[Congressional Record Volume 146, Number 131 (Wednesday, October 18, 2000)]
[House]
[Pages H10238-H10242]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       ACCESS TO HEALTH INSURANCE

  The SPEAKER pro tempore (Mr. Shimkus). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from Pennsylvania (Mr. 
Pallone) is recognized for 60 minutes as the designee of the minority 
leader.
  Mr. PALLONE. Mr. Speaker, I wanted to make reference initially to 
last night's debate between Vice President Al Gore and Texas Governor 
Bush, but my focus this evening is on health insurance and the various 
health care issues that have come into play in this Congress, as well 
as in the presidential debate last evening.
  I have always felt that one of the most important issues that we face 
and one of the biggest concerns that I have is the inability of many 
Americans to find health insurance, to be covered by health insurance. 
The candidates last night presented starkly different views on how to 
extend coverage to the 42.6 million Americans who currently lack health 
insurance. That is a large segment of our population, 42.6 million 
Americans, and it continues to grow.
  During their exchange on this issue last night, the Governor said 
something which I found to be very telling and very disturbing. I 
wanted to read back what Governor Bush said during the debate. He said, 
``There is an issue with uninsured. There sure is. And we have got 
uninsured in my State. Ours is a big State, a fast-growing State. We 
share a common border with another nation, but we are providing health 
care for our people.''
  Continuing, the Governor added, ``One thing about insurance, that's a 
Washington term.''
  Mr. Speaker, I was very offended by Governor Bush's referring to 
insurance, in this context health insurance, as a Washington term. In 
fact, I consider that remark very elitist and really absurd. All 
American parents who are out in the real world struggle to find a way 
to provide insurance for their children. I think they should be very 
alarmed when the Governor views health insurance as a Washington thing.
  Really, all Americans should be alarmed because of his statement that 
somehow this is a Washington thing. Does that mean that Governor Bush 
thinks it is okay, for example, that my colleagues here, I will use the 
opposition, the Republican Members of Congress, the fact that they have 
health insurance and 42.6 million Americans do not?
  And really, I would like to look at Governor Bush's record on the 
issue of health insurance, because I think that by referring to it as a 
Washington thing, he belittles it and shows that he really does not 
have much concern about the 42 million Americans that do not have 
health insurance.
  If we look at the Governor's record in Texas, it shows that Texas has 
the highest number of uninsured children in the country. When setting 
up the State's Child Health Insurance Program, which we adopted as a 
Federal program in this House and was signed into law by President 
Clinton, but when setting up the State's Child Health Insurance Program 
pursuant to and with Federal money, Governor Bush wanted to set the 
eligibility threshold at only 150 percent of the Federal poverty level.
  I say that by way of contrast to my own State of New Jersey, which 
also has a Republican Governor, but set 350 percent of the Federal 
poverty level for that CHIP Federal kids' health insurance program, or 
more than twice the level that Governor Bush proposed in Texas.
  Now, what happened eventually is the Texas legislature came forward 
and said they wanted to push this eligibility threshold up to 200 
percent, which Governor Bush eventually signed. But the point of the 
matter, the fact of the matter is that it was possible under the 
Federal law to push this eligibility higher and to include more 
children under the Texas child health care program, and Governor Bush 
did not do it.
  So when he says that insurance is a Washington thing, does that mean 
that he does not really care that much about the kids in Texas, that 
they should not be able to take advantage of

[[Page H10239]]

the Federal program and Federal dollars that are allowing them to be 
covered by health insurance?
  When it comes to insuring adults, Governor Bush's record is really no 
better than it is with the kids. Texas has the highest percentage of 
uninsured low-income adults, 51 percent, in the Nation. Its Medicaid 
eligibility level is just a paltry $4,728 in annual income for parents 
of three-person families.
  A little later I am going to get into the proposals that Vice 
President Gore and President Clinton and the Democrats in the House 
have put forward to try to get more adults insured. We care deeply to 
try to end the problem of the uninsured in this country. If that is a 
Washington thing, so be it. But I would maintain it is an American 
thing, that kids are suffering because they do not have health 
insurance, parents are suffering because they do not have health 
insurance.
  When it comes to overall spending on health in the State of Texas, 
the Governor has distorted his own record. He made it look like health 
care is a much bigger priority for him than it really is.
  In last week's debate, the previous debate prior to last night, 
Governor Bush said Texas had spent $4.7 billion on health care under 
his administration when in fact that is simply not true. Something like 
$3.5 billion of that money came from private and local sources and not 
the State expenditure.
  I am trying to make the point, Mr. Speaker, that access to health 
insurance is simply not a priority for the Governor, not a priority in 
terms of spending, not a priority in terms of trying to get the State 
of Texas to cover more kids and more adults.
  The lack of health insurance in the United States is not a problem 
that should be cavalierly dismissed as a Washington thing by any 
policymaker or any politician, let alone a candidate for the President 
of the United States. It is a very real problem that affects real 
Americans with real consequences.
  Let me just give some statistics about why I say that, and why it is 
true that health insurance is not just a Washington thing, but 
something that everyone in the country has to be worried about.
  There are millions of American parents who are unable to take sick 
and suffering children to the doctor because they simply cannot afford 
it. There are 27,000 uninsured women who are diagnosed with breast 
cancer every year, and are 50 percent more likely to die from it 
because they are uninsured. There are older couples whose hopes for a 
dignified retirement after a lifetime of work are swept away in an 
instant by an unexpected avalanche of medical debt. There are young 
families whose hopes for the future are destroyed when a breadwinner 
dies or is disabled because an illness was not diagnosed and treated in 
a timely fashion.
  Eighty-three thousand Americans die each year because they do not 
have insurance, and as a result, do not get adequate or timely care. I 
can assure the Members, Mr. Speaker, that to them, insurance is far 
more than just a Washington term to their families.
  The Federal government and State governments across the country have 
spent the last 10 years trying to stem the tide of people turning to 
the emergency room for their medical care.
  I know Governor Bush throughout the debates has talked about the fact 
that, you know, you can go to an emergency room in Texas, you can go to 
a hospital emergency room. The problem with that is that that is not 
really good health care because there is no prevention. If we have 
preventative care and take measures before we have to go to an 
emergency room, our likelihood of doing well and living longer and not 
being disabled are much greater.
  Preventative care does not just save lives and stop tragedies before 
they occur, it is also more efficient and less expensive for everybody, 
including the Federal government. Those facts are understood by health 
experts, but not a lot of times by politicians.
  I would say the same thing to the Governor: Rather than talk about 
the fact that people in Texas have access to an emergency room, put 
programs in effect so people can get health insurance and can take the 
preventative measures so they do not have to wait until they get so 
sick that they have to go to an emergency room.
  Governor Bush's view that insurance is a Washington term may be a 
view that is held by wealthy people who have insurance and can foot the 
bill easily for any medical emergency that may arise, but it is 
definitely a view that is clearly out of touch with the American 
mainstream.
  It is a view every American, particularly those without insurance, 
should be aware of in this political season. It is a view that, if 
followed, will throw a monkey wrench in both private sector and public 
efforts to bring down the cost of health care, and it is a view that 
nobody who is interested in addressing the problems of the uninsured in 
this country should for a single second take seriously.
  I know it sounds very critical of me to talk about the Governor in 
this light, but it really annoyed me to hear the term ``insurance'' 
somehow referred to as a Washington term, as if the rest of the country 
or the average person was not concerned about it. I know that they are.
  I want to spend some time also this evening contrasting, if you will, 
not only the presidential candidates but the parties on the issue of 
health care. I know it sounds very political, but the bottom line is 
that this Congress only has another week or so before it adjourns.
  The Democrats, including myself, over the last 2 years that this 
Congress has been in session have put forth a number of proposals, 
whether it is a prescription drug benefit under Medicare or it is HMO 
reform with the Patients' Bill of Rights, or it is the idea that 
whatever surplus is available should be primarily used to shore up 
social security and Medicare, or it is the idea of trying to cover more 
kids or more parents.
  We have been out there putting forth, with President Clinton and Vice 
President Gore's support, many proposals that would address some of the 
problems that Americans face with health insurance, whether they are 
uninsured or they have some type of insurance that is inadequate.
  It really galls me to think that we are here at the 11th hour and 
most of these problems have not been addressed by the Republican 
leadership on the other side of the aisle, and will not be addressed if 
Governor Bush is elected president.
  So I think it is important to contrast the candidates and the parties 
on health care. I am just going to take a little time tonight if I 
could to give my own view, and then give the view of an independent 
group that has analyzed the proposals that have been put forth by both 
sides.
  I want to start with the issue of prescription drugs, because I think 
right now the fact that so many seniors and disabled people who have 
Medicare are not able to access prescription drugs is a major problem, 
almost a crisis in the country.
  If we listen to what George Bush has been saying, what Governor Bush 
has been saying, he is saying that he wants to provide some sort of 
prescription drug program that would provide coverage initially through 
State-based low-income-only programs, and then through HMOs and 
insurance companies.
  I say that because what the Governor has proposed is not to bring 
prescription drugs under the rubric of Medicare, but rather, to give a 
subsidy or a voucher, if you will, to low-income people so they can go 
out and try to buy prescription drug policies in the open market, in 
the private market.
  That is very different from what Vice President Gore and the 
Democrats have been saying. I think it was clearly defined in last 
night's debate. What Vice President Al Gore has been saying is that 
Medicare is a successful program that provides coverage for one's 
hospital care and for one's doctor's care, and it would not be that 
difficult and would not cost that much money, particularly if we have a 
surplus, for the Federal government to provide prescription drug 
benefits under Medicare, as well.
  So that is the major difference between the Democrat and the 
Republican proposals. The Democrats are saying they want to expand 
Medicare to include prescription drugs. The Republicans are saying they 
do not want to use Medicare as the vehicle, they want to give a subsidy 
or they want to

[[Page H10240]]

give a voucher, or in the case of Governor Bush's proposal, a voucher 
essentially just for low-income people.
  There are a lot of other differences, but I just want to say, Members 
do not have to take my word for it. There is an organization called 
Families USA which just put out a report on health care and the 2000 
election.
  I just want to describe Families USA. Families USA is a nonprofit, 
nonpartisan consumer health organization established under section 
501(c)(4) of the Internal Revenue Code that has never endorsed, 
supported, nor opposed any political candidate, and they are not doing 
it now.
  In addition, Families USA has spent two decades working on various 
aspects of our health care system, and has amassed considerable 
expertise on health issues. The Democrats and myself have cited them 
many times, and the Republicans as well.
  On the issue of prescription drugs, and I just want to run through 
this, if I could, in their report that just came out they say, ``There 
is a marked contrast between the two candidates on this issue.''

                              {time}  2115

  Vice President Gore intends to establish a voluntary prescription 
drug benefit in the Medicare program, and I stress in the Medicare 
program. This would ensure that all seniors and people with 
disabilities gain access to prescription drug coverage. It would also 
enable Medicare to bring its considerable market clout on behalf of 
program beneficiaries to the bargaining table.
  Now, that sounds a little bureaucratic, but let me explain what that 
means. One of the biggest problems with prescription drugs right now is 
the cost for seniors. If they do not have some kind of coverage through 
their employer or through some sort of coverage that they are able to 
purchase, which many do not, then they have to go buy it on the open 
market at the local pharmacy, and the cost is prohibitive.
  There is a price discrimination between seniors who have to just go 
buy the prescription at the local pharmacy out-of-pocket versus seniors 
who happen to be fortunate to be in some sort of plan, either through 
their employer or in some other way.
  But what Vice President Gore does and what the Democrats do with 
their Medicare prescription drug proposal is they give the seniors who 
are now part of this plan clout with regard to prices, because they 
establish a benefit provider in each region of the country that will 
bargain for the best price, just like an HMO does, for example, for the 
prescription drugs, and that brings the price down. So that is what 
they are talking about here when Families USA says that the Democratic 
plan is better.
  Then they say in the Families USA report, they contrast Governor 
Bush's approach by way of contrast. Initially he relies on State-run 
pharmaceutical programs and subsequently on insurance companies, HMOs, 
to offer prescription drug coverage.
  To date, however, State pharmaceutical programs reach only a tiny 
portion of seniors who need drug coverage, and such assistance is 
usually confined to seniors with very low incomes.
  The point is that the Republican plan is only going to help seniors 
with low incomes. It is not going to help the vast majority of seniors 
with middle incomes, which basically are the people that are crying out 
for some sort of help.
  In addition, in analyzing the Bush plan, Families USA's assessment 
says that private health plans and insurance companies have very 
limited success in providing drug coverage for seniors.
  I mention that because what they are basically saying here is that, 
if one gives the senior or the disabled person the voucher, the way 
Governor Bush has proposed, to go out and try to buy prescription drug 
coverage in the open market, not under Medicare, they are not going to 
be able to find it. They are not going to find an insurance company 
that will offer that for the price of the subsidy that the Bush plan 
proposes.
  Now, additionally, what Families USA says about the Gore plan, the 
Democratic Medicare prescription drug plan, is that it is very specific 
in detailing the drug coverage that is guaranteed to every Medicare 
beneficiary as well as the cost sharing that seniors would have to pay.
  So what we are saying in the Democratic plan is that we are going to 
be able to guarantee one to have any drug that is medically necessary. 
We are going to tell one exactly what the premium is, exactly what one 
is going to get.
  Under the Bush proposal, on the other hand, decision making about the 
specifics of the drug benefit as well as out-of-pocket costs are left 
to the private insurance companies and the HMOs. So, again, one does 
not really know what one is getting.
  But I want to stress again the difference here, the difference is the 
Bush Republican plan is a voucher plan. It does not come under the 
rubric of Medicare. The Democratic plan, the Gore plan, is an expansion 
of Medicare that covers prescription drugs just in the same way that 
hospital care and physician care is provided under Medicare right now.
  Now, let me go to a second category here because I want to cover each 
of these health care issues because I think they are so important in 
terms of contrasting the difference between the parties.
  The second one is the future of Medicare itself. Medicare, as we 
know, in the next, maybe, 10, 20 years, not right away, but at some 
point in the future will start to run out of money because there are 
going to be so many baby boomers that become 65, that become seniors, 
that there is not enough money to pay for it.
  Now, what President Clinton and Vice President Gore have been saying 
is that they want to use most of the surplus to shore up the Social 
Security program and the Medicare program.
  But what we see is that, instead, by contrast, Governor Bush talks 
about restructuring the Medicare program in ways that I believe that 
will increasingly privatize and encourage people to opt out of Medicare 
or go to private insurance.
  I do not want to dwell on that too much because I want to get to the 
next issue, which is I think so important and, again, became an issue 
in last night's debate, right at the beginning of the debate.
  That is HMO reform. HMO reform is clearly something that so many 
Americans are concerned about because more and more people are in HMOs, 
and they find that they are victims of various abuses, primarily 
because what they find is that decisions about what kind of Medicare 
they get, whether they get a particular operation, whether they get to 
stay in the hospital a particular length of time is determined, not by 
their physician and themselves as a patient, but by the insurance 
companies. Naturally they do not like it because it lends itself to all 
kinds of abuse.
  Well, it was interesting last night because, during the debate, 
Governor Bush said that he was in support of HMO reform and that he 
mentioned that, in the State of Texas, his home State, that they 
actually had passed legislation that would provide for certain patient 
protections if one was in an HMO.
  But the interesting thing about it is Governor Bush used the example 
of HMO reform to say he would be successful if he were to be elected 
President because, in Texas, he was able to bring both parties together 
and everyone together to pass patient protections.
  Well, I have to point out that, when the issue of patients' rights in 
the context of HMO reform first came up in the tax legislature and the 
bill was passed in 1995, Governor Bush actually vetoed the legislation.
  So he talked about playing a role and bringing people together, the 
Texas legislature decided they wanted HMO reform, he vetoes the bill. 
Well, a couple years later, in 1997, there was again passed in the 
Texas legislature legislation to protect patients in the context of 
HMOs. This was a very comprehensive HMO reform that Governor Bush 
referred to in last night's debate. Well, this time, even though he 
opposed the legislation and refused to sign it, he let it become law.
  That is hardly an advocate for patients' rights. That is hardly 
someone who, as he says, is trying to bring people together to pass 
legislation. You veto it once and then you say, okay, I do not like it, 
but I will let it become law without my signature.

[[Page H10241]]

  What it means is this was happening despite what Governor Bush 
wanted. He did not want it to happen, but he did not want to stop it 
probably because he was afraid of the political consequences if he 
vetoed it again.
  By contrast, Vice President Gore last night and throughout the 7 
years now that he has been the Vice President, with the support of 
Democrats and some Republicans as well in Congress, has been an 
advocate on a Federal level for a comprehensive HMO reform bill which 
Vice President Gore mentioned last night, the Norwood-Dingell bill.
  He was very specific about bringing up that legislation in the debate 
last evening and asking Governor Bush repeatedly whether he supported 
the Norwood-Dingell bill and, of course, Governor Bush would not say 
whether he supported it or not. If he would not admit he supported it, 
I would say we have to assume he does not support it.
  It is a much stronger bill than even what the Texas legislature 
passed without Governor Bush's signature. It is a bill that is 
vehemently opposed by the HMOs and the health insurance industry and 
all of the special interests and very much supported by the majority of 
the American people.
  We passed the Patients' Bill of Rights, the Norwood-Dingell bill here 
in the House of Representatives. Almost every Democrat voted for it, 
and some Republicans voted for it too, otherwise it wouldn't have 
passed. In fact, the gentleman from Georgia (Mr. Norwood), one of the 
sponsors, is a Republican, the lead sponsor.
  But the bottom line is that the Republicans both here, the Republican 
leadership, both here in this House as well as in the other body, have 
tried to kill this bill ever since it passed. It went to conference. I 
was part of the conference committee. It has never come out of 
conference.
  I would almost guarantee that, in the week or two we have left here, 
it will not appear on the floor of this House or this Senate. It will 
not go to the President. It will not become law. Why? Because basically 
what it does is it does two major things. It says that decisions about 
what is medically necessary, what kind of care one gets, what kind of 
operation one gets, how long one stays in the hospital, decisions about 
what is medically necessary are going to be made by the physician and 
the patient, not by the insurance companies; and the insurance 
companies oppose that tooth and nail because they want to make the 
decisions to save money.
  Secondly, it has very good enforcement so that if, in fact, one is 
denied care by one's insurance company, one has a way of redressing 
one's grievances by going to an independent panel that will review the 
decision and have the power to overturn it or ultimately going to a 
court of law and having the decision overturned so that one can get the 
medical care that one's doctor and that one feels is necessary.
  So, again, marked contrast here between the views of the two 
candidates, the Presidential candidates as well as the parties on this 
issue.
  I do not mean to suggest that all the Republicans are bad on this, 
because some of them are good. But the Republican leadership in the 
House as well as in the Senate, as well as Governor Bush, refuse to 
support the Patients' Bill of Rights, the Norwood-Dingell bill.
  Let me go to an issue that I mentioned earlier, and that is the whole 
issue of increased access and for people to be covered with insurance 
who do not have it. I am not going to keep repeating over an over again 
what Governor Bush said about insurance being a Washington thing. I 
think he probably regrets that he made the statement, hopefully. But 
the bottom line is we still have over 40 million Americans who are 
uninsured. What are we going to do about it.
  Again, I would like to contrast the records between the two 
candidates and again between the two parties. Fortunately, here in the 
House of Representatives, the effort to expand coverage for children 
was successfully passed on a bipartisan basis, the CHIP program. 
Initially, the Republican leadership opposed it, but eventually they 
came around to passing it, and it was passed on a bipartisan basis.
  But what happened is that when this program then was given back to 
the States to handle it and to try to handle it in a way that would 
provide for coverage for the 5 million kids that it was meant to try to 
deal with and to give health insurance, as I mentioned already, 
Governor Bush, in his capacity as Governor of Texas, tried to make the 
eligibility for the program very minimal, only 150 percent of the 
poverty level. In terms of the outreach to try to get kids signed up 
for the program, he was very ineffective.
  In fact, the situation in Texas got so bad that a Federal judge just 
ruled a few weeks ago that Texas had to, under pain of the court's 
action or penalty, do a better job about enrolling kids in Medicaid as 
well as the CHIP program. So they were not even doing a good job 
getting kids enrolled in Medicaid at the very low end of poverty, let 
alone the ones that are eligible for the Federal CHIP program.
  Now, by contrast, what Vice President Gore has been saying, and he 
mentioned it in the debate last night, is that he wants to expand the 
eligibility at the Federal level, and that money then goes back to the 
States so kids whose parents are even at a higher income can join up in 
the Federal-State health insurance program called CHIP.
  He suggests raising the CHIP program, the Children's Health Insurance 
Program, eligibility to 250 percent of the Federal poverty level. He 
also says that, if you are parents and your income is even higher than, 
that he will allow you to buy into CHIP or Medicaid for children with 
family incomes above 250 percent of the Federal poverty level.
  Now of course Vice President Gore successfully pushed for enactment 
of the existing CHIP program which Governor Bush tried to cut back in 
the State of Texas. But beyond that, what the Democrats and what Vice 
President Gore are now proposing is that the CHIP program be even 
expanded to cover the parents of the kids who are eligible for CHIP. 
Basically, this is a way of now expanding health insurance for people 
who were working but whose incomes are too high to be eligible for 
Medicaid.
  What I would stress again, Mr. Speaker, is that, when we talk about 
Vice President Gore's program and the Democratic initiative here with 
children, the CHIP program, and expanding it to adults, we are not 
talking about people who are on welfare. They are usually eligible for 
Medicaid. We are talking about working people who on the job, because 
of their low income or because the employer does not offer it, are not 
able to get health insurance. These are working people. These are 
people oftentimes who have two or even three jobs, and they are not 
able to offer health insurance for their kids or for themselves.
  So what Vice President Gore is saying is let us take this CHIP 
program, which is working, and let us expand it to the parents. If we 
enroll the parents, we also find that that means that they are more 
likely to get into the program and enroll their kids.
  Some parents, unfortunately, selfishly, will not enroll their kids if 
they are not eligible for the program.

                              {time}  2130

  Vice President Gore has also been saying that with regard to the 
other large group of people that are uninsured, which are the people 
between 55 and 65, we call them near elderly, who are not yet eligible 
for Medicare, that they would be able to buy into the Medicare program 
and pay so much a month, $300 or $400 a month, to buy into the Medicare 
program. It is another way of expanding access to health insurance for 
people who are currently uninsured.
  Now, I have made reference once so far this evening to the Families 
USA report in the context of prescription drug coverage, but I wanted 
to make reference to it again, if I could, in the context of health 
coverage for children and expanding the CHIP program to include more 
kids at higher incomes and also for their parents. If we look at this 
Families USA report, and I will not repeat what Bush and Gore are 
proposing, but I wanted to just give a little bit of the analysis that 
the Families USA report provides.
  The report says, under the section that deals with expanding 
insurance for adults, that at the centerpiece of his proposal to expand 
coverage Governor Bush proposes to establish a refundable tax credit 
for people and families who purchase health coverage on

[[Page H10242]]

their own if they do not receive insurance through their employers and 
do not qualify for Medicaid or any other government assistance. For 
individuals with incomes below $15,000 per year, the tax credit would 
equal $1,000 and would taper off as an individual's income increases 
above $15,000. For families with incomes below $30,000 per year, the 
tax credit would equal $2,000 and would taper off as the family's 
income increases above $30,000.
  Now, Governor Bush has made reference to these tax credits, $1,000 or 
$2,000 depending on where one is below a certain income, and he 
suggests that that is one way of expanding coverage. This contrasts of 
course to what Vice President Gore has been saying about expanding the 
CHIP program for children and expanding it to include adults, the 
parents of those kids, as well as Gore's proposal to let the near 
elderly buy into Medicare.
  Well, this is how Families USA assesses the two proposals. It says 
Governor Bush's proposals to expand health coverage for adults are 
likely to be ineffectual and in some respects may even be harmful. 
Because of its limited size, the tax credit proposal for low- and 
moderate-income individuals and families who purchase their own health 
coverage is unlikely to make a significant dent in the number of people 
who are uninsured.
  Today, the average cost of a family health plan purchased by an 
employer is $6,351 per year, and coverage purchased by families in the 
individual market typically cost considerably more. As a result, a 
family would need to spend more than $4,300 over and above the $2,000 
family tax credit simply to pay for premiums. This amount would 
constitute over 14 percent of income for a family earning $30,000 a 
year and over one-fifth of the income of a family with $20,000 in 
annual income. Either way, the tax credit would still leave most of 
these families with an inability to purchase health coverage.
  Now, to his credit, Governor Bush is at least proposing something, 
and I will grant him that. But it is not anything that is going to be 
effective in expanding health coverage for those who are uninsured.
  Vice President Gore's proposal, by contrast, and this is what 
Families USA says, to expand health coverage for adults builds on 
public programs, such as Medicaid, CHIP, and Medicare that work well. 
His proposal to establish CHIP-type health coverage for low-wage 
working parents will not only provide increased coverage for those 
parents but is likely to spur children's enrollment in CHIP as families 
are enabled to enroll together. The Medicare buy-in proposal is 
projected to increase health coverage for approximately 300,000 near-
elderly persons.
  Now, Mr. Speaker, I do not want to spend too much more time, and I 
think my time is probably running out; but I just wanted to say this in 
conclusion. I do not look at these health care issues from the point of 
view of ideology. I know that generally most Republicans tend to be 
more conservative than most Democrats, and more Democrats are liberal, 
even though not all of them are. But the bottom line is, I do not look 
at the ideology. I look at what works. And the difference between what 
Vice President Gore and Governor Bush are proposing and between what 
most of the Democrats and most of the Republicans are proposing, I 
think really does not come down so much to ideology but what works 
practically.
  Practically speaking, if we want to provide a prescription drug 
coverage program for seniors, we should put it under Medicare, because 
Medicare works. And we should not look at the Republican proposals to 
provide some voucher that assume that people are going to go out and 
buy coverage that does not exist.
  And the same thing is true for the CHIP program and the efforts to 
try to expand health coverage for the uninsured. Basically what Vice 
President Gore and the Democrats have been doing here for the last 6 
years is advocating and, in some cases passing, legislation that would 
provide for the government to set up a program like CHIP through the 
States that people can pretty much be guaranteed that they are going to 
have health insurance. It is health insurance that is provided by the 
government.

  Now, I am not saying that we want national health insurance, but 
where we have gaps and people who are working and still having the 
inability to get health insurance on the open market, the government 
needs to step in. That is what Vice President Gore proposed with CHIP. 
It is working. That is what he proposes for expanding coverage for the 
near elderly and for the parents whose kids are in CHIP. What Governor 
Bush is proposing as an alternative is simply to give a tax credit, 
which once again will not provide the money or the ability for those 
families to buy health insurance.
  So all I am saying is that there are huge contrasts here between the 
two presidential candidates. There are huge contrasts between the 
parties on these various health care issues. And I think the major 
difference is that the Democrats are proposing plans that will actually 
work and make a difference for people who do not have health insurance, 
or who do not have prescription drugs, and who suffer from the abuses 
of HMOs. That is why what we are proposing should be passed.
  My greatest regret in this Congress is that on many occasions when 
the Democrats have tried to put forward these programs they have not 
been successful because the Republican leadership has opposed them. We 
have had a few occasions where the Republicans have joined us, but in 
most cases they have not. And it is a very sad commentary that this 
Congress is going to end within the next week or two not having 
addressed these major problems that face so many Americans.

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