[Congressional Record Volume 152, Number 56 (Wednesday, May 10, 2006)]
[Senate]
[Pages S4259-S4262]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     EXTENSION OF MORNING BUSINESS

  Mr. ALEXANDER. Mr. President, on behalf of the leader, I ask 
unanimous consent that at 2 p.m. the Senate extend morning business 
until 2:30 p.m. with the time equally divided between the majority and 
minority, and upon conclusion at 2:30 p.m. the majority leader be 
recognized.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ALEXANDER. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. KENNEDY. Mr. President, I ask unanimous consent that the order 
for the quorum call be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KENNEDY. Mr. President, I will yield myself such time as I might 
use.

[[Page S4260]]

  Mr. President, as I mentioned earlier, we thought we would have a 
good opportunity to have a good, healthy debate on a range of different 
health policy issues. This was designated as Health Week. A number of 
our colleagues had some very important amendments--some that are 
extraordinarily timely--one by the Senator from Florida, Mr. Nelson, to 
address what is going to be effectively a new tax or fee on millions--
the best estimate is 8 million of our senior citizens--who are not 
enrolled in the Medicare Part D Program. That will cost seniors 
hundreds of millions of dollars if that is not the addressed. We have a 
good opportunity to address that in the Senate.

  We have the issues on stem cell research. That is enormously 
important legislation at the desk. The bill offers such extraordinary 
hope to millions who are affected by Parkinson's disease, Alzheimer's 
disease, diabetes, other genetic diseases. The possibilities are 
unlimited. I call it the hope bill because it offers so much hope. We 
thought we might have an opportunity to move forward on that. There are 
a clear majority of Senate Members who are for a good stem cell 
research program.
  We have passed a good program in my own State of Massachusetts, 
Republicans and Democrats alike coming together, as we would on this 
legislation, but we are not going to be able to address that issue.
  The whole issue about whether we give the Medicare system the ability 
to negotiate lower prices for prescription drugs that could benefit our 
seniors is something the VA does and it does very effectively. It saves 
millions and billions of dollars for our elderly people because of the 
ability to get a better price, which Medicare is prohibited from doing 
now. We believe we should at least have an opportunity to debate that 
issue and come to judgment on it. It can make a major difference. These 
are just several of the amendments out there.
  I was looking forward to offering an amendment to the Enzi 
legislation that permits States to opt out of the Enzi proposal, if 
they so desired. It sounded to me that we had a vote on that issue in 
our Committee on Human Resources, and it was defeated. It seems to me 
we should give the State the option.
  We have had at least a pretty good discussion of the underlying Enzi 
bill, which effectively means skyrocketing premiums for many if they 
are older or have had some illness in their families. I will get into 
that in greater detail. But we permit States to opt out. That was 
defeated. We ought to have an opportunity to vote on that in the 
Senate.
  All this can be done. I know the proponents of the amendments would 
be willing to agree to very reasonable time limitations on this. 
However, we effectively are being told that is not going to be 
possible. We are going to have a take-it-or-leave-it approach. That is 
not the wise way to proceed. I certainly hope we are not going to have 
to be required to take it.
  I will review some of the statements and comments made by some of 
those who have been in support of this legislation that need focus, 
attention, and some correction. Those who support the Enzi proposal are 
doing it enthusiastically, but I think it is worthwhile to put the 
facts out on the table. The facts are we have some 47 million Americans 
who do not have health insurance. The fact remains, as we have seen in 
the Congressional Budget Office, the Enzi proposal actually benefits 
some 600,000. That is 1 percent of the 45 million who are uninsured.
  In my State of Massachusetts, the Democratic leadership, with Sal 
DiMasi and President Travaglini coming together with Governor Romney, 
have the goal of covering 95 percent, minimum. Most believe we will get 
to 98 percent of all the people in our State. It is a valuable 
undertaking.
  We have a proposal with 45 million uninsured and we expect, according 
to the Congressional Budget Office, some 600,000 will be included. That 
is from the assessment on page 5 from CBO.
  In terms of the firms themselves, the CBO has pointed out one-quarter 
of all the small business firms will actually pay more for their health 
benefits. Those that support it have neglected that. A quarter of all 
the firms under the Enzi bill will have to pay more.
  That is not true with the Durbin-Lincoln proposal, and the Durbin-
Lincoln proposal will cover millions--not 600,000--millions of small 
businesses.
  These are some of the facts from CBO. The premium decrease, according 
to CBO, would be 2 percent to 3 percent, a one-time savings of only $80 
to $120 for the average individual and $215 to $325 for a family plan. 
The cost is lesser benefits. If you are going to eliminate your cancer 
screening, your well-baby care, your help and support in terms of 
diabetes, if you are going to eliminate the mental health benefits, 
sure, you can get some reduction in premium. That is what they do. But 
in State after State, including mine, we have those protections. That 
is the savings, one-time savings, according to the Congressional Budget 
Office.
  For those who want to have a good understanding of exactly what this 
bill does and what it does not do, I hope they will have a chance to 
review the CBO estimate and analysis because it is at odds with a great 
deal of what those who have been supporting the proposal have stated. 
Finally, the total savings on employer-sponsored coverage are two-
tenths of a percent.
  On the other hand, let me mention an excellent analysis that has been 
done by Alex Feldvebel, the deputy commissioner in New Hampshire and an 
expert on this type of health insurance issue. These are his comments, 
talking about the market relief. That is what we call the ratings. What 
is the swing in a particular State? States can vary the ratings in 
terms of the market.

  In, Alaska 2.5 percent to 1; Arkansas 3.3 to 1; California, 1.2 to 1. 
If you are an older person, older worker, if your family has maybe had 
some illness, you can only vary the premiums 1.2 percent in the State 
of California. In my State, it is 3 percent, 3 to 1. There are a number 
of States, such as New York, where you cannot change it. You cannot 
vary it. Everyone is in the same boat, so to speak.
  Now, in the Enzi proposal, listen to this regarding the ratings, the 
permitted rate variation under this small group market rules is 
extreme. The total permitted variation between the highest rate group 
and the lowest rate group for the same health benefit is 25.4 to 1, or 
2,540 percent. If the lowest rate is paying $100 per month, the highest 
rate would pay 2,500 per month. If you are young and healthy and just 
out of school, they give you the physical, and you are an A-1 specimen, 
you get it for $100. But if your family has had some illness or 
sickness and maybe your company has dropped its health insurance, if 
you have to purchase this, you can pay $2,500. Think what that will do. 
That is obviously going to be prohibitive, and more and more people 
will be left out.
  Here is how the variable comes out. Age, 500 percent. Gender, 25 
percent, it should be saying, women, 25 percent. They are 
automatically, under these calculations in this bill, gender, will be 
paying a higher premium. This is the Enzi legislation. And the variance 
continues. If you are in a wellness program, you get a 5-percent 
benefit. If you come in with a whole group of very young people who are 
very healthy, you can get a 40-percent reduction, but if you are an 
older person with sickness, you are up to 500 percent. That is the 
variation.
  That is not acceptable. We all know what is going do happen. That is 
going to be the incentives.
  This legislation, on page 100, talks about the definition relating to 
the model ``small group'' and those who supported the legislation use 
the Model Small Group Rating Rules for the Small Employer Health 
Insurance Availability Model Act of 1993. It is interesting that the 
insurance commissioners have upgraded this review and study several 
times. Do you think we are dealing with the most recent publication? 
No. We are back to 1993. It is the insurance organization, the NAIC 
model, that basically has been rejected and repudiated by the State 
insurance commissioners.
  All you have to do is read from your own insurance commissioners, and 
they ask: Why in the world would the Senate use an old model, when we 
have much more recent information, much more updated information? The 
reason is, if you use this, the profits for the insurance industry are 
going to be much higher.

[[Page S4261]]

  We ought to understand that. The insurance commissioners themselves 
have effectively rejected this particular proposal.
  If we go to page 110, we will see ``Superseding of State Law.''

       This part shall supersede any and all State laws . . .

  This does not just say small business. This is about all State laws. 
Here it is, the clinical trials, cancer screening, diabetes, 
effectively preempt all the State laws, to and after the date relating 
to rating and in the small group insurance market.
  It says to Massachusetts and to most of the States, if you have a 
benefit package, those are going to be preempted. That is what it says 
right there on page 110.

  Page 110 actually is where it permits the fluctuation of the rating 
system. It talks about ratings. And that gives you the flexibility that 
I have mentioned. And then the preemption of State benefits is actually 
on page 119.
  I would have thought, if we were serious about trying to do something 
for small business, we would have had the opportunity--Mr. President, 
how much time do I have left?
  The PRESIDING OFFICER. The time under the control of the minority has 
now expired.
  Mr. KENNEDY. My time has expired?
  The PRESIDING OFFICER. Yes, the Senator's time has expired.
  Mr. KENNEDY. I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. THUNE. Mr. President, the debate we are having today on small 
business health plans is a debate that I hope will ultimately lead to a 
vote in the Senate on this legislation.
  This bill, or something very similar to it, has passed the House of 
Representatives on eight--eight--different occasions. Small business 
health plans have passed the other body, the House of Representatives, 
on eight different occasions.
  I believe if we were allowed to vote today on this legislation in the 
Senate, we would have a big majority vote--a decisive majority vote--
because I believe a majority of Senators support the legislation that 
has been produced by the Health, Education, Labor, and Pensions 
Committee under the leadership of Chairman Enzi. I believe there is 
strong majority support for that in the Senate.
  Unfortunately, what will happen today--and in the days ahead--is we 
will not get a chance to have that vote because our colleagues on the 
other side have decided again to filibuster this legislation, to block 
it from ultimately being voted on. That is unfortunate. It is 
unfortunate for, most importantly, the people across this country who 
do not have health insurance coverage.
  Mr. KENNEDY. Will the Senator yield on that point?
  Mr. THUNE. I will not yield at this point. You had your time, 
Senator.
  Mr. KENNEDY. I was wondering if you would yield for a question.
  Mr. THUNE. I am not prepared to yield at this time. I will allow you 
to speak on your own time.
  But the important point is that this particular legislation has not 
had an opportunity to be voted on in the Senate, legislation that would 
help small businesses in this country that currently cannot cover their 
employees, that currently have families of those employees without 
coverage.
  In fact, if you ask small businesses today--and about 22.5 million of 
the 45 million uninsured in this country are employees of small 
businesses or are their families, and about another 15 million are 
self-employed in small businesses--the reason they cannot cover their 
employees is the cost.
  What this legislation attempts to do is address the issue of cost, to 
make health insurance more affordable to more Americans, to small 
businesses, to their employees, to their families, to self-employed 
people in this country who currently do not have coverage because of 
the cost.
  It is a very simple concept. It is a concept that has been passed 
eight times by the House of Representatives but never voted on in the 
Senate because of obstruction on the other side. They will not allow it 
to come to a vote. That is unfortunate because this is an issue the 
American people expect us to address.
  So I hope when all is said and done, my colleagues on the other 
side--the Senator from Massachusetts has strong feelings on this 
particular issue, which he has articulated--have an opportunity to air 
those opinions, to debate this issue, but that, in the end, they let it 
be voted on.
  Let's let this come to a vote. Let the will of the majority in the 
Senate decide one way or the other about whether we want to do 
something about the high cost of health care in this country to cover 
more people.
  The Congressional Budget Office has said--the Senator from 
Massachusetts quoted the CBO--the Congressional Budget Office has said, 
if this legislation is enacted, almost a million more people in this 
country will be covered and, in fact, it will lead to lower insurance 
costs.
  So it is a good deal for the people who are uninsured. It is a good 
deal for the small businesses that are trying to cover their employees. 
And I might add, it is a good deal for the taxpayers because the 
Congressional Budget Office has also said if this particular piece of 
legislation is enacted, the cost of Medicaid to the Federal Government 
will go down by almost $1 billion and the cost of Medicaid to State 
governments will go down by about $600 million.
  Further, the Congressional Budget Office has also found that this 
will actually lead to higher revenues for the Federal Government. Why? 
Because when the small business cost of health care goes down, they are 
able to provide more benefits and more in the form of salaries to their 
employees. Those salaries and some of those benefits are taxable. 
Health insurance benefits are tax excluded in many cases. So those 
benefits and those additional salaries would be taxed at the marginal 
income tax rates, and it would generate, according to the Congressional 
Budget Office, an additional $3.3 billion over a 10-year period for the 
Federal coffers.
  So we have a bill that covers more people, according to CBO, that 
lowers insurance rates, according to CBO, and that actually generates 
more revenue for the Federal Government. Yet we cannot vote on it. Why? 
Because our colleagues on the other side will not allow this 
legislation to be voted on.

  I think the American people deserve and expect more from their 
elected leadership. As I said, the House of Representatives has voted 
eight times in support of this, with strong majorities. I believe there 
is a majority in the Senate in favor of this bill, if we could bring it 
to a vote today. Maybe we won't vote on it today. Maybe we would vote 
on it tomorrow or maybe we would vote on it next week, but let's vote 
on it.
  Let's vote. That is what we are here for. Let's debate the issue, but 
let's vote. Let's not use the rules of the Senate to obstruct something 
that has clear majority support in the House, something that has been 
debated here but never voted on in the Senate because it has been 
blocked from final consideration.
  Let me also say one other thing about this debate because there is a 
proposal that has been talked about some on the floor of the Senate, 
offered up by some of our colleagues on the other side, that is 
intended to respond to the Enzi legislation, the small business health 
plan legislation, that we are currently debating.
  Interestingly enough, that particular piece of legislation offered by 
our colleagues on the other side is a Government-type approach to this 
issue. The CBO, the Congressional Budget Office, has found that the 
proposal they put forward actually costs the taxpayers $73 billion over 
a 10-year period.
  So you have two bills. You have a bill that has been offered by 
Senator Enzi, the chairman of the HELP Committee, offered by the 
leadership on this side of the aisle, which lowers cost, which covers 
more people, which has been found to actually save the taxpayers money; 
and a bill that has been offered by our colleagues on the other side, 
at a cost to the taxpayers of $73 billion in additional tax dollars 
over a 10-year period.
  Now, it seems to me, at least, that if you are a taxpayer, that bill 
is not a very good deal. It is also a proposal that leads to more 
redtape, more bureaucracy, more Government, at a time when we ought to 
be looking for ways to improve the market-based system we currently 
have in this country, by

[[Page S4262]]

allowing our small businesses to take advantage of the leverage they 
could gain by joining larger groups.
  The very simple principle behind this legislation, behind the Enzi 
bill, is to allow small businesses around this country and their 
employees to be part of a larger group, thereby driving down the cost 
of their insurance premiums.
  Mr. DURBIN. Will the Senator yield for a question?
  Mr. THUNE. I will not yield at the moment. We have a few minutes left 
on our time, and then the Senator from Illinois could use his time to 
speak.
  Mr. DURBIN. Will the Senator yield for a question?
  Mr. THUNE. Not at the moment. Thank you, though.
  What I would simply say is, the bill offered by the Senator from 
Illinois and by his colleagues on the other side is, again, legislation 
that comes at a high cost to the taxpayers: $73 billion over a 10-year 
period.
  So it is important, when we have this debate, that the people in this 
country who are following the debate have a clear understanding of what 
the differences are between the approaches that are being offered--the 
Enzi bill, the bill that is under consideration today, the small 
business health plans bill, and the bill offered by our colleagues on 
the other side--the differences in terms of their approach, one being a 
Government approach, one being a market-based approach, one actually 
being scored by the Congressional Budget Office as achieving savings 
for the Federal taxpayer, and one that clearly adds to the costs of the 
taxpayer by about $73 billion over a 10-year period.
  This has been dubbed Health Week because we are debating health care 
legislation. Small business health plans is one component of that. We 
also tried, Monday, to get a vote on legislation that would allow for 
reforms in our medical malpractice system that would, hopefully, again, 
drive down the cost of covering people in this country. The high cost 
of medical malpractice insurance is driving OB/GYNs and other 
specialists and providers out of the profession, driving up the cost of 
health care in this country.
  In fact, the Department of Health and Human Services, a couple years 
ago, did a study that suggested the cost of defensive medicine and the 
cost of the medical malpractice system we have in the country today is 
actually costing the taxpayers, under Medicaid, an additional $22.5 
billion a year.
  It is important we address these issues. I believe the American 
people want us to act. More importantly, they want us at least to vote. 
That is all I am simply saying. For those on the other side who have 
consistently resisted the enactment of these two pieces of legislation, 
that is fine. I understand that is part of this process, that we have a 
very open and free-flowing debate. That is part of the Senate. That is 
part of our democratic process we have here.
  But when all is said and done, let's bring this to a vote so the 
people of this country, who expect action out of the Senate, at least 
know where their elected folks stand when it comes to the issue of 
small business and whether we are going to provide health care for the 
employees of small businesses across this country and whether we are 
going to do anything to address what I think is a very important 
economic issue to a majority of Americans; that is, this ever-rising, 
increasing cost of health care.
  These two pieces of legislation--small business health care plans, S. 
1955, offered by Senator Enzi, the chairman of the HELP Committee--and 
it is a bipartisan bill; it also has Democratic support, although not 
enough to stop a filibuster--and the medical malpractice reform 
legislation, which, again, there were two pieces of medical malpractice 
reform legislation voted on Monday--we were not able to get enough 
votes to stop a filibuster to invoke cloture--but, there again, I 
believe both pieces of legislation have majority support in the Senate 
and, clearly, have majority support in the House of Representatives.
  They have already passed there repeatedly. Small businesses health 
plans have passed eight times in the House of Representatives. Medical 
malpractice reform has passed five times in the House of 
Representatives. That legislation has come to the floor of the Senate 
and has been blocked from receiving an up-and-down vote.
  I think it is in the best interest of people across this country who 
are expecting Congress to act on the issue of health care and the high 
cost of health care. They want us to come up with solutions that 
respect and are in the best interest of the American taxpayer. I 
believe these two pieces of legislation accomplish that objective.
  So I hope before this Health Week is over--and even if we have to 
push this into next week--we at least get a vote on the floor of the 
Senate that will enable us to take final action on a couple of pieces 
of legislation that have been lingering around here for way too long 
and deserve action by the Senate.
  With that, Mr. President, I yield back the remainder of my time.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. FRIST. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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