[Congressional Record Volume 150, Number 87 (Tuesday, June 22, 2004)]
[Senate]
[Pages S7183-S7189]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN (for himself and Mr. Specter):
  S. 2558. A bill to improve the health of Americans and reduce health 
care costs by reorienting the Nation's health care system towards 
prevention, wellness, and self care; to the Committee on Finance.
  Mr. SPECTER. Mr. President, I have sought recognition to introduce 
the Health Care Assurance Act of 2004, which is legislation designed to 
cover the 43 million Americans who are currently not covered, and to 
provide for offsets in cost to cover the expenditures in covering the 
43 million Americans who are now not covered.
  The United States has the greatest health care system in the world, 
and it is desirable, in my opinion, to incrementally change the health 
care system to cover those who are now not covered as opposed to having 
some vast bureaucracy take over, with the Government taking all of the 
responsibility.
  I have introduced health care legislation in some detail during the 
course of my tenure in the Senate and have been privileged to be the 
chairman of the Appropriations Subcommittee on Health and Human 
Services since 1995, where, working collaboratively with Senator 
Harkin, the ranking, senior Democrat on the subcommittee, we have 
increased funding in the National Institutes of Health, done extensive 
work on stem cell research, and provided a great many health care 
programs. The legislation which I am introducing today I introduce on 
behalf of Senator Harkin and myself.
  The essence of this legislation would provide for small employer and 
individual group purchasing so small employers or individuals can have 
the benefit of what large companies get by virtue of more purchasing 
power. That expenditure would run, over a 10-year period, at $300 
million.
  There is considerable loss of coverage when people change jobs. On 
the so-called portability, this legislation provides in some detail for 
covering people between jobs, at a cost of about $101 billion over the 
course of the 10-year period.
  Financial incentives for young adults are provided. There is an 
outreach program for Medicaid-eligible low-income families. There is 
expanded coverage for the State Children's Health Insurance Program and 
their families.
  The total cost of the programs over a 10-year period would be $540 
billion. There are savings specified and identified in the course of 
this bill to make

[[Page S7184]]

up for that money, for one thing, improving the program integrity and 
efficiency in the Medicare Program by having more audits to stop fraud 
in a very active way by reducing medical errors. The Institute of 
Medicine published a report identifying up to 98,000 deaths a year due 
to medical errors. They specified a program for saving up to $150 
billion over a 10-year period by reducing medical errors.
  The Subcommittee on Health and Human Services, which I chair, had 
provided funding to move ahead in implementing the reduction in those 
errors. There would be savings from improving health care quality, 
efficiency, and consumer education, and there would be considerable 
savings in primary and preventative care providers.
  There needs to be a great deal of additional education. One statistic 
which I found of concern was that there are 14 million Americans who 
qualify for Medicaid programs, being below the 200 percent of poverty, 
who don't seek the coverage and don't know of its availability. In our 
Health and Human Services bill, we are providing funding to try to move 
ahead with an educational program.
  Last month, a nonpartisan campaign was launched to call attention to 
the plight of more than 43 million Americans under age 65 who lack 
health insurance coverage. Two former presidents--Gerald Ford and Jimmy 
Carter--cochaired the effort. They were supported by nine former 
Surgeons General and Department of Health and Human Services 
Secretaries, as well as some of the most influential organizations in 
this country, including the AFL-CIO and the U.S. Chamber of Commerce. 
Nearly 1,500 public events took place throughout the country, all 
designed to bring together diverse interests around a single objective: 
to insist that all Americans have access to health insurance coverage.
  Here in the Senate, a special task force appointed by Majority Leader 
Frist and headed by my distinguished colleague Senator Judd Gregg 
issued a series of recommendations for addressing this problem.
  Well before last month, we knew that, contrary to what some assume, 
the ranks of the uninsured consisted primarily of working families with 
low and moderate incomes--not just the unemployed.
  We knew that the lack of insurance ultimately compromises a person's 
health because he or she is less likely to receive preventive care, is 
more likely to be hospitalized for avoidable health problems, and is 
more likely to be diagnosed in the late stages of diseases.
  And we knew that the lack of insurance coverage leaves individuals 
and their families more financially vulnerable to higher out-of-pocket 
costs for their medical bills.
  As I have said many times, we can fix the problems felt by uninsured 
Americans without resorting to big government and without completely 
overhauling our current system, one that works well for most 
Americans--serving over 82 percent of our non-elderly citizens. We must 
enact reforms that improve upon our current market-based health care 
system, as it is clearly the best health care system in the world.
  When you hear the term ``uninsured'' you immediately think of men and 
women who are unemployed and their children. The unemployed make up 
approximately 18 percent of Americans who lack health insurance. 
However, nearly 26 million individuals are employed and still are 
without health care coverage. Approximately 14 million employed 
individuals have household incomes below 200 percent of the Federal 
poverty level and are eligible for public health insurance programs, 
but have not applied. This statistic includes 4 million children who 
are eligible for Medicaid and the State Children's Health Insurance 
program.
  Because of early retirements, nearly 10 percent of people between the 
ages of 55 and 64, are uninsured.
  Approximately 25 to 30 percent of young adults between the ages of 18 
and 34 are uninsured.
  Immigrants and their U.S.-born children represent more than 90 
percent of the increase in the uninsured population since 1989.
  In the United States, in 2003, $1.7 trillion was spent on health care 
or more than $5,800 per person. It is projected that annual health care 
expenditures will exceed $3.4 trillion by 2013 or 18 percent of gross 
domestic product. Costs of covering the uninsured in 2004 dollars is 
approximately $48 billion or $500 plus billion over 10 years. These 
costs are in addition to the $125 billion per year currently spent for 
Medicare and Medicaid payments, out of pocket expenses paid by the 
uninsured and other state and local programs.
  Accordingly, today I am introducing the Health Care Assurance Act of 
2004. This legislation would provide health care coverage for all 
Americans who are currently uninsured. The bill's $540 billion price 
tag, over the next 10 years, would be offset by improving program 
integrity and efficiency, a reduction in medical errors, increasing the 
use of medical technology, and preventive health measures, including 
improving health care quality and consumer education. Let me briefly 
summarize the provisions of this legislation.
  (1) Small Employer and Individual Purchasing Groups: This legislation 
establishes voluntary small employer and individual purchasing groups 
designed to provide affordable, comprehensive health coverage options 
for employers, their employees, and other uninsured individuals and 
their families. Health plans offering coverage through such groups 
will: (1) provide a standard, actuarially equivalent health benefits 
package; (2) adjust community rated premiums by age and family size in 
order to spread risk and provide price equity to all; and (3) meet 
guidelines for marketing practices. This provision would cost $300 
million over 10 years and provide coverage to approximately 15.6 
million Americans who are currently uninsured.

  (2) COBRA Portability Reform: For those persons who are uninsured 
between jobs and for insured persons who fear losing coverage should 
they lose their jobs, this legislation would reform the existing COBRA 
law by: (1) extending to 24 months the minimum time period in which 
COBRA may cover individuals through their former employers' plan; (2) 
expanding coverage options to include plans with a lower premium and a 
$1,000 deductible--saving a typical family of four 20 percent in 
monthly premiums--and plans with a lower premium and a $3,000 
deductible--saving a family of four 52 percent in monthly premiums. 
This provision would cost $101.7 billion over 10 years and would cover 
8.5 million people.
  (3) State Based Program of Financial Incentives to Young Adults: This 
legislation creates a $4 billion a year grant program which consists of 
financial incentives for full-time independent college students, part-
time students, recent graduates and other young adults without health 
insurance coverage. Coverage would be offered through existing State 
programs, such as State high risk insurance pools and would be limited 
so that when individuals are hired, they receive health insurance 
through their employer. This provision would cost $40 billion over 10 
years and would cover 4 million people who are currently uninsured.
  (4) Outreach Programs for Low-Income Families Who are Eligible to 
Enroll in Medicaid: This program is designed to improve coverage 
through existing public and private health care programs by making low-
income parents aware of State child health insurance programs. The 
legislation would also improve knowledge concerning public health 
benefits of health insurance coverage, including the advantages of 
receiving prevention and wellness services. This new outreach program 
would involve the Departments of Agriculture, Health and Human 
Services, the Social Security Administration and other Federal agencies 
to improve knowledge about health insurance coverage available through 
public programs. Outreach will be targeted to eligible populations and 
be designed in a culturally appropriate manner and identify 
particularly hard to reach populations, including recent immigrants and 
migrant and seasonal farm workers. This provision would cost $4 billion 
over 10 years and would cover up to 3 million previously uninsured 
individuals.
  (5) Expansion of the State Children's Health Insurance Program and 
Family Coverage: The legislation would increase the income eligibility 
to families with incomes at or below 235 percent of the Federal poverty 
level,

[[Page S7185]]

$44,486 annually for a family of four, and would also, for the first 
time, provide health insurance to the child's family. This provision 
would cost $394 billion over 10 years and would cover 12.4 million 
children and extend coverage to their families.
  (6) Improving Program Integrity and Efficiency in the Medicare 
Program: The bill would raise the cap on Medicare contractor audit 
funding/program integrity from $720 million to $1 billion over a 5-year 
period. This provision would save an estimated $60 billion over the 
next 10 years.
  (7) Reducing Medical Errors and Increasing the Use of Medical 
Technology: A provision is included that would provide for 
demonstration programs to test best practices for reducing errors, 
testing the use of appropriate technologies to reduce medical errors, 
such as hand-held electronic medication systems, and research in 
geographically diverse locations to determine the causes of medical 
errors. To assist in the development by the private sector of needed 
technology standards, the bill would provide for ways to examine use of 
information technology and coordinate actions by the Federal Government 
and ensure that this investment will further the national health 
information and infrastructure. This section of the legislation is 
projected to save $150 billion over the next 10 years.
  (8) Improving Health Care Quality, Efficiency and Consumer Education: 
The legislation would set up demonstration projects to educate the 
public regarding wise consumer choices about their health care, such as 
appropriate health care costs and quality control information. The 
Department of HHS would be tasked with developing public service 
announcements to educate the public about their coverage choices, 
eligibility and preventive care services. Also included in this title 
is a provision on ways to improve the effectiveness and portability of 
advance directives and living wills. Projected cost savings of this 
section of the bill is $70 billion over the next 10 years.
  (9) Primary and Preventive Care Services: Language is included to 
encourage the use of nonphysician providers such as nurse 
practitioners, physician assistants, and clinical nurse specialists by 
increasing direct reimbursement under Medicare and Medicaid without 
regard to the setting where services are provided. The bill also seeks 
to encourage students early on in their medical training to pursue a 
career in primary care and it provides assistance to medical training 
programs to recruit such students. The savings from this provision is 
estimated at $260 billion over a 10 year period.

  The bill I am introducing today is distinct from my longstanding 
efforts regarding managed care reform. During the 105th, 106th, and 
107th Congresses, I joined a bipartisan group of Senators to introduce 
the Promoting Responsible Managed Care Act of 1998, 1999, and 2001 
balanced proposals which would ensure that patients receive the 
benefits and services to which they are entitled, without compromising 
the savings and coordination of care that can be achieved through 
managed care.
  I have advocated health care reform in one form or another throughout 
my 24 years in the Senate. My strong interest in health care dates back 
to my first term, when I sponsored S. 811, the Health Care for 
Displaced Workers Act of 1983, and S. 2051, the Health Care Cost 
Containment Act of 1983, which would have granted a limited antitrust 
exemption to health insurers, permitting them to engage in certain 
joint activities such as acquiring or processing information, and 
collecting and distributing insurance claims for health care services 
aimed at curtailing then escalating health care costs. In 1985, I 
introduced the Community-based Disease Prevention and Health Promotion 
Projects Act of 1985, S. 1873, directed at reducing the human tragedy 
of low birth weight babies and infant mortality. Since 1983, I have 
introduced and cosponsored numerous other bills concerning health care 
in our country.
  During the 102nd Congress, I pressed the Senate to take action on the 
health care market issue. On July 29, 1992, I offered an amendment to 
legislation then pending on the Senate floor, which included a change 
from 25 percent to 100 percent deductibility for health insurance 
purchased by self-employed individuals, and small business insurance 
market reforms to make health coverage more affordable for small 
businesses. Included in this amendment were provisions from a bill 
introduced by the late Senator John Chafee, legislation which I 
cosponsored and which was previously proposed by Senators Bentsen and 
Durenberger. When then-majority leader Mitchell argued that the health 
care amendment I was proposing did not belong on that bill, I offered 
to withdraw the amendment if he would set a date certain to take up 
health care, similar to an arrangement made on product liability 
legislation, which had been placed on the calendar for September 8, 
1992. The majority leader rejected that suggestion, and the Senate did 
not consider comprehensive health care legislation during the balance 
of the 102nd Congress. My July 29, 1992 amendment was defeated on a 
procedural motion by a vote of 35 to 60, along party lines.
  The substance of that amendment, however, was adopted later by the 
Senate on September 23, 1992, when it was included in a Bentsen/
Durenberger amendment which I cosponsored to broaden tax legislation, 
H.R. 11. This amendment, which included essentially the same self-
employed tax deductibility and small group reforms I had proposed on 
July 29 of that year, passed the Senate by voice vote. Unfortunately, 
these provisions were later dropped from H.R. 11 in the House-Senate 
conference.
  On August 12, 1992, I introduced legislation entitled the Health Care 
Affordability and Quality Improvement Act of 1992, S. 3176, that would 
have enhanced informed individual choice regarding health care services 
by providing certain information to health care recipients, would have 
lowered the cost of health care through use of the most appropriate 
provider, and would have improved the quality of health care.
  On January 21, 1993, the first day of the 103rd Congress, I 
introduced the Comprehensive Health Care Act of 1993, S. 18. This 
legislation consisted of reforms that our health care system could have 
adopted immediately. These initiatives would have both improved access 
and affordability of insurance coverage and would have implemented 
systemic changes to lower the escalating cost of care in this country. 
S. 18 is the principal basis of the legislation I introduced in the 
last five Congresses as well as this one.
  On March 23, 1993, I introduced the Comprehensive Access and 
Affordability Health Care Act of 1993, S. 631, which was a composite of 
health care legislation introduced by Senators Cohen, Kassebaum, Bond, 
and McCain, and included pieces of my bill, S. 18. I introduced this 
legislation in an attempt to move ahead on the consideration of health 
care legislation and provide a starting point for debate. As I noted 
earlier, I was precluded by majority leader Mitchell from obtaining 
Senate consideration of my legislation as a floor amendment on several 
occasions. Finally, on April 28, 1993, I offered the text of S. 631 as 
an amendment to the pending Department of the Environment Act, S. 171, 
in an attempt to urge the Senate to act on health care reform. My 
amendment was defeated 65 to 33 on a procedural motion, but the Senate 
had finally been forced to contemplate action on health care reform.
  On the first day of the 104th Congress, January 4, 1995, I introduced 
a slightly modified version of S. 18, the Health Care Assurance Act of 
1995, also S. 18, which contained provisions similar to those 
ultimately enacted in the Kassebaum-Kennedy legislation, including 
insurance market reforms, an extension of the tax deductibility of 
health insurance for the self employed, and tax deductibility of long 
term care insurance.
  I continued these efforts in the 105th Congress, with the 
introduction of Health Care Assurance Act of 1997, S. 24, which 
included market reforms similar to my previous proposals with the 
addition of a new Title I, an innovative program to provide vouchers to 
States to cover children who lack health insurance coverage. I also 
introduced Title I of this legislation as a stand-alone bill, the 
Healthy Children's Pilot Program of 1997, S. 435, on March 13, 1997. 
This proposal targeted the approximately 4.2 million children of the 
working poor who lacked health insurance at that time. These are 
children

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whose parents earn too much to be eligible for Medicaid, but do not 
earn enough to afford private health care coverage for their families.
  This legislation would have established a $10 billion/5-year 
discretionary pilot program to cover these uninsured children by 
providing grants to States. Modeled after Pennsylvania's 
extraordinarily successful Caring and BlueCHIP programs, this 
legislation was the first Republican-sponsored children's health 
insurance bill during the 105th Congress.
  I was encouraged that the Balanced Budget Act of 1997, signed into 
law on August 5, 1997, included a combination of the best provisions 
from many of the children's health insurance proposals throughout this 
Congress. The new legislation allocated $24 billion over 5 years to 
establish State Child Health Insurance Programs, funded in part by a 
slight increase in the cigarette tax.
  During both the 106th and 107th Congresses, I again introduced the 
Health Care Assurance Act. These bills contained similar insurance 
market reforms, as well as new provisions to augment the new State 
Child Health Insurance Program, to assist individuals with disabilities 
in maintaining quality health care coverage, and to establish a 
National Fund for Health Research to supplement the funding of the 
National Institutes of Health. All these new initiatives, as well as 
the market reforms that I supported previously, work toward the goals 
of covering more individuals and stemming the tide of rising health 
costs.
  My commitment to the issue of health care reform across all 
populations has been consistently evident during my tenure in the 
Senate, as I have taken to this floor and offered health care reform 
bills and amendments on countless occasions. I will continue to stress 
the importance of the Federal Government's investment in and attention 
to the system's future.
  As my colleagues are aware, I can personally report on the miracles 
of modern medicine. Nearly 10 years ago, an MRI detected a benign 
tumor, meningioma, at the outer edge of my brain. It was removed by 
conventional surgery, with 5 days of hospitalization and 5 more weeks 
of recuperation.
  When a small regrowth was detected by a follow-up MRI in June 1996, 
it was treated with high powered radiation using a remarkable device 
called the ``Gamma Knife.'' I entered the hospital on the morning of 
October 11, 1996, and left the same afternoon, ready to resume my 
regular schedule. Like the MRI, the Gamma Knife is an innovation, 
coming into widespread use only in the past decade.
  In July 1998, I was pleased to return to the Senate after a 
relatively brief period of convalescence following heart bypass 
surgery. This experience again led me to marvel at our health care 
system and made me more determined than ever to support Federal funding 
for biomedical research and to support legislation which will 
incrementally make health care available to all Americans.
  My concern about health care has long pre-dated my own personal 
benefits from the MRI and other diagnostic and curative procedures. As 
I have previously discussed, my concern about health care began many 
years ago and has been intensified by my service on the Appropriations 
Subcommittee on Labor, Health and Human Services, and Education, which 
I now have the honor to chair.
  My own experience as a patient has given me deeper insights into the 
American health care system beyond my perspective from the U.S. Senate. 
I have learned: (1) our health care system, the best in the world, is 
worth every cent we pay for it; (2) patients sometimes have to press 
their own cases beyond doctors' standard advice; (3) greater 
flexibility must be provided on testing and treatment; (4) our system 
has the resources to treat the 40.9 million Americans currently 
uninsured, but we must find the way to pay for it; and (5) all 
Americans deserve the access to health care from which I and others 
with coverage have benefited.
  I have long been convinced that our Federal budget of $2.4 trillion 
could provide sufficient funding for America's needs if we establish 
our real priorities. Over the past 10 years, I believe we have learned 
a great deal about our health care system and what the American people 
are willing to accept from the Federal Government. The message we heard 
loudest was that Americans do not want a massive overhaul of the health 
care system. Instead, our constituents want Congress to proceed at a 
slower pace and to target what is not working in the health care system 
while leaving in place what is working.

  While I would have been willing to cooperate with the Clinton 
administration in addressing this Nation's health care problems, I 
found many areas where I differed with President Clinton's approach to 
solutions. I believe that the proposals would have been deleterious to 
my fellow Pennsylvanians, to the American people, and to our health 
care system as a whole. Most importantly, as the President proposed in 
1993, I did not support creating a large new government bureaucracy 
because I believe that savings should go to health care services and 
not bureaucracies.
  On this latter issue, I first became concerned about the potential 
growth in bureaucracy in September 1993 after reading the President's 
239-page preliminary health care reform proposal. I was surprised by 
the number of new boards, agencies, and commissions, so I asked my 
legislative assistant, Sharon Helfant, to make me a list of all of 
them. Instead, she decided to make a chart. The initial chart depicted 
77 new entities and 54 existing entities with new or additional 
responsibilities.
  When the President's 1,342-page Health Security Act was transmitted 
to Congress on October 27, 1993, my staff reviewed it and found an 
increase to 105 new agencies, boards, and commissions and 47 existing 
departments, programs and agencies with new or expanded jobs. This 
chart received national attention after being used by Senator Bob Dole 
in his response to the President's State of the Union address on 
January 24, 1994.
  The response to the chart was tremendous, with more than 12,000 
people from across the country contacting my office for a copy; I still 
receive requests for the chart nearly ten years later. Groups and 
associations, such as United We Stand America, the American Small 
Business Association, the National Federation of Republican Women, and 
the Christian Coalition, reprinted the chart in their publications--
amounting to hundreds of thousands more in distribution. Bob Woodward 
of the Washington Post later stated that he thought the chart was the 
single biggest factor contributing to the demise of the Clinton health 
care plan. And during the November 1996 election, my chart was used by 
Senator Dole in his presidential campaign to illustrate the need for 
incremental health care reform as opposed to a big government solution.
  The Department of Health and Human Services has stated that the 
health care, education, and child care for the 3.5 to 4 million low-
birth-weight infants and children from their births to the time they 
reach 15 years old costs between $5.5 and $6 billion more than what it 
would have cost if those children had been born at normal weight. We 
know that in most instances, prenatal care is effective in preventing 
low-birth-weight babies. Numerous studies have demonstrated that low 
birth weight does not have a genetic link, but is instead most often 
associated with inadequate prenatal care or the lack of prenatal care. 
The short and long-term costs of saving and caring for infants of low 
birth weight are staggering.
  It is a human tragedy for a child to be born weighing 16 ounces with 
attendant problems which last a lifetime. I first saw one pound babies 
in 1984 when I was astounded to learn that Pittsburgh, PA, had the 
highest infant mortality rate of African-American babies of any city in 
the United States. I wondered how that could be true of Pittsburgh, 
which has such enormous medical resources. It was an amazing thing for 
me to see a one pound baby, about as big as my hand. However, I am 
pleased to report that as a result of successful prevention initiatives 
like the Federal Healthy Start program, Pittsburgh's infant mortality 
has decreased 20 percent.
  To improve pregnancy outcomes for women at risk of delivering babies 
of low birth weight and to reduce infant mortality and the incidence of 
low-birth-weight births, as well as improving the health and well-being 
of mothers and their families, I initiated action that led to the 
creation of the

[[Page S7187]]

Healthy Start program in 1991. Working with the first Bush 
administration and Senator Harkin, as chairman of the Appropriations 
Subcommittee, we allocated $25 million in 1991 for the development of 
15 demonstration projects. This number grew to 22 in 1994, to 75 
projects in 1998, and the Health Resources and Services Administration 
expects this number to continue to increase. For fiscal year 2004, we 
secured $98 million for this vital program.
  To help children and their families to truly get a healthy start 
requires that we continue to expand access to Head Start. This 
important program provides comprehensive services to low income 
children and families, including health, nutritional and social 
services that children need to achieve the school readiness goal of 
Head Start. I have strongly supported expanding this program to cover 
more children and families. Since FY'00, funding for Head Start has 
increased from $5.3 billion to the FY'04 level of $6.8 billion. 
Additional funding has extended the reach of this important program to 
the current level of approximately 920,000 children.
  Our attention to improved health of children shifts to the school 
house door, as all children enroll in schools throughout the Nation. 
And it is in the schools where we have taken our next steps to improve 
the overall health of the Nation and reduce preventable health care 
expenditures. In the past 15 years, obesity has increased by over 50 
percent among adults and in the past 20 years, obesity has increased by 
100 percent among children and adolescents. A recent analysis by the 
National Institute of Child Health and Human Development, NICHD, Study 
of Early Child Care and Youth Development found that third grade 
children in the study received an average of 25 minutes per week in 
school of moderate to vigorous activity, while experts in the United 
States have recommended that young people should participate in 
physical activity of at least moderate intensity for 30 to 60 minutes 
each day. That is why I have supported increased funding for the Carole 
M. White Physical Education for Progress program. Since it was first 
funded at $5 million in FY 2001, this program has grown to $70 million 
in FY 2004. These funds help school districts and community based 
programs across the country improve and expand physical education 
programs in school, while also helping children develop healthy 
lifestyles to combat the epidemic of obesity in the Nation.

  The Labor-HHS bill also has made great strides in increasing funding 
for a variety of public health programs, such as breast and cervical 
cancer prevention, childhood immunizations, family planning, and 
community health centers. These programs are designed to improve public 
health and prevent disease through primary and secondary prevention 
initiatives. It is essential that we invest more resources in these 
programs now if we are to make any substantial progress in reducing the 
costs of acute care in this country.
  As chairman of the Labor, HHS and Education Appropriations 
Subcommittee, I have greatly encouraged the development of prevention 
programs which are essential to keeping people healthy and lowering the 
cost of health care in this country. In my view, no aspect of health 
care policy is more important. Accordingly, my prevention efforts have 
been widespread.
  I joined my colleagues in efforts to ensure that funding for the 
Centers for Disease Control and Prevention, CDC, increased $3.9 billion 
or 390 percent since 1989, for a fiscal year 2004 total of $4.9 
billion. We have also worked to increase funding for CDC's breast and 
cervical cancer early detection program to $209.5 million in fiscal 
year 2004, almost double its 1993 total.
  I have also supported programs at CDC which help children. CDC's 
childhood immunization program seeks to eliminate preventable diseases 
through immunization and to ensure that at least 90 percent of 2-year-
olds are vaccinated. The CDC also continues to educate parents and 
caregivers on the importance of immunization for children under 2 
years. Along with my colleagues on the Appropriations Committee, I have 
helped ensure that funding for this important program together with the 
complementary Vaccines for Children Program has grown from $914 million 
in 1999 to $1.8 billion in fiscal year 2004. The CDC's lead poisoning 
prevention program annually identifies about 50,000 children with 
elevated blood levels and places those children under medical 
management. The program prevents the amount of lead in children's blood 
from reaching dangerous levels and has grown from $38.2 million in 
fiscal year 2000 to $41.7 million in fiscal year 2004.
  In recent years, we have also strengthened funding for Community 
Health Centers, which provide immunizations, health advice, and health 
professions training. These centers, administered by the Health 
Resources and Services Administration, provide a critical primary care 
safety net to rural and medically underserved communities, as well as 
uninsured individuals, migrant workers, the homeless, residents of 
public housing, and Medicaid recipients. Funding for Community Health 
Centers has increased from $1 billion in fiscal year 2000 to $1.6 
billion in fiscal year 2004.
  As former chairman of the Select Committee on Intelligence and 
current chairman of the Appropriations Subcommittee with jurisdiction 
over nondefense biomedical research, I have worked to transfer CIA 
imaging technology to the fight against breast cancer. Through the 
Office of Women's Health within the Department of Health and Human 
Services, I secured a $2 million contract in fiscal year 1996 for a 
research consortium led by the University of Pennsylvania to perform 
the first clinical trials testing the use of intelligence technology 
for breast cancer detection. My Appropriations subcommittee has 
continued to provide funds to continue these clinical trials.
  In 1998, I cosponsored the Women's Health Research and Prevention 
Amendments, which was signed into law later that year. This bill 
revised and extended certain programs with respect to women's health 
research and prevention activities at the National Institutes of Health 
and the Centers for Disease Control and Prevention.
  In 1996, I also cosponsored an amendment to the Fiscal Year 1997 VA-
HUD Appropriations bill which required that health plans provide 
coverage for a minimum hospital stay for a mother and child following 
the birth of the child. This bill became law in 1996.
  I have also been a strong supporter of funding for AIDS research, 
education, and prevention programs.
  During the 101st Congress I cosponsored the Ryan White Comprehensive 
AIDS Resources Emergency Act of 1990 which amended the Public Health 
Service Act to direct the Secretary of Health and Human Services, 
through the administrator of the Health Resources and Services 
Administration, to make grants in any metropolitan area that has 
reported and confirmed more than 2,000 acquired immune deficiency 
syndrome, AIDS, cases or a per capita incidence of at least 0.0025, 
eligible area. This legislation requires that the grants be directed to 
the chief elected official of the city or urban county that administers 
the public health agency serving the greatest number of individuals 
with AIDS in the eligible area. This bill became law in 1990.
  During the 104th Congress I cosponsored the Ryan White CARE 
Reauthorization Act of 1995 which provided federal funds to 
metropolitan areas and states to assist in health care costs and 
support services for individuals and families affected by acquired 
immune deficiency syndrome, AIDS, or infection with the human 
immunodeficiency virus, HIV. This bill became law in 1996.
  Funding for Ryan White AIDS programs has increased from $757.4 
million in 1996 to $2.02 billion for fiscal year 2004. Within the 
fiscal year 2004 funding, $73 million was included for pediatric AIDS 
programs and $749 million for the AIDS Drug Assistance Program, ADAP. 
AIDS research at the NIH totaled $742.4 million in 1989, and has 
increased to an estimated $2.9 billion in fiscal year 2004.
  The health care community continues to recognize the importance of 
prevention in improving health status and reducing health care costs. 
The Balanced Budget Act of 1997 and the Consolidated Omnibus 
Appropriations Act of fiscal year 2001 established new and enhanced 
preventive benefits within the Medicare program, such as flu

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shots, bone mass measurements, yearly mammograms, biennial pap smears 
and pelvic exams, and coverage of colonoscopy for high risk patients. 
However, some of these ``wellness'' benefits have cost obligations, 
such as co payments or deductibles. In this bill, I have also included 
provisions which refine and strengthen preventive benefits within the 
Medicare program, including coverage of yearly pap smears, pelvic 
exams, and screening and diagnostic mammography with no copayment or 
Part B deductible; and coverage of insulin pumps for certain Type I 
Diabetics.
  During the 102nd Congress, I cosponsored an amendment to the 
Veterans' Medical Programs Amendments of 1992 which included 
improvements to health and mental health care and other services to 
veterans by the Department of Veterans Affairs. This bill became law in 
1992.
  During the 106th Congress, I sponsored the Veterans Benefits and 
Health Care Improvement Act of 2000 which increased amounts of 
educational assistance for veterans under the Montgomery GI Bill and 
enhanced health programs. This bill became law in 2000.
  I also sponsored the Department of Veterans Affairs Long-Term Care 
and Personnel Authorities Enhancement Act which improved and enhanced 
the provision of health for veterans. This bill became law in 2003.
  I cosponsored the Jobs and Growth Tax Relief Reconciliation Act which 
became law in 2003. This Act provided $20 billion in fiscal relief to 
the states, half of which went toward Medicaid relief.
  In 1996, I cosponsored the Health Coverage Availability and 
Affordability Act, which improved the portability and continuity of 
health insurance coverage in the group and individual markets, combated 
waste, fraud, and abuse in health insurance and health care delivery, 
promoted the use of medical savings accounts, improved access to long-
term care services and coverage, and simplified the administration of 
health insurance. This bill became law in 1996.
  On November 29, 1999, the Institute of Medicine, IOM, issued a report 
entitled ``To Err is Human: Building a Safer Health System.'' The IOM 
Report estimated that anywhere between 44,000 and 98,000 hospitalized 
Americans die each year due to avoidable medical mistakes. However only 
a fraction of these deaths and injuries are due to negligence; most 
errors are caused by system failures. The IOM issued a comprehensive 
set of recommendations, including the establishment of a nationwide, 
mandatory reporting system; incorporation of patient safety standards 
in regulatory and accreditation programs; and the development of a non-
punitive ``culture of safety'' in health care organizations. The report 
called for a 50 percent reduction in medical errors over 5 years.
  After the report was issued I held a series of three LHHS hearings on 
medical errors: Dec. 13, 1999--to discuss the findings of the Institute 
of Medicine's report on medical errors; Jan. 25, 2000--a joint hearing 
with the Committee on Veterans' Affairs to discuss a national error 
reporting system and the VA's national patient safety program; Feb. 22, 
2000--a joint hearing with the HELP Committee to discuss the 
Administration's strategy to reduce medical errors.

  After hearing from Government witnesses and experts in the field on 
medical errors, I included $50 million in the FY 2001 Senate Labor, 
Health and Human Services and Education for a patient safety 
initiative. In the Senate report I also directed the Agency for 
Healthcare Research and Quality, AHRQ, to: (1) develop guidelines on 
the collection of uniform error data; (2) establish a competitive 
demonstration program to test ``best practices;'' and (3) research ways 
to improve provider training.
  The committee also directed AHRQ to prepare an interim report to 
Congress concerning the results of the demonstration program within 2 
years of the beginning of the projects. The FY 2002 Senate report 
directed AHRQ to submit a report detailing the results of its 
initiative to reduce medical errors. HHS combined both reports into 
one, which it submitted to me earlier this year.
  Since FY 2001 the Labor/HHS Subcommittee has included within the 
Agency for Healthcare Research and Quality funding for research into 
ways to reduce medical errors. The FY 2002 appropriation was $55 
million, in FY 2003 another $55 million was provided, in FY 2004 the 
appropriation was increased to $79.5 million and in FY 2005, while 
still pending Senate action a figure of $84 million is proposed.
  Statistics find that 30 percent of Medicare expenditures occur during 
a person's last year of life and beyond the last year of life, a 
tremendous percentage of medical costs occur in the last month, in the 
last few weeks, in the last week, or in the last few days.
  A New England Journal of Medicine article stated that as much as 3.3 
percent of national health care costs could be saved yearly by reducing 
the use of end of life interventions. While some estimates of the end 
of life costs have been projected to be over $500 billion, over a 10-
year period, the cost analysis in this bill does not include any of 
these estimates in the projected savings calculations.
  The issue of cutting back on end of life treatments is such a 
sensitive subject and no one should decide for anybody else what that 
person should have by way of end-of-life medical care. What care ought 
to be available is a very personal decision.
  Living wills give an individual an opportunity to make that judgment, 
to make a decision as to how much care he or she wanted near the end of 
his or her life and that is, to repeat, a matter highly personalized 
for the individual.
  As part of a public education program, I included an amendment to the 
Medicare Prescription Drug and Modernization Act of 2003 which directed 
the Secretary of Health and Human Services to include in its annual 
``Medicare And You'' handbook, a section that specifies information on 
advance directives and details on living wills and durable powers of 
attorney regarding a person's health care decisions.
  As chairman of the Labor, Health and Human Services, and Education 
Appropriations Subcommittee, I have worked to provide much-needed 
resources for hospitals, physicians, nurses, and other health care 
professionals. The National Institutes of Health provides funding for 
biomedical research at our Nation's universities, hospitals, and 
research institutions. I led the effort to double funding for the 
National Institutes of Health over 5 years. Funding for the NIH has 
increased from $11.3 billion in fiscal year 1995 to $28 billion in 
fiscal year 2004.
  An adequate number of health professionals, including doctors, 
nurses, dentists, psychologists, laboratory technicians, and 
chiropractors is critical to the provision of health care in the United 
States. I have worked to provide much needed funding for health 
professional training and recruitment programs. In fiscal year 2004, 
these vital programs received $436 million. Nurse education and 
recruitment alone has been increased from $58 million in fiscal year 
1996 to $142 million in fiscal year 2004.
  Once recruited and trained, health professionals must be given the 
resources to provide quality health care in all areas of the country. 
Differences in reimbursement rates between rural and urban areas have 
led to significant problems in health professional retention. During 
the debate on the Balanced Budget Refinement Act 2, which passed as 
part of the FY 2001 consolidated appropriations bill, I attempted to 
reclassify some Northeastern hospitals in Pennsylvania to a 
Metropolitan Statistical Area with higher reimbursement rates. Due to 
the large volume of requests from other states, we were not able to 
accomplish these reclassifications for Pennsylvania. However, as part 
of the FY 2004 Omnibus Appropriations bill, I secured $7 million for 
twenty northeastern Pennsylvania hospitals affected by area wage index 
shortfalls.
  As part of the Medicare Prescription Drug and Medicare Improvement 
Act of 2003, which passed the Senate on November 25, 2003, a $900 
million program was established to provide a one-time appeal process 
for hospital wage index reclassification. Thirteen Pennsylvania 
hospitals were approved for funding through this program in 
Pennsylvania.

  The following table outlines the $540 billion in projected health 
care costs offset by the $540 billion in health care saving assumptions 
contained in the

[[Page S7189]]

provisions of the Health Care Assurance Act of 2004. These costs and 
savings are for a 10-year period.

 
                                                       Projected health
                                                          care costs
 
Small Employer and Individual Purchasing Groups.....        $300,000,000
COBRA Portability Reform............................     101,700,000,000
Financial Incentives for Young Adults...............      40,000,000,000
Outreach Program for Medicaid Eligible Low-Income          4,000,000,000
 Families...........................................
Expanded Coverage for the State Children's Health        394,000,000,000
 Insurance Program and Their Families...............
                                                     -------------------
      Total--Projected Health Care Costs............     540,000,000,000
 


 
                                                       Projected health
                                                         care savings
 
Improving Program Integrity/Efficiency in the            $60,000,000,000
 Medicare Program...................................
Reducing Medical Errors and Increasing Medical           150,000,000,000
 Technology.........................................
Improving Health Care Quality, Efficiency and             70,000,000,000
 Consumer Education.................................
Primary and Preventive Care Providers...............     260,000,000,000
                                                     -------------------
      Total--Projected Health Care Savings..........     540,000,000,000
 

  The provisions which I have outlined today contain my ideas for a 
framework to provide affordable, quality health care for all Americans. 
I am opposed to rationing health care. I do not want rationing for 
myself, for my family, or for America. I believe we can provide care 
for the 43 million Americans who are now not covered by savings in 
other areas of the $1.7 trillion currently being spent on health care. 
The time has come for concerted action in this arena. I urge my 
colleagues to move this legislation forward promptly.
                                 ______