[Congressional Record Volume 153, Number 67 (Wednesday, April 25, 2007)]
[Senate]
[Pages S5077-S5079]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   STATE-BASED HEALTH CARE REFORM ACT

  Mr. FEINGOLD. Mr. President, there is a crisis facing our country, a 
crisis that directly affects the lives of over 45 million people in the 
United States, and that indirectly affects many more. The crisis is the 
lack of universal health insurance in America, and its effects are 
rippling through our families, our communities, and our economy. It is 
the No. 1 issue that I hear about in Wisconsin, and it is the No. 1 
issue for many Americans. Nevertheless, the issue has been largely 
ignored in the Halls of Congress. We sit idle, locked in a stalemate, 
refusing to give this life-threatening problem its due attention. We 
need a way to break that deadlock, and that is why I have introduced a 
bill with the Senator from South Carolina, Lindsey Graham, that will do 
just that--the State-Based Health Care Reform Act.
  Senator Graham and I are from opposite ends of the political 
spectrum, we are from different areas of the country, and we have 
different views on health care. But we agree that something needs to be 
done about health care in our country. Every day, all over our Nation, 
Americans suffer from medical conditions that cause them pain and even 
change they way they lead their lives. Every one of us has either 
experienced this personally or through a family member suffering from 
cancer, Alzheimer's, diabetes, genetic disorders, mental illness or 
some other condition. The disease takes its toll on both individuals 
and families, as trips to the hospital for treatments such as 
chemotherapy test the strength of the person and the family affected. 
This is an incredibly difficult situation for anyone. But for the 
uninsured and underinsured, the suffering goes beyond physical 
discomfort. These Americans bear the additional burden of wondering 
where the next dollar for their health care bills will come from; 
worries of going into debt; worries of going bankrupt because of health 
care needs.

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When illness strikes families, the last thing they should have to think 
about is money, but for many in our country, this is a persistent 
burden that causes additional stress and hopelessness when they are 
ill.
  It is difficult to do justice to the magnitude of the uninsurance 
problem, but I want to share a few astounding statistics. Forty-seven 
percent of the uninsured avoided seeking care in 2003 due to the cost. 
Thirty-five percent needed care but did not get it. Thirty-seven 
percent did not fill a prescription because of cost. The uninsured are 
seven times more likely to seek care in an emergency room. They are 
less likely to receive preventative care because they cannot afford to 
see the doctor, and they are more likely to die as a result. Each year, 
at least 18,000 people die prematurely in this country because of 
uninsurance. If the uninsured had access to continuous health coverage, 
a reduction in mortality of 5 percent to 15 percent could be achieved.
  The United States is the only industrialized nation that does not 
guarantee health care for its citizens. In other countries, if someone 
is sick, they get proper care regardless of ability to pay. In our 
country, that is not the case. It is unacceptable for a nation as great 
as America to not provide good health care for all our citizens. We are 
failing those in need. We are failing the hard-working family that 
cannot afford the insurance offered to them. We are failing the 
uninsured children whose parents do not have any access to insurance. 
We are failing low-income Americans and middle-income Americans alike. 
This is not right. We can do better.
  Even for those Americans who currently have health insurance through 
their employer, the risk of becoming uninsured is very real. Large 
businesses are finding themselves less competitive in the global market 
because of skyrocketing health care costs. Small businesses are finding 
it difficult to offer insurance to employees while staying competitive 
in their own communities. Our health care system has failed to keep 
costs in check, and there is simply no way we can expect businesses to 
keep up. More and more, employers are forced to increase employee cost-
sharing or to offer subpar benefits, or no benefits at all. Employers 
cannot be the sole provider of health care when these costs are rising 
faster than inflation.
  I travel to each of Wisconsin's 72 counties every year to hold 
townhall meetings. Almost every year, the No. 1 issue raised at these 
listening sessions is the same--health care. The failure of our health 
care system brings people to these meetings in droves. These people 
used to think government involvement was a terrible idea, but not 
anymore. Now they come armed with their frustration, their anger, and 
their desperation, and they tell me that their businesses and their 
lives are being destroyed by health care costs, and they want the 
government to step in.
  I am pleased to be joined by Senator Graham in introducing the State-
Based Health Care Reform Act. In short, this bill establishes a pilot 
project to provide states with the resources needed to implement 
universal health care reform. The bill does not dictate what kind of 
reform the States should implement, it just provides an incentive for 
action, provided the states meet certain minimum coverage and low-
income requirements.
  Even though Senator Graham and I support different methods of health 
care reform, we both agree that this legislation presents a viable 
solution to the logjam preventing reform. I have long said that a 
single-payer health care system is what I prefer for our country. 
Senator Graham would like to see health care privatized and see a base, 
catastrophic coverage offered to everyone. Despite our disagreements 
about the form that health care reform should take, we agree on this 
legislation.
  This bipartisan legislation harnesses the talent and ingenuity of 
Americans to come up with new solutions. This approach takes advantage 
of America's greatest resources--the mind power and creativity of the 
American people--to move our country toward the goal of a working 
health care system with universal coverage. With help from the Federal 
Government, States will be able to try new ways of covering all their 
residents, and our political logjam around health care will begin to 
loosen.
  Over the years I have heard many different proposals for how we 
should change the health care system in this country. Some propose 
using tax incentives as a way to expand access to health care. Others 
think the best approach is to expand public programs. Some feel a 
national single payer health care system is the only way to go. We need 
to consider all of these as we address our broken health care system.
  Under our proposal, States can be creative in the state resources 
they use to expand health care coverage. For example, a state can use 
personal or employer mandates for coverage, use State tax incentives, 
create a single-payer system or even join with neighboring States to 
offer a regional health care plan. The proposals are subject only to 
the approval of the newly created Health Care Coverage Task Force, 
which will be composed of health care experts, consumers, and 
representatives from groups affected by health care reform. This task 
force will be responsible for choosing viable state projects and 
ensuring that the projects are effective. The task force will also help 
the States develop projects, and will continue a dialogue with the 
States in order to facilitate a good relationship between the State and 
Federal Governments.

  The task force is also charged with making sure that the State plans 
meet certain minimal requirements. First, the State plans must include 
specific target dates for decreasing the number of uninsured, and must 
also identify a set of minimum benefits for every covered individual. 
These benefits must be comparable to health insurance offered to 
Federal employees. Second, the State plans must include a mechanism to 
guarantee that the insurance is affordable. Americans should not go 
broke trying to keep healthy, and health care reform should ensure that 
individual costs are manageable. The State-Based Health Care Reform Act 
bases affordability on income.
  Another provision in this legislation requires that the States 
contribute to paying for their new health care programs. The Federal 
Government will provide matching funds based on enhanced FMAP--the same 
standard used for SCHIP--and will then provide an additional 5 percent. 
States that can afford to provide more are encouraged to, but the 
matching requirement will ensure the financial viability of the bill 
and state buy-in. Other than these requirements, the states largely 
have flexibility to design a plan that works best for their respective 
residents. The possibilities for reform are wide open.
  One of the main criticisms of Federal Government spending on health 
care is that it is expensive and increases the deficit. My legislation 
is fully offset, ensuring that it will not increase the deficit. The 
bill doesn't avoid making the tough budget choices that need to be made 
if we are going to pay for health care reform.
  One of the offsets in the bill was proposed by the Congressional 
Budget Office: an increase in the flat rebate paid by drug 
manufacturers for Medicaid prescription drugs. Currently, Medicaid 
recoups a portion of its drug spending through a rebate paid by the 
manufacturer. The savings mechanism would set a flat rebate, and 
provide funding for the States' health care reform projects. Another 
offset in the bill, also proposed by the Congressional Budget Office, 
is reduced subsidies for Medicare Part D prescription drug benefits for 
the highest income seniors. This would impact only single retirees 
earning more than $80,000 per year and married retirees earning more 
than $160,000--less than 5 percent of all Medicare beneficiaries.
  Additional funding for the bill comes from the President's fiscal 
year 2007 budget proposal to extend the authority of the Federal 
Communications Commission to auction the radio spectrum and the 
authority of Customs and Border Protection to collect multiple 
different conveyance and passenger user fees through fiscal year 2016. 
My bill proposes similar extensions of these established authorities. 
Also, my bill proposes to both simplify and reduce the Federal subsidy 
of airline passenger screening costs by replacing the current variable 
fee, which is capped at $5 per one-way trip, with a flat $5 fee. This 
proposal is similar to one in the president's fiscal year 2007 budget 
and

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would decrease Federal subsidies to about 30 percent of passenger 
security costs, without reducing aviation security spending.
  We can say that it is time to move toward universal coverage, but it 
is empty rhetoric without a feasible plan. I believe that this is the 
way to make universal coverage work in this country. Universal coverage 
doesn't mean that we have to copy a system already in place in another 
country. We can harness our Nation's creativity and entrepreneurial 
spirit to design a system that is uniquely American. Universal coverage 
doesn't have to be defined by what's been attempted in the past. What 
universal coverage does mean is providing a solution for a broken 
system where millions are uninsured, and where businesses and Americans 
are struggling under the burden of health care costs.
  It has been over 10 years since the last serious debate over health 
care reform was killed by special interests and the soft money 
contributions they used to corrupt the legislative process. The 
legislative landscape is now much different. Soft money can no longer 
be used to set the agenda, and businesses and workers are crying out as 
never before for Congress to do something about the country's health 
care crisis.
  We are fortunate to live in a country that has been abundantly 
blessed with democracy and wealth, and yet there are those in our 
society whose daily health struggles overshadow these blessings. That 
is an injustice, but it is one we can and must address. Dr. Martin 
Luther King, Jr., said, ``Of all the forms of inequality, injustice in 
health care is the most shocking and inhumane.'' It is long past time 
for Congress to heed these words and end this terrible inequality. I 
urge my colleagues to support the State-Based Health Care Reform Act.

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