[Congressional Record Volume 146, Number 135 (Wednesday, October 25, 2000)]
[Extensions of Remarks]
[Pages E1908-E1909]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 INTRODUCTION OF THE BASIC ACCESS TO SECURE INSURANCE COVERAGE (BASIC) 
                            HEALTH PLAN ACT

                                 ______
                                 

                          HON. JOHN D. DINGELL

                              of michigan

                    in the house of representatives

                      Wednesday, October 25, 2000

  Mr. DINGELL. Mr. Speaker, today, I am introducing the Basic Access to 
Secure Insurance Coverage Health Plan (BASIC) Act which builds on 
existing health insurance programs to provide all uninsured Americans, 
regardless of age or family status, the opportunity to get health 
insurance. The BASIC plan would create a universal guarantee for health 
insurance for all Americans.
  While we are experiencing unprecedented prosperity and a strong 
economy, yet there are still 43 million of Americans who are uninsured. 
Being uninsured is not a ``Washington problem.'' It is a human problem, 
as those 43 million people understand. In any given year, one-third of 
the uninsured go without needed medical care. Eight million uninsured 
Americans fail to take medication their doctors prescribe, because they 
cannot afford to fill the prescription. A new study published this 
month in the Journal of the American Medical Association confirms the 
serious health consequences of lacking insurance. Long-term and short-
term uninsured adults were more likely than insured adults to face cost 
barriers to care and forgo needed care.
  Lack of health insurance can have serious financial consequences as 
well. An uninsured family is exposed to financial disaster in the event 
of serious illness. Unpaid medical bills account for 200,000 
bankruptcies annually. Over 9 million families spend more than one 
fifth of their total income on medical costs.
  The BASIC Health Plan Act builds on two successful federal-state 
health insurance programs: Medicaid and the Children's Health Insurance 
Program (CHIP). The BASIC plan would extend these programs to all 
individuals and families with income up to 300% of the poverty level 
through a multi-year phase in. Other uninsured individuals may buy in 
to the program by paying the cost through premiums. Since nearly three-
fourths of the uninsured have family incomes below 300 percent of the 
poverty level, this expansion is targeted at those who need it.
  This bill also includes a number of provisions to ensure that 
families can easily access health insurance through the BASIC program. 
First, it simplifies and streamlines the application and enrollment 
process for these programs to make them seamless. Second, the bill 
would make it easier for states to identify and enroll families in 
coverage. Third, the bill improves upon the CHIP benefit package to 
guarantee all children receive adequate preventive services and 
treatment.
  Additionally, since 82 percent of the uninsured are workers or 
dependents of workers, this bill seeks to use families' connection to 
employment to facilitate access to health insurance coverage. Employers 
will not be required to provide coverage or contribute to the cost of 
coverage, although they may if they so wish. However, they will be 
required to facilitate access to the coverage by withholding any 
required premium contributions from the employee's periodic pay, just 
like they do for taxes today.
  I believe the BASIC Health Plan Act is an excellent starting point 
for providing health care coverage for every American. Over the past 
few years, Congress has lost focus on addressing this pressing issue. 
This time is upon us again to place health insurance at the forefront 
of our agenda.
  I look forward to working with my colleagues in the House and the 
Senate on the BASIC Health Plan Act to help provide health insurance 
coverage to many of the millions of Americans who are currently without 
health insurance.

   Need for Legislation and Summary of the ``BASIC'' Health Program: 
        Universal Access to Affordable Quality Health Insurance

       America is the only industrial country in the world, except 
     South Africa, that does not guarantee health care for all its 
     citizens. The number of uninsured declined last year for the 
     first time in more than a decade--but 43 million Americans 
     remain uninsured, and any slowdown in the economy is likely 
     to send the number up again. The vast majority of the 
     uninsured are workers or dependents of workers. The 
     consequences of being uninsured go far beyond vulnerability 
     to catastrophic medical costs. The uninsured often lack 
     timely access to quality health care, especially preventive 
     care. They suffer unnecessary illness and even death because 
     they have no coverage.

                        Growth in the Uninsured

       The number of the uninsured has grown from 32 million in 
     1987 to 43 million this year. Except for a brief pause in 
     1993 and 1994, the number of uninsured has consistently 
     increased by a million or more each year until this year. 
     Even these figures understate the number of the uninsured. 
     During the course of a year, 70 million Americans will be 
     uninsured for an extended period of time.

                    Characteristics of the Uninsured

       The vast majority of privately insured Americans--161 
     million citizens under 65--receive coverage on the job as 
     workers or members of their families. But the uninsured are 
     also overwhelmingly workers or their dependents. Eighty-two 
     percent of those without insurance are employees or family 
     members of employees. Of these uninsured workers, most are 
     members of families with at least one person working full-
     time.
       Most uninsured workers are uninsured because their employer 
     either does not offer coverage, or because they are not 
     eligible for the coverage offered. Seventy percent of 
     uninsured workers are in firms where no coverage is offered. 
     Eighteen percent are in firms that offer coverage, but they 
     are not eligible for it, usually because they are part-time 
     workers or have not been employed by the firm long enough to 
     qualify for coverage. Only 12% of uninsured workers are 
     offered coverage and decline.
       The uninsured are predominantly low and moderate income 
     persons. Almost 25 percent are poor (income of $8,501 or less 
     for a single individual; $13,290 or less for a family of 
     three). Twenty-eight percent have incomes between 100 and 200 
     percent of poverty. Eighteen percent have incomes between 200 
     and 300 percent of poverty. Almost three-fourths have incomes 
     below 300 percent of poverty.

                    Consequences of Being Uninsured

       An uninsured family is exposed to financial disaster in the 
     event of serious illness. Unpaid medical bills account for 
     200,000 bankruptcies annually. Over 9 million families spend 
     more than one fifth of their total income on medical costs. 
     The health consequences of being uninsured are often as 
     devastating as the economic costs:
       In any given year, one-third of the uninsured go without 
     needed medical care.
       Eight million uninsured Americans fail to take medication 
     their doctors prescribe, because they cannot afford to fill 
     the prescription.
       Thirty-two thousand Americans with heart disease go without 
     life-saving and life-enhancing bypass surgery or angioplasty, 
     because they are uninsured.
       Twenty-seven thousand uninsured women are diagnosed with 
     breast cancer each year. They are twice as likely as insured 
     women not to receive medical treatment until their cancer has 
     already spread in their bodies. As a result, they are 50% 
     more likely to die of the disease.
       The tragic bottom line is that 83,000 Americans die every 
     year because they have no insurance. Being uninsured is the 
     seventh leading cause of death in America. Our failure to 
     provide health insurance for every citizen kills more people 
     than kidney disease, liver disease, and AIDS combined.


  THE PROPOSAL: SUMMARY OF BASIC ACCESS TO SECURE INSURANCE COVERAGE 
                  HEALTH PLAN (``BASIC'' HEALTH PLAN)

                                Overview

       The BASIC program builds on two successful federal-state 
     health insurance programs: Medicaid and the Child Health 
     Insurance Program (CHIP). It also incorporates a number of 
     elements from Vice-President Gore's proposal to improve and 
     expand upon insurance coverage under CHIP and Medicaid to the 
     parents of eligible children. The BASIC plan extends the 
     availability of subsidized coverage to all uninsured low and 
     moderate income Americans, regardless of age or family 
     status. It guarantees the availability of coverage in every 
     state for every uninsured person, and includes provisions to 
     encourage enrollment by those who are eligible. The plan also 
     allows other uninsured individuals to buy-in to the program 
     by paying the full premium.

                             Key Provisions


   Phase I: Coverage for Children and Parents--Expansion of CHIP and 
                                Medicaid

       Eligibility levels are raised to 300% of poverty ($42,450 
     for a family of three) for all uninsured children over 2 
     years.
       Coverage is made available to all uninsured parents of 
     enrolled children.
       Coverage is made available to legal immigrant children, and 
     their parents.

[[Page E1909]]

       The minimum benefit package under CHIP for children is 
     improved by adding eye-glasses, hearing aids, and medically 
     necessary rehabilitative services for disabled or 
     developmentally delayed children.
       Additional steps are established to encourage enrollment of 
     eligible children and their parents, including presumptive 
     eligibility, qualification for at least twelve months, and 
     simplified application forms.
       The system of capped state allotments under CHIP is 
     eliminated and federal matching funds are made available for 
     all eligible persons enrolled in the program.


             Phase II: Coverage for the Remaining Uninsured

       Subsidized coverage is made available for the remaining 
     uninsured with incomes below 300% of the poverty level. 
     Coverage is phased in by income levels, beginning with those 
     below 50% of the poverty level in the third year of the 
     program, rising to 300% of the poverty level in the ninth 
     year.
       Other uninsured individuals above 300% of poverty may buy-
     in to the program by paying the cost through premiums.

                      Responsibility of Employers

       Eighty-two percent of the uninsured are workers or 
     dependents of workers. Employers will not be required to 
     provide coverage or contribute to the cost of coverage--but 
     they will be required to offer their uninsured employees an 
     opportunity to enroll in the program and agree to facilitate 
     the coverage by withholding any required premium 
     contributions from the employee's periodic pay.

                                  Cost

       Preliminary estimates of similar proposals indicate that 
     the federal cost will be $200-300 billion over the next ten 
     years, beyond the amount already budgeted for expansions of 
     coverage under the current CHIP program.

     

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