[Congressional Record (Bound Edition), Volume 150 (2004), Part 7]
[Senate]
[Pages 9089-9092]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            HEALTH INSURANCE

  Mr. THOMAS. Mr. President, I would like to take the first 10 minutes 
of our 30 minutes and talk a little bit about the uninsured and talk a 
little bit about insurance, of course. I am pleased this is uninsured 
week, that we are focusing on that problem of uninsured folks. I think 
it is a great thing that we ought to be doing. There are some 
alternatives that we can pursue.
  I have been particularly involved in the rural health care aspect, 
being from Wyoming where, of course, almost all of our health care is 
rural health care. We have had good results in our Medicare bill that 
was passed last year. We have equity pay for the providers in that 
bill. We have assistance for those serving underserved areas. We have a 
number of things that are very necessary. I am pleased they are there.
  We have been focusing on Medicare, of course, because that is the 
Government's responsibility directly. We have made some good progress 
on that. Among other things, we seek to help seniors with 
pharmaceutical costs. We have a program out there. I am a little 
disappointed the minority leader is nothing but critical of it. It is 
out there and we ought to be trying to make it work now rather than 
trying to oppose it for political reasons. I think that is a mistake.
  There are opportunities out there for the elderly to enjoy a 
considerable amount of assistance, particularly low-income people, with 
the $600 assistance in addition to a 20-percent reduction. The fact 
that there are 70 cards out there--all you have to do is call 1-800-
Medicare and get the advice that is necessary to do it. I wish we could 
support something instead of totally always being critical.
  In any event, we have worked on those, and I think it is time that we 
look, now, at the broader aspects of health care. That includes many 
other things. We have a great system. We have probably the best health 
care system in the world. However, if that system gets in the position 
where access is limited by the costs, then of course we are not making 
it possible for everyone to participate. That is really where we are.

[[Page 9090]]

  The costs of health care have increased substantially. There are lots 
of reasons for that. One of them is the new equipment that is being 
used, which everybody wants to take advantage of, of course, because it 
is the high-tech stuff.
  Another reason, obviously, is the liability problem we have tried to 
address on the floor a number of times, and we have not been able to 
move past the obstructionism on the other side. The liability problem 
not only results in the cost of the liability insurance going up, but 
it also results in having more testing, more specialists, more costly 
health care simply to avoid the opportunities that people might have to 
sue. So there are a lot of things.
  I had the opportunity not long ago to talk to the management of one 
of the largest hospitals we have in Wyoming. It was interesting when 
the financial officer broke down the situation with regard to the 
funding. First, he talked about the billing level, which, of course, is 
quite above the cost level because they need to bill some more than it 
costs to make up for those who do not pay. But the point was, they 
broke down the number of people who were there, the number there in 
Medicare, the number there on Medicaid, the number that had their own 
insurance, the number that were uninsured, and the emergency ones. Part 
of the problem is Medicare is not paying the full cost, Medicaid does 
not pay much of the cost at all, so then you get to the uninsured and, 
of course, many of them do not pay, are not able to pay at all, and you 
have the emergencies, so what happens? It goes to those of us who have 
insurance.
  As I go about my State talking to people, I hear more about the cost 
of health insurance than anything else that you talk about in a town 
meeting. It is largely because of some of those shifts there.
  As has been pointed out, we have over 40 million Americans who do not 
have health insurance, and that is unacceptable. We need to do 
something about that. The cost of health care--of course we ought not 
to forget that continues to grow almost unchecked. It has grown to $1.6 
trillion in 2002, a 9.3-percent increase over the previous year. You 
cannot keep having a 10-percent increase in these costs and yet be able 
to deal with them. The health care cost portion of the gross national 
product in 2002 was nearly 15 percent, up from 14 percent the year 
before.
  This is part of it that we ought not forget--the cost of health care. 
We ought to look at the costs as well as who is going to pay. 
Unfortunately, that is about all we ever talk about--who is going to 
pay. There is more to it than that. These rates cannot continue to grow 
at that rate.
  We have had a considerable amount of planning in our State with 
respect to the uninsured. We had a group--I am glad there has been a 
task force here, and we have about 14 percent of our people in Wyoming 
who are uninsured.
  It is largely because of the cost. We have a number of things, 
however, that have been suggested which I think we ought to take a look 
at. There are some important special recommendations.
  We could expand public programs such as Medicaid and CHIP. The 
minority leader was just talking about the CHIP program and why it 
should be such a surprise since it has been there for a good long time. 
It is one that the States participate in funding. We need to do that. 
It needs to be funded at the full level by the States.
  We need to provide a buy-in option for public programs so people have 
an opportunity to buy into these programs that now exist. We need to 
increase the reimbursement for public programs. They are not paying 
their share. Therefore, private insurance goes up, and those people who 
can't afford it or even come close to affording it are even less likely 
because it has gone up more.
  We need to target tax credits and Federal subsidies. I think tax 
credits are valuable. That would allow people to take a higher crisis 
sort of a policy.
  Community health centers that deal with people who aren't able to 
have insurance and need help is an excellent way to deal with this.
  Of course, we need to do something to help participation of employer-
sponsored programs. That is not the only answer because a lot of people 
are self-employed.
  Of course, we also need to push for personal responsibility for 
health. An interesting program has been talked about in Wyoming. It is 
a group called the ``Be Well Program.'' They would deal with employer 
groups that cover their employees. The employees would sign an 
agreement to keep up their own health, to exercise, and do some of the 
things that we all talk about and which not everyone does. That would 
be a condition of being insured. It is already in a couple of 
contracts.
  There are a lot of things to do, and the task force has a number of 
ideas. I think we need to move forward to try to do some things. Most 
of us I don't believe favor a socialist program where the Government 
runs all of the health care programs. That is evidently not the kind of 
thing we want to have because all of the Canadians would come here.
  But, nevertheless, there needs to be a program that gives an 
opportunity for people to fully participate. I am delighted that we are 
moving forward with it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. TALENT. Mr. President, thank you for recognizing me. I came out 
on the floor to talk for a few minutes about the health care task 
force, and particularly about association health plans or small 
business health plans.
  I am very pleased that we are talking about the health care task 
force report. I want to talk a little bit about the drug discount card 
in part because I think it is important that we talk about it. I want 
my senior citizens to be aware of this benefit and to use it. I think 
it is something everyone ought to consider. For many of them, it is 
going to be the relief they have been looking for many years.
  I want to say that it is hard for me to understand these attacks 
which are occurring on a fundamental level against the discount card. 
Without question, this card is going to provide relief to tens and tens 
of thousands of people who have been choosing between the other 
necessities of life and their prescription drugs.
  There are 200,000 senior citizens in the State of Missouri today who 
are buying prescription drugs entirely out of pocket. It is not very 
good for them for two reasons: In the first place, they are buying 
entirely out of pocket. They are paying for it entirely on their own. 
In the second place, they are paying the highest price entirely on 
their own. When they walk into the pharmacy to get prescription drugs, 
they are facing the prescription drug companies alone. They are not 
part of a broader pool that has purchasing power and is able to 
negotiate a discount over the sticker price of the drugs. So they are 
paying the highest price, and they are paying it entirely out of 
pocket. Many of them are the poorest senior citizens. As a result, they 
do not get the prescription drugs. They get sick, or they take every 
other pill.
  I have talked personally to scores of people like that over the 
years. I had a hearing of the Aging Committee that Senator Gregg was 
kind enough to let me hold in Missouri. I had senior citizens come and 
testify.
  Everybody in the Senate is familiar with this. This discount card is 
going to provide relief. Seniors are going to have access to a variety 
of cards that will give them discounts off the prescription drugs. For 
lower income senior citizens, those receiving retirement of less than 
$1,000 a month, they will get $600 from the Government toward the price 
of the discounted drugs. The average price, which it is for 
prescription drugs, for senior citizens is about $1,400 a year for 
prescription drugs. That person in Missouri right now is paying the 
entire $1,400 out of pocket, and probably more than that since they are 
paying the highest price. With a card, they will go into the pharmacy, 
the pharmacist will swipe the card through the machine and say: For 
your Lipitor, which was costing you $80 a month, under this card it 
costs you $65 a month. The first $600 of that this

[[Page 9091]]

year the Government is paying for it. Instead of paying $1,400, which 
you couldn't pay--they get nothing, is what it comes down to--they end 
up getting a $200 or a $300 discount, and the Government pays $600 off 
of that, and they can afford not to get sick anymore.
  I think that is pretty important.
  I understand the concerns on the other side of the aisle that this 
bill isn't Government-dominated enough. I recognize that. They are 
saying basically this is federally subsidized, but they are buying the 
prescription drugs from private organizations. That is not a good 
thing. It is true. This is federally subsidized, but we are buying the 
prescription drugs from private companies.
  There is a word for a Federal health care plan that pays for health 
care costs of senior citizens so that they can go to private companies 
and get health care services or goods. Do you know what the word for 
that is? Medicare. That is what Medicare is. When Medicare was set up 
in 1965, the Government could have gone on and done what it has done 
with the VA health care system--buy or build new hospitals, hire 
physicians, and run the whole thing as a Government organization. We 
didn't do that. What we did instead was set up a system where we would 
pay for the cost of Federal health care, but seniors would have a 
choice of private providers if they wanted. That is what this 
prescription drug plan is about, what it is modeled after.
  It is going to help tens of thousands of people in my State of 
Missouri at a minimum.
  I hope we can get behind it and make it work as well as we can 
possibly make it work.
  Let me switch now to talk a little bit about the health care task 
force which addresses another huge problem; that is, the rising cost of 
health insurance premiums.
  There are a number of things in this health care task force report. I 
recommend it to every Member of the Senate.
  One of the key things about it is that it is designed to attack the 
trends in the system which are driving those costs up. I really like 
this. It is time for us to stop concentrating on how we can keep 
feeding this beast and start getting the beast on a leash, if you will.
  It is fine to subsidize the cost of health care for people who can't 
afford it. I certainly support it. I just talked about prescription 
drug costs. But we also need to bring down the costs of health care. 
There are a lot of things in this report that are designed to do that.
  Liability reform is one of them. Another is the emphasis in the 
report on the use of information technology, which is very important. 
Health care is behind in information technology. If we can get the same 
kind of architecture of technology in health care that we have in other 
parts of the economy, we have the potential to save tens of billions of 
dollars.
  There is important regulatory reform in the bill that will lower 
cost.
  I met with a bunch of nurses and nursing students at Southeastern 
Missouri University and asked them what their big concerns were about 
health care. I was really surprised. The thing that bothers them the 
most is the amount of time they have to spend in filling out forms to 
comply with the oversight of one group or another. It is very 
demoralizing, and it raises costs.
  The task force also includes associated health plans, which I want to 
talk about briefly.
  Of the people who are uninsured--there are about 43 million--two-
thirds either own a small business, work for a small business, or are a 
dependent of someone who owns or works for a small business. We can ask 
ourselves, why is that? Is it because small businesspeople are more 
chintzy than big businesspeople? Small businesspeople and farmers do 
not care about their employees as much as the larger businesses? They 
do not want to buy health care? That is one possibility. But I don't 
think it is true.
  The reason many of these people, working people who work for small 
businesses, are not getting health insurance is that costs for buying 
health insurance are higher for small businesses than they are for 
bigger businesses because the administrative costs cannot be spread 
across as big a pool. The costs of getting health insurance for someone 
who runs a small business are about three times per employee what they 
are for someone who runs a big business.
  Small business health plans allow small businesspeople to pool 
together through a national trade association and get health insurance 
as part of a big national pool.
  My brother owns a Little Tavern restaurant. It is a great place. I 
have talked about it before in the Senate. If anyone is ever in the St. 
Louis area and wants a good hamburger, give me a call and I will give a 
recommendation. My brother has a little restaurant. He could join the 
National Restaurant Association and become like a little division of a 
big company. He would get health insurance then as part of a 10,000, 
20,000 or 30,000-person pool, the same as the employees of Anheuser-
Busch, which is located in St. Louis, or the employees of Hallmark, 
which is located in Kansas City. It will lower his costs 10 to 20 
percent by reducing the administrative costs. It would not cost the 
taxpayers anything because we are not feeding that beast with tax 
dollars. We are empowering people to put the beast on a leash to reduce 
costs that are driving up health insurance premiums without adding 
anything to quality or accessibility.
  There is no reason we should not do this. I am pleased it was 
included in the task force report. We worked on it. I hope we can get 
it, along with the other things in this report.
  We have to remember that as the Democratic leader was saying, if 
Americans are working and do not have health insurance, or they have 
health insurance and these costs continue to go up, this is the No. 1 
thing employees worry about as far as their job is concerned. I have 
had a lot of folks in the last recession--and I am pleased we are 
coming out of this now--who lost jobs and said to me, We have families; 
we have to get our health insurance back. It is very difficult to 
provide it when premiums go up and up and up all the time.
  We can do something about it. There are a number of different ideas 
out there. Many of them are in this task force report. I commend it to 
the Senate. It is time to get these things done. We can all come down 
here and talk about stories back home of people who are suffering 
because of this situation. We need to get something done. It would be a 
huge step forward if we all said we are going to sit down as a group, 
we will work something out, we will agree beforehand we will not 
filibuster everything because we do not like this particular aspect of 
the package or that particular aspect of the package. We are not going 
to take small things we disagree with in a bill and treat them as if 
there is some enormous attempt by people--whom we disagree with 
honestly--to do something that is venal or wrong. These problems are 
big enough to solve if we try to stick together and agree where we can 
agree and disagree reasonably where we do disagree. They will be 
impossible to solve if everything becomes a subject of some kind of a 
political attack.
  I appreciate the time of the Senate and I yield the floor.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. CORNYN. Mr. President, I commend the Senator from Missouri for 
his advocacy on the part of his constituents and, indeed, all the 
American people, to make sure more have access to good quality health 
care.
  I will talk about the work of the task force created by Majority 
Leader Frist, which was chaired by Senator Judd Gregg of New Hampshire. 
This work, over the last number of months, promised a lot in terms of 
new ideas and new approaches. It will help make sure health care is 
accessible to more Americans.
  It is amazing, but we spend in this country somewhere between $1.4 
trillion and $1.7 trillion on health care. That is a lot of money, even 
in Washington. Most people cannot even get their minds around what $1 
trillion is.

[[Page 9092]]

I promise you, I cannot. But I do know that is an enormous amount of 
money.
  If we ask people who should know about it, they will say there is 
enough money in the health care delivery system in the United States of 
America to make sure everyone has access to health care. The problem is 
what we call sometimes a ``health care system'' is not a system but a 
patchwork of different delivery methods. It is a local taxing 
jurisdiction, hospital districts, using property taxes in some States, 
of course supplemented by other taxes, and of course there is Federal 
Government-provided health care available, partially, at least, through 
the CHIPS Program, through Medicaid and through Medicare.
  We do know there is a tremendous challenge to make sure everyone in 
this country has access to good quality health care. Those who do not 
have health insurance represent one of the biggest challenges. One of 
the things we have learned is this is not so much a challenge of 
getting everyone insurance. The real question is, How do we make sure 
everyone has access? Even for those who do not have health care 
insurance, we need to make sure they have access to health care.
  Right now the irony is the Federal Government has already gotten into 
this area and mandated if you have nowhere else to turn for health 
care, you know you can always show up at the local emergency room at 
your hospital and get that health care provided. If you cannot pay for 
it, it is provided without charge to the patient. The problem is, in 
many major metropolitan areas on any given Friday or Saturday night, 
when the demands on the emergency room are great, many emergency rooms 
are on divert status, which means they cannot take anymore patients 
because they are full.
  However, 80 percent of those people being treated in emergency rooms 
could be and should be more humanely, more efficiently, and less 
expensively provided health care in some other setting--in a clinic, 
for example.
  One of the most amazing things about our health care delivery system 
in our country, while we do compensate--although some argue it is not 
as generous as it should be--we do compensate health care providers for 
providing health care to people after they are sick, we do a pretty 
lousy job of trying to give people access to what they need in order to 
prevent their getting sick.
  We have made good strides forward with the Medicare bill we passed 
last year to provide prescription drugs to many seniors who did not 
have that. Of course, this Medicare discount drug card Senator Talent 
talked about is an interim step that leads to the full implementation 
of that program in a couple of years when the vast infrastructure can 
be created to deliver that system.
  For example, for someone who has not previously had access to a drug 
like Lipitor, one of the statin drugs--and there are a number of them; 
that is just one trade name--that perhaps can prevent someone from 
having to have more expensive, invasive, and dangerous surgery, either 
bypass surgery or angioplasty or perhaps placement of a stent, or 
something that costs a lot of money to treat if the basic cause that 
could be prevented is left untreated through the use of prescription 
drugs.
  We have made a great step forward to broaden the number of people, to 
increase the number of people preventive measures are available to. 
That is smart. We ought to continue along that trend.
  Mr. President, I ask to be reminded when I have 1 minute remaining of 
my time.
  One of the things I believe is a great safety net in this country, 
that I have come to learn about and see used so well in my State, is 
federally qualified community health centers. The great thing about 
community health centers is they provide clinical--that is, 
nonemergency room--access to health care in your neighborhood, where 
you pay based on a sliding scale, based upon your ability to pay. These 
are actually designated health centers by the Federal Government. They 
have access to a number of important programs, for example, the Federal 
340B Discount Pricing Program. This task force recommends that program 
be expanded to more people, so we can bring down the price of 
prescription drugs.
  But these community health centers provide, on a sliding scale, 
access to care in one's local community, which I think is very 
important. I was told by the head of Parkland Hospital, one of the 
largest public hospitals in Dallas, TX, for example, that people show 
up in the emergency room to have a baby, where they have no health 
insurance. Because they have no health insurance, and may never have 
seen a doctor before they show up in the emergency room, the risk of 
injury to that baby--either it being born prematurely or some other 
health risk--goes up exponentially.
  Even though they do not receive any income for it, Parkland Hospital 
routinely provides prenatal care for mothers, on a free basis, even 
though they do not get a penny paid by that pregnant mom. One reason is 
because they know the cost of 1 day in the neonatal intensive care unit 
at the Parkland Hospital costs about $10,000. Now, of course, I would 
like to say we would do that from our sheer desire to see healthy 
babies, but, unfortunately, money drives access.
  My point is, in this instance what Parkland Hospital, in Dallas 
County, has decided to do in a way to help control costs is to ensure 
more healthy babies are born who do not need access to the neonatal 
intensive care unit, as they provide free prenatal care to these 
pregnant moms. But community health centers can make sure this pregnant 
mom has access to somewhere other than the emergency room of the 
hospital in which to get that important prenatal care.
  We also would increase, as part of this task force report, the number 
of medical volunteers by extending critical Federal tort claims act 
liability coverage. This is an area that I think is very important.
  The PRESIDING OFFICER. The Senator has 1 minute.
  Mr. CORNYN. That is very important because the medical liability 
crisis in this country does not only hurt doctors and hospitals, but it 
hurts patients who are denied access to health care. One of the issues 
we have to deal with--I know the leader has brought it up several 
times, and we have been unable to get 60 votes to get an up-or-down 
vote on the merits of the legislation--is medical liability reform.
  Whether it is increasing access to specialty care, increasing the 
number of federally qualified community health clinics, increasing 
access to prescription drugs by extending the Federal 340B Program, or 
creating an exemption so religiously sponsored health systems can 
create community health systems, integrated health systems, we have to 
do something about this crisis in this country. It is a crisis of 
access, not only of insurance. But I think we are well on our way to a 
good start.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nevada.

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