[Congressional Record (Bound Edition), Volume 150 (2004), Part 7]
[House]
[Pages 8986-8987]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        COVER THE UNINSURED WEEK

  The SPEAKER pro tempore. Pursuant to the order of the House of 
January 20, 2004, the gentlewoman from the Virgin Islands (Mrs. 
Christensen) is recognized during morning hour debates for 5 minutes.
  Mrs. CHRISTENSEN. Mr. Speaker, in this Cover the Uninsured week, I 
rise to say that our health care system in this country is falling 
short on promise and contributing to disabling illness and premature 
death of the people it is supposed to serve. The picture is worse for 
African Americans who, for almost every illness, are impacted more 
severely and disproportionately, in some cases more than all other 
minorities combined. Every day in this country there are at least 200 
African American deaths which could and should have been prevented.
  The current strongly held-to ``cost containment'' paradigm, while it 
sounds good on the surface, has obviously not worked. We now have 
double digit increases in premiums in an industry that was to rein in 
costs. What it did instead was create a multi-tiered system of care, 
both within managed care and without. Those at the lowest rungs of the 
system got and continue to get sicker. The sicker, and the more costly, 
were and are still being dropped, and those who are sickest were and 
remain locked out entirely.
  In 2003, health care spending rose to $1.7 trillion, or an average of 
almost $5,000 per person. As a percentage of the gross domestic 
product, it grew from 13.1 percent in 1999 to 15.2 percent in 2002. 
National health care expenditures are expected to reach $2.8 trillion 
in 2011.
  These health care costs are driven by, among other things, lack of 
preventive care, poor disease management, the consequent use of high-
cost care, and the cost burden of uncompensated care.
  A recent study by the Kaiser Family Foundation found that the 
uninsured are 30 to 50 percent more likely to be hospitalized for an 
avoidable condition, the average cost of which in 2002 was estimated to 
be about $3,300. Close to 93 percent of the uninsured report having a 
more difficult time getting access to primary care and, therefore, are 
coming first to emergency rooms. About 97 percent of them report having 
medical conditions that have persisted or worsened because of a lack of 
early intervention or preventive care.
  To add insult to injury, these uninsured individuals are also often 
penalized by being charged higher fees for health care services and not 
given the discounts afforded insured patients. A Health Affairs article 
published in 2000 entitled ``Gouging the Medically Uninsured'' found 
that an uninsured patient paid up to twice as much as the insured 
patient. A New York Times article titled ``Medical Fees Are Often 
Higher For Patients Without Insurance'' cited examples of uninsured 
patients being charged up to 7 times more for a gynecological exam.
  Mr. Speaker, lack of health insurance is a major factor in the 
escalating costs of health care and it affects minority populations 
more than others. Over a third of Latinos are uninsured, the highest 
rate among all groups studied, and 2\1/2\ times higher than the rate 
for whites. Nearly a quarter of African Americans and about one fifth 
of Asian Americans and Pacific Islanders have no health coverage.
  Uninsured rates are lower among Native Americans only due to their 
ability to receive services through the Indian Health Service, which 
represents a set of federally provided health services as opposed to 
coverage, yet the level of care for them leaves much to be desired as 
well.
  It is because of these and many other grave health statistics that we 
are asking Congress to pass comprehensive health care reform, 
understanding that none of the diseases causing disparities can be 
successfully managed without sustained universal access to health care.
  This week, the Democrats will introduce three bills to do just that: 
the Family Care Act, the Medicare Early Access Act, and the Small 
Business Health Insurance Promotion Act. There are also other bills 
that have already been introduced, of which I am proud to be a 
cosponsor, by the gentleman from Michigan (Mr. Conyers), the 
gentlewoman from California (Ms. Lee), the gentleman from Maryland (Mr. 
Cummings), and the gentleman from Washington (Mr. McDermott).
  This week we will take up H.R. 660, the Association Health Plan 
proposal,

[[Page 8987]]

which poses, in my opinion, a serious threat to our existing employer-
based health insurance system. It would exempt small employer plans 
from important State regulatory protections, and there is no reason to 
believe that eliminating these protections will help small employers 
expand coverage.
  Instead, AHPs will be able to design services to cover industries and 
sectors with the healthiest employees and leave out small businesses 
with older or sicker workers, those who most need coverage. This 
ability to cherry-pick would drive up the cost of coverage for small 
businesses with less healthy profiles of workers who will then be left 
in the insurance pool by themselves. AHPs would be able to offer less 
generous benefit packages in order to bring down the costs of coverage. 
The CBO has already estimated that 80 percent of workers would be worse 
off under AHPs.
  In closing, I urge my colleagues to put politics aside in addressing 
the issue of coverage as well as in malpractice reform, and the other 
health care bills we will be considering this week. Let us not opt for 
the short-term fix that is really no fix at all. Let us not support 
proposals that do not provide substantive remedies for these problems 
which affect the life and death of those we represent. And, above all, 
let us commit ourselves, this week and always, to do no harm.

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