[Congressional Record (Bound Edition), Volume 149 (2003), Part 5]
[Extensions of Remarks]
[Pages 6268-6269]
[From the U.S. Government Publishing Office, www.gpo.gov]




            STATE HIGH-RISK POOL DRUG ASSISTANCE PROGRAM ACT

                                 ______
                                 

                            HON. MARK UDALL

                              of colorado

                    in the house of representatives

                        Thursday, March 13, 2003

  Mr. UDALL of Colorado. Mr. Speaker, today I am introducing the State 
High-risk Pool Drug Assistance Program Act. The bill provides much 
needed relief on prescription drug costs for those individuals who get 
health insurance coverage through a qualified state high-risk pool 
insurance program.
  While much of the debate on prescription drugs has focused on older 
Americans, there is another group of Americans who need affordable 
access to prescription drugs. These people are the 153,000 individuals 
who get health care coverage through a state high-risk pool insurance 
program.
  Thirty states have established high-risk pools for individuals who 
cannot obtain or afford health insurance in the individual market. 
High-risk pools generally cover people who have been denied coverage 
because of a pre-existing condition or who have received quotes from 
insurers that are higher than the premiums offered by the risk pools. 
Their premiums range from 124 percent to 200 percent of the standard 
market rates in their state.
  For example, a female, non-smoker who lives in Adams County in 
Colorado may pay $850 a month in premiums to obtain coverage through 
Cover Colorado, my state's highrisk pool. If this woman takes 
medications to manage a chronic disease, she will have fewer dollars to 
spend on them. I have heard stories about people with chronic 
conditions cutting their pills in half, choosing between paying for 
drugs and paying for food, or forgoing the medications altogether. 
These folks shouldn't be forced to make these choices at all. I think 
it's time for Congress to do something to help state high-risk pools, 
consumers, employers and state legislatures control the cost of 
healthcare.
  My bill would add qualified state high-risk pool programs to the list 
of entities that participate in the Public Health Service's 340B 
pricing program, which was created in 1992 to help safety net providers 
purchase outpatient drugs at discounted rates. The 340B program has 
expanded access to care to low-income and vulnerable populations 
without increasing the financial burden on taxpayers. The program has 
saved safety net providers and the taxpayers hundreds of millions of 
dollars in outpatient drug costs. We should extend the program to 
include high-risk pools.
  My bill uses the National Association of Insurance Commissioners 
definition of qualified state high-risk pool so that all risk pools 
would be able to participate in the program. It gives the Secretary of 
Health and Human Services the power to promulgate regulations to carry 
out the program so that it is run similarly to the successful AIDS Drug 
Assistance Program; however it sets minimum regulations for the 
operation of the program. People who are enrolled in a risk pool and 
who take maintenance drugs for chronic conditions could save 40 percent 
on their prescriptions.
  The bill uses the federal government's purchasing power to provide 
discounts to drugs for high-risk pools nationwide. If individuals in 
high-risk pools can't get the drugs they need to manage their 
condition, they could end up in the emergency room and cost the 
taxpayers millions of dollars. If they weren't covered under the risk 
pool, they would most likely end up in Medicaid or uninsured, which 
would cost the taxpayers millions of dollars. Ironically, many 
consumers in risk pools have conditions that would qualify them for one 
of the public programs currently covered under the 340B drug discount 
program. But their income level is too high for public health programs 
and too low to afford coverage in the individual market, and that's 
only if they aren't denied coverage due to a pre-existing condition.
  Some may ask what the federal interest is in this issue. Congress has 
already determined that interest by guaranteeing that people have 
access to high-risk pools through the Health Insurance Portability and 
Accessibility Act of 1996 and the Trade Act of 2002, both of which are 
federal laws. Since the federal government is requiring high-risk pools 
to cover more people, it should make high-risk pools covered entities 
under the 340B program to save taxpayer dollars.
  The legislation is good for the insurance market, consumers, 
employers and states. It is good for the insurance market and for 
consumers because high-risk pools stabilize health insurance coverage 
and reduce the number of uninsured.
  It is good for the risk pools because the savings that they 
experience from the drug discount can be used to provide more 
affordable coverage and better health plans.
  It is good for consumers because it will give people in high-risk 
pools access to affordable maintenance medications for chronic 
conditions and keep them out of the emergency room.
  It is good for employers because if we control the costs of the high-
risk programs, it will keep down the assessments that insurers and 
employers pay to fund the program.
  And it is good for states because if we control the costs of the 
program, cash-strapped states won't have to find additional funds to 
stabilize the risk pool, and the state's contribution will go a lot 
further.
  Mr. Speaker, a small but not insignificant number of people would 
benefit from my legislation, and it would save millions of dollars in 
health care costs and uncompensated care. This is a prevention bill, a 
cost savings bill, a pro-business bill and a taxpayer savings bill. I 
look forward to working with my colleagues

[[Page 6269]]

and all interested parties to pass meaningful drug assistance 
legislation for our nation's state high-risk pools.

                          ____________________