[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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