[Congressional Record (Bound Edition), Volume 155 (2009), Part 19]
[Senate]
[Pages 26268-26270]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. CASEY. Mr. President, I rise tonight to speak about health care 
and all the issues we have been debating under the broad umbrella of 
health care reform. Obviously, I will not get to all of them tonight, 
but I am going to spend a few minutes talking about two general areas. 
One is a list of changes that I believe will take place when our work 
is completed in the Senate and after what I hope will be President 
Obama signing a bill on health care reform in a matter of weeks. That 
will change what I believe has been an unfair burden carried by the 
American people, at the expense of the American people but brought on 
by the power, sometimes the awesome power, of insurance companies. I 
will talk about that, but also I want to speak mostly about changes 
that need to be made in our health care system for children.
  There are a couple of points on basic reform measures that I believe 
will be part of what we complete in the next couple of weeks. First, a 
basic list of consumer protections that we talked about for many years 
but we have never made illegal will prevent insurance companies from 
continuing what is often blatant discrimination. One of the things we 
have to do this year is end discrimination for preexisting conditions. 
If what I believe is the prevailing point of view in this body is 
successful, insurance companies will be prohibited from refusing you 
coverage

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because of your medical history. Out-of-pocket costs will be limited, 
as well as deductibles or copays.
  Free preventive care: Why should we say on the one hand we encourage 
prevention, as we have for years, but now we are going to get serious 
about prevention in our health care system and make it part of every 
insurance policy and demand that we all engage in steps that will be 
preventive in nature and we also will say, for example, for a woman a 
mammogram is important but why, in the face of all of that, do we say 
to women in America, as is the current policy, that women have to pay 
exorbitant costs for mammograms? Frankly, I believe they should have to 
pay nothing for something as essential to prevention. So preventive 
care should be free or at a very low cost.
  If you are seriously ill, an insurance company should be prohibited 
from dropping your coverage. We should make that practice illegal.
  We should make gender discrimination illegal as it relates to 
insurance companies. I find it hard to believe that in 2009 we have to 
legislate to prevent insurance companies from discriminating against 
women, but we have to because that in fact happens today. Insurance 
companies will not be able to charge you more because you happen to be 
a woman, as happens today.
  Eliminating annual lifetime caps on coverage has to be part of the 
final health care legislation.
  Extending coverage for young adults is critically important.
  Guaranteed issue renewal: Insurance companies, I believe, should be 
required to renew any policy as long as the policyholders pay their 
premium in full and insurance companies will not be allowed to refuse 
to renew a policy because someone gets sick. If you get sick you should 
not lose your coverage, and if you get sick you should not have to 
bankrupt your family to pay for the health care you deserve.
  Finally on this list, and it is not an exhaustive list but I think it 
is an important list to review: protecting small businesses. Small 
businesses should receive tax credits so they can give their employees 
comprehensive and affordable health care and include a limit on out-of-
pocket costs.
  These are some of the basic consumer protections I believe we should 
enact as part of this health care legislation.
  I also believe if you want to focus on a particularly vulnerable 
group of Americans, a group of Americans we have made some progress 
with in terms of their coverage, though we have not done nearly enough 
yet, I speak of children. We have made tremendous progress with the 
Children's Health Insurance Program, for example, and also the children 
in America covered by Medicaid, so children have the opportunity to 
receive very good care in almost every instance.
  But there are still some problems. Even in a State such as 
Pennsylvania, where you have, by last count, in a survey done in 
Pennsylvania last year for the Insurance Department, it showed that 
just 5 percent of Pennsylvanians up to the age of 18 were uninsured. 
That 5 percent is too high. We want to get that to zero, of course, but 
it is a lot lower than it would have been without the Children's Health 
Insurance Program or without other strategies.
  Unfortunately in our State, and I think it is true of most States, 
when you look at the age category 19 to 64, in that category the 
uninsured rate is more than double the uninsured rate for children. 
Instead of being 5 percent uninsured for children age 19 to 64, it is 
12 percent. In Pennsylvania what that means is, if you are between the 
ages of 19 and 64, you are one of more than 870,000 Pennsylvanians who 
are uninsured. We cannot build an economy or improve our economy in 
Pennsylvania if we have that many people uninsured for a long period of 
time.
  I still believe, even with the progress we have made on children, we 
have much to do. For example, we have to do everything possible to 
increase outreach and facilitate enrollment for low-income families and 
children. We should not have a program such as Children's Health 
Insurance, or Medicaid, and then make it hard for families to enroll. 
So I led the effort in our HELP Committee this summer, even before we 
voted on a bill, to make sure that enrollment is made easier. I worked 
very closely with Senator Dodd, who long has been a champion for 
children and a strong advocate for children's health insurance.
  We should also focus on the benefit packages related to pediatrics, 
pediatricians. We had an amendment this summer in the HELP Committee 
that Senator Merkley and I cosponsored, ensuring that a pediatric 
representative would be part of any advisory commission to the 
Secretary of Health and Human Services regarding what should be in a 
benefit package. It is very important to have a pediatric 
representative at the table.
  Another thing that is critical is to have a requirement that 
pediatric preventive care be included in the list of mandatory 
preventive services that insurance plans offer with a minimum of cost-
sharing requirements for families.
  No. 4 on this list, in terms of what happens to children in pediatric 
settings: In our committee bill we talked about medical homes--not a 
physical place, but a way to provide treatment, that is the idea for 
every American to have a primary care physician and then a network of 
specialists around them they have access to. That is certainly the 
ideal and the intent of a large part of the HELP Committee bill. Also 
it is important to remember that children are not just smaller adults 
or smaller versions of an adult; they have particular and special needs 
in terms of their treatment. So for children, their primary care doctor 
is a pediatrician and therefore pediatricians must be among those 
practitioners who are at the center of the care or the center of the 
medical home that surrounds a child.
  Also ensuring critical health care for children involving their oral 
health care: We ensured in the HELP Committee this summer the 
establishment of an oral health care education prevention campaign at 
the CDC focusing on preventive measures. We also increased funding for 
training for pediatric dentists in the bill we passed this summer out 
of the committee. It is critically important that children have access 
to that kind of health care in the early years of their life. We had a 
tragic, horrific example of what could go wrong when a child died here 
in the Washington region a couple of years ago--I believe actually the 
State of Maryland--when that child did not have access to a dentist and 
had horrific problems which led to that child's death. As a result of 
changes we make in our health care system, we must ensure that does not 
happen.
  Strengthening the pediatric workforce: Along with both Senator Brown 
and Senator Dodd, this summer in our HELP Committee bill we added a 
loan repayment program for pediatric specialists and providers for 
mental health services for children. We can't say that we care about 
children and not build in these particular protections for them in our 
health care system. Part of that is a workforce issue. We heard a lot 
in this debate about the shortage of primary care physicians. The 
intent of our bill in the HELP Committee was to make sure we would have 
a building up, an increase, in the number of primary care physicians. 
Again, for a child, his or her primary care physician is a pediatrician 
and it is critically important that pediatric specialists be available 
to children when they have special needs and special challenges that 
need to be treated by a specialist.
  I know I am over my time. I will conclude. One last point about the 
CHIP program: The Children's Health Insurance Program as we know is now 
a stand-alone program. There were some efforts this past summer and 
into the fall to have that program folded into any exchange that would 
be created as a result of the health care legislation. I thought that 
was a mistake. I made that very clear to others and to the Finance 
Committee as we were debating it. Thank goodness, Senator Rockefeller 
worked so hard and led the fight to keep the Children's Health 
Insurance Program as a stand-alone program. We should not fix what 
``ain't broken,'' as the expression goes, and the Children's' Health 
Insurance Program works well for millions of children today. Within the 
next couple of

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years, that program will cover 4 million children who will be given 
access to the kind of care we would hope every child has.
  I think all these changes I have talked about, and more, come under 
the headline of ``No Child Worse Off.'' That should be, and will 
continue, I believe, to be one of the goals of health care reform. At 
the end of this process no child in America, especially poor children 
and children with special needs, will be worse off.
  We have a long way to go, lots more work to do. But if we are guided 
by that principle we will make sure our children have the kind of 
health care that we all hope for and they have a right to expect.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alabama is recognized.
  (The remarks of Mr. Sessions, Mr. Lieberman and Mr. Bond, pertaining 
to the introduction of S. 2336 are located in today's Record under 
``Statements on introduced Bills and Joint Resolutions.'')
  Mr. SESSIONS. I yield the floor and note the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. REID. 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. REID. Mr. President, would the Chair state the matter before the 
Senate at this stage?

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