[Congressional Record Volume 154, Number 68 (Monday, April 28, 2008)]
[Senate]
[Pages S3417-S3420]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH INSURANCE
Mr. ENZI. Mr. President, I just got back from Wyoming. I am in
Wyoming almost every weekend. I travel to a different part of the State
each time so I can see all the people. As a result, I do not do any
polls. If you talk to more people in a weekend than pollsters cover
when they do something, you can get a pretty good feel for what is
happening.
I did run across a national poll, and the poll said the No. 1 concern
on the minds of people in America was jobs and the economy. They said
the No. 2 concern was health care. There is an interesting little
anomaly in No. 1 and No. 2, which is when you talk to people about No.
1, jobs and the economy, one of the reasons they are concerned about
jobs and the economy is because they don't want to lose their health
insurance. If their job disappears, they are out there in the market
and they don't have the coverage.
So I am going to talk about health care today. I have been talking to
a lot of folks about health care, which isn't difficult because it is
on everyone's mind these days. During the last work period--and we
sometimes call it a recess, but I prefer to call it a work period
because I usually travel from 1,000 to 5,000 miles around my State
during that time--I went on a 10-stop tour of Wyoming. In just over 3
days, we drove over 1,200 miles and visited 10 towns and I met with
lots of Wyomingites. I even spoke to people at several stops who live
outside those 10 communities but drove miles and miles to come to our
meeting. Wyoming does have miles and miles of miles and miles--about
400 miles on a side--and it is a long way between towns.
The dedication and passion of the people who live in the towns and
the people who drove all those miles strengthens my commitment to
getting something more done about health care. We need to do something.
A lot of people feel more economically secure when they have health
insurance. They know that if they have health insurance and something
happens or they get sick, they will be able to get the care they need
without mortgaging their home or going bankrupt. That is another
concern on their mind. Nobody should have to worry about that.
Everybody should be able to carry a health insurance card in their
wallet.
The news isn't all bad, however. There have been plenty of wonderful
things that have come from our health care system in recent years. Each
year, new technologies are being invented and new drugs are being
created that allow people to live longer and healthier lives.
Researchers are finding cures for diseases, and parents are able to
take care of sick children. They are able to take them to clinics in
shopping centers and pharmacies to get throat cultures and flu shots.
Plenty of good things are happening, but we can do better.
Now, during my Wyoming work periods, my wife Diana and I travel
around and talk to folks about health care. I listen to what they tell
me about the problems they are having and I bring that information back
and I compare it to what my colleagues are saying. One of the things I
do is to teach the East about the West. So when I am in DC, I usually
have to explain to folks how Wyoming is different, how a plan designed
around New York or Massachusetts would not work for Wyoming. I have to
tell them it can be hard to get doctors and nurses to come to Wyoming.
The smaller the town, the harder it is to attract good people. I remind
the people in the East that we have a lot of people who work at the
mines and in the oil patch and in the natural gasfields. They work hard
for their hourly wages doing difficult and dangerous tasks. The type of
health care they need is different than the type someone working at a
computer needs. How do we help the construction worker and the computer
technician both get better health care that fits their unique needs at
a more reasonable price?
My position on the Senate Health Committee has allowed me to do a lot
of research on this subject. I have talked to patients, health care
providers, scientists, and financial advisers. You name it and we came
up with a plan that I think is flexible enough to work for everybody.
[[Page S3418]]
The bill I have put together is called Ten Steps to Transform Health
Care in America. The bill would get everyone an insurance card to carry
in their wallets and purses. If you already have an insurance card, the
bill will make sure you get to keep the card by wrangling in health
care costs until they are affordable. The biggest danger people who
have an insurance card have is costs are going to become so
astronomical that it would not be offered anymore. We have to see that
doesn't happen.
Why 10 steps? Well, I have discovered, over the course of the years I
have been in the Senate, that if you put together one massive,
comprehensive bill that solves everything, you will get a lot of
discussion, but you would not get many results because one piece will
have 5 people who don't like it, another piece will have 8 people who
don't like it, and another piece will have 11 people who don't like it,
and another piece will have 3 people who don't like it, and pretty
quickly you are at 51 votes against you and you cannot get the bill
done. When you try to do something comprehensively, it often looks
revolutionary. We don't do things ``revolutionarily'' in the Senate. We
do them ``evolutionarily.'' So I put together 10 pieces. If we don't
get all 10, or even if we only get one, it is not a problem because any
1 step gets us closer to having every American insured. All 10 together
would get every American insured. I will briefly walk you through all
10 steps.
In order to understand how the bill works, it is important to review
a few facts of the history of health care insurance in our country.
Right now, about 60 percent of the people under age 65 are getting
their health insurance through their jobs. The question is, why are 60
percent of Americans getting their health insurance through their jobs?
The short answer to that question is because of the way employer-
sponsored health care insurance is treated for tax purposes.
Our current health insurance system is biased toward employer-based
coverage due to a historical accident. The wage controls of World War
II increased competition among employers for recruiting the best
employees and incentivized employers to offer health benefits instead
of increased wages. They weren't allowed to offer increased wages. In
1954, Congress codified the provision declaring that such a
contribution would not count as taxable income. This tax policy made it
very favorable for individuals to get their health benefits through
their employers and, consequently, has penalized individuals who get
their coverage through the individual market.
The Joint Committee on Taxation estimated that removing this tax bias
and a few related health care tax policies will save the Federal
Government $3.6 trillion over the next 10 years. That is real money--
even in Washington. That is a lot of money that can and should be used
to expand choices and access and give individuals more control over
their health care. Ten Steps ensures every American can benefit from
these savings--whether they get health care from their employers, from
the individual insurance market, or they decide they want to get off
Medicaid and switch to private insurance. That is one of the options.
How does this bill do it? The plan gives all Americans that have at
least a certain amount of health insurance a standard tax deduction.
The national above-the-line standard tax deduction for health insurance
will equal $15,000 a year for a family and $7,500 for an individual.
The bill also gives low-income folks a tax credit equal to $5,000 for a
family and $2,500 for an individual. The subsidy amount phases out as
incomes get higher, so some folks would not be eligible for the
subsidy, but everyone is eligible for the standard deduction I
mentioned first.
The bill takes this hybrid approach of coupling the standard
deduction proposal with the tax credit proposal because I think it is
the best way to ensure no particular group of people is adversely
affected. I know some folks are advocating for just a standard
deduction, and other folks are advocating for a tax credit. My plan
does both, but I am supportive of all approaches. I am pleased so many
colleagues agree we need to fix the flawed Tax Code. The bottom line is
we need to get something done. Correcting the flawed Tax Code will make
it easier for working Americans to buy health insurance. Jobs don't
need insurance; people do.
One of the things this tax policy would do is encourage more
companies in the insurance business to provide more options to the
people. The options would vary in price, bringing prices down through
more competition. We talked about Medicare Part D and got that
instituted in the United States for the cost of pharmaceuticals to
seniors to go down. I was concerned about how that would work. Wyoming
has a low population. I think it will be about half a million in the
next census. I wasn't sure we would be able to attract competition to
our State. There is a little provision in Medicare that says if there
isn't any plan interested in bidding, the Federal Government will
provide a plan. In Wyoming, we had 49 companies bidding for each
person's pharmaceutical work. It gave a lot of options and, more
importantly, it brought the price down about 20 percent before we ever
got started. That is what competition does. We also need to make sure
the insurance is portable; that when one person changes jobs, they can
be sure they still have their insurance. Some people are locked into
jobs because they, or a family member, have a preexisting condition
that will preclude them from getting insurance if they change.
The fourth step gives small businesses greater purchasing power to
reduce the cost of insurance plans. Right now, a lot of rules are in
place that prohibit groups of businesses from getting together and
pooling their purchasing power across State lines--in fact, across the
whole United States--so they can negotiate better deals on insurance
cards. That doesn't make sense. If a group of shoe stores in Wyoming
wants to get together with other shoe store owners in Montana and
Colorado and the rest of the United States and band together to get a
greater discount on health insurance, they should be allowed to do so.
This isn't a brand new concept. Some States have enough population that
they are able to do this anyway within their State borders. Ohio is a
great example. They have been intensely interested in this piece of
legislation. They have put together the small business health plan
within their State, and it has saved a tremendous amount of money. They
were inventive enough to do it in the first place and smart enough to
know if they can expand across State borders and across the United
States, they can reduce those prices a lot more. We should not be
keeping them from doing that.
I mentioned earlier that jobs don't need health insurance, people do.
Right now, when a small business wants to get health insurance for
employees, they contact the health insurance agent and tell the agent
how many are employed and they give information about the employees and
then the agent quotes a price for offering health insurance to those
employees.
Right now, there are some Federal rules in place that govern that
process for small groups of employees and make sure the groups are
fairly treated by insurance companies. The protections provide
assurances to consumers that insurers will deal with preexisting
conditions fairly and provide coverage--even to small groups. This has
helped keep costs down for small businesses, but more needs to be done,
especially given that none of these rules apply to individuals who
purchase health insurance on their own. At a minimum, we need to make
sure individuals get treated the same way groups get treated.
The fifth step blends the individual and group market to extend
important HIPAA portability protections to the individual market so
insurance security can better move with them from job to job.
The sixth step is possibly the most critical and one we must take to
reduce medical costs across the board. This step moves our system from
one that provides sick care to one that provides health care. That is
an important distinction. As Ben Franklin said: ``An ounce of
prevention is worth a pound of cure.'' We need an innovative system
that will do more to help Americans prevent and manage chronic illness,
so they can live healthy lives with fewer medical costs. The Ten Steps
plan would do that.
The seventh step gives individuals the choice to convert the value of
their
[[Page S3419]]
Medicaid and SCHIP program benefits into private health insurance,
putting them in control of their health care, not the Federal
Government. The rationale for this step is simple: If the market can
provide better coverage at a lower price, then why not allow Americans
to access that care?
This gives low-income individuals more options about where they can
receive care and what care is available. It is time for people to start
making decisions about their care. Let's get the Government out of the
doctors' offices.
The eighth step is one that Congress has come close to passing in
years past--a bipartisan plan to encourage the adoption of cutting-edge
information technologies in health care. The health care industry is
the last industry to go digital. Think about what technology has done
to revolutionize every other industry and how it has led to a more
efficient use of time and resources. The health care industry should
not lag behind. The time has come for health information to go digital
so we can save thousands of lives and billions of dollars.
Mr. President, did you know that you own your own health care record?
I would like to know how many of my colleagues have theirs with them. I
am willing to bet none not even me. Try to get your health care record
some time. But you ought to have your health care record on a card you
carry with you that has everything about you so if you come from
Wyoming out to Washington, DC, and you get in a wreck, the doctor who
is taking care of you can have all of the information he needs to make
sure that while he is taking care of you, he is not hurting you another
way. Right now, some of that technology is available in Wyoming, and
some of that technology is available here. The difficulty is the card
in Wyoming cannot be read here, and the card here cannot be read in
Wyoming. Of course, we hope people will come out to Wyoming for a
vacation, and we hope they do not get in an accident. If you are in
Yellowstone Park, Grand Teton Park, or other beautiful places in
Wyoming, if you get sick, we want the doctor there to have all the
information he needs to be sure you are taken care of. That is possible
now. We just need a standard of getting that information from one part
of the country to another. You can take your ATM card anywhere in the
world and get cash, but you cannot take your medical records anywhere.
There is another big problem with medical records. You go to one
provider, and he has a test done. He sends you to a specialist. The
specialist says it is going to take too long to get the test over here,
this is important, and it is an emergency, so they do the test again.
Do you know how much the tests cost? Sometimes $3,000, $4,000, $10,000,
and they are duplicated. The RAND Corporation said duplication of tests
may be costing us as much as $140 billion a year. That is real money.
That is real money that could be spent on health care and health IT.
Some are concerned about the impact of health IT and electronic
health records on the security of personal data, data security. Let me
assure my colleagues that protecting patient information is a very high
priority of mine, and nearly every section of this bill demonstrates
it.
The health IT bill does a lot to build on protections we already have
in place. The bill establishes the American Health Information
Community which is made up of experts representing a complete cross
section in health care, consumer, and technology communities.
The American Health Information Community is charged with providing
the Secretary of Health and Human Services recommendations concerning
national policies for adoption by the Federal Government to ensure that
patient data remain secure. But there is another important part to
this. The companies that are putting together these programs that we
assume will have standardization so they can be used in all parts of
the country have a real desire and a real need, if their product is
going to be lasting, to be sure there is data security. They work on
that every day, just as the banks work on your ATM card every day to
make sure somebody is not getting your money. It should not be a worry.
The ninth step of the bill is one of the most important steps for
frontier areas such as Wyoming. An insurance card in your wallet will
not do any good if there is not a doctor or hospital around when you
need care. If there are not enough nurses working in that hospital or
no one is working at the desk to admit you, a health insurance card
will not help you very much.
The 10-step plan addresses this problem by helping future providers
and nurses pay for their education and encouraging them to serve in
areas of great need. The plan provides competitive matching grants for
States to encourage nurses to return to the profession after having
left the workforce for 3 years or more.
People are living longer. People can be active longer. We need to
encourage more people to stay in the workforce longer. This will do it
for nurses and help solve a tremendous problem seniors are going to
have.
The plan also boosts the current programs we have that are working
well--the Community Health Centers Program and the loan repayment
programs for the National Health Service Corps. Those community centers
are providing a lot of health care to a lot of people who would not be
able to get health care otherwise. We have the reauthorization ready to
go on that issue and almost complete.
Another piece that is critical to Wyoming, the 10-step plan builds on
the success of the current rural health care programs by ensuring the
appropriate development of rural health systems and access to care for
rural patients.
One of the things that continues to be very important to me as I work
on this 10-step plan is listening to real folks about what they want
from their health care. One thing I heard over and over is that seniors
want to stay in their homes longer. They do not want to go to nursing
homes if they don't have to. Sadly, because of the way our laws are
written and the way our reimbursement policies are structured, folks
are sometimes left with no option but to go to a nursing home. If the
policies were different and there were more options and there were more
flexibility, seniors could stay in their homes longer.
My plan works to do just that by putting the emphasis on community
and home-based care, which is often much preferred, less costly and
proven to increase the quality of life. One way to do this is by
supporting programs such as the Greenhouse Project which creates a
community setting rather than an institutional setting.
The final step of the 10-step plan decreases the skyrocketing costs
of health care by restoring reliability in our medical justice system
through State-based solutions. No one--not patients or health care
providers--is appropriately served by our current medical litigation
procedures.
Right now, many patients who are hurt by negligent actions receive no
compensation for their losses. Those who do receive a mere 40 cents of
every premium dollar, given the high cost of legal fees and
administrative costs. That is simply a waste of medical resources.
Additionally, the likelihood and the outcomes of lawsuits and
settlements bear little relation to whether a health care provider was
at fault. Consequently, we are not learning from our mistakes. Rather,
we are simply diverting our doctors, and they are spending more time in
the courtroom. When someone has a medical emergency, they want to see a
doctor in an operating room, not in a courtroom.
Those are the 10 steps. As I mentioned before, I worked on 10 steps
so we can break the steps into separate bills and move them one at a
time in a moveable, reasonable piece. Despite the intentions of
Congress, we have to work in incremental doses rather than monumental
doses in order to get anything done.
Some of the steps I have mentioned are newer ideas that still need
some time to be worked out and will still need some tinkering around
the edges, but some of the steps I went over today are ready to go.
Health IT could be done any day this week. Those bills are drafted,
they are stand-alone bills, and they are ready to move through Congress
at any time. We need to do it.
Some people say this is a Presidential election year; what do the
candidates think about it? What do they think about it? They are
covering that a little bit. I think Senator McCain made a speech
earlier today about
[[Page S3420]]
health care and some of the things he intends to do with it. I have
heard other speeches from other candidates. We do not need to wait for
a Presidential election to do something in health care, to do anything
in health care. When a person gets elected President, they give us
pretty good suggestions, but they no longer get to vote on any of the
issues. We have to do the votes. We have to draft the legislation. We
have to do the debate. There is no reason to wait until we have a
President, no need.
There is a need--a critical need, an understood need--by the people
of America that we need to do something on health care and we need to
do it right now. It is such an issue of great concern to the American
people that it transcends politics as usual.
I never ask when I am in Wyoming whether a person is a Republican or
Democrat when they bring me an idea or a problem. I just want to know
what the idea is or what the problem is, and I do like it when they
provide a solution with it as well. If it is doable, we do it. That is
what we need to do on health care.
If we make sure that we transcend politics, if we get away from the
polarization of a political year, we will have an opening to get
something done that will help patients and doctors.
I am going to suggest we use my 80-percent rule. I came to Washington
as a firm believer in the 80-percent rule. That is, we can reach
agreement on 80 percent of the issues and we are probably never going
to reach agreement on the other 20 percent. By focusing on 80 percent
of the issues we can agree on, we can get something done. If we
continue to let the 20 percent we disagree on serve as a roadblock, we
will let some great opportunities pass. That is something we cannot
afford to have happen again and again.
I truly hope this is the year we stop talking about health care and
start doing something about it because Americans cannot wait another
year. They do not want to wait for an election to see some changes.
They certainly do not want to wait another year to stop their health
care costs from going up and up. They want to see change, and they want
to see change now.
Our small business owners, our working families, our millions of
uninsured cannot afford to wait, and we can do it. We can do it now,
and we can do it together.
Last week, we passed the genetic nondiscrimination bill. That has the
potential to provide health care as opposed to sick care. That has the
potential to let people have their blood tested to find out what
possibilities there are to what could happen to them based on their
genetic information so they can keep that from happening.
What the bill does is make sure that the information you get from
that testing cannot be used against you by your insurance company or
your employer. That should give you encouragement to find out more
about yourself so if there is something that could be a preexisting
condition, you can keep it from becoming a preexisting condition and
your insurance company cannot make it a preexisting condition until it
actually happens.
We have a chance to do a lot of things in health care. We have done
something in health care. I hope we will get health IT done in health
care this week or next week. There is no reason we cannot. The small
business health plans, to let the companies group together over State
lines, there is no reason that cannot get done. There are several ideas
out there that have been put together well that can be combined to get
something done. I hope it goes through the regular process, which means
through committee. I also noticed legislation that does not go through
a committee around here does not get done, and that is because it has
not had that chance to be worked on in a very individual way. When we
are in committee and doing a markup and there is a problem three or
four people have, they can go off and work on that problem and come up
with a solution. Sometimes it is a compromise; sometimes it is leaving
something out; sometimes it is a brandnew way. That is where the
innovation happens, in committee. Whenever we avoid the committee, what
we are saying is: We have this legislation we want to shove down your
throat. It will help make each side take some bad votes, and this is an
election year, so maybe we should have some bad votes. I don't think
that is necessary. I think there are solutions out there, solutions we
can reach agreement on, solutions we can finish, and what is more, I
think the American people expect it and, more importantly, demand it.
We can do it. Let's do it.
I yield the floor.
Mr. DURBIN. Mr. President, is there a unanimous consent agreement
with respect to the order of speaking or the time?
The ACTING PRESIDENT pro tempore. There is no consent with respect to
the order of speaking.
Mr. DURBIN. It is my understanding there is 39 minutes remaining on
the Democratic side?
The ACTING PRESIDENT pro tempore. The Senator is correct.
Mr. DURBIN. I ask unanimous consent to be recognized for 9 minutes
and to be notified by the Chair when that time has expired.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
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