[Congressional Record Volume 150, Number 67 (Thursday, May 13, 2004)]
[Senate]
[Pages S5387-S5389]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
COVER THE UNINSURED WEEK
Mr. KOHL. Mr. President, today I rise to address the growing problem
of the uninsured in America. This week is Cover the Uninsured Week. It
is not only appropriate but necessary that we take this time to
acknowledge the tragedy of American families living without health
insurance, and often, as a result, without adequate health care.
Solving this problem is going to take a lot more than talk; it is going
to take decisive action by the Congress and, very importantly, by the
administration.
The number of Americans without health insurance continues to grow.
In 2002, 15 percent of our population--over 43 million Americans--were
uninsured. Since the year 2000, 3.8 million more Americans have become
uninsured. While Wisconsin is doing better than the national average,
we still had nearly 474,000 people uninsured in 2002--almost 10 percent
of our population.
More than half of the nonelderly uninsured are full-time workers or
their spouses and children. It makes no sense to blame this staggering
figure just on business. Good businesspeople want to provide health
insurance to their employees. They know the value of a workforce that
is receiving necessary preventive health care. They know the bottom-
line productivity losses that occur when workers have to struggle with
the costs of a serious illness in their families, and they are, in
great part, family members themselves, often relying on the same
insurance coverages as their employees, never wanting to see someone
they work with suffer because they cannot afford adequate health care.
Businesses want to offer solid, affordable health insurance to their
employees, but it is getting harder to find every year.
As premiums increase at double-digit rates every year, employers are
forced to drop coverage or pass on more costs to their workers in the
form of higher cost sharing, deductibles, and copays.
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Too often employees' wage increases are more than consumed by the
higher health care costs they face.
This crisis affects everyone. A recent study by the Kaiser Commission
estimates the United States could spend $41 billion for uncompensated
care for the uninsured in 2004. Eighty-five percent of that will be
paid by Federal, State, and local governments using taxpayer funds.
This issue has reached a crisis point. Yet it has been 8 years since
Congress enacted meaningful health insurance reform. Further, this is
not a partisan crisis. It is a national crisis. It will take a national
solution, bipartisan and resolute, ambitious and courageous. That means
we will need to reorder pet projects and other priorities in order to
devote significant new resources to covering the uninsured. That means
we need to give up political rivalries and partisanship in order to
consider any good idea, regardless from which side of the aisle it
comes. It means we need decisive leadership and commitment from the
top; namely, from the President himself.
So far we haven't seen much of that. The proposals the President has
put forward would barely scratch the surface and some would create more
problems than they solve. With over 43 million Americans uninsured,
less than 3 million will be covered by his proposals, and they offer
nothing to stem the rising health care cost problems we face. The
American people deserve a more serious effort.
When the President makes something a priority, we see action. When
the President wanted tax cuts, he pushed two massive bills through
Congress. When the President wanted authorization for war in Iraq, he
successfully argued long and hard, not only here but all over the
world, for the authority he needed. If the President wants to make the
uninsured a priority, he has the influence, the control, and the
position to make it happen.
I know there is no silver bullet for dealing with the cost of health
care. It will take a variety of solutions to expand coverage to the
uninsured and help reign in the skyrocketing cost of health care. And
it will take a combination of market and government-based solutions. We
should look at proposals like tax credits to help small businesses
afford health insurance, expansion of Government programs that work,
like Medicaid and the State Children's Health Insurance Program,
increased funding for community health centers, encouraging more
purchasing pools, and the greater use of technology to improve quality
and cut costs.
Whatever the combinations are, it is time to have this debate. This
administration needs to step up and provide leadership. We cannot
ignore the crisis or wish it away. We cannot waste more time on sound-
bite solutions that do nothing to solve the problem. We need to fight
the plague of the uninsured the way we have fought other threats to our
way of life and our basic values. This fight we desperately need to
win.
I yield the floor.
The PRESIDING OFFICER (Ms. Murkowski). The Senator from New Jersey.
Mr. CORZINE. Madam President, I compliment the Senator from Wisconsin
for his remarks. I will be giving a similar presentation, but I think
there is not a more important domestic issue, one that is impacting the
quality of life for middle-income and moderate-income Americans more
than almost anything in their private financial affairs. Obviously, it
is having a major impact on business and the quality of our economy. I
don't think there is a more important issue for us to debate and to
achieve those necessary elements that will change the terms and
conditions so we can address the 44 million uninsured, but also provide
the kind of underlying support for the quality of life for Americans we
have come to expect. This is the priority domestic issue.
I compliment the distinguished Senator for his remarks. I hope I can
be as eloquent.
I do want to make sure I speak out on this issue. I have been talking
consistently about the state of our economy, particularly the squeeze
middle-class Americans have. Health care costs are absolutely at the
top of that list, but we see it in tuition costs at colleges and
universities, property taxes, gasoline prices, and energy prices. There
are a number of things that are impinging the ability of middle-income
and moderate-income families to navigate the American economy. But none
of those is more troubling than both the access and the affordability
of health care.
Today there are roughly 44 million Americans without health coverage.
Those who do have health coverage are seeing increases in their costs.
Particularly those who are part of group programs see that costs rise
exponentially. We are seeing that carry through into the challenges in
our budgetary policies in Washington with regard to Medicare and
Medicaid. Costs are truly phenomenal.
The average cost of a family health insurance policy today is roughly
$10,000 a year. A study released this week by the Kerry campaign shows
there has been a $2,700 increase in the average annual family premium
per year over the last 3 years for those who have insurance, 4 times
the rate at which family income has grown in the last 4 years.
I have to say this is a particularly troubling issue for those folks
in the State of New Jersey, because we have had the highest rate of
premium increase of any State in the Nation. I am hearing a lot of
complaints back home. This is unsustainable and needs to be addressed.
For the Senate, representing the people of our States, to not have a
serious debate about the uninsured, with all of the pressures on the
middle class, is hard for me to understand.
We used to take for granted that if you had a good job, guaranteed
health benefits came along with the job. This is not the way it is
today. In fact, you would usually be able to count on those health
insurance benefits through retirement. That is no longer a certainty.
Employers, on the other hand, have seen their costs rising 10 or 15
percent. We have a chart that shows how, over the period of time from
1996 to 2003, we have seen a surge in health care costs. For the third
year in a row we have had double-digit increases in the cost of
premiums for health care insurance. When employers have seen their
costs rise, they have taken an obvious strategic step and shifted the
cost to their employees, eliminated coverage for retirees, or
eliminated coverage altogether for employees, or had all kinds of cost-
sharing arrangements. It is amazing how the burden has shifted
increasingly to working families.
Eighty-one percent of the uninsured, those 44 million, are actually
people who are working. A lot of times you think it is folks who are
unemployed or somehow are not connected to the economy. Eighty-one
percent of the uninsured are in working families, people who have jobs.
Competitive pressure among employers to drop coverage is growing
because it is such an important cost element in their overall means of
doing business. We have to take steps to address the health care
coverage and affordability crisis. Fewer and fewer people can afford to
maintain the coverage they have; fewer and fewer businesses can afford
to. It is time we actually get on with it.
To give you one example, the average annual premium for a standard
plan for a healthy, nonsmoking 25-year-old in New Jersey is almost
$5,000.
That is the average--$5,000 for a single individual. Just to contrast
that with some of the initiatives we see out of the administration,
which I find remarkably unacceptable and limited to addressing this
problem, President Bush has proposed giving a $1,000 to $3,000 tax
credit to low to moderate income-tax paying individuals and families. A
$1,000 tax credit for a single individual earning $15,000 a year would
leave that single 25-year-old I just mentioned paying 30 percent of the
gross income to purchase coverage.
How does that work? What kind of help is that? A $5,000 premium, you
get a $1,000 tax credit, and you make $10,000, $15,000, $20,000, and 30
percent of the income pays for coverage. This is the kind of problem
with which individuals are dealing. You can do that across the income
and age spectrum, and it is an enormous issue.
The President's tax credit proposal simply falls far short of
offering the whole health care coverage for 44 million Americans. In
fact, an independent study by Ken Thorpe of Emory University finds that
the President's proposal would provide coverage to only 2.1 million of
that 44 million uninsured. That
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is over 10 years, by the way. So we are making no dent whatsoever. It
would not even cover the 3.8 million who lost coverage since President
Bush came into office.
Furthermore, the CBO determined the President's associated health
plan proposal would actually increase health care premiums for a
majority of employees working in small firms and would cause about
10,000 individuals to lose their coverage. So the second element of the
President's proposal, beyond the tax credit, is going to actually
increase the uninsured and increase premiums. It is hard to see how
that will be helpful in this overall health care crisis.
We could begin to address these difficult issues by acting on health
care in the way that a number of people put forward and, most
particularly, Senator Kerry has put forward. His plan would reduce
health care costs for those with health insurance and expand coverage
to 27 million Americans who currently lack it. Senator Kerry's
commonsense proposal builds on existing successful health care programs
such as SCHIP, State Children's Health Insurance Program; mandates
coverage for all children; and provides incentives to States to expand
coverage to uninsured adults. The Kerry plan would not only expand
access to health coverage, it would reduce premiums by about 10 percent
for those with insurance. He does this by making the Federal Government
a secondary insurer, whenever an individual's health care costs exceed
$50,000 in a year. So it is a catastrophic backstop that the Federal
Government takes up and covers 75 percent of those costs above that
level. It would reduce costs by 10 percent for everybody who has
insurance. It is a very simple but important concept to add to the
expansion of coverage the Senator has talked about.
We can provide coverage to more than half of those currently
uninsured through these steps. I think we must take those programs and
even expand them to make sure everybody has coverage. Expanding health
coverage is not cheap, but the cost of refusing to expand access to
health insurance is enormous as well, and it affects every one of us.
We all pay more for health care because hospitals and other providers
are forced to increase prices to compensate for those without coverage
who use the services. They are mandated to do that at hospitals. We all
pay higher State and local taxes to compensate providers who provide
precare to those without coverage. We all know that. Emergency rooms,
charity care--all of those places where we build up these costs. It is
important that we understand the cost-benefit of actually having health
insurance programs that work to take care of that and to eliminate some
of those costs.
According to the Kaiser Commission on Medicaid and the Uninsured, we
spent $41 billion in this Nation last year for uncompensated care for
the uninsured. We hear about it from our hospitals, local providers.
They give out care, and the total is $41 billion, according to the
Kaiser Commission. The annual cost, by the way, of that program I just
talked about with the Kerry proposal is $35 billion. So you have a
cost-benefit tradeoff. If you could take care of the uninsured, you
could take a big bite out of that $41 billion of uncompensated care. We
would have to spend the money. Some folks would say we don't have the
budget room. We don't have the budget room to pay for the $41 billion
that we have. I think we can make major inroads if we work on it.
There are savings to be had if we are prepared to do it. I think
making sure that we move on to preventive care, in conjunction with
health care access, will make a huge difference in making sure that
people deal with diabetes before it is chronic and critical, deal with
hypertension before it is chronic and critical. All of these things
will make a huge difference. People will deal with these in the normal
course of preventive care as opposed to emergency or critical or
chronic problems.
Madam President, there is a lot to be dealt with on this topic of
access to health care in this country. We need to have that debate.
Senator Kerry has laid down an incredibly important proposal--one that
is self-financed by the costs that it would defray from the
unreimbursed costs going through the system. We need to address these
44 million Americans and address the pressure that middle-class,
moderate Americans are feeling every day as they see this 13-percent
increase in health care.
I hope we can have a real debate on this floor so that we can move
forward to take care of those 44 million uninsured and not have
proposals that are dead on arrival, that have no real impact, maybe
addressing 2 million of the 44 million and not even dealing with the
numbers that are increasing. As we sit here and talk about it today,
3.8 million new Americans have gone on the uninsured rolls since this
administration has been in office. We need to address that problem and
the other 40 million that are without health insurance. There are
proposals that make sense. It is time to address it. I hope we can have
that debate.
I yield the floor.
Mrs. BOXER. Madam President, how much time do we have remaining?
The PRESIDING OFFICER. There is 17 minutes remaining on your side.
Mrs. BOXER. Madam President, I come to the floor, first of all, to
thank my colleagues for pointing out what is happening in every State
in America today. People are struggling to get health care. My mother
used to say, ``If you have your health, you have everything.'' I
thought, as a child, what does she mean? Now, as I get older, I realize
she is right because when your family gets stricken with a disease,
with a problem that makes them hurt and unproductive, your world really
falls apart.
So, clearly, health care is a very big issue as we go into this
election season. It should be a big issue every day here. We don't see
the majority bringing up any kind of legislation to make life easier
for people, in terms of their health care. We cannot even get enough
votes to extend unemployment compensation for people who have been
unemployed. So it is something for the people of America to think
about.
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