[Congressional Record (Bound Edition), Volume 153 (2007), Part 1]
[Senate]
[Pages 386-388]
[From the U.S. Government Publishing Office, www.gpo.gov]




                  ACCESS TO AFFORDABLE HEALTH CARE ACT

  Ms. COLLINS. Mr. President, last week, on the very first day of this 
new Congress, I joined with my colleague from Louisiana, Senator Mary 
Landrieu, in introducing the Access to Affordable Health Care Act. This 
is a comprehensive plan which builds on the strengths of our current 
public programs and private health care system to make affordable 
health care available to millions more Americans. It is similar to 
legislation we introduced in the last Congress. I hope, given the 
urgency of dealing with the cost of health care and health insurance, 
that this will be the year this legislation moves forward.
  One of my priorities in the Senate has long been to expand access to 
affordable health care. There are still far too many Americans without 
health insurance or with woefully inadequate coverage. As many as 46 
million Americans are uninsured, and millions more are underinsured. 
The State of Maine is in the midst of a growing health insurance 
crisis, with insurance premiums rising at alarming rates. Whether I am 
talking to a self-employed fisherman, a displaced mill worker, the 
owner of a struggling small business, or the human resources manager of 
a large company, the soaring costs of health insurance are a common 
concern. These cost increases, double digit this past year, have been 
particularly burdensome for small businesses, the backbone of the Maine 
economy.
  Maine's small business owners want to provide coverage for their 
employees, but they are caught in a cost squeeze. They know that if 
they pass on premium increases to their employees, more and more of 
them will decline coverage altogether because they simply can't afford 
their share. Yet these small businesses cannot continue to simply 
absorb the double-digit increases in their health insurance premiums 
year after year. The problem of rising costs is even more acute for 
individuals and families who must purchase health insurance on their 
own. Monthly health insurance premiums in my State often exceed a 
family's mortgage payment. Clearly, we must do more to make health 
insurance more available and more affordable.
  The legislation Senator Landrieu and I are introducing is a seven-
point plan that combines a variety of public and private approaches. 
The legislation's seven goals are, first, to expand access to 
affordable health care for small businesses; second, to make health 
insurance more affordable for individuals and families purchasing 
coverage on their own; third, to strengthen the health care safety net 
for those without coverage; fourth, to expand access to care in rural 
and underserved areas; fifth, to increase access to affordable long-
term care, a major challenge as our population continues to age; sixth, 
to promote healthier lifestyles; and seventh, to provide more equitable 
Medicare payments to Maine providers to reduce the Medicare shortfall 
which has forced hospitals, physicians, and other health care providers 
to shift costs on to other payers in the form of higher charges, which, 
in turn, drives up the cost of health care premiums.
  Let me discuss these points in greater detail.
  First, expanding access for small businesses by helping small 
employers cope with rising health insurance costs. Since most Americans 
get their health insurance through the workplace, it is a common 
assumption, but a false one, that people without health insurance are 
unemployed. In fact, as many as 83 percent of Americans who do not have 
health insurance are in a family with a worker or are working 
themselves. Uninsured working Americans are most often the employees of 
small businesses. In fact, some 63 percent of uninsured workers are 
employed by small firms. Smaller firms generally face higher costs for 
health insurance than larger companies, which makes them again less 
likely to offer coverage.
  The legislation we have introduced will help these employers cope 
with rising costs by creating a new tax credit for small businesses to 
make health insurance more affordable. It will also encourage small 
businesses that do not offer health insurance to start doing so with 
the help of this tax credit, and it will help employers that do offer 
insurance to continue coverage in the face of escalating premiums.
  Our legislation would also provide grants to provide startup funding 
to

[[Page 387]]

States to help businesses join in purchasing co-ops. These co-ops would 
enable small businesses to band together to purchase health insurance 
jointly, but this part of the bill does not preempt State law, so it is 
a different approach than some have taken.
  The legislation would also authorize the Small Business 
Administration grant program for States, local governments, and 
nonprofit organizations to provide information about benefits of health 
insurance to small employers, including tax benefits, increased 
productivity of employees, and decreased turnover. These would also be 
used to help make employers aware of current incentives under State and 
Federal laws. It is an interesting fact that one survey showed that 57 
percent of small employers did not know they could deduct 100 percent 
of their health insurance premiums as a business expense. I want to 
change that into a tax credit which is far more valuable, but many 
small businesses don't realize that there is a tax incentive even in 
our current tax laws.
  The legislation would also create a new program to encourage 
innovation by awarding demonstration grants in up to 10 States 
conducting the innovative coverage expansions such as pooling 
arrangements or group market reforms, or subsidies to employers or 
individuals. We know the States are the laboratories for reform. 
Insurance is regulated at the State level. This would provide for some 
assistance in conducting some innovative projects to expand coverage.
  The Access to Affordable Health Care Act would also expand access to 
affordable health insurance for individuals and families. One of the 
first bills I sponsored when I first came to the Senate in 1997 was 
legislation introduced by Senator Hatch and Senator Kennedy to create 
the State Children's Health Insurance Program, the SCHIP program, which 
provides insurance for children of low-income parents who cannot afford 
health insurance yet make too much money to qualify for the Medicaid 
Program. Since that time, this program has contributed to a one-third 
decline in the number of uninsured children in this country. Today, 
over 6 million children--including approximately 14,500 in Maine--are 
receiving health care coverage through this remarkably effective 
program.
  Our legislation would shore up the looming shortfalls in the SCHIP 
program in 17 States, including Maine. We want to ensure that children 
currently enrolled in the program do not lose their coverage, and in 
order to achieve that goal, we need to make up that shortfall. Just 
prior to adjournment last month, Congress approved legislation which 
partially addressed that shortfall, but that provides only about one-
fifth of the funds needed. Our legislation would help close that gap.
  Our bill also builds on the success of the SCHIP program by giving 
States a number of new tools to increase participation. I won't go 
through all of the changes we would make, but let me mention one. We 
would allow the parents of those children enrolled in the SCHIP program 
to enroll in the health insurance program on a subsidized rate, 
depending on their income, if the State wants to take advantage of that 
option. The experts tell us that would help provide coverage for about 
6 million more low-income Americans.
  So what I am trying to do is take advantage of some existing programs 
such as SCHIP, expanding them, providing new tax incentives such as the 
tax credit for small businesses to help piece together a program that 
builds on the strengths of the existing program that still has a 
private sector approach and yet fills in the gaps in coverage and helps 
make health insurance more affordable. Part of that is providing for 
more funding for community health centers which operate in underserved 
urban as well as rural communities. They provide critical primary care 
services to millions of Americans regardless of their ability to pay.
  We also know we need to deal with the problem of not enough 
physicians, physician assistants, nurse practitioners, and other 
primary care providers in underserved areas. We need to revamp the 
National Health Service Corps, which helps supply doctors, dentists, 
and other clinicians who serve in rural and inner-city areas. We want 
to revamp that program to make it more flexible. I was talking to 
physicians in Holten, ME, just recently who said that program used to 
be a source of physicians for rural Maine, but over the years it has 
become rigid and encrusted and not flexible enough and is no longer 
nearly as valuable as it once was. We would revamp that program.
  As Senate cochair with Senator Clinton of the bipartisan 
Congressional Task Force on Alzheimer's Disease, I am particularly 
sensitive to the long-term needs of patients with chronic diseases such 
as Alzheimer's and of the impact on their families. Long-term care is 
the major catastrophic health expense faced by older Americans today, 
and these costs will only increase with the aging of the baby boomer 
generation--our generation.
  I have been surprised that many Americans mistakenly believe that 
Medicare or their private health insurance policy will cover the cost 
of long-term care should they develop a chronic illness or a cognitive 
impairment such as Alzheimer's. Unfortunately, far too many do not 
discover they do not have coverage until they are confronted with the 
difficult decision of placing a much loved parent or spouse in a long-
term care facility and facing the shocking realization that unless they 
have long-term care coverage, they have to cover the costs themselves. 
We need to encourage people to purchase long-term care insurance, to 
plan for this need.
  The bill we are introducing provides a tax credit for long-term care 
expenses of up to $3,000 to provide some help to families struggling 
with that cost, and it would encourage more Americans to plan for their 
future long-term care needs by providing a tax deduction to help them 
purchase long-term care insurance.
  Health insurance alone is not going to ensure good health. As noted 
author and physician Dr. Michael Crichton has observed, ``The future in 
medicine lies not in treating illness but in preventing it.'' Many of 
our serious health problems are directly related to unhealthy 
behaviors: Smoking, the lack of regular exercise, poor diet. These 
three major risk factors alone have made my State the State with the 
fourth highest death rate, due to four largely preventable diseases--or 
at least you can delay their onset--cardiovascular disease, cancer, 
chronic lung disease, and diabetes. These diseases are responsible for 
70 percent of the health care problems in Maine.
  Our bill, therefore, contains a number of provisions designed to 
promote healthy lifestyles. It includes, for example, grants to allow 
States to assist small businesses in establishing worksite wellness 
programs for their employees. It also authorizes a grant program to 
support new and existing community partnerships. There is a great one 
in Franklin County, in Maine. It is the Healthy Community Coalition, 
and it has made a difference in promoting healthy lifestyles.
  Finally, the Access to Affordable Health Care Act will promote 
greater equity in Medicare payments and help to ensure that the 
Medicare system rewards, rather than punishes, States such as Maine 
that deliver high-quality, cost-effective Medicare services to our 
elderly and disabled citizens. The Medicare Modernization Act of 2003 
and subsequent legislation did take some significant steps toward 
promoting greater fairness by increasing Medicare payments to rural 
hospitals and by modifying geographic adjustment factors that 
discriminated against physicians and other providers in rural areas. 
Our legislation would build on these improvements by establishing pilot 
programs that reward providers of high-quality, cost-effective Medicare 
services.
  The Access to Affordable Health Care Act outlines a blueprint for 
reform based on principles upon which I am hopeful that a bipartisan 
majority of Congress could agree. The plan takes significant strides 
toward the goal of access to health care coverage by bringing millions 
more Americans into the insurance system and by strengthening the 
health care safety net. Most

[[Page 388]]

of all, it helps address the No. 1 obstacle to health insurance--and 
that is its cost--through a variety of incentives.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Ms. Cantwell). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. GRASSLEY. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________