[Congressional Record Volume 152, Number 55 (Tuesday, May 9, 2006)]
[Senate]
[Pages S4163-S4177]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  HEALTH INSURANCE MARKETPLACE MODERNIZATION AND AFFORDABILITY ACT OF 
                        2006--MOTION TO PROCEED

  The PRESIDENT pro tempore. Under the previous order, the Senate will 
resume consideration on the motion to proceed on S. 1955.
  The legislative clerk read as follows:

       Motion to proceed to Calendar No. 417, a bill (S. 1955) to 
     amend title I of the Employee Retirement Income Security Act 
     of 1974 and the Public Health Service Act to expand health 
     care access and reduce costs through the creation of small 
     business health plans and through modernization of the health 
     insurance marketplace, and for other purposes.

  The PRESIDENT pro tempore. Under the previous order, the time until 
10 a.m. shall be equally divided between the Senator from Wyoming, Mr. 
Enzi, and the Senator from Massachusetts, Mr. Kennedy, or his designee.
  The Senator from Wyoming is recognized.
  Mr. ENZI. Mr. President, I am here this morning to ask this body to 
support the motion to proceed to the debate. All we are voting on is 
whether we are going to get to debate, not whether we are going to have 
health insurance for small businesses. But if this vote does not get 60 
votes, we will not have the opportunity in this Congress to see whether 
we can help out small businesses across this country.
  The bill before us will provide for small businesses to be able to 
join across State lines to negotiate against the insurance companies 
with enough power to make a difference. This is something which the 
small businesses have been asking for for almost 15 years. In the last 
12 years, it has passed the House eight times but has never even gotten 
out of committee in the Senate until this year. The reason it got out 
of committee is because we have drastically changed the bill. We are 
not talking about the old association health plans we had in the past. 
This is one which has had some modifications that have been helped with 
insurance companies and State insurance commissioners. It still keeps 
the power of oversight and consumer protection in the hands of the 
State insurance commissioners, but it does allow the ability to unify 
things so that we can get across State lines.
  How is it doing? Well, the Washington Post says it went too far. The 
Wall Street Journal says it didn't go far enough. So maybe we are 
somewhere right there in the middle. But unless we get to debate this 
issue, we will never know until we can get through the motion to 
proceed and possibly 30 hours of still debating whether we are going to 
debate before we ever get to a motion. So I am hoping that this morning 
we can pass this motion to proceed.
  I can't believe that any Senator here hasn't heard from enough small 
businessmen that he wouldn't allow us to proceed to the debate. I am 
hoping that following that motion to proceed to debate, we can limit 
the hours of debating that particular motion and get on with the 
substance of trying to perfect a bill.
  In my 9 years in the Senate, I have never seen a perfect bill. I am 
not saying this is a perfect bill. I am saying it is one that has come 
out of compromise, long discussions, and has moved away from the point 
of huge objection on the Senate side to less objection on the Senate 
side. It is a bill that can be worked out, can be passed, and can have 
a significant difference for

[[Page S4164]]

small companies across the United States.

  Will it make a difference? There are several surveys that say it will 
make a difference. I am saying that from the amount of advertising 
which was done before we even had the motion to proceed, there must be 
a lot of big bucks in savings in this thing to have the kind of 
opposition we have already had on it. But we will never know unless we 
get the right to debate. So I am asking my colleagues to vote aye on 
the motion to proceed so that we can proceed to a debate, sometime 
within the next 30 hours, hopefully.
  Mr. President, I reserve the remainder of my time.
  The PRESIDENT pro tempore. The Senator from Massachusetts is 
recognized.
  Mr. KENNEDY. Mr. President, I ask the Chair to let me know when I 
have 1 minute remaining.
  Mr. President, this should be a historic week. The Senate has the 
opportunity at last to have a debate on the basic questions of health 
care. Senator Enzi has put forward a proposal that deserves debate and 
the opportunity for amendment, and I commend him for his diligence in 
bringing forward his proposal. But after careful study and debate, I 
believe the Senate will conclude that the course laid out in this 
proposal is the wrong one for health care.
  The legislation will make health care coverage less affordable and 
less accessible for millions of Americans. It will raise premiums for 
Americans when they are older or when they fall ill. It will mean the 
end of laws to guarantee coverage for cancer, for diabetes, for mental 
health parity, and other essential services. It will undermine the laws 
that protect consumers from fraud and abuse, and it will give no real 
help to the self-employed.
  We have a better approach. The proposal offered by Senators Durbin 
and Lincoln will allow small businesses to band together to get the 
same low rates offered to larger employers. It provides real help for 
small businesses with the high costs of health care through tax credits 
and reinsurance programs to defray the cost of the most expensive 
claims.
  When our debate concludes, I believe the Senate will agree with the 
over 200 organizations that have written letters of opposition to this 
legislation. These organizations represent patients with diabetes and 
cancer and mental health needs. They represent older Americans, 
workers, health care professionals, small businesses, and Americans in 
all walks of life. They represent the over 15,000 Americans who have 
called the Senate to ask this body to oppose legislation that will take 
a step backward from our commitment to quality health care, and they 
represent the millions more who will be harmed if we do not reject the 
legislation before us.
  We have heard from Governors, insurance commissioners, and attorneys 
general from Maine to Hawaii and from Florida to Alaska, and all of 
them--all of them--have urged the Senate to reject this bill.
  I urge my colleagues to oppose the current legislation, but I hope 
they will vote to proceed to consideration of this bill. The Senate has 
been denied the chance to take action on major health priorities for 
too long. Next week, seniors will be forced to pay a steep penalty if 
they are unable to navigate through the tangle of confusing Medicare 
plans and options. The Senate ought to vote on Senator Nelson's 
proposal to let seniors make their choice without the threat of heavy 
fines if they do not meet this arbitrary deadline.
  The Republican Medicare law also includes a provision so contrary to 
commonsense that people hardly believe you when you tell them it was 
included. The legislation makes it illegal for Medicare to bargain for 
discounts on drugs for seniors. We have a proposal to end that shameful 
prohibition, and we should vote on that proposal.
  On Medicaid, we should take action to end the cruel cuts imposed on 
the poorest of our fellow citizens by the Deficit Reduction Act, which 
paid for tax cuts for the wealthy through health cuts for the poor.
  We have been promised and promised that the Senate would vote on drug 
importation, but the vote never comes. Senator Dorgan, Senator Snowe, 
Senator McCain, and I have a proposal that will allow safe importation 
of lower cost medicines from Canada and elsewhere. Surely, Health Week 
is the time for a vote.
  Before the week is out, the Senate should see that the promise of 
stem cell research--stem cell research--is no longer denied to the 
millions of patients and their families who look on with anger and 
bewilderment as the bill passed by the House languishes for month after 
month after month in the Senate. And we have failed year in and year 
out to fulfill the promise of this century of the life sciences by 
making quality care a right for every American. Let us at long last 
take action to extend quality care to every American.
  So I say to my colleagues: Vote for cloture on this motion. Vote for 
a health care debate. Vote for a chance to go on record with your 
answer to these important questions on Medicare, on Medicaid, on stem 
cell research, on drug importation, on coverage, and on many other 
health priorities. Let's have a debate, and let's let the Senate decide 
where it stands.
  Mr. President, I reserve the remainder of my time.
  The PRESIDENT pro tempore. Who yields time?
  Mr. ENZI. Mr. President, I thank the Senator from Massachusetts for 
his encouragement on his side of the aisle to vote for the motion to 
proceed. I think that will get us into a debate that will make a 
difference for the working people of America, the people up the street 
and across the street, the working families that are a part of small 
business.
  Today, there are 45 million people in the United States who are 
without health insurance in this country. Twenty-two million people own 
or work for small businesses or live in families that depend on small 
business wages, and another 5 million are unemployed. Those are the 27 
million people we are talking about whom this health care bill will be 
making decisions for in the next few days.
  It is long past time for Congress to take some action. The American 
people aren't going to accept excuses any longer. It has been a long 
time getting to this debate. I am pleased that it sounds like we will 
be able to have it. I welcome any amendments that are alternate 
approaches or improvements to this bill. I know what the complaints are 
out there, I know what the counters to those are, and I know what the 
concerns are. It is very important that when we walk away from this 
week, we walk away with a plan which will help the small business 
people of the United States, the ones working for small businesses, the 
ones owning them, and their families who need the help.
  Mr. President, I reserve the remainder of my time.
  The PRESIDENT pro tempore. Who yields time? Each side has 1 minute 
remaining.
  Mr. KENNEDY. Mr. President, I will mention at this time some of the 
organizations. We will have a chance during the course of the debate to 
get into the reasons why. The American Academy of Pediatrics; the 
American Cancer Society; the Diabetes Association; the Nurses 
Association; Families USA; the lists of Governors--and I will include 
those--more than probably 15, 18 Governors; the attorneys general. I 
think there are probably close to 40 of the attorneys general 
representing States North, South, East, and West who have opposed this 
bill. The Insurance Commissioners of the States--a whole list of those. 
At the appropriate time, I will include those in the Record.
  I hope our colleagues will put their ear to the ground and find out 
what people are saying back home, what your cancer society, diabetes, 
pediatric nurses and doctors are saying about this, what the attorneys 
general are saying about this, and what those in the medical profession 
are saying about this. We think we have a better way to help small 
business, and during the course of the debate, we will show how that 
can be done.
  Mr. President, I yield the floor.
  The PRESIDENT pro tempore. The Senator from Wyoming has 56 seconds.
  Mr. ENZI. Mr. President, I thank the Senator from Massachusetts for 
listing those 200 organizations. I have never done a count on them, and 
I am not familiar with quite that many; I am only familiar with about 
40 that have expressed some concern that I suspect will be taken care 
of in amendment if we can get to the amendment process.

[[Page S4165]]

  I would like to mention that there are over 200 business 
organizations that are looking forward to being able to unite these 
people across State lines to get lower rates for their people. There 
are actually 80 million employees in those businesses, in those 
organizations. The realtors are going to be here with 9,000 people next 
week, expecting that we will have already taken action. The National 
Federation of Independent Businesses is another big one that is 
supporting this. I could mention a lot more. Even some of the 
associations that have concerns about it want to be sure that this bill 
passes so their employees can be covered.
  I yield the floor.


                             Cloture Motion

  The PRESIDENT pro tempore. By unanimous consent, pursuant to rule 
XXII, the chair lays before the Senate the pending cloture motion, 
which the clerk will report.
  The legislative clerk read as follows:

                             Cloture Motion

       We the undersigned Senators, in accordance with the 
     provisions of rule XXII of the standing rules of the Senate, 
     do hereby move to bring to a close debate on the motion to 
     proceed to Calendar No. 417, S. 1955, Health Insurance 
     Marketplace Modernization and Affordability Act of 2005.
         Bill Frist, Johnny Isakson, Sam Brownback, John Thune, 
           Thad Cochran, Wayne Allard, John Ensign, Richard 
           Shelby, Larry Craig, Ted Stevens, John McCain, Lamar 
           Alexander, Norm Coleman, Judd Gregg, Pat Roberts, Craig 
           Thomas, Richard Burr.

  The PRESIDENT pro tempore. By unanimous consent, the mandatory quorum 
call has been waived.
  The question is, Is it the sense of the Senate that debate on S. 
1955, the Health Insurance Marketplace Modernization and Affordability 
Act of 2005, shall be brought to a close? The yeas and nays are 
mandatory under the rule.
  The clerk will call the roll.
  The legislative clerk called the roll.
  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. 
Rockefeller) is necessarily absent.
  I also announce that the Senator from North Dakota (Mr. Conrad) is 
absent due to illness in family.
  The PRESIDING OFFICER (Mr. DeMint). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 96, nays 2, as follows:

                      [Rollcall Vote No. 117 Leg.]

                                YEAS--96

     Akaka
     Alexander
     Allard
     Allen
     Baucus
     Bayh
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Brownback
     Bunning
     Burns
     Burr
     Byrd
     Cantwell
     Carper
     Chafee
     Chambliss
     Clinton
     Cochran
     Coleman
     Collins
     Cornyn
     Craig
     Crapo
     Dayton
     DeWine
     Dodd
     Dole
     Domenici
     Dorgan
     Durbin
     Ensign
     Enzi
     Feingold
     Feinstein
     Frist
     Graham
     Grassley
     Gregg
     Hagel
     Harkin
     Hatch
     Hutchison
     Inhofe
     Inouye
     Isakson
     Jeffords
     Johnson
     Kennedy
     Kerry
     Kohl
     Kyl
     Landrieu
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Lott
     Lugar
     Martinez
     McCain
     McConnell
     Menendez
     Mikulski
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Obama
     Pryor
     Reed
     Reid
     Roberts
     Salazar
     Santorum
     Sarbanes
     Schumer
     Sessions
     Shelby
     Smith
     Snowe
     Specter
     Stabenow
     Stevens
     Sununu
     Talent
     Thomas
     Thune
     Vitter
     Voinovich
     Warner
     Wyden

                                NAYS--2

     Coburn
     DeMint
       

                             NOT VOTING--2

     Conrad
     Rockefeller
       
  The PRESIDING OFFICER. On this vote, the yeas are 96, the nays are 2. 
Three-fifths of the Senators duly chosen and sworn having voted in the 
affirmative, the motion is agreed to.
  Mr. ENZI. Mr. President, I ask unanimous consent that the postcloture 
debate on the motion to proceed be divided as follows: From now until 
11 a.m. will be under majority control; from 11 to 11:30 will be under 
minority control; 11:30 to 12 will be under majority control; and noon 
to 12:30 will be under minority control.
  The Senate will stand in recess from 12:30 to 2:15 p.m. I ask that 
time count under the provisions of rule XXII. The time from 2:15 to 
2:30 will be equally divided between the majority and minority; from 
2:30 to 3 we begin majority control, with the next 30 minutes under 
minority control, and each 30 minutes rotating in this format until the 
hour of 5:30 p.m.
  Before the Chair rules, we would like to make out a time certain to 
begin consideration of the bill. In the interim, this unanimous consent 
allows the Senate to have an orderly debate for speakers.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ENZI. Mr. President, I thank virtually all Members in the Senate 
for their help in getting the motion to proceed. That will allow us to 
do 30 more hours of debate before we actually get into the substance of 
making any changes in the bill. I hope we can work out a unanimous 
consent agreement that will shorten that time and get us into the meat 
of the debate. I will push for some rapid consideration of some 
amendments so we can get this resolved for the small businessmen of 
this country in short order.
  I will address some of the charges made against this bill. I listened 
yesterday and the day before to the minority leader's speech to the 
Senate on Friday. I was surprised by several of the statements he made 
regarding this bill. If I had not already known that he was talking 
about S. 1955, I would never have guessed it.
  The first comment the minority leader made was that our bill 
threatens the coverage of those who have insurance now and does nothing 
to extend coverage to those who need it. I make two points in response 
to that. First, it seems to me the status quo is what is truly 
threatening the coverage of those who are insured now. Prices are going 
up dramatically. Small business has no leverage. No one can afford more 
of the same or more excuses from Washington.
  Blocking an honest debate on this bill is a vote for more of the 
same. It is a vote for health insurance costs continuing to rise 
dramatically, for more small businesses dropping coverage for their 
employees, and for more uninsured American families. Year after year of 
more of the same is what is truly threatening America's health care 
security.
  Second, this bill will indeed extend coverage to more people who need 
health insurance. If you do not believe me, listen to our nonpartisan 
CBO. The CBO says this bill will reduce health insurance costs for 
three out of every four small businesses. The CBO also said the bill 
will extend private health coverage insurance to 750,000 more people 
than have it today.
  Is that a comprehensive solution to the problems of health care and 
the uninsured? Of course not. I understand this is not a comprehensive 
solution to the problem of health care costs and the uninsured, but it 
is definitely a step in the right direction and a building block for 
the future.
  I have more comments about statements made about the bill in ads and 
in editorials, but at this point, I release the remainder of our time 
until 11 o'clock to the Senator from Missouri who has been working on 
this in the House for years in a totally different version but has 
brought his expertise, talent, and knowledge to this side of the 
building. He has been a strong advocate for doing something for small 
businesses. He has been extremely cooperative in finding ways to do 
things so we can have something for small businesses.
  I relinquish the floor to the Senator from Missouri, Mr. Talent.
  Mr. TALENT. Mr. President, I thank the Senator from Wyoming for his 
kind words and his great work and his comments regarding my involvement 
with the idea of small business health plans. What he said is true 
regarding my involvement. I am not the father of this idea, but I think 
I probably ``midwifed'' it years and years ago when I served in the 
House in 1997. It has passed the House on a regular basis ever since 
then and, as the chairman knows, on a very strong bipartisan basis 
because the idea of small business health plans is fully within the 
mainstream of both parties' thinking which is one of the very powerful 
arguments in favor of it.
  The No. 1 issue facing small business today as a whole is not energy 
costs, although certainly they are too high. It is not immigration, 
although that is definitely an issue. It is not taxes, although we all 
hear our share of complaints from small business people about that. It 
is the rising cost of health insurance and the number of

[[Page S4166]]

people who do not have health insurance. That is largely a small 
business problem.
  There are 45.8 million Americans who are uninsured today, 4 million 
more than 2001. That number has grown every year, in years of 
prosperity or recession. The vast majority of those uninsured people 
are working people. And most of those working people are people who 
work for a small business. They work for a small business, they own a 
small business, or they are dependents of someone who works for or who 
owns a small business.
  The smaller the business is, the worse the problem gets. Only 40 
percent of businesses with 3 to 6 employees today have health insurance 
for their employees and that number is down from 52 percent in 2004 and 
58 percent in 2002.
  We are entitled to ask ourselves, Why? I have heard a lot of 
explanations over the years. Why does small business have a problem 
providing health insurance for its employees whereas bigger companies 
don't? You would be surprised at the explanations offered. I had one 
witness from the Government Accountability Office tell me that he did 
not think employees of small business wanted health insurance. I have 
other people speculate that small employers did not care as much about 
their people who work for them as big companies do. That certainly will 
come as a revelation to Senators that big corporate employers care more 
about their employees than the small business owners and managers do--
the small business people who work on a daily basis with their 
employees, the small business people who would like to get health 
insurance themselves from the small business if they could figure out a 
way for the small business to provide that health care to the 
employees.
  It is not a question of the small business people caring enough. The 
problem is, the cost and complexity of getting health insurance for a 
small business is greater than it is for a big business. It will 
surprise no one who has common sense that it is harder to insure a 
small market, a small group, than a big group. The cost of insurance is 
less if you can spread it across a bigger pool of people. This has been 
studied extensively, and that very commonsense conclusion has been 
validated.
  I will go over some of the figures for the Senate. Health insurance 
premiums for small business people increased by 10.9 percent in 2001, 
12.9 in 2002, 13.9 in 2003, 11.2 percent in 2004, and 9.2 percent in 
2005.
  The smallest firms have always seen bigger increases in premiums. 
Why? Well, the SBA's Office of Advocacy has found that small businesses 
typically spend much more than large businesses for the same benefits. 
Not that the benefit packages are different, not that small businesses 
are trying to buy more expensive benefit packages; they have to spend 
more to get the same benefits because the administrative costs of some 
benefits are almost 14 times more for the smallest firms than for their 
largest counterparts.
  According to the Government Accountability Office, from 20 to 25 
percent of small employer premiums typically go toward expenses other 
than benefits compared with about 10 percent for large employers. The 
small business people are paying more to get the same benefits because 
they have higher overhead costs and higher administrative costs. They 
do not enjoy the same economies of scale the big companies enjoy.
  The American people know this. I have a lot of stories from Missouri 
I could tell. I do not have the time. But the American people are 
living with this every day.
  Jim Henderson is the president of Dynamic Sales in St. Louis. It is a 
third-generation family business that sells welding accessories and 
other products. It is a small business. He has eight employees. Health 
insurance has been a problem for 16 years for Jim. He spoke with his 
insurance agent, who suggested raising the deductible to keep the 
premium the same, so he has raised the deductible. It has gone from 
zero to a $1,000 deductible in the last 10 years. So despite that huge 
increase in the deductible, to this day, he experiences huge increases 
each time he tries to renew the policy. When he asked his carrier about 
the enormous increases and why they are raising his premiums so much, 
the carrier responded: Well, because we can.
  Tammy Herbert is a certified optician from Farmington, MO. She is a 
cancer survivor. She had breast cancer. She is a single, working mom. 
She is an inspiration when you talk to her. She told me because of her 
history of breast cancer, 2 years ago her employer's insurer canceled 
all the individual policies for her and her colleagues.
  People talk about small business health plans resulting in cherry-
picking. They ought to see what is happening today in the small group 
market.
  Renee Kerckhoff is the second generation owner of Rudroff Heating & 
Air Conditioning, in Belton, MO. She can only afford to cover a small 
portion of employee insurance premiums--about $150 a person per month. 
As a result, and despite her best efforts, her employees are having to 
drop their health insurance because they cannot afford the copays and 
the premiums they have to make and are going on public assistance.
  These stories are happening all over Missouri and all over the 
country. Sometimes I will get with a group of people and ask them: 
Look, if you had a history of medical illness, and you had the choice 
of working for a big company or a small company, and all you cared 
about was health insurance, and all you knew about the companies was 
that one was a big Fortune 500 company and the other was a small 
company, which one would you work for? I have never had anybody raise 
their hand and say: I would work for the small company because the 
assumption is I am going to get better health insurance from the small 
business.
  They know, because it is a matter of common sense, insuring a large 
pool of people is more efficient, more economical and, therefore, less 
expensive than insuring a small group of people.
  Just look at the people who are insured in the country. Virtually 
everybody who has health insurance, except for the employees of small 
business people, have it as part of a big national pool. It may be 
public, it may be private, but it is a big national pool. They work for 
a big company. They are in a labor union. They are on Medicare or 
Medicaid or they are a Federal employee or a retired Federal employee 
or in the VA.
  All these other organizations could insure on a small group basis if 
they wanted to. The Federal Government could go out and take each 
section of Federal employees in different cities and divide them all up 
and insure them in a small group. There is no law against that. 
Microsoft could do the same thing. Hallmark in Missouri could. 
Anheuser-Busch in Missouri could. They could insure each little section 
if they wanted to. Well, they do not because it does not make any 
sense. It would cost them more money to do it. Yet small business 
people have to do that every day.
  So what is the answer? Well, there is a simple answer that is out 
there. Everybody tries to make it more complicated than it is, but it 
is simple: Empower the small business people to do what the big 
business people can already do. Allow them to pool together through 
their trade associations and get health insurance as part of a big, 
national, voluntary, efficient, economical pool.
  I give an example: I think it is the best way to describe it. Take a 
restaurant owner such as my brother, who owns a little restaurant. It 
is kind of a tavern restaurant. It is a great place. It has great 
chicken sandwiches. And I highly recommend it to you if you get to 
Missouri. He does not have health insurance for his people. It is too 
expensive. It is complex and foreboding for him. He and my sister-in-
law run the business. They do not want to have to wrestle with big 
insurance companies. They are afraid if something goes wrong, they 
could get sued. He would like to have health insurance. Then he could 
get it through the business, too.
  Now, what if the National Restaurant Association could contract with 
big insurance companies? They could be his employee benefits section, 
just like big companies have an employee benefits section. By joining 
the National Restaurant Association, he automatically would have the 
right to join the big pool. They would send him the papers. They would 
show him the options he

[[Page S4167]]

has, and he could decide how much he wants to pay. He could let his 
employees pay the rest and join the pool. He could have health 
insurance as part of a big pool. It would be must-offer, must-carry. 
They would have to let him join the National Restaurant Association and 
would have to offer the health insurance to him.
  When I chaired the Small Business Committee in the House, we studied 
this issue. And I have seen a lot of other studies since then. The best 
estimates I saw were that it would reduce premiums for small employers 
by 10 to 20 percent; a recent study came out and said 12 percent. There 
would be a million fewer people uninsured.
  It costs the taxpayers nothing. It is not a Government program. It is 
empowering small business people to do what big business people already 
can do. I think the impact would be much greater than the studies have 
shown because right now the psychology of health insurance, if you are 
a small business, is so negative. I think you would see whole segments 
of the economy, which traditionally have not provided health insurance 
to their employees, begin to provide health insurance. And the 
restaurant business is one of them. It is one of the reasons the 
National Restaurant Association is so strongly in favor of this 
concept.

  Now I have talked about this for almost 10 years. I lay it out for 
people, and they say to me: Well, who would oppose this? I actually get 
that question a lot: Who is opposed to it? And that is a good question. 
It is fully within the mainstream of both parties' philosophy. It is 
empowering the little guy, just like farm co-ops. It passes the House 
with a strong, bipartisan majority every year. And why shouldn't it?
  What is the downside of it? The downside is: It does not work as well 
as we hope it is going to work. Not as many people go into it as we 
hope and believe will go into it.
  It is not as though the taxpayers are going out on a limb. So who is 
opposed to it? Well, nobody will be surprised to hear that the big 
insurance companies have opposed it, and they have come up with all 
sorts of excuses over the years. I am not going to go heavily into it 
because the chairman has worked very hard to get as much consensus as 
he can get. But I will say this. I think they oppose it not because 
they are afraid it will not work but because they believe it will work. 
And they control most of the small group market now. I do not have time 
to go through those figures. But the concentration of the small group 
market within the five largest carriers has grown and grown and grown. 
And small business health plans would be a powerful, new competitive 
force in that market.
  The State insurance commissioners have been concerned because these 
small business health plans would be national and they felt the State 
would not be able to regulate it. In fairness, I have to say, I have 
never agreed with that. Remember, the big companies already operate 
free of State regulation. That has been the law for 30 years. And we 
have not had any disasters as a result of that. I do not believe 
anything that has happened in the last 10 years or so is proof that we 
can trust the big companies more than we can trust the small companies.
  If I had to decide who was going to be free of State regulation, I 
think I would rather have the small businesses free of that. And it is 
not as though the market the States have regulated never has any 
problems. There are a lot of insurance companies that go bankrupt, and 
the States have to take them over.
  But the good news is that the chairman has squared this circle. He 
has worked out an arrangement for the regulation of small business 
health plans where many of the State regulations and much of the State 
regulatory authority will still apply. I am not saying the State 
insurance commissioners are standing up for his bill, but I think it is 
safe to say that many of their objections have been ameliorated, and 
the chairman has made much progress on that front.
  Folks who tend to be sincerely on the ideological extreme on health 
care issues--and maybe ``extreme'' is the wrong word, but they want to 
go one way or the other--have been lukewarm about small business health 
plans. There are some who wish to eliminate the employer system and 
take the Federal tax deduction and pass it through to individuals and 
let them go out and buy health insurance on their own, and there are 
others who want a total Government solution. And this is not any one of 
those things.
  It is a substantial and important and meaningful but incremental 
change in the world we are in. It makes things better for people on a 
day-to-day basis who are out struggling in the real world. Maybe it is 
not the reform that any of the think tanks on the right or left would 
come up with, but it makes a difference. It will help. There is little 
or no downside to it. We need to help the real people who are really 
hurting.
  Finally--and this I understand entirely; I struggled with this myself 
in the years I had this bill--the groups that have worked to get 
various disease mandates in the States have been concerned. Because if 
you worked hard to get a mandate so that mammogram screening is covered 
in your State as a matter of right, and small business health plans go 
into a national pool, just like the big companies, if we do not do 
something, they would not be subject to those State mandates.
  I have made a point in talking with these groups over the years 
saying that, look, the big company plans, the big pools that exist out 
there--the labor unions, the company plans, the Federal employee plans; 
all those sorts of things--they usually cover all those mandated 
coverages, anyway, because most of them are pretty common sense.
  Again, remember, if you have been sick, and you have a choice of 
working for a big company that is not covered by the State mandates or 
a little company that is, which do you think has the better health 
insurance? The folks I have talked to over the years say: Well, we 
would go with the big company.
  But I think we are going to be able to square that circle as well. 
Senator Snowe is going to offer an amendment which will represent 
progress in this area. It will provide that if 26 States cover a 
mandate, that mandate applies to small business health plans, and it is 
protected in the States that have it. So this is progress. It is not 
just net progress; it is absolute progress for these various groups 
that have sought these protections because they are going to have, if 
that amendment passes--and, certainly, I am going to support it--they 
will have protections on the Federal level for the first time for these 
various coverages.
  So I am very hopeful they will take a look at this. I believe with 
the amendment Senator Snowe is going to offer, the concerns they had 
not only do not apply anymore, but actually they are going to be better 
off because for the first time we are going to have national pools set 
up under Federal law with certain basic patient protections and 
coverages that are guaranteed. As I said, I do not think those would be 
necessary because I think the pools would cover them, anyway. Most of 
those are pretty common sense. But we can put them in the law and 
reassure everybody. And I think we can make the bill better if we do 
that.
  I see my time is running out, Mr. President.
  So what is left? Why should we oppose this? I do not want to be 
presumptuous. I have lived with this bill for so long that maybe there 
are weaknesses I do not see. But this is something we can do for 
people. It passes the House regularly. They like it over there. It has 
a strong measure of bipartisanship, anyway. There is no real downside 
to it.
  Let's debate the bill, and let's resolve that we are going to debate 
it with a view toward actually voting on it.
  I hope nobody filibusters this bill. We can work out agreements about 
debate, work out agreements about amendments, and have a chance to help 
people. This is a problem. This is a case where people are hurting. I 
know politics is important here; I know this is an election year; I 
know all of that. But we can make a difference for real people on the 
ground every day who are worried about losing their health insurance or 
who do not have health insurance and are worried about getting sick. We 
ought to do it.
  I thank the Senator for yielding. It looks as though my time has 
expired. I yield the floor.
  The PRESIDING OFFICER (Mr. Sununu). The Senator from Connecticut.
  Mr. DODD. Mr. President, I yield myself 20 minutes. Senator Kennedy 
is

[[Page S4168]]

not here right now, but pursuant to previous agreement, I would like to 
be notified when 15 minutes expires so I can conclude my remarks in the 
20 minutes.
  I spoke yesterday about this legislation. I want to begin by saying 
to my friend from Wyoming, the chairman, I have a great deal of regard 
for him. I have enjoyed working with him on the HELP Committee. We do a 
lot of work together. I have enjoyed that relationship. It is with a 
note of sadness that I disagree with him about this bill. We had a 
lengthy markup. He was very patient to listen to all of our ideas and 
the amendments we offered during the markup. I appreciated his 
willingness to do so. But as happens from time to time, we have 
disagreements. They are not personal. They are ideas on which we have a 
different point of view. Today is one of those occasions. These remarks 
are in no way intended to denigrate the work of the chairman of the 
committee or those who agree with him.
  There are those of us who believe strongly that this proposal would 
do a lot more harm than good, that, in fact, the cure being proposed 
with this legislation creates far more problems than presently exist, 
as bad as the present situation is. We know, as a matter of fact, that 
over the last 3 years, the premium cost for health care has risen: 9 
percent in 2005, 11 percent in 2004, 14 percent in 2003. These costs 
continue to rise. A family of four today is paying about $11,000 in 
premiums for health care coverage. The problem is significant.
  I regret in some ways--and this is not the fault of the chairman of 
the committee--that we are not debating in a broader sense how we might 
address the far more significant issue, as important as this one is, 
when we have 45 million fellow Americans with no health care coverage 
at all. I regret that we are not having a larger debate on that issue.
  Secondly, I believe it is a legitimate issue to raise the issue of 
how small business is dealt with when it comes to insurance. In the 
next 2 days, we will offer a substitute to the proposal authored by the 
chairman of the committee, the Senator from Wyoming, that we believe 
will deal far more thoroughly with the legitimate issues that smaller 
businesses face. In fact, we redefine small business to mean businesses 
not with 50 employees or less but 100 employees or less, thereby 
covering more small businesses than would be covered by the legislation 
before us.
  The problems are huge in the area of health care. If you do surveys 
of the American public and ask them to identify what are the largest 
concerns they have, if not the No. 1 issue--from time to time other 
issues may be more important to people--consistently year in and year 
out, people will tell you their great concern is about the fear of 
watching a family member or themselves be hit with a major health care 
crisis and not having the resources to pay for it, not being able to 
get the doctors, not being able to have the kind of care they would 
want for their families because they cannot afford the premiums that 
would provide them broader coverage, if they have any kind of coverage 
at all. They may not have any kind of health care. This is a major 
problem. We ought to be spending a lot more time addressing this issue 
than we are.
  Having said that, let me talk about this proposal. I am deeply 
worried about it. It isn't just my concern. Many Governors, more than 
three-quarters of the attorneys general of the States which we 
represent, not to mention the health insurance commissioners of many 
States, have raised very serious concerns about this legislation. They 
are very worried about what this bill will do to their constituents, 
the States that we represent as Senators.
  Let me share a letter from the Connecticut Business and Industry 
Association. This association represents 5,000 small employers in my 
State. This is not an organization that is known for its liberal 
tendencies. Quite the contrary, it is a very conservative business 
group. Listen to what my business group that represents the small 
businesses of my State has to say about this bill.

       We believe that in Connecticut federally certified AHPs 
     would destabilize the small business insurance marketplace, 
     erode carefully crafted consumer protections and raise 
     premium rates for small businesses with older workforces and 
     those that employ people with chronic illnesses or 
     disabilities.

  The letter goes on to say:

       Although the passage of AHP legislation would present us 
     with opportunities to expand our CBIA health connection's 
     product customer base as a regional offering, we do not 
     believe that the proposed legislation represents a sound 
     public policy for providing more affordable coverage or 
     access to health care benefits. The proposed legislation does 
     little to address the underlying causes of health care 
     inflation, which is the most important barrier to small 
     employers providing health care benefits.

  That is a strong letter from an organization that represents 5,000 
small employers in the State of Connecticut. They are worried about 
what this bill will do to smaller employers in my State in terms of 
their costs. They are deeply worried about this legislation and what it 
may mean.
  Let me also share with my colleagues a second chart. This was a chart 
that was produced by Families USA, with estimates from the Agency for 
Health Care Research and Quality, a medical expenditure panel, and from 
the U.S. Census Bureau. It tells us the number of people that will be 
losing State regulatory protections if this bill is passed. What we are 
doing is shrinking the amount of benefits that can be offered. In my 
State, we offer a range of 30 different benefits--that was passed by my 
State legislature--that insurance companies must cover. If you are 
going to do business in my State, then you have to provide coverage for 
these 30 areas that we believe are important.
  I note this morning an editorial in the Wall Street Journal that 
criticizes those of us who have raised issues about this bill. They say 
in one paragraph:

       Some provider groups are opposed for nakedly self-interest 
     reasons since it would allow plans to bypass state 
     regulations mandating coverage for, say, chiropractors.

  Chiropractors provide some decent services to people. But with all 
due respect, I would suggest that it is a lot more than chiropractors 
who get bypassed with this legislation. It is things such as diabetes, 
cancer screening, infant health care, mental health care, pregnancy, 
Lyme disease, to mention a few. I know several of my colleagues have 
had family members affected by Lyme disease. My State thinks that is an 
important area to provide coverage. This bill would eliminate coverage 
for Lyme disease because this legislation would mandate that Federal 
law would supersede State law. Regardless of what your State thinks is 
important, this bill will decide what will be covered. Everything else 
goes. That is an overreach, in my view. As a result, the analysis of 
the legislation presented on this chart suggests that in the State of 
Alabama, 1.7 million people who would be adversely affected if this 
legislation is passed. In Connecticut, more than a million people would 
lose benefits that the State legislature requires the insurance 
industry to cover. In State after State, the numbers are at least in 
the six-figure category. In California, 12 million people would be 
adversely affected, Kentucky over a million people, Kansas over a 
million people, Illinois almost 4 million people, and the like.
  I will leave this chart so my colleagues will be able to see how many 
people will be affected in their States, according to data collected by 
those who have examined what it would mean to a Federal mandate that 
tells every State in the country: We don't care what you have done, we 
don't care what benefits you think are important, this bill will tell 
you what kind of coverage you are going to have.
  We also prohibit the States by preempting their ratings rules, which 
is my second point. This legislation preempts the States from having 
rating rules that will actually determine what the difference in cost 
would be between young and healthy workers and older, sicker workers, 
to make sure they are not going to price the product so beyond the 
reach of an older, less healthy person that it would be unaffordable. 
It is de facto exclusion if you allow the insurance industry to set 
that price by preempting the States from determining whether there 
ought to be a cap on how much an insurance company can charge. By 
limiting benefits and by preempting the States from determining rates 
and holding them down,

[[Page S4169]]

we make it very difficult for literally millions of people to be 
positively affected by this legislation.
  Those are the two major concerns we have. There are other areas that 
we will certainly raise. I mentioned earlier in my State, more than a 
million people will lose access to cancer screening, well childcare, 
diabetes supplies, alcoholism treatment, mental health care, the 
treatment for Lyme disease, to mention some. The list goes on with my 
State.
  In addition to seeing their benefits disappear, millions of Americans 
will see their health insurance premiums skyrocket as well. This bill 
preempts State laws that currently protect older workers, those with 
serious illnesses such as diabetes, cancer, and heart disease, even 
expectant mothers, from seeing their premiums increase. This bill will 
allow the insurance industry to charge people more based on the fact 
that they are sick or pregnant or simply older.
  I have many insurance companies in my State, as my colleagues know, 
that do a wonderful job in many ways. But don't have any illusions 
about this. They are going to be offering as few benefits as they can 
get away with and charge as much as they can. That is what they are in 
business for. This is not the Vista Program or AmeriCorps. These are 
private companies. If we give them a green light to limit the benefits 
you can provide and take the caps off what they can charge, then, 
obviously, they are going to take advantage of it. I am greatly 
concerned, as the major business organization in my State warns. When 
the Connecticut Business and Industry Association says this bill would 
hurt the businesses in my State, we ought to take note of it. This 
organization has a strong record of protecting the interests of smaller 
businesses.
  It doesn't take an expert to predict what will happen. Insurance 
companies are going to offer plans with minimal or no benefits, hoping 
to attract young and healthy workers. Older, sicker people are going to 
be left without a plan that meets their needs. Every analysis of this 
bill reaches the same conclusion.
  Listen to what the Congressional Budget Office says. They found the 
bill ``would tend to reduce health insurance premiums for small firms 
with workers who have relatively low expected costs for health care and 
increase premiums for firms with workers who have relatively high 
expected costs.
  In other words, instead of attacking the real problem, the rising 
cost of health care, this legislation would simply shift costs to small 
businesses with older and less well workers.
  In fact, another study commissioned by the supporters of this 
legislation concluded this bill ``is not going to address the 
underlying causes of high health insurance premiums, which are high 
health care costs.''
  Again, Governors, State attorneys general, the State insurance 
commissioners have all reached the same conclusion, as have an enormous 
number of groups representing health care providers and patients. All 
of them say the same thing. They all can't be wrong. When your 
Governors, attorneys general of the States, insurance commissioners, 
not to mention almost every single health care group in the country 
warns about the passage of this bill, then we ought to take note of it. 
When you hear that you will have literally millions of people losing 
benefits passed by State legislative bodies that require the insurance 
industry to cover them, then we ought to take note of that as well.
  I know my colleagues will be offering amendments to allow lifesaving 
stem cell research to go forward, to strengthen Medicaid, reduce 
prescription drug prices, and ensure access to mental health care. I 
look forward to having an opportunity to debate those amendments, many 
of which I will be supporting. We should also consider an amendment to 
extend the Medicare prescription drug plan enrollment deadline which is 
causing a huge problem. These are the kinds of issues that ought to be 
part of our debate today. Medicare beneficiaries have only until this 
coming Monday, May 15, to enroll in a prescription drug plan, if they 
are to avoid financial penalty. Why don't we take that as an amendment 
and extend that time to allow people to come forward. As we are all 
aware, for many of the Nation's 41 million Medicare beneficiaries, the 
new prescription drug plan offers more confusion than assistance and, 
frankly, extending that date would make sense.
  I intend to offer an amendment to protect newborns and children from 
the damage inflicted by this legislation. Right now, 25 states have 
enacted mandates requiring insurers to provide benefits to the children 
of their enrollee; 31 States require insurers to cover the cost of 
childhood immunization.
  I am going to ask my colleagues to support language that would see to 
it that newborns and children are protected in every State, instead of 
allowing the insurance industry to pick plans that would exclude child 
immunization and well-child care.
  This legislation would completely preempt these State laws, leaving 
babies and children unprotected. That is a major step backward. 
Instead, families will be faced with health insurance that doesn't 
cover routine care for children. They might be forced to pay out of 
pocket, drastically driving up health care costs, or to forego care 
entirely. My amendment would ensure that those State laws not be 
preempted by this Federal mandate that we are about to adopt.
  I will also offer an amendment that would prevent health insurers 
from deciding how much to charge a person for health insurance based on 
how healthy they are. That is something we have done across the country 
in State after State.
  Many States, including my own, have laws preventing the insurance 
industry from charging more based on health status. Unfortunately, this 
legislation would remove those State protections. It would allow the 
insurance industry to charge more based on health status. We ought to 
make sure we don't allow that to occur in this bill.
  Without these protections in place, it just makes good business sense 
for an insurance company to increase premiums for people with diabetes, 
HIV/AIDS, cancer survivors, pregnant women, or anybody with health 
needs that are outside of the ordinary. As a result, the people who 
need insurance the most will find they would be the first to lose it.
  Finally, I will offer an amendment to protect those patients that 
admirably choose to participate in clinical trials from undue costs 
resulting from their routine care. Currently, 19 States, including my 
own State of Connecticut, have enacted mandates requiring insurers to 
provide coverage for routine patient care costs while those patients 
are participating in potentially lifesaving clinical trials. But this 
legislation, as crafted, would completely preempt these State laws, 
leaving patients without needed coverage for items such as blood work 
and physician visits. And this legislation would preempt States like 
mine that provide benefits for people who are willing to become part of 
a clinical trial.
  Clinical trials save lives. Just 50 years ago, less than one in four 
women with breast cancer survived for 5 years or more. Compare that to 
today when 96 percent of women with localized breast cancer reach the 
5-year mark. This legislation would create a powerful disincentive to 
patients weighing the option of whether to participate in a clinical 
trial. Tragically, we know that only 3 percent of adults suffering from 
cancer participate in clinical trials. Compare this to the 60 percent 
of children with cancer that enroll in a trial.
  Mr. President, there are a number of amendments we would offer to try 
to improve this piece of legislation. While I respect the intent of the 
authors, the bottom line is that it would do great damage to the gains 
that have been made in State after State across the country, by 
controlling the costs of premiums and seeing to it that benefits are 
offered to people out there. The States made these decisions, and the 
insurance industry, if they want to do business in their States, should 
comply.
  This legislation would mean that the Federal Government would wipe 
out protection in State after State that has provided for the 
protection of its people--listen to your Governors, your attorneys 
general, your health commissioners, insurance commissioners; listen to 
the groups out there that pay attention to this kind of legislation. 
Listen to the business groups that have warned what this would do to 
smaller businesses across the country.

[[Page S4170]]

  Mr. President, I hope that when the appropriate time comes, we will 
either adopt amendments that will improve the bill substantially or, 
more important, adopt the substitute that will be offered by Senator 
Lincoln of Arkansas and Senator Durbin, which would allow people to 
have the same kind of benefits each and every one of us have as Members 
of Congress, as part of a Federal health benefit program here that 
allows for the pooling of people, that would cover 100 employees or 
less, far beyond what this bill would cover with 50 or less. It would 
not mandate that benefits provided by States be eliminated, and it 
would not preempt the States from setting caps on premiums when it 
comes to older and sicker workers. That is the way to go.
  If you really want to make a difference, why don't we adopt this 
alternative. That would be a major gain for smaller businesses and 
people who work with them. I understand this is an important issue. 
Small businesses could use help, but we are not helping them with this 
bill, with all due respect. We can help them if we take the right 
steps.
  I urge my colleagues to adopt the alternative, or at least improve 
the bill with the amendments we will be offering in the next few days.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
  Mr. KENNEDY. Mr. President, as I understand it, we are rotating back 
and forth. Could the Chair tell us how much time we have on this side?
  The PRESIDING OFFICER. Nine minutes remain.
  Mr. KENNEDY. Well, Mr. President, I thank my friend from Connecticut 
for an excellent presentation and summation of the principal concerns 
about this legislation. I ask the Chair to let me know when there is 1 
minute remaining.
  The PRESIDING OFFICER. The Chair will do so.
  Mr. KENNEDY. Mr. President, I thank the chairman of our committee, 
Senator Enzi, for his diligence in the development of the legislation. 
It is legislation that I cannot support. But the chairman of our 
committee has put his finger on an area of health policy, which is 
enormously important for us to consider, and that is the general kind 
of challenge that is out there for small businesses in this country. By 
and large, they pay two or three times higher premiums than many of the 
very large businesses in their States, and they are also seeing a 
turmoil in the market.
  More often than not, they are changing companies every year, or every 
other year, and increasing numbers of those small businesses have to 
drop coverage. This is a real problem.
  If the proposal that is before us, the Enzi bill, was only to deal 
with that particular issue, it ought to be given focus and attention 
and full debate and support. But his bill goes far beyond that. 
Fortunately, we have an alternative, as the closing remarks of my 
friend and colleague from Connecticut pointed out, in the Durbin and 
Lincoln legislation, which addresses the small business needs. It does 
it creatively and effectively, and it does it without threatening the 
health protections that are there for States. The message and word 
ought to go out to all those who support the Durbin-Lincoln proposal 
that workers in those small businesses will effectively have the same 
kind of health care coverage that we have in the Senate of the United 
States. That has been certainly a goal of mine for all Americans in the 
time I have been in the Senate, and it still is.
  We have an opportunity for the small business community, and for the 
workers in those companies of 100 or less, to provide for them the same 
things that we have for the Members of the U.S. Congress and Senate. 
That statement cannot be made by the Senator from Wyoming. His bill 
does not do that. It has all kinds of adverse impacts in terms of 
workers and health care protections.
  So as we start this debate, we ought to recognize that there is an 
alternative which we on this side strongly support which will focus and 
give attention to the small business community. The other proposal by 
Senator Enzi does not do that.
  Mr. President, I am going to take a few minutes, because that is all 
I have, to review what I think are the most dangerous aspects of this 
legislation. The fact is, today, as has been pointed out, there are 
some 85 million Americans who have protections that will be effectively 
lost with the Enzi proposal. Those are protections for screening on 
cancer, for help and assistance in terms of diabetes, for medicines. 
There are different protections that are given to other diseases that 
are threatened, and it threatens American families. Those have been 
discussed in local communities and in States that are now providing 
those protections; and effectively, under the Enzi bill, those will be 
prohibited. There are a number of groups.
  First of all, this is what the State insurance commissioners say, and 
why they are important is because they have a responsibility in terms 
of protecting consumers. This is what they have pointed out, Mr. 
President:

       Standardizing the rating laws among States will do little 
     or nothing to reduce health insurance costs.

  And also:

       S. 1955 will result in older and less healthy employees 
     being priced out of the market as a result of expanding the 
     rate bands.
       Small New Jersey employers with older and sicker employees 
     would see a dramatic rise and increase under the Federal 
     approach, effectively driving them from the insurance market 
     and leaving them vulnerable citizens without adequate health 
     coverage.

  They are talking about ratings. Insurance companies are going to be 
able to charge for the proposal that the Senator from Wyoming has 
talked about. They are going to have a flexibility of up to 26 percent 
difference--26 times the difference in terms of premiums. Do you 
understand that? If you are an older worker and have had sickness in 
your family, you will pay a rating that will be up through the roof.
  That is not true in Massachusetts. In Massachusetts, no matter how 
sick or young you are, you are still within a 3-point or 3 times rating 
increase. That has worked very effectively. That is something that 
every older worker, every family that has had some kind of health 
challenges ought to recognize--that they, under the Enzi bill, could 
well be priced out of the market.
  This is what the attorneys general have said:

       The Health Insurance Marketplace Modernization And 
     Affordability Act should be more appropriately labeled the 
     Health Insurance Cost Escalation Act.

  That was the attorney general from Minnesota.
  The attorney general of New York said:

       This legislation is not the answer here. It eliminates many 
     of the protections that consumers enjoy, without addressing 
     the underlying problem of cost containment.

  They are also eliminating protections, as we have mentioned, for 
breast cancer and diabetes.
  Another one by the attorneys general:

       There are no legitimate grounds for exempting the type of 
     insurance plan for State laws that provide essential 
     safeguards for persons covered by insurance.

  It is not just Democrats, but Democrats and Republicans; 41 out of 
the 50 attorneys general charged with protecting consumers are saying 
this bill doesn't get it.
  Mr. President, this is very interesting by the New Hampshire Governor 
on S. 1955:

       In 2003, New Hampshire passed a law establishing rating 
     rules similar to those contemplated under S. 1955.

  New Hampshire passed almost the identical bill that is now being 
considered in the Senate.

       With the rules allowing insurance companies to discriminate 
     against businesses with sick workers, or based on geography, 
     this law sent small business health insurance costs 
     skyrocketing across New Hampshire. Small business could not 
     grow, could not hire new workers, and some considered ending 
     their health insurance plans altogether.

  They have done it. It is rare around here when you have a new 
proposal that you have had experience with--and the State of New 
Hampshire has it--and they ended up withdrawing that proposal.
  Finally, we have the various patient groups. Here is the American 
Diabetes Association:

       S. 1955 would result in millions of Americans with diabetes 
     losing their guarantee of diabetes coverage.

  The Cancer Society said:

       Passage of this legislation would represent a retreat in 
     this Nation's commitment to defeat cancer.


[[Page S4171]]


  The National Partnership for Women and Families said:

       Instead of making health care more affordable for those who 
     need it most, S. 1955 would roll back the reforms adopted by 
     many States to require fair pricing.

  We look forward on this side to debating these issues--the Durbin-
Lincoln proposal and the Enzi proposal--and we also look forward to 
debating stem cell research, the real Medicare alternative in the 
prescription drug debate, the ability of Medicare to be able to 
negotiate lower prices for our senior citizens, and drug 
importation. If we are going to have a health care debate, let's make 
sure we are going to deal with many of the issues that people in our 
country want us to deal with.

  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. ENZI. Mr. President, as we wait on a couple of people to speak, I 
would like to make a few comments on the comments that have been made. 
I do appreciate the spirit in which they have been made. I know there 
are amendments waiting to modify several of the things that have been 
suggested, but my biggest concern is that there were some comments 
about the Attorneys General of the United States and the insurance 
commissioners who are against it, and even the Connecticut business 
associations who are apparently saying they are against the bill.
  But what I need to correct is the comments they are making are not on 
this bill. What they are talking about is the bill that the House has 
passed eight separate times: the associated health plans bill. 
Associated health plans are different than this bill. It would be nice 
if some of the people who are going national and public on this would 
actually check with us on some of their comments to see if they are 
remotely right.
  We have put forward a solution which they said that 85 million people 
would lose their benefits from. That would be just as ridiculous as me 
saying that all 27 million people who are uninsured who work for small 
business would be covered by this bill. Neither of those things is 
going to happen. There is a medium in there where there will be more 
people who are insured. The difficult parts that were talked about 
concerning things being taken away from people I am confident are not 
going to happen. There are a couple of reasons they are not going to 
happen.
  First of all, there are experiments across the country which in a 
small way have done what we are talking about in the small business 
health plans, and in those experiments, they have worked: Taking away 
the mandates that States have and actually making a point of mandating 
that we take away the mandates. Around here, ``mandates'' is a bad 
word. Mandates means you are forcing somebody to do something and you 
are not paying for it. You are saying you have to have this, and 
whether you can afford it or not, we are going to make you do it. So 
your choice is to take the mandate or drop your insurance.
  When we are talking about these mandates, a lot of them we are 
talking about are regular maintenance of your body, and we ought to be 
having everybody do those. It shouldn't matter whether they are covered 
by insurance or otherwise. In fact, in Wyoming, we have gone to great 
lengths to have more things done by public health for free. That means 
your insurance doesn't have to pay for it and you don't have to pay 
your insurance company for it and you don't have to pay your insurance 
company for the administration of that service. But you can get that 
service. Then we have some other screenings that are covered in a very 
reasonable way. We have a program in Wyoming trying to get everybody to 
have mammograms, and it is focused on Mother's Day, which is coming up 
this next weekend: Get a mammography for your mom. Show that you care. 
And thousands of people in Wyoming do exactly that.
  I will cover some of the other issues, but I see that Senator Hatch, 
the Senator from Utah, has arrived and has some comments in this 
regard, and he has been a very diligent worker on all of the small 
business problems. So I yield time to the Senator from Utah.
  Mr. HATCH. Mr. President, I thank my distinguished chairman who I 
think has done a terrific job on this bill. I understand the 
distinguished Senator from New Hampshire needs about 3 minutes, so I 
ask unanimous consent that he be given 3 minutes, and then the time be 
returned to me.
  The PRESIDING OFFICER (Mr. Alexander). Without objection, it is so 
ordered.
  Mr. SUNUNU. Mr. President, I wish to speak to the legislation before 
us and in particular to address some of the remarks that were made 
earlier by Senator Kennedy from Massachusetts. He raised concerns about 
the State of New Hampshire and suggested that this legislation would be 
bad for the State of New Hampshire and that the State of New Hampshire 
had already enacted legislation identical to this. I think it is wrong 
for someone to provide information that is not entirely accurate. I 
think that is inaccurate, and it is not inaccurate in some very key 
areas.
  First, the bands that were discussed that were enacted in the State 
of New Hampshire were much smaller than the rating bands contemplated 
in this legislation, and they did it in New Hampshire without any 
transition period. Those are two very significant, specific differences 
between this legislation and what was attempted in New Hampshire.
  Second, as with any legislation, it cuts both ways. There were some 
employers that saw increases in their premiums 2 and 3 years ago that 
some claimed were a result of the legislation in New Hampshire, but 
many businesses--in fact, the NFIB would suggest the majority of 
businesses--in New Hampshire saw some great relief because they are the 
smaller businesses that we are talking about, those who would be 
allowed to improve their negotiating position through the provisions in 
this bill. Moreover, this isn't a debate about one State. This is a 
debate about providing increased access--increased access--to plans 
that are negotiated by associations, by the members of small businesses 
and, as a result, negotiating lower prices.
  Finally, there was discussion about community rating and how 
objectionable it is that there will be an ability to differentiate on 
price based on a number of factors. I think the truth is, when you 
force that kind of price control, you force adverse selection because 
if I tell you that you have to charge the exact same price to anyone, 
no matter what region, circumstance, or situation, then the insurer 
will automatically market to the healthiest people because they won't 
want to take on the additional costs associated with those who might 
have significant needs that result in higher prices.
  So if you go to price control, which is exactly what the other side 
is suggesting, forcing the same price for everyone no matter who is 
covered, businesses will naturally--naturally--only market to those who 
are healthy and, as a result, reduce the accessibility and availability 
of health insurance to those who might need it most.
  It is a dramatic, unintended consequence, and that is the exact 
outcome that will be the result of the policies that are being 
suggested by the other side. We need to be accurate in what we 
represent. This is a good bill for small business and, as a result, it 
is an excellent bill for New Hampshire because in New Hampshire, small 
businesses make up over 95% of all firm with employees. If we want to 
do something about the uninsured, the majority of whom are working as 
self-employed or for small businesses, we need to take up the exact 
kind of provisions that are in this bill: Increased access of health 
insurance for those working in the smallest firms.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Sununu). Senator Hatch is recognized.
  Mr. HATCH. Mr. President, I rise in support of S. 1955, the Health 
Insurance Marketplace Modernization and Affordability Act. This is a 
good bill, with good intentions. The lack of health insurance, 
particularly for employees of small businesses, is a significant 
problem in Utah and throughout the Nation.
  We cannot afford to sit by the sidelines and bemoan this problem, 
taking little action while millions of American families suffer. The 
House of Representatives has acted and we should do the same.
  Immediately upon its passage though, we were besieged by complaints 
about House legislation, principal among them the complaint that it 
overrides State insurance law.

[[Page S4172]]

  I give the Health, Education, Labor and Pensions Committee Chairman 
Mike Enzi a lot of credit.
  Chairman Enzi didn't sit idly by.
  He studied the House bill, he held extensive hearings, and then he 
drafted a compromise that resolved many of the concerns expressed about 
the House bill. This was no easy job.
  Immediately, the HELP Committee effort--a solid effort I might add--
was besieged by criticism. Much of this criticism I must hasten to add, 
is not valid.
  ``It isn't going to cover cancer care,'' the naysayers decry.
  ``It isn't going to cover diabetics and their supplies,'' they 
allege.
  ``It isn't going to cover prenatal care or OB/GYN care for women,'' 
is a recent complaint.
  ``It is going to run chiropractors, podiatrists and optometrists out 
of business,'' say hundreds of form letters that have flooded our 
offices.
  The problem is, these complaints aren't even true. While the standard 
plan employees must be offered under this bill may not cover all those 
things, S. 1955 clearly provides an alternative. Employees must be 
offered an enhanced plan, based on the coverage that public employees 
receive in the five most populous States, if their employer's standard 
plan is not consistent with State law.
  Most, if not all, of these services would be included in those 
enhanced plans that employers must offer under S. 1955.
  But, let's talk about our basic goal here.
  We want to provide affordable health insurance coverage to those who 
currently do not have coverage.
  If we could afford to give them coverage for every possible illness, 
condition, or procedure, if small businesses could afford to give them 
coverage for every possible illness, condition or procedure, don't you 
think it would have been done by now?
  Of course it would.
  That is the genius of the Enzi bill. It allows a basic level of 
coverage--perhaps not every single service imaginable, but good solid 
health care insurance--and for those who want to pay more, there is a 
plan with more coverage.
  In that way, the millions of Americans without health insurance will 
have access to coverage.
  You may ask yourself, ``Who doesn't have health insurance coverage?''
  Today, over 45 million Americans do not have health insurance.
  Over 25 percent of self-employed individuals are uninsured.
  Over 30 percent of people who work for small businesses with fewer 
than 25 employees are uninsured.
  Over 20 percent of the people who work for small businesses with 
fewer than 100 employees are uninsured.
  Something clearly needs to be done.
  And that's why we are here, today, debating S. 1955.
  I want to illustrate why passage of this legislation is necessary.
  Ramona Rudert and her husband, Michael, have owned Professional 
Automotive Equipment in North Salt Lake for 28 years. They have 12 
employees and they offer health insurance to them.
  The Ruderts contribute $200 per month to their employees' health care 
premiums.
  Their employees have to pay approximately $500 per month for family 
coverage.
  Their health insurance plan has a $1000 deductible.
  So at least there is potential coverage. But here's the kicker: only 
one of Professional Automotive Equipment's 12 employees decided to be 
covered by their company's health policy, besides the Rudert family. 
The rest of their employees cannot afford it.
  The interesting twist about this story is that Ramona and Michael 
have a daughter with juvenile diabetes. They recognize that the basic 
plan may not cover all the services their daughter needs.
  But when asked why she supports S. 1955, Mrs. Rudert replied that she 
is ``always looking for ways to improve her employees' access to health 
care'' and that while she has a daughter with Type 1 diabetes, her 
greatest concern is about the affordability of insurance premiums for 
her employees.''
  Passage of this bill is the top priority for Mr. and Mrs. Rudert, and 
thousands of Utah businesses. They recognize that affordability is a 
key component to making that happen.
  Let us not make perfect the enemy of the good.
  It is an economic fact of life that a Federal requirement for small 
businesses to cover every small business employee for every possible 
health care-related service is neither appropriate nor affordable.
  Those who decry this bill because it does not guarantee small 
business employees a comprehensive plan, must be reminded that most 
employees of small businesses do not have a choice today, if they are 
fortunate to have health insurance coverage. The legislation before the 
Senate will create new options for small businesses and, the potential 
for more choices.
  Today, smaller employers do not have the purchasing power of larger 
employers. If they offer different types of health plans to their 
employees, the administrative costs of offering these choices are much 
higher for small employers.
  But by leveraging their combined purchasing power, some local small 
business associations are offering plans that give employers more 
choice. I believe that similar models could be created regionally and 
nationally through S. 1955 through regional and national associations.
  The goals of S. 1955 are simple. We want to create more affordable 
health insurance options through choice and competition.
  And we want to end the decades-long deadlock and give real relief to 
America's small businesses and working families.
  Who can argue with that?
  And small businesses support the freedom to band together across 
state lines, even without self-funding. Insurance companies support the 
creation of a level playing field with Small Business Health Plans.
  Most important, according to a Mercer study released on March 7, 
2006, it is predicted that costs will go down 12 percent for small 
employers and coverage of the working uninsured will go up 8 percent, 
approximately 1 million more working Americans.
  An added benefit is that the Congressional Budget Office, CBO, 
believes that passage of S. 1955 will reduce net spending in the 
Medicaid Program. This is due to the enrollment in employer-sponsored 
insurance plans of people, who under current law, would be covered by 
Medicaid.
  CBO estimates that enacting S. 1955 would reduce direct spending for 
the Federal share of Medicaid expenditures by $235 million over the 
2007-2011 period and $790 million over the 2007-2016 period. In 
addition, the bill would result in estimated Medicaid savings to States 
totaling $180 million over the 2007-2011 period and $600 million over 
the 2007-2016 period.
  CBO estimates that by 2011, approximately 600,000 more people would 
have health insurance coverage. The majority of these newly covered 
individuals would be employees of small companies and their dependents.
  S. 1955 has been endorsed by a host of organizations: The Small-
Business Health Plan Coalition; the National Association of Realtors; 
the Chamber of Commerce, the National Federation of Independent 
Business; the National Restaurant Association; the National Association 
of Manufacturers; the Associated Builders and Contractors; the National 
Association of Home Builders; the National Retail Federation; the 
Association Healthcare Coalition; the Textile Rental Services 
Association of America; the Motor & Equipment Manufacturers 
Association; the Precision Metalforming Association; the American 
Council of Engineering Council; Women Impacting Public Policy; National 
Association of Wholesaler-Distributors; Wendy's International which 
includes Tim Hortons, Wendy's, Baja Fresh and Cafe Express; Cendant 
Corporation; American Institute of Architects; Federation of American 
Hospitals; National Funeral Directors Association; HR Policy 
Association; Motor & Equipment Manufacturers Association; and the 
Society of American Florists.
  Mr. President, that is an impressive list of supporters.
  And I believe that the main reason that we have such an impressive 
list is due to the leadership of the Chairman Mike Enzi.
  He and his staff did something that the Senate has not been able to 
do for

[[Page S4173]]

over a decade report small business health legislation out of the 
Senate HELP Committee.
  For months, Chairman Enzi spearheaded meetings with the major 
stakeholders of this legislation the insurance companies, the small 
business groups, and the insurance commissioners. These meetings 
produced the bill that we are considering today.
  Again, my colleagues may ask themselves, is this bill really needed? 
Will it truly make a difference?
  Just last week a 42-year-old woman from Provo, Utah called my office. 
Both she and her 9-year-old daughter are diabetics. And she had heard 
from the American Diabetes Association that S. 1955 would hurt their 
health coverage.
  But as my staff explained the bill's important role in allowing small 
businesses to provide insurance for their employees, including 
diabetics, she became very emotional. She recalled how, several years 
ago, she had her own small business. And buying health care for her 
employees was forcing her toward bankruptcy. So my constituent had to 
take away their health insurance. This was extremely difficult for her 
because she herself had a chronic illness and fully understood the 
implications. She ended up with an individual health insurance policy. 
And she found that for the same insurance coverage that she had had in 
her group insurance policy, she had to pay nearly twice as much.
  This happened for two reasons. First, as an individual, she was not 
eligible for the tax benefit that supports the cost of insurance paid 
through employers. And, second--because she had diabetes, a chronic 
illness, her insurance rating caused her to pay significantly more than 
someone without that disease. There was no risk pool for her to join.
  Passage of S. 1955 could have prevented these problems.
  I urge my colleagues to think about the health care needs of small 
business employees in their states before voting on this legislation. 
This legislation will improve their health care options. Today, they 
rarely have options when it comes to health insurance and when they do, 
it is extremely expensive.
  Let me conclude by sharing the sentiments of Chris Kyler, the CEO of 
the Utah Association of Realtors.

       Small business owners in Utah are facing a growing crisis 
     with health care availability and affordability. Our 
     profession represents 17% of Utah's gross state product and 
     yet we're arguably the most uninsured working segment in our 
     state simply because we're small business people. As 
     productive contributors to the economy, as a younger, 
     healthier populous, we're supportive of S. 1955 because it 
     will provide us with the opportunity to purchase affordable 
     health insurance.

  I believe that Mr. Kyler's sentiments sum up why the Senate needs to 
pass this legislation as soon as possible. I urge my colleagues to 
support this legislation so that employees of small business will have 
access to affordable health care.
  I yield the floor.
  Mr. ENZI. Mr. President, I yield the remainder of the time to the 
Senator from Maine.
  The PRESIDING OFFICER (Mr. Burr). The Senator from Maine.
  Ms. SNOWE. Mr. President, how much time will that be?
  The PRESIDING OFFICER. The majority has 9 minutes remaining.
  Ms. SNOWE. Mr. President, I thank Chairman Enzi for yielding the time 
as well as for his leadership in bringing this legislation to the 
floor, legislation that is so critical and vital to the future well-
being of small businesses, I know in my State and across America.
  As chair of the Small Business Committee, I know firsthand that this 
crisis is real. It is an undue burden on entrepreneurs throughout this 
country, and it certainly didn't develop overnight. Now we have a 
solution at hand, if we are all willing to forge the consensus 
necessary to make it happen.
  This issue is all the more critical when you consider the fact that 
today nearly 46 million Americans are uninsured. That is an increase of 
over 4 million people since 2001. According to the Employee Benefit 
Research Institute, of the working uninsured, who make up 83 percent of 
our Nation's uninsured population, 60.6 percent either work for small 
business with fewer than 100 employees or are self-employed.
  There should be no doubt or question that the time has long since 
come to pass this legislation that will at once assist our small 
businesses in accessing affordable health insurance for their employees 
and their families while assuring more of those employees can actually 
have health insurance.
  For this past decade, health insurance premiums have exploded at 
double-digit percentage levels and far outpaced inflation and wage 
gains, and Congress has failed to act. Study after study has confirmed 
beyond a doubt that fewer and fewer small businesses are able to offer 
health insurance to their employees. Little has been done to alleviate 
the problem. Quite simply, it has been an abrogation of responsibility.
  As chair of the Senate Committee on Small Business and 
Entrepreneurship, I have held hearings on this question. Small business 
owners in Maine and across America have consistently and repeatedly 
begged Congress for relief. They need competition in the market. They 
need to be able to offer this to their own employees and their 
families.
  That is why I originally introduced the Small Business Health 
Fairness Act which would have allowed the creation of association 
health plans to offer uniform health plans across the country, allowing 
small businesses to leverage their purchasing power on a national 
basis. This week, for the first time, thanks to the leadership of 
Chairman Enzi in bringing this legislation to the floor from his 
committee, the full Senate will be trying to resolve many of the 
issues, many of the differences of positions and perspectives everybody 
has on this question.
  I thank the majority leader for making this legislation the key 
component of Health Week in the Senate.
  I also thank my friends on both sides of the political aisle, Senator 
Byrd, who has cosponsored my initiative originally, Senator Talent, who 
initiated this effort when he was chair of the Small Business Committee 
in the House, and the same is true for my predecessor, Senator Bond, 
when he was chair of the Small Business Committee, for helping to move 
this issue to the pivotal point where we are today.
  I also thank Senator Kerry as ranking member of the Small Business 
Committee because we also modified my original bill, worked on another 
consensus bill that would have been a modification based on regional 
association health plans. I thank him for his effort. Again, that was 
another attempt to bridge these efforts across the aisle.
  But I most especially recognize Senator Enzi's work and his 
commitment in moving this bill, holding the hearings, trying to 
reconcile the differences.
  This week is not about engaging in heated partisan debate to create 
issues for the upcoming election. What this should be all about is 
providing solutions to small businesses and America's uninsured for the 
much needed relief they certainly deserve.
  We are trying to do everything we can to resolve some of the issues. 
I know there are some concerns, as there were with my initial 
legislation and as there is with Chairman Enzi's bill now before the 
Senate. A couple of those issues are, of course, preemption of mandated 
benefits. I hope to be able to address that question with an amendment 
so, hopefully, we can reconcile some of the differences across party 
lines, across philosophical perspectives, so we can get the job done.
  There are some concerns about the changes in community ratings. I 
know that is a particular issue for my State as well. I understand the 
chairman will address that issue in his managers' amendment.
  What we are all here about today is what can we do to address the 
underlying concern that small businesses have across America. This is a 
summary of their foremost concern--increasing health insurance costs 
for themselves and for their employees and their families to the point, 
as I think we all recognize, small businesses are unable to offer this 
crucial benefit at a time when they need to be competitive with larger 
companies because they cannot afford, they simply cannot afford to 
provide health insurance.
  If they can afford it, it is catastrophic coverage, it is a $5,000 or 
$10,000 or $15,000 deductible at best that

[[Page S4174]]

they are able to offer. That is why I introduced the initial 
association health plans, to give fairness to the market, especially to 
the small group markets such as the State of Maine. The State of Maine 
is a small group market and, guess what, there is no competition. No 
competition means higher prices. Higher prices means virtually no 
health insurance.
  That is why I offered the association health plan. That is why 
Chairman Enzi is doing what he is doing here today, to try to bridge 
the differences so we can move and advance this process forward because 
it is good for all of America.
  Small business is the engine that is driving the economy. Two-thirds 
of the job growth occurring in America today is emanating from small 
businesses. So it is important to ensure their well-being.
  By offering the mechanisms that are proposed in Chairman Enzi's 
legislation, the small business health insurance plan will help with 
uniformity as well. Because 50 States have 50 sets of administrative 
rules, regulations, and mandates, it is virtually impossible to have a 
uniform standard nationwide. This will allow small businesses to be 
basically on par with Fortune 500 companies and unions. After all, no 
one is ever complaining about Fortune 500 companies and unions' plans. 
In fact, they are the most generous in America. So if they are good for 
Fortune 500 companies, if they are good for unions, why can't they be 
good for small businesses? That is what it is all about.
  Now people say these associations will not design good plans. If you 
want to attract members to the plan, if you want people to join your 
plan, obviously you are going to ensure that you design these plans 
which will be the most attractive to the greatest number of people who 
join up in these associations. After all, it is in the interests of 
small businesses to have attractive plans for their employees because 
they have to compete with large employers to get good employees, to get 
skilled employees. If they don't have this crucial and vital benefit, 
they do not attract the kind of employees they need to make their 
business successful. That is what it is all about.
  I hope we can reconcile our differences through the amendment 
process, with what I hope to offer as amendments and what others will 
offer, that can lead us to our goal of addressing the fundamental 
question for small businesses in America that ultimately will help 
mitigate the problem of the uninsured that is ever growing in America 
as well.
  As we engage in this debate this week, in the end I hope we can come 
to a conclusion with a reasonable compromise that will become law. That 
is what it is all about. I know people have differences of opinion. But 
I don't think there ought to be a difference of opinion in the final 
analysis when we address all the issues--the ones that Chairman Enzi 
addressed to bridge the gap, the ones that my amendment will do, and 
others might do--which will ultimately get us to the point of beginning 
to resolve this crisis.
  The fact remains that we are seeing fewer and fewer small employers 
that are providing health insurance for their employees.
  If you look at this chart, only 47 percent of the smallest businesses 
in America--those with three to nine workers--offer health insurance. 
It is on a declining trend--down to 52 percent, and down to 58 percent 
in 2002--in sharp contrast to the 98 percent of larger businesses with 
200 or more workers that are offering health insurance as a benefit.
  For small businesses, things are trending in the wrong direction. 
Then you look at the small group marketplaces in States such as Maine, 
which is what this essentially is all about. As we learned from the 
Government Accountability Office study that Senator Talent and I 
requested, Blue Cross-Blue Shield is actually consolidating their 
market share in a number of States across the country. In fact, 44 
percent are in group markets.
  I hope we can begin to reconcile these differences and do what I 
think this Congress can do for the first time that we have had the 
opportunity to do. Let us not deny small businesses and their employees 
this one chance to do it. Time has long since passed for action.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, before she leaves the floor, I want to 
express my thanks to the distinguished Senator from Maine for working 
so closely with me on health care issues. I expect that before long 
Senator Snowe and I will be offering our bipartisan amendment to lift 
the restriction on Medicare that bars Medicare from bargaining to hold 
down health care costs. Senator Snowe and I have worked on this for 
over 3 years. We recently got 54 votes in the Senate to win passage of 
this bipartisan effort. I thank her for all the good work she is doing 
in the health care field and look forward to when she offers our 
bipartisan amendment before too long and to prosecuting this cause on 
behalf of senior citizens and taxpayers alike.
  Mr. President and colleagues, no other health policy in America is 
more objectionable to the people of this country than preventing 
Medicare from bargaining to hold down health care costs.
  This restriction that bars Medicare from bargaining to hold down 
health costs simply defies common sense. The restriction that bars 
Medicare from bargaining to hold down health costs is contrary to what 
goes on in the private sector of this country every single day. It 
certainly is contrary to the needs of this program and the taxpayers of 
this country when we see the Federal budget deficit exploding every 
time we turn around.
  It seems to me that to have Medicare actually barred from bargaining 
to hold down prescription costs simply defies the sensible approaches 
that we have always taken in holding down health costs. That approach 
is to use your bargaining power and the capacity to argue on behalf of 
large numbers of people. That is using marketplace forces to really 
make a difference.
  The way Medicare is buying prescription drugs under this program is 
like somebody going to Costco and buying toilet paper one roll at a 
time. Nobody would ever go shopping that way. Certainly when steel 
companies, auto companies, any major manufacturing concerns first sit 
down with a vendor, they ask: What kind of deal will you give me on the 
basis of the large volume of this product that I am going to be 
purchasing? Not Medicare. Medicare won't do what everyone else does all 
across this country every single day.
  It is especially important that Medicare use this bargaining power, 
given what the American Association of Retired Persons has found 
recently in a report they released to us on the cost of prescription 
drugs. The AARP released a report in February of 2006 that found brand 
name medications most commonly used by older people rose almost twice 
the rate of inflation in other areas of health care.
  So here is a chance to actually save money for senior citizens and 
taxpayers. We can especially expect to see savings when you have 
single-source drugs for which there is absolutely no competition. There 
are concrete cases where the Federal Government says we are not going 
to allow price controls, we are not going to allow the establishment of 
a one-size-fits-all formulary, but we are going to say that the 
Government is going to be able to bargain, and that approach will make 
a real difference.

  I know some colleagues think any effort by the Government to allow 
bargaining to hold down the cost of medicine will lead to price 
controls. The amendment which Senator Snowe and I expect to file before 
long is very clear. It does not permit price setting or the creation of 
a formulary. All it says is the Federal Government, and in effect the 
seniors of this country, would be able to go into the market and use 
their clout just like any other big purchaser could to hold down the 
cost of medicine using marketplace forces.
  As colleagues consider this particular approach I hope--I know the 
distinguished President of the Senate has a great interest in 
pharmaceuticals and prescription drugs--that colleagues will look at 
what Senator Snowe and I advocate. In that amendment, on page 3, lines 
2 through 8 make it clear that we are opposed to price controls. We 
have continually tried to address this. We are not in favor of price 
controls. We are not in favor of establishing a one-size-fits-all 
formulary or instituting a uniform price structure of any kind. All we 
are saying is that the Federal Government ought to have a

[[Page S4175]]

chance to do some hard-nosed bargaining the way everybody else does to 
hold down the cost of prescription drugs.
  Secretary Tommy Thompson, former Secretary of Health and Human 
Services, said that the one power he wanted as he left office and was 
denied by the Congress was the opportunity to negotiate when necessary 
to hold down the cost of prescription drugs.
  This amendment would ensure that the prescription drug benefit is 
sustainable without interfering with marketplace forces and would 
simply say that the Federal Government could leverage the marketplace 
just as any other big buyer of a product does.
  To date, millions of seniors have enrolled in this program and, of 
course, they are realizing some savings on their prescription drugs. We 
are glad to see that, but it has come about primarily through the 
infusion of taxpayer money.
  What I and Senator Snowe would like to do is bring about some 
savings--not just by pouring more and more taxpayer money into this 
program but by using marketplace forces to protect the interests of 
seniors and our taxpayers.
  Prohibiting Medicare from negotiating for drug prices was an 
overreach. I know of no other industry in the United States that has 
power like this. We don't see any other industry that does business 
with the Federal Government in which discussions and negotiations with 
the Federal Government is specifically barred. Everybody else has to 
sit down across the table from the Government representing the 
interests of our taxpayers and get into the nuts and bolts of 
negotiating the best deal for a particular group of Americans. We need 
to end this special treatment, this favoritism, this unwarranted 
preference that only the prescription drug industry has and give our 
Government the bargaining power that is needed so that seniors and 
taxpayers can be protected through marketplace forces.
  Some who are opposed to what Senator Snowe and I want to do have said 
that we are already seeing some negotiations. Of course, that is true. 
Having voted for this program and wanting to see it work--I have welts 
on my back to show for that--I am pleased that we are seeing some 
discussion among health plans and others. But I think we will see a 
whole lot more opportunity to contain costs and contain them through 
marketplace forces if we untie the hands of the Secretary, as the 
previous Secretary of Health and Human Services, Tommy Thompson, sought 
to do. I believe we ought to take every possible step to save every 
possible nickel to protect seniors and taxpayers, and lifting this 
absurd restriction on Medicare bargaining power will do just that.
  I cannot for the life of me conceive of a rational reason Medicare 
should not have the same power to negotiate just the way other smart 
shoppers do across this country. Every smart shopper in the private 
sector--every single one--wants the kind of opportunity that I and 
Senator Snowe are advocating.
  I don't know of any private entity, whether it is a timber company in 
my home State or a big auto company or anybody else who doesn't sit 
down across the bargaining table and ask, what are we going to do to 
work something out that reflects the fact that I am going to be buying 
a lot of something? Why shouldn't Medicare, if it believes it is 
warranted, have that authority in effect as a standby?
  Senator Snowe and I have been crystal clear in saying that there is a 
difference between negotiating and bargaining and price controls and 
uniform formularies. We would say to our colleagues: Look at our 
proposal just as we did in the one that received 54 votes recently. We 
spell it out. We lay it out on page 3 of our amendment, lines 2 through 
8. We stipulate no price controls, no uniform formulary, no particular 
kind of one-size-fits-all price structure in any way.
  I would like to, along with Senator Snowe, offer a market-based, 
comprehensive cost containment to help hold down the cost of 
prescription drugs in our country.
  I am glad we are discussing Medicare this week. I think it is high 
time. I tell colleagues that no other health policy in America is more 
objectionable than the one that prevents Medicare from bargaining to 
hold down health care costs. It is time to inject some common sense 
into the Medicare drug benefit. Giving Medicare bargaining power to 
millions of senior citizens through Medicare is economics 101. If it is 
important to the seniors of this country, it is important to taxpayers.
  We expect to bring a bipartisan proposal to the floor of the Senate 
this week. We all know we could sure use some bipartisanship around 
here at this critical time. I hope colleagues will, as they did a few 
weeks ago, show strong bipartisan support for our proposal. If we are 
serious about reining in health costs, and the American people say it 
is at the top of their agenda, you have to lift this restriction that 
bars Medicare from bargaining. We expect to be filing the bipartisan 
Snowe-Wyden amendment before long.

  We hope, as we did on the last occasion when we voted on this, we 
will have a strong majority in the Senate in support of a commonsense, 
practical way to protect senior citizens who are buying prescription 
drugs and are taxpayers at the same time.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, I thank my colleague from Oregon for his 
incredible leadership on something that makes so much sense, 
negotiating group prices under Medicare.
  Why in the world wouldn't we want to get the best price? Taxpayers 
want us to get the best price. Seniors want us to get the best price. 
The disabled want us to get the best price. Why in the world wouldn't 
we want to do everything possible to have a Medicare prescription drug 
benefit that offers the very best prices so we can offer as much 
coverage as possible? One of the things we know, the gap in coverage is 
partly because we are paying so much for the whole plan. We could give 
people more coverage and spread it out differently if we were, in fact, 
negotiating group prices.
  I thank my colleague who has come to the Senate floor on so many 
occasions. He always makes so much sense. I know the people in Oregon 
are proud of what he has done.
  To add to the discussion on Medicare, I am pleased we have Health 
Week. Even though I will speak at some later time in terms of the 
concerns I have about the underlying bill, we all chose to vote to 
proceed to debate on health care because there is nothing more 
important to the people we represent, whether it is the manufacturers I 
represent who are having to compete in a global economy and figure how 
to do that while paying so much of the cost of health care or whether 
it is small businesses, self-employed people who cannot find coverage 
at affordable prices, whether it is our seniors or whether it is women 
and children who need care.
  We have a serious issue when we spend twice as much on health care in 
this country than any other country and still have 46 million people 
with no insurance, 80 percent of them working.
  This is an important debate. Part of that debate, I believe because 
of the timing, needs to be to address what is happening with Medicare 
prescription drug coverage. Unfortunately, we are 6 days away from a 
Medicare prescription drug deadline. Right now, 6 days from now, folks 
are going to be penalized if they have not signed up for a Medicare 
prescription drug plan, even though they are having to wade through a 
lot of information and misinformation in order to be able to figure out 
what to do, if anything.
  I am sure my colleagues have received as many calls as I have 
received, thousands of calls and letters from people all across 
Michigan about the trouble they are having related to this Medicare 
prescription drug program--calls from pharmacists trying to help people 
figure what to do, spending hours on the phone, being put on hold, 
unfortunately, receiving inaccurate information too much of the time. 
We know there are serious issues that have come about because the 
Government has not gotten its act together, as we should, to be able to 
present them to people in a way they can understand and make sure it 
works for seniors and disabled.
  We know choosing a plan is extremely challenging and confusing. We 
have an obligation on our end to do something about that, not wait 6 
days and penalize people because they have not signed up for a plan 
that they may not be able to figure out.

[[Page S4176]]

  This is not because people are not bright. In Michigan alone there 
are at least 79 different plans to choose from. Each plan has a 
different premium, a different copay, covers different medicines. Under 
the current law, as I indicated before, anyone who does not go through 
these 79 plans, or whatever number they have in their State, by next 
Monday will find themselves paying a lifetime penalty, more for 
prescription drugs than they would if they signed up before then.
  A decision about something that is so fundamental to a person's 
health as their medicine should not be rushed. We should not be scaring 
seniors into picking a plan that may not work for them because of a 
penalty they will receive after next Monday. Unfortunately, that is 
exactly what is happening.
  Unfortunately, I continue to believe the ``D'' in Medicare Part D 
stands for disaster. That does not mean some people are not getting 
helped. We want people to be helped. We want people who have not 
otherwise had help to be able to receive it. That is a very important 
point in this process because the administration has been talking about 
the 29.7 million seniors who are now covered, seniors and disabled who 
now have drug coverage under Part D.
  But what they are not saying, of the 29 million, 20 million already 
had coverage. They were covered under Medicaid, they were covered under 
private insurance, under a Medicare HMO. We are talking about less than 
30 percent of those who have not had any help with their medicine, less 
than 30 percent, have actually signed up so far.
  Is it because they do not want help? Of course not. It is because 
they are having challenges getting through the bureaucracy and trying 
to figure out what works for them and what does not work for them?
  I will share a story of a woman who called me yesterday. This 
exemplifies the thousands of calls and stories I receive in Michigan. A 
member of my staff spoke with Shirley Campbell from Midland, MI, 
yesterday, not far from my hometown. Shirley told my staff about the 
experience she and her sister had enrolling in Part D. First, they had 
a terrible time getting through to the so-called ``help'' line.
  By the way, the Government Accountability Office says almost 60 
percent of the time folks trying to get through to the 1-800 Medicare 
number are getting incomplete or inaccurate information. That is 
stunning. We have to get our act together before we penalize people for 
not signing up for a program.
  She kept trying. Shirley kept trying. Once she got through, in 
response to her question, she was told, ``I can't answer that question 
because the site is down.'' She did not give up. She called back the 
next week and she called back the following week. Each time she had the 
same experience. She could not get an answer to her question because 
``the site is down.'' This is the administration's idea of a ``help'' 
line? It is not much help.
  Because Shirley could not get the information she needed from the 
administration, she called several plans and asked them all to send her 
their information. Imagine how big that mailbox was. Then she and her 
sister sat down and spent more than 10 hours sifting through all the 
information they had received. They narrowed it down to six plans and 
began a thorough analysis.
  What did they find? From the six plans, all of the plans would cost 
Shirley more than she is currently paying for the medications necessary 
for her rheumatoid arthritis. Six plans she narrowed it down to, and 
all of them would cost her more than what she is currently paying. 
Shirley currently does not have any coverage. Yet she would end up 
paying more under any of the six plans she studied.
  Think of that. We are trying to help people who do not have coverage, 
and less than 30 percent of the folks who have signed up have been 
people who did not have help before. Maybe it is because they were like 
Shirley, when they tried to find someone to help them, they found out 
they would be paying even more under this privatized scheme that has 
been set up than they are currently paying.
  She also told my staff that most of the plans would have cost her 
twice as much as she is now paying. But she ended up choosing a plan 
that would cost her more than what she is currently paying, even though 
she currently does not have any coverage. She says she signed up 
because she was worried about the looming May 15 enrollment deadline 
and the prospect of paying a penalty for the rest of her life.
  What sense does this make? Folks are seeing the clock count, 6 days 
away, until the May 15 deadline and penalty. And Shirley is so worried 
about what that means down the road, the cost she would be paying and a 
lifetime penalty, she signs up for a plan that costs her more than she 
is currently paying. I don't believe Shirley or any senior should be 
rushed into a premature decision because of an arbitrarily determined 
deadline. That is all this is. There is nothing magical about May 15, 
nothing at all.
  Shirley worked in middle management all her life. She had the ability 
to spend hours and hours wading through the plan, the brochures, the 
paperwork. In the end, she had to make a decision that leaves her worse 
off than she is today.
  Shirley wrapped up her experience of choosing a Part D plan by 
saying, ``I never in a million years would have done anything like this 
to my staff.''
  She then asked my health legislative assistant to deliver the message 
to me that the Medicare Part D Program needs to be fixed. Amen. I could 
not agree more with Shirley.
  This is Health Week. This is the time to fix it. The first thing we 
need to do to fix it is to give folks more time.
  I am proud to be joining Senator Bill Nelson on legislation to extend 
the deadline to the end of the year. If given the opportunity, and I 
hope we will have the opportunity, we intend to offer that as an 
amendment, as we proceed with Health Week. People should not be 
penalized because the Government cannot get its act together. People 
should not be penalized when almost 60 percent of the time when they 
call a hotline they cannot get the information they need, it is 
inaccurate or incomplete. That is not their fault.
  The whole point of this was to make sure we were helping people who 
were choosing between food and medicine, people who were choosing 
between medicine and paying the rent, the electric bill or gas prices 
right now. If that is not happening, why are we moving full steam ahead 
with some arbitrary deadline? Six days from now, folks are going to be 
penalized because the Government has been slow to get its act together, 
and they will be permanently penalized by paying more.
  Less than 30 percent of the people who do not currently get help 
paying for their medicines have actually signed up. That should say 
something. It should either say, it is not a good deal, and they found 
out they would be paying more, and they said forget it or it says to us 
that maybe we need to go back to the drawing board and make sure the 
right information, in the right way, is given out to people so they can 
make the best decision for themselves.
  I am also extremely concerned that in my home State of Michigan only 
22 percent of the 256,000 seniors eligible for low-income help, only 22 
percent of those whom we said we wanted to help the most by waiving the 
premium and the copay, only 22 percent have signed up to get that extra 
help.
  Unfortunately, our low-income seniors are caught twice because they 
have to pick a plan. They have to, similar to Shirley, wade through all 
kinds of plans. Then they have to sign up separately to be able to get 
low-income help.
  I am pleased the administration has said they will allow low-income 
seniors to be able to sign up after May 15. I appreciate that. That is 
a good start. Unfortunately, the penalty is not waived. Our lowest 
income seniors, even though they may be able to sign up in June, July, 
and August--and that is a good thing and I appreciate the 
administration doing that--I urge them to waive that penalty. It makes 
no sense if you allow people to sign up for extra help and then take it 
away through a penalty for signing up late.
  The final issue is our poorest seniors, our lowest income seniors in 
Michigan and individuals making less than $14,700 a year, our lowest 
income seniors or the disabled, in too many instances are actually 
paying more under this plan than they were before. Why? Because they 
were on Medicaid before for the low-income health care. In Michigan, 
that meant paying a $1

[[Page S4177]]

copay for a prescription, and that has doubled, tripled or gone higher. 
This also makes no sense.
  On top of that, those who were in Medicaid, our lowest income 
seniors, many in nursing homes, were automatically enrolled sometime in 
the last few months, into a plan, regardless of whether it covered the 
medicines. We have said to the lowest income seniors, many of them in 
nursing homes, you are signed up for a plan, and you have to go figure 
out whether it even helps you and how you are going to get out of it if 
it doesn't help you. And, by the way, you are going to pay more.

  We can do better than this. I believe No. 1 is to stop the 6-day 
count. No. 1, we have to give folks more time to wade through all of 
this, to figure out what is going on, and we have to give some more 
time to the Government to get its act together. The administration is 
doing a disservice to people by the way this has been handled. Giving 
more time will allow that to happen.
  I am also very hopeful we are going to come back and come together 
and give people the one choice they really want. People do not want 70 
plans. They are not saying: Oh, please, give me a whole bunch of 
insurance papers to wade through. Give me increased premiums. Give me 
all kinds of deadlines to deal with. What they said was: I need help 
with my medicine.
  We are blessed in this country to have more medicine available as a 
part of the way we allow ourselves to live healthier lives, longer 
lives, to be able to treat cancers, to be able to treat other chronic 
illnesses. Medicines are available now. But they are not available if 
they are not affordable. We can do better.
  Mr. President, I am hopeful at some point we are going to come back 
to this floor and give people the choice they want: A real Medicare 
benefit through Medicare, with a reasonable copay and premium, where 
you sign up and you can go to your local pharmacy, and Medicare 
negotiates good prices. That is what we ought to be doing.
  In the meantime, let's stop the countdown to May 15.
  Thank you, Mr. President.

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