[Congressional Record Volume 150, Number 67 (Thursday, May 13, 2004)]
[House]
[Pages H2967-H2986]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
[[Page H2967]]
House of Representatives
SMALL BUSINESS HEALTH FAIRNESS ACT OF 2004--Continued
{time} 1415
Mr. HOLT. Mr. Speaker, I rise in opposition to this bill and in
support of the substitute that the gentleman from Wisconsin (Mr. Kind)
and the gentleman from New Jersey (Mr. Andrews) will be submitting.
Mr. ANDREWS. Mr. Speaker, I yield 2 minutes to the gentlewoman from
New York (Ms. Velazquez), for whom I have the most profound respect,
the ranking Democrat member of the Committee on Small Business.
Ms. VELAZQUEZ. Mr. Speaker, I thank the gentleman from New Jersey
(Mr. Andrews) for yielding me this time.
Today, we should be focusing on helping small businesses address the
health care problems they face. Instead, our debate is not about policy
but about politics. The House has already passed this once, and it is a
bit early for summer reruns. It is a good bill with broad bipartisan
support. Passing it twice will not change that.
As we move forward, small businesses are facing a real health care
crisis. Small firms that can afford health insurance are seeing costs
rise by nearly 20 percent every single year, and many small businesses
do not even have health insurance.
This is a good bill. It has strong solvency requirements and
safeguards to ensure there will be no cherrypicking of healthy
employees.
Critics of this legislation will cite an outdated study that examines
legislation far different than the bill before us today. This has the
same validity as saying Columbus should never have sailed to the New
World because previous studies had shown the world was flat.
Association health plans will give small businesses the same
advantages that corporate America and unions already have. I always
say, if it is good enough for IBM, GM, and Lockheed Martin, it is good
enough for small businesses.
But we should stop playing politics with small business. If the Bush
administration was truly committed to small businesses, association
health plans would already be law.
Today's debate is not going to help small businesses lower their
health care costs, it is not going to help them cope with the constant
fear of being just one illness away from bankruptcy. It is about time
small businesses were able to afford quality health care. That is why I
will encourage my Democrat colleagues to support this proposal and show
as a party that we are bigger than this political gamesmanship.
I call on the Republican leadership in the Senate and President Bush
to make this bill a priority and pass it. I urge a ``yes'' vote.
Mr. BOEHNER. Mr. Speaker, I am pleased to yield 2 minutes to the
gentlewoman from West Virginia (Mrs. Capito).
Mrs. CAPITO. Mr. Speaker, today I rise in strong support of
association health plans. As we have heard, small businesses pay 17
percent more for their health care than employees of large companies.
In a State like West Virginia, where over 90 percent of our business is
small business, this is impossible for our small business owners.
Over 44 million Americans, sadly, are without health insurance, and
more than 60 percent of those are employed by a small business. The
high costs small businesses have to bear to provide health care, for
what in many cases are just a few employees, prohibits owners from
providing affordable health insurance and losing employees at the same
time.
Through a trade association, like the National Federation of
Independent Businesses, small businesses would be allowed to band
together, pool their resources, drive down health care costs and gain
buying power.
Nondiscrimination provisions in the legislation ensure health
coverage will be offered to those who need it most, and solvency
requirements will make sure that the health plans have the financial
resources on hand to cover their employees' needs.
Mr. Speaker, during a roundtable I had several weeks ago with small
business owners in my district, everyone was concerned about offering
health care coverage. Small business owners want to be able to afford
this, not only for them as owners but also for their employees.
This House has passed this association health plan legislation
before. Workers need health care coverage, their children need health
care coverage, and small business owners want to offer health care
coverage. I urge my colleagues to support association health plans.
Mr. TIERNEY. Mr. Speaker, I yield myself 3\1/2\ minutes.
Mr. Speaker, the so-called Small Business Health Fairness Act is a
bill that is attractive to a few but it is sufficient for none, and it
seems to be harmful for everyone else. While there are employers,
workers and family members who do depend on health insurance, what they
really need is solutions that are going to work for everybody and not
just some empty promises.
The Congressional Budget Office did an estimate on this proposed bill
and estimated that approximately 4.6 million people might obtain some
coverage through these proposed associated health plans but only about
330,000 of those people would be new customers.
The fact of the matter is that there is not going to be the dramatic
savings that is proposed here. That simply will not materialize. The
Congressional Budget Office found that these AHP
[[Page H2968]]
premiums would only be marginally less than the traditional health care
plans. In fact, the Mercer Consulting STUDY that was done for the
National Small Business Association found that premiums would increase
by 23 percent for those outside the AHP market. It also found there
would be an increase in the number of uninsured workers in small firms,
an increase of a million people, as a result of this being implemented.
The fact of the matter is that Americans would also lose their right
to vital medical coverage, like OB-GYN and pediatrician services,
cervical, colon, mammography and prostrate cancer screening, maternity
benefits, well-care child services, and diabetes treatment.
When we had witnesses testifying at the committee hearing, Mr.
Speaker, we specifically asked the small business witness whether that
is what she wanted to have happen to her company. And her testimony
indicated clearly she did not, and she did not understand that was
going to be the result of this bill passing.
This bill is going to disallow a lot of State protections, and almost
all the States have in protections for people under this bill. This
House voted for a Federal Patients' Bill of Rights that would have
recognized States' protections that are in place for insurance
programs. Almost every single Member on both sides of the aisle voted
for that legislation; yet this piece of legislation, the AHP bill,
would peel that away and take away the State protections for all those
things that people in small business want.
As a person in a small business and representing a number of small
businesses for over 22 years, I can tell you small business employers
do not want an inferior policy for their employees.
With respect to the question one of our colleagues on the other side
raised about the distrust of the private sector, we are all very much
in favor of the private sector, but most people are in favor of it
being a balanced situation in this country. We understand unless there
is some reasonable regulation, some private industries will go too far
in one direction, as has happened in the past with programs similar to
this, the so-called MEWAs that existed at one time that were replete
with fraud, corruption, and solvency problems.
This is a situation that has to be corrected. We cannot allow it to
happen again here, and there is evidence in recent times that that is
exactly what would happen with this bill.
Mr. Speaker, small business owners and their employees deserve
protections. They deserve to go to the emergency room. Women small
business owners deserve to go to gynecologists without referral from
another doctor. Why should we treat small business owners and employees
like second-class citizens by giving them second-class health care?
Instead of extending the patient protections to all Americans, this
bill would roll back the limited protections that exist today.
I think if we speak plainly, Mr. Speaker, this bill eliminates the
State regulation of AHPs and is in fact an anti-patients' bill of
rights. For this reason and the other reasons I have mentioned, and
others have said, and the fact that over a thousand different
organizations oppose this bill, including the National Governors
Association, the Republican Governors Association, 41 State attorneys
general, the National Small Business Administration, the National
Association of Insurance Commissioners, as well as a dozen other groups
of labor business and consumer groups, I believe this is not a good
bill for small business, it is not a good bill for the employees of
small businesses. We can do better and we should.
Mr. BOEHNER. Mr. Speaker, I yield 3 minutes to the gentleman from
Maryland (Mr. Wynn).
Mr. WYNN. Mr. Speaker, I thank the gentleman for yielding me this
time.
It is interesting to note the gentleman just said, why should small
businesses be treated as second class citizens. The fact of the matter
is, they are already treated as second-class citizens because they do
not have and cannot afford to have health insurance for their
employees. Sixty percent of the 44 million uninsured people in America
work in small businesses.
Now, there is something very interesting happening in this debate,
and I want to lay it on the line. All the people who are against this
bill have health insurance. Yes, the unions and the governors, be they
Democrat or Republican, and all the other folks who are saying this is
a bad bill, have health insurance. On the other side, the folks who
want this bill, are small business owners, 12 million of them, who
cannot afford to provide health insurance for their employees. Why
should they not have an opportunity to pool together to gain the
leverage that would enable them to provide affordable health insurance?
Now, you hear people saying the benefits are too skimpy and you do
not have the State mandated benefits and all these other things. Those
benefits are fine, and I have supported them. But the fact of the
matter is if you do not have any health insurance, then the benefits
and the protections and the consumerism and all that does not mean a
thing because you do not have any health insurance.
Number one, why not let the employees make the decision? If the
benefits are too skimpy, the employees will not buy them. On the other
hand, if a basic plan enables you to see a doctor or save money on
going to a doctor, that is a good thing and people will buy it.
The second item I might mention, large corporations that self-insure
and unions that cross States lines do not have to adhere to these
mandates that people are saying is so important. So what is the
difference? It seems to me that if we do not want to treat folks as
second-class citizens, let small businesses have the same benefits that
big corporations and unions currently enjoy.
Now, the other item you will hear about is cherrypicking. There are
provisions in this bill to prevent cherrypicking. You will hear about
solvency problems. There are provisions in the bill to ensure that the
solvency is the same as the solvency for other insurance companies.
Now, who gets insured? You have heard, well, people will lose
insurance, insurance rates will rise. CONSAD Research Institute
conducted a study that concluded that 8.5 million more Americans,
uninsured workers, would have access to insurance under this bill.
Now, this bill is not a panacea. It is not perfect. But it is a step
forward that will enable us to insure the group of people who do not
have insurance. Instead of listening to all the thousands and hundreds
of groups that they are saying are against this bill, but who for some
reason have insurance, let us provide a benefit to the uninsured small
businessperson, give them the opportunity to have associated health
plans and move towards insuring the uninsured.
This is National Insure the Uninsured Week, not National Let Us Talk
About Insuring the Uninsured Week. The thing that we can do that would
do the most good is to pass this bill and move toward insuring the
uninsured.
Mr. ANDREWS. Mr. Speaker, may I inquire as to how much time is
remaining on our side?
The SPEAKER pro tempore. The gentleman from New Jersey has 12\3/4\
minutes remaining, and the gentleman from Ohio has 10 minutes
remaining.
Mr. ANDREWS. Mr. Speaker, I yield myself 30 seconds.
My friend from Maryland, whom I respect very much, when they talk
about the number of people who would gain insurance with AHPs, the
Congressional Budget Office drew the conclusion that the vast majority
of members of AHPs would not be newly-insured people. They would be
people shifted from existing plans into the AHPs.
I think the better authority is that one million people, net, one
million more people would be uninsured as a result of this bill.
Mr. Speaker, I yield 2 minutes to the gentleman from Ohio (Mr. Brown)
a member of the Committee on Energy and Commerce.
Mr. BROWN of Ohio. Mr. Speaker, I thank the gentleman from New Jersey
for yielding me this time and for his leadership on health care issues.
In my home State of Ohio, we have a successful multi-employer health
insurance program sponsored by the Council of Smaller Enterprises, or
COSE. Some 14,000 businesses participate. For 30 years, Ohio's COSE has
been negotiating with commercial insurers to offer small businesses
coverage and rates usually reserved for the
[[Page H2969]]
largest companies. Each year, COSE members collectively save almost $50
million in health insurance premiums.
Unlike the association plans envisioned under 4281, COSE works within
the framework of State insurance law. That means COSE is not subject to
the scams, to the insolvencies, to the indiscriminatory coverage
schemes that are the hallmark of association plans. This bill puts Ohio
COSE at risk.
It is like a poker game. If one person is playing by the rules and
the other is cheating, the cheater will probably win. Now the stakes
are even higher. Not only is health coverage at risk for those who play
by the rules, but the gains are short-lived for those who do not.
Companies that join an association health plan may see favorable
premiums one year and be priced out of coverage the next. Their
employees may or may not be covered for needed health care and claims
may or may not be paid. It is simply a crap shoot.
The American Academy of Actuaries has no stake in the outcome of this
debate. Private insurers hire actuaries to calculate premiums. Here is
what the Academy has to say about this bill. ``This bill will likely
have unintended negative consequences.'' The Academy says ``AHPs
produce fragmentation of the market,'' as we have heard over and over
and over today. They say, ``AHPs are likely to lead to cherrypicking,
to adverse selection, and to increased costs for sicker individuals.''
{time} 1430
The academy says that AHPs create an unlevel playing field, there
have been many examples of AHP-like organizations becoming insolvent,
and that the anticipated expense reductions are simply unlikely to
materialize. Even though 44 million Americans are uninsured, the
Republican majority has no intention of seriously considering proposals
to expand access to health insurance.
Mr. BOEHNER. Mr. Speaker, I yield myself such time as I may consume.
Let me remind all of my colleagues that we are talking about 44
million Americans who have no health insurance. They get to the doctor,
albeit very late, they get to the hospitals, albeit very late, they die
sooner, and they have higher health care costs that we all who have
health insurance pay for. It all ends up in the size of our bill.
But the bigger disgrace is that there are 44 million Americans who
have no health insurance, no preventive care; and we are attempting to
do something about it. The gentleman from Ohio (Mr. Brown) denigrated
these interstate plans as scams that could go corrupt. Let me see. If I
recall, we have companies like General Electric which have employees in
virtually every State. They have a plan under the Employee Retirement
Income Security Act. How about the Teamsters? I would say the Teamsters
have plans that cover virtually every State.
Why would we not allow small employers that belong to the NFIB,
belong to the U.S. Chamber of Commerce, belong to the Electrical
Contractors Association, why would we not let them come together to
form the same kinds of health insurance plans that large companies and
unions offer from coast to coast? What do we have to fear? What do we
have to fear in trying to help 44 million Americans have a chance at
good health insurance?
Mr. ANDREWS. Mr. Speaker, will the gentleman yield?
Mr. BOEHNER. I yield to the gentleman from New Jersey.
Mr. ANDREWS. Mr. Speaker, I assume the gentleman's question was not
rhetorical. What we have to fear, we should listen to the advice of
attorneys general and Governors and insurance commissioners from around
the country who say we have to fear this: we have to fear a poorly
regulated or unregulated structure that is not properly accountable
under fiduciary standards and has no experience in running insurance
companies, which is why they oppose the bill.
Mr. BOEHNER. Mr. Speaker, reclaiming my time, those regulatory
requirements are not on the GEs that we talked about, they are not on
the Teamsters, they are not on other big employer or union plans. They
are governed under a Federal statute called ERISA that has worked very
well to insure and provide the basis for health insurance in America,
and we ought to trust small businesses that would join these
associations and give them the same rights that big companies and
unions have.
Mr. Speaker, I yield 2 minutes to the gentleman from Georgia (Mr.
Kingston).
Mr. KINGSTON. Mr. Speaker, I thank the gentleman from Ohio (Mr.
Boehner) for yielding me this time.
I want to talk about this as a former insurance agent. I sold
property and casualty insurance to small businesses all over Georgia
before I came to Congress. I was not in the health care business, but
quite frequently my clients would come to me and say, Can you help us
with health care? Can you point us in the right direction? So I have
some knowledge of it on the ground from the perspective of a pet store,
a barber shop, a brick mason, small employers with 5 to 15 people.
What their problem is, they have been priced out of the health care
business because we insist through state-mandated benefit that they
have to buy a Cadillac insurance plan. They cannot buy a stripped down
Toyota; they have to buy the Cadillac with all of the options. That is
what we are doing. Because of that, that brick mason with seven
employees says to his employees, We cannot do health care any more. If
your wife or somebody in your family cannot put you on as a dependent,
you do not have any health care.
What this plan does is it gets uninsured employees back in the
business of health insurance, those employees who are making too much
money for Medicaid, for example, and workers comp is only going to
cover them on the job. This gives them access to the health care. It
makes it affordable because that brick mason, that pet store, that
barber shop can combine with other similar businesses all around the
country, and they can go into the marketplace with the economy of
scale, the buying clout which the GEs and big unions have, and then
they can have affordable health care. It gives relief from some of
these mandated benefits. A mandated benefit is not necessarily bad; but
if you require someone to have pediatric shots, nobody is going to say
that is a bad idea, it makes sense, but it might not apply to you or
you might want to assume that risk or cost yourself.
We are saying to these employers and employees you have no option,
you have to buy this because we are the government and we know what is
best for you. This gives them a commonsense approach, a great
compromise so they can afford health care again. I urge my colleagues
to support this bipartisan legislation.
Mr. ANDREWS. Mr. Speaker, I yield 2 minutes to the gentleman from
Ohio (Mr. Kucinich), another voice who joins the coalition of AFL-CIO,
66 chambers of commerce and the National Governors Association, a
gentleman who has brought great honor to this House during his
Presidential campaign.
Mr. KUCINICH. Mr. Speaker, when a doctor prescribes a path of care
that does not work out, patients are always advised to get a second
opinion, so I want to offer a second opinion in answer to the gentleman
from Ohio (Mr. Boehner).
This bill would increase the number of uninsured. It would increase
costs. It would increase discrimination against older workers, and it
would remove patient protections. Despite the widespread agreement on
the need to provide more health care coverage, decrease cost and
improve care, this bill moves in the opposite direction. Instead of
improving access to health care, this legislation would worsen access.
Approximately 1 million people would lose their insurance coverage if
this bill is enacted. Instead of reducing premium costs, this bill
would increase premiums for 20 million small business workers. Instead
of making coverage more equitable, AHPs would lead to discrimination
against older workers who would have a much more difficult time getting
coverage. Instead of increasing patient protections, this bill would
remove them. State patient protection laws would be effectively waived
for AHPs, leaving patients without the ability to enforce protections
for basic benefits, like emergency medical services and access to
specialists.
The Hippocratic Oath says ``Above all, do no harm.'' This bill takes
a bad
[[Page H2970]]
health care situation in this country and makes it worse, which is not
what the people ought to expect from this Congress. I urge the Congress
to reject the underlying bill and at some point in the future we are
going to have to answer the issue of universal, single-payer, not-for-
profit health care so we do not look at these kinds of phony, stopgap
measures.
Mr. BOEHNER. Mr. Speaker, I yield myself such time as I may consume.
I remind my colleagues one more time that we are talking about trying
to assist 44 million Americans who have no health insurance. This may
not be the perfect product, it may not be the perfect package, but for
the life of me, I cannot understand why people do not want to come to
the plate and try to do something to help these Americans who do not
have access to affordable health insurance.
Maybe the answer is what we just heard from my good friend and
colleague, a member of the committee from the other end of the great
State of Ohio who wants a single-payer national health plan. I think
most Americans looked up in the mid-1990s when this idea was floating
around and said, Oh, no. No, no, I like my health insurance. I like
going to the doctor I choose. I do not need the government running my
health insurance plan.
Mr. Speaker, I yield 1 minute to the gentleman from Illinois (Mr.
Crane).
Mr. CRANE. Mr. Speaker, today the House has a chance to help small
business with their number one concern: health care. Many Members are
already aware of this, but 25 million small business owners, their
families and employees currently do not have health insurance. It is
simply too expensive. We have a system in our country today that puts
small business on one playing field and big business on another, and
that is not acceptable. Small business is the driving force of our
economy, the number one job creator in the Nation, and the backbone of
our local communities.
H.R. 4281, the Small Business Health Fairness Act, puts small
business and big business on a level playing field. It gives small
business the capability of buying health insurance at the same cost and
with the same rules that big business plays by. I think it is time we
gave our small businesses a helping hand.
I am confident that we will pass legislation to create association
health plans today, and I encourage all of my colleagues to support it;
but it is time for the other body to act and pass the Small Business
Health Fairness Act. The time has come to address this problem, and the
entire Congress should support this legislation.
Mr. ANDREWS. Mr. Speaker, I yield myself 10 seconds.
Mr. Speaker, we certainly take up the challenge to present a better
idea, which the gentleman from Wisconsin (Mr. Kind) and I will be doing
in a few minutes under the alternative. We understand that the American
Academy of Actuaries, a group with no vested interest in this debate,
has concluded that 1 million people will be added to the roles of the
uninsured by this bill.
Mr. Speaker, I yield 2 minutes to the gentleman from Illinois (Mr.
Emanuel).
Mr. EMANUEL. Mr. Speaker, I rise in opposition to this bill. I do it
as the son of a pediatrician and the brother of an oncologist. I
appreciate that the Congress today and the Senate, the other body, is
having a debate about health care. Senator Kerry is out presenting his
health care plan; the only person lacking a health care plan in this
debate, after 3 years in office, is the President of the United States.
The Institute of Medicine estimates that 18,000 Americans die
prematurely because of not having health care. This is not just a
problem of the poor. The fastest growing group of working uninsured in
this country are people earning up to $50,000 a year. Kaiser Family
Foundation found that the system, the insurance system, literally pays
somewhere close to $125 billion to cover the uninsured who do not
receive health care. All of us who have health care pay an uninsured
premium in our health care cost for those who show up at hospitals
without health insurance, getting critical care rather than preventive
care.
Even as we spend more money than any other industrialized nation on
health care, we have 44 million uninsured, of whom 33 million work and
10 million are children.
To address the needs, we can do better than the bill which experts
say will damage, rather than benefit, the insurance market. We can do
better than a bill that takes away important insurance requirements
like cancer screenings and other critical preventive care rather than
relying on the emergency care which is what the uninsured patient
receives today.
This bill would actually increase the uninsured premium all of us pay
who have health insurance by putting additional strains on the
insurance system and increasing premiums for many Americans. In 2000,
the health costs for a family of four was $6,500. Today it is $9,000.
It is going up exponentially by a third. Nobody has gotten an increase
in salary by a third. What is the driving force behind that
inflationary fact in health care insurance premiums? The uninsured who
show up at hospitals. Hospitals recoup the cost by passing it on, which
raises premiums.
Mr. Speaker, I urge my colleagues to reject this bill and pass the
substitute which will help small businesses provide health insurance,
reduce the number of uninsured while reducing the premiums the rest of
us pay.
Mr. ANDREWS. Mr. Speaker, I yield 3 minutes to the gentleman from
North Dakota (Mr. Pomeroy), who had a career in State government in
insurance regulation and, frankly, I think knows more about this
subject than any other Member of the House.
Mr. POMEROY. Mr. Speaker, I thank the gentleman for yielding me this
time and commend the gentleman as well as the chairman for what is a
very interesting debate with some technical sophistication on the
business of how we expand health insurance in the small business
environment.
Let me begin by explaining briefly how purchase decisions work in a
small business, unlike General Electric. General Electric has a human
resources department. They have actuaries on contract. They can
thoroughly do due diligence on any health insurance program they are
evaluating for their employees.
Our Own Hardware store in Valley City, North Dakota, my hometown, is
quite different. There is one business proprietor, may a half a dozen
or a dozen employees, and when he sits down to visit with a person
promoting a health insurance program, he does not have an ability to
evaluate the rating scheme. He does not have an ability to assess the
adequacy of the fairness of the medical underwriting. That Our Own
Hardware store does not have the ability to determine whether the
company is solvent and reserving adequately to pay future claims, the
Our Own Hardware does not have to do that because when they sell health
insurance now, it is regulated. We have a State insurance department
that does that. That used to be my job. And the State insurance
commissioners across this country are in their offices every day making
certain that the presentations to the Our Own Hardware stores
represents a product that is going to be there when they need it.
When we buy insurance, we pay premiums today with the hope of getting
the claim paid tomorrow, and that means we have to have a reliable
entity on the other end. That is what regulation brings us.
{time} 1445
The bill before us would depart from that. They would basically
substantially do away with State solvency checks, with the State
regulation on underwriting criteria, with the assessment of whether or
not the rating is fair. I believe there would be very, very damaging
results. In order to bring the cost of insurance down, we have seen
self-regulated companies like the AHPs try to cheat on the business of
paying claims. They do not have the capital to pay the claims when the
claims come due. In fact, the most recent version of the AHPs that have
been out there, these MEWAs, the insurance commissioners tell us they
left more than 400,000 people holding the bag with medical claims but
no insurance company to pay them.
The majority talks a lot about trying to get coverage to those who do
not have it. You sure do not want to give people the illusion of
coverage that is not real because they count on that company in paying
the claim. And what we see with these self-regulated
[[Page H2971]]
outfits, when you need them, they are not there. They have taken your
money and they have left. So not only does it fail in a meaningful way
to get coverage to those who need it, it undercuts the coverage of
those who already have insurance. In fact, the estimate from the
actuarial firm that a million would lose their coverage is yet another
solid reason why we should not take this path and adopt the AHPs.
Vote ``no'' on this measure.
Mr. BOEHNER. Mr. Speaker, I yield myself such time as I may consume.
With all due respect to my good friend from North Dakota who is one
of the real experts on insurance and pension matters in the House, he
is a former State insurance regulator, we have heard this claim that
Governors, State insurance regulators and attorneys general are opposed
to this bill. Of course they are. Every State, we know what they want
to do. They want to regulate, regulate, regulate, regulate.
Let us go back to the example. The Procter & Gambles, the GEs, the
Teamsters, they are not regulating those plans. They have got some of
the best benefits that they offer to their employees. Let us go back to
your example of the dry cleaner. The dry cleaner does not have the
actuary. He has got the regulator, the attorney general. What if all
those dry cleaners in a State, the State of North Dakota, or all those
dry cleaners from around the country in their national association came
together and formed an association health care plan? Those employees at
that local dry cleaner would have better benefits at more competitive
prices than they could ever get in a State insurance risk pool.
What do we have to fear from giving those small employers and, more
importantly, their employees the chance to come together to have the
same kind of a plan that big companies and unions have today?
Mr. Speaker, I reserve the balance of my time.
Mr. ANDREWS. Mr. Speaker I yield myself the balance of my time.
I agree completely with the chairman that the number one issue on the
health care agenda of this country is finding insurance for the 43, 44
million uninsured. I agree with him completely that it is a worthy
project for this House to pursue. Long overdue. Usually it does not
persuade me when you submit a list of people who are against a bill or
for a bill, because I think each one of us has the obligation to make
our own judgment about these matters, as each one of us should here.
At this point in the Record, by the way, I include the Mercer study
to which I referred, the actuarial study to which I referred, and the
letter from the Congressional Budget Office to which I referred.
[Prepared for: National Small Business United, June 2003]
Impact of Association Health Plan Legislation on Premiums and Coverage
for Small Employers
(By Beth Fritchen, FSA, MAAA; and Karen Bender, FCA, ASA, MAAA, Mercer
Risk, Finance & Insurance)
executive summary
National Small Business United (NSBU) engaged Mercer Risk,
Finance & Insurance (Mercer) to analyze the ``Small Business
Health Fairness Act of 2003'' (H.R. 660 and S. 545). This
legislation would encourage the formation of federally
certified Association Health Plans (AHPs) by exempting these
plans from various state laws that govern health insurance
sold to small employers today.
Proponents of H.R. 660 and S. 545 argue that federally
certified AHPs would expand access to affordable health
insurance for small employers and reduce the number of
uninsured. Opponents believe the legislation would have the
exact opposite effect--that is, it would cause premiums to
rise and the number of uninsured to increase.
Mercer developed an actuarial model to assess how this
legislation would affect premiums for small firms that
purchase state-regulated coverage and firms that enroll in
AHPs over a four year period as well as the impact on the
number of uninsured.
The analysis concludes that federal AHP legislation would
not alleviate the health insurance cost pressures faced by
small employers. Rather, the proposed AHP legislation would
have a detrimental impact on small employer premiums,
especially for firms with high-cost workers, and would cause
a significant number of small employers to drop coverage,
thereby increasing the nation's uninsured population.
In brief, we found that once federal AHP legislation was
fully implemented:
Health insurance costs would increase significantly for
small businesses in the state-regulated insurance market.
Health insurance premiums would increase by 23% for small
employers that continued to purchase state-regulated coverage
This increase would result from AHPs' ability to attract
healthier-than-average firms out of the state-regulated
market. AHPs' exemption from mandated benefits would allow
them to tailor products attractive to healthier populations.
Moreover, exemption from sate limits on premiums and
marketing standards would allow AHPs to enroll healthier-
than-average groups and encourage firms with high cost
workers to switch back to the state-regulated market.
As AHPs attract small employers whose perceived health
status is good, firms with greater expected health care
utilization would remain in the state-regulated market, where
they have the protection of mandated benefits and other
requirements. The resulting outflow of low-cost groups from
the state-regulated market and the remaining concentration of
high-cost groups would start an adverse selection spiral that
would accelerate premium increases for employers in the
state-regulated market.
AHP legislation would increase, not decrease, the number of
uninsured. The number of uninsured would increase by over 1
million as a result of coverage losses among workers in small
firms and their dependents. As premiums for small employers
in the sate-regulated market increased, some firms would drop
coverage and not switch to an AHP. Coverage declines would
also result when groups covered by AHPs drop their coverage
when their rates increase because someone in the group gets
sick. While some of these groups would switch back to the
state-regulated market, others would drop coverage entirely.
Federal AHPs would gain a pricing advantage through risk-
selection, not greater administrative efficiency. The
modeling predicts that after four years premiums for AHPs
would average 10% below that of the existing small group
market. However, we expect these price reductions to result
from favorable risk selection and exclusion of benefits
rather than improved purchasing efficiency or lower
administrative costs. AHPs could use a variety of techniques
to select healthier-than-average firms--techniques available
to AHPs because the legislation preempts key provisions of
state law designed to prevent risk selection.
Specifically, under H.R. 660 and S. 545 AHPs could: charge
firms with high-cost workers much higher premiums than
permitted under state law; experience rate each association
based on the risk of only their members; and offer pared-down
products without benefits that would be needed or desired by
higher-risk small employers. Together, these strategies would
allow AHPs to offer the most attractive rates to healthy
groups and avoid the cross-subsidies that state small
employer health insurance reforms require.
Federal AHPs would insure the healthiest small employers.
The modeling estimates that the average morbidity (a measure
of whether a firm is ``sick'' or ``healthy'') of firms
enrolling in AHPs would be 21% lower than the average
morbidity of small employers in the market today. Further, as
higher-cost small employers dropped coverage in response to
rate increases resulting from the movement of healthy
employers out of the state-regulated market, the average
morbidity of the uninsured population would increase by
12.3%. AHPs would appeal most to firms with younger workers
given the close correlation between age and health status.
Small employers would face higher premiums overall. Average
small employer premiums (considering both cost increases for
the state-regulated market and premium reductions for AHPs)
would increase by 6%. Average premiums would increase because
the size of the average premium increase for the population
remaining in the state-regulated market (23%) would outweigh
the smaller average premium decrease for those covered by
AHPs (10%).
These results indicate that AHP legislation is not a
solution to rising health care costs for small employers.
While some firms obtaining coverage through AHPs may see
lower premiums, firms with higher-cost employees would see
their premiums increase. Overall, small employers would pay
higher premiums and the uninsured population would increase
if this legislation were enacted.
____
Association Health Plan Bills Need Changes: Actuaries Find AHP
Legislation Flawed
In a letter to members of Congress, the nonpartisan
American Academy of Actuaries identified several serious
concerns with the Small Business Health Fairness Act of 2003
(H.R. 660 and S. 545). The bills would amend the Employee
Retirement Income Security Act to allow trade, industry,
professional and similar associations to be sponsors of
health insurance plans for their members. The Academy offered
to work with proponents of the bills, which bill sponsors
hope will expand the availability, affordability, and
accessibility of health insurance coverage.
Karen Bender, M.A.A.A., chairperson of the Association
Health Plan Work Group, said that while the legislation has
merit and is
[[Page H2972]]
well intentioned, ``we have serious concerns about some of
the bills' provisions. As written, the bills are flawed and
need significant rewriting to be actuarially sound and
protect consumers.''
Some of the concerns that the group has with the
legislation are:
Risk of Insolvency--The proposed rules governing the
minimum surplus requirements for an AHP does not account for
the growth of the AHP. Similar organizations have become
insolvent in the past. In response, most states enacted
solvency standards. To maintain the benefit of such standards
to consumers, the surplus standards should be similar to the
minimum requirements for Health Risk-Based Capital developed
by the National Association of Insurance Commissioners. The
legislation also relies on reinsurance vehicles that do not
currently exist in the market.
Unclear Regulatory Authority--AHP government regulation is
not clearly defined in the law. Consumers, AHPs, and
regulators may have no place to go for redress and guidance
without clear regulatory authority.
Unlevel Playing Field--The consequences of different rules
for AHPs vs. state-regulated plans fragments the market,
producing an unlevel playing field in insurance coverage that
will lead to cherry-picking, adverse selection, and increased
costs for some individuals.
The House Committee on Education and the Workforce is
considering the House bill, and the Senate bill has yet to be
scheduled for committee consideration. For a copy of the
letter, go to the Academy website at www.actuary.org, or call
Tracey Young at 202-785-7872.
American Academy of Actuaries,
April 28, 2003.
Hon. John A. Boehner,
Chairman, House Committee on Education and the Workforce,
Rayburn House Office Building, Washington, DC.
Dear Representative Boehner: This letter presents the
comments of the American Academy of Actuaries Association
Health Plan Work Group regarding the Small Business Health
Fairness Act of 2003 (H.R. 660 and S. 545). As you know,
these bills would amend ERISA to establish a new ``Part 8--
Rules Governing Association Health Plans.''
H.R. 660 and S. 545 are designed to expand access to
affordable health insurance by promoting the use of
Association Health Plans (AHPs). We support efforts to
increase the availability, affordability, and accessibility
of health insurance. While the goals of the legislation are
laudable, the bills do not address the core problem, which is
the high cost of health care. As currently written, the bills
will likely have unintended negative consequences that would
hinder the intent of the legislation.
Members of the American Academy of Actuaries are available
to assist Congress in developing solutions to address the
issue of small-employer health insurance reform.
Executive Summary
Some of the unintended negative consequences of the
legislation and our related concerns are as follows:
Unlevel Playing Field: The consequences of different rules
for AHPs versus state-regulated insured plans is a
fragmentation of the market resulting from an unlevel playing
field. This is likely to lead to cherry-picking, adverse
selection, and increased costs for sicker individuals.
Risk of Insolvency: The proposed rules governing the
minimum surplus requirements for AHPs do not account for the
growth of the AHP. Historically, there have been many
examples of AHP-like organizations becoming insolvent.
Following such events, most states enacted solvency
standards. To maintain the benefit of these standards to
consumers, the surplus standards should be similar to the
minimum requirements for Health Risk-Based Capital (RBC)
developed by the National Association of Insurance
Commissioners (NAIC). Also, the bills at issue rely on
affordable reinsurance vehicles that do not currently exist
in today's marketplace.
Unclear Regulatory Authority: Governmental authority for
regulating AHPs should be clearly specified. Absent this
clarification, it is likely that nobody will be regulating
AHPs or that there will be conflicting regulation. When
regulatory authority is unclear, consumers have no place to
turn for redress.
Unclear State Assessment Authority: The authority to levy
assessments will depend on what governmental body has
regulatory authority over AHPs. It should be clear what
states are allowed to do with assessments generated by AHPs.
Actuarial Certification: The definition of a ``qualified
actuary'' should require membership in the American Academy
of Actuaries and should specify that the individual must have
pertinent health actuarial expertise.
Other Concerns: Anticipated expense reductions are unlikely
to materialize.
Issues Contributing to an Unlevel Playing Field and Subsequent
Destabilization of the Small-Group Market
Allowable Rating Practice Differences Contribute to an
Unlevel Playing Field
Section 805(a)(2) requires that contribution rates must be
nondiscriminatory with regard to individual participants. It
also states that contribution rates for any participating
small employer must not vary on the basis of any health
status-related factor or the small employer's type of
business or industry.
However, the term ``contribution rates'' is not defined.
Clarification of whether this refers to a contribution by an
individual within a small employer group or the rate an
individual employer within an AHP pays is necessary. If this
is intended to eliminate the possibility of varying rates for
individual small employers by health status, there is a
conflict in the language of the paragraphs that follow. The
language states that nothing in the bill shall be construed
to preclude an AHP from varying contribution rates for small
employers to the extent allowed under the state for
regulating small group insurance rates. Later in the
legislation, it allows an AHP to choose a single state as its
``applicable authority'' and it need only follow the rating
rules of that state for the nationwide plan. If an AHP
chooses a state that has no restrictions on small group
rates, it seems the limitation on varying contribution rates
by health status is not enforceable, thereby resulting in
cherry-picking.
This provision would permit an AHP to be exempt from small-
group rating laws, which have been enacted by many states.
The AHP could charge small employers with less healthy
employees a higher rate than would be permitted for health
insurers operating under the small-employer rating
restrictions. The result would be that small employers whose
employees are greater health risks are more likely to obtain
coverage from the private health insurance market, where
rates are limited, than through AHPs, who may not have the
same limitations. State small group legislation sought to
eliminate this sort of selection in the market by requiring
health insurers to put all their small groups in one pool and
to limit the premium charged to one employer relative to
another. Introducing AHPs that are not required to adhere to
the same rating rules brings selection back into the market.
The consequence will be that the rates for the two pools will
diverge, causing further instability in an already fragile
market.
Lower Solvency Standards Contribute to an Unlevel Playing
Field.--State-regulated, non-AHP insured plans are subject to
state solvency regulation. Ongoing surplus requirements are
normally met by risk or profit charges within the premiums or
contributions. While this may result in short-term premium
savings for the AHPs, the inadequate contributions to surplus
likely will contribute to AHP insolvencies, resulting in
consumers and providers being responsible for unpaid claims.
Benefit Differences Contribute to an Unlevel Playing
Field.--AHP groups, according to the bills, will be exempt
from state mandated benefits. Healthier groups are less
likely to utilize mandates and, therefore are more likely to
choose AHP coverage, while groups with higher health risks
and higher utilization of these mandated services are more
likely to remain in the traditional insured market, thus
widening the gap between the two markets. Currently, both
high and low utilizers are in the same insured pool and the
cost for mandates is spread across a larger pool for a small
incremental cost. Splitting the required mandates by market
will lower the cost for some, but raise the incremental cost
for others.
In summary, market destabilization is a likely result of
the proposed AHP legislation, as currently written, because
of the disparity in allowable rating practices and solvency
standards, which would be compounded by benefit
differentials. The only way to maintain a level playing field
is to have a common set of rating rules and consumer
protection laws for every entity, whether it is an insurance
company, health maintenance organization (HMO), or a self-
funded AHP.
Solvency Standards
Solvency standards should include both claim reserves and
surplus requirements. The description of claim reserve
requirements for AHPs in Section 806 of the bills seems
adequate. The proposed rules governing AHPs should include
ongoing requirements that are similar to the minimum
requirements for Health Risk-Based Capital (RBC) developed by
the National Association of Insurance Commissioners (NAIC).
The start-up capital included in Section 806(b), ``Minimum
Surplus in Addition to Claims Reserves,'' does not adjust for
future inflation or size of the AHP. Many states had similar
minimum surplus requirements that became inadequate until
they made legislative changes to increase minimums for
inflation.
However, capital requirements also need to increase with
the growth of AHP claim volume. Recognizing that capital
requirements need to be tied to the size and risk profile of
risk-bearing entities, states are now implementing the NAIC
Health RBC formula. Under the Health RBC Underwriting Risk
Factor, an approximation of surplus for many entities would
be a minimum of eight percent to 10 percent of the total
projected claims for the AHP during the year following the
evaluation of such claims. The minimum surplus is adjusted to
reflect the purchase of stop-loss reinsurance and other types
of reinsurance.
While the requirements for claim reserves, surplus, and
other factors may be adequate for the start-up phase of an
AHP, they appear inadequate if the total annual claims volume
of the AHP exceeds $5 million to $10 million (5,000 to 10,000
individuals). As the AHP gets larger, the total surplus
requirement for solvency rises with claim volume. AHPs that
provide coverage for employers in
[[Page H2973]]
higher-risk industries may have even larger surplus
requirements. Such employers may not have higher initial
claims, but due to higher employee turnover they may have
higher claims in future years, necessitating larger surplus
requirements.
Actuarial Certification
Section 806 of the bills provides for the certification of
AHP solvency by a ``qualified actuary.'' The work group
wishes to stress the importance of defining that term as ``an
individual who is a member of the American Academy of
Actuaries,'' and they further recommend that the definition
be strengthened by requiring pertinent health actuarial
expertise.
It is important that the definition of a ``qualified
actuary'' should be ``an individual who is a member of the
American Academy of Actuaries.'' As the U.S.-based
organization with primary responsibility for promoting
actuarial professionalism, the Academy staffs and supports
the Actuarial Standards Board (which promulgates actuarial
standards of practice), the Committee on Qualifications
(which develops qualification standards), and the Joint
Committee on the Code of Professional Conduct (which develops
and maintains standards of conduct for actuaries).
The Academy also staffs and supports the Actuarial Board
for Counseling and Discipline (ABCD), which provides
confidential guidance to actuaries on how to maintain high
professional standards in their practices and investigates
complaints that may be brought against them. Academy members
who fail to comply with applicable professional standards are
subject to public discipline up to and including expulsion
from membership. Academy membership thus brings with it the
obligation to comply with high standards of qualification,
conduct, and practice, and we believe Academy members will
satisfy that obligation when making the solvency
certification required by Section 806.
Actuaries who are not members of the Academy, or one of the
other U.S.-based actuarial organizations, are not subject to
the professional standards and discipline process just
described. Therefore, in a situation where a non-member
actuary had issued a flawed certification of an AHP's
solvency, the Academy would be unable to help monitor the
situation.
Applicable Authority
Section 812(a)(5) provides a definition for ``applicable
authority'' that allows the U.S. Department of Labor (DOL) to
delegate responsibility to enforce federal standards for AHPs
to states in certain instances. However, this authority is
not universal. The section provides for situations in which
there is ``joint authority,'' presumably between the state
and federal levels. There are also situations in which the
DOL has sole authority over an AHP and state jurisdiction is
preempted.
These provisions create confusion about which regulatory
entity has responsibility for oversight of the various
functions of AHPs. We make note of the bills' recognition of
the value of the expertise and resources currently in place
at the state level. However, we are concerned that the
current language will create situations similar to previously
proposed legislation on Multiple Employer Welfare
Arrangements (MEWAs) in which the scope of regulatory
responsibility over such plans was unclear. As an example,
Section 802 of the bills gives certification authority to the
secretary of labor. It may be difficult for an individual
department of insurance to monitor the certification status
of AHPs operating within their state. It is crucial that the
oversight responsibility regarding solvency standards be
clear to avoid situations where AHPs fail because of
confusion regarding what entity is to be monitoring and
taking action when necessary.
There are a number of specific questions not answered by
this language in the bills. For example, does the current
language enable individual states to require AHPs operating
within their boundaries to abide by all existing insurance
regulations, including small-group rating laws and mandated
benefits? Or is the scope of states' responsibilities limited
to verifying the solvency of an AHP? Can the states
require AHPs to meet minimum solvency standards required
for insurance companies if those requirements are more
stringent than those described in these bills? Thus, it is
not clear that states would be willing to effectively
regulate these entities if the exemptions are viewed as
contrary to the intent of the state legislature.
Section 813(b)(2)(D) establishes that each AHP can identify
a single state to act as its ``applicable authority.'' This
section further provides that the laws of this single state
``supersede any and all laws of any other State in which
health insurance coverage of such type is offered.'' Many
states have devoted much time and many resources to
developing requirements pertaining to rating, benefit
coverage, and consumer disclosures that they believe serve
the best interests of their citizens. However, this section
would exempt AHPs from having to abide by these laws if the
AHP has elected a different state to act as its ``applicable
authority.'' This could result in AHPs ``shopping'' for the
state perceived to have the least oversight, effectively
negating the existing health insurance laws in most states.
In some states with small employer regulations that
significantly increase the cost of health insurance, all of
the small employers could migrate to AHPs, resulting in
federalization of the state's small group market.
In addition to rating and benefit regulations, provider and
claim payment laws add further complexity to this issue.
These include, but are not limited to: any willing provider
laws, prompt payment rules, privacy and patient protection
laws, and regulations regarding assignment of claims.
The work group is concerned that by dividing the oversight
responsibilities between the state and federal governments,
confusion will result regarding which entity has authority
over which function. The end result could be either
overregulation to the point that AHPs cannot operate, or
underregulation. When regulatory authority is unclear,
consumers have no place to turn for redress.
State Assessment Authority
Section 811 of the legislation allows states to impose
assessments on AHPs based on the amount of premiums or
contributions received from employers and employees who make
up the plan. Many states use assessments to subsidize ``high-
risk'' pools for uninsured individuals. However, it is
questionable whether a state would have the authority to levy
such assessments if it defers to the DOL to regulate its AHPs
or if a multi-state AHP is domiciled in another state's
jurisdiction.
The states also may have problems enforcing the provision,
given the requirement that such assessment ``is otherwise
nondiscriminatory . . . .'' Section 811 provides that the
rate of the assessment cannot exceed premium taxes paid by
health insurers or HMOs. In most states, HMOs are not taxed
or pay a lower tax than health insurance companies. AHPs
might argue that imposing an assessment based on the premium
tax rate applied to a health insurer would be discriminatory
if a lower rate or no premium tax was applied to HMOs. The
work group recommends that the legislation clearly delineate
where assessment authority will be placed, at the state or
federal level, and what the provisions of the assessments
will be.
other concerns
Expense reductions are not likely to materialize.
Administratively, each employer group will require the same
amount of underwriting, enrollment, mailings, and customer
support as they currently do in the small group insurance
market. It is unlikely that the AHPs will have more buying
power than the insurers that represent small employers today.
conclusion
The work group supports efforts to expand access to health
insurance. However, H.R. 660 and S. 545 can have many
unintended negative consequences. These include: An unlevel
playing field, leading to market destabilization and higher
rates for sicker individuals; potential AHP insolvencies,
resulting in unpaid claims for consumers and providers;
unclear regulatory responsibility; unclear directives
relating to assessments; and a promise of expense reductions
that are unlikely to materialize.
Again, members of the American Academy of Actuaries are
available to assist Congress in developing solutions to
address the issue of small-employer health insurance reform.
If you or your staff would like additional information or
assistance, please feel free to contact Holly Kwiatkowski,
the Academy's senior health policy analyst (federal), by
phone at (202) 223-8196 or by e-mail at
[email protected].
Sincerely,
Karen Bender,
Chairperson.
Other Academy members contributing to this letter are:
Michael S. Abroe, FSA, MAAA; David J. Bahn, FSA, MAAA;
Jennifer J. Brinker, FSA, MAAA; Michael L. Burks, MAAA; James
E. Drennan, FSA, MAAA, FCA; Richard M. Niemiec, MAAA; Donna
C. Novak, ASA, MAAA, FCA; John R. Parsons, MAAA, FCA; John J.
Schubert, ASA, MAAA, FCA; David A. Shea, Jr., FSA, MAAA; Mark
Wernicke, FSA, MAAA; and Jerome Winkelstein, FSA, MAAA.
____
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 18, 2003.
Hon. George Miller,
Senior Democratic Member, Committee on Education and the
Workforce,
House of Representatives, Washington, DC.
Dear Congressman: This letter responds to your request of
June 17, 2003, for additional information on CBO's estimate
of the impact of H.R. 660 on enrollment in the health
insurance markets for small employers and self-employed
workers. We expect that the effects of the bill would be
fully reflected in those markets by 2008, and all of the
following numbers refer to that year.
Under current law, CBO estimates that approximately 30.1
million people will be enrolled in health insurance offered
by plans in the state-regulated small group insurance market.
Under the bill, CBO estimates that combined enrollment in
state-regulated plans and association health plans (AHPs)
would rise by about 550,000 people to a total of 30.7 million
people. Of this, approximately 23.2 million people would
retain coverage in the state-regulated market. About 7.5
million people would be enrolled in AHPs, including the
additional 550,000 people who would not have been covered by
any small-employer plan under current law, and 6.9 million
people who would have been covered in the state-regulated
market.
The same considerations apply to self-employed people. We
estimate that approximately 4.7 million people will be
enrolled in
[[Page H2974]]
state-regulated coverage purchased by self-employed workers
under current law. Under H.R. 660, CBO estimates that
combined enrollment through state-regulated insurers and AHPs
would rise by about 70,000 people to 4.8 million people. Of
this, approximately 3.8 million people would retain state-
regulated coverage. About 1.0 million people would obtain
coverage through AHPs, including the additional 70,000 people
who would not have been insured under current law, and 0.9
million people who would have been covered in the state-
regulated market.
If you would like additional information on this estimate,
the CBO staff contact is Stuart Hagen, who can be reached at
225-2644.
Sincerely,
Douglas Holtz-Eakin,
Director.
There is a reason that it is not just Democratic Governors but
Republican Governors who object to this bill. There is a reason why
Democratic and Republican attorneys general object to this bill, why
Democratic insurance commissioners and Republican insurance
commissioners object to this bill. It does not work. What it does is
offer a Faustian bargain, where people give up their guaranteed
protection for breast cancer screenings, care for OB-GYN services, care
for diabetics. They give that up. They leave it to the whim of the
insurance industry. What they get for it is not lower premiums and more
people insured, but you get more uninsured.
The actuaries have concluded that 1 million people will be added to
the rolls of the uninsured by this bill. Outside experts who do not
favor either side in a partisan sense have concluded that 1 million
persons will be added to the ranks of the uninsured by this bill. The
insurance commissioners, the attorneys general and the Governors of
both parties throughout the country do not object to this bill because
they have some turf desire to regulate. They object to this bill
because it presents an unworkable situation where insurance companies
will fail, where creditors will not be paid, where people depending
upon insurance will not be insured, and we will have the chaos that we
had some years ago under the multiple employer welfare associations.
There is a better way to cover the uninsured. We will debate that
better way in just a few minutes in the substitute that the gentleman
from Wisconsin and I are putting forward. But we should not add to the
ranks of the uninsured. It is our responsibility to offer a better
alternative, and we do. But it is the responsibility of this entire
House to join with Governors of both parties, 66 chambers of commerce,
the National Association of Health Underwriters who perhaps best
understand this, insurance regulators, attorneys general, and not turn
to a gimmicky, insufficient solution to this problem. I urge defeat of
the legislation.
Mr. BOEHNER. Mr. Speaker, I yield myself the balance of my time.
We often have debates here in Congress about public policy and how to
change public policy. Many times the debates, once they get here, the
perfect becomes the enemy of the good. We do not claim that the
underlying bill is going to cover all of the uninsured and eliminate
that problem, but we do think it is a giant step forward in helping the
uninsured get access to high-quality health insurance at affordable
prices.
Even the flawed study that my colleague has pointed to on a number of
occasions, the CBO study which was flawed in a number of areas, says
that 330,000 of the uninsured will in fact get health insurance. I
think the number is far, far higher than that. I think we are talking
about millions of Americans will have a chance at good health
insurance. But let us say it is only 330,000, 330,000 families that
would get coverage under this bill. I think that is a good step in the
right direction.
Let me take an example of how this would work. Let us take a Realtor.
We all know Realtors work all over the country. They are independent
contractors. They have their own business. In many cases they are not
employees of the firm that they work for, but they have to go buy an
individual policy or family policy in a State insurance pool, the most
expensive way to buy health insurance in America. In the case of
Realtors, you could take the Ohio Association of Realtors, New Jersey
Association of Realtors, maybe the National Association of Realtors,
could put together a plan of maybe 5 or 6 choices, maybe 10 choices for
their members all over the country. I will guarantee that those
Realtors would have much better health insurance policies than they
have today and the cost of that policy will be far more competitive
than what they are paying in these State insurance pools.
This is a very good opportunity to help many small employers and
their employees all across the country. We should not miss this
opportunity.
Mr. CANTOR. Mr. Speaker, I rise today in support of three important
initiatives we took this week to meet the uninsured crisis head-on and
to address the rising costs of health care.
We have a crisis on our hands--over 40 million Americans are without
health insurance. In addition, it is becoming increasingly difficult to
not only obtain affordable health coverage, but to keep it--especially
for America's small businesses.
According to the Associated Builders and Contractors, over 60 percent
of the Nation's uninsured are small business employees. Small
businesses are the backbone of our economy. We must ensure that we
create an environment that allows these businesses access to affordable
health care. If we do not address the issue, we will see more and more
small businesses stop growing or close their doors. It is imperative,
therefore, that we pass legislation creating Association Health Plans
and legislation that allows families to roll-over money year-to-year
from their Flexible Spending Accounts or into new Health Savings
Accounts.
These two pieces of legislation will dramatically improve our
Nation's health care climate, especially for small businesses. More
individuals and their employers will be able to afford health care; and
in turn, we will see the health of Americans improve and the costs of
health care decline.
The third piece of legislation addresses America's medical liability
crisis. Physicians in Virginia and across the country are being forced
to close their doors due to the astronomically rising costs of medical
malpractice premiums.
On February 4, 2004, as many as 1,500 physicians from all over my
State marched on the Virginia Capitol to make the case for common-sense
medical liability from reform in the State legislature. Led by the
Medical Society of Virginia, Virginia's White Coat Day march on
Richmond was designed to educate state lawmakers on how doctors'
skyrocketing malpractice insurance is limiting patients' access to
medical care. Outrageous runaway jury awards are causing malpractice
premiums to rise uncontrollably,and many doctors are being forced to
raise prices or shut their doors. These higher costs are then passed on
to working families and small businesses.
Not only should the Virginia legislature address this issue, but we
as a Congress need to do the same. We need to take President Bush's
lead in ending the jackpot payouts that our legal system encourages.
Mr. Speaker, we must pass these common sense reforms into law in
order to help our Nation's uninsured and address the rising costs of
health care. These are issues we cannot afford to ignore.
Mr. BLUMENAUER. Mr. Speaker, one of the most frustrating aspects of
the way we run Congress today is an interest in scoring political
points as opposed to solving problems. Nowhere is that more in evidence
than the symbolic political acts surrounding healthcare this week in
the House of Representatives.
We are in the midst of a healthcare crisis for the uninsured, for
small businesses, and for practitioners. There is a complicated,
interconnected fabric that provides healthcare in this country that
includes insurance companies, HMO's, public agencies, Federal
Government programs and the institutions that represent and train
medical professionals. Advocacy groups, legal experts and consumers all
have legitimate interests and something to say.
Sadly, the Republican leadership in the House of Representatives
continues to be more interested in scoring political points than
solving problems. Simply recycling the same flawed legislation, is
clearly far less than our best effort and stands little likelihood of
passage to the Senate, where similar legislation continues to languish.
These bills would undermine our efforts by insuring only the
healthiest and wealthiest, leaving 511,00 uninsured Oregonians and tens
of millions of Americans behind. Furthermore, the Association Health
Plans proposals would exempt state solvency requirements, leaving the
consumers at a significant risk.
If we were able to openly debate these proposals on the floor I know
that the healthcare community would be well served because the majority
of Congress does not want to short change it or our citizens. Most in
Congress do not want to artificially restrict payments and are
sincerely interested in making sure that Federal policy does not create
or enhance abusive or distorted behaviors.
[[Page H2975]]
The most dramatic example would be fixing flawed funding. There is a
gusher of money going to items far less important, far less essential
to the American public, such as the unaffordable, unnecessary
additional tax benefits to those who need help the least. It is time
for the vast array of interests represented by the healthcare community
and the people vitally dependent upon it to insist that the Republican
Leadership stop the games. Everyone should commit to full, fair, honest
debate in a more open legislative process. This is the only way we will
enact cost effective legislation, and stop the funding abuses. We must
stop holding legislation hostage, to another political agenda. I will
continue to work with my healthcare community at home along with
national groups and organizations to produce the type of process,
discussion and legislation Americans critically deserve.
Mr. SANDLIN. Mr. Speaker, with nearly 44 million Americans lacking
basic health care coverage, it is time to take action. Today, in a
disingenuous public attempt to respond to the crisis of the uninsured,
the Republican leadership has decided to spend the valuable time and
limited resources of the American taxpayers debating Association Health
Plan (AHP) legislation that has already been voted on in the 108th
Congress.
The absolute irony, of course, is that instead of strengthening the
health of our nation, AHPs will increase the ranks of the uninsured,
increase the health insurance costs for small businesses that don't
participate in AHPs and destroy consumer protections currently
safeguarded by state regulations. Clearly, this is not sound policy.
Why are AHPs so bad? The creation of Association Health Plans will
destabilize health insurance markets by forcing the state-regulated
market and national AHP market to compete with each other. Few will
benefit and most will suffer from this damaging division. Small
businesses who choose to stay in the safer, state-regulated health
insurance market will see their health insurance premiums skyrocket by
23 percent. The reality is that AHPs can offer lower premiums mainly
because they offer fewer benefits--which is attractive to people in
good health. With the AHPs siphoning off healther people into their
market, state-regulated insurers will be responsible for covering a
larger proportion of people with higher health care costs. Rather than
risk being spread out and absorbed by many, it is divided, thereby
threatening the solvency and accessibility of the state-regulated
insurance businesses.
Mr. Speaker, it is clear that Association Health Plans hurt American
workers and their families. The lower costs available to small
businesses opting into AHPs are simply not worth it when you consider
the damaging strings attached. This legislation allows AHPs to pre-empt
over 1,000 important state laws that States enacted to protect the
basic health care needs of our communities. These laws include
critically necessary benefits like mammographies, diabetes care, well-
child visits, mental health services, and direct access to OB/GYN and
pediatricians. Pre-empting state laws also allows AHPs to redline and
re-underwrite insurance for higher risk people, allowing discrimination
against consumers and causing insurance premiums to rise.
Employees will be further compromised by the lack of rights afforded
to them under their AHP policies. If consumers are denied important
healthcare treatment, they will not be allowed an independent external
review and/or Consumer Ombudsmen program as state consumer-protection
laws regulate. Further, there are very weak protections
against insolvency under the AHP program which means small employers,
American workers and their families may be burdened with millions of
dollars of unpaid claims, which is exactly what health insurance is
supposed to insure against.
Finally, Mr. Speaker, it is worth noting that a recent study by
Mercer and the National Small Business Association concluded that AHPs
would swell the ranks of the uninsured to rise by more than one million
people--an increase of 8.5 percent. This is because as premiums for
small business employers in the state-regulated market increase, some
firms would drop coverage. Further, businesses covered by AHPs might
have to drop coverage if they are forced to pay new, higher premiums if
someone in their group gets sick.
Mr. Speaker, it's hard to imagine why anyone would vote for such a
flawed piece of legislation that would be devastating to American
families. Sadly, the answer is clear: The Wall Street Journal recently
said that a major business trade organization stands to reap more than
$100 million of annual revenue by selling AHP policies if H.R. 4281 is
passed. Mr. Speaker, our constituents deserve better than this.
The fact is that there are clear alternatives. Yesterday, I
introduced H.R. 4356, the Small Business Health Insurance Promotion
Act. This legislation will provide immediate, concrete relief by
securing affordable health insurance coverage for millions of self-
insured individuals and employees of small businesses.
Mr. Speaker, as an incentive to provide coverage, the Small Business
Health Insurance Promotion Act would make small businesses or self-
employed individuals eligible to receive a 50 percent tax credit for
four years to defray the cost of health insurance. The bill would also
authorize funding to create state and national multi-insurer pools to
provide comprehensive and affordable health insurance choices to small
employers and the self-employed. Regardless of whether a business
elected to enter the state or national pool consumers would be
guaranteed quality coverage--coverage in each pool must be
substantially similar to health benefits coverage offered in any of the
four largest health plans in the Federal Employees Health Benefit
Program (FEHBP). In this legislation, unlike in AHPs, important
consumer protections would be safeguarded, the same coverage available
to Members of Congress and other federal employees.
Forget the gimmick. Rather than offering up stale legislation which
will hurt--not help--the health of our nation, let's take real action
and pass sound coverage policies. Pass the Kind substitute, and take up
the Small Business Health Insurance Promotion Act, as well as other new
Democratic initiatives like the FamilyCare Act and the Medicare Early
Access Act. Together these initiatives could provide health coverage to
more than one-half of the 44 million uninsured Americans. Our American
families deserve no less.
Mr. STARK. Mr. Speaker, I rise today to oppose H.R. 4281, the ``Small
Business Health Fairness Act of 2004.'' This bill would hurt small
businesses and patients by increasing the costs of health insurance and
the number of uninsured.
If my comments today sound familiar, it is because they are almost
exactly the same arguments I made last June, when this exact same bill
passed the House. It was a bad idea then, and it is an even worse idea
today. During this ``Cover the Uninsured Week'' the Republicans suggest
association health plans can cover millions of uninsured Americans. In
reality H.R. 4281 would actually add to the nearly 44 million uninsured
in this country. This warmed over re-vote is a waste of time and
taxpayer resources, and has nothing to do with providing affordable
healthcare options to our citizens.
According to recent studies, association health plans would actually
increase costs for most small businesses and their employees. Our own
Congressional Budget Office has estimated that over 80 percent of small
businesses would see increased premium costs under H.R. 4281. Those
small employers that currently offer traditional, state-regulated
health insurance would see their premiums increase by 23 percent on
average. Premiums will increase because AHPs will offer only bare-bones
coverage, attracting the healthiest individuals, leaving traditional
health insurance plans with the sickest and most expensive patients.
This shift would penalize businesses with sicker employees, and make
health insurance even more unaffordable for those who need it most.
I am glad to see my Republican friends are concerned about the 43.6
million people in this country who lack health insurance. However, AHPs
are not a real solution, and will actually add 1 million people to the
continuously growing number of uninsured. As traditional health
insurance becomes increasingly expensive, more and more businesses
would have no choice but to drop health insurance for their employees,
leaving these individuals with little or no opportunity to purchase
health coverage.
Not only will this bill increase the number of uninsured, it will
blatantly discriminate against small businesses with sicker employees--
often those businesses with lower-income and minority workers. Because
H.R. 4281 would allow AHPs to avoid state laws against cherry picking,
these plans would only offer insurance to small businesses with the
healthiest employees. Any premium reductions touted by the bill
sponsors--at most a modest 10 percent reduction--would be a direct
result of cherry-picking and reduced benefits, not greater efficiency.
As healthy people move into AHP's skeletal coverage, sicker people are
left without health insurance, increasing the morbidity of the
uninsured population by over 12 percent.
Small businesses will not be able to provide more affordable health
insurance to their employees under this bill. Although proponents claim
that AHPs would give small-employers bargaining power to purchase
affordable health insurance, most states already have laws in place
that allow for group purchasing arrangements. This bill would harm
existing State laws and usurp the traditional role of States to
regulate small-employer health insurance.
This bill would also preempt key State provisions that protect
millions of insured Americans. For example, many States regulate
insurance premiums to prevent insurers from discriminating against the
sick. But under this
[[Page H2976]]
bill, AHPs could offer extremely-low ``teasers'' rates, and then
rapidly increase premiums if the enrollee becomes sick. Many small
businesses would find these high rates unaffordable, and would be
forced to drop coverage. Furthermore, nearly all States have enacted
external review laws, which allow patients to have an independent
doctor review a claim that has been denied by the insurer. Patients who
join AFPs would lose this right.
Additionally, this legislation would be a setback to government
efforts to reign in fraud and abuse. Association health plan exemptions
in this bill are nearly identical to those Congress grated to multiple
employer welfare arrangements (MEWAs) in the 1970s, which led to
widespread fraud and abuse. These exemptions allowed MEWAs to rack up
$123 million in unpaid healthcare bills, and prompted the Department of
Labor to open 90 fraud and abuse investigations. Congress recognized
and corrected this problem, but now my Republican colleagues are
ignoring the lessons of the past and are headed right back down the
same dangerous road with AHPs.
Finally, this bill would exempt AHPs from state-required benefits,
which have helped to ensure that millions of Americans get access to
necessary healthcare services. These benefits include mammography
screenings, maternity care, well-child care, and prompt payment rules.
In my State, California, employees who join AHPs could also lose access
to certain emergency services, direct access to OB/GYNs, mental health
parity, and other important benefits.
The Democratic substitute offered today by Representatives Andrews
and Kind is a real solution for providing small-businesses access to
affordable health insurance. Using the $50 billion President Bush
included in his FY04 budget for the uninsured, this proposal would
allow small businesses to buy-into a small employer health benefits
plan (SEHBP). Republicans have been stammering for years about giving
people the same insurance options as members of Congress and this
substitute would do just that. The SEHBP would be substantially similar
to the Federal Employers Health Benefits Plan (FEHBP) and millions of
uninsured would finally have the same options we have as Members of
Congress.
This association health plan bill is bad for patients, bad for small
businesses, and bad for states. It is opposed by over 1,000
organizations, including the National Governors Association, local
Chambers of Commerce, small business associations, physician
organizations, labor unions, and healthcare coalitions. H.R. 4281 would
increase premiums, increase the number of uninsured, lead to massive
fraud, and remove key state patient protections. I urge my colleagues
to reject this legislation.
Mr. JONES of Ohio. Mr. Speaker, I rise today in support of Small
Businesses, and I am an advocate of Small Businesses providing quality
health insurance to the men, and women, and the families of those who
work for them. But, because I oppose H.R. 4281 that does not make me
anti-Small Business, just like opposing the war in Iraq does not make
one unpatriotic. What it makes me is an advocate for the truth and the
facts. And the fact is that these association health plans would be
exempt from almost all state consumer protection laws regarding
benefits, premiums, and solvency. States are generally the primary
regulators of health insurers, and assure appropriate access to health
care, and protect against fraudulent marketing schemes. It is no wonder
the National Governors Association, the National Conference of State
Legislature, and Consumer Unions oppose this legislation. This
initiative would allow Associated Health Plans to engage in the cherry
picking of the healthiest population nationwide. In Ohio, AHPs would
not be required to provide basic mammography screening, direct access
to OB-GYN's, mental health services, alcoholism treatment, and vital
primary health care. In addition to not providing particular types of
services, there would be no limitation on how frequently AHPs could
increase an employee's premium to continue coverage. AHPs could then
also vary their rates for older or sicker members of their plans.
Establishing association health plans will not significantly reduce the
number of uninsured Americans. The Congressional Budget Office
estimates that while 4.8 million Americans would join association
health plans; only 330,000 of them would come form the ranks of those
currently uninsured. The remaining 4.5 million would simply switch from
an existing health plan to an association health plan. These plans
would discriminate against older and sicker Americans, putting an extra
burden on those who rely on health plans, and forcing the state to
provide coverage for those who may not otherwise find an AHP. I believe
governmental authority for regulating AHPs should be clearly specified.
Absent this clarification, it is likely that no one will be regulating
AHPs, or there will be conflicting regulation. When regulatory
authority is unclear, consumers have no place to turn for redress. If
is for these reasons that I support Small Business and oppose this
bill.
Mrs. BIGGERT. Mr. Speaker, I rise today in support of H.R. 4281, the
Small Business Health Fairness Act.
Sixty percent of those who are uninsured are employed. Their
employers either cannot afford to offer health insurance, or the
premiums are so high, employees cannot afford to pay their share.
When small companies are allowed to band together, they can take
advantage of the same economies of scale that large companies have
enjoyed for years. The costs of insurance are spread out over a larger
pool of individuals. By spreading the cost of insurance among a larger
number of employees, we make health insurance affordable for working
families.
The Congressional Budget Office has estimated that small businesses
that participate in AHPs will save an average of 9 to 25 percent of
their healthcare costs. CBO also concluded that AHP legislation would
cover up to 2 million uninsured American workers, with no cost to the
government.
It is simply not fair that individuals who work for a small business
do not have the same access to healthcare that they would if they
worked for a large corporation. I am proud to support this fair,
common-sense bill and I urge my colleagues to do the same.
Mr. RUPPERSBERGER. Mr. Speaker, I rise in opposition to this bill
because it will negatively impact my home state of Maryland. To
paraphrase what was in Governor Ehrlich's letter to Chairman Boehner,
this legislation will undue what the state of Maryland has worked so
hard on for the past 10 years.
The rising cost of health care is a concern for all Americans. We
need to find ways to make sure that we help people reduce their
healthcare cost. We need to find a way to provide insurance for the 44
million Americans without any coverage at all.
Association Health Plans has many benefits such as allowing a group
of shared interest businesses and individuals to purchase health
insurance at a group rate. However, what we should be working toward is
a solution where everyone benefits. One of my concerns with Association
Health Plans is one I also have with the prescription drug bill that is
law. My concern is that AHP's will be able to skim off the healthiest
individuals leaving those most in need without coverage. Also, the
legislation would allow the AHP's to not comply with state health
mandates.
I would be more supportive of tax credits for businesses to purchase
health insurance and also allow for states to establish insurance pools
like we have in Maryland. Again, we need to make sure the states and
businesses have the tools to address this issue. We cannot have a
forced federal mandate that will hurt what the state of Maryland has
already done.
The SPEAKER pro tempore (Mr. Simpson). All time for debate on the
bill has expired.
Amendment in the Nature of a Substitute Offered by Mr. Kind
Mr. KIND. Mr. Speaker, I offer an amendment in the nature of a
substitute.
The SPEAKER pro tempore. The Clerk will designate the amendment in
the nature of a substitute.
The text of the amendment in the nature of a substitute is as
follows:
Part B amendment in the nature of a substitute printed in
House Report 108-484 offered by Mr. Kind:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Small
Employer Health Benefits Program Act of 2004''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title.
Sec. 2. Establishment of Small Employer Health Benefits Program
(SEHBP).
``Part 8--Small Employer Health Benefits Program
``Sec. 801. Establishment of program.
``Sec. 802. Contracts with qualifying insurers.
``Sec. 803. Additional conditions.
``Sec. 804. Dissemination of information.
``Sec. 805. Subsidies.
``Sec. 806. Authorization of appropriations.
SEC. 2. ESTABLISHMENT OF SMALL EMPLOYER HEALTH BENEFITS
PROGRAM (SEHBP).
(a) In General.--Subtitle B of title I of the Employee
Retirement Income Security Act of 1974 is amended by adding
after part 7 the following new part:
``Part 8--Small Employer Health Benefits Program (SEHBP)
``SEC. 801. ESTABLISHMENT OF PROGRAM.
``(a) In General.--The Secretary shall establish, in
accordance, with this part, a program under which--
``(1) qualifying small employers (as defined in subsection
(b)) are provided access to qualifying health insurance
coverage (as defined in subsection (c)) for their employees,
and
[[Page H2977]]
``(2) such employees may elect alternative forms of
coverage offered by various health insurance issuers.
``(b) Qualifying Small Employer Defined; Other
Definitions.--For purposes of this part:
``(1) Qualifying small employer.--
``(A) In general.--The term `qualifying small employer'
means a small employer (as defined in paragraph (2)) that--
``(i) elects to offer health insurance coverage provided
under this part to each employee who has been employed by
that employer for 3 months or longer; and
``(ii) elects, with respect to an employee electing
coverage under qualified health insurance coverage, to pay at
least 50 percent of the total premium for qualifiing health
insurance coverage provided under this part.
``(B) Elections.--Elections under sub paragraph (A) may be
filed with the Secretary during the 180-day period beginning
with the first enrollment period occurring under section 803
and during open enrollment periods occurring thereafter under
such section. Such elections shall be filed in such form and
manner as shall be prescribed by the Secretary.
``(C) Part-time employment.--Under regulations of the
Secretary, in the case of an employee serving in a position
in which service is customarily less than 1,500 hours per
year, the reference in subparagraph (A) (ii) to `50 percent'
shall be deemed a percentage reduced to a percentage that
bears the same ratio to 50 percent as the number of hours of
service per year customarily in such position bears to 1,500.
``(2) Small employer.--The term `small employer' means,
with respect to a year under the program, an employer who
employed an average of fewer than 100 employees on business
days during the preceding calendar year and who employs at
least 1 employee on the first day of such year under the
program.
``(3) SEHBP.--The term `SEHBP' means the small employer
health benefits program provided under this part.
``(c) Qualifying Health Insurance Coverage.--For purposes
of this part, the term `qualifying health insurance coverage'
means health insurance coverage that meets the following
requirements:
``(1) The coverage is offered by a health insurance issuer.
``(2) The benefits under such coverage are equivalent to or
greater than the lower level of benefits provided under the
service benefit plan described in section 8903(l) of title 5,
United States Code.
``(3) The coverage includes, with respect to an employee
that elects coverage, coverage of the same dependents that
would be covered if the coverage were offered under FEHBP.
``(4) (A) Subject to subparagraph (B), there is no
underwriting, through a preexisting condition limitation,
differential benefits, or different premium levels, or
otherwise, with respect to such coverage for covered
employees or their dependents.
``(B) The premiums charged for such coverage are community-
rated for employees within any State and may vary only--
``(i) by individual or family enrollment, and
``(ii) to the extent permitted under the laws of such State
relating to health insurance coverage offered in the small
group market, on the basis of geography.
``(d) Other Terms.--
``(1) Health insurance coverage; health insurance issuer;
health status-related factor.--The terms `health insurance
coverage', `health insurance issuer', `health status-related
factor' have the meanings provided such terms in section 733.
``(2) Small group market.--The term `small group market'
has the meaning provided such term in section 2791(e)(5) of
the Public Health Service Act (42 U.S.C. 300gg-91(e)(5)).
``(3) FEHBP.--The term `FEHBP' means the Federal Employees
Health Benefits Program under chapter 89 of title 5, United
States Code.
``(e) Treatment of Partnerships and Self-Employed
Individuals.--For purposes of this part, and for purposes of
applying section 3 to this part and to part 5 as it applies
to this part, in any case in which qualifying health
insurance coverage is, or is to be, provided under a plan,
fund, or program to individuals covered thereunder--
``(1) if such plan, fund, or program is maintained by a
partnership, the term `employer' (as defined in section 3(5))
includes the partnership in relation to the partners, and the
term `employee' (as defined in section 3(6)) includes any
partner in relation to the partnership; and
``(2) if such plan, fund, or program is maintained by a
self-employed individual, the term `employer' (as defined in
section 3(5)) and the term `employee' (as defined in section
3(6)) shall include such individual.
``SEC. 802. CONTRACTS WITH QUALIFYING INSURERS.
``(a) In General.--The Secretary shall enter into contracts
with health insurance issuers for the offering of qualifying
health insurance coverage under this part in the States in
such manner as to offer coverage to employees of employers
that elect to offer coverage under this part. Nothing in this
part shall be construed as requiring the Secretary to enter
into arrangements with all such issuers seeking to offer
qualifying health insurance coverage in a State.
``(b) Continued Regulation.--Nothing in this part shall be
construed as preempting State laws applicable to health
insurance issuers that offer coverage under this part in such
State.
``(c) Coordination With State Insurance Commissioners.--The
Secretary shall coordinate with the insurance commissioners
for the various States in establishing a process for handling
and resolving any complaints relating to health insurance
coverage offered under this part, to the extent necessary to
augment processes otherwise available under State law.
``SEC. 803. ADDITIONAL CONDITIONS.
``(a) Limitation on Enrollment Periods.--The Secretary may
limit the periods of times during which employees may elect
coverage offered under this part, but such election shall be
consistent with the elections permitted for employees under
FEHBP and shall provide for at least annual open enrollment
periods and enrollment at the time of initial eligibility to
enroll and upon appropriate changes in family circumstances.
``(b) Authorizing Use of States in Making Arrangements for
Coverage.--In lieu of the coverage otherwise arranged by the
Secretary under this part, the Secretary may enter an
arrangement with a State under which a State arranges for the
provision of qualifying health insurance coverage to
qualifying small employers in such manner as the Secretary
would otherwise arrange for such coverage.
``(c) Use of FEHBP Model.--The Secretary shall carry out
the SEHBP using the model of the FEHBP to the extent
practicable and consistent with the provisions of this part,
and, in carrying out such model, the Secretary shall, to the
maximum extent practicable, negotiate the most affordable and
substantial coverage possible for small employers.
``SEC. 804. DISSEMINATION OF INFORMATION.
``The Secretary shall widely disseminate information about
SEHBP through the media, the Internet, public service
announcements, and other employer and employee directed
communications.
``SEC. 805. SUBSIDIES.
``(a) Employer Subsidies.--
``(1) Enrollment discount.--
``(A) In general.--In the case of a qualifying small
employer who is eligible under subparagraph (B), the portion
of the total premium for coverage otherwise payable by such
employer under this part shall be reduced by 5 percent. Such
reduction shall not cause an increase in the portion of the
total premium payable by employees.
``(B) Employers eligible for discounts.--A qualifying small
employer is eligible under this subparagraph if such employer
employed an average of fewer than 25 employees on business
days during the preceding calendar year.
``(2) Employer premium subsidy.--
``(A) In general.--The Secretary shall provide to
qualifying small employers who. are eligible under
subparagraph (C) and who elect to offer health insurance
coverage under this part a subsidy for premiums paid by the
employer for coverage of employees whose individual income
(as determined by the Secretary) is at or below 200 percent
of the poverty line (as defined in section 673(2) of the
Community Services Block Grant Act (42 U.S.C. 9902(2)),
including any revision required by such section) for an
individual.
``(B) Subsidy scaled according to size OF employer.--The
subsidy provided under subparagraph (A) shall be designed so
that the subsidy equals, for any calendar year--
``(i) 50 percent of the portion of the premium payable by
the employer for the coverage, in the case of eligible
qualifyng small employers who employ an average of fewer than
11 employees on business days during the preceding calendar
year;
``(ii) 35 percent of the portion of the premium payable by
the employer for the coverage, in the case of eligible
qualifying small employers who employ an average of more than
10 employees but fewer than 26 employees on business days
during the preceding calendar year; and
``(iii) 25 percent of the portion of the premium payable by
the employer for the coverage, in the case of eligible
qualifying small employers who employ an average of more than
25 employees but fewer than 51 employees on business days
during the preceding calendar year.
``(C) Employers eligible for premium subsidy.--A qualifying
small employer is eligible under this subparagraph if such
employer employed an average of fewer than 50 employees on
business days during the preceding calendar year.
``(b) Employee Subsidies.--
`` (1) In general.--The Secretary shall provide subsidies
to employees of qualifying small employers in any case in
which the family income of the employee (as determined by the
Secretary) is at or below 200 percent of the poverty line (as
defined in section 673(2) of the Community Services Block
Grant Act (42 U.S.C. 9902(2)), including any revision
required by such section) for a family of the size involved.
``(2) Amount of subsidy.--Such subsidies shall be in an
amount equal to the excess of the portion of the total
premium for coverage otherwise payable by the employee under
this part for any period, over 5 percent of the family income
(as determined under paragraph (1) (A)) of the employee for
such period.
``(3) Coordination of subsidies.--Notwithstanding paragraph
(1), under regulations of the Secretary, an employee may be
entitled to subsidies under this subsection for any period
only if such employee is not eligible for
[[Page H2978]]
subsidies for such period under any Federal or State health
insurance subsidy program (including a program under title V,
XIX, or XXI of the Social Security Act). For purposes of this
paragraph, an employee is `eligible' for a subsidy under a
program if such employee is entitled to such subsidy or
would, upon filing application therefore, be entitled to such
subsidy.
``(4) Authority to expand eligibility.--The Secretary may,
to the extent of available funding, provide for expansion of
the subsidy program under this subsection to employees whose
family income (as defined by the Secretary) is at or below
300 percent of the poverty line (as determined under
paragraph (1)).
``(c) Limitations.--For purposes of this section--
``(1) Restrictions on treatment of employment
relationship.--Section 801(e) shall not apply.
``(2) Requirement of multiple employees.--A small employer
shall not be treated as a qualifying small employer with
respect to an applicable year unless the employer employs at
least 2 employees on the first day of such year.
``(d) Procedures.--The Secretary shall establish by
regulation applications, methods, and procedures for carrying
out this section, including measures to ascertain or confirm
levels of income.
``SEC. 806. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated, for the period
beginning with fiscal year 2005 and ending with fiscal year
2014, $50,000,000,000 to carry out this part, including the
establishment of subsidies under section 805.''.
(b) Report on Offering National Health Plans.--Not later
than 18 months after the date of the enactment of this Act,
the Secretary of Labor shall report to Congress the
Secretary's recommendations regarding the feasibility of
offering national health plans under part 8 of subtitle B of
title I of the Employee Retirement Income Security Act of
1974, as added by subsection (a).
(c) Clerical Amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 is
amended by inserting after the item relating to section 734
the following new items:
``Part 8--Small Employer Health Benefits Program (SEHBP)
``Sec. 801. Establishment of program.
``Sec. 802. Contracts with qualifying insurers.
``Sec. 803. Additional conditions.
``Sec. 804. Dissemination of information.
``Sec. 805. Subsidies.
``Sec. 806. Authorization of appropriations.''.
The SPEAKER pro tempore. Pursuant to House Resolution 638, the
gentleman from Wisconsin (Mr. Kind) and the gentleman from Ohio (Mr.
Boehner) each will control 30 minutes.
The Chair recognizes the gentleman from Wisconsin (Mr. Kind).
Mr. KIND. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, first of all I want to recognize the gentleman from New
Jersey for the fine work and the leadership that he has shown on such
an important issue. This is an important issue.
It has been said that the definition of insanity is doing the same
thing over and over again without any change in the result. Yet that is
what we have been having this week in Congress, bills that have already
been debated and deliberated upon and voted upon last year coming back
again for another kick at the can, which is fine. In an issue as
important as this, I think it is important for the Congress to take a
moment and start talking about the plight of small businesses and
family farmers across the country who are suffering under rising health
care costs and fearful of the inability of being able to provide
coverage for their families or their employees because of the cost of
insurance today.
This is such a fundamental and crucial issue if we want to be serious
about economic growth, if we want to be concerned about the 43-million-
plus uninsured that exist in this country. As I travel through my
congressional district in western Wisconsin meeting with small business
owners and their employees, meeting with family farmers, the number
one, chief concern that they continuously raise is the expensive health
care and accessing the quality system that exists in this country right
now on an affordable basis.
It is a travesty that 20 percent of my dairy farmers in Wisconsin
have no health coverage at all for themselves or their families, one of
the more dangerous occupations in the entire country. It is a travesty
that as I talk to small business owners who would like nothing better
than to provide some health coverage for their employees, tell me that
they cannot because they cannot afford it. In a country as great and as
powerful and as wealthy as ours, we have got to do better and we have
to get serious.
What we are about to talk about in the remaining minutes of the
duration of this debate is there is a better way. The gentleman from
New Jersey and I have drafted a substitute to what is being offered
before the House today. It is one based in common sense, in reality in
regards to what will work and what will not, what will extend coverage
to the uninsured and what will not; what will bring more affordability
to the health care system, to these small business owners, their
employees and to our family farmers, and what will not.
Our bill is very simple. It is based on the Federal Employee Health
Plan. It does establish national purchasing pools but it goes through
State-licensed insurers so we do not have Federal preemption of State
law over such crucial areas as cancer screening, whether it is
mammograms, breast cancer, cervical cancer screenings, whether it is
emergency care or maternity care, issues that the States have wrestled
with with themselves and found it important enough to pass law on a
State-to-State basis to provide coverage for these important services.
And also to cover autism health care. I am proud that the State of
Wisconsin is one of 17 that does mandate the coverage of autism health
care for our citizens in the State, one that is exploding right now and
very expensive for society. Health care experts and those affected by
autism, those families of autistic children, realize that the key to
effective treatment is early identification. If we allow this AHP plan
to pass, which preempts State law, that says, hey, insurers, you don't
have to provide coverage even though the State of Wisconsin says this
is the right policy to do, it is only going to exacerbate the system in
this country in regard to effective autistic treatment for children in
our communities.
That is what this debate is all about. It is a very simple,
commonsense approach to dealing with what is a national crisis and, I
view, a national emergency.
Rather than offering a piece of legislation where the American
Academy of Actuaries, where Mercer has released a study indicating that
it would increase rather than decrease the rolls of the uninsured by 1
million people, our substitute version that provides national
purchasing options, that provides subsidy payments to employers with 50
or fewer employees in order to keep those health care premiums down and
our ability to potentially extend health care coverage to the 43
million uninsured to an additional 33 million Americans, we think this
is the best approach to take. This is not an issue about who supports
small business or family farmers more or who is more concerned about
the plight of the uninsured. This is about what will work and what will
not work. That is why we have the National Governors Association, the
Republican and Democratic Governors Association, the National
Association of Attorneys General and Insurance Commissioners, over
1,000 organizations including 66 chambers of commerce who are saying
that the majority AHP plan will not work. Not because they desire some
power grab and to maintain their own State regulations, but because it
is based on reality and an independent and objective study of what will
and what will not work.
That is why I would hope that my colleagues, before they ultimately
make up their mind and cast their vote today, that they have a chance
to quickly look at the actuary study, to quickly look at the Mercer
study and to pause before we embark upon a road that could potentially
lead to another million uninsured in our society. Enough is enough.
{time} 1500
We need to be going in the opposite direction rather than where I
fear the AHP bill would go. The substitute that the gentleman from New
Jersey (Mr. Andrews) and I are offering offers that hope and that
potential to achieve that, and I would encourage my colleagues to
support the substitute, vote ``no'' on the AHP bill, and let us move
forward together on something that has the potential of working very
well for small businesses and family farmers throughout the country.
Mr. Speaker, I reserve the balance of my time.
[[Page H2979]]
Mr. BOEHNER. Mr. Speaker, I yield 2 minutes to the gentleman from
Nebraska (Mr. Osborne), one of the active members of our committee.
Mr. OSBORNE. Mr. Speaker, I thank the chairman for yielding me this
time.
Mr. Speaker, I represent a district that is entirely rural and has
nothing but small businesses in it. The number one complaint that I
hear is about the cost of health insurance. These businesses employ
more employees than all of the other industries in the country. They
are the driving force behind it; and more and more of these
individuals, as has been mentioned in the previous debate, are simply
having to reduce or eliminate their health care coverage because it is
going up 15, 20 percent every year and they simply cannot afford it.
I would like to give one personal example. I have a son-in-law who is
managing a small franchise company, has 130 franchises in roughly 30,
40 States, and he says that this is the number one priority they have
as far as health insurance, that if they could have an association of
health plans, this would certainly cut their costs and enable them to
maintain their health insurance at the present level.
So I realize that there are some problems with some of the States;
but from my perspective and from what I have heard, I would say this is
certainly a good bill. I appreciate the authors of the substitute. I
think they are thoughtful people. I am sure they have done a good job
at doing their homework, but at this point I would certainly have to
oppose the substitute and support the underlying bill.
Mr. KIND. Mr. Speaker, I yield 3 minutes to the gentlewoman from the
Virgin Islands (Mrs. Christensen), a true champion of small business
owners and their employees.
Mrs. CHRISTENSEN. I thank the gentleman for yielding me this time.
Mr. Speaker, this is Insure the Uninsured Week, and for me as a
physician and Chair of the Health Brain Trust of the Congressional
Black Caucus, ensuring health coverage to everyone is a priority every
day.
And so I want to be very clear that I rise in strong support of
providing small businesses and their employees access to high-quality
health insurance that is truly affordable. That is why I oppose H.R.
4281, the Association Health Plan bill, and support the Kind-Andrews
substitute.
We in the minority caucuses have spent a great deal of time looking
at the issue of insurance, of how we can allow small business
associations to come together to pool their purchasing power to buy
quality health coverage at the lowest possible cost. We examined the
AHPs. I did not originally sign on to the bill, but after a closer look
at what it would do and as a physician who understands how important it
is to do no harm, I removed my name from what I consider a harmful
bill.
In H.R. 4281, the base bill, AHPs would be exempt from State
insurance regulations and consumer protections. They would increase
health care costs for most small business employees, cause premiums to
rise for those outside of the AHP market, and eventually not lower, but
increase, the number of uninsured in small business firms.
While AHP supporters will insist that this will not happen, by
removing these important protections, the major harm this bill can do
is too great a risk to take. We are talking about workers' health; we
are talking about their lives. There is a better way to provide this
insurance which will not harm, and that is the Kind-Andrews substitute.
It would establish an employer health benefit plan similar to the
Federal employees' health benefits, which would contract with state-
licensed health insurers to offer an insurance package for employees of
businesses of fewer than 100 employees.
Unlike the underlying bill, this better Democratic substitute will
keep these small employer plans subject to State health insurance and
consumer regulations and protections. It would provide small businesses
and their employees access to high-quality health coverage; and by
ensuring that the risk is spread, that everyone is included, not
keeping sicker employees out, it keeps it truly affordable.
As a member of the Committee on Small Business since coming to this
Congress, I am for helping small businesses. This substitute does that.
H.R. 4281 will not.
I urge my colleagues to join the more than 150 organizations,
including all of the prominent civil rights organizations, in opposing
H.R. 4281. Instead, I urge them to vote for the Kind-Andrews
substitute. Let us make sure we cover this important group who are over
60 percent of all the uninsured; and above all, let us do no harm.
Mr. BOEHNER. Mr. Speaker, I yield 2 minutes to the gentleman from
Oklahoma (Mr. Sullivan).
Mr. SULLIVAN. Mr. Speaker, I would like to commend the gentleman from
Ohio (Chairman Boehner) for his hard work on this very important
legislation.
I rise in support of this commonsense legislation which will deliver
quality health care to millions of Oklahomans. One of the greatest
challenges the State of Oklahoma faces is our uninsured population.
With 650,000 uninsured, Oklahoma ranks fourth in the number of
uninsured across the country. This is a shocking statistic, an
unacceptable situation; and today I am proud to take action to fix this
problem.
Association Health Plans will allow small businesses to group
together with their national trade associations to utilize their
collective buying power when dealing with large insurance companies.
AHPs will bring quality health care to Oklahomans covering specific
diseases, maternal and newborn hospitalization, and mental health. With
the enactment of this legislation, up to 8.5 million uninsured
Americans will gain coverage immediately.
Nationwide, 44 million Americans are uninsured; and 60 percent of
those uninsured are employed by small businesses who will benefit. AHPs
will cut an average of 13 percent, up to 25 percent, off insurance
premiums.
This is smart legislation that will bring better health care to
American families. It is time that 5th Avenue benefits find their way
to shops on Main Street. I urge my colleagues to support this
legislation.
Mr. KIND. Mr. Speaker, I yield 3 minutes to the gentleman from
Arkansas (Mr. Ross), an expert in the health care field and one who
does not want to embark upon a course of adding an additional 1 million
people to the uninsured ranks.
Mr. ROSS. Mr. Speaker, in America we have 44 million people today
without health insurance. We are the only industrialized nation in the
world where people go without health insurance. And who are they? It is
the folks that are trying to do the right thing and work.
Unfortunately, they are working jobs with no benefits.
Nearly 80 percent of the uninsured are the working poor and often
work in small businesses. They have jobs and are trying to do the right
thing, but cannot afford a policy, an insurance policy, for themselves
or for their families.
Each weekend as I go back home to Arkansas, I meet more and more
small business owners, and I understand this because my wife and I are
small business owners. We provide health insurance for our employees
back home. And just as it is for us, I learn it is for so many small
business owners across this Nation. They are struggling to be able to
continue to afford the premiums, not only for their employees but for
themselves as well.
Association Health Plans, quite frankly, are not the answer. It would
do little to help the 44 million uninsured Americans. In fact, Mercer
Consulting analyzed the Association Health Plans proposal and found
that the number of the uninsured would increase by over 1 million as a
result of coverage losses among workers in small firms and their
dependents.
I support the Kind substitute that truly addresses the problem of the
uninsured in this country. It is fully paid for. It will not preempt
State law, and it offers meaningful and immediate help to small
businesses.
The substitute legislation would create a Small Employer Health
Benefits Plan similar to the Federal Employee Health Benefit Plan and
would offer coverage to all small businesses with fewer than 100
workers.
This legislation works with existing State laws and does not preempt
State laws regarding health care coverage.
[[Page H2980]]
Also, this legislation goes far beyond vague words and empty promises
and actually commits Federal funds to aid small businesses in offering
insurance to its employees by offering to help subsidize the cost of
insurance for small businesses to the tune of 50 percent of the cost of
the premiums.
I urge my colleagues to support the Kind substitute and oppose H.R.
4281.
Mr. BOEHNER. Mr. Speaker, I yield myself such time as I may consume.
I believe that the underlying bill does, in fact, address the needs
of many of our uninsured, and I am concerned about the substitute that
we have before us. And I know that the gentleman from Wisconsin (Mr.
Kind) and the gentleman from New Jersey (Mr. Andrews), my good friends
from the committee, have worked hard on this. But I have to take issue
with the comment that was just said that this commits the Congress to
spend money. It does not.
There is a $50 billion price tag on the substitute that we have
before us, and all we do here is authorize it. It still has to go
through the entire appropriation process, no guarantee that it is going
to be appropriated; but even more troubling is that the substitute that
is being offered would allow the Secretary of Labor to set up this
national risk pool, but they would still be subject to every state-
mandated benefit in each of the States, over 1,500 state-mandated
benefits from one coast to the next. And on top of that, even if the
Congress were to appropriate the money and the Secretary were to set up
the plan, employers would still have to pay 50 percent of the premium
cost, and they would have to cover every employee who was there as
little as 3 months.
If we begin to look at how this plan would work, I think that the
Members will find that it would actually be cheaper for those companies
to get health insurance in their own States without this national
bureaucracy.
But even more disturbingly, when we look at this substitute, it will
not cover any of the self-employed individuals across the country, and
whether they be Realtors, whether they be salesmen of some sort, small
business people who operate by themselves, the self-employed, no
coverage under this plan. Unlike under the underlying plan where if
these self-employed people belong to some association, some State
association, national association, local association, they would, in
fact, be able to work through their associations to get high-quality
coverage at competitive prices.
There has been a lot said about who is supporting the underlying bill
and who is opposing the underlying bill. I have got pages and pages
here of national associations and State associations that are
supporting the underlying bipartisan bill. And I would remind my
colleagues that this is the fourth time we have had this bill on the
floor in the last 8 years, still waiting for the other body to deal
with it. All three times previously that this bill has been on the
floor, it has passed with broad bipartisan majorities, and I would
suspect today we will see the same benefit.
Mr. Speaker, I include in the Record the list of companies and
associations that are supporting the underlying bill.
groups supporting AHPs
Adhesive and Sealant Council
Air Conditioning Contractors of America
American Alliance of Service Providers
American Association of Advertising Agencies
American Association of Engineering Societies
American Association of Small Property Owners
American Composites Manufacturers Association
American Concrete Pumping Association
American Council of Engineering Companies
American Disc Jockey Association
American Electronics Association
American Furniture Manufacturers Association
American Institute of Chemical Engineers
American International Automobile Dealers Association
American Hotel and Lodging Association
American Lighting Association
American Nursery and Landscape Association
American Rental Association
American Road and Transportation Builders Association
American Small Businesses Association
American Society of Association Executives
American Society of Civil Engineers
American Society of Home Inspectors
American Society of Mechanical Engineers, Board on Member
Interests & Development
American Textile Machinery Association
American Veterinary Medical Association
American Wholesale Marketers Association
AOMALLIANCE
Archery Trade Association
Associated Builders and Contractors
Associated General Contractors of America
Associated Prevailing Wage Contractors, Inc.
Association for Manufacturing Technology
Association of California Water Agencies
Association of Equipment Manufacturers
Association of Independent Maryland Schools
Association of Ship Brokers and Agents
Association of Suppliers to the Paper Industry
Automotive Aftermarket Industry Association
Automotive Aftermarket Association Southeast
Automotive Service Association
Automotive Undercar Trade Organization
Automotive Wholesalers Association of New England
Automotive Wholesalers Association of Texas
California Motor Car Dealers Association
California Society of CPAs
California/Nevada Automotive Wholesalers Association
Center for New Black Leadership
Central Service Association
Chesapeake Automotive Business Association
Cleveland Automobile Dealers Association
Club Managers Association of America
Christian Schools International
Coca Cola Bottlers Association
Communicating for Agriculture
Consumer Specialty Products Association
Deep South Equipment Dealers Association
Electronics Representatives Association Insurance Trust
Far West Equipment Dealers Association
Farm Equipment Manufacturers Association
Financial Executives International
Financial Planning Association
First Health Group Corporation
Food Marketing Institute
GrassRoots Impact
Hearth, Patio and Barbecue Association
Hispanic Business Roundtable
Independent Electrical Contractors
Independent Office Products & Furniture Dealers Association
Independent Stationers, Inc.
Institute of Electrical and Electronics Engineers--United
States of America
International Association of Professional Event Photographers
International Foodservice Distributors Association
International Franchise Association
Iowa Automobile Dealers Association
Iowa-Nebraska Equipment Dealers Association
The Latino Coalition
Mason Contractors Association
Material Handling Equipment Distributors Association (MHEDA)
Metal Manufacturers' Education and Training Alliance
Midwest Automotive Industry Association
Midwest Equipment Dealers Association
NAMM, the International Music Products Association
National Association for the Self-Employed
National Association of Chemical Distributors
National Association of Community Health Centers
National Association of Convenience Stores
National Association of Home Builders
National Association of Manufacturers
National Association of Plumbing-Heating-Cooling Contractors
National Association of Realtors
National Association of Theatre Owners
National Association of Wholesaler-Distributors
National Association of Women Business Owners
National Automobile Dealers Association
National Black Chamber of Commerce
National Burglar and Fire Alarm Association
National Cattlemen's Beef Association
National Club Association
National Concrete Masonry Association
National Council of Agricultural Employers
National Federation of Independent Business
National Franchisee Association
National Funeral Directors Association
National Lumber and Building Material Dealers Association
National Newspaper Association
National Office Products Alliance
National Paint and Coating Association
National Portable Storage Association
National Precast Concrete Association
National Rental Association
National Retail Federation
National Restaurant Association
National Roofing Contractors Association
National Spa and Pool Institute
National Society of Accountants
National Society of Professional Engineers
National Sporting Goods Association
National Tile Contractors Association
National Tooling & Machining Association
National Utility Contractors Association
Nebraska New Car and Truck Dealers Association
New Mexico Automotive Parts and Service Association
New York State Automotive Aftermarket Association
North American Die Casting Association
[[Page H2981]]
North American Equipment Dealers Association
North American Retail Dealers Association
North Dakota Automobile and Implement Dealers Association
Northeastern Retail Lumber Association
Office Furniture Dealers Alliance
Ohio Valley Automotive Aftermarket Association
Outdoor Industry Association
Piano Technicians Guild
Precision Machine Products Association
Precision Metalforming Association
Printing Industries of America
Printing Industries of Maryland
Process Equipment Manufacturers' Association
Professional Golfers' Association of America
Professional Photographers of America
Retailers Bakery Association
Service Station Dealers of America and Allied Trades
Self Insurance Institute of America
Small Business Survival Committee
Specialty Equipment Market Association (SEMA)
Society of American Florists
Society of the Plastics Industry
Society of Professional Benefit Administrators
Southern Equipment Dealers Association
Southeastern Equipment Dealers Association
Southeastern Farm Equipment Dealers Association
Southwestern Association
Snack Food Association
Student Photographic Society
Textile Rental Services Association of America
The Association Healthcare Coalition
Timber Operators Council Management Services
Timber Products Manufacturers Association
Tire Industry Association
U.S. Chamber of Commerce
U.S. Hispanic Chamber of Commerce
U.S. Pan Asian America Chamber of Commerce
Vermont Automobile Dealers Association
Virginia Bankers Association
Washington Area New Automobile Dealers Association
Western Growers Association
Women Impacting Public Policy
Wisconsin Automobile & Truck Dealers Association
Mr. Speaker, I reserve the balance of my time.
Mr. KIND. Mr. Speaker, I yield myself 30 seconds.
With all due respect to the chairman of our committee, and I have
great respect and admiration for him and I think he is well motivated
with this underlying bill, but our bill does, in fact, cover self-
employed. Under the definition of what constitutes an employer, an
individual who is self-employed would also be covered. So I just wanted
to clarify the record in that regard.
Mr. Speaker, I yield such time as he may consume to the gentleman
from New Jersey (Mr. Andrews), the co-author of our substitute bill
before us.
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
{time} 1515
Mr. ANDREWS. Mr. Speaker, I would like to begin by thanking my
coauthor, the gentleman from Wisconsin (Mr. Kind), for what has now
been more than a year of hard work on this effort, a very practical,
commonsense solution that would not have been possible without him; and
I thank him for his effort.
It is important to understand how this proposal works. If a small
employer, and we define that as an employer with 100 or fewer
employees, chooses, only if he or she chooses, they may enroll their
employees in a plan that would operate similarly to the Federal
Employees Health Benefit Plan. It would create the largest purchasing
pool of small businesses ever in the history of the country. It would
achieve the economies of scale that the majority attempts to achieve in
the underlying bill. But there are some important differences.
The first difference is that we believe our plan would in fact save
money for that employer. In my home State, a small business pays about
$12,000 or $13,000 a year to insure an employee and his or her family.
The average cost under the Federal Employees Health Benefit Plan is
slightly over $9,000. We believe a similar price reduction would occur
by the option of joining this plan.
Secondly, under our plan, for very small employers, those with 25 and
under, they would receive a 5 percent premium discount. That is to say,
their premium would only be 95 percent of the premium paid by the
others in the pool.
Thirdly, very small employers with a lot of low-income employees,
those who are most likely to be uninsured, are offered additional
subsidies that are drawn from the budget resolution passed by the
majority. This fits within the majority's budget resolution.
So the first important difference is our version, our plan, would add
to the rolls of the insured rather than subtracting from it the way the
majority's plan would.
Second, under our plan, none of the protections that people enjoy,
the right to a mammogram, the right to women's health services, the
right to mental health services, guaranteed under State laws around the
country, none of those rights would be lost or forfeited under our
plan.
Third, the risks of insolvency, unpaid creditors, uninsured insurers
that the majority's plan proposes, would be avoided here, because you
would have a large plan under the regulatory jurisdiction of the
Federal Government that would be solvent and would be prepared to meet
its obligations because it is properly regulated.
This is a commonsense idea. We believe in pooling as well. Frankly, I
think that the majority has half of a good idea. The idea of permitting
small employers to pool their employees to get a better deal from the
health insurance marketplace is a very good idea. The problem is that
the majority's plan also includes the repeal and forfeiture of
protections like mammogram coverage, like diabetic care, like women's
health services; and that is both unnecessary and undesirable.
Second, the majority's plan does not include any subsidies or special
incentives for small business. A lot of small businesses in my State,
even if you dropped the price of the coverage from $12,000 to $11,000
or $10,000, could still not afford it. It does not do them any good.
Our plan, unlike the majority plan, puts some subsidy into this in
the form of premium discounts for very small employers and even deeper
discounts for small employers who hire many, many lower-compensated
employees.
We have said a lot of critical things about the majority's plan
because we believe they are right; but we also understand, Mr. Speaker,
it is our responsibility to put forward a positive alternative. The
work that the gentleman from Wisconsin (Mr. Kind) has done, that I am
proud to join in, is such a positive alternative. It would offer real
benefits in a meaningful way for the small business community of the
country.
I would urge my colleagues to vote for its adoption.
Mr. BOEHNER. Mr. Speaker, I am pleased to yield 3 minutes to the
gentleman from Pennsylvania (Mr. Peterson).
Mr. PETERSON of Pennsylvania. Mr. Speaker, I thank the chairman for
yielding me time.
Mr. Speaker, let us put some competition into the marketplace. We
just have a proposal now that says we will have a government-subsidized
program, and we all know where that will take us. The taxpayers will
pay and pay.
Here is the problem: 50 percent of America has one insurer. That
means you have a monopoly, and that is where we are getting 20, 30, and
40 percent increases annually, and businesses are straining. But when
you only have one insurer, the new pharmacy plan, we have guaranteed
everybody two. But in health care, over half of America have one.
Associated Health Plans would, I think, change the marketplace
dramatically, because you would bring lots of competition to the
marketplace. The monopolies would no longer rule. A lot of other
companies that are not monopolies do not want health care either. Why?
It is going to be competition. Whenever America is successful, we bring
competition into the marketplace.
Yes, those monopolies are leaving community rating; yes, they are
cherry-picking today. And State mandates are part of the problem,
because 50 States have different mandates and we guarantee everybody
gets a Cadillac plan. That means a lot of people cannot afford a plan
at all, because you only can deliver a Cadillac plan. That is the
system we have.
In rural areas, where monopolies exist, businesses, individuals and
governments pay measurably more for
[[Page H2982]]
health insurance than neighboring counties. In my district, I have
school districts and counties who will pay $650 for a family plan. Two
counties away they pay $1,100 for the same insurance coverage under the
current system. Why? Because there is no competition there.
Now, the hospitals, the doctors and providers under these monopolies
get paid less too, because they have no bargaining power with the big
insurance giants that are the monopolies.
The current system will change dramatically with Associated Health
Plans, because, for the first time, all parts of America will have many
people who they can purchase insurance from. Yes, maybe if I am a
restaurateur, I will be part of a national restaurant association who
has a plan tailored for restaurants.
I was a supermarket operator for 26 years. I probably, if I were back
in that business, would have a plan that works well for super markets.
But when you put them all in the same box, you put all kinds of
employers in the same box, as we currently do with State mandates.
Let us give our businesses and our government service agencies
choices. Let us give them Associated Health Plans, not another
government-subsidized program. But let us turn the competitiveness of
American ingenuity, and we will solve the uninsured problem in this
country.
Mr. KIND. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, again, this debate really is about two very distinct and
different options: one that, again, through independent analysis and
review, indicates could lead to an increase of 1 million more uninsured
in this country, as opposed to the substitute that the gentleman from
New Jersey (Mr. Andrews) and I are offering today; one that is based on
reality and supported by a host of organizations throughout the Nation,
including the Governors Association, the Attorneys General, and the
insurance commissioners, those who work with this on a day-to-day basis
and see the real impact it is having on real people in their individual
States.
Our plan is simple. It also talks about establishing a national
purchasing pool, but one working with state-licensed insurers, so we do
not preempt State law and the judgment being made by State legislatures
and local decisionmakers on what is or is not appropriate health care
coverage in that particular State.
I am proud of many of the coverages that the State of Wisconsin has
chosen to include under the State regulations. I am also proud of the
fact that the State legislature and Governor are signing into law and
setting up model programs of this purchasing pool concept in Wisconsin,
allowing small business owners and family farmers to join cooperatives
with a menu of health options, but under State regulation, not
exempting them and not preempting what the State has already done.
I have a feeling that that is going to work, and work very well, if
the demand that exists from back home is any indication of the desire
to enter into these pilot programs.
That is the identical version that the gentleman from New Jersey (Mr.
Andrews) and I are offering and talking about today, allowing this
purchasing pool concept to go forward under State law, so that
important health care services and screening does not get preempted and
lead to a diminution in the quality of care that citizens in States
have come to expect and desire.
Why is this important? 44 million uninsured is a travesty and a
blemish on our national character. It gets to the real root and basis
of us and what we are all about as a Nation. Being able to access
quality and affordable health care is something that affects all of us,
from businesses large and small, from individuals to small business
owners, to farmers, to us here in Congress; and the fear we see in
constituents' eyes back home when they know they do not have health
coverage for their families and their children, it is real.
And when they do not have coverage and they do get sick or they do
get hurt, they still are able to access the health care system, just
through more expensive means, typically through the emergency door. And
those costs then are shifted on to private plans that do have coverage,
which contributes to the rising premium expenses that are sweeping the
Nation today.
So I think it is in our fundamental national interest to do what we
can to make sure that the 43 million or 44 million currently uninsured
receive coverage, so we have better preventive care up front, so the
children of our Nation have a way to access the health care system,
which can save us money and pay dividends in the long run.
I think this is an objective that we share in a bipartisan fashion,
but it is one that I think can better be achieved through the Kind-
Andrews substitute.
It is paid for within the budget resolution that the majority party
has passed in this session of Congress. It does offer premium support
payments to employees with 50 or fewer employees, because the gentleman
from New Jersey (Mr. Andrews) is correct, even if we have some savings
in premium expenses, your average small business employer probably is
still prohibited from being able to access an insurance pool and being
able to pick up the expense and providing coverage for their employees.
We are saying we can do better by offering them some of this premium
price assistance to make it more affordable and to create the
incentives so we have small business owners who I believe want
desperately to be able to provide coverage, to be in a position to
better afford that type of coverage.
This is what we need to try to achieve. This should be a dream we all
hold in this Congress. Because unless and until we fix this fundamental
flaw in the health care system in our country, we are not going to see
the robust job growth that we desperately need today. We are not going
to see businesses, either large or small, anxious for additional hires
for fear of incurring the additional health care expense. I think it is
one of the reasons why we have not seen the explosion of job growth
over the last couple of years, even though the administration has been
fond of pointing to expanding economic conditions in this country. It
is the health care system, and it needs to be addressed.
I think we desperately need to do it, and I think we have the
opportunity today to make a significant step in that direction.
I would encourage my colleagues to vote ``no'' on the majority
Associated Health Plan and support a real plan that can work for real
Americans, the Kind-Andrews substitute.
Mr. Speaker, I yield back the balance of my time.
Mr. BOEHNER. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I have great respect for my two committee colleagues,
the gentleman from Wisconsin (Mr. Kind) and the gentleman from New
Jersey (Mr. Andrews), and their thoughtful approach to bringing their
substitute to the floor.
As the gentleman from Wisconsin (Mr. Kind) pointed out, there are
some similarities here. We both create large pools of small employers
in order to increase their purchasing power so that they can go into
the marketplace like a large company or union and get as good a quality
plan at a competitive price. But once you get beyond the big picture,
that we are creating large pools in both the substitute and the
underlying bill, there are a few differences.
The first difference I would say is that the underlying bill allows
the private sector to create those large pools. Whether they be State
associations, national associations, whatever, they will in fact create
their own pools, while the substitute offered by the gentleman from
Wisconsin (Mr. Kind) and the gentleman from New Jersey (Mr. Andrews)
has the government creating this large pool.
Now, we all know when the government gets involved, it is just a
matter of time before the government begins to believe, well, we have
this large pool, we have got employers signed up in it, maybe we ought
to require them to do X or Y or Z. I do not think anyone wants to take
that risk.
Secondly, I would point out that the substitute pool will cost $50
billion of taxpayer funds in order to set up and to provide subsidies,
while the underlying bill has no Federal taxpayer money involved in it
in any way, shape, or form.
I am a big believer that we need to do something to reach out to help
the uninsured gain better access to high-quality, affordable health
insurance. I
[[Page H2983]]
think the underlying bill does it. It has passed on a broad bipartisan
basis on a number of occasions here in the House. I urge my colleagues
here today to reject the Kind-Andrews substitute and support the
underlying bill.
Mr. HOLT. Mr. Speaker, I rise in support of the substitute
legislation offered by Mr. Kind and Mr. Andrews and in opposition to
H.R. 4281.
Across this great nation, over 40 million people continue to lack
adequate health insurance coverage. This is a problem that merits
immediate Congressional action.
Moreover, small businesses across my district in central New Jersey
come to me all the time, telling me how difficult it is to continue
providing health care to their employees. I am glad that so many of
them believe in providing good benefits to their workers, but I know
they are really hurting.
Unfortunately, the House leadership is more interested in scoring
political points than in helping small businesses continue to provide
quality health care for their employees. The very fact that we are
poised to pass a bill that is virtually identical to what we did here
last June is a clear indication that we are here to play partisan
games, not to find a real solution.
I hope my colleagues do not believe the hype we're hearing today.
H.R. 4281 is not a realistic way to help small businesses with their
health care costs.
It looks like a good idea at first glance. Under this bill, small
businesses could join together to form ``associations'' that will
leverage their collective buying power to get lower-cost health
insurance for their employees.
I certainly support the concept of companies working together
collectively to control costs. It's an idea that has worked within
individual states.
That is why I urge my colleagues to vote for the Kind-Andrews
substitute. This legislation commits actual federal funds--the $50
billion allocated in the budget--to form Small Employer Health Benefit
plans similar to our oft-cited Federal Employee Health Benefit plans.
This would create a realistic, workable way for small businesses to use
their collective buying power to lower costs and increase coverage.
Kind-Andrews would expand coverage for the uninsured and will help
small businesses deal with the rising costs of insuring their
employees. Moreover, it is fully paid for and will not preempt state
law, maintaining the kind of minimum benefit levels that ensure quality
coverage for beneficiaries and their dependents.
H.R. 4281, on the other hand, expands ERISA to preempt state law.
States have traditionally taken the lead on insurance regulation, and
they have implemented rules to protect beneficiaries and ensure minimum
coverage levels. This bill would allow AHPs to avoid all of these
regulations.
Most states require that any health plan cover some basic items such
as mammograms, contraception, prostate cancer screenings, and many
mental health services. H.R. 4281 would allow ``associations'' to avoid
having to offer these basic benefits, to the detriment of
policyholders.
For example, under this bill, I could create a plan that covers
nothing but ingrown toenail surgery. It would certainly be the cheapest
plan out there, but how much would it actually help beneficiaries?
Several of my colleagues and I tried to amend H.R. 660, the first
iteration of the bill before us, in both subcommittee and full
committee to ensure that AHPs would indeed have minimum benefit
requirements. I offered one amendment requiring parity between physical
and mental health benefits and another requiring coverage for oral
contraception. Despite the fact that these common-sense minimum
requirements are law in a number of states, my amendments were shot
down by the majority.
So we're still left with a bill that brings a real possibility of the
creation of comically inadequate health plans, which is rather
disturbing.
What's even more alarming is the effect that this legislation will
have on the overall health care environment.
The danger is, of course, cherry-picking. While AHPs may work well to
help insure generally healthy, young people, the sickest of our
population--those most in need of health care coverage--will be left
with higher premiums. What kind of an effect will this have on our
current health care environment? Could this actually take us farther
away from covering the uninsured in this country? One study, in fact,
said that AHPs would actually cause premiums to rise for the vast
majority of small businesses and their employees.
Here's another important question. Exactly how many of the uninsured
would get coverage from these new types of AHPs? CBO has estimated that
about 8.5 million people might get coverage through the types of plans
proposed under H.R. 4281. That sounds pretty good--until you realize
that only 620,000 of them would come from the ranks of the uninsured,
while the other 7.9 million would be in firms switching from
traditional coverage. That means we'd be extending coverage to a
miniscule fraction of the uninsured in this country.
The bottom line is that more than forty million Americans lack health
insurance--a serious crisis that needs to be addressed. But H.R. 4281
won't do much good, and could very well make a bad situation even
worse.
I urge my colleagues to oppose H.R. 4281 and vote for the Kind-
Andrews substitute.
Ms. WOOLSEY. Mr. Speaker, as we once again celebrate Cover the
Uninsured Week, I rise to support a sensible legislative proposal that
will do just that: Cover the Uninsured.
I know that I've heard from constituents who wish they had the
opportunity to purchase the same kind of high quality health insurance
that we enjoy as Federal Employees. And they are right. The Federal
Employee Health Benefits Program is an excellent model for effective
health care coverage.
That's why I rise to proudly support the Kind-Andrews Substitute,
which would give small businesses and their employees the opportunity
to purchase coverage similar to ours.
The Small Employer Health Benefits Program created by this substitute
would not ask employees to sacrifice the guaranteed coverage and
protections provided by State law.
Small businesses and their employees would have real health coverage
that provides them with access to the care they need--not sham
insurance that serves only those who are healthy.
We've talked a great deal about how to expand health coverage to the
uninsured this week, and I urge my colleagues to support their words
with action by supporting this sensible substitute.
Mr. BOEHNER. Mr. Speaker, I yield back the balance of my time.
{time} 1530
The SPEAKER pro tempore (Mr. LaTourette). Pursuant to House
Resolution 638, the previous question is ordered on the bill and on the
amendment by the gentleman from Wisconsin (Mr. Kind).
The question is on the amendment in the nature of a substitute
offered by the gentleman from Wisconsin (Mr. Kind).
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. KIND. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The vote was taken by electronic device, and there were--yeas 193,
nays 224, not voting 16, as follows:
[Roll No. 172]
YEAS--193
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Chandler
Clay
Clyburn
Conyers
Cooper
Costello
Crowley
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Dooley (CA)
Doyle
Edwards
Emanuel
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Frank (MA)
Frost
Gephardt
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Harman
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lucas (KY)
Lynch
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Peterson (MN)
Pomeroy
Price (NC)
Rahall
Rangel
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Smith (WA)
Snyder
Solis
Spratt
Stark
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Visclosky
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
Wynn
[[Page H2984]]
NAYS--224
Akin
Bachus
Baker
Ballenger
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carson (OK)
Carter
Case
Castle
Chabot
Chocola
Coble
Cole
Collins
Cox
Cramer
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis, Jo Ann
Davis, Tom
DeLay
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Dreier
Duncan
Dunn
Ehlers
Emerson
English
Everett
Feeney
Ferguson
Flake
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gibbons
Gilchrest
Gillmor
Gingrey
Goode
Goodlatte
Goss
Granger
Graves
Green (WI)
Greenwood
Gutknecht
Hall
Harris
Hart
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hunter
Hyde
Isakson
Issa
Istook
Jenkins
Johnson (CT)
Johnson (IL)
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
Kucinich
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas (OK)
Manzullo
McCotter
McCrery
McHugh
McIntyre
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Neugebauer
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Ose
Otter
Oxley
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shaw
Shays
Sherwood
Shuster
Simmons
Simpson
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Stearns
Sullivan
Sweeney
Tancredo
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Toomey
Turner (OH)
Upton
Velazquez
Vitter
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Young (AK)
Young (FL)
NOT VOTING--16
Aderholt
Deal (GA)
DeGette
DeMint
Filner
Ford
Hulshof
Israel
Majette
McInnis
Nethercutt
Reyes
Scott (GA)
Shadegg
Shimkus
Tauzin
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (Mr. LaTourette) (during the vote). Members
are advised 2 minutes remain in this vote.
{time} 1554
Ms. VELAZQUEZ and Mr. SAXTON changed their vote from ``yea'' to
``nay.''
So the amendment in the nature of a substitute was rejected.
The result of the vote was announced as above recorded.
Stated for:
Mr. FILNER. Mr. Speaker, on rollcall No. 172, I was attending to
official business in my Congressional District, and I missed the vote.
Had I been present, I would have voted ``yea.''
The SPEAKER pro tempore. The question is on engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
Motion to Recommit Offered by Mrs. Mc Carthy of New York
Mrs. McCARTHY of New York. Mr. Speaker, I offer a motion to recommit.
The SPEAKER pro tempore. Is the gentlewoman opposed to the bill?
Mrs. McCARTHY of New York. Yes, I am, Mr. Speaker.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Ms. McCarthy of New York moves to recommit the bill H.R. 4281 to the
Committee on Education and the Workforce with instructions to report
the same back to the House forthwith with the following amendment:
Page 13, insert after line 7 the following:
``(e) Protection of Existing Group Health Plan Coverage.--
``(1) In general.--The requirements of this section are not
met with respect to an association health plan if--
``(A) during the 1-year period preceding the date of the
enactment of the Small Business Health Fairness Act of 2004,
any participating employer of the plan maintained another
group health plan providing a type of coverage described in
paragraph (2), and
``(B) such association health plan does not provide such
type of coverage.
``(2) Types of coverage.--A type of coverage is described
in this paragraph if it consists of--
``(A) coverage for breast cancer screening and tests
recommended by a physician,
``(B) coverage for the expenses of pregnancy and
childbirth,
``(C) coverage for well child care, or
``(D) direct access to those obstetric or gynecological
services which are provided by the plan.
``(3) Predecessors and controlled groups.--For purposes of
this subsection, a predecessor of an employer or any member
of the employer's controlled group shall be treated as the
employer. For purposes of this paragraph, the term
`controlled group' means any group treated as a single
employer under subsection (b), (c), (m), or (o) of section
414 of the Internal Revenue Code of 1986.
Mrs. McCARTHY of New York (during the reading). Mr. Speaker, I ask
unanimous consent that the motion to recommit be considered as read and
printed in the Record.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from New York?
There was no objection.
The SPEAKER pro tempore. The gentlewoman is recognized for 5 minutes
on her motion.
Mrs. McCARTHY of New York. Mr. Speaker, this motion to recommit is
very simple. The motion ensures that the bill does not preempt State
regulations regarding coverage for breast cancer, pregnancy and
childbirth, and well-child OB/GYN services.
Mr. Speaker, this bill, the National Republican Governors
Association, the Democratic Governors Association, they are all against
it. Forty-one State Attorneys General are against it. There is a reason
for that, going back many years ago, when the insurance companies were
not giving health care insurance to those that would carry it.
Mr. Speaker, this bill undermines health care legislation in 48
States, including New York. As patients and advocates across the Nation
quickly discovered that their basic health care needs were not being
served by their insurance companies, they demanded the State step in
and protect them.
Mr. Speaker, 48 States responded overwhelmingly and gave basic health
care to their citizens. Today, we are undermining the State's efforts.
Today, we are saying that basic health care does not matter.
As a nurse, my policy is ``first do no harm.'' Mr. Speaker, this bill
does harm to millions of patients across the country. Mr. Speaker, a
reduction in health insurance in any form is a reduction in health
care. It is just that simple.
Almost every State has recognized the need to cut down the cost of
health care and still provide basic health care to their citizens. The
States know that without guaranteeing basic health care patients will
not get the health care they desperately need. They will only seek help
when they are very sick, thus requiring much more expensive medical
care for their diseases, putting their lives and the lives of their
children at risk.
Let us just look at what it would mean for breast cancer, which is so
high in New York State.
According to the American Cancer Society, over 211,000 new cases of
breast cancer will be diagnosed in the United States this year. In my
State of New York, there will be 2,000 new cases of breast cancer
diagnosed alone. Breast cancer is a fatal, but eminently treatable,
disease. However, early detection is the key to proper treatment of the
disease.
Mammogram screenings are essential for the early detection of cancer.
Timely screening can prevent approximately 15 to 30 percent of all
deaths from breast cancer among women over the age of 40. Currently,
New York and 48 States require insurance companies to cover mammogram
screenings. However, under this bill associated health plans would be
exempt from having to provide this critical benefit. This amendment
would at least prevent a reduction of health care services to those who
already have this benefit.
Preserving the coverage of mammogram screenings will help save the
lives of our wives, our mothers, and
[[Page H2985]]
their daughters. I urge all of my colleagues to vote ``no,'' and as I
said earlier, the National Association of Governors, Democratic
Governors, Republican Governors are against this legislation.
Mr. Speaker, I yield the balance of my time to my colleague, the
gentlewoman from Wisconsin (Ms. McCollum).
Ms. McCOLLUM. Mr. Speaker, I am pleased to join the gentlewoman from
New York (Mrs. McCarthy) in offering this motion to recommit.
To protect the health benefits that women and children currently have
today, we must not allow association health plans to deny necessary
care for women and their children.
This motion to recommit stops association health plans from refusing
to cover state-mandated health benefits for well-child care visits and
maternity coverage or other types of care that is vital to our
families. Children deserve a healthy start in life.
In Minnesota and 30 other States, children are guaranteed regular
visits to their pediatricians to get the necessary care they deserve.
Well-child care ensures that children get the vaccinations and
immunizations that they need to protect themselves from preventable
diseases like measles and mumps.
Regular doctor visits for newborns are absolutely critical. Thirty-
three children are born every day with severe hearing loss. If caught
early through preventative doctor visits, we can make a positive
difference in the lives of our children, and we can save future dollars
spent on special education.
Having early access to adequate health care can prevent illness,
identify disabilities and reduce future health costs.
The motion we are offering ensures that families who have health
coverage that protects the health of women and children today will not
lose it tomorrow.
Today, we should be considering legislation to ensure quality
comprehensive health care for our Nation's working families, not
cutting basic benefits.
I urge my colleagues to support the motion to recommit and to protect
important State laws that protect the health of women and children.
{time} 1600
Mr. BOEHNER. Mr. Speaker, I rise in opposition to the motion to
recommit.
Mr. Speaker, AHPs that would self-insure are exempted from State
insurance mandates exactly like large company plans and union plans all
over the country. We all know that health insurance mandates drive up
the cost of health insurance. When the cost of health insurance goes up
for small employers, it is their employees who lose coverage.
The underlying bill attempts to help the 44 million Americans who do
not have health insurance have a better chance of getting health
insurance. And small employers, just because of their size, should not
be denied the right to group together to get a better-quality product
at a more competitive price for their employees.
I urge my colleagues to reject the motion to recommit, the same
motion to recommit this House rejected last year, and to support the
underlying bill.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. LaTourette). Without objection, the
previous question is ordered on the motion to recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Recorded Vote
Mrs. McCARTHY of New York. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, this 15-
minute vote on the motion to recommit will be followed by 5-minute
votes on the question of passage, if ordered, the motion to suspend the
rules and pass House Joint Resolution 91, and adoption of House
Concurrent Resolution 414.
The vote was taken by electronic device, and there were--ayes 196,
noes 218, not voting 19, as follows:
[Roll No. 173]
AYES--196
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Becerra
Bell
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boswell
Boucher
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Carson (OK)
Chandler
Clay
Clyburn
Conyers
Cooper
Costello
Cramer
Crowley
Cummings
Davis (AL)
Davis (CA)
Davis (FL)
Davis (IL)
Davis (TN)
DeFazio
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Dooley (CA)
Doyle
Edwards
Emanuel
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Ford
Frank (MA)
Frost
Gephardt
Gonzalez
Gordon
Green (TX)
Grijalva
Gutierrez
Harman
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Jackson (IL)
Jackson-Lee (TX)
Jefferson
John
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Lofgren
Lowey
Lucas (KY)
Lynch
Maloney
Markey
Marshall
Matheson
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McNulty
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Moran (VA)
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Peterson (MN)
Pomeroy
Price (NC)
Rangel
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Smith (WA)
Snyder
Solis
Spratt
Stark
Stenholm
Strickland
Stupak
Tanner
Tauscher
Taylor (MS)
Thompson (CA)
Thompson (MS)
Tierney
Towns
Turner (TX)
Udall (CO)
Udall (NM)
Van Hollen
Visclosky
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
Wynn
NOES--218
Akin
Bachus
Baker
Ballenger
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bereuter
Biggert
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carter
Case
Castle
Chabot
Chocola
Coble
Cole
Collins
Cox
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis, Jo Ann
Davis, Tom
DeLay
Diaz-Balart, L.
Diaz-Balart, M.
Doolittle
Dreier
Duncan
Dunn
Ehlers
Emerson
English
Everett
Feeney
Ferguson
Flake
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gibbons
Gilchrest
Gillmor
Gingrey
Goode
Goodlatte
Goss
Graves
Green (WI)
Greenwood
Gutknecht
Hall
Harris
Hart
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hunter
Hyde
Isakson
Issa
Istook
Jenkins
Johnson (CT)
Johnson (IL)
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
LoBiondo
Lucas (OK)
Manzullo
McCotter
McCrery
McHugh
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy
Musgrave
Myrick
Neugebauer
Ney
Northup
Norwood
Nunes
Nussle
Osborne
Ose
Otter
Oxley
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Rahall
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shaw
Shays
Sherwood
Shuster
Simmons
Simpson
Smith (NJ)
Smith (TX)
Souder
Stearns
Sullivan
Sweeney
Tancredo
Taylor (NC)
Terry
Thomas
Thornberry
Tiahrt
Tiberi
Toomey
Turner (OH)
Upton
Velazquez
Vitter
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Young (AK)
Young (FL)
NOT VOTING--19
Aderholt
Deal (GA)
DeGette
DeMint
Filner
Granger
[[Page H2986]]
Hulshof
Israel
Linder
Majette
McInnis
Meehan
Nethercutt
Reyes
Scott (GA)
Shadegg
Shimkus
Smith (MI)
Tauzin
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (Mr. LaTourette) (during the vote). Members
are advised 2 minutes remain in this vote.
{time} 1620
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
Stated for:
Mr. FILNER. Mr. Speaker, on rollcall No. 173, I was attending to
official business in my Congressional District, and I missed the vote.
Had I been present, I would have voted ``aye''.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. CARDIN. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--yeas 252,
nays 162, answered ``present'' 1, not voting 18, as follows:
[Roll No. 174]
YEAS--252
Akin
Bachus
Baker
Ballenger
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bass
Beauprez
Bell
Bereuter
Biggert
Bilirakis
Bishop (GA)
Bishop (UT)
Blackburn
Blunt
Boehlert
Boehner
Bonilla
Bonner
Bono
Boozman
Boucher
Bradley (NH)
Brady (TX)
Brown (SC)
Brown-Waite, Ginny
Burgess
Burns
Burr
Burton (IN)
Buyer
Calvert
Camp
Cannon
Cantor
Capito
Carson (OK)
Carter
Case
Castle
Chabot
Chocola
Clay
Clyburn
Coble
Cole
Collins
Cooper
Costello
Cox
Cramer
Crane
Crenshaw
Cubin
Culberson
Cunningham
Davis (AL)
Davis (TN)
Davis, Jo Ann
Davis, Tom
DeLay
Diaz-Balart, L.
Diaz-Balart, M.
Dooley (CA)
Doolittle
Dreier
Duncan
Dunn
Edwards
Ehlers
Emerson
English
Everett
Feeney
Ferguson
Flake
Foley
Forbes
Fossella
Franks (AZ)
Frelinghuysen
Frost
Gallegly
Garrett (NJ)
Gerlach
Gibbons
Gilchrest
Gillmor
Gingrey
Gonzalez
Goode
Goodlatte
Goss
Graves
Green (WI)
Greenwood
Gutknecht
Hall
Harman
Harris
Hart
Hastings (WA)
Hayes
Hayworth
Hefley
Hensarling
Herger
Hobson
Hoekstra
Hostettler
Houghton
Hunter
Hyde
Isakson
Issa
Istook
Jackson-Lee (TX)
Jefferson
Jenkins
John
Johnson (CT)
Johnson (IL)
Johnson, E. B.
Johnson, Sam
Jones (NC)
Keller
Kelly
Kennedy (MN)
King (IA)
King (NY)
Kingston
Kirk
Kline
Knollenberg
Kolbe
LaHood
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lucas (KY)
Lucas (OK)
Manzullo
Marshall
Matheson
McCotter
McCrery
McHugh
McIntyre
McKeon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Moran (VA)
Murphy
Musgrave
Myrick
Neugebauer
Ney
Northup
Nunes
Nussle
Osborne
Ose
Otter
Oxley
Paul
Pearce
Pence
Peterson (MN)
Peterson (PA)
Petri
Pickering
Pitts
Platts
Pombo
Porter
Portman
Pryce (OH)
Putnam
Quinn
Radanovich
Rahall
Ramstad
Regula
Rehberg
Renzi
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Rothman
Royce
Ryan (WI)
Ryun (KS)
Saxton
Schrock
Sensenbrenner
Sessions
Shaw
Shays
Sherwood
Shuster
Simmons
Simpson
Smith (NJ)
Smith (TX)
Snyder
Souder
Stearns
Stenholm
Sullivan
Sweeney
Tancredo
Taylor (MS)
Taylor (NC)
Terry
Thomas
Thompson (MS)
Thornberry
Tiahrt
Tiberi
Toomey
Turner (OH)
Turner (TX)
Upton
Velazquez
Vitter
Walden (OR)
Walsh
Wamp
Weldon (FL)
Weldon (PA)
Weller
Whitfield
Wicker
Wilson (NM)
Wilson (SC)
Wolf
Wynn
Young (AK)
Young (FL)
NAYS--162
Abercrombie
Ackerman
Alexander
Allen
Andrews
Baca
Baird
Baldwin
Ballance
Becerra
Berkley
Berman
Berry
Bishop (NY)
Blumenauer
Boswell
Boyd
Brady (PA)
Brown (OH)
Brown, Corrine
Capps
Capuano
Cardin
Cardoza
Carson (IN)
Chandler
Conyers
Crowley
Cummings
Davis (CA)
Davis (FL)
Davis (IL)
DeFazio
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Doggett
Doyle
Emanuel
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Ford
Frank (MA)
Gephardt
Gordon
Green (TX)
Grijalva
Gutierrez
Hastings (FL)
Hill
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Honda
Hooley (OR)
Hoyer
Inslee
Jackson (IL)
Jones (OH)
Kanjorski
Kaptur
Kennedy (RI)
Kildee
Kilpatrick
Kind
Kleczka
Kucinich
Lampson
Langevin
Lantos
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lofgren
Lowey
Lynch
Maloney
Markey
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McNulty
Meek (FL)
Meeks (NY)
Menendez
Michaud
Millender-McDonald
Miller (NC)
Miller, George
Mollohan
Moore
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Pomeroy
Price (NC)
Rangel
Rodriguez
Ross
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Sabo
Sanchez, Linda T.
Sanchez, Loretta
Sanders
Sandlin
Schakowsky
Schiff
Scott (VA)
Serrano
Sherman
Skelton
Slaughter
Smith (WA)
Solis
Spratt
Stark
Strickland
Stupak
Tanner
Tauscher
Thompson (CA)
Tierney
Towns
Udall (CO)
Udall (NM)
Van Hollen
Visclosky
Waters
Watson
Watt
Waxman
Weiner
Wexler
Woolsey
Wu
ANSWERED ``PRESENT''--1
Norwood
NOT VOTING--18
Aderholt
Deal (GA)
DeGette
DeMint
Filner
Granger
Hulshof
Israel
Majette
McInnis
Meehan
Nethercutt
Reyes
Scott (GA)
Shadegg
Shimkus
Smith (MI)
Tauzin
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Members are advised 2
minutes remain in this vote.
{time} 1629
Mr. LEVIN, Mr. MOLLOHAN and Ms. KAPTUR changed their vote from
``yea'' to ``nay.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated against:
Mr. FILNER. Mr. Speaker, on rollcall No. 174, I was attending to
official business in my Congressional District, and I missed the vote.
Had I been present, I would have voted ``no''.
The SPEAKER pro tempore. Pursuant to section 4 of House Resolution
638, the text of H.R. 4280 and H.R. 4281 will be appended to the
engrossment of H.R. 4279; and H.R. 4280 and H.R. 4281 shall be laid on
the table.
____________________