[Congressional Record (Bound Edition), Volume 156 (2010), Part 3]
[Senate]
[Pages 3756-3761]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. CASEY. Madam President, I wished to review a couple points with 
regard to where we are on health care. We are at a point now where, of 
course, we are still awaiting action in the House--the other body, as 
it is sometimes referred to in the Senate--so we have to allow the 
House process to take place, and then, of course, we will be taking up 
health care more directly or more definitively next week.
  But I think it is important to put this issue into the context of 
real people. We have a lot of discussions in the Senate and throughout 
Washington on process and procedure and numbers and all that, and that 
is important and relevant, but at the end of the discussion--the old 
expression ``at the end of the day''--we have to be able to not only 
talk to the American people, as we have over many months now--in some 
cases many years--about what this legislation will do, but also we have 
to be aware of what is concerning a lot of people, a lot of families.
  I received a letter in the early part of 2009 from a woman in 
Pennsylvania who lives in Berks County--kind of the eastern side of our 
State, just north of Philadelphia, a couple counties north of 
Philadelphia, Berks County--and the woman who wrote to me, Trisha 
Urban, is someone whom I have come to know over the past couple years 
because of the tragedy in her own life which relates directly to health 
care.
  Trisha Urban related to me, in a letter she wrote to me but also in 
subsequent conversations, her story, which was the subject of a lot of 
discussion and public notoriety in her home area. I wish to read 
portions of the letter--not the whole letter but I think the relevant 
parts of this letter. She talks about her husband, she and her husband 
having all kinds of trouble with health care, which relates directly to 
almost every major issue we are talking about. Quoting from her, she 
said:

       Like many Americans, we have difficulty with our health 
     insurance. My husband had to leave his job for 1 year to 
     complete an internship requirement to complete his doctorate 
     in psychology. The internship was unpaid and we could not 
     afford COBRA.

  I will end the quote there for a second. We have had debates for 
weeks on extending COBRA health insurance to those who are unemployed--
a safety net not only for Trisha Urban and her family, at that time, 
but so many American families--millions of them--especially in the 
midst of a terrible recession.
  Picking back up on her letter:

       Because of preexisting conditions, neither my husband's 
     health issues nor my pregnancy--

  She talked earlier in the letter about her pregnancy.

     --would be covered under private insurance. I worked four 
     part-time jobs and was not eligible for any health benefits. 
     We ended up with a second-rate health insurance plan through 
     my husband's university. When medical bills started to add 
     up, the insurance company decided to drop our coverage 
     stating the internship did not qualify us for the benefits.

  I will comment on that section. In those few sentences, you have the 
preexisting condition problem and the ``insurance company dropped our 
coverage'' problem. This is information we have heard over and over in 
testimony from real people about what insurance companies in America 
are doing to these families. They are discriminating against families--
legally, apparently, under current law. That is part of why we want to 
change what has been happening in America, change the law through 
passage of legislation to deal with the question of protecting families 
with preexisting conditions.
  At long last--we have talked about this issue for decades but 
certainly in the last couple of years and more intensively in the last 
couple of months--this opportunity we have, this legislation gives us a 
chance not just to talk and to pontificate about what is wrong with the 
system but to act, to vote and to act to change the system to protect 
families.
  Again, we are talking about preexisting conditions, we are talking 
about people, families who are going to work every day, paying their 
premiums, doing their part of the agreement they have with an insurance 
company. Yet, despite paying their premiums, despite doing what they 
are supposed to do under the current system, they are being denied 
coverage, they are being discriminated against because they have a 
preexisting condition or, even more outrageously, their children are 
being denied coverage because of a preexisting condition.
  I have to ask myself--and I think a lot of Americans are asking this 
question--why do we tolerate this? Why do we go from year to year and 
say: it is terrible, insurance companies deny people coverage because 
of preexisting conditions even though they have been paying their 
premiums; it is terrible that insurance companies drop their coverage; 
it is terrible that they put limits on the kind of care they will 
provide, but they will put a dollar limit on it for a year or for a 
lifetime? That is really terrible, but there is nothing we can do about 
it.
  That is basically what we have been saying for years. We complain 
about the problem, and no one or not enough people here in Washington 
are willing to take on the insurance company and say: No, you are not 
going to do that any longer. We are going to make those practices 
illegal.
  We have a chance, and it is an up-or-down vote situation. We have a 
chance over the next couple of days--I hope not weeks but certainly the 
next couple of days--to decide these questions once and for all. We are 
either going to stand up to insurance companies or we are going to 
allow them to control people's lives in a way that is insulting to the 
American people. It is damaging the ability for families to have 
coverage and to have better health care.
  I believe what insurance companies do on these discriminatory 
practices is harming our economy long term. How can you be a productive 
worker if you have to worry every day, even though you paid your 
premium, whether an insurance company can discriminate against you, 
against your family, and especially against your children?
  That is what Tricia Urban was pointing to here, not because it was an 
issue in Washington but it was an issue in her life, in the life of her 
husband, and eventually having an impact on her own pregnancy. I pick 
up the letter again, and I am quoting Tricia Urban again in the letter. 
She talks about what the costs were for her and for her husband:

       We were left with close to $100,000 worth of medical bills. 
     Concerned with the upcoming financial responsibility of the 
     birth of our daughter and the burden of current medical 
     expenses, my husband missed his last doctor's appointment 
     less than 1 month ago . . .

  Meaning less than 1 month prior to February of 2009.
  Here is where she begins to close the letter. I am quoting again.

       I am a working class American and do not have the money or 
     the insight to legally fight the health insurance company. We 
     had no life insurance. I will probably lose my home, my car, 
     and everything we worked so hard to accumulate and our life 
     will be gone in an instant.
       If my story is heard, if legislation can be changed to help 
     other uninsured Americans in a similar situation, I am 
     willing to pay the price of losing everything.

  You might be wondering what happened to her, what happened in her 
life. Was it just a situation where they got dropped from their 
coverage? That is bad enough. Is it a situation where they got dropped 
from coverage and also were denied treatment or care or coverage 
because of a preexisting condition? That would be bad enough in and of 
itself. But, no, the story gets worse from there. She talks about the 
day when her water broke and she is about to go to the hospital to 
deliver her baby. The baby's name is Cora--just a little more than a 
year old now. Here is what she says:

       My water had broken the night before, we were anxiously 
     awaiting the birth of our new child. A half-hour later, 2 
     ambulances were in my driveway. As the paramedics were 
     assessing the health of my baby and me, the paramedic from 
     the other ambulance told me that my husband could not be 
     revived.

  She walks out the driveway to get into the car to go to the hospital 
to deliver her daughter Cora, and she sees her husband dead on the 
driveway, largely because or maybe exclusively because he missed his 
doctor's appointment for a heart condition because he

[[Page 3757]]

was worried about paying for the doctor visit.
  This is not some screenplay or some theoretical story; this is real 
life for people in America. We have to ask ourselves, on both sides of 
the aisle--our friends on the other side have to ask themselves: Is 
this good enough? Is this the best America can do, that we have to say 
sorry to Tricia Urban; sorry that happened to you about a preexisting 
condition, but we do not have the guts or the ability here in 
Washington to stand up to insurance companies; sorry you were denied 
coverage, but it is not going to change; sorry that a doctor's visit 
might have cost too much at a particularly vulnerable point in your 
life or the life of your husband; sorry that your husband died, but we 
don't think we can be responsive to those situations.
  Why do we tolerate this? Why do we allow insurance companies to 
control our lives this way? This is not just another vote in 
Washington. This is not just some discussion about reconciliation or 
the House vote and all that other stuff. This is about real life, and 
in the next couple of days we are either going to stand up to insurance 
companies or we are not.
  I think it is a whole set of questions Tricia Urban is asking. She is 
asking me, she is asking all the Democrats in this Chamber and all the 
Republicans.
  Then there is another set of questions I have and I think a lot of 
Americans have for our colleagues on the other side. They say they want 
health care reform, but they are not willing to support what we are 
trying to do. You say: OK, if they do not support what you are trying 
to do, they probably have an alternative plan they have all come 
together on and worked on for months and they are going to propose that 
alternative; that is the American way.
  They have an idea, we have an idea, we have a debate and vote, and 
someone wins, right? That is not the case. I am still waiting--we are 
all still waiting for Republican elected officials in Washington, House 
or Senate, to tell us what their plan is, to tell us definitively what 
they really want to do. Do they really want to be responsive to this 
problem of a preexisting condition? Do they really want to stand up 
against the insurance companies and say: No, you can't discriminate 
against families any longer.
  Oh, by the way, they are going to do just fine, those insurance 
companies, because if our bill passes they are going to have 30 to 31 
million more Americans covered. So they are going to do just fine. 
Don't worry about the insurance companies, they will do just fine even 
if we put a lot of protections in the bill.
  We have to ask our Republican friends: You say you care about 
covering Americans. Our legislation covers more than 30 million; how 
about you? Their latest proposal covers 3 million Americans. That is 
not even a serious attempt to cover Americans. We passed a bill last 
year on children's health insurance where we are going from 4 million 
children covered and, because President Obama signed the children's 
health insurance reauthorization into law, we are going up to 7 
million. We have already proven we can cover more children with an 
expansion of an existing program than the other side of the aisle is 
going to cover in their entire health care plan. But there is not much 
detail other than that. They say they want to cover 3 million. So it is 
a choice: Shall we cover 31 million Americans and strengthen our 
economy and give people the security of health care or give 3 million 
coverage and pretend that is a serious proposal?
  They say they care. They say they care on deficit reduction and 
controlling costs. Yet they will not support a proposal that at last 
count reduced the deficit by $130 billion. We are getting new 
information that is just coming out today from the Congressional Budget 
Office that number might still remain true from what it was in 
December--$130 billion of deficit reduction over the first 10 years and 
in the second 10 years maybe as high as $1 trillion or more. If you 
care about deficit reduction, then why wouldn't you sign on to 
something that would provide maybe the most significant deficit 
reduction in American history in one piece of legislation?
  They say they care about Medicare. We have heard that a lot over 
there. They care about Medicare and all that. Then, when their proposal 
comes out, they want to have vouchers for Medicare. Is that a serious 
proposal?
  They have to answer some basic questions, and they have to 
specifically answer the questions Tricia Urban is asking us because 
Tricia Urban's story is a story we have heard in different forms all 
over the country, certainly all over Pennsylvania. Maybe not every 
story has preexisting conditions, limiting coverage, jacking up rates 
so you can't afford to have coverage, and, tragically, a death in the 
family. Maybe not every story is that substantial. But we have heard 
stories over and over.
  I also point to our businesses. I ask unanimous consent to have 
printed in the Record an Associated Press--Pittsburgh Tribune Review 
article from earlier this month, ``Health Tops Pennsylvania Business 
Woes.''
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                  [From the Pittsburgh Tribune-Review]

                 Health Tops Pennsylvania Business Woes


  state's small businesses also see the recession as a severe obstacle

                            (By Joe Napsha)

       Pittsburgh.--Pennsylvania's small businesses say rising 
     health care costs, along with the recession and business and 
     personal taxes, are the biggest challenges they will face 
     this year, according to a recent survey
       ``It really confirms that in Pennsylvania, we need to zero-
     in on health care costs and taxes,'' said Thomas Henschke, 
     acting president of the SMC Business Councils, a Churchill-
     based trade association that conducted the Small Business 
     State Opinions survey in February SMC represents about 5,000 
     businesses throughout western and central Pennsylvania.
       About 71 percent of the 250 businesses that responded to 
     the survey said health care costs were their biggest 
     challenge. More than 70 percent said that high business and 
     personal taxes were a moderate-to-severe challenge to their 
     business.
       Increases in health care costs--ranging between 7 and 12 
     percent a year--are a ``huge problem'' for small business 
     that isn't being addressed by politicians in Washington, said 
     Peter Cady, president of Command Systems Inc. of Oakmont. The 
     company operates Advanced Mining Service, which repairs and 
     sells coal mining equipment.
       ``You can't pass those costs along. Nobody wants to hear 
     that your health care costs went up,'' Mr. Cady said.
       In response to a 23 percent jump in health care costs four 
     years ago to cover about 55 employees, Command Systems moved 
     to a high-deductible insurance plan, which makes it partially 
     self-insured. Command Systems pays 99 percent of the 
     insurance costs for its employees, Mr. Cady said.
       In addition to health care, the poor state of the economy 
     was cited as a severe challenge by about 45 percent of the 
     respondents
       ``Even before the recession, Pennsylvania was a very 
     difficult place to operate a business,'' compared to the 
     neighboring states, Mr. Henschke said.
       The survey was released the same day that President Barack 
     Obama announced his latest version of health care reform.
       ``That's politics. This is reality'' Mr. Henschke said.
       ``Proposed reforms change daily, and you can't find 
     anything that is going to lower costs.''
       Small-sized employers often believe they are overpaying for 
     health insurance for employees. But self-insurance for their 
     work force is really not available because the pool of 
     covered employees is ``too small to spread the risk out,'' 
     said Vincent Wolf executive vice president of Cowden 
     Associates Inc., a. Pittsburgh-based health care benefits 
     consulting firm.
       Health care costs are a major concern for businesses, which 
     is driving their need to make changes in health care plans, 
     said Lorin Lacy, principal for the health and productivity 
     practice at Buck Consultants Inc., a Pittsburgh-based human 
     resources consulting firm. Those changes include revising 
     cost-sharing between employees and employers and the use of 
     wellness programs, Ms. Lacy said.

                        COUNTY HEALTH COMPARISON
                   [Ranking (Out of 67 Pa. counties)]
------------------------------------------------------------------------
                                                          Environmental
                  County                      Overall     and lifestyle
                                               health        factors
------------------------------------------------------------------------
Lackawanna................................           51               19
Luzerne...................................           57               37
Monroe....................................           46               40
Pike......................................            6               20
Susquehanna...............................           41               31
Wayne.....................................           62               21
Wyoming...................................           43              46
------------------------------------------------------------------------
Source: County Health Rankings Study.


[[Page 3758]]

                        Overall health by county

     1. Chester
     2. Centre
     3. Union
     4. Snyder
     5. Montgomery
     6. Pike
     7. Bucks
     8. Lancaster
     9. Cumberland
     10. Franklin
     11. Butler
     12. Bradford
     13. Warren
     14. Columbia
     15. Lebanon
     16. Berks
     17. Indiana
     18. Westmoreland
     19. Lehigh
     20. Jefferson
     21. Adams
     22. Tioga
     23. Lycoming
     24. Potter
     25. York
     26. Northampton
     27. Fulton
     28. Juniata
     29. Washington
     30. Erie
     31. Bedford
     32. Somerset
     33. Crawford
     34. Clinton
     35. Perry
     36. Delaware
     37. Huntingdon
     38. Sullivan
     39. Montour
     40. Cameron
     41. Susquehanna
     42. Clarion
     43. Wyoming
     44. Beaver
     45. Clearfield
     46. Monroe
     47. Dauphin
     48. Mifflin
     49. Allegheny
     50. McKean
     51. Lackawanna
     52. Mercer
     53. Forest
     54. Venango
     55. Northumber-
     land
     56. Carbon
     57. Luzerrie
     58. Armstrong
     59. Elk
     60. Schuylkill
     61. Lawrence
     62. Wayne
     63. Blair
     64. Cambria
     65. Fayette
     66. Greene
     67. Philadelphia
  Mr. CASEY. It is an article, so you will not be able to see it, but 
the headline is ``Health Tops Pennsylvania Business Woes.'' The 
subheadline is ``State's Small Businesses Also See the Recession as a 
Severe Obstacle.''
  If you are a small business owner in Pennsylvania, this survey shows, 
you are worried about two things: the recession--no question about that 
having an adverse impact; that is why the recovery bill and jobs bill 
are so important to these small businesses--but also health care.
  I am reading an excerpt here:

       About 71 percent of the 250 businesses that responded to 
     the survey said health care costs were their biggest 
     challenge.

  Health care costs. This is not a group of Democrats sitting around a 
room in Pennsylvania saying: Let's pass health care. These are small 
business owners in Pennsylvania. They might be Democratic, Republican, 
Independent, or they may not have any affiliation. Their life is 
running a small business and raising their families, and 71 percent of 
those surveyed describe health insurance as their ``biggest 
challenge.'' We do not need any longer to debate whether this is an 
issue we have to deal with.
  I want to walk through some of the basic provisions of what we have 
put in place in the Senate bill, what the House has been wrestling with 
all these months, and what President Obama has been trying to do. Just 
a couple of quick highlights.
  First of all, if we are successful in this opportunity to pass major 
health care reform, other issues we have talked about for years but do 
not get a lot of attention are going to be finally the law of the land. 
Quality and prevention--the information and research on this is 
irrefutable. If you insist on prevention and you make it free or very 
low cost, that person is going to be healthier because they are going 
to take steps that are preventive in nature. They are going to be 
healthier, their family is going to be healthier, they are going to be 
better on the job and the economy will be stronger. But also we are 
going to strengthen our health care system in terms of costs. We are 
going to reduce costs in a lot of ways, but one of them is prevention 
and elevating the quality of our care. Sometimes people get the best 
care in the world, but in some places that can be very limited.
  The second point on cost and deficit. I mentioned that before. The 
deficit reduction in the Democratic health care bill is $130 billion 
over the first 10 years. We will see if the Congressional Budget Office 
alters that.
  But from what we are hearing today, some of the preliminary reports, 
that number might hold up. Some thought that because of the passage of 
time that number might go down $130 billion to $100 billion. But it is 
a tremendous deficit reduction over 10 and over 20 years.
  Protections. I talked about that before. I just want to highlight 
that quickly. Basic protections for American families who have health 
insurance coverage now, families going to work, paying their premiums, 
and not protected. They think they are protected because they have a 
policy, an agreement, and they are paying their premiums. They are 
doing their part. Then some insurance company bureaucrat or some other 
player in this marketplace comes to them and says: We know you are 
paying your premiums; that you are holding up your end of the bargain. 
But we, the insurance company, do not think you or your child should 
have coverage. Sorry. You are out of luck.
  Well, we are dealing with that in a couple of ways. First of all, it 
is important for people to understand what will happen now and what 
will happen later. If we get this bill passed, 6 months after the 
President would sign it into law, it would be illegal for an insurance 
company to deny a child coverage because of a preexisting condition. 
That is a tremendous change in the first year--literally, after 6 
months.
  In that same time period and beyond that, if you are an adult, 
technically you would not have the legal protection because you cannot 
do all of this at once. So we had to decide, do we do nothing in the 
short term or do we at least protect children. We are protecting 
children in the first couple months of the bill. But even though 
technically an adult would not have legal protection until 2014, they 
will have recourse. They will have an option to say: I am an adult. I 
have been denied coverage because of a preexisting condition. I can go 
into a high-risk pool and get coverage.
  So there is recourse in the first--actually, that is in the first 3 
months for the adult. So that is a very important protection. We can 
talk more later about that.
  Finally, and I will begin to close, on children's health insurance--I 
talked about that before--it is important to note what the bill does on 
a great successful program, the Children's Health Insurance Program.
  For example, in our State this is what children's health insurance 
has meant. It has meant that we have been able to reduce our rate of 
uninsured children down to 5 percent. It is still not good enough; we 
still want to go lower. But our uninsured rate among children in 
Pennsylvania is 5 percent. With regard to adults between the ages of 18 
and 64, it is 12 percent, so more than double for the adult uninsured 
prior to getting to the age of Medicare. That is more than double the 
children's uninsured rate. That is good for children that we have made 
progress--we need to make more--but it is bad for adults who have not 
had a strategy to help them.
  That is part of why we are trying to pass the bill. At long last we 
are going to be helping many adults, tens of millions. The Children's 
Health Insurance Program is extended under the bill for 2 years, until 
September 30, 2015.
  What the President wants to do as part of the so-called 
reconciliation process is to maintain--he proposes to require States to 
maintain eligibility for children's health insurance to 2019, not just 
2015, 2019. He wants to fund it through 2016. I think that is a very 
important change that the President has proposed and that we have a 
chance to ratify in our debate.
  There is a lot more we can talk about, but I am running low on time. 
But I think the basic question for the American people is, Are we going 
to have an up-or-down vote on health care?
  Some over there who have used this process before for other measures 
over many years seem to not want us to have an up-or-down vote on 
health care.
  I think the American people want that, even if they disagree with 
parts of the bill. But the real question for our Republican friends is, 
Will they be responsive to Trisha Urban? Are they just going to say 
that preexisting conditions are a problem; I know recisions are a 
problem, I know limits on coverage are a problem for you and your 
family; I know that denying a child health care coverage because of a 
preexisting condition is a problem, but we are not going to do anything 
about it; the insurance companies were too strong; we could not beat 
them; we are just going to go the way that so many have gone in 
Washington.
  I do not think that is going to be a good enough answer for Trisha 
Urban and her family and for millions of Americans.
  Finally, the question is, If you are not for our bill, if you are 
going to vote against it, what are you going to do about this? What are 
you going to do if you vote against covering 31 million

[[Page 3759]]

Americans? What are you going to do? Are you going to cover three? Is 
that a serious proposal?
  If you say you care about Medicare, are you going to support--which 
is the Republican proposal--having vouchers for Medicare? If you say 
you care about deficit reduction, you are going to vote against the 
bill that cuts the deficit by $130 billion, and let's say that number 
goes down, the worst we could do is $100 billion. But the estimates 
might hold up in the next couple of days. We will see what the 
Congressional Budget Office has.
  So I think Republicans in the Senate and the House have to answer 
those basic questions, not necessarily my questions or our questions 
but the questions that Trisha Urban and others across our country and 
every single State, the millions of Americans who have been denied 
coverage because of a preexisting condition.
  Notice I said millions over the last couple of years, according to 
one estimate, one survey. They have some questions to answer over on 
the other side of the aisle. We will see what their answer is, and the 
answer will be the vote. How you vote on this will be one answer to all 
of those and many other questions.
  So I hope we can have some conversions on the other side; that they 
will see that it is important to cover Americans, it is important to 
provide the kind of security and protection to families who are paying 
their premiums every day and not being given the protections they 
deserve. I hope our friends do that.
  I hope they do not just spend all of their time debating the finer 
points of process in the Senate. People really do not care about what 
the procedure is in Washington in the Senate. They want to know are we 
going to have, at long last, real protections for real families, or 
will the insurance companies win again.
  This is not complicated. That is one of the basic questions they are 
asking us to answer for them.
  I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. CASEY. I ask unanimous consent that the order for the quorum call 
be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. CASEY. Madam President, I know I have less than 2 minutes, but I 
wanted to add a couple of things to the Record. One is an article from 
the Los Angeles Times of February 4 of this year, headlined ``Anthem 
Blue Cross Dramatically Raising Rates for Californians With Individual 
Health Policies.''
  I ask unanimous consent that article be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From the Los Angeles Times, Feb. 4, 2010]

  Anthem Blue Cross Dramatically Raising Rates for Californians With 
                       Individual Health Policies

                           (By Duke Helfand)

       Anthem Blue Cross is dramatically raising rates for 
     Californians with individual health policies. Policyholders 
     are incensed over rate hikes of as much as 39%, which they 
     say come on top of similar increases last year. State 
     insurance regulators say they'll investigate.
       California's largest for-profit health insurer is moving to 
     dramatically raise rates for customers with individual 
     policies, setting off a furor among policyholders and 
     prompting state insurance regulators to investigate.
       Anthem Blue Cross is telling many of its approximately 
     800,000 customers who buy individual coverage--people not 
     covered by group rates--that its prices will go up March 1 
     and may be adjusted ``more frequently'' than its typical 
     yearly increases.
       The insurer declined to say how high it is increasing 
     rates. But brokers who sell these policies say they are 
     fielding numerous calls from customers incensed over premium 
     increases of 30% to 39%, saying they come on the heels of 
     similar jumps last year.
       Many policyholders say the rate hikes are the largest they 
     can remember, and they fear that subsequent premium growth 
     will narrow their options--leaving them to buy policies with 
     higher deductibles and less coverage or putting health 
     insurance out of reach altogether.
       ``I've never seen anything like this,'' said Mark Weiss, 
     63, a Century City podiatrist whose Anthem policy for himself 
     and his wife will rise 35%. The couple's annual insurance 
     bill will jump to $27,336 from $20,184.
       ``I think it's just unconscionable,'' said Weiss, a member 
     of Blue Cross for 30 years.
       Woodland Hills-based Anthem declined to say how many 
     individual policyholders will be affected or what a typical 
     increase will be under the new pricing, which will vary from 
     one individual to another. But the company defended its 
     premiums, even as it tried to strike a sympathetic tone.
       ``We understand and strongly share our members' concerns 
     over the rising cost of healthcare services and the 
     corresponding adverse impact on insurance premiums,'' the 
     company said in a statement.
       ``Unfortunately, the individual market premiums are merely 
     the symptoms of a larger underlying problem in California's 
     individual market--rising healthcare costs.''
       About 2.5 million Californians have individual insurance 
     policies, accounting for a small portion of the state's 
     overall insurance market. By contrast, nearly 21 million 
     people in California are covered by health maintenance 
     organizations.
       Individual policies are often the only option for those who 
     are uninsured, self-employed or do not receive health 
     coverage through employers.
       Insurers are free to cherry-pick the healthiest customers 
     in the lightly regulated individual market. They can raise 
     rates at any time as long as they notify the state Department 
     of Insurance and prove that they are spending at least 70% of 
     premiums on medical care.
       The size of the individual rate increases prompted state 
     Insurance Commissioner Steve Poizner recently to call for a 
     review of Anthem's charges.
       ``Commissioner Poizner is very concerned by these large 
     rate increases,'' spokesman Darrel Ng said.
       Poizner directed his department to retain an ``independent 
     outside actuary to examine Blue Cross'' rates'' to ensure 
     that the company spends at least 70% of the premiums on 
     medical care, as required by state law, Ng said. Anthem said 
     it had already hired an actuary who found that the rates were 
     sound.
       Anthem is not the only health insurer imposing double-digit 
     rate increases. Competitors such as Blue Shield of California 
     and Aetna also have raised premiums significantly in recent 
     years, insurance brokers said. But they said the impending 
     Anthem increases are the largest they have seen.
       ``Do they really think they are going to keep clients this 
     way?'' asked Bill Robinson, a Palm Springs broker who has 
     informed his Anthem clients that they will face increases of 
     as much as 39% on March 1.
       Anthem sent letters to agents a few weeks ago informing 
     them of the March 1 increases and followed up with similar 
     notices to policyholders last week.
       That's when Mary Feller of San Rafael learned that the rate 
     for herself and her husband will jump 39%, or $465 a month, 
     driving the couple's annual premium to $19,896 from $14,316.
       Feller, 56, said the premium for her 26-year-old daughter 
     also will rise 38%, costing the family an additional $1,572 a 
     year.
       As a result, starting March 1, the Fellers' health 
     insurance bill will surpass the family's monthly mortgage 
     payment on their home north of San Francisco.
       ``It's breathtaking,'' said Feller, an entertainment 
     journalist. ``We're going to have to cut back somewhere else. 
     This kind of stuff strikes fear in the heart.''
       Feller said she was troubled by another part of the Anthem 
     letter. Besides detailing the premium increase, it said: 
     ``Anthem Blue Cross will usually adjust rates every 12 
     months; however, we may adjust more frequently in accordance 
     with the terms of your health benefit plan.''
       She and others voiced anger about the increases as Anthem's 
     parent company, WellPoint Inc., sees big profits. Last week 
     the company announced an eightfold increase in profit for the 
     last three months of 2009, a surge attributed largely to the 
     sale of subsidiaries.
       Broker and insurance industry analysts said the California 
     rate increases will leave individual policyholders with few 
     good options: Anthem subscribers such as the Fellers can 
     switch to a company plan with a higher deductible. Or they 
     can try to switch insurers, a dicey proposition because 
     carriers in the individual market can reject applicants who 
     have preexisting medical conditions.
       ``It's putting people's backs up against the wall,'' said 
     Shana Alex Lavarreda, director of health insurance studies at 
     the UCLA Center for Health Policy Research. ``They are 
     finding new ways to create new problems for consumers.''
       The insurer said it had a team of workers to help customers 
     balance costs and insurance.
       ``Anthem offers a variety of health benefit plans,'' the 
     company said, ``and we are dedicated to working with our 
     members to find health coverage plans that are the most 
     appropriate and affordable for their needs.''


[[Page 3760]]

  Mr. CASEY. Basically, many Americans have heard these stories and 
experienced the pain of these health insurance premium increases. But I 
am going to read quick portions of it:

       Anthem Blue Cross dramatically raised rates for 
     Californians with individual health policies. Policyholders 
     are incensed over rate hikes of as much as 39 percent.

  Going on to say: Anthem Blue Cross is telling many of its 
approximately 800,000 customers who may buy individual coverage--people 
not covered by group rates--that their premiums will increase 30 to 39 
percent.
  Finally, I ask unanimous consent to have printed in the Record a 
series of statements contained in a 3\1/2\-page summary entitled ``GOP 
on Reconciliation.'' This is a series of statements that Republican 
Senators have made over the years with regard to this process they are 
complaining about and think that we should not be able to use, even 
though they supported it in the past. It is interesting reading which 
we do not have time to highlight.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                         GOP on Reconciliation


                                 gregg

       Gregg 2005: ``What's Wrong With Majority Rule?'' During a 
     floor debate on drilling in the Arctic National Wildlife 
     Refuge (ANWR), Senator Gregg said, ``We are using the rules 
     of the Senate. That is what they are. Reconciliation is a 
     rule of the Senate set up under the Budget Act. It has been 
     used before for purposes exactly like this on numerous 
     occasions. The fact is, all this rule of the Senate does is 
     allow a majority of the Senate to take a position and pass a 
     piece of legislation, support that position. Is there 
     something wrong with majority rules? I don't think so. The 
     reason the Budget Act was written in this way was to allow 
     certain unique issues to be passed with a majority vote. That 
     is all that is being asked for here. . . . The point, of 
     course, is this: If you have 51 votes for your position, you 
     win.'' [Congressional Record, 3/16/05]
       Gregg 2008: Reconciliation ``One Tool of Significance'' 
     Budget Committee Can Use. ``Reconciliation, as we know--those 
     of us who work here--is the one tool of significance which 
     the Budget Committee has. It allows us to change how 
     entitlement programs are funded and slow their rate of 
     growth--that was the purpose of reconciliation--and do it 
     without the changes being subject to the filibuster rule. It 
     is a vehicle basically directed on the purposes of the 
     Senate.'' [Gregg Floor Statement, 3/13/08]
       Gregg 2005: Republicans Used Reconciliation to Avoid 
     Democratic Opposition to ANWR Drilling, Passing Medicaid 
     Savings. ``The ANWR language has been a source of controversy 
     all year, and along with Medicaid savings, was one of two 
     principal reason for attempting to pass a reconciliation bill 
     this year, according to Senate Budget Chairman Judd Gregg, R-
     N.H. Either provision on its own could not have survived a 
     Democratic filibuster without the protection of budget 
     reconciliation, Gregg said.'' [CQ Today, 12/19/05]
       Gregg 2005: Mocked Democrats' Use of the ``Byrd Rule'' to 
     Slow Reconciliation Bill, Said Democrats ``Enforcing Minutia 
     Over Policy.'' ``Anybody who knows the Byrd rule knows it's 
     an extremely arcane and incredibly complex piece of precedent 
     that we deal with. And we had received estimates from CBO 
     which said that all three items which points of order were 
     made against scored . . . But the point here, of course, is 
     there are so many rules in this institution that go to 
     minutia on instances, that if you are using rules to enforce 
     minutia over policy, you can have a pretty massive unintended 
     consequence. Now in this case, I think it's intended, but the 
     consequence of promoting minutia by use of the rules is that 
     Katrina money isn't going to go out, people aren't going to 
     see doctors because doctors aren't going to get paid, and 
     students aren't going to be able to get student loans and 
     it's potential that the welfare program won't have the funds 
     it needs in order to continue to go forward. That's the 
     consequence of promoting minutia in this instance.'' 
     [Republican Press Conference, 12/21/05]
       Gregg 2005: Reconciliation is the Mechanism that Deals With 
     Entitlement Spending, Tax Policy. ``The letter asks that we 
     indefinitely postpone reconciliation, reconciliation being 
     the mechanism by which we address the entitlement spending 
     and tax policy here at the Federal level. It is an outgrowth, 
     of course, of the budget process.'' [Gregg Floor Statement, 
     9/7/05]


                                GRASSLEY

       Grassley 2003: If a Broad Energy Bill Lagged, He'd Favor 
     Attaching Energy Tax Credits to the Budget Reconciliation 
     Legislation. ``The result is an energy bill much like the one 
     lawmakers sought to finish in the final weeks of the 107th 
     Congress that is composed largely of energy-related tax 
     credits. . . . But if a broader energy measure lags, Grassley 
     said, the tax package could be accelerated by also attaching 
     it to reconciliation. 'If we weren't going to move an energy 
     bill, then I would want to do that,' he said.'' [CQ Weekly, 
     1/17/03]
       Grassley 2003: Aimed to Use Budget Reconciliation to Pass 
     President Bush's Economic Stimulus Plan. ``The Finance 
     Committee plans four hearings on Bush's economic plan in late 
     January and early February. Grassley is aiming to use a 
     budget reconciliation measure as a vehicle and hopes to have 
     a stimulus bill completed by April.'' [CQ Daily Monitor, 1/
     16/03]
       Grassley 2003: Planned to Move a Tax Package Through Budge 
     Reconciliation Legislation, Said Some GOP Senators Would 
     Oppose the Measure. ``Lawmakers and aides in both chambers, 
     including Grassley, said a tax package probably will move as 
     a fiscal 2004 budget reconciliation measure protected from 
     Senate filibusters. 'We're still going to have to have a 
     bipartisan agreement,' Grassley said. 'We won't keep all 51 
     Republicans together. I wish we could. But don't forget, 
     we're going to have to work with Democrats to get something 
     we can agree on.''' [CQ Weekly, 1/10/03]
       Grassley 2001: Said Republicans Would Have to Use 
     Reconciliation to Get the Bush Tax Cuts Passed, Would Protect 
     Legislation from Filibuster and Limit Debate. When asked by 
     Paula Zahn, ``As you know, House members have been 
     criticized, particularly Republicans, for sailing, at least 
     the rate cut portion of this bill, through the House so 
     quickly. As Senate Finance Committee chair, how much debate 
     will you allow?'' Grassley responded, ``Well, we're going 
     to--in the Senate of the United States, if we do this under 
     the reconciliation process--and that's probably the way it 
     will have to be done in order to get it done at all--and 
     that's a limit of 20 hours of debate. It's almost the only 
     process in the Senate that does not have unlimited debate and 
     cannot be filibustered. So we will probably adopt the budget 
     the first week of April, get it through finally, and 
     compromise the last week of April, and then go to the taxes 
     during the month of May. But it will be the expedited 
     procedure.'' [Fox News, 3/8/01]
       Grassley 2001: If Tax Cuts Were Divisive, They Would Have 
     to Be Passed Through Reconciliation. ``Many observers expect 
     the Senate to take up the tax issue as part of the budget 
     reconciliation process. Under Senate rules, debate is limited 
     under the reconciliation process, preventing any individual 
     senator from holding up the process with a filibuster. If 
     there is a strong bipartisan consensus, the Senate may be 
     able to move ahead with a separate bill that could move 
     through in relatively short order, Grassley said. `On the 
     other hand, if you're going to have it be very divisive--even 
     if it's a bipartisan bill it could still be very divisive--
     then it would demand to be part of the reconciliation 
     process,' which could stretch into May or June, Grassley 
     said.'' [CBS Marketwatch, 1/26/01]


                               MCCONNELL

       McConnell 2005: Republicans Would Use Budget Process to 
     Extend Tax Cuts Because They Could Not Reach the 60 Votes 
     Needed to Make Permanent Changes Outside of the Budget 
     Process. ``Well, we're going to try to extend a number of the 
     taxes through the budget process that we're involved in this 
     week. That's the good news. The bad news is you can't make 
     these taxes permanent through the budget process, which is 
     why we have what is perceived by a lot of people as the 
     bizarre situation with regard to the death tax, where it 
     phases down over a period of time, goes away for one year and 
     then comes back. We are working on the death tax separately, 
     hoping to come up with a proposal that could get to 60 votes, 
     which we would need if we did it outside of the budget 
     process. So we haven't given up on trying to get a major 
     permanent improvement, if not total repeal, of the death tax. 
     The other taxes that you mentioned we hope to extend for an 
     additional period of years through the budget process.'' 
     [Kudlow & Company, 3/15/05]


                                 HATCH

       Hatch 2001: Important to Pass a Budget So Senate Could Do a 
     Reconciliation Bill to Pass President Bush's Tax Cuts. ``The 
     important thing is, is that we got a budget through the 
     Senate. The House has passed the tax cut of $1.6 trillion. 
     Now that that budget's through, I think we can do a 
     reconciliation bill that'll have an overwhelming number of 
     senators and Congresspeople voting for this $1.3 trillion to 
     $1.6 trillion tax cut. And that's critical for our economy, 
     critical to this country.'' [Fox News Network, 4/16/01]


                                ROBERTS

       Roberts 2003: Majority Rules. On the Senate floor, Pat 
     Roberts said, ``If we do not end this business and get to the 
     business of the Nation, and understand there is a majority 
     and a minority and that the majority rules, we will open up a 
     wound further that will not heal without significant price 
     and scar, not to mention public ridicule for our 
     institution.'' [Congressional Record, 1/14/03]


                                COLEMAN

       Coleman: ``Principal of Majority Rule.'' On the Senate 
     floor, Norm Coleman said, ``The fact is that what happened 
     here is that my

[[Page 3761]]

     colleagues followed the history and tradition of this body 
     and said they would make sure they got a vote because that is 
     what the Senate is called upon to do, advise and consent. 
     There is a principle of majority rule, a principle, again, 
     espoused in this document, in this Constitution, of the 
     United States.'' [Congressional Record, 11/12/03]


                                  KYL

       Kyl: Reconciliation Is a Perfectly Legitimate Legislative 
     Process. On Hugh Hewitt's radio show, Senator Kyl discussed 
     reconciliation and said: ``Reconciliation is a perfectly 
     legitimate legislative process to deal with budgetary 
     matters. It is a, it is the one exception to the general 
     rules of the Senate that was created about thirty or forty 
     years ago, and Robert Byrd was one of the people that helped 
     to create it, to deal with budget matters where you didn't 
     want a filibuster to prevent the balancing of the budget, in 
     effect. I mean, there's one thing you have to do. You have to 
     be able to either increase your revenues or reduce your 
     spending in order to balance the budget, theoretically. So 
     they made that one exception to the policy of the Senate, 
     which otherwise would have required sixty votes to do the big 
     things. Now that process is available for those kinds of 
     monetary-related subjects. And it has been used many times. 
     That's true. The Bush tax cuts were done as, through 
     reconciliation, for example. Now there have been a couple of 
     other examples where they ventured outside of pure monetary 
     issues. They shouldn't have. I wasn't there. I don't know why 
     or how they did it. But in any event, it is not available for 
     large, substantive, comprehensive kinds of legislation like 
     this health care bill. It doesn't work, it's not suitable, 
     and it certainly isn't appropriate.'' [Hugh Hewitt via Think 
     Progress, 2/25/10]
       Kyl: Only Takes 51 Votes To Extend the Bush Tax Cuts. In 
     2005, Senator Kyl said, ``the bottom line is in the Senate, 
     to do anything permanently, it takes 60 votes because that's 
     what it takes to break a filibuster. So if you don't have 60 
     votes, you've got to do the best you can. The best we can do 
     right now, I suspect, is not to make all these tax cuts 
     permanent but to extend them out as far as we can. If we had 
     a five-year budget this year, for example, we could extend 
     these tax cuts out through the year 2010. For example, that 
     would mean that with dividends and capital gains, we need to 
     take those two 15 percent rates and carry them forward two 
     more years, so that they would include not only 2008 but also 
     2009 and 2010. And we can do that with some of the other 
     rates as well. So with a five-year budget, that's doable. . . 
     . And I would hope that--that only take 51 votes to 
     accomplish, so I would hope that we would do that.'' [CNBC, 
     2/14/05]


                                 CANTOR

       2005: Cantor Hoped Congress Would Engage in Budget 
     Reconciliation Every Year. ``I would again say, though, that 
     obviously reconciliation is a two-part process; that we are 
     focusing on reducing spending on this one. And again, a first 
     step in a process that I hope we can engage in every year, 
     that we would cut the size and growth in the entitlement 
     programs, at the same time reform these programs to promote 
     the efficiency that the taxpayers expect.'' [Republican Press 
     Conference, 11/8/05]
       2005: Cantor Praised His Colleagues for Passing Budget 
     Reconciliation Legislation. ``Well, I too am here to also 
     thank the entire team, from the speaker on down, for all that 
     we did for America last night. And I think what is really 
     telling, though, is the fact that we were able to vote and 
     pass a reconciliation spending package, and unfortunately, we 
     did it by ourselves. The fact is not one member from the 
     other side of the aisle participated in doing what it is the 
     whip just said, which was reform--beginning the process of 
     reforming government. And I think it does demonstrate that 
     the other side remains stuck to their old tax-and-spend ways 
     and has not even presented--did not even present last night 
     an alternative. I think that's very telling.''

  Mr. CASEY. I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DORGAN. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

                          ____________________