[Congressional Record Volume 149, Number 117 (Friday, August 1, 2003)]
[Senate]
[Pages S10877-S10879]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ASSOCIATION HEALTH PLANS
Mr. TALENT. Mr. President, it is my pleasure to speak to the Senate
today about a subject on which I have risen to speak before, a very
important piece of legislation that I think has the potential to solve
what is probably the No. 1 problem that small businesspeople and their
employees confront today. I am talking about the bill which I have
cosponsored along with Senator Snowe, who is the chairman of the Small
Business Committee, and others. It is a bill to allow small
businesspeople to create association health plans.
This bill is not a Government program. In a time of great deficits,
it does not require us to spend any money. It is going to take a long
step toward solving the problems of the uninsured, reducing the number
of the uninsured, and getting working people better health insurance at
less cost. It does not cost the taxpayers anything because all it does
is allow people to work together and do for themselves, as small
businesspeople and employees of small businesses, what big companies
and employees of big companies can already do.
Most people in the United States who have health insurance are a part
of a big national pool--almost everybody is. You are either in Medicaid
or Medicare or the Federal Employees Health Benefits Plan or covered by
a labor union plan or a multi-employer plan with a labor union or you
work for a big company. If you are in any of those situations, you are
covered by health insurance, and it is health insurance where you are a
part of a big national pool.
The only people who are not in that situation are people who work for
small businesses. I define that very broadly. That includes farmers. It
includes people who are self-employed consultants operating out of
their own home. They are in the small group market. They have to buy
insurance. If they own or run a small business or a farm, they are
buying insurance for small groups of people, 5 people or 10 people or
20 people or 25 people.
Insurance works better when you spread the risk across as large a
pool as possible. It doesn't take an advanced degree to understand
that. All association health plans do--and it is very important what
they do--is simply allow the employees of small businesses to get the
same efficiencies and economies of scale that employees of big business
already enjoy. All I would do is allow trade associations--the Farm
Bureau, the NFIB, the Chamber of Commerce, the National Restaurant
Association--to sponsor health insurance coverage nationally the same
way the human resources side of a big company would do.
Let's take a big company such as Emerson Electric, a great company in
Missouri, or Sprint, or Anheuser Busch, all headquartered there. They
have a human resources side, an employee benefits side. They contract
with insurance companies nationally; they may have a self-insured side.
Then their employees all over the country can enjoy an option in
different plans as part of pools of 5 or 10 or 20 or 30,000 people. The
administrative costs of such plans are much lower because they are
spread across a much wider base of employees. They have much greater
purchasing power and negotiating power when dealing with the big
insurance companies. They have the competitive possibilities of self-
insurance. So insurance is better in that situation and it costs less.
It doesn't mean they don't have problems, but you are a lot better
off there than you would be and are right now if you are struggling as
a small business owner or the employee of a small business.
Of the 44 million people uninsured in the country, about two-thirds
either own a small business or work for a small business or are
dependents of somebody who owns or works for a small business. I am
including farmers. Then there are tens of millions of other people who
may have health insurance through a small business, but it is bare-
bones health insurance. It is not what it should be because the costs
are so high, and they are going up every year.
There is a human side to this. Senators who have not done this--I
imagine most Senators have--go out and talk to people who work in small
businesses or run small businesses. I guarantee you, they will tell you
the No. 1 problem they are confronting, short and long term, is the
rising cost of health insurance and increasing unavailability. This
hits people where they live.
We have had too many layoffs in Missouri. We have lost more jobs in
Missouri in a 1-year period than any other State. There are a lot of
bad results connected with the layoff, obviously. But I think maybe the
first that hits a family when they lose a job or are concerned about
losing a job, particularly if it is a family with kids, is: What about
my health insurance? What do I do for that? It is as important as
people's wages.
Folks in the small business sector, employees of people in the small
business sector have labored too long in a market that does not work.
It is dominated by a few companies, and they are acting more and more
like monopolists, raising prices higher and higher, providing fewer and
fewer services, less and less quality insurance. We need to do
something about it. We can do it, if this Senate will pass association
health plans. It passed in the House by 100 votes last month--strong
bipartisan support. It has passed several years in a row in the House.
The President supports it. We in the Senate ought to pass it.
I fought on the floor of the Senate for it. I will continue to do so.
It is a great bill. We have great sponsors. We will take up the debate
again in the fall. I am very hopeful we can pass it.
[[Page S10878]]
It is no secret--and Senators know this because I have been talking
to them and I know how strongly they are being lobbied on both sides,
lobbied in opposition to association health plans--who is at the core
of the lobbying effort against association health plans. It is the Blue
Cross Insurance Company. It is no secret why. Blue Cross is dominant in
many States. It is one of the few big insurance companies in almost
every State that currently provide health insurance to small
businesses. They have a big stake in not having association health
plans enter the market to compete. It would be a huge competitive
force. It would take business away from them or cause them to lower
their prices in order to keep the business.
I don't begrudge them or anybody else their opportunities or rights
to lobby on legislation that comes before this Senate. They have
lobbied. They spent $4.3 million last year on lobbyists. I don't know
how much of that was spent on association health plans. We do know this
is the No. 1 priority for that company--to stop this bill. We can all
infer why. I don't begrudge them that. But the debate ought to be done
honestly, and it ought to be done within the limits of fair play. That
is not happening. I want the Senate to know about it.
First, I said it is not being done within the limits of honesty. The
No. 1 charge being brought against association health plans is not only
not true, it is exactly the inversion of the truth. It is exactly the
opposite of the truth. If you want to fool somebody, tell them
something that not only isn't true but is the opposite of the truth.
Try and sell them on that.
The No. 1 charge against association health plans is that they would
result in cherry picking; that is, that small businesses that are
healthy would want to go into the association health plans; small
businesses with employees who are sick would not want to go into
association health plans. That is the exact opposite of the truth. I
think everybody who currently is trapped in the small group market is
going to want to be a part of an association health plan. Who would not
want to get insurance through a big national pool as opposed to a small
group of 5 or 10 people, if you could do it? It is simply economics. It
operates more efficiently. It operates better. It is going to lower
costs for everybody. By our estimates, it will lower costs for small
business, on average, 10 to 20 percent and reduce the number of
uninsured by millions. It will provide good quality health insurance to
others who right now are laboring with bare-bones insurance because the
market is so difficult. Everybody is going to benefit. The people who
will benefit especially are people who are trapped in small groups
where somebody has become sick.
I have talked about this subject and toured scores and scores of
small businesses. I have brought up this charge of cherry picking. I
say to people: If you had a history of medical problems and you had a
choice of working for a big company which provides health insurance the
way an association health plan would or, on the other hand, working for
a small company which is trapped in this small group market and that
was all you knew about the two opportunities--big company, national
pool; small company, small group market--and you were sick, for which
one would you want to work? I have never had a single person say: I
want to work for the small business; I think I am going to get better
health insurance there.
One of the big competitive advantages big businesses have over small
businesses is that generally they offer better health insurance.
Everybody in the job market knows it. I have had a lot of small
business people tell me: We have lost employees to big companies on the
health insurance issue. We have not been able to hire people we want to
because they went to work for a big company because they thought they
would get better health insurance.
I don't begrudge the larger companies. But why should small
businesses and their employees not have the same opportunities? This
will benefit everybody in the small business market, but it is going to
benefit most the people who are ill, or employers who are struggling
along with people who are ill and are doing the best they can to
provide good health insurance.
Here is another reason it is not association health plans that will
cherry-pick. The legislation requires that they take everybody, all
comers. Must offer/must carry. Join the association and you get the
health insurance. They cannot screen you out because you have somebody
who has cancer or heart disease or something like that.
Mr. President, it is the big interest companies now who are cherry-
picking. Just talk to people who run small businesses. When somebody in
their business gets sick and files a claim, their rates get jacked up
or they get canceled. Everybody knows it. I could give a lot of
examples. One example is Janet Poppen, a small business owner from St.
Louis. Like many small business owners, she wants to do right by her
five employees, so she tries to provide them health insurance. How many
hours and hours does Janet and people like her spend just on the
administrative details? It is hours they need to spend running their
small business.
If we had an association health plan, they would join the trade
association, and the trade association has done all that work. It just
sends them the papers and they sign up their employees. She had health
insurance through Blue Cross/Blue Shield, and one of her employees had
the temerity to get sick with non-Hodgkins lymphoma. As soon as she
started getting treatment for the cancer, Janet's premiums increased by
16 percent. That is on top of the substantial premium increases that
had occurred the year before. Her premiums had gone up 35 percent over
2 years.
This is not an uncommon story. Everywhere I go, small businesses say
that premiums are going up 15, 20, 25 percent a year, doubling over 3
years, going up by a third over 2 years. That happened to Janet Poppen,
and she is insured by Blue Cross. They are the ones cherry-picking.
Association health plans are the remedy, and to say otherwise is the
exact opposite of the truth.
One other point, and then I will close. I have trespassed on the
Senate's time enough. We ought not to turn this debate, which is one of
the most important ones we are going to have in the Senate, into a
sweepstakes. Blue Cross is doing that. They have sponsored a Web site.
There are other problems as well, but on that Web site they have a
sweepstakes. You can enter the sweepstakes to win a trip to Washington
for four people, and they will give you $300 cash on top of it. Do you
know what you have to do to enter the sweepstakes? You have to click on
the place where you can send an e-mail to your Congressman and Senator
opposing association health plans. Then you get in the sweepstakes.
Then you get a chance to win a trip to Washington--if you will just
click on the e-mail and send a letter to Washington opposing
association health plans. You don't get anything if you send in a
letter supporting association health plans. I will show the Senate
where it says enter to win.
Here is a chart, and this is the Web site now. It says that you can
make your voice heard by sending a free fax to Congress. That is what
they tell people. They don't tell you what the fax is about, that the
fax has to oppose association health plans and support their business
interests. Then they have some misrepresentations about association
health plans.
Go to the third chart. This is what you get if you do it. At least
you have a chance at this. It is a drawing. The grand prize is a trip
for four to Washington, DC, including round-trip coach class air
transportation at the U.S. airport nearest the winner's home, double
occupancy, standard hotel accommodations, two rooms, a 4-hour
Washington, DC, bus tour, shuttle bus airport transfers, and a total of
$300 in spending money. It has an approximate retail value of $4,000.
All you have to do is join Blue Cross, sending in an e-mail opposing
the association health plans. You don't get to join if you decide you
want to support them. You don't get a chance at the sweepstakes then.
I always encourage people to contact their Congressmen and Senators.
I like it when people contact me, even if they disagree with me on
something. That gives me a chance to write back and explain my
position. I have had great exchanges with constituents that way.
[[Page S10879]]
But we ought not to give people a monetary incentive one way or another
because that means the opinions we are getting are not unnecessarily
unbiased, are they?
I don't blame anybody who wants a shot at a $4,000 trip and
participates in a sweepstakes in order to get it. But I sure blame the
people who have sponsored that Web site and are distorting the debate
on this serious issue before the Senate. And this is a serious issue.
There are millions and millions of people in this country who don't
have health insurance and who need it. Most of them are stuck in a
market that isn't working and is dominated by a few competitors, and we
have a chance to change that. It doesn't even cost the taxpayers
anything. I hope we can do it. They have done it in the House with a
bipartisan vote. I hope we can do it in the Senate. At the very least,
we need a debate that is conducted honestly, conducted fairly, and that
doesn't turn health care into a sweepstakes. I hope after this we will
have it.
I yield the floor.
The PRESIDING OFFICER. The Senator from New Jersey is recognized.
____________________