[Congressional Record Volume 150, Number 65 (Tuesday, May 11, 2004)]
[Senate]
[Pages S5173-S5176]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        COVER THE UNINSURED WEEK

  Mr. DURBIN. Mr. President, the preamble to our Constitution makes it 
clear what our responsibilities shall be and puts in order that first 
we provide for common defense and then promote the general welfare. A 
lot has been said on the floor of the Senate about our common defense, 
what is happening in Iraq and Afghanistan in our war on terrorism. It 
is an issue front and center for the American people, as it should be.
  Considering that issue alone is to ignore our obvious requirement 
under the Constitution to also promote the general welfare. We need to 
look beyond the defense issue to the welfare of American citizens and 
look to specific items that concern them. This I can tell you with some 
degree of certainty.
  Pick any State in this Union. Allow me or anyone to visit that State 
and meet with businesses large and small, and families, and ask them 
what they are worried about, what do they sit and talk about, what are 
the issues that give them caution about the future.
  What I have found in Illinois, which is a fairly typical State, being 
rural and urban south and north and midwestern, as well as showing 
signs of big city with our city of Chicago, when I have visited with 
these businesses for the is that last several years--small and large 
businesses alike--their concern is the cost of health insurance. Over 
and over they say to me: Senator, we are glad you are out there. We are 
glad you are serving in the Senate. When are you going to start talking 
about issues that really count for us when it comes to our business and 
its costs?
  This year we are going to make certain that we at least raise this 
issue in debate on the Senate floor, even if we will not raise a single 
bill to be considered in the Senate to deal with this issue and grapple 
with it.
  This is ``Cover the Uninsured Week'' across the United States. An 
impressive coalition of individuals and groups have come forward. 
Former President Jimmy Carter, former President Gerald Ford, the AFL-
CIO, the U.S. Chamber of Commerce, AARP, United Way, the Catholic 
Health Association, and the American Medical Association have all come 
forward this week and said: Do not overlook the obvious. Too many 
people in America do not have health insurance.
  Mr. President, 44 million people in our country, 15.2 percent of our 
population, were uninsured in the year 2000--that was up from 14.6 
percent the year before--the largest single-year increase in both 
number and rate of uninsured people in a decade.
  When one wants to measure the strength of the economy and whether we 
are recovering, it is not enough to say a person has a job. Clearly the 
obvious question has to be asked: Does the job pay a decent wage? Is 
there any health insurance coverage involved in it?
  We are finding the raw statistics of employment do not tell the whole 
story. Keep this in mind: More than 20 million working adults lacked 
health insurance in the year 2002 and the number is growing. These are 
not lazy people, stretched out on the couch watching soap operas and 
eating chocolate-covered cherries. These are people getting up every 
morning, getting the kids off to school, getting a little bit of lunch 
together, heading off to work, knowing full well if they start feeling 
bad, if they need to go to a doctor or a hospital, they have to pay for 
the whole thing out of their own pocket.
  There are 20 million Americans without health insurance. Part of the 
reason is, of course, the cost of health insurance is outpacing 
inflation and workers' earnings. So if one is earning more money, it is 
not enough because the cost of health insurance is going up 
dramatically. Look at these charts, which show from 1996 a 14-percent 
increase in the cost of health insurance. I think that shows what we 
are faced with. Look on this chart at wages, which linger around 2 or 3 
percent.
  The cost of health insurance goes up dramatically. Premiums have 
outpaced inflation by 4\1/2\ times. For the last 6 years, health 
insurance premiums have increased more than wages. If we go to 
virtually any city in America and ask why workers are on strike, why 
they are involved in a long contract dispute, we will find the 
underlying cause is the cost of health insurance.
  Over and over again, I cannot tell my colleagues how many times not 
only business owners but members of labor unions have said to me: It is 
breaking our back. We have a dollar more an hour for the next year and 
every darn penny of it is going to health insurance and we have less 
coverage.
  This is the reality of what businesses and workers face across 
America, but it is not the reality of what we debate on the Senate 
floor.
  I have had the honor to serve in this Chamber for almost 8 years and 
in that period of time there has been no--underline no--serious 
discussion of this issue. In that period of time since 1996, up go the 
costs of health insurance premiums, down goes the conversation on the 
Senate floor and in Congress about what we can do about it as a nation.
  Since President Bush took office, the number of uninsured Americans 
has risen by almost 4 million people from 39.8 million in the year 2000 
to 43.6 million in 2002, almost a 10-percent increase. Look at the 
average premiums, from $2,426 on an annual basis to $3,060 in the year 
2002; a 26-percent increase in the health insurance premiums, and 
almost 10-percent increase in the number of people.
  In his State of the Union Address, President Bush called for high 
quality, affordable health care for all Americans and argued we must 
work toward a system in which all Americans have a good insurance 
policy. Take a look at his budget. Rhetoric in a State of the Union 
Address is almost meaningless if the President's budget does not 
address it. Frankly, this budget does not. The President calls for 
a tax credit proposal but says before we can enact it we have to offset 
it with cuts in other areas.

  I will tell my colleagues how impossible that is. As our defense 
budget goes up dramatically at historically high levels, as spending 
for homeland security goes up in our war on terror, as the national 
increase in costs for Social Security and Medicare goes up, the amount 
of money left over for everything else in our Government, education, 
health care, infrastructure, corrections, all of those things have been 
shrinking.
  We face the largest deficit in the history of the United States of 
America under this administration, which has

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given us tax cuts in time of war, virtually unprecedented in American 
history, and the largest deficit in the history of the United States. 
So when the President says we will deal with health insurance with a 
tax credit proposal and we will offset it by cutting spending in 
domestic programs, frankly, it is an empty promise.
  I will tell my colleagues what this means: A 55-year-old in America 
today buying health insurance as an individual is going to pay at least 
as high as $6,000 in annual premiums. If one is in an employer-based 
group, one might pay closer to $1,000 out of pocket. Now the President 
and many Republicans are coming forward with health savings accounts. 
Quite frankly, this is a very suspicious proposal. When one looks at 
the company that is behind health savings accounts, it turns out to be 
a very politically well-connected company. Originally, Golden Rule, 
which was out of Illinois and Indiana, became United Health Care and 
came up with health savings accounts, which frankly are not going to 
provide the relief America needs for our serious health insurance 
problems.
  Then the administration has suggested something called association 
health plans. What that means is the health insurance for groups, small 
businesses, for example, would be exempt from State regulation and 
coverage requirements. What does that mean? Right now, insurance is a 
State responsibility. My State of Illinois, the State of Alaska, and 
the State of Iowa, all of the States, have insurance commissioners to 
make certain the companies selling health insurance are solvent.
  If a company is going to sell health insurance in my State, they have 
to prove they have the money to back it up when the claims are filed.
  The State association health plans that are now being suggested would 
be exempt from State regulation, so people will not be certain of the 
solvency of the companies involved. So what is that worth? A State 
health association plan with no guarantee of solvency could be worth 
nothing, and it has been worth nothing.
  Secondly is coverage. In my State, we have requirements; if one wants 
to sell health insurance, here are the things they must cover. Let me 
give one example because it is a provision in Illinois law I added as a 
staff attorney many years ago. There was a time when one could sell a 
family health insurance policy in Illinois and exempt from coverage 
newborn infants for 30 days after they were born--a pretty smart 
provision from the insurance company point of view. The baby has a 
problem at birth, it can be very expensive. They said, if that happens, 
the family is on their own for 30 days.
  We said, no way. If a company wants to sell health insurance in 
Illinois, they cover that baby from the moment of birth and everything 
that might happen. We required it in law. When a person goes to these 
association health plans, it would exempt this coverage requirement for 
newborn coverage, for mammograms, and for many of the things we 
consider essential for real health insurance coverage.

  We asked the Secretary of Health and Human Services Tommy Thompson 
what about the state of health care in America? Do you not think we 
need to be concerned about uninsured people? Should we not move toward 
universal coverage? Here is what he said on February 3 of this year:

       Even if you don't have health insurance in America, you get 
     taken care of. That could be defined as universal health 
     care.

  What does he mean? He means if someone sick shows up in an emergency 
room, they will not turn that person away. That is Secretary Thompson's 
view of universal health care and that is why this conversation is 
going nowhere in Washington, DC. This administration has no meaningful 
proposal to deal with the health insurance crisis in America. This 
Congress is afraid to act and has refused to address it. We have 
refused to address the No. 1 business and labor issue in America today.
  In 2003, nearly half of uninsured adults postponed seeking medical 
care and over a third say they needed it but did not get it in the 
previous year. More than a third of the uninsured had a serious problem 
paying medical bills in the last year. The list goes on.
  Uninsured people still have to do their best to pay, though. If a 
person shows up at a hospital and they are provided care, even if they 
have a low-paying job, they may find themselves being hounded for the 
payment to the hospital. That is not unusual.
  I might add as a postscript, many of my colleagues in the House are 
raising questions as to why the uninsured person is charged 
dramatically more at a hospital than someone who is under an HMO or 
under a Medicaid plan. They are charged 600 to 700 percent above the 
charge of the low plans. I am speaking about people who have no money 
to pay.
  Bertha Hardiman, who is a 60-year-old laundry worker in Chicago, 
makes $17,000 a year. She was sued by a Chicago hospital because of a 
$6,200 hospital bill. A law enforcement official showed up at her door 
with a summons. She worked out a payment plan. This 60-year-old lady is 
paying $200 a month, 15 percent of her monthly take-home pay.
  A hospital in Champaign-Urbana in my State filed a collections 
lawsuit against Kara Atteberry, a 26-year-old single mother of 
two. They said she failed to pay $1,678 after treatment for a 
miscarriage. She is a waitress at a pizzeria. She was unable to get off 
work to go to the court hearing and a arrest warrant was issued. She 
turned herself in to the authorities because she didn't want to be 
facing the embarrassment of being arrested in front of her daughters. 
That is what happens in America when you are working at a low-wage job 
and you have a hospital bill of even $1,600 that you can't pay.

  There is a better way. We have to first look at the obvious. 
Businesses are overwhelmingly looking for ways to save money on health 
care. This shows the number of businesses that have been shopping for 
new plans, the number of businesses that have changed health care 
plans, that are in a constant search to find affordable health 
insurance because, frankly, it is outstripping their ability to be 
profitable and to pay their workers.
  How big an obstacle are health insurance costs in hiring? Take a look 
at this chart. When, you ask, is it not an obstacle for businesses in 
America? An obstacle? Look at the numbers: 71 percent of the businesses 
in 2000 said health insurance costs were an obstacle to hiring 
employees, 64 percent in the next year, 71 percent in the year 2002, 
and 78 percent in the year 2003.
  I am glad my colleague Senator Blanche Lambert Lincoln of Arkansas 
has come to the floor because she and I believe this conversation 
should not stop with a lot of complaints.
  We ought to be moving forward in a constructive way. What we suggest 
is very basic. We think American businesses and workers should be 
entitled to the same health insurance opportunity to which Senators and 
Congressmen and Federal workers are entitled.
  The Federal Employees Health Benefits Program is an amazing 
opportunity. We have the best health insurance in the world. Is it our 
own creation? No. We shop in the marketplace. Each year we have an open 
enrollment period for every Federal worker, to pick the best health 
insurance plan for their family. My choice in Illinois is seven to nine 
plans each year from which to pick, for my wife and myself. How much do 
we want to pay? What kind of coverage do we want? We go shopping as 
people shop for a car.
  What we are suggesting is creating a pool of health insurance 
coverage for small businesses and groups around America, very similar 
to the Federal Employees Health Benefits Program. It would basically 
give these small businesses an opportunity to be part of a purchasing 
pool that is very large, to shop with individual private insurance 
companies, and to get the benefits of lower costs. We think this is a 
fair way to approach it. Senator Lincoln will give more detail on that 
as she addresses the Senate this morning.
  I yield the floor.
  The PRESIDENT pro tempore. The time of the Senator has expired.
  Mr. REID. On my time, I ask a question of the Senator. I ask the 
Senator to comment through the Chair.
  A lot of people think that doctors are getting fat in our modern 
society. The fact is, in Nevada--I am sure it is the same in Illinois 
and Arkansas--doctors are having a difficult time with the managed care 
programs and the mass numbers of uninsured.

[[Page S5175]]

  So I ask, does my friend agree that we in this Congress are doing 
things not to help the physician himself? For example, we come to this 
floor often and talk about medical malpractice reform, setting caps. 
Half the doctors you talk to recognize that is not going to help them. 
But a program the Senator from Illinois has advocated, and I have 
joined with him, giving an incentive taxwise, a tax credit to a doctor 
for insurance premiums, they would love that because it would give them 
immediate help.
  The point I am making is we have a health care crisis in this country 
and the physicians are part of it. They are not doing as well as I 
personally would like. Would the Senator agree with that?
  Mr. DURBIN. I thank the Senator. In response to his question, let me 
tell you if I am sick or a member of my family is sick, and I look up 
from that gurney, I want to see the best and brightest physicians in 
America looking down at me, and I want them to feel they are being 
rewarded for many years of study and hard work. They are facing 
frustration today because HMOs are taking away their power to make 
medical decisions.
  Second, I believe there are costs of practice, which include 
malpractice premiums. In my State, they are terrible. The increases in 
some areas are unbearable and physicians are retiring from practice. I 
do not believe putting a cap on the monetary recovery of innocent 
victims of malpractice is the answer.
  As the Senator from Nevada has alluded, I think the way to approach 
this is to make sure we help these physicians pay for the malpractice 
premiums with a tax credit. Let us give them a helping hand. Let us 
recognize we need to do something about it. I think it is incumbent 
upon us in the Senate, with a leader who is a medical doctor, Senator 
Frist, to come together on a bipartisan basis. We can do this. We can 
have good, affordable health care in America. We can start expanding 
insurance instead of reducing it. We are not going to have a jobless 
economic recovery and we are not going to have an economic recovery 
where people don't have health insurance, and have this country believe 
we are moving in the right direction.
  Mr. REID. Mr. President, I yield 10 minutes to the Senator from 
Arkansas.
  The PRESIDENT pro tempore. The Senator from Arkansas is recognized 
for 10 minutes.
  Mrs. LINCOLN. Mr. President, I thank my colleagues from Illinois and 
Nevada for being here to talk about an issue critical to our country. I 
rise to speak about the same issue, the growing crisis of the uninsured 
here in our great country. I have devoted a great deal of time and 
energy during my career in public service to develop solutions to our 
health care crisis. I believe it is critical, as Senator Durbin has 
mentioned, that we begin by dealing with this problem of the uninsured 
and doing it now.
  This is an issue on which we can come together and work through our 
differences and produce a product that actually is not only going to 
provide a better quality of life for all Americans, but it is also 
going to be an enormous step in dealing with the economics and the 
budgetary concerns that we have in our country today.
  One of our No. 1 employers in most of our communities in rural 
America are our health care providers. It is not just that the health 
care providers provide us with the quality of life and the medical care 
we need, but they are also a huge part of the economy in this country, 
if we can begin to work toward balancing that out and making sure we 
can predict what people's needs are going to be and where that payment 
is going to exist.
  The fact is, the number of uninsured in our country is alarming and 
it must become more of a national priority. One of the ways we have 
noticed it tremendously in our State of Arkansas is the number of 
uninsured who serve in our Guard and Reserves. We have found they are 
uncovered until they are activated. It creates a huge national crisis 
in many instances because we can't call these individuals up until they 
meet military health specifications. Most of them are employed by small 
businesses, so they are not getting the health care they need.
  The consequences of not addressing this problem are enormous, in 
terms of our Nation's physical and economic well-being. Right now, as 
many as 44 million Americans are uninsured. The vast majority, over 80 
percent of the uninsured persons under the age of 65, are part of 
families where at least one family member is working. Many times, these 
individuals' jobs do not provide insurance or the coverage offered is 
too costly, given their limited incomes. Buying insurance on the 
individual market is unthinkable for many because the costs can be even 
higher in that marketplace.
  In my home State of Arkansas and in other rural States, the health 
care crisis has its own special character. In Arkansas, over 400,000 
lack health insurance. Given the scope of this problem in Arkansas and 
nationwide, we need to develop innovative solutions to ensure people 
get the coverage they need.
  Why is access to health insurance so critical? Many believe even if 
people don't have access to insurance, that they still have their 
health care needs taken care of. I have no earthly idea where they come 
up with this misconception.
  The truth is, without health insurance many Americans find themselves 
faced with a barrier to health care. Uninsured families have less 
access to important screenings, the state-of-the-art technology that we 
have so meticulously developed, and prescription drugs. Uninsured 
adults have a 25-percent greater mortality risk than adults with health 
care coverage. An estimated 18,000 deaths among people younger than 65 
are attributed to the lack of health insurance coverage every year.
  Uninsured adults with chronic conditions such as diabetes, 
cardiovascular disease, HIV infection, and mental illness have less 
access to preventive care and have worse clinical outcomes than insured 
patients. Uninsured adults negatively affect our health care providers 
and local economies, too.
  Senator Reid from Nevada brought up the issue of our health care 
providers who are trying desperately to provide needed medical care. A 
community's high rate of uninsurance can adversely affect the overall 
health status of the community, the financial stability of its health 
care institutions and its providers, and access to emergency 
departments and trauma centers. I can assure you hospitals in Arkansas 
will tell you how much uncompensated care jeopardizes the access to 
health care for the communities they serve.
  The facts make it clear. People without health insurance don't have 
their health care needs taken care of. Those who lack health insurance 
don't get access to timely and appropriate health care. For Americans 
without health insurance, children and adults suffer worse health and 
die sooner than those who have health insurance.
  It is clear the uninsured who have inadequate health care options 
tend to fend for themselves in the marketplace and with health care 
providers. Working families need help with this problem and they need 
it today. The lack of insurance also creates tremendous financial 
obstacles for working families. If an uninsured family member has 
serious health problems such as cancer or a heart attack, the bills can 
destroy the financial foundation of that entire family. Uninsured 
families are more likely to pay a higher percentage of their income for 
medical care, and often will have to borrow money from family members 
to cover medical expenses. The reality is debt from medical expenses 
often drives the uninsured into bankruptcy. In my home State of 
Arkansas, the No. 1 cause of bankruptcy is high medical bills.
  Recently, I, along with Senator Durbin, Senator Carper, and Senator 
Reid, introduced legislation in the Senate to help more Americans get 
access to health insurance coverage through their employers. We know 
that is the most logical place for them to access it.
  Small businesses are the No. 1 source for jobs in Arkansas. What 
better way to help our economy than to help these small businesses 
offer affordable health care options. More than half of workers in 
firms under 100 people make less than $25,000 a year--$25,000 a year, 
and they don't even get the child tax credit when we don't make it 
refundable. Can't we at least do something about providing them some 
health care? A

[[Page S5176]]

high proportion of businesses with low-wage workers are much less 
likely to offer insurance.
  Our bill, The Small Employers Health Benefits Program Act, will 
provide the self-employed and the small businesses with a variety of 
private insurance plans. This approach would give these employers 
access to a larger purchasing pool and negotiated rates for health 
insurance. They would get more choice at lower costs--exactly what we 
as Federal employees get. The purchasing pool will be similar in the 
structure to the Federal Employees Health Benefit Program to which all 
Government employees across this great country have access.
  This is a far cry from the associated health plans some folks here in 
Washington talk about. These other plans--AHPs--allow companies to 
cherry-pick only the healthiest workers, leaving a pool of the sickest 
and neediest without coverage. That is not a way to attack this 
problem. It is only going to drive up costs in the long run.
  Our plan would provide more comprehensive coverage to a far greater 
number of workers. We have seen its success in what it provides to us 
and to our workers in the Federal Employees plan, not to mention all of 
the others who work in Federal Government across this land, from rural 
areas to urban areas.
  We have seen the increase in our ability to offer them choice and 
better cost. If we can make health insurance more affordable for all of 
these workers through their employers--all of these small-business 
workers--we would not necessarily solve the problem of the uninsured, 
but we would certainly make an enormous dent in it.
  Our plan would go a long way toward making health care more 
accessible for millions of workers and their families. After all, more 
than half of the private sector workers in the United States are 
employed by small businesses, and many of these businesses struggle 
with the cost of providing quality health coverage. That would go a 
long way toward helping to ease some of the anxiety and concerns people 
in this country are feeling. In my home State, 76 percent of businesses 
have fewer than 50 employees, so Arkansans would benefit greatly from 
this program.
  I have heard from many of our small-business owners in Arkansas who 
have been forced to drop or reduce their employees' health coverage 
because of the high cost. But it is not just small businesses. Health 
care and health care costs in this country are the first item of 
business for anyone who comes into our offices to talk to us about 
their needs and concerns.
  These small-business employers want to provide their employees with 
the best coverage possible because they recognize how valuable health 
insurance is as a tool for boosting recruitment, retention, and 
employee morale, not to mention their production. They are so much more 
productive when they have healthy people in their workforce.
  Clearly, health insurance can play a vital role in the overall 
success of a small business. Our plan would help our small-business 
owners provide employees with health coverage at a much lower cost--a 
win-win situation for everyone.
  With solutions such as this, health insurance plans for small 
businesses, we can ensure health coverage is a fundamental component of 
every American worker's economic security.
  We must make the growing number of uninsured in our country a 
priority. It must be a priority we all embrace in the Senate. It is 
clear working families are not getting the health care they need. Let 
us come together and do something good for the hard-working folks in 
this country who can't afford health insurance today.
  For those who can't get access to the most basic of preventive 
medicine, Congress needs to address this issue. The high cost of health 
care in the United States is giving other developed countries an 
advantage in keeping and attracting jobs.
  For each car they build, DaimlerChrysler AG pays about $1,300 in 
employee health care costs. When they make a car in Canada, they pay 
hardly anything. That is why the Big Three automakers actually lobbied 
the Canadian Government to maintain their national health care system.
  At a time when jobs are leaving our country, at a time when health 
care insurance premiums are rising by leaps and bounds and working 
families are feeling insecure about their jobs and health care 
coverage, Congress must do something, and we can do it now.

  Mr. REID. Mr. President, when we finish with morning business, we 
will have about 15 minutes remaining to speak on the Cantwell 
amendment. All Senators who wish to speak on the Cantwell amendment 
should get over here at about 10 after 11. Time will be equally 
divided. That is the only opportunity to speak on the Cantwell 
amendment today prior to the vote.
  The PRESIDING OFFICER (Mr. Sununu). The Senator from Utah.
  Mr. BENNETT. Mr. President, what is the time situation?
  The PRESIDING OFFICER. The majority controls 30 minutes of morning 
business, and the time of the minority has expired.
  Mr. BENNETT. Mr. President, I will claim such portion of that time as 
I may consume up to the 30 minutes.
  The PRESIDING OFFICER. The Senator is recognized.

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