Congressional Record, Volume 152 Issue 56 (Wednesday, May 10, 2006)

[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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