[Congressional Record Volume 150, Number 66 (Wednesday, May 12, 2004)]
[Senate]
[Pages S5245-S5248]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH INSURANCE
Mr. THOMAS. Mr. President, I would like to take the first 10 minutes
of our 30 minutes and talk a little bit about the uninsured and talk a
little bit about insurance, of course. I am pleased this is uninsured
week, that we are focusing on that problem of uninsured folks. I think
it is a great thing that we ought to be doing. There are some
alternatives that we can pursue.
I have been particularly involved in the rural health care aspect,
being from Wyoming where, of course, almost all of our health care is
rural health care. We have had good results in our Medicare bill that
was passed last year. We have equity pay for the providers in that
bill. We have assistance for those serving underserved areas. We have a
number of things that are very necessary. I am pleased they are there.
We have been focusing on Medicare, of course, because that is the
Government's responsibility directly. We have made some good progress
on that. Among other things, we seek to help seniors with
pharmaceutical costs. We have a program out there. I am a little
disappointed the minority leader is nothing but critical of it. It is
out there and we ought to be trying to make it work now rather than
trying to oppose it for political reasons. I think that is a mistake.
There are opportunities out there for the elderly to enjoy a
considerable amount of assistance, particularly low-income people, with
the $600 assistance in addition to a 20-percent reduction. The fact
that there are 70 cards out there--all you have to do is call 1-800-
Medicare and get the advice that is necessary to do it. I wish we
could support something instead of totally always being critical.
In any event, we have worked on those, and I think it is time that we
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look, now, at the broader aspects of health care. That includes many
other things. We have a great system. We have probably the best health
care system in the world. However, if that system gets in the position
where access is limited by the costs, then of course we are not making
it possible for everyone to participate. That is really where we are.
The costs of health care have increased substantially. There are lots
of reasons for that. One of them is the new equipment that is being
used, which everybody wants to take advantage of, of course, because it
is the high-tech stuff.
Another reason, obviously, is the liability problem we have tried to
address on the floor a number of times, and we have not been able to
move past the obstructionism on the other side. The liability problem
not only results in the cost of the liability insurance going up, but
it also results in having more testing, more specialists, more costly
health care simply to avoid the opportunities that people might have to
sue. So there are a lot of things.
I had the opportunity not long ago to talk to the management of one
of the largest hospitals we have in Wyoming. It was interesting when
the financial officer broke down the situation with regard to the
funding. First, he talked about the billing level, which, of course, is
quite above the cost level because they need to bill some more than it
costs to make up for those who do not pay. But the point was, they
broke down the number of people who were there, the number there in
Medicare, the number there on Medicaid, the number that had their own
insurance, the number that were uninsured, and the emergency ones. Part
of the problem is Medicare is not paying the full cost, Medicaid does
not pay much of the cost at all, so then you get to the uninsured and,
of course, many of them do not pay, are not able to pay at all, and you
have the emergencies, so what happens? It goes to those of us who have
insurance.
As I go about my State talking to people, I hear more about the cost
of health insurance than anything else that you talk about in a town
meeting. It is largely because of some of those shifts there.
As has been pointed out, we have over 40 million Americans who do not
have health insurance, and that is unacceptable. We need to do
something about that. The cost of health care--of course we ought not
to forget that continues to grow almost unchecked. It has grown to $1.6
trillion in 2002, a 9.3-percent increase over the previous year. You
cannot keep having a 10-percent increase in these costs and yet be able
to deal with them. The health care cost portion of the gross national
product in 2002 was nearly 15 percent, up from 14 percent the year
before.
This is part of it that we ought not forget--the cost of health care.
We ought to look at the costs as well as who is going to pay.
Unfortunately, that is about all we ever talk about--who is going to
pay. There is more to it than that. These rates cannot continue to grow
at that rate.
We have had a considerable amount of planning in our State with
respect to the uninsured. We had a group--I am glad there has been a
task force here, and we have about 14 percent of our people in Wyoming
who are uninsured.
It is largely because of the cost. We have a number of things,
however, that have been suggested which I think we ought to take a look
at. There are some important special recommendations.
We could expand public programs such as Medicaid and CHIP. The
minority leader was just talking about the CHIP program and why it
should be such a surprise since it has been there for a good long time.
It is one that the States participate in funding. We need to do that.
It needs to be funded at the full level by the States.
We need to provide a buy-in option for public programs so people have
an opportunity to buy into these programs that now exist. We need to
increase the reimbursement for public programs. They are not paying
their share. Therefore, private insurance goes up, and those people who
can't afford it or even come close to affording it are even less likely
because it has gone up more.
We need to target tax credits and Federal subsidies. I think tax
credits are valuable. That would allow people to take a higher crisis
sort of a policy.
Community health centers that deal with people who aren't able to
have insurance and need help is an excellent way to deal with this.
Of course, we need to do something to help participation of employer-
sponsored programs. That is not the only answer because a lot of people
are self-employed.
Of course, we also need to push for personal responsibility for
health. An interesting program has been talked about in Wyoming. It is
a group called the ``Be Well Program.'' They would deal with employer
groups that cover their employees. The employees would sign an
agreement to keep up their own health, to exercise, and do some of the
things that we all talk about and which not everyone does. That would
be a condition of being insured. It is already in a couple of
contracts.
There are a lot of things to do, and the task force has a number of
ideas. I think we need to move forward to try to do some things. Most
of us I don't believe favor a socialist program where the Government
runs all of the health care programs. That is evidently not the kind of
thing we want to have because all of the Canadians would come here.
But, nevertheless, there needs to be a program that gives an
opportunity for people to fully participate. I am delighted that we are
moving forward with it.
I yield the floor.
The PRESIDING OFFICER. The Senator from Missouri.
Mr. TALENT. Mr. President, thank you for recognizing me. I came out
on the floor to talk for a few minutes about the health care task
force, and particularly about association health plans or small
business health plans.
I am very pleased that we are talking about the health care task
force report. I want to talk a little bit about the drug discount card
in part because I think it is important that we talk about it. I want
my senior citizens to be aware of this benefit and to use it. I think
it is something everyone ought to consider. For many of them, it is
going to be the relief they have been looking for many years.
I want to say that it is hard for me to understand these attacks
which are occurring on a fundamental level against the discount card.
Without question, this card is going to provide relief to tens and tens
of thousands of people who have been choosing between the other
necessities of life and their prescription drugs.
There are 200,000 senior citizens in the State of Missouri today who
are buying prescription drugs entirely out of pocket. It is not very
good for them for two reasons: In the first place, they are buying
entirely out of pocket. They are paying for it entirely on their own.
In the second place, they are paying the highest price entirely on
their own. When they walk into the pharmacy to get prescription drugs,
they are facing the prescription drug companies alone. They are not
part of a broader pool that has purchasing power and is able to
negotiate a discount over the sticker price of the drugs. So they are
paying the highest price, and they are paying it entirely out of
pocket. Many of them are the poorest senior citizens. As a result, they
do not get the prescription drugs. They get sick, or they take every
other pill.
I have talked personally to scores of people like that over the
years. I had a hearing of the Aging Committee that Senator Gregg was
kind enough to let me hold in Missouri. I had senior citizens come and
testify.
Everybody in the Senate is familiar with this. This discount card is
going to provide relief. Seniors are going to have access to a variety
of cards that will give them discounts off the prescription drugs. For
lower income senior citizens, those receiving retirement of less than
$1,000 a month, they will get $600 from the Government toward the price
of the discounted drugs. The average price, which it is for
prescription drugs, for senior citizens is about $1,400 a year for
prescription drugs. That person in Missouri right now is paying the
entire $1,400 out of pocket, and probably more than that since they are
paying the highest price. With a card, they will go into the pharmacy,
the pharmacist will swipe the card through the machine and say: For
your Lipitor, which was costing you $80 a
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month, under this card it costs you $65 a month. The first $600 of that
this year the Government is paying for it. Instead of paying $1,400,
which you couldn't pay--they get nothing, is what it comes down to--
they end up getting a $200 or a $300 discount, and the Government pays
$600 off of that, and they can afford not to get sick anymore.
I think that is pretty important.
I understand the concerns on the other side of the aisle that this
bill isn't Government-dominated enough. I recognize that. They are
saying basically this is federally subsidized, but they are buying the
prescription drugs from private organizations. That is not a good
thing. It is true. This is federally subsidized, but we are buying the
prescription drugs from private companies.
There is a word for a Federal health care plan that pays for health
care costs of senior citizens so that they can go to private companies
and get health care services or goods. Do you know what the word for
that is? Medicare. That is what Medicare is. When Medicare was set up
in 1965, the Government could have gone on and done what it has done
with the VA health care system--buy or build new hospitals, hire
physicians, and run the whole thing as a Government organization. We
didn't do that. What we did instead was set up a system where we would
pay for the cost of Federal health care, but seniors would have a
choice of private providers if they wanted. That is what this
prescription drug plan is about, what it is modeled after.
It is going to help tens of thousands of people in my State of
Missouri at a minimum.
I hope we can get behind it and make it work as well as we can
possibly make it work.
Let me switch now to talk a little bit about the health care task
force which addresses another huge problem; that is, the rising cost of
health insurance premiums.
There are a number of things in this health care task force report. I
recommend it to every Member of the Senate.
One of the key things about it is that it is designed to attack the
trends in the system which are driving those costs up. I really like
this. It is time for us to stop concentrating on how we can keep
feeding this beast and start getting the beast on a leash, if you will.
It is fine to subsidize the cost of health care for people who can't
afford it. I certainly support it. I just talked about prescription
drug costs. But we also need to bring down the costs of health care.
There are a lot of things in this report that are designed to do that.
Liability reform is one of them. Another is the emphasis in the
report on the use of information technology, which is very important.
Health care is behind in information technology. If we can get the same
kind of architecture of technology in health care that we have in other
parts of the economy, we have the potential to save tens of billions of
dollars.
There is important regulatory reform in the bill that will lower
cost.
I met with a bunch of nurses and nursing students at Southeastern
Missouri University and asked them what their big concerns were about
health care. I was really surprised. The thing that bothers them the
most is the amount of time they have to spend in filling out forms to
comply with the oversight of one group or another. It is very
demoralizing, and it raises costs.
The task force also includes associated health plans, which I want to
talk about briefly.
Of the people who are uninsured--there are about 43 million--two-
thirds either own a small business, work for a small business, or are a
dependent of someone who owns or works for a small business. We can ask
ourselves, why is that? Is it because small businesspeople are more
chintzy than big businesspeople? Small businesspeople and farmers do
not care about their employees as much as the larger businesses? They
do not want to buy health care? That is one possibility. But I don't
think it is true.
The reason many of these people, working people who work for small
businesses, are not getting health insurance is that costs for buying
health insurance are higher for small businesses than they are for
bigger businesses because the administrative costs cannot be spread
across as big a pool. The costs of getting health insurance for someone
who runs a small business are about three times per employee what they
are for someone who runs a big business.
Small business health plans allow small businesspeople to pool
together through a national trade association and get health insurance
as part of a big national pool.
My brother owns a Little Tavern restaurant. It is a great place. I
have talked about it before in the Senate. If anyone is ever in the St.
Louis area and wants a good hamburger, give me a call and I will give a
recommendation. My brother has a little restaurant. He could join the
National Restaurant Association and become like a little division of a
big company. He would get health insurance then as part of a 10,000,
20,000 or 30,000-person pool, the same as the employees of Anheuser-
Busch, which is located in St. Louis, or the employees of Hallmark,
which is located in Kansas City. It will lower his costs 10 to 20
percent by reducing the administrative costs. It would not cost the
taxpayers anything because we are not feeding that beast with tax
dollars. We are empowering people to put the beast on a leash to reduce
costs that are driving up health insurance premiums without adding
anything to quality or accessibility.
There is no reason we should not do this. I am pleased it was
included in the task force report. We worked on it. I hope we can get
it, along with the other things in this report.
We have to remember that as the Democratic leader was saying, if
Americans are working and do not have health insurance, or they have
health insurance and these costs continue to go up, this is the No. 1
thing employees worry about as far as their job is concerned. I have
had a lot of folks in the last recession--and I am pleased we are
coming out of this now--who lost jobs and said to me, We have families;
we have to get our health insurance back. It is very difficult to
provide it when premiums go up and up and up all the time.
We can do something about it. There are a number of different ideas
out there. Many of them are in this task force report. I commend it to
the Senate. It is time to get these things done. We can all come down
here and talk about stories back home of people who are suffering
because of this situation. We need to get something done. It would be a
huge step forward if we all said we are going to sit down as a group,
we will work something out, we will agree beforehand we will not
filibuster everything because we do not like this particular aspect of
the package or that particular aspect of the package. We are not going
to take small things we disagree with in a bill and treat them as if
there is some enormous attempt by people--whom we disagree with
honestly--to do something that is venal or wrong. These problems are
big enough to solve if we try to stick together and agree where we can
agree and disagree reasonably where we do disagree. They will be
impossible to solve if everything becomes a subject of some kind of a
political attack.
I appreciate the time of the Senate and I yield the floor.
The PRESIDING OFFICER. The Senator from Texas.
Mr. CORNYN. Mr. President, I commend the Senator from Missouri for
his advocacy on the part of his constituents and, indeed, all the
American people, to make sure more have access to good quality health
care.
I will talk about the work of the task force created by Majority
Leader Frist, which was chaired by Senator Judd Gregg of New Hampshire.
This work, over the last number of months, promised a lot in terms of
new ideas and new approaches. It will help make sure health care is
accessible to more Americans.
It is amazing, but we spend in this country somewhere between $1.4
trillion and $1.7 trillion on health care. That is a lot of money, even
in Washington. Most people cannot even get their minds around what $1
trillion is. I promise you, I cannot. But I do know that is an enormous
amount of money.
If we ask people who should know about it, they will say there is
enough money in the health care delivery system in the United States of
America to make sure everyone has access to
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health care. The problem is what we call sometimes a ``health care
system'' is not a system but a patchwork of different delivery methods.
It is a local taxing jurisdiction, hospital districts, using property
taxes in some States, of course supplemented by other taxes, and of
course there is Federal Government-provided health care available,
partially, at least, through the CHIPS Program, through Medicaid and
through Medicare.
We do know there is a tremendous challenge to make sure everyone in
this country has access to good quality health care. Those who do not
have health insurance represent one of the biggest challenges. One of
the things we have learned is this is not so much a challenge of
getting everyone insurance. The real question is, How do we make sure
everyone has access? Even for those who do not have health care
insurance, we need to make sure they have access to health care.
Right now the irony is the Federal Government has already gotten into
this area and mandated if you have nowhere else to turn for health
care, you know you can always show up at the local emergency room at
your hospital and get that health care provided. If you cannot pay for
it, it is provided without charge to the patient. The problem is, in
many major metropolitan areas on any given Friday or Saturday night,
when the demands on the emergency room are great, many emergency rooms
are on divert status, which means they cannot take anymore patients
because they are full.
However, 80 percent of those people being treated in emergency rooms
could be and should be more humanely, more efficiently, and less
expensively provided health care in some other setting--in a clinic,
for example.
One of the most amazing things about our health care delivery system
in our country, while we do compensate--although some argue it is not
as generous as it should be--we do compensate health care providers for
providing health care to people after they are sick, we do a pretty
lousy job of trying to give people access to what they need in order to
prevent their getting sick.
We have made good strides forward with the Medicare bill we passed
last year to provide prescription drugs to many seniors who did not
have that. Of course, this Medicare discount drug card Senator Talent
talked about is an interim step that leads to the full implementation
of that program in a couple of years when the vast infrastructure can
be created to deliver that system.
For example, for someone who has not previously had access to a drug
like Lipitor, one of the statin drugs--and there are a number of them;
that is just one trade name--that perhaps can prevent someone from
having to have more expensive, invasive, and dangerous surgery, either
bypass surgery or angioplasty or perhaps placement of a stent, or
something that costs a lot of money to treat if the basic cause that
could be prevented is left untreated through the use of prescription
drugs.
We have made a great step forward to broaden the number of people, to
increase the number of people preventive measures are available to.
That is smart. We ought to continue along that trend.
Mr. President, I ask to be reminded when I have 1 minute remaining of
my time.
One of the things I believe is a great safety net in this country,
that I have come to learn about and see used so well in my State, is
federally qualified community health centers. The great thing about
community health centers is they provide clinical--that is,
nonemergency room--access to health care in your neighborhood, where
you pay based on a sliding scale, based upon your ability to pay. These
are actually designated health centers by the Federal Government. They
have access to a number of important programs, for example, the Federal
340B Discount Pricing Program. This task force recommends that program
be expanded to more people, so we can bring down the price of
prescription drugs.
But these community health centers provide, on a sliding scale,
access to care in one's local community, which I think is very
important. I was told by the head of Parkland Hospital, one of the
largest public hospitals in Dallas, TX, for example, that people show
up in the emergency room to have a baby, where they have no health
insurance. Because they have no health insurance, and may never have
seen a doctor before they show up in the emergency room, the risk of
injury to that baby--either it being born prematurely or some other
health risk--goes up exponentially.
Even though they do not receive any income for it, Parkland Hospital
routinely provides prenatal care for mothers, on a free basis, even
though they do not get a penny paid by that pregnant mom. One reason is
because they know the cost of 1 day in the neonatal intensive care unit
at the Parkland Hospital costs about $10,000. Now, of course, I would
like to say we would do that from our sheer desire to see healthy
babies, but, unfortunately, money drives access.
My point is, in this instance what Parkland Hospital, in Dallas
County, has decided to do in a way to help control costs is to ensure
more healthy babies are born who do not need access to the neonatal
intensive care unit, as they provide free prenatal care to these
pregnant moms. But community health centers can make sure this pregnant
mom has access to somewhere other than the emergency room of the
hospital in which to get that important prenatal care.
We also would increase, as part of this task force report, the number
of medical volunteers by extending critical Federal tort claims act
liability coverage. This is an area that I think is very important.
The PRESIDING OFFICER. The Senator has 1 minute.
Mr. CORNYN. That is very important because the medical liability
crisis in this country does not only hurt doctors and hospitals, but it
hurts patients who are denied access to health care. One of the issues
we have to deal with--I know the leader has brought it up several
times, and we have been unable to get 60 votes to get an up-or-down
vote on the merits of the legislation--is medical liability reform.
Whether it is increasing access to specialty care, increasing the
number of federally qualified community health clinics, increasing
access to prescription drugs by extending the Federal 340B Program, or
creating an exemption so religiously sponsored health systems can
create community health systems, integrated health systems, we have to
do something about this crisis in this country. It is a crisis of
access, not only of insurance. But I think we are well on our way to a
good start.
I yield the floor.
The PRESIDING OFFICER. The Senator from Nevada.
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