people's lives.
  I will never forget a discussion with a woman whose husband I had met 
a year earlier. When I met him a year earlier, he was in bad shape. He 
is a young man, maybe 40 at most, a railroad worker struggling with 
cancer. And then I met her a year later out at a farm gathering, and 
she came up to me and she said, ``I want you to come over and meet my 
husband again, Senator'' or ``Paul.'' ``He's a real fighter. The doctor 
said he only had 3 months to live, but it's a year later and he's still 
struggling. He's now in a wheelchair.'' And so we talked.
  Then she took me aside, and she said, ``Every day is a living hell. 
Every day I'm battling with these companies to find out what they're 
going to cover.''
  I do not think any American with a loved one who is struggling with 
an illness or a sickness should have to worry about whether or not 
there is going to be decent coverage. I think that is unacceptable. I 
think we can do better in America. I think it is time again to talk 
about humane, affordable, dignified health care for every man, woman, 
and child. That is what this Healthy Americans Act does.
  I love ideas. I am really interested in policy. I am proud of the 
people who have helped me on this legislation: Dr. John Gilman in my 
office; Rick Brown, who is with the UCLA School of Public Health; 
Doctors Nicole Lurie and Steve Miles from Minnesota.
  I like the fact that the Healthy Americans Act is a decentralized 
plan. I like that. I like the fact that it is simple. I like the fact 
that it gives States a lot of leeway, so different States can try 
different approaches, and we can see what works best.
  But we do have here, colleagues, a commitment as a nation to make 
sure

[[Page S4827]]

those people who are uninsured have health insurance, to make sure 
families do not go broke and are able to afford health insurance, to 
make sure it is a package of benefits as good as what we have. 
Shouldn't the people we represent have as good health care coverage as 
Members of the Congress have, and shouldn't they be guaranteed strong 
patient protections?
  I think this is, in my not so humble opinion, an excellent piece of 
legislation. I think it is going to take a real battle to get it 
passed. But I will bring amendments out on the floor. I will do 
everything I can as a U.S. Senator to bring this to people in the 
country. I am absolutely convinced that this is one of the most 
important things we can do as a Senate to respond to a very real issue 
that affects the lives of so many people we represent.
                                 ______