[Congressional Record Volume 153, Number 1 (Thursday, January 4, 2007)]
[Senate]
[Pages S149-S151]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Ms. Landrieu):
  S. 158. A bill to expand access to affordable health care and to 
strengthen the health care safety net and make health care services 
more available in rural and underserved areas; to the Committee on 
Finance.
  Ms. COLLINS. Mr. President, I am pleased to join with my colleague 
from Louisiana, Senator Landrieu, in introducing the Access to 
Affordable Health Care Act, a comprehensive plan that builds on the 
strengths of our current public programs and private health care system 
to make affordable health care available to millions more Americans.
  One of my priorities in the Senate has been to expand access to 
affordable health care. 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.
  Maine is in the midst of a growing health insurance crisis, with 
insurance premiums rising at alarming rates. Whether I am talking to a 
self-employed fisherman, a displaced worker, the owner of a struggling 
small business, or the human resource manager of a large company, the 
soaring costs of health insurance is a common concern.
  These cost increases have been particularly burdensome for small 
businesses, the backbone of the Maine economy. Maine small business 
owners want to provide coverage for their employees, but they are 
caught in a cost squeeze. They know that if they pass on premium 
increases to their employees, more of them will decline coverage. Yet 
these small businesses simply cannot afford to absorb double-digit 
increases in their health insurance premiums year after year.
  The problem of rising costs is even more acute for individuals and 
families who must purchase health insurance on their own. Monthly 
health insurance premiums in Maine often exceed a family's mortgage 
payment. Clearly, we must do more to make health insurance more 
available and affordable.
  The Access to Affordable Health Care Act, which we are introducing 
today, is a seven-point plan that combines a variety of public and 
private approaches. The legislation's seven goals are: one, to expand 
access to affordable health care for small businesses; two, to make 
health insurance more affordable for individuals and families 
purchasing coverage on their own; three, to strengthen the health care 
safety net for those without coverage; four, to expand access to care 
in rural and underserved areas; five, to increase access to affordable 
long-term care; six to promote healthier lifestyles; and seven, to 
provide more equitable Medicare payments to Maine providers to reduce 
the Medicare shortfall, which has forced hospitals, physicians and 
other providers to shift costs onto other payers in the form of higher 
charges, which in turn drives up health care premiums.
  Let me discuss each of these seven points in greater detail.
  First, our legislation will help small employers cope with rising 
health care costs.
  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 per cent of uninsured workers are employed 
by small firms. Smaller firms generally face higher costs for health 
insurance than larger firms, which makes them less likely to offer 
coverage. The Access to Affordable Health Care Act will help these 
employers cope with rising costs by creating new tax credits for small 
businesses to make health insurance more affordable. It will encourage 
those small businesses that do not offer health insurance to do so and 
will help employers that do offer insurance to continue coverage for 
their employees even in the face of rising costs.
  Our legislation will also provide grants to provide start-up funding 
to States to help businesses to form group purchasing cooperatives. 
These cooperatives will enable small businesses to band together to 
purchase health insurance jointly. This will help to reduce their costs 
and improve the quality of their employee's health care.
  The legislation would also authorize a Small Business Administration 
grant program for States, local governments and non-profit 
organizations to provide information about the benefits of health 
insurance to small employers, including tax benefits, increased 
productivity of employees, and decreased turnover. These grants would 
also be used to make employers aware of their current incentives under 
State and Federal laws. While costs are clearly a problem, many small 
employers are simply not aware of laws that have already been enacted 
by both States and the Federal government to make health insurance more 
affordable. For example, in one survey, 57 percent of small employers 
did not know that they could deduct 100 percent of their health 
insurance premiums as a business expense.
  The legislation would also create a new program to encourage 
innovation by awarding demonstration grants in up to 10 States 
conducting innovative coverage expansions, such as alternative group 
purchasing or pooling arrangements, individual or small group market 
reforms, or subsidies to employers or individuals purchasing coverage. 
The States have long been laboratories for reform, and they should be 
encouraged in the development of innovative programs that can serve as 
models for the Nation.
  The Access to Affordable Health Care Act will also expand access to 
affordable health care for individuals and families. One of the first 
bills that I sponsored when I came to the Senate was legislation to 
establish the State Child Health Insurance Program, which provides 
insurance for the children of low-income parents who cannot afford 
health insurance, yet make too much money to qualify for Medicaid. 
Since 1997, this program, which is known as SCHIP, has contributed to a 
one-third decline in the uninsured rate of low-income children. Today, 
over six million children--including approximately 14,500 in Maine--
receive health care coverage through this remarkably effective health 
care program.
  First, our legislation will shore up the looming shortfalls in SCHIP 
funding that 17 states--including Maine--will face in Fiscal Year 2007 
to ensure that children currently enrolled in the program do not lose 
their coverage. Just prior to adjournment in December, the Congress 
approved legislation to partially address these shortfalls. That 
legislation, however, provides only about one-fifth of the funds 
needed. Our legislation will close that gap.
  Our legislation also builds on the success of the SCHIP program and 
gives States a number of new tools to increase participation. The bill 
authorizes new grants for States and non-

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profit organizations to conduct innovative outreach and enrollment 
efforts to ensure that all eligible children are covered. States would 
also have the option of covering the parents of the children who are 
enrolled in programs like MaineCare. States could also use funds 
provided through this program to help eligible working families pay 
their share of an employer-based health insurance plan. In short, the 
legislation will help ensure that the entire family receives the health 
care they need.
  And finally, to help make health coverage more affordable for low and 
middle-income individuals and families who do not have employer-
provided coverage and who are not eligible for the expanded programs, 
our legislation would provide an advanceable, refundable tax credit of 
up to $1,000 for individuals earning up to $30,000 and up to $3,000 for 
families earning up to $60,000. This could provide coverage for up to 
six million Americans who would otherwise be uninsured for one or more 
months, and will help many more working lower-income families who 
currently purchase private health insurance with little or no 
government help.
  To strengthen our nation's health care safety net, the Access to 
Affordable Health Care Act calls for a doubling of funding over five 
years for the Consolidated Health Centers program, which includes 
community, migrant, public housing and homeless health centers.
  These centers, which operate in underserved urban and rural 
communities, provide critical primary care services to millions of 
Americans, regardless of their ability to pay. About 20 percent of the 
patients treated in Maine's community health centers have no insurance 
coverage and many more have inadequate coverage, so these centers are a 
critical part of our nation's health care safety net.
  The problem of access to affordable health care services is not 
limited to the uninsured, but is also shared by many Americans living 
in rural and underserved areas where there is a shortage of health care 
providers. The Access to Affordable Health Care Act therefore calls for 
increased funding for the National Health Service Corps, which supports 
doctors, dentists, and other clinicians who serve in rural and inner 
city areas.
  The legislation will also give the program greater flexibility by 
allowing National Health Service Corps participants to fulfill their 
commitment on a part-time basis. Current law requires all National 
Health Service Corps participants to serve full-time. Many rural 
communities, however, simply do not have enough volume to support a 
full-time health care practitioner. Moreover, some sites may not need a 
particular type of provider on a full-time basis. Our bill therefore 
gives the program additional flexibility to meet community needs.
  As the Senate co-chair of the bipartisan Congressional Task Force on 
Alzheimer's Disease, I am particularly sensitive to the long-term care 
needs of patients with chronic diseases like Alzheimer's and their 
families.
  Long-term care is the major catastrophic health care expense faced by 
older Americans today, and these costs will only increase with the 
aging of the baby boomers. Most Americans mistakenly believe that 
Medicare or their private health insurance policies will cover the 
costs of long-term care should they develop a chronic illness or 
cognitive impairment like Alzheimer's Disease. Unfortunately, far too 
many do not discover that they do not have coverage until they are 
confronted with the difficult decision of placing a much-loved parent 
or spouse in long-term care and facing the shocking realization that 
they will have to cover the costs themselves.
  The Access to Affordable Health Care Act will provide a tax credit 
for long-term care expenses of up to $3,000 to provide some help to 
those families struggling to provide long-term care to a loved one. It 
will also encourage more Americans to plan for their future long-term 
care needs by providing a tax deduction to help them purchase long-term 
care insurance.
  Health insurance alone is not going to ensure good health. As noted 
author and physician Dr. Michael Crichton has observed, ``the future of 
medicine lies not in treating illness, but preventing it.'' Many of our 
most serious health problems are directly related to unhealthy 
behaviors--smoking, lack of regular exercise, and poor diet. These 
three major risk factors alone have made Maine the state with the 
fourth highest death rate due to four largely preventable diseases: 
cardiovascular disease, cancer, chronic lung disease and diabetes. 
These four chronic diseases are responsible for 70 percent of the 
health care problems in Maine.
  Our bill therefore contains a number of provisions designed to 
promote healthy lifestyles. An ever-expanding body of evidence shows 
that investments in health promotion and prevention offer returns not 
only in reduced health care bills, but in longer life and increased 
productivity. The legislation will provide grants to States to assist 
small businesses wishing to establish ``worksite wellness'' programs 
for their employees. It would also authorize a grant program to support 
new and existing ``community partnerships,'' such as the Healthy 
Community Coalition in Maine's Franklin County, to promote healthy 
lifestyles among hospitals, employers, schools and community 
organizations. And, it would provide funds for States to establish or 
expand comprehensive school health education, including, for example, 
physical education programs that promote lifelong physical activity, 
healthy food service selections, and programs that promote a healthy 
and safe school environment.

  And finally, the Access to Affordable Health Care Act would promote 
greater equity in Medicare payments and help to ensure that the 
Medicare system rewards rather than punishes states like Maine that 
deliver high-quality, cost-effective Medicare services to our elderly 
and disabled citizens.
  The Medicare Modernization Act of 2003 and subsequent legislation did 
take some significant steps toward promoting greater fairness by 
increasing Medicare payments to rural hospitals and by modifying 
geographic adjustment factors that discriminated against physicians and 
other providers in rural areas. The legislation we are introducing 
today will build on those improvements by establishing State pilot 
programs that reward providers of high- quality, cost-efficient 
Medicare services.
  The Access to Affordable Health Care Act outlines a blueprint for 
reform based on principles upon which I believe a bipartisan majority 
in Congress could agree. The plan takes significant strides toward the 
goal of universal health care coverage by bringing millions more 
Americans into the insurance system and by strengthening the health 
care safety net.
  Ms. LANDRIEU. Mr. President, I am pleased to join with my colleague 
from Main, Senator Collins, in introducing the Access to Affordable 
Health Care Act. The latest available Census figures show that 46.6 
million people in our country--including almost 19 percent of the 
people in my home State of Louisiana--are without health insurance.
  This statistic has been referred to so often in the media and in this 
body that it is almost possible to hear it without realizing the full 
impact of such uncertainty on one's day-to-day life. 46.6 million 
people without health insurance means 36.3 million families struggling 
with the knowledge that they may be just one hospitalization away from 
bankruptcy. It means 8.3 million children who may not be able to access 
the care they need to prevent increasingly common and often 
debilitating chronic illnesses such as diabetes and asthma, adversely 
affecting them for the rest of their lives. It means 27.3 million 
Americans with jobs, who work everyday knowing that they still may not 
be able to provide for their families in their time of need.
  Across the country, small business owners and families are struggling 
with the high cost of health care. This is particularly true in 
Louisiana and across the gulf coast, where recovery from the 2005 
hurricanes has already placed heavy burdens on thousands of families 
trying to rebuild and businesses working to reopen. Since 2000, the 
number of employees nationwide receiving health insurance through their 
employers has actually decreased, reversing the progress we saw in the 
1990s. Small businesses create two out of every three new jobs in 
America and account for nearly half of America's overall employment. 
Yet only 26 percent of businesses with fewer than 50 employees can 
offer health insurance

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to their employees. The Access to Affordable Health Care Act gives the 
small businesses that are the backbone of this country the opportunity 
to help make their employees' lives just a little easier.
  This legislation further provides for the expansion of the enormously 
successful SCHIP program, allowing States to cover increased numbers of 
pregnant women and poor, working adults. It allows for more community 
health centers and encourages health care providers to practice in the 
increasingly underserved rural areas of all States. It gives businesses 
the tools to not only insure their employees against illness but to 
encourage wellness, decreasing health care costs for everybody. It 
allows our government to reward States that find ways to improve health 
outcomes among Medicare patients, actively supporting the types of 
cost-efficient successes that improve the quality of life.
  A country identified by its ingenuity and creativity has a moral 
responsibility to do more than we have to provide its citizens with the 
ability to keep their families safe and healthy. These comprehensive, 
real steps forward will open new doors of opportunity and access to 
affordable health care for millions of American families and business 
owners, and I am proud to have partnered with Senator Collins in this 
important pursuit. I encourage my colleagues to consider this 
legislation and to help provide our all our constituents with the peace 
of mind.
                                 ______