[Congressional Record Volume 148, Number 34 (Thursday, March 21, 2002)]
[Senate]
[Pages S2262-S2265]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Ms. Landrieu):
  S. 2042. A bill to expand access to affordable health care and to 
strengthen the health care safety net and make health care services 
more available in rural and underserved areas; to the Committee on 
Finance.
  Ms. COLLINS. Mr. President, I am pleased to join with my good friend 
and colleague, the Senator from Louisiana, Mary Landrieu, in 
introducing the Access to Affordable Health Care Act. This is a 
comprehensive seven-point plan that builds on the strengths of our 
current programs, both public and private, to make quality affordable 
health care available to millions more Americans.
  One of my top priorities in the Senate has been to expand access to 
affordable health care to all Americans. There are still far too many 
people in our country without health insurance or with woefully 
inadequate coverage. An estimated 39 million Americans do not have 
health care insurance, including more than 150,000 in my home State of 
Maine.
  The fact is, health insurance matters. The simple fact is that people 
with health insurance are healthier than those who lack coverage. 
People without health insurance are less likely to seek care when they 
need it and tend to forgo services such as periodic checkups and 
preventative services. As a consequence, they are far more likely to be 
hospitalized or to require costly medical attention for conditions that 
could have been prevented or cured if caught at an early stage.

[[Page S2263]]

  Not only does this put the health of these individuals at greater 
risk, but it also puts additional pressure on our already financially 
challenged hospitals and emergency rooms. Compared with people who have 
health insurance coverage, uninsured adults are four times and 
uninsured children five times more likely to use a hospital emergency 
room. The costs of care for these individuals are often absorbed by 
providers and then passed on to covered individuals through increased 
fees and higher insurance premiums.
  Maine is in the midst of a growing health insurance crisis. Insurance 
premiums are rising at alarming rates. Whether I am talking to a self-
employed fisherman or the owner of a struggling small business or the 
human resources manager of a large corporation, the cost of health 
insurance is a common concern.
  In 1999, the average family premium for employer-based coverage in 
Maine was more than $6,000, the 14th highest in the Nation at that 
time. Since then, Maine employers have faced premium increases of as 
much as 40 percent a year. In fact, my own brother called me recently 
to tell me that his small business is faced with a 40-percent increase 
in health insurance premiums on top of a 30-percent increase the year 
before.
  These premium increases are particularly burdensome for smaller 
businesses, the backbone of Maine's economy. Many small business owners 
are caught in a real squeeze. They know if they pass on the premium 
increase to their employees, then more and more employees will be 
forced to decline coverage and, thus, will be completely uninsured, and 
yet these small employers simply cannot continue to absorb premium 
increases of 20 to 30 to 40 percent year after year.
  The problem of rising costs is even more acute for individuals and 
families who must purchase health insurance on their own. Anthem Blue 
Cross/Blue Shield, the single remaining carrier in Maine's nongroup 
market, has increased its rates by 40 percent over the past 2 years. 
Monthly insurance premiums often exceed the family's monthly mortgage 
payments. It is no wonder that more than 150,000 Mainers are now 
uninsured. Clearly, we simply must do more to make health insurance 
more affordable and more available.
  The Access to Affordable Health Care Act, which Senator Landrieu and 
I are introducing today, is a 7-point plan that combines a variety of 
public and private approaches to make quality health care coverage more 
affordable.
  The legislation's seven goals are: One, to expand access to 
affordable health care for small businesses; two, to make health 
insurance more affordable for individuals and families purchasing 
coverage on their own; three, to strengthen the health care safety net 
for those who lack coverage; four, to expand access to care in rural 
and underserved areas; five, to increase access to affordable long-term 
care; six, to promote healthier lifestyles, and seven, to provide more 
equitable Medicare payments to Maine providers to reduce the Medicare 
shortfall.
  This shortfall, this lack of fair reimbursement for Medicare 
services, has forced hospitals, physicians, and other providers to 
shift costs on to other payers in the form of higher charges. That 
drives up the cost of health insurance, and it is one of the reasons 
that Maine's rates are higher than the insurance rates in most other 
States.
  I will discuss each of these seven points in more detail. First, 
expanding access for small businesses, this legislation builds upon a 
bill I introduced with Senator Landrieu last year to help small 
employers cope with rising health care costs. Since most Americans get 
their health insurance through their employers, it is a common 
assumption that people without health insurance are unemployed, but 
that is not accurate. The fact is most uninsured Americans are members 
of families with at least one full-time worker.
  As many as 82 percent of Americans without health insurance are in a 
family with a full-time worker. Uninsured working Americans are most 
often the employees of small businesses. In fact, some 60 percent of 
uninsured workers are employed by small firms. Smaller firms generally 
face higher costs for health insurance than larger companies, which 
makes them less likely to offer coverage.
  I know from my conversations with small businesses all over Maine 
that they want to offer health insurance as a benefit for their 
employees. They know it would help them to attract and retain good 
workers. The only reason these small businesses are not offering health 
insurance is a simple one: They simply cannot afford the premium costs.
  The legislation we are introducing today will help small businesses 
cope with rising costs by providing new tax credits for them to make 
health insurance more affordable. It will encourage those small 
businesses who are now offering health insurance to continue to do so 
in the face of escalating premiums. It will encourage them to make the 
decision not to drop coverage, and it will prompt small employers who 
want to provide this coverage but have found it financially out of 
reach, to now offer this important benefit.
  The legislation will also help to increase the clout of small 
businesses in negotiating with insurers. Premiums are generally higher 
for smaller businesses because they do not have as much purchasing 
power as large companies. This limits their ability to bargain for 
lower rates. They also tend to have higher administrative costs than 
larger companies because they have fewer employees among whom to spread 
the fixed costs of a health insurance plan.
  Moreover, they are not able to spread the risks of medical claims 
over as many employees as large firms. The legislation we are 
introducing will help address these problems by authorizing Federal 
grants to provide start-up funding to States to assist them with the 
planning, development, and operation of small employer purchasing 
cooperatives.

  I am not talking about association health plans, which are 
controversial for a number of reasons. I am talking about small 
employer purchasing cooperatives. They will help to reduce the costs of 
health insurance for small employers by allowing them to band together 
to purchase insurance jointly.
  Group purchasing cooperatives have a number of advantages for smaller 
employers. They will, for example, bring an increased number of 
participants into the group and that helps to lower the premium costs. 
They also decrease the risk of adverse selection. Our legislation would 
also authorize a Small Business Administration grant program for 
States, local governments, and nonprofits to provide information about 
the benefits of health insurance to smaller employers, including the 
tax benefits, the increased productivity of employees and decreased 
turnover. Grants would be used to make employers aware of their current 
rights under State and Federal laws.
  For example, one survey showed that 57 percent of small employers did 
not realize they could deduct 100 percent of the costs of their health 
insurance premiums as a business expense.
  The legislation that Senator Landrieu and I are introducing would 
also create a new program to encourage innovation by awarding 
demonstration grants in up to 10 States to look at innovative coverage 
expansion such as alternative group purchasing or pooling arrangements, 
individual or small group market reforms, or subsidies to employers or 
individuals purchasing coverage.
  The States have been the laboratories of reform. For example, some 
States have looked at providing assistance to employees to help them 
afford their share of an employer-provided insurance plan.
  Second, the Access to Affordable Health Care Act will help expand 
access to affordable health care for individuals and families who are 
purchasing coverage on their own. It would, for example, allow self-
employed Americans to deduct the full amount of their health care 
premiums retroactive to January 1 of this year.
  Some 25 million Americans are in families headed by a self-employed 
individual, and of these 5 million are uninsured. So if we establish 
parity in the tax treatment for health insured costs between the self-
employed and those working for large corporations, we will promote 
equity, and we will help to reduce the number of uninsured by working 
Americans.
  Another step this bill would take would build on the success of the 
State children's health insurance program,

[[Page S2264]]

one of the very first bills I sponsored as a Senator. This program 
provides insurance for children of low-income families who cannot 
afford health insurance and yet earn too much money to qualify for 
Medicaid.
  We are proposing that we allow, as Senator Kennedy's family care bill 
would, the option for States to cover the parents of children who are 
enrolled in programs like Maine's MaineCare program. States could also 
use funds provided through this program to help eligible working 
families pay their share of an employer-based health insurance plan. In 
short, this legislation will help ensure low-income working families 
receive the health care they need.
  Another provision of the bill would allow States to expand coverage 
to eligible legal immigrants through the Medicaid and SCHIP programs. 
Maine is one of a number of States that is already covering eligible 
legal immigrants, pregnant women, and children under Medicaid using 100 
percent State dollars. Giving States the option of covering these 
children and families under Medicaid will enable them to receive 
Federal matching funds.

  Another provision of the bill would give States the option of 
extending Medicaid to childless adults below 125 percent of the Federal 
poverty level who cannot afford private insurance and who have been 
forgotten or overlooked by other public programs. Maine has applied for 
a waiver to expand its Medicaid Program in this way, and the State 
estimates this will provide health coverage to an estimated 16,000 low-
income uninsured Mainers.
  Many people with serious health problems encounter difficulties in 
finding a company that is willing to insure them. To address this 
problem, the Collins-Landrieu bill authorizes Federal grants to provide 
money for States to create high-risk pools through which individuals 
who have preexisting health conditions can obtain affordable health 
insurance.
  Finally, the legislation in this section would provide an 
advanceable, refundable tax credit of up to $1,000 for individuals 
earning up to $30,000, and up to $3,000 for families earning up to 
$60,000.
  This provision, which is similar to that proposed by President Bush, 
would help to provide coverage for up to 6 million Americans who 
otherwise would be uninsured for 1 or more months. It will help many 
more working lower income families who currently purchase private 
health insurance with little or no government help and finding it 
increasingly difficult to do so.
  Third, the Access to Affordable Health Insurance Act will help to 
strengthen our Nation's health care safety net by doubling funding over 
the next 5 years for community health centers. We want to make sure we 
are reaching individuals who are homeless, individuals who are migrant 
workers, individuals who are living in public housing. These centers, 
which operate in underserved rural and urban communities, provide 
critical primary care services to millions of Americans, regardless of 
their ability to pay. About 20 percent of the patients treated at 
Maine's community health centers have no insurance coverage. Many more 
have inadequate coverage. These community health centers play a 
critical role in providing a health care safety net for some of our 
most vulnerable individuals.
  The problem of access to affordable health care services is not 
limited to the uninsured. It is also shared by many Americans living in 
rural and underserved areas where there is a serious shortage of health 
care providers. The legislation we are introducing, therefore, includes 
a number of provisions to strengthen the National Health Service Corps, 
which supports doctors, dentists, and other clinicians who serve in 
rural and inner-city areas.
  For example, taxing students adversely affects their financial 
incentive to participate in the National Health Service Corps and 
provide health care services in underserved communities. Last year's 
tax bill provided a tax deduction for National Health Service Corps 
scholarship recipients to deduct all tuition, fees, and related 
educational expenses from their income taxes. The deduction did not 
extend to loan repayment recipients however, so loan repayment amounts 
are still taxed as income. Participants in the loan repayment program 
are actually given extra payment amounts to help them cover their tax 
lability which, frankly, is a little ridiculous. It makes much more 
sense to simply exempt them from taxation in the first place.
  In addition, the legislation will allow National Health Service Corps 
participants to fulfill their commitment on a part-time basis. Current 
law requires all National Health Service Corps participants to serve 
full time. Many rural communities, however, simply do not have enough 
volume to support a full-time health care practitioner. Moreover, some 
sites may not need a particular type of provider--for example, a 
dentist--on a full-time basis. Some practitioners may also find part-
time service more attractive, which, in turn, could improve recruitment 
and retention. Our bill will therefore give the program additional 
flexibility to meet community needs.
  Long-term care is the major catastrophic health care expense faced by 
older American today, and these costs will only increase with the aging 
of the baby boomers. Most Americans mistakenly believe that Medicare or 
their private health insurance policies will cover the costs of long-
term care should they develop a chronic illness or cognitive impairment 
like Alzheimer's Disease. Unfortunately, far too many do not discover 
that they do not have coverage until they are confronted with the 
difficult decision of placing a much-loved parent or spouse in long-
term care and facing the shocking realization that they will have to 
cover the costs themselves.
  The Access to Affordable Health Care Act will provide a tax credit 
for long-term care expenses of up to $3,000 to provide some help to 
those families struggling to provide long-term care to a loved one. It 
will also encourage more Americans to plan for their future long-term 
care needs by providing a tax deduction to help them purchase private 
long-term insurance.
  Health insurance alone is not going to ensure good health. As noted 
author and physician Dr. Michael Crichton has observed, ``the future of 
medicine lies not in treating illness, but preventing it.'' Many of our 
most serious health problems are directly related to unhealthy 
behaviors-- smoking, lack of regular exercise, and poor diet. These 
three major risk factors alone have made Maine the State with the 
fourth highest death rate due to four largely preventable disease: 
Cardiovascular disease, cancer, chronic lung disease and diabetes. 
These four chronic diseases are reponsible for 70 percent of the health 
care problems in Maine.
  Our bill therefore contains a number of provisions designed to 
promoted healthy lifestyles. An ever-expanding body of evidence shows 
that these kinds of investment in health promotiong and prevention 
offer returns not only in reduced health care bill, but in longer life 
and increased productivity. The legislation will provide grants to 
States to assist small businesses wishing to establish ``worksite 
wellness'' programs for their employees. It would also authorize a 
grant program to support new and existing ``community partnerships,'' 
such as the Healthy Community Coalition in Franklin County, to promote 
healthy lifestyles among hospitals, employers, schools and community 
organizations. And, it would provide funds for States to establish or 
expand comprehensive school health education, including, for example, 
physical education programs that promote lifelong physical activity, 
healthy food service selections, and programs that promote a healthy 
and safe school environment.

  And finally, the Access to Affordable Health Care Act would promote 
equity in Medicare payments and help to ensure that the Medicare system 
rewards rather than punishes States like Maine that deliver high-
quality, cost effective Medicare services to our elderly and disabled 
citizens.
  According to a recent study in the Journal of the American Medical 
Association, Maine ranks third in the nation when it comes to the 
quality of care delivered to our Medicare beneficiaries. Yet we are 
11th from the bottom when it comes to per-beneficiary Medicare 
spending.
  The fact is that Maine's Medicare dollars are being used to subsidize 
higher reimbursements in other parts of the country. This simply is not 
fair.

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Medicare's reimbursement systems have historically tended to favor 
urban areas and failed to take the special needs of rural States into 
account. Ironically, Maine's low payment rates are also the result of 
its long history of providing high-quality, cost-effective care. In the 
early 1980s, Maine's lower than average costs were used to justify 
lower payment rates. Since then, Medicare's payment policies have only 
served to widen the gap between low and high-cost States.
  As a consequence, Maine's hospitals, physicians, and other providers 
have experienced a serious Medicare shortfall, which has forced them to 
shift costs on to other payers in the form of higher charges. The 
Medicare shortfall is one of the reasons that Maine has among the 
highest health insurance premiums in the Nation. The provisions in the 
Access to Affordable Health Care Act provide a complement to 
legislation that I introduced earlier this year with Senator Russ 
Feingold to promote greater fairness in Medicare payments to physicians 
and other health professionals by eliminating outdated geographic 
adjustment factors that discriminate against rural areas.
  Mr. President, the Access to Affordable Health Care Act outlines a 
blueprint for reform based upon principles upon which I believe a 
bipartisan majority in Congress could agree. The plan takes significant 
strides toward the goal of universal health care coverage by bringing 
million more Americans into the insurance system, by strengthening the 
health care safety net, and by addressing the inequities in the 
Medicare system.
                                 ______