[Congressional Record (Bound Edition), Volume 152 (2006), Part 7]
[Senate]
[Pages 8961-8963]
[From the U.S. Government Publishing Office, www.gpo.gov]




   CREATING OPPORTUNITIES FOR PUBLIC-PRIVATE PARTNERSHIPS FOR SMALL 
                               BUSINESSES

  Ms. STABENOW. Mr. President, I wish to have included in the Record 
statements of support for S. 2588, the Health Care Access for Small 
Businesses Act, from all across the state of Michigan. I am proud to 
have support from organizations as diverse as providers, insurers, and 
elected officials.
  The three share model is an innovative community-based concept that 
has worked across the United States from California to Arkansas, of 
course, to Michigan. The name, ``three share'' stems from the program's 
payment structure. Premiums are shared between the employer who pays 30 
percent, the employee who pays 30 percent and the community which 
covers the remaining 40 percent of the cost.
  I ask unanimous consent that the support letters be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                             Ascension Health,

                                    St. Louis, MO, April 28, 2006.
     Hon. Debbie Stabenow,
     U.S. Senate,
     Washington, DC.
       Dear Senator Stabenow: I am writing in strong support of 
     the legislation you recently introduced, S. 2588, the 
     ``Health Care Access for Small Business Act of 2006,'' that 
     would expand health insurance coverage for employees who work 
     for small companies through a ``Three-Share Program'' modeled 
     on a successful initiative first developed in Michigan. As 
     you know, Ascension Health--through our sponsored hospitals 
     and heal systems in Michigan that include Standish Community 
     Hospital; Borgess Health Alliance in Kalamazoo; St. Joseph 
     Health System in Tawas City; Saint Mary's Medical Center in 
     Saginaw; Genesys Health System in Flint; and St. John Health 
     in Detroit--has a significant presence in Michigan. We 
     believe your legislation will help us in our work at the 
     local level in Michigan and across the country to achieve 
     100% access to health care.
       Over the past 6 years, Ascension Health has fostered the 
     development of local community coalitions to expand access 
     and improve the quality of care provided to the uninsured. 
     Our experience led to the development of a 5 step model to 
     expand access to care. Step One is to build a formal 
     infrastructure that can support safety net services for the 
     uninsured. Step Two is to fill service gaps, such as dental 
     prescription drugs, and mental health services. Step Three is 
     to develop and implement a care model for the uninsured that 
     emphasizes coordinated services throughout the continuum of 
     care. Step Four is to recruit physicians to provide medical 
     homes and specialty care for the uninsured. Step Five is to 
     get funding to ensure the long term sustainability of the 
     initiative.
       Since 2000, community coalitions in Michigan with an 
     Ascension Health partner have received over $11 million in 
     federal support through the Healthy Community Access Program 
     (HCAP) and approximately $2 million in matching funds from 
     Ascension Health. These funds have been used to develop and 
     implement many of the steps identified above to achieve 100% 
     access. We believe your legislation would help us reach the 
     final step of achieving long term sustainability by providing 
     small business, owners and their workers an opportunity to 
     afford insurance coverage.
       We enthusiastically support your legislation. Please let us 
     know what we can do to further help you in your efforts to 
     expand coverage for the 47 million Americans without health 
     insurance, the additional 40 million Americans who go 
     uninsured during some part of the year, and the additional 80 
     million Americans who are only partially covered.
           Sincerely.
                                               Athony R. Tersigni,
     President and Chief Executive Officer.
                                  ____



                                  Upper Peninsula Health Plan,

                                    Marquette, MI, April 20, 2006.
     Hon. Debbie Stabenow,
     U.S. Senate,
     Washington, DC.
       Dear Senator Stabenow: I am writing to express my 
     organization's support for Senator Stabenow's SB 2588, 
     ``Health Care Access for Small Business Act of 2006.'' SB 
     2588 will provide grants to eligible ``three-share programs'' 
     for the start-up and operation costs of providing specific 
     health care benefits to eligible covered individuals for a 
     period of five years.
       A ``Three-Share Program'' is a basic plan for health care 
     coverage that brings together employers, workers without 
     health care coverage and outside funding to create a health 
     care coverage plan for those workers who have no other access 
     to health insurance. The plan encourages employers (formerly 
     not offering insurance coverage) to assist in the payment of 
     modest fees for their employees' health coverage. Additional 
     private, state, and/or federal funds are required to augment 
     fees paid by other parties to complete the reimbursement of 
     care. This transforms the ``slow pay/no pay'' patients into 
     ``assuredly-pay/discount-pay'' patients.
       Presently in Michigan, 1.2 million people do not have 
     health care coverage. Sixty percent of the 1.2 million are 
     employed and work full or part-time. Fifty percent of the 1.2 
     million are employed by small businesses and are not offered 
     health care benefits. Michigan has seen two successful and 
     separate community initiatives that began offering health 
     care coverage for employed, low-income persons using the 
     three-share model: HealthChoice in Wayne County (1994) and 
     Access Health in Muskegon County (1999). Both are received 
     grant monies for their start-up and operation costs.
       The three-share program is a successful model for other 
     regions to replicate. However, without start-up seed money in 
     which to build community involvement, determine market needs, 
     and establish administrative systems to carry out operational 
     functions, these programs cannot get off the ground. In order 
     to begin solving the health care crisis on a local level, 
     communities need monetary supports in which to fund 
     initiatives such as three-share programs.
       Michiganders want access to high-quality, affordable health 
     care. Thank you for initiating this legislation to help them 
     receive it.
           Sincerely,
                                                  Dennis H. Smith,
                                                  President & CEO.

[[Page 8962]]

     
                                  ____
                                               Trinity Health,

                                           Novi, MI, May 12, 2006.
     Hon. Debbie Stabenow,
     U.S. Senate,
     Washington, DC.
       Dear Senator Stabenow: I am writing to congratulate and 
     thank you for your legislation, the Health Care Access for 
     Small Businesses Act of 2006, and to offer Trinity Health's 
     support and assistance in its passage.
       As you know, Mercy General Health Partners, one of Trinity 
     Health's twelve hospitals in Michigan, was instrumental in 
     the creation of Access Health, one of the nation's most 
     successful community-initiated programs for the working 
     uninsured. Access Health now has a seven year track record. 
     We are proud to be associated with Access Health, and 
     appreciate your past contributions in helping to make it the 
     success that it is.
       The Health Care Access for Small Businesses Act of 2006 
     will help communities across the nation replicate the Access 
     Health model, and thus become an important piece of the 
     solution for the country's millions of uninsured individuals.
       Specifically, your bill would leverage a federal 
     contribution with community funds to help small businesses 
     and their employees purchase a health coverage product 
     developed by the community. In addition to reducing the local 
     uninsured population, increased access to health care in a 
     community will result in community-wide economic benefit. 
     Employers in the community will experience less health care 
     cost-shifting, and increased productivity and employee 
     retention. With greater emphasis on preventive and chronic 
     care, communities' uninsured populations will become less of 
     a financial burden on state and local budgets.
       Thank you for your very thoughtful effort to help 
     communities, small business, and to ensure that the uninsured 
     are not forgotten. We look forward to working with you on 
     this national effort.
           Sincerely,
                                                  Marsha J. Casey,
     President, Michigan Ministries.
                                  ____

                                         Detroit, MI, May 9, 2006.
     Hon. Debbie Stabenow
     U.S. Senate,
     Washington, DC.
       Dear Senator Stabenow: I am writing to express Wayne 
     County's strong support for S. 2588, the Health Care Access 
     for Small Businesses Act of 2006. As you know, Wayne County, 
     Michigan has long been on the forefront of developing 
     innovative health coverage for small business employees and 
     the uninsured. Our experience demonstrates that these 
     programs have a meaningful impact on employee retention and 
     well-being and provide a much-needed safety net to scores of 
     workers in Wayne County. As such, we appreciate Senator 
     Stabenow's leadership and strongly support the authorization 
     of federal grant programs for pilot demonstrations that will 
     help ensure the establishment and the continued success of 
     three-share health coverage programs across the country.
       The ``three-share'' programs developed in Wayne County 
     provide affordable coverage and quality medical care to 
     working uninsured residents. As you are aware, the two 
     primary three-share programs operating in Wayne County are 
     the Health Choice program and the Four Star Program. Under 
     both programs, workers receive coverage for primary health 
     care, prescription drugs, emergency and urgent care, hospital 
     care, and diagnostic services. Employers, employees, and the 
     County each pay roughly one-third of the premium cost of the 
     coverage, which is less than $60 per month for employees. 
     There are currently 607 employers, including 3,700 members, 
     participating in Health Choice and approximately 40 
     businesses, including 150 members, participating in Four 
     Star.
       These three-share programs not only provide coverage to 
     individuals who badly need it; but they also help small 
     businesses attract and retain skilled employees. In Wayne 
     County, roughly 280,000 persons are uninsured, many of whom 
     are employed by small businesses that cannot afford to bear 
     the cost of providing a health insurance benefit to their 
     employees. The three-share programs operating in Wayne County 
     provide these employers with a low-cost way of providing 
     health insurance to their workers, which in turn reduces sick 
     days, builds employee morale and loyalty, and ultimately 
     improves our local economy.
       Federal grants that would be authorized by S. 2588 could 
     enable Wayne County to expand these programs to serve more 
     persons or include additional benefits. Currently, Wayne 
     County's three-share programs only cover employees and their 
     spouses, as the County is unable to provide coverage to the 
     children of employees. Funding could also support the 
     County's outreach efforts to eligible employers, including 
     reaching out to the Hispanic and Arab American communities to 
     ensure awareness of the program and how it operates. Finally, 
     it is possible that federal grant money would allow the 
     County, working with its underwriters to lower the portion of 
     premiums that employers have to pay, thus providing an 
     incentive to additional small businesses to participate in 
     the program. Numerous other counties would similarly benefit 
     from a federal grant program for three-share programs.
       Wayne County's programs have enhanced access to health 
     services for the most needy in our community and we commend 
     your leadership and vision for seeking expanded nationwide 
     access to this model. We are confident other municipalities 
     will find your legislation attractive as well. Expanding 
     insurance opportunities for our nation's uninsured and 
     providing small businesses with a meaningful way of offering 
     health coverage to their employees are significant challenges 
     to many, if not most, municipalities. Three-share programs 
     can positively impact other counties and cities nationwide so 
     that both employers and employees benefit from the continued 
     strength of these programs. Thank you again for all your 
     leadership and all your efforts to address pressing national 
     health coverage access problems.
           Sincerely,
                                                 Robert A. Ficano,
     Wayne County Executive.
                                  ____



                                     Oakwood Healthcare, Inc.,

                                       Dearborn, MI, May 16, 2006.
     Hon. Debbie Stabenow,
     U.S. Senator,
     Washington, DC.
       Dear Senator Stabenow: Thank you for introducing Senate 
     Bill 2588 that certifies and supports programs to provide 
     uninsured employees of small businesses access to health 
     coverage.
       As the Chief Executive Officer of a health system in a 
     market experiencing high unemployment and increasing numbers 
     of uninsured patients among the employed, I am hearing of 
     many individuals avoiding visits to their healthcare provider 
     due to lack of insurance. This has resulted in significant 
     decreases in hospital admissions in Southeast Michigan during 
     the past six months.
       Of course, the underlying health problems of these 
     uninsured individuals are not going away. We fully expect to 
     see many of them in our Emergency Room when their condition 
     reaches a crisis stage.
       While the problem of the uninsured is entrenched and 
     growing, there are potential solutions. Our governor in 
     Michigan is working to create a statewide plan that would 
     cover significant numbers of uninsured residents. While we 
     support this work, we also believe that development of shared 
     resource insurance programs could very quickly begin 
     addressing the problem in a number of local markets.
       Oakwood has already established one such program, known as 
     the ``Four-Star'' health plan, in which Oakwood Healthcare 
     System, St. John Health System, Henry Ford Health System, and 
     the Detroit Medical Center, partner with the Wayne County 
     Health Department to provide coverage to qualified 
     individuals who share the cost with their employer and the 
     county.
       We believe this program and others like it offer a timely 
     and viable approach to providing health care access to the 
     uninsured employed by small businesses. It is exactly the 
     approach described in S. 2588.
       We welcome the support this bill would provide to build and 
     market plans like ours. While we believe such three-share 
     plans offer the right solution to many employers and their 
     employees, they require significant startup investment. The 
     grants called for in Section 2201 would do much to encourage 
     additional three-share programs, thus providing access to 
     health care for thousands of employed individuals while 
     adding to the viability and competitiveness of many small 
     businesses. We heartily endorse passage of this legislation.
           Sincerely,
                                             Gerald D. Fitzgerald,
     President and CEO.
                                  ____



                                    www.CoverTheUninsured.org,

                                        Dearborn, MI, May 2, 2006.
     Hon. Debbie Stabenow,
     U.S. Senate,
     Washington, DC.
       Dear Senator Stabenow: I want to thank you for developing 
     and introducing the ``Health Care Access for Small Businesses 
     Act of 2006.'' I support efforts to expand coverage for the 
     uninsured, and I am pleased that your legislation is modeled 
     on the successful multi-share program in Muskegon that 
     provides affordable health insurance options for small 
     businesses. It is this kind of program that should be 
     replicated to reduce the number of working uninsured in our 
     country.
       I hope you will find other ways to bring the urgent issue 
     of the uninsured to the forefront of the national political 
     agenda. Nearly 46 million Americans are living without health 
     insurance, including more than 8 million children. As you 
     know, more and more Michigan families are facing the hardship 
     of being uninsured as cutbacks in manufacturing leave them 
     unemployed or in jobs without health benefits.
       The economic impact of the growing uninsured is most 
     evident for states and localities like ours trying to attract 
     job-creating investments. Small businesses often find that 
     insurance coverage for their employees is either unaffordable 
     or simply unavailable. Large employers that do provide health 
     insurance are bearing many of the uninsured

[[Page 8963]]

     treatment costs, which are shifted to them through steeply 
     rising premiums. The result is an uneven playing field for 
     employers.
       More importantly, the uninsured often receive care that is 
     ``too little too late.'' Minor illnesses become more severe 
     because care is delayed. The Institute of Medicine has 
     determined that thousands of uninsured people die each year 
     because of this delayed care.
       I hope you will work to find bipartisan support for the 
     ``Health Care Access for Small Businesses Act of 2006,'' and 
     that you can continue to support other legislative 
     initiatives on behalf of the uninsured. ``Coverage and access 
     for all'' makes economic sense because it will mean more 
     efficient and effective care, a healthier population, and a 
     more competitive local economy. More importantly, coverage 
     and access for all is the right thing to do for our 
     community. In a just society, no one should be left behind.
       Thank you for your efforts on behalf of the uninsured.
           Sincerely,
     Stanley Goldberg.

                          ____________________