[Congressional Record Volume 152, Number 57 (Thursday, May 11, 2006)]
[Senate]
[Pages S4447-S4460]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  HEALTH INSURANCE MARKETPLACE MODERNIZATION AND AFFORDABILITY ACT OF 
                             2006--Resumed

  The PRESIDING OFFICER. The Senate will proceed to the consideration 
of S. 1955 which the clerk will report.
  The assistant legislative clerk read as follows:

       A bill (S. 1955) to amend title I of the Employee 
     Retirement 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 of the health 
     insurance marketplace.

  Pending:

       Frist amendment No. 3886 (to S. 1955 (committee substitute) 
     as modified), to establish the enactment date.
       Frist amendment No. 3887 (to amendment No. 3886), to change 
     the enactment date.
       Motion to recommit the bill to the Committee on Health, 
     Education, Labor and Pensions, with instructions to report 
     back forthwith, with Frist amendment No. 3888, in the nature 
     of a substitute.
       Frist amendment No. 3889 (to the instructions of the motion 
     to recommit), to change the enactment date.
       Frist amendment No. 3890 (to amendment No. 3889), to 
     provide for the enactment date.

  The PRESIDING OFFICER. Under the previous order, there will be 60 
minutes of debate equally divided between the Senator from Wyoming, Mr. 
Enzi, and the Senator from Massachusetts, Mr. Kennedy, or his designee.
  Who yields time?
  Mr. FRIST. Mr. President, we have a lot going on on the floor, and we 
are going to have one more vote today, and it will be up to an hour 
from now. But what we would like to clarify is who needs to speak from 
our side. Chairman Enzi is right here. Do we have anybody on our side? 
I know Chairman Enzi will be speaking. Is there anybody else from our 
side?
  I ask the Democratic leader through the Chair who will be speaking on 
their side.
  Mr. REID. Mr. President, the only request for time I have at the 
present time is for the Senator from Arkansas, Senator Lincoln, for 7 
minutes. Is there anyone who wishes to speak? Senator Kennedy wants 10 
minutes. Senator Durbin may request time, I think 7 minutes for Senator 
Durbin. No for Senator Durbin. So 7 and 10, 17 minutes over here.
  Mr. FRIST. Mr. President, I ask our chairman approximately how much 
time we would need. What we want to do is try to get the time down as 
far as we can. We have a number of people who have plans that they need 
to make, and we would like to vote as quickly as we can, but we want 
adequate time to speak.
  Mr. President, through the Chair, I ask the Democratic leader, would 
it be agreeable that we have a unanimous consent request propounded 
that we vote at 10 minutes after 6, the time equally divided between 
now and then?
  Mr. REID. Does that give us our 17 minutes? I ask to amend the 
request to 17 minutes on each side.
  Mr. FRIST. So to restate, I ask unanimous consent for 17 minutes on 
either side, so the vote will be at approximately 14 minutes after 6 
o'clock.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Arkansas is recognized.
  Mrs. LINCOLN. Mr. President, I was so excited when we came to work 
this week with the opportunity to focus our Nation and the debate of 
this body toward health, the health of our Nation, the health of our 
people, and the health of our businesses, the fabric of this country, 
the fabric of our Nation. It is such an important thing for so many of 
us--certainly, each of us in our own families. I have small children 
and aging parents.
  All of us have responsibilities in our own lives and responsibilities 
to our constituencies. We have different constituencies such as the 
elderly who live in our communities and the small businesses that are 
striving hard to keep our economy going; children, and those with 
chronic diseases and illnesses who desperately need to make sure that 
the coverage they have is sufficient for what they may have or may not 
have, but want to make sure that they are protected against in case, 
unfortunately, something might happen.
  So as we came to the Senate this week to talk about health and how we 
could make health a very real part of the discussion in this Nation, a 
real part of what it meant to our economy and to our people and the 
quality of life, the real value of who we are as Americans, I was 
excited. Yet I saw so much of it cut short. The discussion that started 
on Monday ended with a line in the sand that said: My way or the 
highway, not let's work a deal and let's figure out what will make 
health care real in this Nation and sustainable and that will make 
sense in our communities. Then we moved to talking about how we deal 
with small businesses. To me, the most important thing we can do for 
our small businesses is to make available to them affordable, 
accessible health care but quality health care, the same kind of 
benefits that we ourselves as Members of Congress are blessed enough to 
be able to experience for our families and for ourselves.
  As we proceeded into this debate, way too much of the debate centered 
around not what we could work hard to do that was right but what people 
wanted. Then, all of a sudden, we leave abruptly this incredibly 
important debate.
  We leave behind this incredibly important debate to talk about a tax 
bill for tax cuts that don't even expire until January of 2009, instead 
of looking at something real and new, such as a new tax cut for small 
businesses to engage in the health insurance marketplace for their 
employees and for themselves or looking at how we could extend tax cuts 
that had expired, such as research and development and for education 
and tuition and so many more things that have been productive in our 
economy and in our communities. We go through this debate, and we come 
back now to finalize debate on the health care of our Nation. And what 
have we done? We have missed an opportunity to say to our seniors they 
are important enough that we are going to extend a deadline, a deadline

[[Page S4448]]

that means so much for them to be able to take the time and the 
opportunity to understand this new prescription drug component of 
Medicare that we have passed.
  I voted for it, Mr. President, and I want it desperately to work. I 
have been out in the field in Arkansas, and I have made sure I met with 
seniors. We have hosted meetings and tried to educate, but there simply 
has not been time enough to get to the complexity of what is offered 
out there. We look back at what efforts have been made. The GAO has 
reported that one-third of seniors' calls to Medicare operators 
resulted in flawed or no information. Think about that for a moment. 
One in three seniors who called CMS for help were given bad or no 
information. Now those seniors must make difficult, sound decisions 
about their health care by Monday of next week. I wish we had been 
given the opportunity to make a difference in that.

  I wish we had the ability to make the difference for small 
businesses, offering them again the same opportunity we have, to enjoy 
quality health insurance at a low cost, with many choices for the 
variety of Federal employees who work in this great Nation. We can do 
the same. We could allow employers and small businesses and self-
employed individuals--think about that, a one-man shop--to reap the 
benefits of group purchasing power and streamlined administrative costs 
as well as access to more plan choices.
  The proposal we had looked to present would create all of that, 
without any new bureaucracy. How about not reinventing the wheel? For 
once, we in Government would use something that was time tested for 40 
years, has a 1-percent administrative cost, that we could implement for 
small businesses and bring to them again the same quality of product we 
enjoy as Members of Congress.
  On top of that, we could have incentivized it and brought them a new 
tax cut, a new tax benefit in order to be able to invest in themselves 
and in their employees and provide the kind of health care they 
deserve.
  It is hard for me to believe that we have missed all of those 
opportunities: to be progressive, to be thoughtful, to invest in our 
country, to make sure we are taking care of the fabric of this Nation 
and who we are.
  About 53 million Americans work for businesses with less than 100 
employees. That pool is bigger than the Medicare population, which is 
about 42 million. Think of what we could do in offering those small 
businesses that type of a pool, to be able to bring down their costs, 
increase their choices, and maintain the quality they have demanded, 
the types of services they may need now or that they may need in the 
future, whether it is diabetes or cancer screening, making sure that 
immunization and child well care are all in there. We had an 
opportunity to do this and many things and we have missed that 
opportunity.
  Working families and small businesses need help. Our seniors need 
help. Our community providers need help.
  Mr. President, I ask for an additional minute.
  Mr. KENNEDY. Mr. President, how much time do I have?
  The PRESIDING OFFICER. The Senator has 10 minutes.
  Mrs. LINCOLN. Thank you, Mr. President. I encourage my colleagues to 
look at the missed opportunities and pull together to make a difference 
for the people of this country.
  The PRESIDING OFFICER. The Senator from Nebraska.
  Mr. NELSON of Nebraska. Mr. President, as many of you are aware, I am 
a former insurance commissioner from Nebraska. For several years, I 
served as the head of the National Association of Insurance 
Commissioners and spent most of my adult working life, except for 
Government service here and in the State house, in the insurance 
business. I do not propose that I can propound I am an expert, but I do 
think I have some experience in this field.
  I know you have heard from small businesses in your States. The 
average cost of health care premiums has doubled in 5 years for small 
businesses. Everywhere I have gone around the State of Nebraska, every 
small business owner I have spoken to has told me the same story: We 
either can't afford or we can't find health care coverage for our 
workers. We are very concerned about that. What can you do to find a 
solution?
  They pushed me toward the House version of the associated health 
plans. I couldn't support that unregulated form of self-insurance for 
the promoting of insurance on an association basis. I couldn't support 
it. There was no guaranteed fund protection, no requirement for the 
filing of forms--nothing. I could not support it.
  I also knew the status quo where there are now more mandated 
coverages in several States than people can afford, so the status quo 
continues to add to the problem, creating more and more uninsureds. We 
now have gone to the total of 40 to 45 million uninsured, and the 
number continues to grow.
  I am pleased that the Senate is finally debating the problem. We all 
recognize it is here and it needs to be solved. I agree with my 
colleague from Arkansas that we need to spend time on this. We just 
disagree on how to get there.
  More time is important, but I can tell you right now that the 
chairman of the committee, Senator Enzi, has spent more time listening 
and listening and acting on suggestions than I have ever seen happen in 
this body. We could probably spend more time, but I think that is what 
it is about, that is what a cloture vote is about, spending more time 
rather than cutting it off at this point in the discussion. I believe 
we were starting to make progress in finding the solution when Senator 
Enzi and I and our staffs began to talk with one another about how we 
might solve the problem of having an uninsured plan with an insured 
plan with regulatory oversight, but cutting out the unnecessary cost to 
reduce overhead expense, therefore reducing the cost of the premiums, 
making it more available and more affordable to the employees and to 
the owners.
  I didn't want to create an adverse playing field between association 
health care plans and the small group market. The traditional AHP bill 
gave a rating and mandate advantage to association plans that resulted 
in adverse selection and an unlevel playing field. The proposed SBHP 
legislation has eliminated this unfair playing field by including rules 
to prevent these problematic practices and at the same time requiring 
all insuring entities to abide by the same regulations.
  Therefore, there is more than a modicum of State regulation 
associated with this plan--on a financial solvency basis, on a rating 
basis, and fairness as to the practices that could be provided.
  Unlike AHPs, SBHPs must be fully insured and marketed by State-
licensed insurance companies. The insuring entities must meet the 
capital and solvency requirements within each State they operate, 
comply with the consumer protection laws in each State, pay the 
applicable premium taxes, and be part of any assessments associated 
with high risk pools and/or guarantee funds. As a former State 
insurance commissioner, keeping State regulation involved in this 
process was important to me because I know the value of State insurance 
regulation.
  Competition will return to the small group market when we move 
forward with this legislation. The market will expand. There will be 
more opportunities today than ever before when this passes. The rates 
will be in competition as well. Everybody will benefit.
  There are those who have suggested that this is not in the best 
interests of some special interest groups. Senator Enzi and I and our 
staffs have met with these individuals and in some cases we have made 
the changes that would take away the concerns they have, but they still 
oppose the bill.
  It seems to me what we need to do is refine this legislation after a 
cloture vote and listen to the proposals that will be brought up. If 
there are better ideas out there, I know this body will find them. But 
to close it off at this point in time is to say no to small business. 
It is to say we don't care enough to move forward, to consider other 
proposals, but we simply are going to close debate.
  I hardly ever vote to avoid moving forward and I am not going to vote 
against it now. I am going to vote to go to cloture so we can get a 
chance, if we get 60 votes. I would hate to see us be four or five or 
six votes short of that process because I think there is too much at 
stake for our small businesses, too much at stake for us not to be able

[[Page S4449]]

to find solutions. I am afraid if we don't move forward and debate it 
fully and see what we can do on the floor of the Senate, it will carry 
over into another year.
  I have been here long enough to know when somebody says we will do it 
next year, you can't always count on next year coming. I think it is 
important we move this forward.
  I yield the floor.
  Ms. COLLINS. Mr. President, the Senate has spent much of this week 
debating S. 1955, the Health Insurance Marketplace Modernization and 
Affordability Act of 2006. I commend my good friend and colleague from 
Wyoming for all of his hard work on this legislation, which is intended 
to make health insurance more affordable for small businesses by 
allowing them to join together to purchase association-based small 
business health plans. Despite my support for the goal of this bill, I 
think its approach is fundamentally flawed. Let me explain my concerns.
  One of my top priorities in the Senate has been to expand access to 
affordable health care for all Americans. There are still far too many 
Americans without health insurance or with woefully inadequate 
coverage. As many as 46 million Americans are uninsured, and millions 
more are underinsured.
  Since most Americans get their health insurance through the 
workplace, it is a common assumption that people without health 
insurance are unemployed. The fact is, however, that as many as 83 
percent of Americans who do not have health insurance are in a family 
with a worker.
  Uninsured working Americans are most often employees of small 
businesses. In fact, some 63 percent of uninsured workers either work 
for a small firm or are self-employed. Taking a look at the problems 
faced by small businesses is, therefore, a good place to start as we 
attempt to reduce the numbers of uninsured.
  Small businesses want to provide quality health insurance for their 
employees, but the cost is often just too high. So I am totally in 
agreement with the underlying goal of this legislation, which is to 
make health insurance more affordable for small businesses and their 
employees. To that end, I have introduced bipartisan legislation to 
help employers cope with rising costs by creating new tax credits for 
small businesses to make health insurance more affordable and by 
providing grants to States to assist with the development and operation 
of small employer purchasing cooperatives to increase the clout of 
small businesses in their negotiations with insurers.
  I do, however, have a number of very real concerns about S. 1955, as 
it was reported out of the Senate HELP Committee.
  First, the legislation preempts the States' traditional authority to 
regulate insurance and allows not just small business health plans but 
all health insurers to exclude important benefits like cancer 
screenings, mental health coverage, and diabetes care that currently 
are guaranteed under many State laws.
  States have had the primary responsibility for the regulation of 
health insurance since the 1940s, and based on my experience in 
overseeing the Maine Bureau of Insurance for five years, I believe that 
States have generally done a good job of responding to the needs and 
concerns of their citizens.
  As the founder and cochair of the Senate Diabetes Caucus, I also am 
all too aware of the tremendous emotional and economic toll that this 
devastating disease takes on an estimated 21 million Americans and 
their families. I am particularly concerned that the bill would preempt 
as many as 46 State laws guaranteeing coverage for the medications, 
equipment, services, and supplies that people with diabetes need to 
manage their disease and prevent costly and potentially deadly 
complications.
  This simply is penny wise and pound foolish. Diabetes currently costs 
our Nation more than $132 billion annually. Eighty percent of those 
costs are due to the complications associated with diabetes--
complications that, absent a cure, can only be prevented through 
prevention and proper management of the disease. If cloture is invoked, 
I will be offering an amendment with Senators Bingaman and Domenici to 
preserve State laws requiring coverage for comprehensive diabetes care. 
Both the American Diabetes Association and the Juvenile Diabetes 
Research Foundation have endorsed our amendment.

  I am also concerned that the bill would preempt State rating rules 
and establish a new national standard. Proponents of the legislation 
contend that the application of this new national standard may not 
cause much disruption in many states. In Maine, however, which uses 
modified community rating, it could alter the market substantially.
  In fact, the nonpartisan Congressional Budget Office, CBO, estimates 
that one-quarter of all small businesses will actually pay higher 
premiums if this bill is passed. It is therefore likely that many small 
employers in Maine--particularly those with an older workforce--will 
wind up paying more, and in some cases substantially more, under this 
bill.
  This bill is no panacea, even for those small employers who will see 
savings. The CBO estimates that health care premiums will only average 
about 2 to 3 percent lower if S. 1955 is passed. Many small business 
owners have been told that the bill will cut their costs by from 12 to 
20 percent. Even those employers who do see savings are likely to be 
disappointed that they are not as great as they had been led to 
believe.
  Finally, I am concerned that the bill, as reported by the committee, 
could allow health plans to exclude a class of health care providers, 
solely on the basis of their license or certification, restricting 
patients' access to qualified health professionals. This is a 
particularly important issue in rural areas like Maine, where there may 
not be a sufficient supply of physicians to provide the care that the 
health plan has promised to cover.
  For example, virtually all health plans cover medically necessary 
primary care services. Many rural Americans use a physician assistant 
or nurse practitioner as their primary care provider because there 
simply isn't an adequate supply of physicians where they live. In these 
areas, if a plan only covers primary care services offered by a 
physician, patients will either have to drive great distances to 
receive the care they need or pay out of pocket for services that are 
supposed to be covered benefits.
  If cloture is invoked, I will be offering an amendment to maintain 
the application of all existing State laws prohibiting health insurers 
from discriminating against health providers who are acting within 
their scope of practice under State law, solely on the basis of their 
license or certification.
  Mr. President, I do plan to vote for cloture. Congress should be 
taking action to make health insurance more affordable for small 
businesses, and I believe that this debate should go forward.
  I do not, however, believe that we need to preempt the good work that 
States have done in the area of patient's rights and protections in 
order to help our small businesses. I would, therefore, oppose the 
current bill on final passage unless it is substantially changed.
  Mr. DOMENICI. Mr. President, I rise today to support affordable, 
adequate and accessible health insurance. We have a bill before the 
Senate, S. 1955, the Health Insurance Marketplace Modernization 
Affordability Act of 2006. Chairman Enzi has worked very hard on this 
bill for many months now and I believe that it will help small business 
people who are struggling to afford health insurance for themselves, 
their employees, and their families. I hope that the Senate will pass 
this bill because the time for Congress to take action on this issue is 
long overdue.
  Most people in the U.S. who have health insurance obtain it through 
their employer or through a family member's employer as a workplace 
benefit. Small employers however are far less likely than larger 
employers to provide health insurance to their workers. In my home 
state of New Mexico, I am embarrassed to say that almost 25 percent of 
the citizens do not have health care. This is the second highest rate 
of uninsured in the country. Furthermore, there are approximately 
143,909 small businesses in New Mexico, and of these small businesses, 
only about 37 percent of firms with fewer than 50 employees offer 
health insurance. For much smaller firms with five or less employees, 
the numbers are

[[Page S4450]]

even more staggering; fewer than 50 percent of firms offer health 
insurance. This is unacceptable. Working people deserve better.
  The current realities of the insurance market make it much more 
difficult for a small business people to secure quality, affordable 
insurance. I believe that by allowing small businesses to band 
together, as this bill does, that economy of scale will be created and 
small businesses will be able to leverage their larger purchasing power 
to lower their health care costs. This would hopefully enable more 
employers to afford such coverage and ideally reduce the number of 
small firm workers without health insurance. It is a real first step to 
providing more access in a market where small business is currently 
struggling.
  Over the past few weeks, I have heard from many advocacy groups who 
are concerned with the way in which this bill addresses State benefit 
mandates. I understand these concerns and agree that widely accepted 
critical protections for patients must be preserved in any legislation 
the Senate ultimately adopts. That is why I have joined together with 
Senators Snowe, Byrd, and Talent to offer an amendment that would 
require small business health plans to comply with the benefits adopted 
by a majority of States. This amendment says if 26 States mandate it, 
than a small business health plan must comply with it. This amendment 
is a good and workable compromise that alleviates one of my primary 
concerns with the small business health plan bill. This compromise will 
help ensure that millions of Americans will continue to receive health 
care coverage for most areas, including mammograms, diabetes care and 
mental illnesses. It is vitally important that we pass a bill that will 
bring health insurance to employees of small businesses who currently 
are not covered without consequently diminishing coverage already 
offered in other areas. This amendment should make it easier for us to 
do so.
  It is time for the Senate to take action on this issue. The House of 
Representatives has passed this type of legislation multiple times. The 
American people are tired of excuses and they are tired of the status 
quo. They want to see change for the better. I again thank my 
colleague, Senator Enzi, the chairman of the HELP Committee for his 
hard work on this important issue. I have long said that something 
needs to be done to address the problem of the uninsured, and I have 
also said that I support the idea of legislation aimed at helping small 
business. I sincerely hope that the Senate will pass a bill that will 
allow small businesses to afford insurance for their employees.
  Mr. LEVIN. Mr. President, I take a brief moment to explain why I will 
be voting against cloture on S. 1955. The availability and 
affordability of health care is one of the most important issues that 
we can debate this year in Congress. As was highlighted during the 
recent ``Cover the Uninsured Week,'' the United States spends more on 
health care than any other nation, yet we still have almost 46 million 
uninsured Americans. This means that over 18 percent of Americans are 
uninsured and that there are 9 million children in our country without 
health insurance.
  The Senate's response to this health care crisis, however, has been 
sorely lacking. The majority leader called this week health week and 
scheduled debate on three bills that would do little or nothing to 
assist the Nation's uninsured. The first two bills were medical 
liability bills that did not even achieve a majority of votes in the 
Senate. I have stated many times that I believe any meaningful tort 
reform should be enacted on the state level and voted accordingly. The 
third bill is S. 1955, and I would like to take this opportunity to 
explain my reservations about the bill.
  The concept of S. 1955 is to allow small business or trade 
associations to pool together in an effort to purchase health insurance 
at affordable costs. These new health plans would cross state lines and 
therefore be eligible to bypass the state coverage and solvency 
mandates that apply to health plans offered by larger employers.
  S. 1955 is a well intentioned bill. Senators Enzi and Nelson and 
their staffs have spent many hours meeting with all sides involved in 
this important debate. This effort to bring everyone to the table 
resulted in a bill that improved upon previous small business health 
plan bills referred to as ``association health plans.'' However, S. 
1955 still falls short.
  I have several concerns about S. 1955. First, I am concerned that 
this bill could reduce access to critical benefits. S. 1955 replaces 
state benefit requirements with a new standard that would allow 
insurers and small business health plans to offer ``basic'' benefit 
plans, which would not have to include state-required benefits as long 
as they also make available an ``enhanced'' benefit plan, which would 
be equivalent to one of the benefit plans offered to state employees in 
one of the five most populous states. However, this new standard is 
meaningless since those coverage options are likely to include a high 
deductible/low coverage plan that would afford little protection to 
consumers who need health care, whether due to illness or age.
  Currently, insurance rating rules and the regulation and approval of 
insurance plans are by done by state insurance commissioners. Most 
state insurance commissioners are elected officials charged with making 
sure a state's market is based on rates that are fair and equitable to 
all based on state law. In my home State of Michigan, we have few 
benefit mandates, but those mandates are important to the populations 
that are protected. Some of the benefits that would no longer be 
required to be covered for Michigan citizens include hospice care, 
newborn coverage, access to obstetrician/gynecologist, access to 
pediatrician and diabetic drugs and prevention of diabetes programs. By 
some estimates, this could affect over 2.7 million people in Michigan. 
This pattern could be repeated in states across the country. My concern 
about this is shared by many Governors, State Attorney Generals and 
State Insurance Commissioners, who have written the Senate to express 
their reservations about this bill.

  A second concern I have about S. 1955 regards rate setting rules. 
This legislation would create a new system allowing for insurers to 
vary premiums based upon, among other factors, health status and age. 
S. 1955 would wipe out state-based protections against discrimination. 
This would affect older Americans and others such as groups with large 
numbers of women, small businesses with fewer workers, and higher risk 
industries.
  Finally, I am concerned that S. 1995 would increase the potential for 
fraud and abuse. This concern is the basis for the recent letter to the 
Senate from 41 State Attorney Generals expressing opposition to this 
bill. S. 1955 will potentially erode state oversight of health 
insurance plans and eliminate consumer protections in the areas of 
mandated benefits and internal grievance procedures. The bill provides 
no additional authority or resources to enforce the new Federal 
standards created within it. This is eerily reminiscent to me of an 
experience our country had in the 1970's with Multiple Employer Welfare 
Arrangements or MEWAs. MEWAs were then exempted from state regulatory 
insurance requirements, and the result was that almost 400,000 
Americans were left with more than $123 million in unpaid health 
insurance claims.
  Yesterday, the majority leader used a procedural tactic to prevent 
Democrats from offering meaningful amendments to this bill which could 
have improved it. One such amendment would have been the Democrat 
substitute to use the Federal Employee Health Benefit Plan as a model 
pool to allow for lower health care costs for small businesses. I would 
have liked to have had the opportunity to also debate other health care 
issues as well such as extending the Medicare Part D enrollment 
deadline, lifting the Federal restrictions on stem cell research and 
other efforts regarding the nation's 46 million uninsured.
  Health care costs are rising too quickly, and I am sympathetic to the 
plight of small businesses. As a senior member of the Senate Small 
Business and Entrepreneurship Committee, I often hear from small 
business constituents of mine about annual double digit health premium 
increases. However, rising health care costs are not unique to small 
businesses--it is an untenable situation shared by most

[[Page S4451]]

Americans--and this bill takes the wrong approach to solving this 
problem. For all of these reasons, there is strong opposition to this 
bill from many state leaders, and from a coalition of more than 200 
organizations, including the AARP, the National Partnership for 
Families and Women and Families USA.
  At a minimum, we needed the chance to improve this bill. I cannot 
support cloture to end debate and restrict amendments on this 
legislation.
  Mr. REED. Mr. President, I would like to comment on the legislation 
the majority has brought forward during what it has dubbed Health Week 
and on health care more broadly.
  While I do not support this legislation as drafted, I commend Senator 
Enzi for attempting to address the important issue of health insurance 
for small businesses.
  As of 2004, over 45 million Americans were uninsured. Unfortunately, 
these numbers continue to rise with each passing year as more and more 
employers cease offering coverage to their employees. In Rhode Island, 
the percentage of companies offering health insurance coverage declined 
from 80 percent in 1999 to 68 percent in 2005. In my State, a small 
business is more likely to drop coverage because of the prohibitive 
cost.
  While some employers have stopped offering coverage altogether, 
others have struggled to keep up with escalating costs. Since 2000, 
premiums for family coverage have increased by 73 percent compared to 
an inflation growth of 14 percent and a wage growth of 15 percent over 
the same period.
  Health insurance affordability not only affects employee 
satisfaction, it also has a direct impact on a company's 
competitiveness.
  We need to address these issues, but S. 1955 is not the answer. It 
decreases cost by changing rating structures, allowing cherry-picking 
of healthy individuals, and offering plans with very few benefits.
  S. 1955 would amend the Employee Retirement Income Security Act of 
1974 (ERISA) to allow for the creation of small business health plans, 
SBHPs, sponsored by business or trade associations that would, like 
self-insured plans, be exempt from State laws. As was the case with 
legislation proposing the creation of association health plans, AHPs, a 
considerable number of health care experts have expressed concerns that 
this legislation would exempt SBHPs from important State regulations 
that protect consumers, guarantee access to coverage and treatment, and 
ensure financial solvency. Millions of Americans could lose coverage 
for such important care as screening for breast, cervical, colorectal, 
and prostate cancer; well-child care and immunizations; emergency 
services; mental health; and diabetes supplies and education.
  I have serious concerns that this legislation could weaken the 
already fragile insurance market we currently have in the United 
States. States have worked diligently to craft insurance regulations 
that reflect their individual needs. They have developed rating systems 
and mandated benefits to best protect their citizens.
  This bill will affect not only health insurance for small businesses 
but also health insurance for all markets. In a letter to the chairman 
and ranking member of the Health, Education, Labor, and Pensions HELP 
Committee, the Rhode Island health insurance commissioner expressed his 
strong concerns about how S. 1955 would affect the State's health 
insurance regulatory system, its ability to hold health plans 
accountable, and develop solutions particular to our Sate. I will ask 
that the text of this letter be printed in the Record.
  I have serious concerns about the health insurance that would be 
offered under this legislation. If insurance does not offer adequate 
coverage, it is insurance in name only. It is of little use if you 
can't afford it or access it when you need it.
  A recent program on PBS' NOW focused on what it termed ``junk 
insurance plans'' and profiled two particular cases where the insurance 
was really no insurance at all, leaving couples who had faithfully paid 
premiums with astronomical medical bills. In one case, the insurance 
plan sold was marketed through an association for the self-employed.
  It is important to try to address the problem of the uninsured, but 
we need to be sure that it is being done in a sensible and thoughtful 
manner.
  While Senator Enzi has taken a great deal of time to meet with a 
variety of stakeholders in drafting this legislation, there have been 
no hearings on the bill, even though my colleagues and I on the HELP 
Committee requested such hearings. Moreover, 41 attorneys general have 
signed a letter in opposition to S. 1955; 19 State insurance 
commissioners and State departments responsible for insurance 
regulation have written letters opposing this legislation.
  There are better options. The Lincoln-Durbin proposal would be more 
effective in curbing health care costs and expanding coverage, as well 
as help small businesses and their employees. It would create the Small 
Employers Health Benefits Program SEHBP and provide tax breaks for 
employers that offer financial assistance for insurance premiums to 
low-income employees. SEHBP is based on the Federal Employee Health 
Benefits Program and would extend the purchasing power of the Federal 
Government to small businesses that choose to participate. In addition, 
SEHBP enrollees in local plans would enjoy an array of coverage 
options, while at the same time benefiting from State consumer 
protections.
  I filed three straightforward, commonsense amendments to guarantee 
more comprehensive coverage, to preserve State authority, and to make 
sure SBHPs actually reduce costs. I first proposed these amendments 
during the HELP Committee consideration of this bill. The first 
amendment would create a commission to establish a Federal floor of 
benefit mandates in accordance with the laws adopted in a plurality of 
the States, which would preserve some of the critical benefits 
currently mandated by Rhode Island and other States. The second 
amendment would limit the preemption of State laws by clarifying that 
unless specifically provided for, nothing in S. 1955 would override any 
State or local law related to health insurance. The third amendment 
requires the Government Accountability Office GAO to evaluate the 
program 24 months after its implementation, and if there is no evidence 
of a decrease in cost or increase in access to health care, the program 
would be terminated.
  I am disappointed that the majority is not allowing us to engage in a 
full and fair debate on these and other amendments in the absence of a 
broad agreement on the bill.
  Earlier this year, we saw the implementation of another program that 
was not well thought out and was fraught with problems as a result. 
Many of the problems with the Medicare Part D prescription drug benefit 
could have been averted. This crisis was anticipated for some time by 
independent researchers and advocates for Medicare beneficiaries, yet 
the Republican-controlled Congress repeatedly blocked remedies and 
continues to do so. Working to improve the Medicare drug plan is not 
even on the agenda for Health Week.
  I did not support the Medicare Modernization Act because I felt the 
benefit was insufficient and the emphasis on a privately administered 
program made it excessively complex for beneficiaries. This plan 
imposes penalties for those enrolled to change plans but allows the 
plans to change the prescriptions they cover at will. Millions of 
retirees faced with choosing among a large number of private drug plans 
struggled with different rules, lists of covered drugs, and premiums. 
Many who are eligible to sign up have avoided doing so all together.

  The problems have been so widespread that more than 20 States, 
including Rhode Island, had to step in to pay drug claims that should 
have been paid by the Federal Medicare Program. At least two dozen 
States have taken emergency action to help low-income individuals who 
could not get their medications under the program, and States spent 
many millions of dollars on this assistance.
  Since its launch on January 1, doctors and pharmacists have 
complained that many drugs theoretically covered by the new Medicare 
drug benefit are not readily available due to the insurers' 
restrictions and requirements. Many pharmacists can't keep track of

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the plans' myriad policies and procedures and doctors say the diverse 
requirements are onerous and can delay or deny access to needed 
medications.
  The May 15 deadline for enrollment in Part D is looming. We should be 
taking action to extend the deadline and improve Part D during this 
sole week the majority has dedicated to so-called health care reform. 
Let's put America's Medicare beneficiaries first.
  Another issue that is imperative for us to address is stem cell 
research. Last May, the House passed the Stem Cell Research Enhancement 
Act, H.R. 810, by a wide margin. We heard Senator Frist last summer 
announce that he agrees with lifting the stem cell ban, but we have not 
seen any movement on this issue.
  President Bush's policy limits Federal funding of embryonic stem cell 
research in practice to 22 stem cell lines that have been in existence 
since 2001, and these lines are unsuitable for research. In recent 
years, we have seen amazing medical breakthroughs thanks to a 
dedication to research. HIV disease, which was a virtual death sentence 
just over a decade ago, has become for many a chronic disease. The 5-
year survival rate for childhood acute lymphoblastic leukemia is 
approximately 85 percent, a dramatic increase because of new lifesaving 
treatments.
  I hope to be able to stand on this Senate floor a few years from now 
asking for support for new research and highlighting the advancements 
that have been made in the treatment of spinal cord victims, children 
with diabetes, and those with Parkinson's because of embryonic stem 
cell research. The Senate should be marking the 1-year anniversary of 
the House passage of H.R. 810 by having a vote on the bill. We have an 
obligation not only to those stricken with these devastating conditions 
but to the family and friends who care for them. H.R. 810 opens the 
door to medical research that could unlock the mystery behind many of 
these devastating diseases while ensuring strong ethical and scientific 
oversight.
  I share Senator Enzi's desire to stem the rising costs of health 
insurance, which pose a challenge to many, including our Nation's small 
businesses and self-employed individuals. While Congress should 
certainly do more to address this matter and expand coverage to those 
who currently lack it, S. 1955 would have little impact on these 
crucial needs.
  There are other equally critical health issues facing millions of 
Americans. In addition to Medicare and stem cell research, we should be 
considering legislation to expand health insurance coverage to every 
child in this country, legislation to strengthen our public health 
system, and legislation to ensure an adequate number of nurses and 
other health professionals to care for our aging Nation. While the 
majority is stunting this week's debate, it is my hope that the Senate 
will actually take the time and find a way to work together to have a 
serious debate on important health care issues this year.
  I ask unanimous consent that the before-mentioned letter be printed 
in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                   March 13, 2006.
     Hon. Michael B. Enzi,
     Chair, Committee on Health, Education, Labor, and Pensions, 
         U.S. Senate, Washington, DC.
     Hon. Edward Kennedy,
     U.S. Senate, Washington, DC.
       Dear Chairman Enzi and Senator Kennedy: I am writing to 
     express my strong concerns Senate Bill 1955, and to ask that 
     it not be passed.
       Context: Rhode Island has a strong history of active health 
     insurance regulation. In 1996, the state passed broad managed 
     care regulations regarding utilization review, member rights 
     and appeals and health plan oversight. These provided 
     protections which were later duplicated in other states. In 
     2000, the state overhauled its small group rating laws to 
     bring more equity between large group and small group rates. 
     In 2004, the legislature created a first-in-the-nation 
     cabinet-level health insurance commissioner role, to (in 
     part) ``direct health plans towards policies that promote the 
     public good through increased access, and improved efficiency 
     and quality''.
       The results speak for themselves, Rhode Island has one of 
     the lowest rates of uninsurance in the country, lower medical 
     costs than its neighbors, high health plan satisfaction 
     measures, excellent scores in HEDIS and public health 
     performance measures, and nationally recognized innovations 
     in health care quality measurement and health care 
     information technology innovation. Studies by my office 
     indicate that rating forms have closed the health insurance 
     price gap between large and small employers.
       Effect: In spite of recent amendments, the proposed bill 
     would put all this in jeopardy by eliminating the ability of 
     states to bring together stakeholders to develop local 
     solutions to the problems of affordable health insurances for 
     small businesses.
       Specifically: Imposing national underwriting rules and 
     coverage standards for small businesses creates 1 local 
     instability in pricing and hinders innovation. States should 
     be allowed to develop programs for affordable health 
     insurance products and pricing, and then learn from one 
     another. Just this year, small business health insurance 
     reform bills have been introduced by both Democrats and 
     Republicans in the RI legislature that call for crafting new 
     affordable health plans, subsidizing their purchase through 
     reinsurance mechanisms and promoting price transparency. 
     These innovative programs would not be possible under this 
     bill.
       The bill weakens health plan accountability. Health care is 
     delivered locally. It is intrinsically tied to public health 
     and important community institutions. Health insurers need to 
     be held accountable by local entities for their actions in 
     states--for the incentives created by their payment 
     mechanisms, for their support of local community health 
     activities and state-wide health policy. Bill 1955, in spite 
     of recent clarifications regarding the role of insurance 
     commissioners, would make it harder for national health plans 
     to be answerable to their local stake holders. It would usurp 
     public authority and place it with large national insurers, 
     who would be accountable to no one.
       The bill does not address the real problem. The fundamental 
     health policy challenge facing the U.S. is the effect of 
     rising medical costs on the number of uninsured. As both of 
     you have noted, we need to move beyond underwriting and cost 
     shifting solutions to addressing the underlying utilization 
     drivers. This is best accomplished through local 
     experimentation and accountable insurers--both of which are 
     weakened by this measure. Mass group purchasing--which this 
     attempts to create--will not result in informed purchasers 
     driving system change, but a one-size-fits-all approach which 
     cedes power to national insurers.
       As witnessed by the efforts of the sponsors with the 
     National Association of Insurance Commissioners, much good 
     work has gone into amending this bill. Unfortunately, major 
     concerns remain. The bill in its current form fails to 
     address the critical issues states and communities face in 
     developing an affordable, sustainable health care system that 
     works for employees in small businesses. To accomplish this, 
     we need accountable health plans, not association health 
     plans.
           Sincerely,

                                        Christopher F. Koller,

                                    Health Insurance Commissioner,
                                            State of Rhode Island.

  Mrs. FEINSTEIN. Mr. President, I rise today to speak about my concern 
for the 6.6 million uninsured individuals in California and the impact 
the Enzi Small Business Health Insurance bill, S. 1955, will have on 
both the uninsured and the insured in my State.
  While the goal of this legislation is one I agree with--finding a 
solution to lower health insurance costs and greater access to health 
insurance for small business owners and their employees--I have serious 
concerns about the fundamental shift toward insurance deregulation and 
bare bones insurance coverage under the Enzi bill.
  It is my understanding that some changes have been made in the 
substitute amendment to the Enzi bill but that those changes do very 
little to change the fact that this bill will result in a loss of 
covered benefits and an increase in costs for older, sicker workers.
  While I respect the position of small businesses that support this 
legislation, I simply cannot support a proposal that I believe would 
result in higher costs for older, sicker workers and would result in a 
loss of covered benefits my State fought hard to guarantee.
  My concerns are shared by a wide range of people.
  It was also the conclusion of the nonpartisan Congressional Budget 
Office, 41 State attorneys general including the attorney general of 
California, 13 Governors, the California State insurance commissioner, 
the California Public Employees' Retirement System and countless 
national organizations such as the AARP, the American Medical 
Association, the American Cancer Society, and many more.
  California has one of the most comprehensive set of required 
insurance benefits in the country. A partial list includes: Coverage of 
routine patient care costs of cancer clinical trials; coverage of 
breast, prostate, cervical,

[[Page S4453]]

colorectal and other cancer screening; coverage of breast cancer 
screening, diagnosis and treatment, including prosthetic devices and 
reconstructive surgery; the right to a second opinion when requested by 
insured individual or health professional treating an insured 
individual; minimum maternity hospital stay; coverage of equipment, 
supplies, including prescriptions, and management of diabetes; coverage 
of alcoholism and drug abuse treatment; coverage of blood lead 
screening; coverage of contraceptives approved by the FDA; coverage of 
services related to diagnosis, treatment and appropriate management of 
osteoporosis; coverage of domestic partners and coverage of infertility 
treatment.
  The legislation before us sets a ceiling, not a floor for insurance 
coverage of vital services. Amendments that have been discussed such as 
creating a 26-State benefit mandate threshold are a ceiling, not a 
floor.
  The reality is that any attempt to ``harmonize'' State benefit 
mandates will likely result in harm to Californians.
  Just like legislation passed by the House last March called the 
National Uniformity for Food Act which I strongly oppose, this 
legislation preempts States rights.
  California voters and elected officials have determined what they 
think is best for the State and this legislation override the will of 
Californians whether they work for a small business or large one.
  I am also concerned about the impact this bill will have on premiums 
for small business employees. California has rules to protect premium 
adjustments from increasing year to year beyond 10 percent.
  And in California, insurance companies may set premium rates for 
employees based on only three risk factors: age, family composition, 
and geographic region.
  Under this bill, not only will employees be subject to rating based 
on additional factors such as the size of business, gender and type of 
business, but California's age and geographic region limitations are 
preempted.
  The new rating factors in the bill disadvantage certain small 
businesses and they disadvantage businesses with a high proportion of 
women of child-bearing age.
  I find it deeply troubling that Senators on both sides of the aisle 
have been denied the opportunity to vote on amendments to address the 
problems with this legislation.
  I would like to address another healthcare issue that I have been 
deeply concerned about and that is stem cells.
  The Senate has spent a week dedicated to health care and yet, the 
majority leader has not scheduled a vote on embryonic stem cell 
legislation.
  It has been 8 years--1998--since I introduced one of the first bills 
dealing with the ethical issues around stem cell research.
  It is almost one year--May 24--since the House passed the Castle-
DeGette bill.
  It has been 9 months--July 29--since the majority leader shocked the 
Senate and announced his support for stem cell legislation.
  But no bill has been passed by the Senate.
  What we have learned over that period is that the more than seventy 
lines the President said were available when he set his policy in 
August 2001 are down to just over twenty.
  Those approximately twenty lines are contaminated with mouse feeder 
lines and they are old. They are of no therapeutic value.
  We need more lines if we are going to untie the hands of researchers 
so they can do the research needed to learn about the biology of 
diseases, the restoration and repair of damaged tissue, and the 
development of treatment therapies.
  Time and time again researchers say they need more embryonic stem 
cell lines.
  But, the leadership of the Senate and White House won't listen. They 
would rather obstruct the work of scientists who want to work with 
embryonic stem cells. The result is scientists moving to other 
countries to do their work.
  The time to act is now. The price of inaction goes up every day.
  Since this fight began, we have lost Christopher Reeve on October 10, 
2004, Dana Reeve on March 6, 2006, 4 million Americans to cancer, 1.8 
million Americans to diabetes, and 144,000 Americans to Parkinson's.
  I have heard opponents of embryonic stem cell research talk about the 
promise of adult stem cell research. No one I know is arguing that we 
shouldn't pursue adult stem cell research. That's why the Senate passed 
the cord blood bill unanimously last year.
  But, we must not fund this research to the exclusion of embryonic 
stem cells.
  There is no question that this country needs an effective stem cell 
policy--both to provide Federal funding for viable stem cell lines and 
to provide Federal ethical guidelines.
  It is simply appalling that here we have a week dedicated to a debate 
on health care and the leadership of the Senate has not scheduled a 
vote on the Castle-DeGette, embryonic stem cell bill.
  I personally believe this week should be renamed the ``week of missed 
opportunities'' instead of ``health week''.
  Instead of addressing problems associated with the Medicare drug 
benefit such as the amendment I filed to the pending legislation to 
protect seniors from insurance plans who may decide to end coverage of 
drugs they said they'd cover when the senior enrolled in the plan, we 
are doing nothing.
  Instead of allowing the Federal Government to use its bulk purchasing 
power to negotiate with drug companies to provide lower prices for 
seniors, we are doing nothing.
  Instead of addressing the fact that millions of confused seniors will 
face a penalty in Medicare forever if they are eligible and don't sign 
up for the drug program by this Monday, we are doing nothing.
  And yet we will have a cloture vote on a bill that will leave 
millions of Californians without a guaranteed access to cancer 
screenings and treatment, diabetes coverage, the right to a second 
medical opinion if they request it, among many others.
  All of those protections will be lost, and Senators will have been 
denied without the opportunity to vote on any amendments to address the 
problems associated with this legislation.
  It is a shame that the leadership of the Senate has allowed this week 
to become one of missed opportunities when we have bills such as the 
Castle-DeGette embryonic stem cell bill that have passed the House and 
are sitting at the President's desk waiting to be taken up and passed 
by the Senate.
  Mr. SALAZAR. Mr. President, access to affordable, quality health care 
is on the minds of virtually every American. As I travel across my 
State of Colorado and this nation, people urge me and my colleagues in 
Congress to solve our health care crisis. I rise today to again add my 
voice to the millions calling for meaningful, comprehensive health care 
reform--reform that allows Americans to get the health care that they 
need; reform that will stop the crippling effect that the rising costs 
of health care has on our citizens, businesses and economy.
  Last year, Senator McCain and I introduced the National Commission on 
Health Care Act, S. 2007. Its purpose is simple and bold--to fix our 
broken health care system.
  The need to reform our health care system could not be more 
compelling. An astounding 46 million Americans lack health insurance. 
They come from every community, every walk of life, and every race and 
ethnic group. But the most telling part about them is that they come 
from working families who struggle to put food on their tables and pay 
their bills. They live in constant fear of getting sick. When they get 
sick, they often go without medical care and get sicker.
  For those fortunate enough to have health insurance, the picture is 
also grim. Health insurance premiums for family coverage have risen by 
over 59 percent since 2000, with the average annual premiums for 
employer-sponsored family coverage costing nearly $11,000. Rising 
premiums place working families at risk of joining the ranks of the 
uninsured.
  Rising health care coverage has also threatened the ability of 
American businesses to maintain insurance coverage for their employees 
and compete on a global level.
  Congress must act now to reform our system. We need much more than a

[[Page S4454]]

week of gimmicks or piecemeal bills. We need comprehensive reform. S. 
2007 reflects that need. The act creates a bipartisan commission of 10 
elder states men and women. I want to stress that this is a bipartisan 
commission. Our health care crisis is not a Democratic or Republican 
problem. It is a national problem that we must solve together.
  The members will conduct a thorough investigation into our health 
care system, building on the work of others to comprehensively look at 
availability, affordability, quality and costs relating to our health 
care system. It will look at the uninsured, the small business 
insurance market, the increases in premiums and health care costs, and 
the problems that businesses face in maintaining insurance coverage.
  The commission will study our government programs and the private 
health insurance industry. And, most importantly, the commission will 
develop comprehensive proposals and recommendations to actually solve 
problems associated with our Nation's health care system. It is not 
enough to chip away at the problem by enacting policies related to one 
aspect of our health care system. We need a comprehensive study and 
comprehensive solutions.
  The National Commission on Health Care will not duplicate the very 
important work that has already been done by other commissions and 
think tanks. What it will do is study the proposals from a 
comprehensive perspective, engage business, labor, health care, 
consumer, insurance and other groups to develop workable policies that 
if enacted will solve the crisis we face today.
  I look forward to working with my colleagues on both sides of the 
aisle to pass the Commission Act to reform our broken health care 
system.
  Mr. President, I want to take a few minutes to talk about the 
Medicare prescription drug program. I want to talk about the need to 
extend the deadline for seniors and people with disabilities and I want 
to talk about the rural, independent pharmacies that have suffered 
because of implementation problems with the drug program.
  I was not a member of this esteemed body when the Medicare 
Modernization Act creating this program was enacted. I therefore have 
no political stake in defending or criticizing the drug program. I have 
every interest, however, in making sure that the program is properly 
implemented and that our seniors and people with disabilities have 
adequate time and accurate resources with which to make decisions about 
what plans best meet their health care needs. I strongly support 
Senator Bill Nelson's legislation extending the deadline for seniors 
and people with disabilities to enroll in the program. I want to thank 
Senator Bill Nelson for his commitment to ensure that seniors and 
people with disabilities have adequate time and accurate information to 
make wise decisions about their prescription drug insurance.
  In less than 1 week, seniors will face the deadline for enrollment in 
the prescription drug program. For many seniors and their family 
members, selecting an appropriate prescription plan is a difficult and 
challenging endeavor. I know firsthand how time-consuming and difficult 
it is to navigate through the various plans to select the plan that 
meets the needs of an individual senior.
  Several weeks ago, I helped my 82-year-old mother select a 
prescription drug program. In Colorado, there are over 42 plans to 
choose from--each covering different drugs or formularies as they are 
known, each with different monthly premiums; each with different 
copayments, each with different drug prices, and each with different 
participating pharmacies. I speak from experience--the process is 
daunting.
  My offices have been helping many Coloradans with questions on 
Medicare prescription drug program. Often, individuals have called my 
office in exasperation, trying to find a friendly voice to help them 
through this process. My staff has assisted these individuals. However, 
many seniors continue to put off signing up for the program because 
they are confused and nervous. In Colorado, there are still 
over 100,000 individuals who are eligible to enroll in the plans who 
have not. Coloradans consistently tell me that they need more time to 
make sure they review reliable accurate information to select the right 
plan. They should have that time.

  The complexity of the plans and the importance of the choice that 
seniors and the disabled must make dictate that we allow them more time 
to make these important decisions regarding their health. Beyond the 
complexity of the program, seniors and people with disabilities need 
more time because of the government's own inability to provide reliable 
information and available help to navigate the choices they are being 
asked to make.
  Just this month the Government Accountability Office released a 
report that highlighted the government's own shortcomings with respect 
to the implementation of the drug benefit. The report highlighted that 
the Medicare help-lines were not providing accurate information for 
beneficiaries with questions about enrollment. Posing as seniors and 
senior advocates, the GAO made calls to the Medicare help-line with 
questions about how the program works. Astonishingly, the GAO often 
could not get through to an operator!
  When the GAO staff did finally get through to an operator, the 
information specialists often could not answer their questions about 
the drug benefit, could not help them with questions about specific 
plans, and could not provide the detailed information that seniors need 
to enroll. If the government that administers this program could not 
provide timely, adequate information to beneficiaries, how can we hold 
them to an artificial deadline? Our seniors and people with 
disabilities deserve better. They certainly do not deserve to be 
penalized.
  Individuals who miss the approaching deadline will not have an 
opportunity to enroll until November. In turn, they will face increased 
premiums and co-pays. And these costs increase the longer the 
individual waits. Seniors should not be punished for the government's 
inability to provide them with information with which to make a choice 
regarding their health. We need to help our seniors in this process, by 
giving them the time and resources needed to make the best decision for 
them.
  I also want to speak in support of Senator Lautenberg's Pharmacists 
Medicare Relief Act of 2006 to modify the Medicare drug benefit to 
allow pharmacies to get timely payment from prescription drug plans. As 
we all know, pharmacies operating in rural towns and communities, like 
my hometown in Colorado, are important components of the community's 
already fragile health care delivery system. Because rural residents 
tend to be older and have more chronic conditions, pharmacy services to 
rural residents are particularly important.
  The Medicare drug program has threatened the very survival of some 
rural pharmacies because of the manner in which the plans pay the 
pharmacies. These pharmacies must pay their wholesalers on a weekly or 
biweekly basis. Unfortunately, the prescription drug plans reimburse 
the pharmacies every 6 weeks. The discrepancy in payment has seriously 
affected the business of many pharmacies, and particularly pharmacies 
in rural communities.
  Fortunately, there is a simple fix: require the plans to reimburse 
the pharmacies every 14 days. That is exactly what Senator Lautenberg's 
legislation will do. This legislation would require the plans to pay 
pharmacists within 14 days if the claims are submitted electronically, 
and 30 days if the claims are submitted by paper. The legislation also 
prohibits plans from cobranding Medicare beneficiaries eligibility 
cards--which means that it bans brands or names of pharmacies from 
being printed on the prescription drug cards, so that large pharmacies 
cannot use this advertising advantage at the expense of small 
operations.
  These simple fixes will enable pharmacies in rural areas to continue 
to serve beneficiaries. Our rural pharmacies and the seniors and 
disabled people they serve deserve our best efforts to correct problems 
with the drug benefit plan to enhance health care delivery. I urge my 
colleagues to support this small but very important fix.
  One thing that we can all agree on is that our health care system is 
in crisis, and that crisis is harming health care providers and 
patients who need health care services. It is clear that we need

[[Page S4455]]

real reform. The time for enacting piecemeal legislation that chips 
away at the massive health care problems is over. Our healthcare crisis 
will persist long after this healthcare week in the Senate is over. I 
pledge to put partisanship aside and work with all of my colleagues 
toward real health care solutions.
  Mr. MENENDEZ. Mr. President, while Republicans proclaim this week as 
Health Week on the Senate floor, it is quite the contrary in the homes 
of millions of American families. Today, 46 million Americans have no 
health insurance at all. And 1.3 million New Jerseyans have no health 
insurance. Another 16 million or more Americans are underinsured, 
meaning that they have insurance, but still do not have access to the 
care they need. Complicating matters even more is the fact that the 
average cost of family health coverage--$10,880--now exceeds annual 
earnings for a minimum-wage earner.
  So what does the Senate majority propose to do to solve the problem? 
Nothing more than dust off the old playbook and make another run at the 
same old play. They propose a medical malpractice bill that has been 
defeated over and over again, that does not even really reduce costs 
for providers or patients, and in the process actually reduces remedies 
for patients. They propose a bill claiming to help small businesses, 
but it actually hurts patients by removing existing coverage and 
protections and exacerbates the problem of the underinsured.
  So at the end of Health Week in the Senate, all we have to show the 
American people is more of the same--the same 46 million with no 
insurance, the same 16 million people with inadequate insurance, and 
the same families working 40 hours a week to earn a living for their 
family but still unable to afford quality health care for them.
  Instead of leading us down a dead-end road, as Republicans have done 
this week, we should be on the expressway to real health care 
solutions--legislation such as the Stem Cell Research Enhancement Act, 
legislation to extend the enrollment deadline for the new Medicare Part 
D drug benefit, legislation to provide real solutions to the large and 
growing number of uninsured Americans, and legislation to address long-
term care needs that will only become more pressing as the baby boom 
generation ages.
  The Republican proposals being considered this week never even 
received a hearing or a vote in their committees of jurisdiction and 
were destined to fail from the beginning. Is this really all the 
majority party plans to address regarding the endless needs of our 
health care system? I believe we can and must do better.
  First, Alzheimer's disease does not boast a party affiliation. 
Neither does cancer or diabetes or Parkinson's disease. Yet, potential 
cures to these debilitating and fatal diseases are being ensnared in 
political wrangling, posturing, and obstruction.
  Today, almost 35 years after President Nixon declared war on cancer, 
the Federal Government and Washington Republicans remain AWOL in the 
fight against this fatal illness and a host of other debilitating 
diseases. While we have made great strides in researching potential 
vaccines and cures, our colleagues on the other side of the aisle 
choose to tie our researchers hands.
  The bottom line is this: When your life--or the life of a loved one--
is on the line, you never give up and you never limit your options--
never. You never lose faith, and you pursue every option, every sliver 
of hope, of finding a cure.
  This issue is about more than statistics, it is about more than 
numbers on a fact sheet. These are real people. These are families. 
These are mothers and fathers, sons and daughters, aunts and uncles. 
These diseases cut through race, age, religion, country, and political 
affiliation. We all suffer, which is why we must move beyond the usual 
partisan posturing and fight for expanding research.
  I had the opportunity to vote on this stem cell legislation in the 
House of Representatives, where we had broad, bipartisan support. And I 
believe that same bipartisan support exists in the Senate, which makes 
it even more difficult to understand why we cannot come together and do 
something meaningful for those who are suffering.
  We have an opportunity to do what is right, and the majority has 
again let that opportunity pass them by. This bill means so much more 
than ending restrictions placed on stem cell research. This bill means 
hope for the individuals challenged and fighting to live a life with 
dignity.
  Stem cell research has vast potential for curing diseases, 
alleviating suffering, and saving lives. I know my colleagues recognize 
the enormous potential of this research too, and it is time to clear 
the way for discovering new cures and therapies and bring this bill to 
a vote.
  Another thing we cannot ignore is the fast approaching deadline for 
seniors to enroll in a Medicare prescription drug benefit without being 
penalized. We need to stand up for our seniors and extend the deadline 
so that our seniors have time to choose the plan that is right for 
them.
  When the Federal Government rolled out the new benefit, and it did 
not go as planned, States such as New Jersey stepped up to the plate 
and provided emergency drug coverage to seniors and people with 
disabilities in need. Now the Federal Government has a responsibility 
to recognize its shortcomings and give our seniors a chance to enroll 
without having to pay the price for the Federal Government's mistakes.
  And the concerns go beyond just seniors' drug benefits. There is also 
a grave concern that seniors and people with disabilities may lose 
access to their local neighborhood pharmacies. Almost any senior will 
tell you that they rely on their local pharmacist to help them when 
they have complications with their drugs--whether it is interactions 
between drugs or problems getting their medications.
  I recently heard from Adolph Gonzalez and Alan Garcia who run the 
North Bergen Pharmacy, which has been open and serving its customers 
for the past 21 years. Unfortunately, since prescription drug plans are 
not paying their claims in a timely fashion, pharmacies such as this 
one are dipping into their line of credit, taking out loans and 
scrambling to stay afloat. Unless things change, pharmacies such as the 
one in North Bergen, NJ, are going to be forced to close their doors.

  I introduced legislation to address problems with the Medicare Part D 
drug benefit and so have many of my colleagues. All of us recognize 
that unless we start making important changes to improve the program, 
seniors are going to see lapses in their care. We must be committed to 
making sure that all Americans have a comprehensive drug benefit that 
allows them to take the medication prescribed by their doctors, 
provides them the information and flexibility to pick a plan that works 
best for them without being penalized, and allows them to continue 
visiting their local pharmacy.
  Unfortunately, the majority party is not going to allow us the 
opportunity to improve the Medicare Part D prescription drug benefit 
this week. Our fight for seniors is one we are going to continue, but 
one that has been overlooked this week in the U.S. Senate.
  Second, the unproductive nature of this week is most insulting to the 
46 million people across the country who have no health insurance at 
all--1.3 million in New Jersey alone. No American family should be 
forced to skip a trip to the doctor because they fear it will also mean 
an unfortunate trip to the bank.
  That is why I strongly support initiatives that will help small 
businesses afford meaningful health insurance for themselves and their 
employees; increase coverage for uninsured parents by extending the 
State Children's Health Insurance Program, SCHIP; and help Americans 
nearing retirement buy into Medicare--programs that have proven 
successful in reducing the uninsured and providing access to quality 
coverage.
  In addition, I introduced the Health Care COSTS Act, which will help 
hard-working Americans afford their health insurance when they are 
between jobs by providing an ``advanceable'' tax credit for half the 
cost of COBRA premiums. As I mentioned earlier, the average cost of a 
family health plan exceeds a full year's earnings for a minimum-wage 
worker, so there is no way most families can afford to continue to 
purchase coverage if they lose their job and have to find another.
  Instead of debating a bill that will preempt the important New Jersey

[[Page S4456]]

State coverage protections--including coverage of cervical cancer 
screening, contraceptives, home health care, mammography screening, 
mental health parity, and prostate cancer screening, to name a few--and 
protection against age discrimination in setting premiums, the Enzi 
bill takes the high bar of health insurance for New Jersey, and lowers 
it to a dangerously low level that strips away the coverage our State 
fought so hard to get.
  The choice before us this week--the Enzi bill or nothing--is a false 
choice. This policy will result in reduced access to important health 
benefits and substantially increase premiums for people who need 
coverage most. It will allow insurance companies to cherry-pick the 
most profitable patients and punish those who need coverage most. It 
will allow companies to discriminate against older, sicker patients by 
charging them 3 exhorbitant premiums for the care they get. It will pit 
young versus old, the healthy versus the sick. These are false choices, 
and we should not allow the majority to force us into making them.
  What we should be doing is considering a bill that preserves State 
benefits and prevents such cherry-picking. By offering small businesses 
access to the Federal Employees Health Benefits Program, which has 
provided extensive benefit choices at affordable prices to me, my 
colleagues, and all Federal employees for decades, we can do just that.
  By pooling small businesses across America into one risk and 
purchasing pool like the Federal Employees Health Benefits Plan, the 
new Small Employees Health Benefit Plan will allow employers to reap 
the benefits of group purchasing power and streamlined administrative 
costs, as well as access to more plan choices. That is why I support 
the Lincoln-Durbin alternative. Unfortunately, the Republican 
leadership has refused to let us have a full debate and up-or-down vote 
on this proposal.
  Finally, the challenge of caring for our aging population will only 
increase as the baby boom generation grows older and our life 
expectancy increases. We need to work now to address the challenges of 
providing affordable long-term care, encourage future retirees to plan 
for their own long-term care, and strengthen our existing programs to 
address this growing need.
  I have introduced legislation to do just that. This week we should be 
supporting legislation that helps all families afford to care for the 
ones they love while also preparing for their own long-term care needs.
  While I am disappointed in the partisan nature of this week's debate, 
it makes my commitment to fighting for the health and well-being of all 
Americans that much stronger. I call on my colleagues to finally make 
the health care priorities of the America people the health care 
priorities of the Senate.
  No longer should we avoid a vote on stem cell research, a vote on 
improving the Medicare Part D prescription drug benefit, a vote for a 
real solution to solve the issue of the uninsured, and a vote to help 
our growing senior population age with dignity. At the end of so-called 
Health Week in the Senate, we will have accomplished nothing for the 
millions of Amerians who are uninsured or underinsured and struggling 
every day to provide health care for their families.
  Mr. BAUCUS. Mr. President, I rise today in support of the State 
Health Insurance Assistance Program. I filed amendment No. 2917 to 
increase resources for this important initiative.
  The State Health Insurance Assistance program, known as SHIP, 
provides one-on-one counseling and assistance to people with Medicare 
and their families. Congress created the program in 1990 so that 
Medicare beneficiaries could obtain free, unbiased and personal 
assistance with their health benefits. Today, SHIPs operate in all 50 
States, Washington, DC, and the territories.
  Over the last 2 years, SHIPs have had the formidable task of helping 
Americans understand the new Medicare prescription drug benefit. In all 
States, SHIPs enlisted the help of thousands of volunteers--over 11,000 
nationally--for a massive public outreach campaign.
  SHIP counselors and volunteers--like Bobbie Roberts and Sue Bailey in 
Billings, MT.--conducted public education programs at senior centers, 
hospitals, assisted-living facilities, libraries, and other public 
venues. They answered questions via telephone and in face-to-face 
sessions. And they spent countless hours helping Medicare beneficiaries 
choose and enroll in a drug plan that best meets their needs.
  These folks deserve our thanks. They are truly unsung heroes who have 
helped make the drug benefit a reality for millions of people with 
Medicare.
  And they did all this on a shoe-string budget.
  The Centers for Medicare and Medicaid Services, CMS, operates the 
Medicare Program. As such, CMS is responsible for providing funding to 
the SHIP. But last year, in the midst of the largest Medicare expansion 
ever, CMS provided SHIPs just $32 million to carry out their important 
work. Thirty-two million dollars sounds like a lot of money. But when 
you think about the workload the SHIPs faced, it is not much. In fact, 
that $32 million translates to only 70 cents per Medicare beneficiary. 
A five-county region in Montana about the size of Delaware received 
about $8,500 in SHIP funds for the entire year. That is not enough. I 
believe that the lack of sufficient resources for SHIPs goes a long way 
toward explaining why enrollment in the drug program continues to lag.
  I might also note that the $32 million CMS provided to SHIPs pales in 
comparison to the roughly $300 million CMS spent promoting the new drug 
benefit. That $300 million went to programs like the toll-free 1-800 
Medicare hotline.
  Last week the nonpartisan Government Accountability Office, GAO, 
Congress's investigative arm--found major flaws with the Medicare 
hotline. GAO found that the Medicare hotline failed to give seniors 
correct information on one key question--which plan offered the lowest 
costs for individuals taking a given set of drugs--almost 60 percent of 
the time.
  And what about some of the other funding devoted to promoting the 
drug benefit? CMS spent some of the funds on a bus tour. In 2003 CMS 
spent $600,000 to promote Medicare with a blimp at football games. And 
other funding went to Ketchum Communications, which produced simulated 
news reports on the drug program. In 2004, the GAO found that these 
videos violated the government ban on publicity and propaganda.
  We can do better. We can promote the drug benefit in more cost-
effective ways by appropriately funding SHIPs. Recent findings from the 
Medicare Payment Advisory Commission underscore this assertion. A 
recent study by MedPAC suggests that only 1 in 5 people used the 
Medicare hotline and only 1 in 10 used the Medicare Web site to make 
decisions about their Medicare drug coverage.
  And even though this year's enrollment deadline is almost upon us, 
the hard work is not over. Enrollment in the Medicare drug benefit is 
still too low in many States. In Montana, 40 percent of people with 
Medicare still don't have any form of drug coverage. A study released 
yesterday by Families USA estimates that most people who haven't signed 
up have low income and would qualify for the extra help that Congress 
included in the drug benefit.
  We need to increase SHIP funding to help meet challenges that lie 
ahead. My amendment would provide $25 million for States to expand 
their SHIP activities. Funds also would be available for innovative 
programs in States where Medicare drug coverage is low. And funds would 
be available to CMS to promote the existence and services of SHIPs.
  As the new program evolves, many people with Medicare and their 
families will have even greater need for a reliable source of impartial 
advice. And more needs to be done to help low-income people enroll. 
Many of us voted for the drug benefit because we believed it would help 
people who need help the most. Let's make that happen in every 
community in every State. Let's devote resources to a program that 
works. Let's help thousands of volunteers help our seniors. Let's 
increase vital resources for the State Health Insurance Assistance 
Program.
  Ms. MIKULSKI. Mr. President, I rise today to support America's small 
businesses. I know how important small businesses are to the health of 
the economy and to the communities that

[[Page S4457]]

they serve. I know that small businesses are struggling to provide 
health care for their workers. We should move to offer small businesses 
reasonable solutions. I commend Senator Enzi for tackling such a tough 
issue, but this bill would ultimately end up increasing the cost of 
health care coverage for those that need it most.
  We need to be talking about improving health care for all Americans 
at any age and making the care more affordable for patients, as well as 
employers. American families are feeling stressed and strained, facing 
the ballooning cost of health care. Health care coverage is one of the 
most important issues facing Americans who are worried they will lose 
coverage, and won't be able to afford the care they need.
  It is true having health insurance is crucial but it cannot be just 
any health care packet; it must be a comprehensive packet. One of the 
big problems with Senator Enzi's bill is allowing insurance companies, 
instead of State-elected legislators who speak for their constituents, 
decide the benefits that consumers should have when they purchase 
health care.
  The benefits I am most concerned about protecting are preventive 
services. There is a reason that so many of these benefits mandated by 
States are preventive service--they wouldn't have been included 
otherwise. There is a reason Maryland guarantees access to 
mammography--insurers were not covering it. There is a reason that 
diabetic equipment and supplies are a guaranteed benefit--beneficiaries 
were complaining that they couldn't get the supplies covered.
  Imagine being diagnosed with diabetes--there are in fact 21 million 
Americans who have received just this diagnosis. Then imagine being 
told you must carefully check your blood sugar to keep your disease in 
control--but your insurance company won't pay for this? The American 
Diabetes Association estimates that it costs $13,243 for every patient 
to manage their disease. This is what health insurance is for. Most 
States have recognized the importance of guaranteeing coverage for 
diabetes supplies and education and have passed laws that provide this 
coverage to residents in State-regulated health plans. We must not undo 
what these States have identified as important covered services.
  And what about mammograms? Breast cancer is the most common cancer 
among women, accounting for nearly one of every three cancers diagnosed 
in the United States. Over 40,000 deaths from breast cancer are 
anticipated this year alone. Screening and early detection are critical 
for decreasing the mortality rates of breast cancer. Our reduction in 
cancer mortality depends on the increased use of mammography screenings 
for early detection of this disease.
  I have worked hard in Congress to ensure women have access to quality 
mammogram care. I authored the Mammography Quality Standards Act, MQSA, 
over 10 years ago. This improved the quality of mammograms by setting 
federal safety and quality standards for mammography facilities. This 
includes personnel, equipment and operating procedures. Before MQSA 
became law, there was a patchwork of standards for mammography in this 
country. Radiation levels used on patients varied widely, equipment was 
shoddy, and physicians often didn't have proper training. I went to 
work in Congress to set national standards, helping to make mammograms 
a more safe and reliable tool for detecting breast cancer.
  My own State of Maryland is one of the many States that mandates 
insurers provide mammography screening. We know this saves lives. 
Maryland also mandates insurers provide coverage for breast cancer 
patients who participate in clinical trials, so we can work toward a 
cure for breast cancer.
  Covering services that prevent health conditions is not only sound 
health policy, it is sound fiscal policy. By finding and treating 
diseases early we will save the U.S. taxpayers millions of dollars. In 
fact, it is the only real way to really decrease the cost of health 
care in this country.
  Knowing how important health insurance coverage is for small 
businesses, I have joined 26 of my Senate colleagues to support the 
Small Employers Health Benefits Program, SEHBP, which gives small 
businesses affordable choices among private health insurance plans and 
expands access to health care coverage for their employees. The SEHBP 
would allow small businesses across America to band together for lower 
health care prices by pooling their purchasing power and spreading 
their risk over a large number of participants. Employers would qualify 
for an annual tax credit to partially offset contributions on behalf of 
low-income employees.
  I came to the Senate to change lives and save lives. We need to 
guarantee that more Americans have access to services that prevent and 
treat chronic illness. Unfortunately, S. 1955 will not do this and in 
fact this bill will compromise the coverage people already have. I will 
continue to work toward a solution for affordable health care for 
patients and employers. I will fight to make a difference. Together, we 
can change lives.
  The PRESIDING OFFICER. Who yields time?
  Mr. ENZI. I reserve the remainder of the time.
  Mr. KENNEDY. Mr. President, I believe we have 10 minutes. I yield 5 
minutes to the Senator from Connecticut and I will yield myself the 
remaining time.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. DODD. Mr. President, I thank my colleague from Massachusetts and 
very quickly say to our good friend from Wyoming as well, I appreciate 
his interest in the subject matter and his concern about it. I want to 
point out to our colleagues why I am terribly disappointed with the 
procedures we have been confronted with this evening dealing with this 
legislation.
  In committee we spent quite a bit of time and had some rather close 
votes, tie votes on a number of amendments that were not adopted to the 
underlying bill.
  I raise two issues here in the very short time we have remaining. 
First is the process itself. This is the Senate. This Chamber 
historically is the place where debate occurs. To have a process here 
this evening on an issue where we have dedicated the entire week to 
health care and then to basically lock out any amendments that might be 
offered to this proposal runs contrary to the very essence of this 
body.
  Whether or not you are impressed with the substance of this bill, if 
you believe the Senate ought to be heard on a variety of issues 
relating to the subject matter--when the amendment tree has been 
entirely filled, then obviously we are dealing with a process that 
ought not to be. Even if you are supportive of the bill, it seems to me 
the Senate ought to be a place where we can offer amendments, have 
healthy debate over a reasonable time, and then come to closure on the 
subject matter.
  I am terribly disappointed. I know there are relevant issues and 
irrelevant issues. Members wanted to talk about things such as 
extending the time on the Medicare proposal. It is going to expire on 
May 15. That is not an unreasonable proposal, in a Health Care Week, 
when you are debating these subject matters. My colleagues wanted to 
talk about prescription drugs, to spend an hour or two out of the 
entire week to debate whether we ought to have a different proposal 
regarding prescription drugs. I don't think that is asking too much of 
this body, for one small debate about an issue that is so important to 
people. Even amendments designed to help small business would have been 
prohibited from being offered here as a result of this process. I am 
terribly disappointed that we are not going to have a chance to talk 
about this bill in a broader context where Members could bring their 
ideas to the debate.
  The second issue deals with the substance itself. My colleagues ought 
to take note. The key word here is preempts, because this bill preempts 
our States--each and every one of us--from having the kind of health 
care benefits that have been debated and discussed and adopted by our 
respective States. We each have unique problems. I mentioned earlier 
this week in this debate, Lyme disease is a huge issue in my State. It 
originated and was discovered in the town of Lyme, CT. I live 2 miles 
away from Lyme, CT. People in my State are deeply worried about that 
issue. So the State of Connecticut in its wisdom adopted as part of its 
health

[[Page S4458]]

care plan a requirement that insurance cover Lyme disease.
  I recognize that may not be an issue in the State of some other 
Member. But we ought to allow Connecticut and every other of the 49 
States to decide how they can best serve their constituents, their 
people, when it comes to health care coverage. This bill preempts my 
State from deciding whether they can cover certain problems that are 
unique to my part of the country.
  And second, of course, we preempt the States when it comes to setting 
any kind of rating rules. That is a critical issue because even if you 
have a comprehensive plan, if you allow the industry to price those 
products way beyond the reach of the average person, then de facto they 
are eliminated. So we preempt them on what they can cover and we 
preempt the States from determining what the prices ought to be for the 
insurance products that will be sold.
  I point out to my colleagues, not a single Governor has supported 
this bill. Not a single attorney general, not a single insurance 
commissioner. Over 200 health care organizations have said this bill is 
flawed and it ought not to be approved.
  We are urging our colleagues to reject this proposal. Listen, if you 
will, to what a business organization in my State had to say about this 
bill. The Connecticut Business and Industry Association represents 
5,000 small businesses in the State of Connecticut. They said:

       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.

  That is a business organization representing 5,000 small employers. 
This is not an organization that says those words lightly.
  For those reasons, for process and procedure, as well as preempting 
state benefits and rating rules, this bill ought to be rejected. I urge 
my colleagues to do so.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I understand we have 5 minutes. Will the 
Chair let me know when I have 30 seconds remaining, please.
  I want to pay tribute to my two colleagues who are in support of 
this, Senator Enzi and Senator Nelson. Senator Enzi and I, and 
Democrats on our committee and Republicans alike, have worked very long 
and hard on a whole range of different issues.
  We have made important progress. We are going to continue to do so, 
but we take exception on this issue.
  I commend the staff as well for all of their good work and help and 
assistance.
  Senator Nelson, who has been enormously concerned about the problems 
of small business, has talked about this issue with me and, I know, 
with other Members here on different occasions. He was such a strong 
voice when we were considering the Patients Bill of Rights legislation. 
I always enjoy working with him, although we have a different position 
on this issue.
  We are in the last few minutes of this debate and discussion. In 
these last few minutes, I want to join with those who have expressed a 
certain amount of frustration in being unable to address maybe a 
handful of different health care issues that I find are of concern to 
the people of my State. In traveling around the country, people are 
concerned about the prescription drug program. They are concerned about 
the high cost of prescription drugs. They are concerned about the 
problems small business has. But we do not believe the proposed 
solution that has been advanced by Senators Enzi and Nelson is really 
the best way. We have had a brief debate over this proposal and over an 
alternative way that we think would be more comprehensive, more 
realistic, and more expansive than reaching the 1 percent or 2 percent 
of those who are uninsured and who, according to the Congressional 
Budget Office, will be covered under the Enzi proposal.
  The reasons the insurance commissioners have serious reservations, 
the reasons the Governors and the attorneys general have taken 
exception to this legislation, are very important and have been stated 
again and again; first is this bill's effective preemption of a number 
of the very important benefits that my State of Massachusetts and a 
great number of the States in this country have been willing to write 
into law, to provide protections for their citizens. These protections 
are in the area of cancer, in the area of cancer screening, in the area 
of mental health, in the area of diabetes, and well-baby care. State 
laws have effectively been preempted. The people of my State will no 
longer be assured of those kinds of protections, if this legislation 
passes.
  The second point, which has been raised again and again, is the 
question of raising premiums. In the legislation we refer to this as 
rating. In the initial Enzi proposal, it would have been possible to 
have a 25-fold variation in the cost of insurance premiums--from $100 
to $2,500--based upon your age, your past health history, or that of 
your family. We know what would happen.
  When you allow such variation, you are denying people an effective 
health insurance program. That is what Blue Cross-Blue Shield says in 
Massachusetts, my own State. They basically say that younger people 
will be able to have insurance, but the older people and families who 
have had health care challenges will be knocked off, unable to afford 
it.
  What will happen? These people will go to the public health clinics, 
with the State having to pick up the cost. That is what Blue Cross-Blue 
Shield in my State says. This proposal is a shifting of the cost.
  In this very excellent letter, which I will ask to have printed in 
the Record, Blue Cross-Blue Shield in my State has been ranked among 
the top five plans in the Nation by U.S. News & World Report.
  In this letter, Blue Cross-Blue Shield warns us about preempting the 
State regulations of rating and benefit requirements. They say do not 
do this. It will have a bad effect on our seniors. It will increase the 
number of uninsured and transfer the costs back to the public. The 
taxpayers will pick it up.
  We believe Blue Cross-Blue Shield and the other organizations that 
have been identified are correct. This bill should not pass at this 
time. We are prepared to work with the Senators from Wyoming and 
Nebraska to try to deal with these health care challenges.
  I ask unanimous consent to have the aforementioned letter printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:
                                            Blue Cross Blue Shield


                                             of Massachusetts,

                                                     May 10, 2006.
     Hon. Edward M. Kennedy,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senator Kennedy: On behalf of Blue Cross Blue Shield 
     of Massachusetts, I am writing to express our opposition to 
     S. 1955 (``the Health Insurance Marketplace Modernization 
     Act''). The legislation being considered by the United States 
     Senate will completely undermine the historic health care 
     achievements made by Massachusetts for which you played a 
     critical role.
       At Blue Cross Blue Shield of Massachusetts, we are 
     committed to providing access to affordable, quality health 
     care to the citizens of Massachusetts. With over 2.9 million 
     members, we are proud to be ranked among the top five health 
     plans in the nation by U.S. News & World Report and the 
     National Committee for Quality Assurance.
       As you know, S. 1955 preempts state regulations as to 
     rating and benefit requirements. In so doing, it seriously 
     destabilizes the small group market nationally and critically 
     disrupts states, like Massachusetts, that utilize community 
     rating. Under Enzi, medical underwriting is permitted as are 
     premium surcharges based on age, gender, geography and group 
     size. In Massachusetts, older and sicker individuals will 
     face increased premiums, as will the self-employed and 
     smaller businesses.
       Despite its intended goal, the Enzi legislation will 
     actually lead to a rise in the uninsured in Massachusetts as 
     older, sicker workers lose coverage. According to a recent 
     study by the Lewin Group, there will be an increase of over 
     37,000 uninsured in Massachusetts with an associated rise in 
     uncompensated care costs of over $8 million. Needless to say, 
     this places a further strain on our health centers, community 
     hospitals, urban medical centers as they see increased 
     uninsured and unhealthy individuals.
       The Enzi legislation takes a completely different tact to 
     increasing access to affordable insurance than the 
     Massachusetts health reform bill. The Massachusetts approach 
     seeks to pool risk and optimize coverage to benefit the 
     community. S. 1955 would lower costs for individual groups by

[[Page S4459]]

     basing their rate on their own particular risk and minimizing 
     coverage. The Enzi approach may serve to increase access to 
     young and healthy small groups but does so at the expense of 
     older and sicker populations. From a philosophical and 
     practical standpoint, the two approaches cannot coexist.
       The impossible dream, to which you so eloquently spoke, of 
     quality health care that will truly be available and 
     affordable for each and every man, woman, and child in our 
     state, will become just that--impossible--if S. 1955 is 
     allowed to pass.
       We thank you for your ongoing efforts for our shared goals 
     of ensuring access to affordable, quality health care to the 
     citizens of the nation and our state of Massachusetts and 
     urge you to continue to vigorously oppose S. 1955 so that it 
     fails in the Senate.
       As always, please do not hesitate to contact me.
           Sincerely,
                                           Cleve L. Killingsworth.

  The PRESIDING OFFICER (Mr. Cornyn). The Senator from Wyoming.
  Mr. ENZI. Mr. President, actions speak louder than words. People are 
going to have a chance in a little while to show some action for small 
business. Once in a while there is a moment when you have a chance to 
make a difference.
  Today, most of the Democrats appear to be willing to sacrifice that 
moment to make a statement. They are saying we cannot give small 
business anything until we have votes on stem cells, until we have 
votes on prescription drugs, until we have votes on drug importation, 
and to heck with the small businesses. What kind of an attitude is 
that?
  The Democrats' argument is: We are going to deny small business 
anything until we get them everything. Of course, they are promising 
everything in their bill.
  Let us get this clear. The Democrats care so much about families 
employed by small business that they are willing to keep them from 
having any insurance until they find a way to provide everything they 
think they need. Spare me the care. We have a lot of smokescreens. One 
of the smokescreens is the process did not allow them to have votes.
  I asked unanimous consent a little while ago, and I said I will 
guarantee you a vote on Durbin-Lincoln. I will guarantee you debate on 
Durbin-Lincoln. I will let that happen right after cloture.
  The reason that has to happen is because of the process of the 
Senate; otherwise, they only get a vote and they still block me from 
getting a vote on this bill that has been worked out with the insurance 
companies, with the insurance commissioners, and with the associations.
  That is a smokescreen. There is going to be a vote on whether we care 
to debate some more on small business. There can be amendments after 
cloture. Amendments will allow you to cover everything that has been 
mentioned over here, whether it is ratings or whether it is mandates.
  Let me tell you that mandates is another smokescreen. Where this has 
been done inside States, the companies that had the right not to have 
mandates, it covers the ones that you mentioned. This is about being 
able to have enough opportunity to expand across State lines where 
there are 1,800 different mandates. You have to be able to get them 
together so that small businesses can go together across State lines 
and gather a big enough pool to effectively negotiate against insurance 
companies.
  Yes, there are some insurance companies that are writing letters 
saying: Do not let them do this. There is a profit motive. I can't 
blame them for that. But what the small businesspeople are really 
asking for on that is the same thing that big businesses have. We 
already excluded big business from all of the mandates and the 
oversight by States. We are not going that far.
  We even have some provisions in there, and I am sure with some 
amendments there would be some mandates in there. Here is where the 
savings come in for these small businesses. I am extremely excited 
about this.
  The cost for administration for a small business policy is about 35 
percent. If you check with Wal-Mart, which is excluded from everything 
and gets to have their own plan, their cost of administration is 8 
percent. The savings are in the administration. That is 27 percent 
which they save.
  For every 1 percent of savings, insurance brings in 200,000 to 
300,000 people into the market.
  There are 27 million uninsured small businesspeople and employees out 
there. They are like families.
  I was talking to Senator Harkin. He was telling me about a small 
businessman he knows. These small businesses are kind of interesting. 
They go to church with the same people who work for them. They go to 
watch baseball with the same people who work for them. Their kids are 
in the same little league. They go to the same organizations. And this 
small businessman said: I have to tell them that I can't afford the 
insurance anymore. And I still want to live with them. I want my family 
to have insurance, but that is not going to happen.
  This is an opportunity to make a difference, to offer amendments to 
perfect the bill in whatever way the majority of people think needs to 
be done. Anything else is a smokescreen.
  I gave them an opportunity to vote on Durbin-Lincoln. I gave them an 
opportunity to vote on this, but it was an assurance that we would get 
to vote on both, so small business would get a vote. There is going to 
be a vote on small business.
  There are hundreds of people around the Capitol right now who are 
with small business who are saying: We need the opportunity to have a 
better health care plan. Some of them will get insurance for the first 
time; some will get a better health insurance plan.
  As an accountant, I have to remind you that this is not a case of 
subtraction. This insurance plan is an addition. We are bringing in 
newly insured people. Anybody who votes against cloture needs to go to 
their dry cleaners tonight to pick up their laundry and look that 
person in the eye and say: I do not think you deserve health insurance 
because you might not demand enough for yourself. So you know what? I 
saved you from yourself. Can you say that to the mom and pop running 
the business down the street from your home? Can you say that they do 
not deserve health insurance? As you go home today after you leave the 
Hill, think about the people around you, the regular people--the cab 
driver, the worker at the dry cleaners, the person in the neighborhood 
restaurant, all of those people you may not notice who really make the 
world operate. Many of them do not have any insurance. Some may even 
own that little restaurant around the corner and still not be able to 
afford the insurance. I am not talking about deluxe insurance; I am 
talking about any insurance.
  So please overlook the smokescreen and vote to have some more debate 
and amendments and a vote on a small business health plan.
  I yield the floor and yield the remainder of my time.


                             Cloture Motion

  The PRESIDING OFFICER. Under the previous order, the clerk will 
report the motion to invoke cloture on the pending modified substitute 
amendment to Calendar No. 417, S. 1955, Health Insurance Marketplace 
Modernization and Affordability Act of 2005.
       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 pending 
     modified substitute amendment to Calendar No. 417, S. 1955, 
     Health Insurance Marketplace Modernization and Affordability 
     Act of 2006.
         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, John E. Sununu, 
           Pat Roberts, Craig Thomas.

  The PRESIDING OFFICER. By unanimous consent the mandatory quorum call 
has been waived.
  The question is, Is it the sense of the Senate that debate on the 
modified substitute amendment to Calendar No. 417, 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 assistant legislative clerk called the roll.
  Mr. McCONNELL. The following Senator was necessarily absent: the 
Senator from Pennsylvania (Mr. Specter).

[[Page S4460]]

  Mr. DURBIN. I announce that the Senator from West Virginia (Mr. 
Rockefeller) is necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The yeas and nays resulted--yeas 55, nays 43, as follows:

                      [Rollcall Vote No. 119 Leg.]

                                YEAS--55

     Alexander
     Allard
     Allen
     Bennett
     Bond
     Brownback
     Bunning
     Burns
     Burr
     Chambliss
     Coburn
     Cochran
     Coleman
     Collins
     Cornyn
     Craig
     Crapo
     DeMint
     DeWine
     Dole
     Domenici
     Ensign
     Enzi
     Frist
     Graham
     Grassley
     Gregg
     Hagel
     Hatch
     Hutchison
     Inhofe
     Isakson
     Kyl
     Landrieu
     Lott
     Lugar
     Martinez
     McCain
     McConnell
     Murkowski
     Nelson (NE)
     Roberts
     Santorum
     Sessions
     Shelby
     Smith
     Snowe
     Stevens
     Sununu
     Talent
     Thomas
     Thune
     Vitter
     Voinovich
     Warner

                                NAYS--43

     Akaka
     Baucus
     Bayh
     Biden
     Bingaman
     Boxer
     Byrd
     Cantwell
     Carper
     Chafee
     Clinton
     Conrad
     Dayton
     Dodd
     Dorgan
     Durbin
     Feingold
     Feinstein
     Harkin
     Inouye
     Jeffords
     Johnson
     Kennedy
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lincoln
     Menendez
     Mikulski
     Murray
     Nelson (FL)
     Obama
     Pryor
     Reed
     Reid
     Salazar
     Sarbanes
     Schumer
     Stabenow
     Wyden

                             NOT VOTING--2

     Rockefeller
     Specter
  The PRESIDING OFFICER. On this vote, the yeas are 55, the nays are 
43. Three-fifths of the Senators duly chosen and sworn not having voted 
in the affirmative, the motion is rejected.
  Mr. McCONNELL. I move to reconsider the vote, and I move to lay that 
motion on the table.
  The motion to lay on the table was agreed to.

                          ____________________