[Congressional Record (Bound Edition), Volume 156 (2010), Part 14]
[House]
[Pages 19787-19788]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          AFFORDABLE CARE ACT

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Connecticut (Mr. Courtney) is recognized for 5 minutes.
  Mr. COURTNEY. Madam Speaker, yesterday Virginia District Court Judge 
Henry Hudson's decision striking down one provision of the Affordable 
Care Act has generated a lot of noise in the last 24 hours.
  Opponents of health care reform are celebrating as if the whole law 
was struck down, even though Judge Hudson refused the Commonwealth of 
Virginia's request to strike down the entire law and Judge Hudson 
refused the Commonwealth of Virginia's request to stop implementation 
of the health care bill which has been proceeding since last March.
  Thank goodness the judge had enough common sense not to stop the 
health care bill's important protections for families and patients that 
have been implemented since last March, such as age 26 dependent 
coverage which employers all across America have been implementing 
since last July, giving families the opportunity to keep children 
covered on their family's health insurance plan up to age 26; such as 
protections like the elimination of insurance company rescissions of 
coverage, the practice of denying claims after the fact, many times 
after patients have had surgery or have had treatment; such as the $250 
payments, which seniors who fell into the part D doughnut hole received 
in 2010; such as the 50 percent discount for brand-name medications, 
which seniors in the doughnut hole will start to receive starting on 
January 1; such as the new Medicare coverage for annual checkups, 
cancer screenings, smoking cessation, vaccinations for flu, which the 
new health care bill will provide starting on January 1; such as the 
early retiree reinsurance program, which employers all across the 
country, private employers as well as public employers, are using to 
stabilize age 55 and up retirement health benefits, including 96 plans 
just in the Commonwealth of Virginia alone.
  For all the crowing and boasting by opponents of health care reform, 
there was less there than meets the eye. But there is no doubt that the 
judge did strike down an important part of the bill, namely, the shared 
responsibility provision, the requirement that nearly all Americans 
carry health insurance, a provision which two other district court 
judges, one in Virginia and one in Michigan, upheld as a proper 
exercise of Congress' power to regulate interstate commerce.
  Judge Hudson ruled that this provision doesn't ``fit within the 
letter or spirit of the Constitution.'' Well, Madam Speaker, there is a 
long, long history of Supreme Court cases which have held exactly the 
opposite of what Judge Hudson wrote.
  Indeed, Antonin Scalia, the leader of conservative forces on the U.S. 
Supreme Court, himself, wrote that Congress has the authority to enact 
a regulation of interstate commerce, and it possesses every power 
needed to make that regulation effective.
  Using Justice Scalia's interpretation of the commerce clause, it is 
clear that this bill's provision to eliminate preexisting condition 
exclusion, the practice by insurance companies for denying coverage for 
people with cancer, high blood pressure, diabetes, chronic conditions, 
which require a pooling mechanism which the shared responsibility 
requirement was designed to accomplish, clearly fits within Justice 
Scalia's definition of the commerce clause. In fact, we know this from 
real-life experience.
  Seven States tried to enact a guaranteed issuance law requiring 
insurance companies to insure all people regardless of preexisting 
conditions, and what happened was that rates went through the roof. 
Only one State was able to implement a prohibition on preexisting 
condition exclusions, that was the State of Massachusetts, which was 
coupled with a shared responsibility mechanism. And, as a result, 
insurance premiums fell in the individual market by 42 percent.
  The impact on interstate commerce in terms of what is happening in 
the health insurance market could not be clearer. In fact, the trade 
organization representing America's health insurance industry back in 
2008, after the election, made it clear that a shared responsibility 
mandate requirement is essential to actually executing and performing 
real reform in the insurance market. Allowing people to enter the 
market and exit the market when they get sick and when they get better 
is like insuring a burning building. And the fact of the matter is that 
the judge's decision, despite the fact that conservative judges like 
Antonin Scalia have recognized Congress' ability to regulate interstate 
commerce, which the health insurance industry clearly falls under, 
would allow for the Congress to set up the real mechanism to make sure 
that its goal of eliminating preexisting conditions can actually take 
place. And the health insurance industry knows over the last 5 years 
the collapse that has been occurring within the marketplace because of 
rising premiums.
  I come from the State of Connecticut. We have Aetna, we have CIGNA, 
we have United Health Care. These are the largest plans in the country 
that are selling to employers, and they have seen the percentage of 
their coverage across America decline, not since the passage of the 
health care bill, but going back to 2005. And this measure is designed, 
in fact, really just to stabilize that private health insurance market.
  Madam Speaker, in a few short weeks, new Members of Congress are 
going to be sworn into office. They are going to be given a PIN that 
gets them into the building, they are going to be given a voting card, 
and they are also going to be given an opportunity to enroll in the 
Federal Employee Health Benefit plan, a purchasing exchange which 
Members of Congress can participate in, get a nice comprehensive 
package of benefits, taxpayer subsidies, affordable rates. And on page 
29 of this booklet, it makes it very clear that preexisting conditions 
will not be imposed against them.
  The people of this country deserve the same type of coverage. And it 
is my hope, as the appellate courts review that decision yesterday, 
that they will uphold the Affordable Care Act's provision to stabilize 
the private health insurance market.

                     [Press Release, Nov. 19, 2008]

 Health Plans Propose Guaranteed Coverage for Pre-Existing Conditions 
                    and Individual Coverage Mandate

       Washington, DC.--Health plans today proposed guaranteed 
     coverage for people with pre-existing medical conditions in 
     conjunction with an enforceable individual coverage mandate.
       Under the new proposal, health plans participating in the 
     individual health insurance market would be required to offer 
     coverage to all applicants as part of a universal 
     participation plan in which all individuals were required to 
     maintain health insurance.
       Health plans also said that premium support for moderate-
     income individuals and broad spreading of risk was necessary 
     to promote affordability and maintain premium stability in 
     the individual health insurance market.
       To ensure that all Americans can access coverage, health 
     plans also reiterated their long-standing support for making 
     eligible for Medicaid every uninsured American living in 
     poverty and strengthening the Children's Health Insurance 
     Program.
       ``No one should fall through the cracks of our health care 
     system,'' said Karen Ignagni, President and CEO of America's 
     Health Insurance Plans (AHIP). ``Universal coverage is within 
     reach and can be achieved by building on the current 
     system.''
       The announcement follows a nationwide listening tour 
     conducted by AHIP as part of its Campaign for an American 
     Solution. Concerns about coverage for pre-existing 
     conditions, continuity of coverage for those between jobs and 
     maintaining affordability for those with insurance were 
     raised repeatedly across the country.
       ``AHIP's Board of Directors is responding to the concerns 
     of the American people by offering a workable solution to 
     ensure that no one is left out of the health care system 
     because of their health, age, income or employment status,'' 
     said Ignagni.
       The new proposal builds on the series of comprehensive 
     reform plans that AHIP's Board of Directors began releasing 
     in November 2006. Further reform proposals addressing the 
     affordability, accessibility and quality of health care are 
     anticipated in the weeks ahead.

[[Page 19788]]




   Summary of AHIP's Proposal to Guarantee Coverage for Pre-existing 
   Conditions and Promote Affordability in the Individual Insurance 
                                Market:

       Guarantee-issue coverage with no pre-existing condition 
     exclusions;
       Establish an individual coverage requirement with an 
     insurance coverage verification system, an automatic 
     enrollment process and effective enforcement of the 
     requirement that all individuals purchase and maintain 
     coverage;
       Promote affordability by: providing refundable, advanceable 
     tax credits for moderate-income individuals and working 
     families; and promoting tax equity whether coverage is 
     obtained through an employer or the individual market; and
       Ensure premium stability for those with existing coverage 
     through a broadly funded reimbursement mechanism that spreads 
     costs for the highest-risk individuals.


        Background on the Individual Market and Guarantee Issue

       AHIP's survey of the individual market shows that 
     individually purchased health insurance is far more 
     affordable and accessible than is widely known. The survey 
     found that 9 out of 10 applicants undergoing medical 
     underwriting were offered coverage. The plans commonly 
     purchased by consumers provided substantial financial 
     protection and a wide range of benefits, including coverage 
     for behavioral health, prescription drugs and preventive 
     services.
       Some individuals are unable to purchase individual health 
     insurance coverage in the private market because of their 
     health status. One approach taken by states to address this 
     issue has been the enactment of guarantee issue legislation 
     requiring health plans to offer coverage to all applicants. 
     These well-intentioned reforms have often resulted in severe 
     unintended consequences, including significantly higher costs 
     for all policyholders.
       A report by Milliman, Inc. found that enactment of 
     guarantee issue laws in the absence of requirement that 
     individuals purchase coverage may incentivize people to defer 
     seeking coverage until they have health problems--a situation 
     which unfairly penalizes those who are currently insured. 
     According to the report, states that implemented these laws 
     saw a rise in insurance premiums, a reduction of individual 
     insurance enrollment and no significant decrease in the 
     number of uninsured. To learn more about the individual 
     market survey and the Milliman report, please visit 
     www.ahip.org.

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