[Congressional Record Volume 153, Number 9 (Wednesday, January 17, 2007)]
[Senate]
[Pages S696-S702]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself and Mr. Voinovich):
  S. 325. A bill to provide for innovation in heath care through State 
initiatives that expand coverage and access and improve quality and 
efficiency in the health care system; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, I rise today to introduce bipartisan 
legislation with Senator Voinovich entitled the ``Health Partnership 
Act of 2007,'' which along with a companion House bill introduced by 
Representatives Tammy Baldwin, John Tierney, and Tom Price, intends to 
set us on a path toward affordable, quality health care for all 
Americans. The Health Partnership Act creates partnerships between the 
Federal Government, State and local governments, tribes and tribal 
organizations, private payers, and health care providers to seek 
innovation in health care systems.
  Under this Act, States, local governments, and tribes and tribal 
governments would be invited to submit applications to the Federal 
Government for funding to implement expansion and improvements to 
current health programs for review by a bipartisan ``State Health 
Innovation Commission.'' Based on funding available through the Federal 
budget process, the Commission would approve a variety of reform 
options and innovative approaches.
  This federalist approach to health reform would encourage a broad 
array of reform options subject to monitoring, to determine what is and 
is not successful. As Supreme Court Justice Louis D. Brandeis wrote in 
1932, ``It is one of the happy incidents of the federal system that a 
single courageous State may, if its citizens choose, serve as a 
laboratory; and try novel social and economic experiments without risk 
to the rest of the country.''
  Our bipartisan legislation, the ``Health Partnership Act,'' 
encourages

[[Page S697]]

this type of State-based innovation and will help the Nation better 
address both the policy and the politics of health care reform. 
Currently, we do not have a ``one-size-fits-all'' model of reform, so 
encouraging States, local governments, and tribes to adopt a variety of 
approaches will help us better understand what may or may not work.
  Inaction on the growing and related problems of the uninsured and 
increasing health care costs is unacceptable and unconscionable.
  In fact, while spending on health care in our country has reached $2 
trillion annually, the number of uninsured has increased to nearly 47 
million people, seven million more than in 2000. The consequences are 
staggering, as uninsured citizens get about half the medical care they 
need compared to those with health insurance and, according to the 
Institute of Medicine, about 18,000 unnecessary deaths occur each year 
in the U.S. because of lack of health insurance.
  While gridlock continues to permeate Washington, DC, in regards to 
this issue, a number of States and local governments are moving ahead 
with health reform. The ``Health Partnership Act'' would provide 
support, in the form of grants, to States, groups of States, local 
governments, and Indian tribes and tribal organizations to carry out 
any of a broad range of strategies intended to reduce the number of 
uninsured, reduce costs, and improve the quality of care.
  Responding to urgent needs, State and local governments have not been 
able to wait for Federal action. We observed this in the early 1990s as 
States such as New Mexico, Massachusetts, Pennsylvania, Florida, Rhode 
Island, Hawaii, Maryland, Tennessee, Vermont, and Washington led the 
way to expanding coverage to children through the enactment of a 
variety of health reforms. Evaluation proved that some of these 
programs worked better than others, so the Federal Government took note 
and responded in 1997 with passage of the ``State Children's Health 
Insurance Program'' or SCHIP. This legislation, built upon experiences 
of the States, enjoyed broad bipartisan support. SCHIP is a popular and 
successful State-based model that covers millions of children and 
continues to have broad-based bipartisan support across this Nation.
  So, why not use that successful model and build upon it? In fact, 
State and local governments are already taking up that challenge and 
the Federal Government should, through the enactment of the ``Health 
Partnership Act,'' do what it can to be helpful with those efforts. For 
example--
  On November 15, 2005, Illinois Governor Rod Blagojevich signed into 
law the ``Covering All Kids Health Insurance Act'' which, beginning in 
July 2006, intended to make insurance coverage available to all 
uninsured children.
  In April, Massachusetts Governor Mitt Romney signed into law 
legislation that requires all Bay State residents to have health 
insurance. Their State experiment involves partnerships between the 
State Medicaid, employer groups, and insurance companies.
  Now California's Governor Schwarzenegger proposes health reform to 
include health promotion and wellness services for all, insurance 
coverage, and cost containment measures.
  Other States, including New Mexico, Vermont, Tennessee, Maine, West 
Virginia, Oklahoma, and New York have enacted other health reforms that 
have had mixed success.
  All of these efforts add importantly to our knowledge base, and can 
then lead to a national solution to our uninsured and affordability 
crisis. We can learn from each and every one of these efforts, 
including those which failed.
  Commonwealth Fund President Karen Davis said it well by noting that 
State-based reforms, such as that passed in Massachusetts, are very 
good news. As she notes, ``First, any substantive effort to expand 
access to coverage is worthwhile, given the growing number of uninsured 
in this country and the large body of evidence showing the dangerous 
health implications of lacking coverage.''
  She adds, ``But something more important is at work here. While we 
urgently need a national solution so that all Americans have insurance, 
it doesn't appear that we'll be getting one at the Federal level any 
time soon. So what Massachusetts has done potentially holds lessons for 
every State.'' I would add that it holds lessons for the Federal 
Government as well and not just for the mechanics of implementing 
health reform policy but also to the politics of health reform.
  As she concludes, ``One particularly cogent lesson is the manner in 
which the measure was crafted--via a civil process that successfully 
brought together numerous players from across the political business, 
health care delivery, and policy sectors.''
  Senator Voinovich and I have worked together and reached out to like 
minded colleagues in the House of Representatives via a process much 
like that described by Karen Davis. The legislation stems from past 
legislative efforts by Senators such as Bob Graham, Mark Hatfield, and 
Paul Wellstone, but also from work across ideological lines by Henry 
Aaron of the Brookings Institution and Stuart Butler of the Heritage 
Foundation.
  The legislation also benefits from advice and support from health 
care providers. Dr. Tim Garson who, as Dean of the University of 
Virginia, brought a much needed provider perspective, ensuring support 
from the House of Medicine. Supporters include the American Medical 
Association, the American Academy of Pediatrics, the American College 
of Physicians, the American College of Cardiology, American 
Gastroenterological Association, the Visiting Nurses Association, the 
National Association of Community Health Centers, and from state-based 
health providers such as the New Mexico Medical Society and Ohio 
Association of Community Health Centers.
  The Health Partnership Act supports providers.
  The Health Partnership Act received much comment and support from 
consumer-based groups advocating for national health reform, including 
that by Dr. Ken Frisof of the Universal Health Care Action Network, 
Bill Vaughan at Consumers Union, and from numerous health care 
advocates in New Mexico, including Community Action New Mexico, Health 
Action New Mexico, Health Care for All Campaign of New Mexico, New 
Mexico Center on Law and Poverty, New Mexico Health Choices Initiative, 
New Mexico POZ Coalition, New Mexico Public Health Association, New 
Mexico Religious Coalition for Reproductive Choice, New Mexico 
Progressive Alliance for Community Empowerment, and the Health Security 
for New Mexicans Campaign, which includes 115 State-based 
organizations.
  The Health Partnership Act supports consumers.
  Support from stakeholders throughout our Nation's health care system 
has been sought and I would like to thank the many organizations from 
New Mexico for their support and input to this legislation. There is 
great urgency in New Mexico because our State, like all of those along 
the U.S.-Mexico border, faces a severe health care crisis. Over one in 
five New Mexicans does not have insurance coverage. In fact, only one 
State, Texas, has more uninsured. New Mexico is also the only State in 
the country with greater than half of its population covered by State 
or federally funded health programs.
  A rather shocking statistic, which also continues to worsen, is that 
one out of every three Hispanic citizens are uninsured. In fact, less 
than 41 percent of the Hispanic population now has employer-based 
coverage nationwide, which is in sharp comparison to the 66 percent of 
non-Hispanic whites who have employer-based coverage.
  Because so few New Mexicans have employer-based health insurance, the 
State of New Mexico has enacted its own health reform plan called the 
State Coverage Initiative, or SCI, in July 2005. SCI is a public/
private partnership intended to expand employer-sponsored insurance, 
developed in part with grant funding from the Robert Wood Johnson 
Foundation. As of December 2006, there were 4,256 people covered by 
this initiative and there are efforts to expand this effort to cover 
over 20,000 individuals. With Federal support for my State, the hope 
would be to further expand coverage to as many New Mexicans as 
possible.
  The Health Partnership Act encourages reforms at both the state and 
local levels of government. Senator Voinovich, as former mayor of 
Cleveland, suggested language that would capture community-based 
efforts as well. Illinois, Georgia, Michigan, and

[[Page S698]]

Oregon have all initiated efforts at the local level for reform, 
including so-called ``three-share'' programs in Illinois and Michigan. 
Under these initiatives, employers, employees, and the community each 
pick up about one-third of the cost of programs.
  Jeaneane Smith, deputy administrator in the Office of Oregon Health 
Policy and Research was recently quoted by an Academy Health 
publication stating, ``In recent years it has become apparent that 
there is a need to consider both state- and community-level approaches 
to improved access. We want to learn how best to support communities as 
they play an integral part in addressing the gaps in coverage.''
  The Health Partnership Act supports communities.
  Our hope is to spawn innovation. Brookings Institution senior health 
fellow Henry Aaron and Heritage Foundation vice president Stuart Butler 
wrote a Health Affairs article in March 2004 that lays out the 
foundation for this legislative effort. They argue that while we remain 
unable to reconcile how best to expand coverage at the Federal level, 
we can agree to support states in their efforts to try widely differing 
solutions to health coverage, cost containment, and quality 
improvement. As they write, ``this approach offers both a way to 
improve knowledge about how to reform health care and a practical way 
to initiate a process of reform. Such a pluralist approach respects the 
real, abiding differences in politics, preferences, traditions, and 
institutions across the nation. It also implies a willingness to accept 
differences over an extended period in order to make progress. And it 
recognizes that permitting wide diversity can foster consensus by 
revealing the strengths and exposing the weaknesses of rival 
approaches.''
  In addition to Dr. Garson, Mr. Aaron, Mr. Butler, and Dr. Frisof, I 
would like to express my appreciation to Dan Hawkins at the National 
Association of Community Health Centers, Bill Vaughan at Consumers 
Union, and both Jack Meyer and Stan Dorn at ESRI for their counsel and 
guidance on health reform and this legislation.
  I would also like to commend the American College of Physicians, or 
ACP, for their outstanding leadership on the issue of the uninsured and 
for their willingness to support a variety of efforts to expand health 
coverage. ACP has been a longstanding advocate for expanding health 
coverage and has authored landmark reports on the important role that 
health insurance has in reducing people's morbidity and mortality. In 
fact, to cite the conclusion of one of those studies, ``Lack of 
insurance contributes to the endangerment of the health of each 
uninsured American as well as the collective health of the Nation.''
  And finally, I would also thank the many people at the Robert Wood 
Johnson Foundation on their forethought and knowledge on all the issues 
confronting the uninsured. Their efforts to continue the dialogue on 
the uninsured has successfully kept the issue alive for many years.
  I urge my colleagues to break the gridlock and support this 
legislation, which offers financial support to states, communities, 
providers, and consumers, as they adopt important innovations in 
healthcare coverage and expansion.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 325

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Health Partnership Act''.

     SEC. 2. STATE HEALTH REFORM PROJECTS.

       (a) Purpose; Establishment of State Health Care Expansion 
     and Improvement Program.--The purposes of the programs 
     approved under this section shall include, but not be limited 
     to--
       (1) achieving the goals of increased health coverage and 
     access;
       (2) ensuring that patients receive high-quality, 
     appropriate health care;
       (3) improving the efficiency of health care spending; and
       (4) testing alternative reforms, such as building on the 
     public or private health systems, or creating new systems, to 
     achieve the objectives of this Act.
       (b) Applications by States, Local Governments, and 
     Tribes.--
       (1) Entities that may apply.--
       (A) In general.--A State, in consultation with local 
     governments, Indian tribes, and Indian organizations involved 
     in the provision of health care, may apply for a State health 
     care expansion and improvement program for the entire State 
     (or for regions of the State) under paragraph (2).
       (B) Regional groups.--A regional entity consisting of more 
     than one State may apply for a multi-State health care 
     expansion and improvement program for the entire region 
     involved under paragraph (2).
       (C) Definition.--In this Act, the term ``State'' means the 
     50 States, the District of Columbia, and the Commonwealth of 
     Puerto Rico. Such term shall include a regional entity 
     described in subparagraph (B).
       (2) Submission of application.--In accordance with this 
     section, each State desiring to implement a State health care 
     expansion and improvement program may submit an application 
     to the State Health Innovation Commission under subsection 
     (c) (referred to in this section as the ``Commission'') for 
     approval.
       (3) Local government applications.--
       (A) In general.--Where a State declines to submit an 
     application under this section, a unit of local government of 
     such State, or a consortium of such units of local 
     governments, may submit an application directly to the 
     Commission for programs or projects under this subsection. 
     Such an application shall be subject to the requirements of 
     this section.
       (B) Other applications.--Subject to such additional 
     guidelines as the Secretary may prescribe, a unit of local 
     government, Indian tribe, or Indian health organization may 
     submit an application under this section, whether or not the 
     State submits such an application, if such unit of local 
     government can demonstrate unique demographic needs or a 
     significant population size that warrants a substate program 
     under this subsection.
       (c) State Health Innovation Commission.--
       (1) In general.--Within 90 days after the date of the 
     enactment of this Act, the Secretary shall establish a State 
     Health Innovation Commission that shall--
       (A) be comprised of--
       (i) the Secretary;
       (ii) four State governors to be appointed by the National 
     Governors Association on a bipartisan basis;
       (iii) two members of a State legislature to be appointed by 
     the National Conference of State Legislators on a bipartisan 
     basis;
       (iv) two county officials to be appointed by the National 
     Association of Counties on a bipartisan basis;
       (v) two mayors to be appointed by the United States 
     Conference of Mayors and the National League of Cities on a 
     joint and bipartisan basis;
       (vi) two individuals to be appointed by the Speaker of the 
     House of Representatives;
       (vii) two individuals to be appointed by the Minority 
     Leader of the House of Representatives;
       (viii) two individuals to be appointed by the Majority 
     Leader of the Senate;
       (ix) two individuals to be appointed by the Minority Leader 
     of the Senate; and
       (x) two individuals who are members of federally-recognized 
     Indian tribes to be appointed on a bipartisan basis by the 
     National Congress of American Indians;
       (B) upon approval of \2/3\ of the members of the 
     Commission, provide the States with a variety of reform 
     options for their applications, such as tax credit 
     approaches, expansions of public programs such as medicaid 
     and the State Children's Health Insurance Program, the 
     creation of purchasing pooling arrangements similar to the 
     Federal Employees Health Benefits Program, individual market 
     purchasing options, single risk pool or single payer systems, 
     health savings accounts, a combination of the options 
     described in this clause, or other alternatives determined 
     appropriate by the Commission, including options suggested by 
     States, Indian tribes, or the public;
       (C) establish, in collaboration with a qualified and 
     independent organization such as the Institute of Medicine, 
     minimum performance measures and goals with respect to 
     coverage, quality, and cost of State programs, as described 
     under subsection (d)(1);
       (D) conduct a thorough review of the grant application from 
     a State and carry on a dialogue with all State applicants 
     concerning possible modifications and adjustments;
       (E) submit the recommendations and legislative proposal 
     described in subsection (d)(4)(B);
       (F) be responsible for monitoring the status and progress 
     achieved under program or projects granted under this 
     section;
       (G) report to the public concerning progress made by States 
     with respect to the performance measures and goals 
     established under this Act, the periodic progress of the 
     State relative to its State performance measures and goals, 
     and the State program application procedures, by region and 
     State jurisdiction;
       (H) promote information exchange between States and the 
     Federal Government; and
       (I) be responsible for making recommendations to the 
     Secretary and the Congress, using equivalency or minimum 
     standards, for minimizing the negative effect of State 
     program on national employer groups, provider organizations, 
     and insurers because of

[[Page S699]]

     differing State requirements under the programs.
       (2) Period of appointment; representation requirements; 
     vacancies.--Members shall be appointed for a term of 5 years. 
     In appointing such members under paragraph (1)(A), the 
     designated appointing individuals shall ensure the 
     representation of urban and rural areas and an appropriate 
     geographic distribution of such members. Any vacancy in the 
     Commission shall not affect its powers, but shall be filled 
     in the same manner as the original appointment.
       (3) Chairperson, meetings.--
       (A) Chairperson.--The Commission shall select a Chairperson 
     from among its members.
       (B) Quorum.--A majority of the members of the Commission 
     shall constitute a quorum, but a lesser number of members may 
     hold hearings.
       (C) Meetings.--Not later than 30 days after the date on 
     which all members of the Commission have been appointed, the 
     Commission shall hold its first meeting. The Commission shall 
     meet at the call of the Chairperson.
       (4) Powers of the commission.--
       (A) Negotiations with states.--The Commission may conduct 
     detailed discussions and negotiations with States submitting 
     applications under this section, either individually or in 
     groups, to facilitate a final set of recommendations for 
     purposes of subsection (d)(4)(B). Such negotiations shall 
     include consultations with Indian tribes, and be conducted in 
     a public forum.
       (B) Hearings.--The Commission may hold such hearings, sit 
     and act at such times and places, take such testimony, and 
     receive such evidence as the Commission considers advisable 
     to carry out the purposes of this subsection.
       (C) Meetings.--In addition to other meetings the Commission 
     may hold, the Commission shall hold an annual meeting with 
     the participating States under this section for the purpose 
     of having States report progress toward the purposes in 
     subsection (a)(1) and for an exchange of information.
       (D) Information.--The Commission may secure directly from 
     any Federal department or agency such information as the 
     Commission considers necessary to carry out the provisions of 
     this subsection. Upon request of the Chairperson of the 
     Commission, the head of such department or agency shall 
     furnish such information to the Commission if the head of the 
     department or agency involved determines it appropriate.
       (E) Postal services.--The Commission may use the United 
     States mails in the same manner and under the same conditions 
     as other departments and agencies of the Federal Government.
       (5) Personnel matters.--
       (A) Compensation.--Each member of the Commission who is not 
     an officer or employee of the Federal Government or of a 
     State or local government shall be compensated at a rate 
     equal to the daily equivalent of the annual rate of basic pay 
     prescribed for level IV of the Executive Schedule under 
     section 5315 of title 5, United States Code, for each day 
     (including travel time) during which such member is engaged 
     in the performance of the duties of the Commission. All 
     members of the Commission who are officers or employees of 
     the United States shall serve without compensation in 
     addition to that received for their services as officers or 
     employees of the United States.
       (B) Travel expenses.--The members of the Commission shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Commission.
       (C) Staff.--The Chairperson of the Commission may, without 
     regard to the civil service laws and regulations, appoint and 
     terminate an executive director and such other additional 
     personnel as may be necessary to enable the Commission to 
     perform its duties. The employment of an executive director 
     shall be subject to confirmation by the Commission.
       (D) Detail of government employees.--Any Federal Government 
     employee may be detailed to the Commission without 
     reimbursement, and such detail shall be without interruption 
     or loss of civil service status or privilege.
       (E) Temporary and intermittent services.--The Chairperson 
     of the Commission may procure temporary and intermittent 
     services under section 3109(b) of title 5, United States 
     Code, at rates for individuals which do not exceed the daily 
     equivalent of the annual rate of basic pay prescribed for 
     level V of the Executive Schedule under section 5316 of such 
     title.
       (6) Funding.--For the purpose of carrying out this 
     subsection, there are authorized to be appropriated 
     $3,000,000 for fiscal year 2007 and each fiscal year 
     thereafter.
       (d) Requirements for Programs.--
       (1) State plan.--A State that seeks to receive a grant 
     under subsection (f) to operate a program under this section 
     shall prepare and submit to the Commission, as part of the 
     application under subsection (b), a State health care plan 
     that shall have as its goal improvements in coverage, quality 
     and costs. To achieve such goal, the State plan shall comply 
     with the following:
       (A) Coverage.--With respect to coverage, the State plan 
     shall--
       (i) provide and describe the manner in which the State will 
     ensure that an increased number of individuals residing 
     within the State will have expanded access to health care 
     coverage with a specific 5-year target for reduction in the 
     number of uninsured individuals through either private or 
     public program expansion, or both, in accordance with the 
     options established by the Commission;
       (ii) describe the number and percentage of current 
     uninsured individuals who will achieve coverage under the 
     State health program;
       (iii) describe the minimum benefits package that will be 
     provided to all classes of beneficiaries under the State 
     health program;
       (iv) identify Federal, State, or local and private programs 
     that currently provide health care services in the State and 
     describe how such programs could be coordinated with the 
     State health program, to the extent practicable; and
       (v) provide for improvements in the availability of 
     appropriate health care services that will increase access to 
     care in urban, rural, and frontier areas of the State with 
     medically underserved populations or where there is an 
     inadequate supply of health care providers.
       (B) Quality.--With respect to quality, the State plan 
     shall--
       (i) provide a plan to improve health care quality in the 
     State, including increasing effectiveness, efficiency, 
     timeliness, patient focused, equity while reducing health 
     disparities, and medical errors; and
       (ii) contain appropriate results-based quality indicators 
     established by the Commission that will be addressed by the 
     State as well as State-specific quality indicators.
       (C) Costs.--With respect to costs, the State plan shall--
       (i) provide that the State will develop and implement 
     systems to improve the efficiency of health care, including a 
     specific 5-year target for reducing administrative costs 
     (including paperwork burdens);
       (ii) describe the public and private sector financing to be 
     provided for the State health program;
       (iii) estimate the amount of Federal, State, and local 
     expenditures, as well as, the costs to business and 
     individuals under the State health program;
       (iv) describe how the State plan will ensure the financial 
     solvency of the State health program; and
       (v) provide that the State will prepare and submit to the 
     Secretary and the Commission such reports as the Secretary or 
     Commission may require to carry out program evaluations.
       (D) Health information technology.--With respect to health 
     information technology, the State plan shall provide 
     methodology for the appropriate use of health information 
     technology to improve infrastructure, such as improving the 
     availability of evidence-based medical and outcomes data to 
     providers and patients, as well as other health information 
     (such as electronic health records, electronic billing, and 
     electronic prescribing).
       (2) Technical assistance.--The Secretary shall, if 
     requested, provide technical assistance to States to assist 
     such States in developing applications and plans under this 
     section, including technical assistance by private sector 
     entities if determined appropriate by the Commission.
       (3) Initial review.--With respect to a State application 
     for a grant under subsection (b), the Secretary and the 
     Commission shall complete an initial review of such State 
     application within 60 days of the receipt of such 
     application, analyze the scope of the proposal, and determine 
     whether additional information is needed from the State. The 
     Commission shall advise the State within such period of the 
     need to submit additional information.
       (4) Final determination.--
       (A) In general.--Not later than 90 days after completion of 
     the initial review under paragraph (3), the Commission shall 
     determine whether to submit a State proposal to Congress for 
     approval.
       (B) Voting.--
       (i) In general.--The determination to submit a State 
     proposal to Congress under subparagraph (A) shall be approved 
     by \2/3\ of the members of the Commission who are eligible to 
     participate in such determination subject to clause (ii).
       (ii) Eligibility.--A member of the Commission shall not 
     participate in a determination under subparagraph (A) if--

       (I) in the case of a member who is a Governor, such 
     determination relates to the State of which the member is the 
     Governor; or
       (II) in the case of member not described in subclause (I), 
     such determination relates to the geographic area of a State 
     of which such member serves as a State or local official.

       (C) Submission.--Not later than 90 days prior to October 1 
     of each fiscal year, the Commission shall submit to Congress 
     a list, in the form of a legislative proposal, of the State 
     applications that the Commission recommends for approval 
     under this section.
       (D) Approval.--With respect to a fiscal year, a State 
     proposal that has been recommended under subparagraph (B) 
     shall be deemed to be approved, and subject to the 
     availability of appropriations, Federal funds shall be 
     provided to such program, unless a joint resolution has been 
     enacted disapproving such proposal as provided for in

[[Page S700]]

     subsection (e). Nothing in the preceding sentence shall be 
     construed to include the approval of State proposals that 
     involve waivers or modifications in applicable Federal law.
       (5) Program or project period.--A State program or project 
     may be approved for a period of 5 years and may be extended 
     for subsequent 5-year periods upon approval by the Commission 
     and the Secretary, based upon achievement of targets, except 
     that a shorter period may be requested by a State and granted 
     by the Secretary.
       (e) Expedited Congressional Consideration.--
       (1) Introduction and committee consideration.--
       (A) Introduction.--The legislative proposal submitted 
     pursuant to subsection (d)(4)(B) shall be in the form of a 
     joint resolution (in this subsection referred to as the 
     ``resolution''). Such resolution shall be introduced in the 
     House of Representatives by the Speaker, and in the Senate, 
     by the Majority Leader, immediately upon receipt of the 
     language and shall be referred to the appropriate committee 
     of Congress. If the resolution is not introduced in 
     accordance with the preceding sentence, the resolution may be 
     introduced in either House of Congress by any member thereof.
       (B) Committee consideration.--A resolution introduced in 
     the House of Representatives shall be referred to the 
     Committee on Ways and Means of the House of Representatives. 
     A resolution introduced in the Senate shall be referred to 
     the Committee on Finance of the Senate. Not later than 15 
     calendar days after the introduction of the resolution, the 
     committee of Congress to which the resolution was referred 
     shall report the resolution or a committee amendment thereto. 
     If the committee has not reported such resolution (or an 
     identical resolution) at the end of 15 calendar days after 
     its introduction or at the end of the first day after there 
     has been reported to the House involved a resolution, 
     whichever is earlier, such committee shall be deemed to be 
     discharged from further consideration of such reform bill and 
     such reform bill shall be placed on the appropriate calendar 
     of the House involved.
       (2) Expedited procedure.--
       (A) Consideration.--Not later than 5 days after the date on 
     which a committee has been discharged from consideration of a 
     resolution, the Speaker of the House of Representatives, or 
     the Speaker's designee, or the Majority Leader of the Senate, 
     or the Leader's designee, shall move to proceed to the 
     consideration of the committee amendment to the resolution, 
     and if there is no such amendment, to the resolution. It 
     shall also be in order for any member of the House of 
     Representatives or the Senate, respectively, to move to 
     proceed to the consideration of the resolution at any time 
     after the conclusion of such 5-day period. All points of 
     order against the resolution (and against consideration of 
     the resolution) are waived. A motion to proceed to the 
     consideration of the resolution is highly privileged in the 
     House of Representatives and is privileged in the Senate and 
     is not debatable. The motion is not subject to amendment, to 
     a motion to postpone consideration of the resolution, or to a 
     motion to proceed to the consideration of other business. A 
     motion to reconsider the vote by which the motion to proceed 
     is agreed to or not agreed to shall not be in order. If the 
     motion to proceed is agreed to, the House of Representatives 
     or the Senate, as the case may be, shall immediately proceed 
     to consideration of the resolution without intervening 
     motion, order, or other business, and the resolution shall 
     remain the unfinished business of the House of 
     Representatives or the Senate, as the case may be, until 
     disposed of.
       (B) Consideration by other house.--If, before the passage 
     by one House of the resolution that was introduced in such 
     House, such House receives from the other House a resolution 
     as passed by such other House--
       (i) the resolution of the other House shall not be referred 
     to a committee and may only be considered for final passage 
     in the House that receives it under clause (iii);
       (ii) the procedure in the House in receipt of the 
     resolution of the other House, with respect to the resolution 
     that was introduced in the House in receipt of the resolution 
     of the other House, shall be the same as if no resolution had 
     been received from the other House; and
       (iii) notwithstanding clause (ii), the vote on final 
     passage shall be on the reform bill of the other House.
     Upon disposition of a resolution that is received by one 
     House from the other House, it shall no longer be in order to 
     consider the resolution bill that was introduced in the 
     receiving House.
       (C) Consideration in conference.--Immediately upon a final 
     passage of the resolution that results in a disagreement 
     between the two Houses of Congress with respect to the 
     resolution, conferees shall be appointed and a conference 
     convened. Not later than 10 days after the date on which 
     conferees are appointed, the conferees shall file a report 
     with the House of Representatives and the Senate resolving 
     the differences between the Houses on the resolution. 
     Notwithstanding any other rule of the House of 
     Representatives or the Senate, it shall be in order to 
     immediately consider a report of a committee of conference on 
     the resolution filed in accordance with this subclause. 
     Debate in the House of Representatives and the Senate on the 
     conference report shall be limited to 10 hours, equally 
     divided and controlled by the Speaker of the House of 
     Representatives and the Minority Leader of the House of 
     Representatives or their designees and the Majority and 
     Minority Leaders of the Senate or their designees. A vote on 
     final passage of the conference report shall occur 
     immediately at the conclusion or yielding back of all time 
     for debate on the conference report.
       (3) Rules of the senate and house of representatives.--This 
     subsection is enacted by Congress--
       (A) as an exercise of the rulemaking power of the Senate 
     and House of Representatives, respectively, and is deemed to 
     be part of the rules of each House, respectively, but 
     applicable only with respect to the procedure to be followed 
     in that House in the case of a resolution, and it supersedes 
     other rules only to the extent that it is inconsistent with 
     such rules; and
       (B) with full recognition of the constitutional right of 
     either House to change the rules (so far as they relate to 
     the procedure of that House) at any time, in the same manner, 
     and to the same extent as in the case of any other rule of 
     that House.
       (4) Limitation.--The amount of Federal funds provided with 
     respect to any State proposal that is deemed approved under 
     subsection (d)(3) shall not exceed the cost provided for such 
     proposals within the concurrent resolution on the budget as 
     enacted by Congress for the fiscal year involved.
       (f) Funding.--
       (1) In general.--The Secretary shall provide a grant to a 
     State that has an application approved under subsection (b) 
     to enable such State to carry out an innovative State health 
     program in the State.
       (2) Amount of grant.--The amount of a grant provided to a 
     State under paragraph (1) shall be determined based upon the 
     recommendations of the Commission, subject to the amount 
     appropriated under subsection (k).
       (3) Performance-based funding allocation and 
     prioritization.--In awarding grants under paragraph (1), the 
     Secretary shall--
       (A) fund a diversity of approaches as provided for by the 
     Commission in subsection (c)(1)(B);
       (B) give priority to those State programs that the 
     Commission determines have the greatest opportunity to 
     succeed in providing expanded health insurance coverage and 
     in providing children, youth, and other vulnerable 
     populations with improved access to health care items and 
     services; and
       (C) link allocations to the State to the meeting of the 
     goals and performance measures relating to health care 
     coverage, quality, and health care costs established under 
     this Act through the State project application process.
       (4) Maintenance of effort.--A State, in utilizing the 
     proceeds of a grant received under paragraph (1), shall 
     maintain the expenditures of the State for health care 
     coverage purposes for the support of direct health care 
     delivery at a level equal to not less than the level of such 
     expenditures maintained by the State for the fiscal year 
     preceding the fiscal year for which the grant is received.
       (5) Report.--At the end of the 5-year period beginning on 
     the date on which the Secretary awards the first grant under 
     paragraph (1), the State Health Innovation Advisory 
     Commission established under subsection (c) shall prepare and 
     submit to the appropriate committees of Congress, a report on 
     the progress made by States receiving grants under paragraph 
     (1) in meeting the goals of expanded coverage, improved 
     quality, and cost containment through performance measures 
     established during the 5-year period of the grant. Such 
     report shall contain the recommendation of the Commission 
     concerning any future action that Congress should take 
     concerning health care reform, including whether or not to 
     extend the program established under this subsection.
       (g) Monitoring and Evaluation.--
       (1) Annual reports and participation by states.--Each State 
     that has received a program approval shall--
       (A) submit to the Commission an annual report based on the 
     period representing the respective State's fiscal year, 
     detailing compliance with the requirements established by the 
     Commission and the Secretary in the approval and in this 
     section; and
       (B) participate in the annual meeting under subsection 
     (c)(4)(B).
       (2) Evaluations by commission.--The Commission, in 
     consultation with a qualified and independent organization 
     such as the Institute of Medicine, shall prepare and submit 
     to the Committee on Finance and the Committee on Health, 
     Education, Labor, and Pensions of the Senate and the 
     Committee on Energy and Commerce, the Committee on Education 
     and Labor, and the Committee on Ways and Means of the House 
     of Representatives annual reports that shall contain--
       (A) a description of the effects of the reforms undertaken 
     in States receiving approvals under this section;
       (B) a description of the recommendations of the Commission 
     and actions taken based on these recommendations;
       (C) an evaluation of the effectiveness of such reforms in--
       (i) expanding health care coverage for State residents;
       (ii) improving the quality of health care provided in the 
     States; and
       (iii) reducing or containing health care costs in the 
     States;

[[Page S701]]

       (D) recommendations regarding the advisability of 
     increasing Federal financial assistance for State ongoing or 
     future health program initiatives, including the amount and 
     source of such assistance; and
       (E) as required by the Commission or the Secretary under 
     subsection (f)(5), a periodic, independent evaluation of the 
     program.
       (h) Noncompliance.--
       (1) Corrective action plans.--If a State is not in 
     compliance with a requirements of this section, the Secretary 
     shall develop a corrective action plan for such State.
       (2) Termination.--For good cause and in consultation with 
     the Commission, the Secretary may revoke any program granted 
     under this section. Such decisions shall be subject to a 
     petition for reconsideration and appeal pursuant to 
     regulations established by the Secretary.
       (i) Relationship to Federal Programs.--
       (1) In general.--Nothing in this Act, or in section 1115 of 
     the Social Security Act (42 U.S.C. 1315) shall be construed 
     as authorizing the Secretary, the Commission, a State, or any 
     other person or entity to alter or affect in any way the 
     provisions of title XIX of such Act (42 U.S.C. 1396 et seq.) 
     or the regulations implementing such title.
       (2) Maintenance of effort.--No payment may be made under 
     this section if the State adopts criteria for benefits, 
     income, and resource standards and methodologies for purposes 
     of determining an individual's eligibility for medical 
     assistance under the State plan under title XIX that are more 
     restrictive than those applied as of the date of enactment of 
     this Act.
       (j) Miscellaneous Provisions.--
       (1) Application of certain requirements.--
       (A) Restriction on application of preexisting condition 
     exclusions.--
       (i) In general.--Subject to subparagraph (B), a State shall 
     not permit the imposition of any preexisting condition 
     exclusion for covered benefits under a program or project 
     under this section.
       (ii) Group health plans and group health insurance 
     coverage.--If the State program or project provides for 
     benefits through payment for, or a contract with, a group 
     health plan or group health insurance coverage, the program 
     or project may permit the imposition of a preexisting 
     condition exclusion but only insofar and to the extent that 
     such exclusion is permitted under the applicable provisions 
     of part 7 of subtitle B of title I of the Employee Retirement 
     Income Security Act of 1974 and title XXVII of the Public 
     Health Service Act.
       (B) Compliance with other requirements.--Coverage offered 
     under the program or project shall comply with the 
     requirements of subpart 2 of part A of title XXVII of the 
     Public Health Service Act insofar as such requirements apply 
     with respect to a health insurance issuer that offers group 
     health insurance coverage.
       (2) Prevention of duplicative payments.--
       (A) Other health plans.--No payment shall be made to a 
     State under this section for expenditures for health 
     assistance provided for an individual to the extent that a 
     private insurer (as defined by the Secretary by regulation 
     and including a group health plan (as defined in section 
     607(1) of the Employee Retirement Income Security Act of 
     1974), a service benefit plan, and a health maintenance 
     organization) would have been obligated to provide such 
     assistance but for a provision of its insurance contract 
     which has the effect of limiting or excluding such obligation 
     because the individual is eligible for or is provided health 
     assistance under the plan.
       (B) Other federal governmental programs.--Except as 
     provided in any other provision of law, no payment shall be 
     made to a State under this section for expenditures for 
     health assistance provided for an individual to the extent 
     that payment has been made or can reasonably be expected to 
     be made promptly (as determined in accordance with 
     regulations) under any other federally operated or financed 
     health care insurance program, other than an insurance 
     program operated or financed by the Indian Health Service, as 
     identified by the Secretary. For purposes of this paragraph, 
     rules similar to the rules for overpayments under section 
     1903(d)(2) of the Social Security Act shall apply.
       (3) Application of certain general provisions.--The 
     following sections of the Social Security Act shall apply to 
     States under this section in the same manner as they apply to 
     a State under such title XIX:
       (A) Title xix provisions.--
       (i) Section 1902(a)(4)(C) (relating to conflict of interest 
     standards).
       (ii) Paragraphs (2), (16), and (17) of section 1903(i) 
     (relating to limitations on payment).
       (iii) Section 1903(w) (relating to limitations on provider 
     taxes and donations).
       (iv) Section 1920A (relating to presumptive eligibility for 
     children).
       (B) Title xi provisions.--
       (i) Section 1116 (relating to administrative and judicial 
     review), but only insofar as consistent with this title.
       (ii) Section 1124 (relating to disclosure of ownership and 
     related information).
       (iii) Section 1126 (relating to disclosure of information 
     about certain convicted individuals).
       (iv) Section 1128A (relating to civil monetary penalties).
       (v) Section 1128B(d) (relating to criminal penalties for 
     certain additional charges).
       (vi) Section 1132 (relating to periods within which claims 
     must be filed).
       (4) Relation to other laws.--
       (A) HIPAA.--Health benefits coverage provided under a State 
     program or project under this section shall be treated as 
     creditable coverage for purposes of part 7 of subtitle B of 
     title I of the Employee Retirement Income Security Act of 
     1974, title XXVII of the Public Health Service Act, and 
     subtitle K of the Internal Revenue Code of 1986.
       (B) ERISA.--Nothing in this section shall be construed as 
     affecting or modifying section 514 of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1144) with respect to 
     a group health plan (as defined in section 2791(a)(1) of the 
     Public Health Service Act (42 U.S.C. 300gg-91(a)(1))).
       (k) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, such sums as 
     may be necessary in each fiscal year. Amounts appropriated 
     for a fiscal year under this subsection and not expended may 
     be used in subsequent fiscal years to carry out this section.

  Mr. VOINOVICH. Mr. President, I rise to speak about a bill my 
colleague Senator Bingaman and I introduced today, the Health Care 
Partnership Act. For too many years, I have listened to my colleagues 
on both sides of the aisle talk about the rising cost of health care 
and the growing number of uninsured Americans. Yet, at the Federal 
level we have made little progress toward a solution for improving 
access to quality, affordable health care. I believe it is the greatest 
domestic challenge facing our Nation. In fact, the rising cost of 
health care is a major part of what is hurting our competitiveness in 
the global marketplace.
  While surveys have indicated that health insurance premiums have 
stabilized--a 9.2 percent increase in 2006 the same increase as in 2005 
and compared with; 12.3 percent in 2004; 14.7 percent in 2003 and 15.2 
percent in 2002--health insurance costs continue to be a significant 
factor impacting American competitiveness. In addition, the share of 
costs that individuals have paid for employer sponsored insurance has 
risen roughly 2 percent each year, from 31.4 percent of health care 
costs in 2001 to 38.4 percent this year.
  In fact, spending on health care in the United States reached $2 
trillion in 2005--16 percent of our GDP--the largest share ever.
  Yet, despite all the spending some 45 million Americans--15 percent 
of the population--had no health insurance at some point last year. 
This number has increased steadily. In 2000, that number was 39.8 
million. In 2002 it was 43.6 million.
  These statistics are startling, and it is beyond time that we do 
something about them.
  The bill Senator Bingaman and I are introducing today aims to break 
the log-jam here in Washington and allows States to experiment the way 
we did with welfare reform when I was Governor of Ohio. This bill would 
support State-based efforts to reduce the uninsured, reduce costs, 
improve quality, improve access to care, and expand information 
technology.
  I have been in this situation before. As Governor of Ohio, I had to 
work creatively to expand coverage and deal with increasing health care 
costs for a growing number of uninsured Ohioans. I am happy to report 
that we were able to make some progress toward reducing the number of 
uninsured during my time as the head of the State by negotiating with 
the State unions to move to managed care; by controlling Medicaid costs 
to the point where from 1995 to 1998, due to good stewardship and 
management, Ohio ended up under-spending on Medicaid without harming 
families; and implementing the S-CHIP program to provide coverage for 
uninsured children. In fact, I recently learned from the Cuyahoga 
Commissioners that in our county, 98 percent of eligible children are 
currently enrolled in this program.
  Like we did in Ohio, a number of States are already actively pursuing 
efforts to reduce the number of their residents who lack adequate 
health care coverage. This bill will build on the goals of States like 
Massachusetts, California and others, while providing a mechanism to 
analyze results and make recommendations for future action on the 
Federal level.
  Under the Health Partnership Act, Congress would authorize grants to 
individual States, groups of States, and Indian tribes and 
organizations to carry out any of a broad range of strategies to 
improve our Nation's health

[[Page S702]]

care delivery. The bill creates a mechanism for States to apply for 
grants to a bipartisan ``State Health Innovation Commission'' housed at 
the Department of Health and Human Services, HHS. After reviewing the 
State proposals, the Commission would submit to Congress a list of 
recommended State applications. The Commission would also recommend the 
amount of Federal grant money each State should receive to carry out 
the actions described in their plan.
  Most importantly, at the end of the 5-year period, the Commission 
would be required to report to Congress whether the States are meeting 
the goals of the act and recommend future action Congress should take 
concerning overall reform, including whether or not to extend the 
program.
  I believe it is important that we pass this legislation and provide a 
platform from which we can have a thoughtful conversation about health 
care reform at the Federal level.
  Since I have been in the Senate, Congress has made some progress 
toward improving health care, most notably for our 43 million seniors 
with the passage of the Medicare Modernization Act.
  Yet, we have been at this too long here in Washington without 
comprehensive, meaningful results. It is my hope that we will have 
bipartisan support for this very bipartisan comprehensive bill that I 
hope will move us closer toward a solution to the uninsured.
                                 ______