[Congressional Record Volume 151, Number 77 (Monday, June 13, 2005)]
[Senate]
[Pages S6407-S6409]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Ms. Landrieu):
  S. 1225. A bill to expand access to affordable health care and to 
strengthen the health care safety net and make health care services 
more available in rural and underserved areas; to the Committee on 
Finance.
  Ms. COLLINS. Mr. President, I am pleased to join with my colleague 
from Louisiana, Senator Landrieu, in introducing the Access to 
Affordable Health Care Act, a comprehensive, seven-point plan that 
builds on the strengths of our current public programs and private 
health care system to make quality, affordable health care available to 
millions more Americans.
  One of my top priorities in the Senate has been to expand access to 
affordable health care for all Americans. There are still far too many 
Americans without health insurance or with woefully inadequate 
coverage. As many as 45 million Americans--almost 16 percent of our 
population--are uninsured, and millions more are underinsured.
  Health care coverage matters. The simple fact is that people with 
health insurance are healthier than those who are uninsured. People 
without health insurance are less likely to seek care when they need 
it, and to forgo services such as periodic check ups and preventive 
services. As a consequence, they are more likely to be hospitalized or 
require costly medical attention for conditions that could have been 
prevented or treated at a curable stage. Not only does this put the 
health of these individuals at greater risk, but it also puts 
additional pressure on our hospitals and emergency rooms, many of them 
already financially challenged.
  Compared with people who have health coverage, uninsured adults are 
four times, and uninsured children five times, more likely to use the 
emergency rooms. The costs of care for these individuals are often 
absorbed by providers and passed on to the covered population through 
increased fees and insurance premiums.
  Maine is in the midst of a growing health insurance crisis, 
with insurance premiums rising at alarming rates. Whether I am talking 
to a self-employed fisherman, a displaced worker, the owner of a 
struggling small business, or the human resource manager of a large 
company, the soaring costs of health insurance is a common concern.

  Maine's employers are currently facing premium increases of as much 
as 20 percent a year. These premiums have been particularly burdensome 
for small businesses, the backbone of the Maine economy. Many small 
business owners are caught in a cost-squeeze: they know that if they 
pass on the premium increases to their employees, more of them will 
decline coverage. Yet these small businesses simply cannot afford to 
absorb double-digit increases in their health insurance premiums year 
after year.
  The problem of rising costs is even more acute for individuals and 
families who must purchase health insurance on their own. Monthly 
health insurance premiums in Maine often exceed a family's mortgage 
payment. It is no wonder that as many as 150,000 Mainers are uninsured. 
Clearly, we must do more to make our health care system more efficient 
and health insurance more available and affordable.
  The Access to Affordable Health Care Act, which we are introducing 
today, is a seven-point plan that combines a variety of public and 
private approaches to make quality health care coverage more affordable 
and available. The legislation's seven goals are:
  No. 1. To expand access to affordable health care for small 
businesses;
  No. 2. To make health insurance more affordable for individuals and 
families purchasing coverage on their own;
  No. 3. To strengthen the health care safety net for those without 
coverage;
  No. 4. To expand access to care in rural and under-served areas;
  No. 5. To increase access to affordable long-term care;
  No. 6. To promote healthier lifestyles;
  And No. 7, to provide more equitable Medicare payments to Maine 
providers to reduce the Medicare shortfall, which has forced hospitals, 
physicians and other providers to shift costs onto other payers in the 
form of higher charges, which, in turn drives up health care premiums.

  Let me discuss each of these seven points in more detail.
  First, our legislation will help small employers cope with rising 
health care costs.
  Since most Americans get their health insurance through the 
workplace, it is a common assumption that people without health 
insurance are unemployed. The fact is, however, that most uninsured 
Americans are members of families with at least one full-time worker. 
As many as 82 percent of Americans who do not have health insurance are 
in a family with a worker.
  Uninsured working Americans are most often employees of small 
businesses. In fact, some 60 percent of uninsured workers are employed 
by small firms. Smaller firms generally face higher costs for health 
insurance than larger firms, which makes them less likely to offer 
coverage. Small businesses want to provide health insurance for their 
employees, but the cost of often just too high.
  The legislation we are introducing today will help small employers 
cope with rising costs by providing new tax credits for small 
businesses to help make health insurance more affordable. It will 
encourage those small businesses that do not currently offer health 
insurance to do so and will help employers that do offer insurance to 
continue coverage for their employees even in the face of rising costs.
  Our legislation will also help increase the clout of small businesses 
in

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negotiating with insurers. Premiums are generally higher for small 
businesses because they do not have as much purchasing power as large 
companies, which limits their ability to bargain for lower rates. They 
also have higher administrative costs because they have fewer employees 
among whom to spread the fixed cost of a health benefits plan. 
Moreover, they are not as able to spread the risks of medical claims 
over as many employees as large firms.
  Our legislation will help address these problems by authorizing 
Federal grants to provide start-up funding to States to assist them 
with the planning, development and operation of small employer 
purchasing cooperatives. These cooperatives will help to reduce health 
care costs for small employers by allowing them to band together to 
purchase health insurance jointly. Group purchasing cooperatives have a 
number of advantages for small employers. For example, the increased 
number of participants in the group help to lower the premium costs for 
all. Moreover, they decrease the risk of adverse selection and spread 
the cost of health care over a broader group.

  The legislation would also authorize a Small Business Administration 
grant program for States, local governments and non-profit 
organizations to provide information about the benefits of health 
insurance to small employers, including tax benefits, increased 
productivity of employees, and decreased turnover. These grants would 
also be used to make employers aware of their current rights under 
State and Federal laws. While costs are clearly a problem, many small 
employers are not fully aware of laws that have already been enacted by 
both States and Federal Government to make health insurance more 
affordable. For example, in one survey, 57 percent of small employers 
did not know that they could deduct 100 percent of their health 
insurance premiums as a business expense.
  The legislation would also create a new program to encourage 
innovation by awarding demonstration grants in up to 10 States 
conducting innovative coverage expansions, such as alternative group 
purchasing or pooling arrangements, individual or small group market 
reforms, or subsidies to employers or individuals purchasing coverage. 
The States have long been laboratories for reform, and they should be 
encouraged in the development of innovative programs that can serve as 
models for the Nation.
  The Access to Affordable Health Care Act will also expand access to 
affordable health care for individuals and families.
  One of the first bills I cosponsored as a Senator was legislation to 
establish the State Children's Health Insurance Program, S-CHIP, which 
provides insurance for the children of low-income parents who cannot 
afford health insurance, yet make too much money to qualify for 
Medicaid. This important program has provided affordable health 
insurance coverage to an estimated six million children nationwide, 
including almost 13,000 who are currently enrolled in the MaineCare 
program. Even so, nationwide, millions of qualified children have yet 
to be enrolled in this program, many because their parents simply don't 
know that they are eligible for the assistance.
  Our legislation builds on the success of this program and gives 
States a number of new tools to increase participation. The bill 
authorizes new grants for States and non-profit organizations to 
conduct innovative outreach and enrollment efforts to ensure that all 
eligible children are covered. States would also have the option of 
covering the parents of the children who are enrolled in programs like 
MaineCare. States could also use funds provided through this program to 
help eligible working families pay their share of an employer-based 
health insurance plan. In short, the legislation will help ensure that 
the entire family receives the health care they need.

  And finally, to help make health coverage more affordable for low- 
and middle-income individuals and families who do not have employer-
provided coverage and who are not eligible for the expanded public 
programs, our legislation would provide an advanceable, refundable tax 
credit of up to $1,000 for individuals earning up to $30,000 and up to 
$3,000 for families earning up to $60,000. This could provide coverage 
for up to 6 million Americans who would otherwise be uninsured for one 
or more months, and will help many more working lower-income families 
who currently purchase private health insurance with little or no 
government help.
  The Access to Affordable Health Insurance Act will also help to 
strengthen our Nation's health care safety net by doubling funding over 
5 years for the Consolidated Health Centers program, which includes 
community, migrant, public housing and homeless health centers. These 
centers, which operate in underserved urban and rural communities, 
provide critical primary care services to millions of Americans, 
regardless of their ability to pay. About 20 percent of the patients 
treated at Maine's community health centers have no insurance coverage 
and many more have inadequate coverage, so these centers are a critical 
part of our Nation's health care safety net.
  The problem of access to affordable health care services is not 
limited to the uninsured, but is also shared by many Americans living 
in rural and underserved areas where there is a serious shortage of 
health care providers. The Access to Affordable Health Care Act 
therefore calls for increased funding for the National Health Service 
Corps, which supports doctors, dentists, and other clinicians who serve 
in rural and inner city areas.
  The legislation will also give the program greater flexibility by 
allowing National Health Service Corps participants to fulfill their 
commitment on a part-time basis. Current law requires all National 
Health Service Corps participants to serve full-time. Many rural 
communities, however, simply do not have enough volume to support a 
full-time health care practitioner. Moreover, some sites may not need a 
particular type of provider--for example, a dentist--on a full-time 
basis. Some practitioners may also find part-time service more 
attractive, which, in turn, could improve recruitment and retention. 
Our bill therefore gives the program additional flexibility to meet 
community needs.

  Long-term care is the major catastrophic health care expense faced by 
older Americans today, and these costs will only increase with the 
aging of the baby boomers. Most Americans mistakenly believe that 
medicare or their private health insurance policies will cover the cost 
of long-term care should they develop a chronic illness or cognitive 
impairment like Alzheimer's Disease. Unfortunately, far too many do not 
discover that they do not have coverage until they are confronted with 
the difficult decision of placing a much-loved parent or spouse in 
long-term care and facing the shocking realization that they will have 
to cover the costs themselves.
  The Access to Affordable Health Care Act will provide a tax credit 
for long-term care expenses of up to $3,000 to provide some help to 
those families struggling to provide long-term care to a loved one. It 
will also encourage more Americans to plan for their future long-term 
care needs by providing a tax deduction to help them purchase long-term 
care insurance.
  Health insurance alone is not going to ensure good health. As noted 
author and physician Dr. Michael Crichton has observed, ``the future of 
medicine lies not in treating illness, but preventing it.'' Many of our 
most serious health problems are directly related to unhealthy 
behaviors--smoking, lack of regular exercise and poor diet. These three 
major risk factors alone have made Maine the state with the fourth 
highest death rate due to four largely preventable diseases: 
cardiovascular disease, cancer, chronic lung disease and diabetes. 
These four chronic diseases are responsible for 70 percent of the 
health care problems in Maine.
  Our bill therefore contains a number of provisions designed to 
promote healthy lifestyles. An ever-expanding body of evidence shows 
that these kinds of investments in health promotion and prevention 
offer returns not only in reduced health care bills, but in longer life 
and increased productivity. The legislation will provide grants to 
States to assist small businesses wishing to establish ``worksite 
wellness'' programs for their employees. It would also authorize a 
grant program to support new and existing ``community partnerships,'' 
such as the Healthy Community Coalition in

[[Page S6409]]

Maine's Franklin County, to promote healthy lifestyles among hospitals, 
employers, schools and community organizations. And, it would provide 
funds for States to establish or expand comprehensive school health 
education, including, for example, physical education programs that 
promote lifelong physical activity, healthy food service selections, 
and programs that promote a healthy and safe school environment. 

  Finally, the Access to Affordable Health Care Act would promote 
greater equity in Medicare payments and help to ensure that the 
Medicare system rewards rather than punishes States like Maine that 
deliver high-quality, cost-effective Medicare services to our elderly 
and disabled citizens.
  According to a study in the Journal of the American Medical 
Association, Maine ranks third in the Nation when it comes to the 
quality of care delivered to our Medicare beneficiaries. Yet we are 
11th from the bottom when it comes to per-beneficiary Medicare 
spending.
  The fact is that Maine's Medicare dollars are being used to subsidize 
higher reimbursements in other parts of the country. This simply is not 
fair. Medicare's reimbursement systems have historically tended to 
favor urban areas and failed to take the special needs of rural States 
into account. Ironically, Maine's low payment rates are also the result 
of its long history of providing high-quality, cost-effective care. In 
the early 1980s, Maine's lower than average costs were used to justify 
lower payment rates. Since then, Medicare's payment policies have only 
served to perpetuate the gap.
  The Medicare Modernization Act of 2003 did take some significant 
steps toward promoting greater fairness by increasing Medicare payments 
to rural hospitals and by modifying geographic adjustment factors that 
discriminated against physicians and other providers in rural areas. 
The legislation we are introducing today will build on those 
improvements by establishing State pilot programs that reward providers 
of high-quality, cost efficient Medicare services. It will also 
establish a program to expand graduate medical education programs in 
rural and underserved areas of the nation.
  Mr. President, the Access to Affordable Health Care Act outlines a 
blueprint for reform based on principles upon which I believe a 
bipartisan majority in Congress could agree. The plan takes significant 
strides toward the goal of universal health care coverage by bringing 
millions more Americans into the insurance system, by strengthening the 
health care safety net, and by addressing inequities in the Medicare 
system.
                                 ______