[Congressional Record Volume 155, Number 132 (Thursday, September 17, 2009)]
[Senate]
[Pages S9521-S9525]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                           Health Care Reform

  Mr. CASEY. Mr. President, as you can tell from the chart on my left, 
I rise today to speak about the issue that is probably the No. 1 
challenge we face in the Congress today, which is debating and devising 
solutions for the improvement of our health care system in so many 
ways. I rise today to talk about some aspects of that and especially 
not only where we are headed in terms of focusing on both those with 
insurance and those without insurance but also to focus on some of the 
goals here.

[[Page S9524]]

  From the beginning, both President Obama and Members of Congress have 
focused on a couple of priorities--first of all, to reduce costs. We 
cannot go forward with any health care bill that does not do that, and 
I think we will do that.
  We have to reduce costs, but we also have to ensure choices. We have 
to continue to give the American people the kind of choice they should 
have a right to expect and give them a sense of a peace of mind in 
terms of what that choice will mean. We ought to make sure this bill, 
for example, leads to the following conclusion: You get the treatment 
you need from the doctor you choose. I think we can do that in the 
Congress.
  Thirdly, I think we have to make sure, as we are controlling costs 
and ensuring choice, that we ensure quality and that we put both 
quality and prevention in the final bill. They are in the bill I voted 
for already this summer.
  The Health, Education, Labor, and Pensions Committee, as people know, 
debated all summer, with hours and hours and hours of debate, accepting 
Republican and Democratic amendments, sometimes not agreeing, but we 
voted out a bill that did a lot of what I just talked about. It focused 
on making sure we are covering more Americans. It protected Americans 
who have coverage.
  So many people, as the Presiding Officer knows--whether it is in the 
State of Illinois or the State of Pennsylvania or any State in the 
country--even those with insurance, are not secure, even those with 
insurance feel a sense of instability, a lack of control over their own 
destiny, sometimes because an insurance company says: We are going to 
deny you coverage because of a preexisting condition. Why have we 
permitted that? Why have we tolerated that year after year? Instead of 
just talking about preventing them from doing that, why haven't we 
literally made it illegal for an insurance company to do that? We are 
going to make sure this year we do not just talk about it but we 
legislate about it and make that part of our law.
  So we will go through some of those issues, but the first thing I 
want to highlight is where we are headed if we do not do anything.
  There are some people in Washington who, to be candid or blunt about 
it, want to scratch their heads for a couple more years or maybe 10 
more years.
  Here, as shown on this chart, is where we are headed by one 
estimation. The New America Foundation is the source for this 
information. But here we are in 2008. When you talk about the cost of 
an annual premium, OK, it is roughly--and actually we found out the 
other day that number is a little higher--we can say it is a little 
more than $13,000 for family coverage. If you look between 2008 and 
2016--just 8 years in that estimation, and we are already into 2009--
that premium will rise by more than 83 percent. Why should we allow 
that to happen when we know we can do something about it this year? So 
that is one way to look at this in terms of the cost of doing nothing.
  Also, often people with insurance will say: Well, I have some 
problems with my insurance. I worry about a preexisting condition, I 
worry about exorbitant out-of-pocket costs, and I am glad you are 
working on that and I will support that part of the bill. But they say: 
Look, if I have coverage, I am worried about giving millions of more 
Americans coverage without some adverse effect to those who have 
coverage.
  Well, let's look at this chart for a little bit of a discussion about 
this topic: families paying 8 percent surcharge on premiums. If we look 
at this chart, what this red or red-orange part of the chart shows is a 
$1,100 hidden tax to cover the cost of uncompensated care for the 
uninsured. So the idea that those with insurance right now are not 
paying for those without insurance is ridiculous. Fortunately, in 
Pennsylvania, that number is a little lower, but it is still 900 bucks. 
So the idea that somehow if we change the system, improve the existing 
system, build upon what works but improve the system, that somehow that 
is going to adversely impact in a cost sense those with insurance--the 
Center for American Progress did this research--this chart and others 
show if you have insurance today, you are paying for those without 
insurance. Right now you are paying for them. We know that right now.
  So, if anything, broadening the number of Americans who have coverage 
will actually reduce costs. It will be one of the contributors, I 
should say, of reducing costs--not the only way but one of the ways we 
do that.
  Let me go to the next chart which is a depiction in very simple 
colors, red and green, about what the existing system does adversely as 
it relates to women. There are a lot of things that insurance companies 
do today that we don't like and we have complained about, but now we 
can do something about it. One is a preexisting condition problem and 
another one is the out-of-pocket costs and another one is how often 
insurance policies definitively discriminate against some Americans.
  This map shows in the orange or red section: gender rating allowed. 
In other words, insurance practices that lead to policies in States 
that result in discrimination against women. So you want this chart to 
show all in the green States where gender rating is banned.
  What we would like to do with our legislation, one of the goals--and 
it is in our bill and in the bill we passed this summer, the Affordable 
Health Choices Act--is to make sure the whole country is green on this 
issue, green in the sense that we have banned gender rating; that an 
insurance company can't say, when they are trying to determine how they 
make up their policy, that if you happen to be a woman, a policy would 
discriminate against you.
  Unfortunately, Pennsylvania is a State that has permitted this 
discrimination, along with all of these other States. So we ought to 
have a national standard. Very simply: No more discriminating insurance 
policies against women. It is that simple, folks.
  What I voted for this summer in the bill we passed was this, along 
with other provisions. So that is something we shouldn't just talk 
about for another year or 2 or 5 or 10; let's do something about this 
now. Let's make this practice illegal this year, and we can do it with 
the legislation.
  The next one is an enlarged version of some language. I mentioned 
preexisting conditions in my remarks today, and we are going to keep 
mentioning this because this is a reality for millions of Americans in 
the individual market, the people who have to go it alone. They are not 
part of the big pool of people getting insurance. They have to go it 
alone to get insurance. They are the ones who are often most adversely 
affected by preexisting conditions. Why should we tolerate that?
  The other point about this chart is, I purposefully put legislative 
language on it because a lot of people here want to say: Well, this 
legislation and language gets complicated. Admittedly, some of it does, 
but this is pretty easy. This is in the bill we passed this summer. I 
will just read this one sentence. Anyone can understand this. This 
isn't some complicated legislative language:

       A group health plan and a health insurance issuer offering 
     group or individual health insurance coverage may--

  We know what they are; we know exactly what we are talking about 
here--

     not impose any preexisting condition exclusion--

  That is in our bill--

     with respect to such plan or coverage.

  Let's do it this year. Let's make it illegal for insurance companies 
to do this to an individual or to a family or to those who happen to be 
employees of a small business.
  So some of this debate gets lost in detail, but this is very simple 
language taken right out of the bill.
  Let's go to the next one and our final chart before I conclude. I am 
going to spend more time on this issue, but I just wanted to spend a 
couple of minutes on this issue.
  What happens at the end of this road with regard to health care as it 
pertains to children, especially children who happen to be poor or 
children with special needs? What will happen? At the end of the road, 
when we pass a bill and send it to the President and he signs it--and 
that is what I hope will happen, of course--will poor children and 
children with special needs be better off or worse off? That is still a 
question. That is still an open question we are debating right now.

[[Page S9525]]

  Children are different than those of us who happen to be adults. They 
are not smaller versions of adults; they are different. Their treatment 
needs are different. We have to give them different kinds of preventive 
care. In Medicaid, for example, we give what they call early periodic 
screening and diagnostic testing, known by the acronym EPSDT. We focus 
on the special needs of children and give them early diagnosis, early 
treatment. That is what I am talking about in general. So they aren't 
small adults. It seems like a simple concept, but we have to say it 
more than we do. It is clear they have different needs, particularly 
the ones who are the most disadvantaged. The poor are the ones who 
could potentially be a lot sicker with the threat of sickness and 
disease. We make sure they get the highest quality care throughout 
their childhood. That is a resolution I introduced as a statement of 
policy.
  So we are going to continue to debate not just a question of bringing 
down costs--that is central to what we are trying to do--not just a 
question of quality, and not only the question of enhancing choice and 
giving people some stability over their own lives with insurance and 
those who don't have insurance, giving them some affordable choices--
that is all important, and we are going to spend a lot more time on 
those questions, but another question we have to address is, what 
happens at the end of the road for poor children or children with 
special needs?
  The rule ought to be very simple: No child in those categories, no 
child worse off. Four words: No child worse off at the end of this.
  So we will have a lot more time to continue to debate the legislation 
and a lot of these important issues. I think the American people want 
us to act. They don't want us to just debate and not get something 
done.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona.
  Mr. McCAIN. Mr. President, I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.