[Congressional Record Volume 151, Number 103 (Tuesday, July 26, 2005)]
[House]
[Pages H6466-H6472]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 525, SMALL BUSINESS HEALTH FAIRNESS 
                              ACT OF 2005

  Mr. BISHOP of Utah. Mr. Speaker, by direction of the Committee on 
Rules, I call up House Resolution 379 and ask for its immediate 
consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 379

       Resolved,  That upon the adoption of this resolution it 
     shall be in order without intervention of any point of order 
     to consider in the House the bill (H.R. 525) to amend title I 
     of the Employee Retirement Income Security Act of 1974 to 
     improve access and choice for entrepreneurs with small 
     businesses with respect to medical care for their employees. 
     The bill shall be considered as read. The previous question 
     shall be considered as ordered on the bill and on any 
     amendment thereto to final passage without intervening motion 
     except: (1) one hour of debate on the bill equally divided 
     and controlled by the chairman and ranking minority member of 
     the Committee on Education and the Workforce; (2) the 
     amendment in the nature of a substitute printed in the report 
     of the Committee on Rules accompanying this resolution, if 
     offered by Representative Kind of Wisconsin or his designee, 
     which shall be in order without intervention of any point of 
     order, shall be

[[Page H6467]]

     considered as read, and shall be separately debatable for one 
     hour equally divided and controlled by the proponent and an 
     opponent; and (3) one motion to recommit with or without 
     instructions.

  The SPEAKER pro tempore. The gentleman from Utah (Mr. Bishop) is 
recognized for 1 hour.
  Mr. BISHOP of Utah. Mr. Speaker, for the purpose of debate only, I 
yield the customary 30 minutes to the gentlewoman from California (Ms. 
Matsui), pending which I yield myself such time as I may consume. 
During consideration of this resolution, all time yielded is for the 
purpose of debate only.
  This resolution provides for a structured rule and provides for 1 
hour of debate equally divided between the chairman and ranking 
minority member of Committee on Education and the Workforce, waives all 
points of order against consideration of the bill, and makes in order 
an amendment in the nature of a substitute offered by the minority. 
This is a good and a fair rule. It allows the House to focus the debate 
and the vote upon two different approaches aimed at helping America's 
small businesses to offer health coverage to its employees, and to 
debate and examine the proper role of the Federal Government in the 
health care arena.
  Amendments not made in order were offered and discussed by the 
committee, so it is appropriate, I think, not to duplicate that 
committee action here on the floor.
  H.R. 525 is the Small Business Health Fairness Act of 2005, sponsored 
by the distinguished gentleman from Texas (Mr. Sam Johnson), and is 
virtually identical to legislation passed in the 108th Congress, then 
H.R. 660, which passed this House by a 90-vote margin of 252 to 162. So 
I commend the subcommittee chairman, the gentleman from Texas (Mr. Sam 
Johnson); the chairman of the full committee, the gentleman from Ohio 
(Mr. Boehner), for once again moving this bill through the committee 
process.
  Mr. Speaker, H.R. 525 is a modest bill. It does not seek to address 
every aspect of health care in America. It does not seek to mandate 
Federal control into every aspect of medical treatments. To the chagrin 
of some of my friends on both sides of the aisle, it does not move our 
country in the direction of government control and taxpayer-funded 
universal health care.
  What it does do, and this is really the bottom line, is make health 
insurance more affordable to small business and thereby increase the 
total number of Americans and families that are insured.
  H.R. 525, if enacted, will result in more Americans and more American 
families being covered by private health insurance, and that is a 
worthy goal that we should all be working to achieve.
  Mr. Speaker, I would like to point out that large corporations and 
unions already enjoy, many through ERISA, the same insurance-risk 
pooling features and already enjoy the cost efficiencies built into 
this health coverage package for their workers and their members. This 
bill, therefore, is about achieving a measure of fairness towards small 
business, an effort for the mom and pop businesses and industries to be 
treated the same way as giant corporations and union organizations.
  The small guy will have nothing the large guy does not already have, 
with specific regulations placed in the bill to ensure against unfair 
pooling practices. It has bipartisan support from a wide range of 
groups, from the U.S. Chamber of Commerce, the National Federation of 
American Business, the American Farming Bureau, Associated Builders and 
Contractors, the Latino Coalition, the National Black Chamber of 
Commerce, the National Association of Women Business Owners and the 
National Restaurant Association, as well as many others.
  In the course of this debate, Mr. Speaker, there will be many who 
will be giving facts and figures. I do not wish to go into those right 
now. But I wish to make sure that this is part of a larger picture.
  As politicians, we oftentimes talk about the Nation or issues being 
at a crossroads. We do that a lot because it is a very dramatic phrase, 
and it makes us seem more important because we are in the middle of it. 
But I do believe in the issue of health care and insurance we are as a 
Nation in the crossroads. We can take one direction which would be to 
have greater government control, especially on the Federal level which 
ultimately would lead to a single-payer Federal program where 
decisions, right or wrong, would be made here.
  Indeed, I think the substitute that will be ordered is illustrative 
not in topic but in spirit of this, where there is greater government 
control, greater regulations being put in there so that one wonders if 
the issue is really health insurance or if the issue is control.
  The other approach that we are in the crossroads of and could take 
would be an approach to try and add market forces into the system to 
try and move some type of reforms along the way. This bill is not a 
panacea for all of our health care issues; but it is a step for certain 
groups who are currently excluded, often by well-intended decisions of 
the government.
  I clearly understand both sides of these particular issues. I was a 
State legislator who did both while I was down there. There were 
requirements in health care which I thought were good at the time, 
which I also knew were costly at the time; and I also realize in 
hindsight, in helping one group of very vulnerable people, we actually 
hurt a different group of very vulnerable people.
  For example, in my State, family health care is covered for everyone 
until the age of 25. When I joined this august body, all of the sudden 
the limitation was now at age 22, not 25; and I immediately realized I 
had three sons who had no health insurance whatsoever. I still have two 
sons who are out there in that risky group with no health insurance 
whatsoever.
  I clearly realized from personal experience that all the mandates of 
coverage of health care systems are useless to those who cannot get or 
cannot afford insurance in the first place.
  My oldest son finally got a job with a large corporation. I was very 
relieved that now he has insurance until a couple of weeks ago when he 
came and talked to me about joining a friend in an entrepreneurial 
enterprise, in which case they would start their own business. I should 
have been excited about his attitude; but the first question out of my 
mouth was, Well, what about your insurance?
  We make decisions here that have far-reaching effects in creating a 
society of limitations instead of visions as they should be. With all 
sorts of good intentions, government also has helped create people 
whose options are shut to them when all they want really is hope and 
the freedom to choose some kind of options. Sometimes it is a matter of 
control of those options, which is frightening for any government level 
to try and give up.
  This bill does not try to create mandatory efforts. It tries to 
create options. It tries to create options from which people can 
choose. People who are not now covered have a chance to be covered in 
some way with insurance. Regardless of how one votes on this issue in 
the past or in the future, this is a fair rule. With that, I urge my 
colleagues to support this rule.
  Mr. Speaker, I reserve the balance of my time.
  Ms. MATSUI. Mr. Speaker, I thank the gentleman from Utah (Mr. Bishop) 
for yielding me this time, and I yield myself such time as I may 
consume.
  (Ms. MATSUI asked and was given permission to revise and extend her 
remarks.)

                              {time}  1400

  Ms. MATSUI. Mr. Speaker, today I rise in opposition to this rule and 
the underlying measure of H.R. 525. This country leads in medicine and 
technology. When combined with increased education and awareness, we 
have made diseases more preventable and treatable. We have made huge 
strides, for example, diagnosing and treating breast cancer. Women are 
now going in for annual mammograms. In and of itself, mammograms do not 
prevent breast cancer, but they can save lives by finding breast cancer 
as early as possible.
  For example, mammograms have been shown to lower the chance of dying 
from breast cancer by 35 percent in women over the age of 50. And 
studies suggest for women between 40 and 50, they may lower the chance 
of dying of breast cancer by 25 to 35 percent.

[[Page H6468]]

  Having worked on educational campaigns for over a decade, I know that 
it has not been easy to convince women that they should be asking their 
doctor for a mammogram, nor, I might add, has it been easy to ensure 
that health insurance companies cover the cost of these mammograms. But 
through the tireless efforts of doctors, survivors, and advocates, the 
insurance companies relented.
  Today we are increasingly catching and treating breast cancer in the 
early stages, yet the legislation we are debating here on the floor 
today would effectively roll back these advances, and, even worse, 
doctors would now have to tell the 28-year-old woman who thinks she has 
found a lump in her breast that her health care insurance does not 
cover a mammogram to better see the abnormality; that her health care 
coverage is no longer subject to minimum standards established by her 
State because she is covered by an associated health plan, an AHP, 
which is located in a different State with far more relaxed laws on 
health care coverage.
  Too many Americans are already without sufficient health care 
coverage. They are being forced to accept health care that does not 
provide what they need when they fall ill, whether it is breast cancer 
exams, diabetes medication, or childhood vaccinations. Why would we 
increase the number of these individuals without adequate health care 
coverage?
  Some may claim that these standards for health care treatments, like 
those that require insurance companies to cover mammograms, are nothing 
but burdensome regulations, but these safeguards go to the heart of 
what responsible health care is all about: providing necessary care to 
those in need. And AHPs would not even reduce the cost of the premiums. 
Under the legislation we debate today, AHPs could skim off a small 
minority of small businesses, those with younger and healthier 
workforces. As a direct result, 80 percent of small businesses would 
see an increase in their health care premiums.
  Mr. Speaker, I truly question what we are doing today. Why would we 
create a situation that increases the already skyrocketing health care 
costs for four out of five small businesses? Sadly, this is what we are 
doing. We are putting our small businesses in the awkward position of 
not being able to offer health care coverage to that young woman facing 
the possibility of breast cancer, or offering access to a health care 
plan that will not cover her diagnosis and certainly not a treatment.
  We could do better by that young woman and our Nation's small 
business owners. Congress could pass the Democratic substitute offered 
by the gentleman from Wisconsin (Mr. Kind) and the gentleman from New 
Jersey (Mr. Andrews), which would allow small business employees to 
access the same quality health care coverage which Federal employees 
enjoy. The substitute's Federal partnership would allow this plan to be 
offered at an affordable price. This alternative would truly have a 
positive impact, ensuring that Americans have access to affordable and 
quality health care. I urge my colleagues to support it.
  Unfortunately, the legislation we debate on the floor, H.R. 525, 
which would create AHPs will most likely worsen health care situations. 
Mr. Speaker, if we, Members of Congress, would not accept a health plan 
that does not include minimum coverage, why then should the American 
people?
  We have an opportunity today. We can support the Democratic 
alternative and pass legislation that actually addresses the critical 
health care problems facing small business owners, or we can pass the 
legislation in front of us that does the opposite. It should not be a 
difficult decision. Mr. Speaker, I urge all Members to votes against 
the rule and the underlying bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BISHOP of Utah. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from West Virginia (Mrs. Capito).
  Mrs. CAPITO. Mr. Speaker, I thank my friend and colleague on the 
Committee on Rules, the gentleman from Utah (Mr. Bishop), for yielding 
me this time; and I rise today in support of the rule and the 
underlying legislation, the Small Business Health Fairness Act.
  Mr. Speaker, a trip to the doctor should not bust the family budget. 
Too many of America's small business employees go without health 
insurance or pay a big chunk of their paycheck for health care. This 
House has acted on four separate occasions in a bipartisan way to pass 
reforms that will allow small business owners to provide their 
employees with affordable health insurance options, yet our efforts to 
help reduce the ranks of the uninsured has not gone forward.
  This crucial legislation allows small business owners to have similar 
purchasing power for health insurance as large corporations. The 
creation of association health plans will permit small business owners 
to band together through a trade association or other method to 
purchase health insurance for them and their employees. The ability to 
provide health insurance is critical for our small businesses to remain 
competitive.
  Mr. Speaker, workers are frustrated with paying the high cost of 
health care. Congress needs to finish this job and pass association 
health plans into law. I urge my colleagues to support the rule and the 
underlying legislation.
  Ms. MATSUI. Mr. Speaker, I yield 2\1/2\ minutes to the gentlewoman 
from California (Ms. Lee).
  Ms. LEE. Mr. Speaker, I want to thank the gentlewoman for yielding me 
this time and for her leadership and consistent work on behalf of the 
American people regardless of what issue and what bills we are dealing 
with today. I want to say that I join her today in opposition to this 
rule and to the underlying bill. It is fundamentally flawed not only 
for what it does, but for what it fails to do.
  Mr. Speaker, if this bill were made law, we would still have well 
over 44 million people in our country uninsured. Something is wrong. 
Something is fundamentally wrong where in the wealthiest Nation in the 
world we have 44 million uninsured. Where, quite frankly, is the 
morality in that? Under this bill, of the 45 million uninsured 
Americans in this country, only 600,000 people would move into 
coverage, while 10,000 workers with coverage would be pushed off of 
their current plans.
  Not only does this bill fail to provide any significant coverage for 
the uninsured, it also puts women and girls at risk by preempting very 
strong State laws. Specifically, the bill overrides contraceptive 
protections in 21 States that currently ensure access to contraceptives 
and treatments for sexually transmitted diseases. Clearly, Mr. Speaker, 
this bill puts women and girls at risk and makes empty promises to 
millions of uninsured Americans in desperate need of health care.
  Instead of considering this bill, we should be debating the real 
question: How do we begin to put people before profits in our own 
health care system? Millions of Americans are calling on Congress to 
address this question by debating and voting on meaningful proposals, 
like universal health care, reimportation of prescription drugs, and 
allowing HHS to negotiate drug prices for Medicare recipients. It is 
time for Congress to wake up and take a hard look at our broken health 
care system. It is time for us to make a real effort at reform.
  Mr. Speaker, H.R. 525 does nothing to expand health care to those who 
need it the most, and it undermines vital protections for women and 
girls. As a former small business owner, I know from years of 
experience the difficulties small businesses face due to a lack of 
consistent cash flow to afford these payments. Profitability for small 
businesses to afford health care contributions should really be 
addressed, and that is what we should be talking about today.
  What this bill should do is assist small employers or employees in 
affording premium payments. I am sure that is why 69 local Chambers of 
Commerce, the National Governors Association, 41 attorneys general, 
Blue Cross/Blue Shield, and over 1,300 business, labor and community 
organizations oppose H.R. 525. This bill is bad for the health of our 
country.
  Mr. BISHOP of Utah. Mr. Speaker, I am pleased to yield 3 minutes to 
the distinguished gentleman from Ohio (Mr. Boehner), the chairman of 
the Committee on Education and the Workforce.
  Mr. BOEHNER. Mr. Speaker, uninsured working families are looking to

[[Page H6469]]

Congress for answers to help give them access to quality health care, 
and before us today is a bipartisan bill that should give them hope.
  The economic picture remains bright, and more Americans are finding 
work every day. Earlier this month, the Department of Labor reported 
that 3.7 million new jobs have been created since May of 2003, marking 
25 consecutive months of positive job growth for the U.S. economy. 
Unfortunately, there are still millions of working families without 
health insurance. They need access to quality health care, and they are 
asking for our help. The bill we will consider on the floor later today 
responds directly to their needs.
  It is simply unacceptable that more than 45 million Americans lack 
health insurance today. Studies indicate that 60 percent of these 
uninsured Americans either work for a small business or are dependent 
upon someone who does. Many of these Americans work for small employers 
who cannot afford to purchase quality health insurance benefits for 
their workers. That is the crux of the problem. More Americans are 
finding new jobs, but many small businesses cannot afford to offer 
health insurance because of rising premium costs.
  Our primary goal here in Congress, Mr. Speaker, should be creating 
affordable options to help the uninsured. With health care costs 
continuing to rise sharply across the country, more and more employers 
and their employees are sharing the burden of increased premiums. 
Employer-based health insurance premiums rose by 11 percent last year, 
following a 15 percent increase in 2003. As costs escalate, the ranks 
of the uninsured could continue to increase as well.
  The Small Business Health Fairness Act before us represents a 
bipartisan solution to this problem. By creating association health 
plans, the bill gives small businesses the opportunity to band together 
through bona fide trade associations and purchase quality health 
insurance for their workers at a lower cost. In the last year, we have 
seen how large corporations are now starting to band together to 
provide health care to their part-time workers. Small businesses and 
their workers deserve the same opportunities.
  This bipartisan bill would increase small businesses' bargaining 
power with health care providers, giving them freedom from costly 
State-mandated benefit packages and lowering their overhead costs by as 
much as 30 percent, which are benefits many large corporations and 
unions already enjoy. By pooling their resources and increasing their 
bargaining power, association health plans will reduce the cost of 
health insurance for employers and allow more small businesses to 
provide health care to their workers.
  Last year, the House passed this measure on a bipartisan basis with 
the support of 37 of my colleagues on the other side of the aisle. 
Unfortunately, the other body has yet to act on this bill. But there 
remains hope. Senator Enzi, who chairs the Senate Committee on Health, 
Education, Labor, and Pensions, has expressed a strong interest in 
working on this proposal, and I am more optimistic than ever that the 
Senate will address this problem.
  This measure is supported by President Bush, the Labor Department, 
Republicans and Democrats, and, moreover, a poll conducted last year 
reveals that 93 percent of Americans support AHPs as an option for 
providing affordable health care for American workers. Small businesses 
deserve the chance to obtain high-quality health insurance at an 
affordable price for their workers, and AHPs are a prescription for 
helping the uninsured.
  Mr. Speaker, I think the rule before us today is a fair rule, and I 
urge my colleagues to support it.
  Ms. MATSUI. Mr. Speaker, I yield myself such time as I may consume to 
comment that only 1 out of every 14 people enrolled in an AHP will be 
newly insured. Overwhelmingly, this is a bill that shifts the already 
insured into plans with lower coverage.
  Mr. Speaker, I yield 4 minutes to the gentlewoman from New York (Mrs. 
McCarthy).
  Mrs. McCARTHY. Mr. Speaker, I oppose this rule and the underlying 
bill because it will result in preempting State laws and in a reduction 
in health care. AHPs would be exempt from having to provide certain 
critical services, preempting State laws which require coverage.
  Mr. Speaker, this Nation spends millions and millions of dollars on 
cancer treatments. We also spend millions of dollars just on research 
and development. This bill would take away a tool that is used to save 
lives.

                              {time}  1415

  The gentlewoman from California (Ms. Woolsey) and I offered an 
amendment to this legislation both in committee and again last night in 
the Committee on Rules. The amendment would have prohibited employers 
from joining AHPs if it would mean a reduction in coverage for breast 
and cervical cancer services. Unfortunately, the amendment was not 
accepted.
  Almost every State has recognized the need to cut health care costs 
and still provide quality services to their citizens. The States know 
that without guaranteeing these services, patients will not receive the 
health care they need. Members have to remember the attorneys general 
fought in their States to make sure that women would have this care. 
Why did they fight for it? Because the insurance companies would not 
offer it.
  According to the American Cancer Society, over 211,000 new cases of 
breast cancer will be diagnosed in the United States in this year 
alone. In New York State, there will be 14,000 new cases of breast 
cancer diagnosed this year alone. Breast cancer is a potentially fatal, 
but very treatable, disease. However, early detection is the key to 
proper treatment. Mammogram screenings are essential for the early 
detection of breast cancer. Timely screening can prevent 15 to 30 
percent of all deaths from breast cancer among women over 40 years old.
  Currently, New York and 48 other States require insurance companies 
to cover mammogram screenings. The U.S. Department of Health and Human 
Services has stated that mammograms save women's lives. Former 
Secretary Tommy Thompson stated, ``The Federal Government makes a clear 
recommendation for women over 40 to have mammograms, get screened for 
breast cancer with mammograms every 1 to 2 years. The early detection 
of breast cancer can save lives.''
  Preventive screening for cervical cancer is also vital for women's 
health. Over 10,000 new cases of cervical cancer will be diagnosed this 
year, and nearly 1,000 of those cases are residing in my home State of 
New York. Nearly 4,000 women will die in 2005 from cervical cancer.
  Preserving the coverage of mammograms and cervical screenings will 
help save the lives of our wives, mothers and daughters, and also keep 
down the cost of health care in this country. I know many of my 
colleagues on both sides of the aisle have supported similar measures 
while in their home States as legislators. They have shown commitment 
to their home State, and now it is time to show commitment to the 
Nation.
  As a nurse, I know first hand the importance of early detection. I 
have seen the hardships cancer patients endure. Since I have been here, 
I have done outreach within my district to get women in for their 
cervical exams and women over 40 in to get their mammograms. This is 
very important, and we should not miss this opportunity to save lives. 
For this reason, I oppose the rule and the underlying bill.
  Mr. BISHOP of Utah. Mr. Speaker, I yield 1\1/2\ minutes to the 
gentleman from Nebraska (Mr. Osborne).
  Mr. OSBORNE. Mr. Speaker, I appreciate this opportunity to speak on 
behalf of the rule and the underlying legislation.
  Mr. Speaker, I would like to just mention a personal story. I have a 
son-in-law who manages 150 stores. They are part of a franchise and are 
spread across 40 different States. If they have to purchase health care 
store by store, it is prohibitively expensive. Their costs are going up 
10 to 20 percent a year. One of the previous speakers said it may not 
add a whole lot of people, but what is happening is we are losing more 
and more people out of health care plans each year because small 
businesses simply cannot afford it.
  If they can band together, those 150 stores, and pool their resources 
and have 500 employees in a pool, they have a chance to keep their 
health care. I think it is critical.

[[Page H6470]]

  Mr. Speaker, 60 percent of all Americans work for small businesses, 
and this is key to this legislation. Small businesses are particularly 
important to rural areas like Nebraska. The measure would do three 
things: one, increase small business' bargaining power with health care 
providers; number two, give them freedom from costly state-mandated 
benefit packages. In many cases, the State regulations simply stifle 
the health care packages. And, number three, lower their overhead cost 
by as much as 30 percent.
  Republicans and Democrats alike have joined together in each of the 
last two Congresses to pass this legislation. I urge support of the 
underlying rule and the bill.
  Ms. MATSUI. Mr. Speaker, I yield 4 minutes to the gentleman from 
Wisconsin (Mr. Kind).
  Mr. KIND. Mr. Speaker, I rise in opposition to the rule even though 
it has made in order a substitute that the gentleman from New Jersey 
(Mr. Andrews) and I will be offering.
  The reason I rise in opposition is because this is such an important 
issue that we really should have an open and fair and reasonable debate 
on the floor of the House of Representatives. Eight of the Democratic 
amendments offered last night were effectively blocked. Instead, we 
have a closed rule that will allow some time for general debate on the 
AHP underlying bill, an hour on the substitute, and that is it.
  I think we can all stipulate that when we go home, this is clearly 
the overriding issue we hear from our constituents: the rising cost of 
health care and the inability, especially in small businesses, to be 
able to afford and access quality health care which is crucial to a 
growing and vibrant economy.
  There is a reason why we are here year after year debating the same 
issue, and that is because the underlying bill is bad policy. It is 
recognized as bad policy by over 1,400 organizations nationwide that 
have come out and publicly opposed it, including the National Governors 
Association, both the Democratic and the Republican Governors 
associations; including 41 of the States attorneys general; the 
National Association of Insurance Commissioners; the National 
Conference of State Legislatures, all of whom recognize this does not 
make sense, it is bad policy and we should offer something more than 
just a broken promise or false hope to small businesses and their 
employees hoping to obtain coverage.
  There should be an unwritten rule when we are debating any type of 
health care policy changes, and that is following the Hippocratic Oath 
that our doctors and health care providers follow: first, do no harm.
  Unfortunately, the AHP bill before us today does plenty of harm. And, 
again, it has been recognized by independent studies both within the 
congressional body and outside. In fact, a recent Mercer Study 
indicates that adoption of this AHP legislation could raise the ranks 
of the uninsured by over 1 million people. You would think that alone 
would be enough for a ``no'' vote on this underlying bill. Any policy 
that is going to increase the number of uninsured, which is roughly 
between 45 and 48 million today, is something that we should resist.
  It also shows that those who do not join AHPs and are not part of an 
association, who have health coverage for their employees, the premiums 
are going to increase for those people by 23 percent. This is 
consistent with what the Congressional Budget Office has shown in their 
study that shows that adoption of this bill would leave 20 million of 
the workers with higher premium payments overall.
  Also, recently there was a study out of Georgetown University that 
shows that adoption of this bill, and again it is consistent with past 
GAO studies, would increase the likelihood of greater fraud and abuse 
within the associated health plan system. The GAO in a study showed 
that there are 144 illegal AHPs operating affecting every State in the 
Union with unpaid claims affecting over 200,000 workers today.
  The underlying bill is going to take oversight and accountability 
away from the States where it has traditionally resided with oversight 
powers and audit responsibilities, put it in the Department of Labor 
with insufficient resources and no accountability and no oversight at 
all. Because of that, the State attorneys general in a letter stated: 
``The elimination of the State role and replacement with weak Federal 
oversight is a bad deal for small businesses and consumers.''
  Finally, as the gentlewoman from New York (Mrs. McCarthy) has 
indicated, it does preempt consumer protection which has been 
traditionally guaranteed by the States if they found that necessary.
  So there are a lot of reasons why the underlying bill before us today 
is bad policy. That is one of the reasons it has had a difficult time 
moving through the Senate. We are going to have a substitute offered 
that the gentleman from New Jersey (Mr. Andrews) and I and others who 
support think is a viable and reasonable approach to deal with the 
growing health care crisis that so many of our small businesses and 
their employees are facing. It is a bill that does allow the purchasing 
pool concept to go forward, but it is modeled after what Federal 
employees currently have under their health care plan. And it also does 
not preempt State law.
  Mr. Speaker, I ask my colleagues to defeat the rule so we have an 
honest debate and support the substitute and vote ``no'' on the 
underlying bill.
  Mr. BISHOP of Utah. Mr. Speaker, I yield 2 minutes to the gentleman 
from Florida (Mr. Keller), a member of the committee who has gone 
through this discussion many times.
  Mr. KELLER. Mr. Speaker, I support the rule, and I support H.R. 525. 
The number one problem facing small businesses today is the 
skyrocketing cost of health insurance. Association health plans are a 
big part of the solution.
  I met with many small business people in my hometown of Orlando, 
Florida, and they told me they need association health plans. I agree 
with them, and here is why: of the 45 million Americans without health 
insurance, 60 percent are small business employees and their families. 
They do not have health insurance because their small business 
employers cannot afford it.
  If we would allow these small businesses to join together, they could 
have the same bargaining power as large Fortune 500 corporations, which 
could lower their health insurance premiums by up to 30 percent. 
Association health plans will increase access to health care for 
millions of Americans now without insurance.
  It certainly is an issue that is personal to me. I had the happy 
privilege of flying down to Orlando, Florida, with President Bush on 
Air Force One on March 18 of this year. He asked me what, if anything, 
he could do to help small businesses in my area. I told him what the 
small businesses told me: the number one thing they want is association 
health plans, and he pledged to support it and use his bully pulpit to 
help it get through the Senate.
  I also authored a Small Business Bill of Rights that passed this 
House back in April. It called for the passage of association health 
plans, fixing the death tax, and cracking down on frivolous lawsuits. 
This House is on record as supporting that. It is time for us to take 
the lead today and help small business people provide health insurance 
to their employees. Vote ``yes'' on the rule and vote ``yes'' on H.R. 
525. I urge my colleagues to do these things.
  Ms. MATSUI. Mr. Speaker, I reserve the balance of my time.
  Mr. BISHOP of Utah. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. Mr. Speaker, increasingly, one of the things I hear 
from small business owners back in Tennessee is they want Congress to 
open the way, just to open the way and set the stage for more 
affordable health care choices.
  Over 90 percent of the jobs in Tennessee are small business jobs. It 
is the largest employer in my district.
  Mr. Speaker, one of the things that we hear is that these employers 
want to do the best they can for their employees. They feel like they 
are a part of their family. The gentleman from Texas (Mr. Sam Johnson) 
really should be applauded for introducing the Small Business Health 
Fairness Act of 2005. It is one of those things that will help small 
businesses, as we have heard from so many of the speakers, to pool 
together and to purchase association health plans through their 
national trade groups.
  I have joined him as a co-sponsor of the legislation, and I believe 
we do

[[Page H6471]]

have that opportunity to extend affordable, quality health care to 
millions of Americans. Every small business owner knows that providing 
quality health care is one of the most costly items in running a 
business. It is a very difficult part, handling the mountains of 
paperwork and finding the right policies. We have the power to help by 
passing this commonsense legislation. I ask my colleagues to support 
the rule and to support the underlying legislation.
  Ms. MATSUI. Mr. Speaker, I reserve the balance of my time.
  Mr. BISHOP of Utah. Mr. Speaker, I yield 2 minutes to the gentleman 
from Texas (Mr. Hensarling).
  Mr. HENSARLING. Mr. Speaker, today I rise in strong support of the 
rule for H.R. 525, the Small Business Health Fairness Act of 2005, 
offered by the gentleman from Texas (Mr. Sam Johnson).
  Mr. Speaker, if we do not act soon, America will face a health care 
crisis. Health care costs are skyrocketing. We all know it; and, 
unfortunately, so do the ranks of America's uninsured. As usual, 
government is part of the problem. More freedom and more competition is 
part of the solution.
  With nearly half of the 45 million uninsured Americans employed by 
small businesses, or dependent upon someone who is, H.R. 525 will help 
more Americans get access to the affordable health insurance they need.

                              {time}  1430

  H.R. 525 would allow the creation of association health plans to help 
alleviate the enormous health care burden on America's small 
businesses. They will empower small businesses to join together to 
bargain with insurance carriers to get health care coverage for their 
workers at an affordable cost. No affordable cost, no insurance. Under 
current law, large employers that self-insure are exempt from State 
mandates while small businesses are not. This increases the cost of 
health insurance up to 13 percent and bars up to one-quarter of the 
uninsured from acquiring health care.
  Mr. Speaker, that is not right. Small businesses and their employees 
should have the same right to quality health care insurance that large 
corporations and unions already enjoy. The Congressional Budget Office 
estimates that association health plans could actually reduce premiums 
for small businesses up to 25 percent. That could mean an average 
savings of $1,000 to $2,000 for the average family health plan offered 
by a small business. That means more people covered, more lives saved.
  I urge all my colleagues to support the rule for H.R. 525 and the 
underlying legislation. With association health plans, we can 
dramatically reduce the number of uninsured Americans while increasing 
health care access, affordability, and choice.
  Ms. MATSUI. Mr. Speaker, I reserve the balance of my time.
  Mr. BISHOP of Utah. Mr. Speaker, I yield myself such time as I may 
consume.
  I must admit that much of the opposition gloom-and-doom predictions 
are based on assumptions of what people and companies will choose to do 
and, therefore, the government should make those mandates. I am pleased 
that this particular piece of legislation is based on the assumption 
that people have the ability to make good choices for themselves 
without the assistance of the heavy hand of government.
  Mr. Speaker, I am pleased to yield 2 minutes to the gentleman from 
Texas (Mr. Sam Johnson), the sponsor of this bill.
  Mr. SAM JOHNSON of Texas. Mr. Speaker, I am pleased to be here today 
to support the rule to govern H.R. 525, the Small Business Health 
Fairness Act of 2005. As costs continue to escalate annually at 
unprecedented rates, our employers are being forced to drop health care 
coverage, or not be able to afford it at all. Our small businesses 
share a large part of that burden because they are forced to shop for 
health insurance in the costly small group market. Large employers 
bring bargaining clout to the table when they work with insurance 
companies. Small businesses have fewer employees and thus have little 
or no bargaining power. Not only that, but large employers and unions 
are exempt from burdensome State mandates. These mandates dictate what 
health plans must cover and which vary from State to State. Small 
employers do not have that luxury.
  We know that more than 60 percent of the over-40 million uninsured 
Americans either work for a small business or are dependent upon 
someone who does. The clear course of action here is to help our small 
businesses afford health coverage by giving them the same opportunity.
  Association health plans, or AHPs, do just that. Small businesses 
would be able to group together in bona fide trade associations. AHPs 
would then be able to use economies of scale to their advantage and 
provide more affordable health care for working families while avoiding 
the administrative cost of State mandates. AHPs are expected to save 
small business owners and their employees as much as 30 percent on 
their health insurance.
  This bipartisan bill makes sense. The time to act is now. I urge a 
``yes'' vote on this rule.
  Ms. MATSUI. Mr. Speaker, I yield 3 minutes to the gentleman from New 
Jersey (Mr. Andrews).
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. Mr. Speaker, I thank my friend from California for 
yielding me this time.
  I hear the phrase ``burdensome State mandates.'' A woman has a C 
section and gets to stay in the hospital for at least 48 hours. A woman 
has the right under a health insurance policy to get a mammogram paid 
for by the insurance company every year. A diabetic has the right to 
get insulin provided and other blood care paid for by their insurance 
company. These are the burdensome mandates that we hear talked about on 
the floor. One of my other friends talked about the heavy hand of 
government. That heavy hand of government in this case is evidently 
shared by Republican Governors around the country, because the National 
Governors Association opposes this bill. Republican and Democratic 
Governors have looked at this bill and said laws that they have passed 
that many of our friends on the majority side voted for in State 
legislatures around the country, laws that protect C sections, 
mammograms, diabetic care, substance abuse care, mental health care, 
these laws should not be repealed and thrown aside by the heavy hand of 
government at the Federal level. That is what this is really about.
  Amendments that would have addressed these issues, that would have 
let us discuss these issues on this floor, were prohibited by the rule 
that we are debating right now. I would suspect that maybe one of the 
reasons they were prohibited is because Republican attorneys general 
and Republican Governors around the country would have supported such 
amendments because they oppose the good work that is undone by this 
bill. Members should oppose this rule and eventually, after debate, 
oppose the underlying bill.
  Mr. BISHOP of Utah. Mr. Speaker, I am pleased to yield 3 minutes to 
the gentleman from Georgia (Mr. Gingrey).
  Mr. GINGREY. I thank the gentleman for yielding me this time.
  Mr. Speaker, I rise today in strong support of H. Res. 379 and the 
underlying bill, H.R. 525, the Small Business Health Fairness Act of 
2005. My good friend, the gentleman from New Jersey, just spoke about 
some mandates regarding OB care and, of course, there are mandates that 
have been passed in the several States, all 50, in fact, that are very 
compassionate sounding. The gentleman from New Jersey is right. Many of 
us have, as former members of State legislatures, voted for mandates.
  I am one of them. In fact, in the State of Georgia, there was a 
mandate, because of managed care intrusion and the requirement that 
everybody go through a gatekeeper and not to a specialist, that women 
in the State of Georgia, if any health insurance policy was written, 
they would have direct access to their OB-GYN. Certainly, as an OB-GYN 
specialist, I liked that mandate. In fact, I think I voted for that 
one. But shortly after that along came the dermatologists and they 
wanted direct access to everybody who had an itch, to have to be able 
to go, demand to be seen by a specialist, a dermatologist, rather than 
their family practitioner.
  I want to tell you about a couple of other mandates in the State of 
Georgia. There was one to require that every woman would have the right 
to

[[Page H6472]]

have a blood test to be screened for ovarian cancer. It is called CEA-
125. Any cancer specialist would tell you that that screening test for 
ovarian cancer is absolutely worthless. A better mandate would have 
been to say that anybody over age 30, any woman, could have an 
ultrasound done every 6 months to look at the ovaries, but that would 
be astronomically expensive. Another mandate in the State of Georgia 
says that every baby born in a hospital in the State of Georgia has to 
be screened for sickle cell anemia, even when they are a part of an 
ethnic group where the percentage of sickle cell anemia is zero. Nada. 
These mandates just go and on, and you have got them in all 50 States.
  Clearly, we need to do something about that because they are driving 
up the cost of health care. We need to give people the opportunity to 
join their other employees in trade associations.
  This is a good bill. It will reduce the rolls of the uninsured by 8 
million people. I commend it to my colleagues on both sides of the 
aisle. I urge you to support this rule and pass the Sam Johnson 
legislation. It is a good bill. It will get people the protection they 
need and provide health care for so many who do not have it.
  Ms. MATSUI. Mr. Speaker, I yield myself the balance of my time.
  Earlier this month, the Los Angeles Times ran a story that I think 
cuts to the heart of this discussion. It is the story of a husband and 
wife living in Southern California. After successfully battling bone 
cancer 7 years earlier, Doug did what so many Americans would like to 
do. He started a small business making boat parts. Soon, he was 
approached by an AHP offering a $400-a-month health insurance policy 
which even included special cancer coverage.
  Tragically, a few months after he purchased the policy, his cancer 
returned and it became quite clear that the quality of that association 
plan was not what Doug or his wife, Dana, expected. It turned out that 
this particular plan covered less than 18 percent of Doug's $550,000 
treatment cost. Doug and Dana rapidly found themselves buried under 
hundreds of thousands of dollars in bills. And as his wife recounted to 
the Los Angeles Times, at several points before the cancer ultimately 
claimed his life, Doug begged her to divorce him so that she would not 
be responsible for his debt.
  I cannot believe this is the solution we are offering to small 
business owners like Doug and Dana. The American people deserve better.
  Mr. Speaker, this bill offers no health care solutions for small 
business owners. It raises premiums on 80 percent of small businesses; 
will increase the number of uninsured by 1 million people; and reduce 
coverage for another 7 million individuals who are most in need of 
care. My friends on the other side might find these facts inconvenient, 
but that does not make them less true. And it will accomplish all of 
this by loosening or removing consumer protections and by walking away 
from State mandates that guarantee treatment for diabetes and 
screenings for breast cancer.
  We can do much, much better than this for America, Mr. Speaker. I 
urge Members to oppose the rule, oppose the underlying bill, and 
support the Kind-Andrews substitute.
  Mr. Speaker, I yield back the balance of my time.
  Mr. BISHOP of Utah. Mr. Speaker, I yield myself the balance of my 
time.
  I appreciate those who have spoken on the bill today. I appreciate 
the gentleman from Georgia (Mr. Gingrey), a member of the medical 
profession, who so eloquently talked about some of the realities of 
this particular bill and what we are looking at. And I appreciate the 
gentlewoman from California and her wonderful and kind way in which she 
handled the rule on the minority side.
  Just as a means of criteria of what we are going through as far as 
the rule itself, every amendment that was proposed for this particular 
rule was discussed thoroughly and voted upon in the committee, with the 
exception of obviously the motion to recommit. With the debate we have 
had in previous years, every element of this bill has been thoroughly 
debated both on the floor and in committee, this year as well as in 
years past.
  I have to admit, Mr. Speaker, my favorite Senator, even though I am 
not supposed to have one, is the junior Senator from Kentucky who is 
the only one to have won 100 games in both the American and the 
National League. Because of that, I have his baseball cards. I hope he 
does very well over there because if they continue to rise in value, 
that may be the only way I pay for my health care in the future.
  I was reading on the airplane coming back yesterday of a story of 
Senator Bunning when he was a pitcher for the Detroit Tigers and he was 
facing the Yankees. The Yankees sent out Bob Turley to be the first 
base coach because he was great at picking off signals. Sure enough, he 
knew what the signals were. His signal would be every time a fastball 
was coming, he would whistle at the batter. Hank Bauer is the first 
batter up there. Fastball, he whistled, Bauer hit a screamer into left 
field. The second batter is Tony Kubek. Fastball, whistle, he hit what 
would have been extra bases into right field except the second baseman 
caught the ball in self-defense.
  The third hitter up is Mickey Mantle. By this time the pitcher is 
upset with what is going on and takes a couple of steps to Turley and 
says, ``Next time you whistle, I'm going to drill the batter.'' He 
takes a couple of steps to the batter and tells him the same thing. 
Sure enough, a fastball, the whistle, Mantle does not swing. The next 
pitch is a slider which hits Mantle right in the legs. He is upset, 
takes a couple of steps towards the mound, but the catcher and the 
umpire direct him to first base.
  The next batter up is Yogi Berra. Once again, fastball, the whistle 
comes, Yogi does not take it, but then remembering what happened, he 
steps out of the batter's box, cups his hands and yells back at Senator 
Bunning who is the pitcher at this time and says, ``He may be 
whistling, but I ain't listening.''
  Mr. Speaker, there are a lot of people who have been whistling at us 
on this particular issue. Every time I go to a town hall meeting, I 
face people who want some kind of relief in the ability of getting 
insurance. I get letters from them all the time. When small 
businesspeople come to my office, they are talking repeatedly about 
this particular issue. They are all whistling, asking for some kind of 
relief.
  I realize I talked about my three sons who did not have insurance. My 
two that still do not will not have it under this bill because the 
provisions do not allow them to participate. But my next-door neighbor 
who is trying to make a living in a shop down on Main Street that does 
not have insurance could under the provisions of this bill. Those are 
real-life people who need this kind of assistance and help, and they 
cannot get it any other way. The status quo does not offer this kind of 
assistance. This is one of those few rays of hope that they will have. 
These people are truly whistling at us. Our job as Congress is to 
finally listen.
  Mr. Speaker, I urge support of the rule on the underlying bill, H.R. 
525.
  Mr. Speaker, I yield back the balance of my time, and I move the 
previous question on the resolution.
  The previous question was ordered.
  The resolution was agreed to.
  A motion to reconsider was laid on the table.

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