[Congressional Record (Bound Edition), Volume 152 (2006), Part 6]
[Senate]
[Pages 7535-7538]
[From the U.S. Government Publishing Office, www.gpo.gov]




                      SMALL BUSINESS HEALTH PLANS

  Mr. ALLARD. Mr. President, I am going to speak under morning business 
on Senate bill 1955, the small business health plans legislation that 
is going to be before us shortly for formal debate. I come to the floor 
to talk about a piece of legislation that is important to my Colorado 
constituents. I would like to talk about the Health Insurance 
Marketplace Modernization Act, sometimes known as HIMMA.
  This legislation, which is also known as the small business health 
plans bill, would allow for small businesses to come together to form a 
group which could then use their combined purchasing power to influence 
insurance companies for affordable health plans.
  It has been suggested that those who serve in the Senate have no 
understanding of what small business folks

[[Page 7536]]

are going through and that most of us have never been faced with the 
reality of having no health insurance and therefore don't understand 
the plight of the small businessman. I come to dispel that rumor. I am 
a former small businessman who couldn't afford the cost of health 
insurance for myself or for my employees.
  My wife and I discussed options for ourselves and for our employees. 
Similar to many other small business owners across the country, we 
decided it would be better to raise our employees' rate of pay and 
allow them to purchase their own individual plans. My wife and I 
decided to begin setting aside our own savings account to pay for 
health care costs in case, for some reason or another, I had an 
incident or she had an incident where we needed to go to the hospital 
and thus needed health care coverage.
  Being a veterinarian and lifting heavy dogs onto the exam table all 
the time, and not expecting the dog owner to pick up the other half of 
a giant breed such as a Great Dane, I ended up having back problems and 
had to have back surgery. I didn't have health insurance, but I paid 
for it myself out of my own pocket. Fortunately, my wife and I had the 
foresight to set aside a savings plan so that if something such as this 
did happen, we could pay for it. But it did set us back.
  We were able to survive that particular incident. It was kind of an 
interesting thing, what happened to me when I went to go to the 
hospital. The administrators didn't want me to go into the hospital. 
The hospital would not let us in because we did not have health 
insurance. I said: Well, I will pay for it. When we got in there, I had 
the surgery, and I did very well, and I am very active today. The 
doctors did a great job on surgery. When we checked out of the 
hospital, the administrator said that they would reduce our costs by 20 
percent because they did not have to deal with the paperwork and with 
the cost of having to process my claim. So much of the paperwork is 
driven by trying to protect the hospital, the doctors, and the 
administrators from frivolous lawsuits. That has been my personal 
experience.
  I must admit I was disappointed when, earlier in the week, Members of 
the Senate chose to side with trial lawyers instead of women and 
children. And I was disappointed that Members of the Senate decided to 
support turning the medical profession into a cash cow for the legal 
profession instead of allowing for legitimate compensation.
  Again, in a matter of minutes, we will be debating the small business 
health plans bill and another attempt to bring down the high cost of 
health care, specifically for working class families who are employed 
by small businesses that, similar to my own situation, cannot afford to 
provide health insurance for their employees.
  I think it is important for us to focus this debate on at least 
giving small businesses the opportunity to make a choice on providing 
health care for themselves and for their employees. Currently, because 
of the prohibitive cost of health care coverage for their employees, 
many small business employers don't even have the option of offering 
coverage.
  Some of my constituents have brought to my attention over the past 
few weeks their worries that because of the lack of insurance benefit 
mandates, they could lose important benefits such as diabetes services 
and supplies, and coverage of preventive services such as colorectal 
screenings and mammograms. These worries are unfounded. Today there are 
over 1,800 different State mandates for health care coverage, including 
different coverage mandates in different States for the same preventive 
care, services, and supplies. This huge variation in mandates has made 
it nearly impossible to provide standardized coverage on a national 
basis.
  Additionally, the Government Accountability Office, which is an 
agency which helps to watch our dollars, has also found that the cost 
of mandates to a typical plan results in an increase between 5 and 22 
percent. The Congressional Budget Office, another dollar-watching 
agency, estimates that for every 1 percent increase in insurance costs, 
a minimum of 200,000 Americans are left uninsured.
  Facts suggest that things such as diabetes services and supplies and 
preventive services such as mammograms and colorectal screenings are 
usually covered by health plans, regardless of the State mandates. For 
example, the five most populous States require that diabetes care be 
covered. According to the American Diabetic Association and the GAO, 
only 4 out of 50 States do not require diabetic coverage.
  The General Accounting Office also studied States that are not 
subject to mandated coverages of diabetic services and supplies. 
Despite not being subject to mandated requirements for coverage, 
several of the largest plans and many of the largest Fortune 500 
companies provide comprehensive coverage for diabetes care.
  This factual evidence also applies to preventive services such as 
cancer screening. The Government Accountability Office found that the 
majority of States that do not have mandates continue to provide 
coverage in a majority of their employer plans for cancer screening.
  The bottom line is that the small business health plan bill makes 
logical sense. It will give small business owners what they want and 
what they need, and they will offer insurance coverage for their 
employees. It makes logical sense that plans covering preventive care 
will be offered because preventive care costs less in the long run. It 
makes logical sense that small business owners who currently cannot 
provide their employees with health care would purchase coverage 
because it is more affordable.
  It is important to note at this point that a small business owner who 
buys health care coverage is also naturally subject to the same health 
care coverage that he provides his employees. Small business owners are 
pushing for health insurance coverage for themselves and their 
employees, which they otherwise could not afford. It is not logical 
that they would pay money for a plan that does not provide them with 
medical coverage. Also, the point of small business health plans is so 
that small businesses can join together to use joint collaboration to 
get their health care needs met.
  I support the legislation because I support giving small businesses a 
choice. I support giving small businesses the opportunity for health 
care coverage that they currently do not receive. I support giving 
diabetics the opportunity for health care coverage, instead of leaving 
them completely without services and supplies. I support giving small 
business employees the opportunity for cancer screening and preventive 
care, instead of leaving them with nothing and no opportunity to 
provide health care for themselves and their families.
  I urge my colleagues to support the small business health plans 
legislation, and I urge my colleagues to vote in favor of Senate bill 
1955, the Health Insurance Marketplace Modernization Act. I urge my 
fellow Senators to give small businesses the opportunity to access 
health care for themselves and their employees.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ALEXANDER. Mr. President, I come to the Senate floor to speak 
about getting some long overdue help for small business men and women 
in Tennessee who have really been struggling to afford health insurance 
for themselves, their employees, and their families. We have an 
opportunity in this body to do something about it. This is not some 
abstract discussion we are having here; this is about something every 
single one of us hears--at least I know I hear it. Whether I go to 
Mountain City or Sevierville or Lexington or Memphis--wherever I go in 
Tennessee, a small business man or woman says to me: We cannot afford 
health care costs; we need some help.

[[Page 7537]]

  We have some help. We have a proposal by Senator Enzi that will 
provide some help to small business men and women. Now is the time for 
us to act. Now is the time for the people of this country who are 
listening to this, who know we need this, to say to Senators: Let's go. 
Let's do this. Let's take the Enzi bill and reduce health care costs 
for small businesses across this country, and at the same time let's 
cut into the millions of Americans who are uninsured because the people 
for whom they work cannot afford to offer them health care insurance.
  Here is the situation in Tennessee. We have well over 2 million 
people at work in Tennessee, and 97 percent of all businesses are what 
we would call small businesses. So that is whom we are talking about in 
our State--more than 2 million people who work, many of whom are 
working for companies that cannot afford to provide them health care 
insurance or are gradually reaching the point where they can't give 
them that benefit anymore. Increased health insurance costs are driving 
employers and families away from comprehensive coverage. Increased 
costs are taking away the opportunity for a working family in Tennessee 
to be able to work for a company that can offer a basic insurance 
policy that the family and the employer can afford. What we are doing 
this week is moving away from that situation. What we are doing in the 
Senate this week and next week is providing an opportunity to change 
that situation.
  Dennis Akin runs the Wash Wizard car wash in Hendersonville, TN. We 
are not talking about big-time CEOs who make $350 million a year and 
fly corporate jets somewhere. We are talking about Dennis Akin who runs 
the Wash Wizard car wash in Hendersonville, TN, just outside of 
Nashville. This is what he says:

       I am currently providing health care for all my employees 
     and their families. The cost at the present time is over 
     $44,000 per year for 5 employees, up 28 percent from last 
     year. The premiums have escalated at about that rate for the 
     last several years, and twice I have had to drop to plans 
     with lesser coverage to be able to pay the premiums.

  Dennis Akin went on to say:

       We really need to be able to find some kind of relief or 
     we'll have to reduce our benefit level to where the financial 
     burden on my staff could be devastating. In a business as 
     small as mine health care costs are my largest expense and 
     there seems to be no end in sight.

  According to the Kaiser Family Foundation, about a third of Tennessee 
firms with 50 or fewer employees offer health insurance to their 
employees. In contrast, 95 percent of Tennessee firms with 50 or more 
employees offer health insurance to their employees.
  Our economy is not static. It changes all the time. Every year, we 
lose an estimated 5 to 8 percent of our jobs. That is a lot of jobs. 
That is between 100,000 and 150,000 jobs just in Tennessee. The good 
news is we have the strongest economy in the world and we are gaining 
more jobs than we lose. But where do those jobs come from? They don't 
primarily come from Federal Express or Eastman Chemical or the Aluminum 
Company of America or DuPont. We are glad to have all those great 
employers in Tennessee, but most of the new jobs come from the Wash 
Wizard car wash in Hendersonville, TN, and companies like that. These 
are new companies, small companies. They may be adding two or three 
employees a year. Currently, only a third of those firms, those firms 
with 50 or fewer, can afford to offer health insurance of any kind to 
their employees.
  What does that mean? That means that most Tennesseans are simply left 
without any access to health care that they can afford because in our 
country, the way things are today, most people get their health 
insurance from their employer. Maybe that is not the way it should be. 
Maybe 10 years from now, we will be in a different sort of system. But 
since World War II, that has been the way it has been. By an accident 
of our history, most Americans get their health insurance at the place 
where they work.
  What we are saying is, in States such as Tennessee, and all across 
this country, only a third of the people who work for small 
businesses--which is where 97 percent of the people work--can get a 
health care plan there. No wonder we have a lot uninsured people, and 
no wonder we have a lot of families worrying about the rising cost of 
health care.
  The reason we are having this debate is the chairman has a bill that 
will fix that situation. It will lower health care costs for small 
businesses and help families be able to afford a basic health insurance 
plan. Every American ought to want that to succeed, and we need to pass 
this bill. We need to do this, and it is important for the American 
people to know that we intend to bring this to a vote in the next few 
days.
  The discrepancy between what is available in the big companies and 
what is available in the small, independent companies is absolutely 
unfair. There is no reason for it.
  Earlier this month, the National Federation of Independent Business, 
Tennessee's largest small business advocacy group, delivered 10,905 
petitions in support of this bill signed by small business owners in 
Tennessee who want lower health care costs. We must make health 
insurance affordable for Tennessee's small business owners and for 
working families.
  How will the Enzi bill help? When I say the Enzi bill, that is the 
chairman of the committee who has worked on this bill and who has been 
able to work through a lot of obstacles that prevented this from 
happening in the Senate before.
  The Small Business Act--a fancy name is the Health Insurance 
Marketplace Modernization and Affordability Act--I, like Chairman Enzi, 
like to call it the Small Business Health Insurance Act. That is a 
pretty good name because that says what it does. Here is what it will 
do.
  It will allow businesses and trade associations to band their members 
together and offer group health insurance coverage on a national or 
regional basis.
  It will empower small business owners and give them the opportunity 
to choose a health plan that is best for their families and best for 
their employees. This bill will promote lower costs and greater access 
to health care. Lower cost means the employer can afford it. The plan 
itself, with the employee contribution--if the employee can afford it--
being available means there will be more access to it. It will do that 
by, No. 1, permitting the creation of fully insured small business 
health plans; No. 2, creating more options in benefit design--in other 
words, you will have more choices; if you want this or this, if you 
can't afford that, you can try this--and, No. 3, it harmonizes 
insurance regulations across State lines while keeping States as the 
primary regulators.
  I am a former Governor. I am for States rights. You often see me on 
the Senate floor asserting the principle of federalism. I believe 
strong States and strong communities are important for our country and 
that we ought not be constantly passing national solutions to problems 
without recognizing that.
  But I believe the Enzi bill properly respects the principle of 
federalism. It protects State oversight. It protects State authority. I 
also believe it is important to have a level playing field for everyone 
in the market--and the bill does that as well.
  A study prepared by the Milwaukee firm of Mercer Oliver Wyman for the 
National Small Business Association found that the Enzi bill would, 
one, reduce health insurance costs for small businesses by 12 percent, 
about $1,000 per employee, and reduce the number of uninsured and 
working families by 8 percent, approximately 1 million people 
nationwide would have basic health insurance who today don't have it.
  This bill would cut the cost of health insurance for small 
businesses, which is 97 percent of where the people in my State work. 
That is No. 1. No. 2, it reduces the number of uninsured and working 
families by 1 million people across this country.
  This is a piece of legislation worth passing. It actually does 
something for somebody. This is a rare opportunity to help small 
businesses. It is a real milestone moment, and Chairman Enzi is to be 
commended for getting the bill this far.
  The House of Representatives has passed this legislation, on which 
the

[[Page 7538]]

Presiding Officer served, and I am sure he has voted for it three, 
four, or five times over in the House of Representatives. But then it 
gets over here to the Senate, and we have been in gridlock for 10 years 
on this issue. The House of Representatives has passed this legislation 
eight times, and for 10 years we haven't been able to find a way to say 
we are going to reduce the health care costs for small businesses by 12 
percent and decrease the number of Americans who are uninsured, that we 
are going to give 1 million of them insurance. That was until Chairman 
Enzi set his sights on trying to unravel the stalemate. He did it. He 
got the small business community together with the insurance 
commissioners and the insurance companies all around one table to 
discuss how to make it work.
  We need to take advantage of this rare opportunity to help the small 
business men and women in Tennessee and across this country to find 
affordable health insurance by passing this important legislation.
  We have said on the Republican side that this is Health Week; that we 
have heard the American people; we know that there are uninsured 
Americans; and, we know that small businesspeople are struggling. They 
are struggling with the cost of runaway litigation. We are trying to 
stop that, but the other side of the aisle blocked that twice this week 
when we put up legislation that would have given mothers and babies a 
chance to be better served by OB/GYN doctors.
  Who can be against that? The other side of the aisle was against it. 
They basically kept Tennessee mothers who are pregnant from having a 
chance to be served by OB/GYN doctors. Now they have to drive a long 
way to have their babies. Unfortunately, they are going to have to keep 
driving because the other side of the aisle said, no; you are not going 
to even be able to vote on that.
  Now we have moved to the next issue that will help small business. If 
we couldn't this week help mothers who are about to have babies by 
giving them better access to health care, at the very least we can take 
the Enzi bill and pass it and say to the thousands and thousands of 
realtors, to the thousands and thousands of barbershops, gas stations, 
and say to Dennis Akin who runs the Wash Wizard car wash in 
Hendersonville, TN, we can say to the small businesses in Tennessee--
which is 97 percent of all the businesses--we will cut your insurance 
costs by 12 percent, or at least give you that option, and to the 
people of this country we will increase by 1 million the number who are 
able to get insurance.
  This legislation is a good piece of legislation to help lower the 
cost of health insurance. I hope very much that in the next several 
days we can pass it. The House has passed it eight times. We can at 
least pass it once, and then the American people will see that we hear 
them and we are doing the job they want us to do.
  Thank you. I yield the floor.

                          ____________________