[Congressional Record Volume 155, Number 151 (Monday, October 19, 2009)]
[Senate]
[Pages S10508-S10511]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. CASEY. Mr. President, I rise to talk about health care in three 
ways, three different subjects but all vitally important to making sure 
we get the job done in the next couple weeks. As many Americans know, 
in the Senate right now, we have the HELP Committee bill that passed in 
July and the recent passage of the Finance Committee bill coming 
together in a merger process which is days away from completion or 
certainly in the near future. As that process unfolds, there are parts 
of our bill, meaning the HELP Committee bill, that I hope remain intact 
or at least, in large measure, are left as part of the final Senate 
bill.
  One part is on the issue of children's health insurance. We had an 
important debate about this program, which was authorized in 2009, so 
that within the next several years, within the next 4 years, maybe by 
the end of 4 years, we will have as many as 14 million children across 
America covered by that program, a tremendous advancement from where we 
were even 10 years ago. It has shown results in a lot of places. It is 
a well-tested program.
  One of the more recent debates, within the Finance Committee, was 
whether children in CHIP, whether that program itself would be stand-
alone--as I believe and as I am glad the Finance Committee agreed with 
me and with others--or whether it would be folded into the exchange. 
They didn't do that in the Finance Committee. I am glad they did not.
  In this instance, we have a program which started in States such as 
Pennsylvania back in the early 1990s and then became a national program 
in the mid-1990s, about 1997. What we have seen in Pennsylvania are 
tremendous results. I ask unanimous consent to have printed in the 
Record a one-page survey by the Pennsylvania Insurance Department from 
2008 about uninsured numbers, ages zero to 18 and then 19 to 64.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

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[GRAPHIC] [TIFF OMITTED] TS19OC09.001



[[Page S10510]]

  Mr. CASEY. What this chart shows is when we compare individuals who 
happen to be zero to 18 in age versus 19 to 64, we find that in 
Pennsylvania, across the 67 counties, we have an uninsured rate of 5 
percent among children. So ages zero to 18, it is 5 percent uninsured. 
It is still too high--we want to bring that down to zero--but much 
lower than it had been. But among the age category 19 to 64, meaning 
everyone above the age of 18 prior to the time they have an opportunity 
to receive Medicare, 12 percent are uninsured in Pennsylvania. I doubt 
that is much different across the country.
  One of the lessons from that is that when we take concerted action to 
focus, whether it is public resources or private resources but of a 
strategy for health care, we can bring the numbers down dramatically. 
So children's health insurance in Pennsylvania is in much better shape 
than it was 10 or 15 and certainly 20 or 25 years ago. But we haven't, 
as a country, begun to focus on that age category 19 to 64. If it is 12 
percent in Pennsylvania, it is probably similar across the country 
because there has been no strategy for people in that age category 
comprising our workforce.
  We have to bear that in mind. When we have one category with an 
uninsured rate of 5 percent versus another that is more than double 
that at 12 percent, we have to continue to focus strategies in the 
debate on that age category. In this process of coming to a bill, I 
believe there are several policies and several strategies that will get 
us to the point where the rate for ages 19 to 64 will come down as 
well. As many Americans know, the Affordable Health Choices Act, the 
bill from the HELP Committee, has as its goal and is premised upon the 
idea of covering as many as 97 percent of the American people. We 
finally have a strategy for every age group in addition to what we have 
tried to do for children and what we have done to help older citizens, 
over more than 40 years now, over the age of 65 or 65 and up.
  One of the parts of the HELP Committee bill which does not get a lot 
of attention is a part of the bill which is set forth in sections 3201 
to 3210. It starts on about page 228 of the HELP Committee bill. I know 
these bills are big, well more than 800 pages, but this section on the 
Community Living Assistance Services and Supports Act, the so-called 
CLASS Act, is a breakthrough--I think to be understated--because what 
it does is provide individual Americans who have functional limitations 
to be able to continue working but also to provide some of the help 
that goes into providing them the wherewithal to continue working.
  Here is what the fundamental purpose is. I am reading from the 
summary: The fundamental purpose of the bill ``is to establish a 
national voluntary''--voluntary--``insurance program for purchasing 
community living assistance services and supports in order to provide 
individuals with functional limitations with tools that will allow them 
to maintain their personal and financial independence''--probably the 
most important word in that paragraph--``and live in the community 
through a new financing strategy for community living assistance 
services and supports,'' and ``establish[ing] an infrastructure that 
will help address the Nation's community living assistance services and 
supports needs, and alleviate burdens on family caregivers.''
  What we have now, unfortunately, in many places is two or three major 
problems. The individuals themselves are not able to work sometimes; 
they have an inability to work because of limitations, and they are not 
able to pay for the kind of care they need. That is the main problem.
  The second problem is, in many families, caregivers try to make up 
for that. If the family member with limitations cannot pay for 
services, family members provide the kind of services they would hope 
to get from some other person or entity.
  What we are doing here is relieving a burden on individuals so they 
can be fully functional and independent because of the support and help 
they get, such as someone coming into their home in the morning to help 
them get off to work and to be able to meet them at the end of the day 
and help them with so-called activities of family living, things we all 
take for granted in our daily lives: everything from feeding and 
bathing and other fundamental things that all of us have to do every 
day. With a little bit of help from someone, many Americans can lead a 
life of employment, a life of dignity, and a life of contribution to 
our economy.
  It also gives some real help to family members. So we will talk more 
about the details of how this works. I should mention the person who 
was the driving force on this legislation--and he and his staff worked 
on this for years--was the late Senator Kennedy. He spent many years 
developing this program, developing the CLASS Act, and making sure it 
was part of our bill. That is why we wanted to make sure it was part of 
the Affordable Health Choices Act, and it should be part of the final 
health care legislation we enact here in the Senate. If we are going to 
do the right thing, it will be in the bill. I think most people here 
want to do the right thing as it relates to people with functional 
limitations who can contribute more to their workplace and contribute 
more to our economy.
  Senator Kennedy's work was focused not just on providing a program to 
give people that opportunity, his focus was also: How can we do it in a 
way that is fiscally responsible? Well, this program provides not just 
a lot of help for people with limitations and their families, but it 
also does not cost the Federal Government in the process because people 
will be paying in overtime and then have the opportunity to use those 
resources when they need them.
  Let me finally move to another area in the remaining time I have. In 
addition to the importance of preserving the Children's Health 
Insurance Program the way it is right now--which I think was a great 
advancement in the Finance Committee--in addition to enacting 
legislation which will have the CLASS Act as part of it, the third 
thing I am going to mention today is an issue that has received a lot 
of attention, but sometimes we do not highlight some of the elements 
that are very important to the American people. I speak of the so-
called public option, which in our Senate health care bill, the HELP 
Committee bill, is entitled the ``Community Health Insurance Option.''
  One of the most important parts of the bill--in fact, I think the 
first word in the section is the word ``voluntary.'' When I was going 
across Pennsylvania talking to people about our health care bill--and 
our bill passed in July, so when I was on the road in August, we had a 
chance to talk about a bill, not just a concept but a bill we had 
already passed out of committee--some people who were opposed to the 
public option would ask a question or make a statement, and often they 
would say to me: Well, I don't want to be forced into some government 
program and lose my ability to choose or lose some of the rights I have 
now.
  I would point to the Community Health Insurance Option section of the 
bill and say: The first word is ``voluntary.'' There is no requirement 
here. I think that mythology kind of got ahead of the truth. It is 
voluntary; that is, voluntary as it relates to an individual but also 
voluntary as it relates to a provider.
  Second, as to the benefit package, as we wrote it in our bill, in the 
HELP Committee, it would meet the so-called gateway. In our bill we 
call it a ``gateway.'' In the other bills, they call it an 
``exchange.'' But it meets the gateway standard by offering coverage 
that has an essential benefit package, including ambulatory patient 
services, emergency services, hospitalization, maternity and newborn 
care, mental health and substance abuse services, prescription drugs, 
rehabilitative services and devices, preventive and wellness services, 
and pediatric services. States can offer additional benefits beyond 
that essential benefit package with any cost of such additional 
benefits being assumed by the State. So that is what the public option 
in our bill, the Community Health Insurance Option, would offer as a 
benefit package.
  The premium rates will be set by the Secretary of Health and Human 
Services at an amount sufficient to cover expected local costs--local 
costs. So you are going to have a lot of impact and relevance as to 
what is happening in the local community. And also--this is very 
important--the Community Health Insurance Option has to meet

[[Page S10511]]

solvency standards. It cannot just operate and not worry about 
standards that involve solvency. If there are States that have higher 
levels or higher requirements as to solvency, the public option would 
have to meet that.
  The reimbursement rates will be negotiated by the Secretary and shall 
not be higher than the average of all local--local--gateway 
reimbursement rates.
  I mentioned the importance of solvency as a requirement.
  Startup funds will be provided by the Treasury to cover costs of 
initial operations and cover payments for the first 90 days of the 
plan's operation. But then that public entity, which is State based, 
would have to pay the money back over time. I think that is critically 
important to point out.
  Finally, State-based advisory councils will provide recommendations 
to the Secretary on operations and policies regarding the Community 
Health Insurance Option, to take advantage of local innovative efforts 
and meet local concerns. So this is not some entity that is going to 
operate in Washington. It is an entity that will have not just public 
input and local input and local relevance but actually will take 
advantage of local innovative efforts that we see all across the 
country. I know in Pennsylvania there are hospitals or hospital systems 
or communities that do things a different way and are very successful, 
and we have to be giving them the opportunity to have that kind of 
flexibility.
  I believe it is the right thing to do to have as part of the final 
bill a public option. I believe our bill we passed out of committee is 
the right way to do it. Others might have another version of it. But I 
believe the Community Health Insurance Option is a voluntary, focused 
way to make sure we are injecting real competition and thereby lowering 
costs but also enhancing choice.
  One thing we do not want to do at the end of this road is limit 
choices people have. A lot of people will stay with their private 
insurance policy or their private plan. They will want to stay there. 
But others may say: I am in such a predicament or I am in such a cost 
situation that I need to choose a public option.

  Finally, Mr. President--I will wrap up with this--I believe this 
debate has been critically important to the American people, even the 
debates that get a little heated. It is very important we get this 
right. It is very important we have spent the time we have spent over 
these many weeks and months. But we are reaching the point now where we 
are down to weeks, thank goodness, not months.
  I believe we can get this right, we can put in place strategies to 
give people peace of mind, so when they go to work in the morning, they 
do not have to worry, as they do, about health care--the cost of it, 
the burden of it, being denied coverage because of a preexisting 
condition or having a child denied coverage because of that or a loved 
one. I believe we can also begin to wrestle the costs to the ground and 
not have them spiraling upward, as they have been doing for 10 or 15 or 
more years. I also believe we can enhance choice and quality.
  Even with all the debates we are having, all the disagreements we 
sometimes have here in Washington, there is a lot of consensus about 
the need to pass a bill, about the need to enhance prevention efforts 
and quality efforts. I believe we can get there. But we will continue 
to highlight some major aspects of the bill, and we are going to 
continue to fight hard for these fundamental priorities of health 
insurance reform.
  Mr. President, with that, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee.
  Mr. ALEXANDER. Mr. President, how much time is remaining on the 
Republican side?
  The ACTING PRESIDENT pro tempore. There is no divided time at this 
point. Morning business goes until 4:30 p.m.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent to speak in 
morning business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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