[Congressional Record Volume 142, Number 117 (Friday, August 2, 1996)]
[Senate]
[Pages S9501-S9526]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996--CONFERENCE
REPORT
The Senate continued with the consideration of the conference report.
The PRESIDING OFFICER. The Senate is now operating under control of
debate time.
Who yields time?
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, as I understand by the previous
agreements, we have divided up the time for the next few hours between
the Kassebaum-Kennedy bill and also on the minimum wage legislation,
but that there has been agreement to vote on these measures at 6
o'clock. So there is an expectation that it would be at 6 o'clock.
So I expect that during the course of the next period of time that we
have between now and 6 that perhaps that time could be divided, if it
is agreeable with Senator Kassebaum; that we might just divide the time
between she and I until 6 o'clock.
Mrs. KASSEBAUM. I anticipate, of course, if there is more time
allocated to us, that will take us past 6 o'clock. As you know, Senator
Domenici and Senator Wellstone want a large share of that time to be
equally divided. We will try to do so. But we will have to make sure
that time is allocated to them.
Mr. DOMENICI. Mr. President, I think the Senators will be fair. But
it seems to me that the spirit of the understanding would provide a
portion of that time to the Senator from New Mexico. I think the spirit
of it was that a portion of that time would go directly to the Senator
from New Mexico.
Mr. KENNEDY. If we have 55 minutes, I suggest that we divide it
between Senator Kassebaum and myself. And then we will allocate it to
our Members between now and 6 o'clock, if that is agreeable.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mrs. KASSEBAUM. Mr. President, I allocate to myself 5 minutes.
The PRESIDING OFFICER. The Senator from Kansas is recognized for up
to 5 minutes.
Mrs. KASSEBAUM. Mr. President, today, we stand on the threshold of
passing long-overdue reforms to our Nation's health insurance system.
According to the General Accounting Office, the bipartisan conference
agreement before us today will help at least 25 million Americans each
year who now face discrimination and live in fear that their health
insurance coverage will be canceled if they change jobs, lose their
job, or become sick.
It was exactly 1 year ago today that the Senate Labor Committee
passed the core provisions of this legislation by a unanimous vote. For
many months prior to that time, Senator Kennedy and I worked together
with insurance companies, consumers, Governors, State regulators, large
employers, small employees, and other to forge a bipartisan consensus
which would bring us to this day.
Mr. President, it has been a long, and sometimes bumpy, road. But the
spirit of cooperation and bipartisanship that began this process 1
years ago has allowed us to overcome very difficult obstacles that
threatened--but never derailed--our drive to pass common-sense health
reforms that would provide real health security.
Whilte there has been a great deal of debate and polemics over the
last few months about extraneous provisions, Senator Kennedy and I have
never lost sight of our primary goal. The heart and soul of the
Kassebaum-Kennedy bill that passed the full Senate unanimously are
firmly embedded in the conference agreement before us.
Mr. President, beginning July 1, 1997, every American who has played
by the rules will be able to keep their health insurance coverage even
if they change jobs, lose their job, or have a preexisting illness.
Last night, the House of Representatives passed the Health Insurance
Portability and Accountability Act by an overwhelming vote of 421 to 2.
Today, we will have the opportunity to do the same and to send this
bill to President Clinton for his signature.
This is a dramatic victory for the American people--not only because
the bill will help millions of Americans with preexisting illnesses,
but also because--I believe--the process of compromise, negotiation,
and bipartisanship that was the hallmark of this bill will go a long
way toward restoring Americans' faith that their Government can work to
address their most pressing concern.
Depending on who was speaking yesterday, one would think that health
reform was entirely the province of one party. But as Senator Kennedy
and I both know, this effort has been bipartisan from the start.
Senator Kennedy and Representative Archer worked together to develop
a compromise on medical savings accounts that broke a months-long
impasse on the bill.
The majority and minority leaders, as well as Senator Dole, deserve
much credit for breaking the gridlock over this bill.
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In fact, Mr. President, I would just like to say a special word of
appreciation to the majority leader. I think that Senator Lott has
devoted a great deal of time and energy to making sure that we could
reach this point this evening before we go out on our recess.
And there also has been significant bipartisan support in the House
from Representatives Thomas, Bliley, Bilirakis, Waxman, Hyde, Dingell,
and others. I especially want to recognize Representative Hastert of
Illinois for his leadership in bringing together members of both
parties to reach agreement on this very important bill.
I regret that we could not do more to help small employers. In an
effort to avoid controversy that could have derailed the legislation,
both the House and Senate small business pooling provisions were
dropped from the conference agreement. Representative Fawell from
Illinois is perhaps the greatest advocate of this reform, and Senator
Jeffords, from Vermont, also has worked very diligently to help small
employers enjoy the same economies of scale as large employers. My hope
is that those Members and others will continue to show leadership in
the future to find constructive bipartisan solutions in this area.
I also regret that this legislation does not include malpractice
reforms that could significantly lower costs for consumers.
Finally, Mr. President, I know many of my colleagues are disappointed
that the bill does not do more to help end discrimination against those
with mental illnesses. I know that Senator Domenici and others will
speak to that issue later. But I would just like to express my
appreciation to Senator Domenici who has devoted his time and heartfelt
efforts to achieving legislation to address parity in insurance
coverage for those with mental illness.
We did not do enough in this bill, and I certainly can understand
those who wish we could have done more. However, the bill does
represent significant progress for those with mental illness and other
chronic conditions. The bill expressly prohibits employers and insurers
from denying coverage to individuals because of preexisting mental
illnesses as well as physical illnesses, and people who suffer with
mental illnesses will be able to change jobs without the fear of losing
their health coverage.
I also have received letters in recent days from nearly 30 groups,
including the American Association of Retired Persons, the American
Medical Association, the American Hospital Association, the American
Cancer Society, the Healthcare Leadership Council, the American Lung
Association, the American Heart Association, the March of Dimes, and
others.
Let me read from one of these letters:
The American Cancer Society estimates that more than one
million people will be diagnosed with cancer this year. Ten
million Americans alive today have a history of cancer. Under
current insurance practices, many of these people will be
denied coverage if they change jobs or lose their job, or
they will be squeezed out of their existing plan because of
their health status. The health insurance reform bill
addresses these critical issues by limiting preexisting
condition restrictions and ensuring greater portability of
coverage. * * * The modest reforms contained in [this bill]
will go a long way toward protecting people with chronic
illness and their families. * * *
So, Mr. President, let us move forward. Let us cap this bipartisan
effort with another strong vote today and send this historic
legislation to the President's desk for his immediate signature.
There is no controversy about the central elements of the bill. There
is no question that the President will sign the legislation. There is
no question that--despite its long delay--the President, and members of
both parties, in both the House and the Senate, can take credit for
passing these sensible reforms.
And there is no question that the American people will be the real
winners today. This bill will guarantee that those who need coverage
the most are not shut out of the system. It is a small step forward,
but it is a historic step. And it will mean the world to millions of
Americans who will no longer live in fear that they will lose their
health coverage when they change jobs or lose their job.
I urge my colleagues to support the conference agreement, and to send
this important measure to the President today.
Mr. President, I think many will be helped by this bill. While it is
not a great leap, it is an important, historic step forward in
addressing many of the American people's most pressing concerns about
health care.
I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, in the final moments before we are going
to have legislative completion of this Kassebaum-Kennedy bill, I once
again commend the chairman of our committee, Senator Kassebaum, for her
leadership and work in fashioning this legislation, which reflects the
strong bipartisan support of her committee. As she has rightfully
pointed out, it was a year ago today that the committee reported it
unanimously. It did take us a period of time, some 8\1/2\ months,
before the Senate finally considered the legislation, and then passed
it unanimously. So this does really reflect an extraordinary
legislative achievement and accomplishment.
As we come into the final days and hours of this part of the
Congress, I think all Americans are very much in the debt of Senator
Kassebaum for all she has done on this legislation and on many other
pieces of legislation, and it is important for the record to note it. I
think the Members of the Senate respect and understand that.
Secondly, Mr. President, this legislation is right and necessary not
just because, as the leaders of all of the great religions have pointed
out, it is morally imperative for those who have some preexisting
condition or some illness, or disability. It is not only right because
we have virtual unanimous support from the business, consumer, and
labor communities, but most powerfully it should pass because it has
the support of the working families in this country.
There will be many who will try to claim credit for the legislation.
But ultimately this legislation was passed for the parents, those
parents who today are worried about a child who may have some
disability and wonder what in the world is going to happen to their
child when they reach maturity and they are no longer included in that
parent's policy. Those parents know that today it is virtually
impossible for that child to be able to get some kind of health
insurance.
Victory can be expressed by workers, who currently can see a new
opportunity for themselves and for their families by moving up in terms
of the employment opportunities but hesitate to do so. They hesitate to
attempt to fulfill the great American dream because they wonder whether
that job which is out there and offered to them in which they feel they
can do a superior job may not provide that degree of coverage for a
member of their family, for their wife or for one of their children. As
a result, they turn down that opportunity. The American dream becomes
somewhat more remote and distant to them.
It is a victory for those older workers, in my State of Massachusetts
and around the country who, as a result of downsizing, changes in
defense procurement, and changes in our commercial markets, become
down-sized and put out, effectively to pasture, and wonder whether they
are going to be able to acquire any kind of health insurance because
maybe they are not as physically able as they were at an earlier period
of time. These older workers--who have worked hard, paid their dues
over the long period of time and who may be a little ill--now have this
anxiety--just when they are looking at their golden years in
retirement.
It is the entrepreneur, the individual who wants to start up their
own business but knows that because a member of their family has some
illness, they are virtually prohibited from acquiring any kind of
health insurance. Today, their hopes and dreams are further diminished.
When the final vote on the Kassebaum-Kennedy is taken later today, it
will pass overwhelmingly. It will pass because it is bipartisan
legislation. It will pass because it is supported by over 200 groups in
a broad-based coalition representing consumers, business,
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labor, and responsible insurance companies. It will pass because the
conference committee agreed to limit the controversial medical savings
account proposal to a genuine test--not a full-blown program--and to
accept meaningful portability reforms. Most of all, it will pass
because the American public deserves and demands action.
I want to give special praise to the chair of our committee and the
leading sponsor of this bill, Senator Kassebaum. It was her leadership
that resulted in a unanimous vote from our committee. It was her vision
and commitment that made it possible for this bill to pass the Senate
without crippling amendments. She was tireless in her efforts to reach
a constructive compromise to get a bill that all of us can support. As
she nears retirement from the Senate, this bill is her gift to the
American people. The American people owe her a great debt of gratitude,
and I'm proud to have served with her on the Labor Committee for all
these productive years.
This bill will end many of the most serious health insurance abuses
and provide greater protection to millions of families. It is an
opportunity we can't afford to miss.
The abusive practices addressed by this bill create extensive and
unnecessary suffering. Ending them will bring greater opportunity and
peace of mind to millions of Americans. Twenty-five million Americans a
year will be helped by the provisions of this bill. Everyone knows a
family member or friend who has been hurt because of the abuses this
bill will end.
Millions of Americans are forced to pass up opportunities to accept
new jobs that would improve their standard of living or offer them
greater opportunities because they are afraid they will lose their
health insurance. Many others have to abandon the goal of starting
their own business because health insurance would be unavailable to
them or members of their families.
Parents who have a child with a health problem worry that their son
or daughter will be uninsurable when they are too old to be covered by
the family policy. Early retirees find themselves uninsured just when
they are entering the years of the highest health risks. Other
Americans lose their health insurance because they become sick, lose
their job, or change their job--even when they have faithfully paid
their insurance premiums for many years.
With each passing year, the flaws in the private health insurance
market become more serious. More than half of all insurance policies
impose exclusions for preexisting conditions. As a result, insurance is
often denied for the very illnesses most likely to require medical
care.
The purpose of such exclusions is reasonable: to prevent people from
``gaming'' the system by purchasing coverage only when they get sick.
But current practices are indefensible. No matter how faithfully people
pay their premiums, they often have to start over again with a new
exclusion period if they change jobs or lose their coverage.
Eighty-one million Americans have conditions that could subject them
to such exclusions if they lose their current coverage. Sometimes these
conditions make them completely uninsurable.
Insurers impose exclusions for preexisting conditions on people who
don't deserve to be excluded from the coverage they need. Sometimes,
insurers deny coverage to entire firms if one employee of the firm is
in poor health. Even if people are fortunate enough to obtain coverage
and have no preexisting condition, their policy can be canceled if they
have the misfortune to become sick--even after paying premiums for
years.
One of the most serious consequences of the current system is ``job
lock.'' Workers who want to change jobs must often give up the
opportunity because it would mean losing their health insurance. A
quarter of all workers say they are forced to stay in a job they
otherwise would have left--because they are afraid of losing their
health insurance.
When we originally debated this legislation on the Senate floor, I
spoke of just a few of the millions of Americans who have been
victimized by the abuses in the current system.
Robert Frasher from Mansfield, OH works for an employer who offers
health coverage to employees. But the insurance company won't cover him
because he has Crohn's disease.
Jean Meredith of Harriman, TN and her husband Tom owned Fruitland
USA, a small convenience store. They had insurance through their small
business for 8 years. But Tom was diagnosed with non-Hodgkin's
lymphoma, and their insurance company dropped them because they were no
longer profitable insurance risks. Without health insurance, Tom
Meredith had to wait a year to get the surgery he needed. After
spending $60,000 dollars of his own funds, his cancer recurred and he
died a year ago. Tom Meredith might still be alive today, if he hadn't
been forced to wait that year.
Diane Bratten from Grove Heights, MN and her family have insurance
through her employer. Because of a history of breast cancer now in
remission, Diane and her family would not be able to get coverage if
she decided to change jobs or was laid off.
Nancy Cummins of Louisville, KY lost her health insurance when her
husband's employer went bankrupt. When their COBRA coverage expired,
they were uninsured for 3 years until they qualified for Medicare.
During this period, she suffered three heart attacks, which left their
family with $80,000 in debts.
Jennifer Waldrup of my home state of Massachusetts was covered by her
husband's health insurance until his employer went out of business.
When she applied for coverage under her own policy, she was turned down
because she had multiple sclerosis. Her employer tried to help, but
could not find an insurer who would insure here. Her husband had to
cash in his life insurance to pay her medical bills.
Tom Hall of Oklahoma City testified before our Committee. He
faithfully paid for premiums for 30 years under the group policy of the
construction business he co-owned. When the company dissolved and he
became self-employed, the same insurance firm refused to give him
coverage because he had a heart condition. He lives in fear that his
life savings will be wiped out.
This legislation is a health insurance bill of rights for Robert
Frasher, for Jean Meredith, for Diane Bratten, for Nancy Cummins, for
Jennifer Waldrup, for Tom Hall--and for millions of other Americans as
well.
Those who have insurance deserve the security of knowing that their
coverage cannot be canceled, especially when they need it the most.
They deserve the security of knowing that if they pay their insurance
premiums, they cannot suddenly be denied coverage or be subjected to a
new exclusion for a preexisting condition when they change jobs and
join another group policy, or when they need to purchase coverage in
the individual market.
This health insurance reform bill corrects these fundamental flaws in
the private insurance system. It limits the ability of insurance
companies to impose exclusions for preexisting conditions. Under the
legislation, no such exclusion can last for more than 12 months. Once
someone has been covered for 12 months, no new exclusion can be imposed
as long there is no gap in coverage--even if people change jobs, lose
their job, or change insurance companies.
The bill requires insurers to sell and renew group health policies
for all employers who want coverage for their employees. It guarantees
renewability of individual policies. It prohibits insurers from denying
insurance to those moving from group coverage to individual coverage.
It prohibits group health plans from excluding any employee based on
health status.
These rules are important for helping people with a wide range of
health conditions. They also address the relatively new but serious and
growing concern that genetic screening information will be used to deny
coverage to people who aren't sick yet--a concern that prevents many
from getting the medical tests that could help protect them against
future illness.
Also, because of this bill, victims of domestic violence will know
that they can seek help without jeopardizing their insurance coverage.
The bottom line is that this legislation guarantees that no one who
faithfully pays their premiums can have their insurance taken away or
preexisting conditions imposed, even if they change jobs or lose their
job.
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There has been a sudden rush in recent day to claim credit for this
bill as it reaches final action. This is not a partisan bill. It was
developed by a Republican Senator and a Democratic Senator. Members on
both sides of the aisle have made important contributions. But the
American people should be clear as to who fought to pass this bill--and
who fought to derail it.
The Kassebaum-Kennedy bill was approved by the Labor and Human
Resources Committee on August 2, 1995--exactly 1 year ago today. It was
approved by a unanimous vote of 17-0. And then it languished for months
on the Senate calendar because Bob Dole and the Republican Senate
leadership tried to kill it by a system of rolling, anonymous holds. In
fact, it would still be on the Senate calendar today, if it had not
been for the courageous leadership and timely intervention of President
Clinton.
Let there be no mistake about the facts. This bipartisan bill was
passed because President Clinton led an all-out effort. And it almost
died because Bob Dole and the Republican leadership tried to kill it.
They blocked it for months because they were more concerned about the
profits of insurance companies than the health care of America's
families. The party that tried to slash Medicare was at it again.
President Clinton's eloquent call for action on the bill in the State
of the Union Address on January 23d this year was the trumpet that blew
down the wall of Republican obstruction. The President focused the
attention of both the press and the public on the legislation--and on
the secret maneuvers that were stabbing it in the back. The obstruction
failed. President Clinton's State of the Union Address lit a fire that
Bob Dole couldn't extinguish.
Two months later, on February 6, Bob Dole agreed in principle to let
the bill come before the Senate. At that time, hardly by coincidence,
he was in the middle of a difficult campaign in the New Hampshire
primary.
And even after he agreed in principle to bring up the bill, he still
managed to postpone action for more than 3 months--until April 18--so
that insurance companies who profit from the abusive practices of the
current system would have more time to organize their opposition and
prepare their poison pills.
One of the poison pills was medical savings accounts [MSAs]. The
House and Senate Republicans tried to force Congress to swallow that
pill, even though it would clearly jeopardize passage of the entire
reform. This radical and untried concept was fueled by lavish campaign
donations from the Golden Rule Insurance Company--one of the worst
abusers of the current health insurance system. Authoritative,
independent analyses of the concept warned that widespread use of
medical savings accounts could easily drive up premiums for other
citizens by 60 percent or more. In the words of the Congressional
Budget Office, medical savings accounts ``could threaten the existence
of standard health insurance.''
The Republican plan lacked even the most basic consumer protections
for people who selected MSAs. Deductibles could be as high at $5,000
per individual and $7,500 per family. There was no limit on how high
their total out-of-pocket costs could rise.
The Kassebaum-Kennedy health insurance reform bill is supposed to
make the insurance system better for the American people, not undermine
it through untested programs or expose people to excessive health care
costs. But that is exactly what Senator Dole and the House Republicans
tried to do. When medical savings accounts were proposed on the Senate
floor, Senator Dole led the effort--and was soundly defeated.
House Republicans also demanded other protections for the insurance
industry that would have made a mockery of the entire bill. Under their
proposal, the promise of portability became a hollow one. Insurance
companies could offer only one policy to sick people at a prohibitive
cost. A family plan would have cost $18,000 a year under the Republican
plan.
This scheme would have been a setup for the insurance industry and a
setback for health reform, if Democrats had not stood firm. The
intransigence of the House Republican leadership stalled the bill until
July 25--4 months after it passed the Senate. Until the last day of the
conference, they continued their attempt to undermine the portability
provisions. Because President Clinton and Congressional Democrats stood
firm, the American people are the winners.
Obviously, this bill is not a cure-all for the health care system.
But it is an important first step on the road to further reform.
We all know the problems that continue to exist. Between 1990 and
1994, the number of uninsured Americans rose 18 percent--from 34
million to 40 million citizens. The average person who becomes
uninsured today will stay uninsured twice as long as in the 1980s.
According to a recent study, the number of uninsured could rise by
another two-thirds--to 67 million Americans--over the next 7 years. The
percentage of Americans with job-based insurance will fall from 61
percent in 1989 to 45 percent by 2002.
These trends will not change because of the legislation we are
enacting today. Too many families will still be just one pink slip away
from losing their coverage. Too many families forced into unemployment
or retirement by corporate downsizing will not be able to afford the
insurance they need--even if they cannot be denied the right to
purchase it simply because they are ill.
Tens of millions of other Americans have no coverage today because
they work for employers who won't provide it and because they can't
afford it themselves. They will get no relief from this bill.
Too many senior citizens will continue to pay more than they can
afford for the health care they need. Too many children will still not
get the healthy start in life they deserve.
Across the landscape of America there is not a family that has not
been affected by some preexisting condition, some illness, some
disability. There is not a family that does not know a neighbor or
friend that has not been presented with this kind of fear and anxiety.
So, Mr. President, we move this legislation forward, and we are very
hopeful that when this measure is actually signed by the President of
the United States, we will be helping to lift that sense of anxiety and
fear and frustration from among our fellow Americans when they have
been turned down by the fiercest and most abusive policies of insurance
companies.
We know that this legislation is not going to resolve all the
problems, but there will be those families, there will be those
parents, there will be the members of the family, there will be the
older worker, there will be the entrepreneur who will know they can
look to the future with additional hope and anticipation in fulfilling
the American dream.
So, although this is not all of what some of us may have wanted, this
is a meaningful, important piece of legislation that can make an
extremely important and significant difference in the quality of life
for our fellow Americans. The passage of the legislation is the
beginning of a journey, not an end.
Next year I hope, under President Clinton's leadership, and I would
say a Democratic Congress, we will take the next step forward toward
assuring every American family the basic right to health care.
Mrs. KASSEBAUM. Mr. President, I agree with the ranking member of the
Labor Committee on some things. But the last part of his statement I
would, perhaps, have to have some question about.
I yield 5 minutes, now, to the chairman of the Finance Committee,
Senator Roth.
Mr. DOMENICI. Mr. President, I ask if the senior Senator from Kansas
will yield to me for 10 seconds?
Mrs. KASSEBAUM. I will so yield.
Mr. DOMENICI. Senator Kennedy, I know your desire for next year, but
I would remind you, you had the Senate and House for 2 years with the
President, and you did not get anything done with health care. I yield
the floor.
Mr. KENNEDY. Mr. President, I would like to yield to myself. I think
I have a right to recognition--
The PRESIDING OFFICER (Mr. Santorum). The Senator from Massachusetts
should be warned the Senator from Kansas yielded to the Senator from
Delaware.
Mr. ROTH. Mr. President, today we fulfill a promise to the American
people. We bring greater security to American families. We offer peace
of mind to
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hard-working, responsible men and women who are providing for
themselves and for their families.
There has been no question on either side of the aisle--or throughout
America--about the need to make necessary improvements in our health
care system.
The improvements in this legislation primarily focus on making health
care coverage accessible and affordable. It goes without saying that we
have the highest quality of care, the best technology, the finest
health care personnel found anywhere in the world.
Our objective, then, is to initiate fundamental reforms in access to
health care without doing irreversible harm to quality, research and
technology. This legislation is an excellent first step toward
accomplishing our objective.
Unlike the health care reform effort made 2 years ago, this
legislation does not harm the system in the process of reforming it.
Rather, this legislation meets the most pressing needs associated
with reform: Increased portability; limitations on pre-existing
conditions exclusions; guaranteed renewability of health care
insurance; and, improved means for small businesses and self-employed
individuals to provide health care coverage, including long-term care.
I want to particularly thank Senator McConnell for his leadership and
active participation in these reforms, especially in the area of long-
term care. Likewise, I want to acknowledge the work done by Senator
Cohen toward preventing health care fraud and abuse. I want to thank
Senator Grassley for the work he has done in the area of coordination
and duplication of Medicare-related plans, and Senator Bond who has
been instrumental in his work for administrative simplification.
This has certainly been a team effort--a valiant effort by Senators
and hard-working staff. I am proud of what we have accomplished. Beyond
the critical reforms I have already outlined, this legislation also
takes a very important first step toward a program that I have long
advocated--that is the medical savings account. Medical savings
accounts provide a fundamental way to make health insurance affordable
to small business employees and self-employed individuals, and this
bill provides for a 4-year demonstration project--a project in which
self-employed individuals and companies of 50 or fewer can participate.
Mr. firm belief is that this project will prove the success of
medical savings accounts, and we will then be in a strong position to
provide MSA's for Americans everywhere.
Beyond these important reforms, this legislation also helps control
the cost associated with health care by creating new tools in our fight
against health care fraud and abuse. While I would like to see our
efforts to control fraud and abuse go much further, the provisions in
this bill represent a good starting point.
Along with providing these tools, this legislation improves the
Medicare and Medicaid programs and the private health care system
through uniform standards that will cut out much of the redtape in
health care.
It is important to note, Mr. President, that this bill does not pre-
empt State privacy laws. Instead, it provides protection for an
individual's health information.
Each of these changes represents a significant improvement over
current law. Combined they represent a strong first step toward
reforming America's health care delivery system in a way that improves
without destroying. And this is critically important to the American
people.
Two years ago they rejected the wholesale restructuring of our health
care system. They understood that reform, as it was proposed then, was
throwing the baby out with the bath water. It was tampering dangerously
with one-eighth of our Nation's economy, and a system that had the
highest standards of quality in the world. What we do with this
legislation is make the reforms they want--the reforms they need--
without destroying all that is good and working in the current system.
With this Health Insurance Portability and Accountability Act, we
keep our promise. We effectively address the problems facing the
Nation's health care system in an incremental fashion.
I am honored to be a part of this momentous effort--I appreciate all
the work that's been done by valiant staff members--and I am heartened
by the positive, bipartisan way in which we have succeeded.
I yield the floor.
Mr. KENNEDY. Mr. President, I yield myself 1 minute.
I am very, very surprised at my good friend from New Mexico, talking
about what has been achieved, that this has only been achieved under a
Republican Congress. Where were the Democrats? I will tell you where
the Democrats were not. They were not cutting Medicare and cutting
Medicaid so we could have tax breaks for the wealthiest individuals in
this country. And where the Democrats were not is waiting 8\1/2\ months
to bring this bill up, which the Republicans are crowing about at this
time. That is where the Democrats were.
I yield 5 minutes to the Senator from New York.
The PRESIDING OFFICER (Mr. Burns). The Senator from New York is
recognized.
Mr. MOYNIHAN. I rise in support of the Health Insurance Portability
and Accountability Act of 1996. It makes elemental and much-needed
improvements in health care coverage for Americans by guaranteeing
``portability'' of health insurance for employees who change jobs, and
by eliminating the current practice of denying coverage to persons with
preexisting health conditions. These were the areas in which there was
by far the greatest consensus when the President's health care
legislation was considered in the Finance Committee in 1994, and I am
pleased that agreement has been reached to make these changes.
However, I am not pleased with the resolution of another issue in
this bill: the provision to prevent persons from renouncing their
American citizenship and moving abroad in order to avoid U.S. taxation.
That dubious practice has come to be called ``expatriation'' among
members of the tax bar, although that is not a very illuminating term.
The word expatriate derives from the Late Latin expatriare, to banish.
Ex, out of. Patria, native country. Perhaps a term that better reflects
the tax consequences of the issue will emerge in time.
The conference report on the health legislation before us today
contains as a revenue offset the House expatriation version, rather
than the Senate provision. The Senate provision also was included in
the small business tax relief legislation marked up by the Finance
Committee on June 12, but it was later dropped in the conference on
that legislation. I am convinced that the House proposal will leave in
place a continuing tax incentive to renounce citizenship in order to
evade taxes.
This issue gained notoriety in late 1994, when expatriation by
several very wealthy individuals was widely reported. On April 6, 1995,
shortly after the issue arose for the first time in Congress, I
introduced S. 700, a bill to close the loophole in the Tax Code that
permits ``expatriates,'' as they have come to be called, from escaping
U.S. taxation.
Although expatriation to avoid taxes occurs infrequently, it is a
genuine abuse. The Tax Code currently contains provisions, dating back
to 1966, intended to prevent tax-motivated relinquishment of
citizenship, but these provisions have proven difficult to enforce, and
they are easily circumvented with the assistance of resourceful tax
counsel. One international tax expert described avoiding them as
``child's play.'' Under current law, individuals may, by
renouncing their U.S. citizenship, avoid taxes on gains that accrued
during the period in which they acquired their wealth--and while they
were afforded the many benefits and advantages of U.S. citizenship.
Even after renunciation, these individuals are permitted to keep
residences and reside in the United States for up to 120 days per year
without incurring U.S. taxes. Indeed, certain wealthy Americans have
``expatriated'' while still maintaining their families and homes in the
United States. They need only take care to avoid being in the United
States for more than 120 days each year.
Meanwhile, ordinary Americans who remain citizens continue to pay
taxes on their gains when assets are sold, or when estate taxes become
due at death.
[[Page S9506]]
I regret to say that the expatriation issue has been and, in light of
the decision taken by the conferees on the health insurance reform
bill, may continue to be the subject of more controversy than it
probably deserves. In the interest of making the record complete, I
will briefly review the history of the issue's consideration in the
Congress.
On February 6, 1995, the President announced a proposal to address
expatriation in his fiscal year 1996 budget submission. Three weeks
later, on March 15, 1995, during Finance Committee consideration of
legislation to restore the health insurance deduction for the self-
employed, I offered a modified version of the administration's
expatriation tax provision as an amendment to the bill. My amendment
would have substituted the expatriation proposal for the repeal of
minority broadcast tax preferences as a funding source for the bill.
The amendment failed in the face of united opposition by members of the
majority on the committee. The vote against the amendment was 11-9.
Later in the markup, Senator Bradley offered the expatriation
provision as a free-standing amendment, with the revenues it raised to
be dedicated to deficit reduction. Senator Bradley's amendment was
adopted by voice vote.
After the Finance Committee reported the self-employed health
deduction bill, but before full Senate action and before our conference
with the House, the Finance Committee held a hearing to review further
the issues raised by expatriation. At our hearing, we heard criticisms
of some technical aspects of the provision, as well as testimony
raising the issue of whether the provision comported with Article 12 of
the International Covenant on Civil and Political Rights, which the
United States ratified in 1992. Section 2 of Article 12 states:
``Everyone shall be free to leave any country, including his own.''
Robert F. Turner, a professor of international law at the U.S. Naval
War College, testified that the expatriation provision was problematic
under the Covenant because it constituted a legal barrier to the right
of citizens to leave the United States. The State Department's legal
experts disagreed, as did two other outside experts who provided
written opinions to the committee: Professor Paul B. Stephan III, a
specialist in both international law and tax law at the University of
Virginia School of Law; and Mr. Stephen E. Shay, who served as
International Tax Counsel at the Department of the Treasury under the
Reagan administration.
Given this division in authority, it seemed clear that the Senate
should not act improvidently on the matter. Genuine questions of human
rights under international law, and the solemn obligations of the
United States under treaties, had been raised. We therefore sought the
views of other experts. Opinions concluding that the expatriation
provision did not violate international law were received from
Professor Detlev Vagts of Harvard Law School and Professor Andreas F.
Lowenfeld of New York University School of Law. The State Department
issued a lengthier analysis supporting the legality of the provision,
and the American Law Division of the Congressional Research Service
reached a like conclusion.
However, there were contrary views, most notably the powerful opinion
of Professor Hurst Hannum of the Fletcher School of Law and Diplomacy
at Tufts University, who first wrote to me on March 24, 1995.
This is where things stood when the House-Senate conference met on
March 28, 1995. At that time, the weight of authority appeared to
support the validity of the provision under international law, yet very
real questions remained unresolved. The underlying bill had to move at
great speed. As my colleagues well know, the legislation restoring the
health insurance deduction for the self-employed for calendar year 1994
had to be passed and signed into law well in advance of the April 17,
1995 tax filing deadline, so that self-employed persons would have time
to prepare and file their 1994 tax returns.
The conference committee had to decide immediately whether to retain
the expatriation provision. There was no time for further inquiry into
its validity under international law. We accordingly chose not to risk
making the wrong decision, which might violate international law and
human rights. We elected not to include the provision in the conference
report. The conferees instead adopted a provision directing the Joint
Committee on Taxation to study the matter and report back.
That decision, which was the only prudent one at the time, was met
with some not very pleasant criticism in the Senate. This was
surprising, since I believed it was axiomatic, particularly on our side
of the aisle, that Government should proceed with great care when
dealing with human rights--particularly the rights of persons who are
despised. The persons affected by the expatriation proposal--
millionaires who renounce their citizenship for money--certainly fell
into the category of persons who are easy to despise.
Since that time, a general consensus has developed that the Senate
provision does not conflict with the obligations of the United States
under international law. Professor Hannum, after receiving additional
and more specific information about the expatriation tax, wrote a
second letter on March 31, 1995 stating that he was ``convinced that
neither its intention nor its effect would violate present U.S.
obligations under international law.'' And in the interim, there has
been time to consider other approaches to the problem. On June 1, 1995,
the Joint Committee on Taxation published its report on the tax
treatment of expatriation.
Shortly thereafter, on June 9, 1995, Chairman Archer introduced an
expatriation bill that adopted a different approach than S. 700, which
was the bill introduced by the Senator from New York. A second Finance
Committee hearing on expatriation was held on July 11, 1995 to consider
the two competing approaches. The Senate thereafter incorporated in its
version of the Balanced Budget Act of 1995 a slightly modified version
of the bill I introduced. The Senate bill adopted the accrued gains
approach rather than the House alternative as the superior response to
the problem. However, the House prevailed in conference and a version
very similar to the Archer bill was included in the final Balanced
Budget Act of 1995, which was later vetoed by President Clinton.
That same House provision has now been incorporated in the conference
agreement before us on the health insurance reform bill.
Adoption of the House expatriation proposal rather than the Senate
proposal is being justified, in part, based on the fact that the Joint
Committee on Taxation has scored it as raising substantially more
revenue than the Senate version. These revenue estimates are difficult
to believe, because almost any member of the tax bar would concede that
the Senate proposal would deter tax-motivated expatriations far more
effectively than the House proposal. In contrast to the Joint Tax
Committee, the Treasury Department estimates that the Senate proposal
would raise substantially more revenue than the House version. This
comports with the views of most tax experts.
Here is why I believe the House provision is unsatisfactory. Under
the Senate provision, an expatriate with a net worth of over $500,000
(or average annual tax liability in excess of $100,000) generally would
be taxed on his asset appreciation existing at the time of
expatriation. Alternatively, an expatriate could elect to continue to
be taxed as if a U.S. citizen--i.e., to be subject to worldwide tax on
his assets until their disposition. The provision also offers
alternatives for delayed payment of the tax on accrued gains, with
interest.
Rather than impose a tax on accrued gains, the House bill attempts to
build on the current law approach of taxing only a portion of the
income generated by assets of expatriates during the 10-year period
following expatriation. This approach will fail to eliminate the very
substantial tax advantages that currently inure to persons willing to
give up their citizenship.
Under the House proposal, several categories of taxpayers would
continue to owe no tax at all should the IRS be unable to prove a ``tax
avoidance motive'' for expatriating. As under current law, patient
taxpayers would avoid all tax on accrued gains by simply holding their
assets for ten years. Gains recognized after that period
[[Page S9507]]
would never be taxed by the United States. A wealthy expatriate needing
money during the 10-year period could simply borrow money using his or
her assets as security.
Under the House provision, no tax at all would be owed on income or
gains from foreign assets following expatriation, as under current law.
Given the enormous incentive to own foreign assets, experienced tax
practitioners would continue to find ways to convert U.S. assets into
foreign assets in order to avoid tax on the income earned during the
10-year period.
The House approach also would risk nonpayment of amounts owed, as it
relies on the voluntary payment of taxes for 10 years following
expatriation, well after the taxpayer has moved beyond the reach of
U.S. courts. In contrast, the Senate version generally would not
require looking beyond the facts at the time of expatriation, making it
much more likely that taxes owed would be collected. Further, taxpayers
would be required to provide security for delayed payment of taxes.
Another flaw in the House bill is that it will unilaterally override
existing tax treaties. In its report on expatriation, the Joint Tax
Committee staff stated that the House version may ultimately require
that as many as 41 of our 45 existing tax treaties be renegotiated and
that it might be necessary for the United States to forego benefits to
accomplish renegotiation.
As the first Senator to have introduced legislation to end tax
avoidance by so-called expatriates, and as one who urged that it be
acted upon expeditiously, I am disappointed that the expatriation
changes I have sought, and that have been passed by the Senate on three
separate occasions, have been set aside in favor of far less effective
measures. I believe the honor of the tax-writing committees is at issue
here. The action taken today will allow this issue to fester for some
time to come because the new rules will not measurably reduce the tax
advantages of expatriation.
On another matter, I also wish we could have addressed the issue of
mental health parity in this conference report. In April, I voted for
the Domenici-Wellstone amendment to the Senate version of the
underlying bill. It would simply have required health plans to provide
coverage of mental health services equal to that provided for acute
medical services. The amendment got 65 votes.
Subsequent scoring of the amendment by the Congressional Budget
Office determined that it would be relatively expensive. Senators
Domenici and Wellstone then prepared a scaled-down version of their
amendment which would have required health plans to provide equal
treatment only of annual and lifetime limits. This alternative would
have cost approximately one-tenth of what the original amendment would
have cost.
Unfortunately, this modest revised proposal was also unacceptable to
the majority members of the conference. Subsequent proposals by Senator
Domenici to scale back the parity requirement even further were also
rejected without the benefit of consideration by Senators appointed to
the conference, or even by our staffs. After the initial meeting of the
conference in the Ways and Means room on July 26, 1996, the conferees
were never assembled to discuss this or any of the elements of the
final conference agreement.
For these reasons, I chose not to sign the conference report on this
legislation. We could have done better on expatriation, and on mental
health parity. Even so, I am prepared to vote for this legislation
because its central features--the health insurance reforms--are
important and overdue. I congratulate Senators Kennedy and Kassebaum
for their hard work and persistence on this legislation, and I urge its
adoption.
The Presiding Officer. The Senator from Kansas.
Mrs. KASSEBAUM. Mr. President, I know the Senator from Iowa, [Mr.
Grassley] had wished to speak, because the State of Iowa has done some
very innovative things regarding the question of health care insurance,
but we are running out of time. He is going to address his full
statement and make it a part of the Record at some point as we find
time at the close of this debate. I would like to right now, though,
yield 15 minutes to the Senator from New Mexico [Mr. Domenici].
The PRESIDING OFFICER. The Senator from New Mexico is recognized for
15 minutes.
Mr. DOMENICI. Mr. President, I say to my friend from Massachusetts,
we may not agree on the issues we just spoke of, but we agree on the
issue I am going to speak of, and for that I thank him.
Mr. President, I say to my fellow Senators, about 8 months ago, I
went to a meeting in Gallup, NM, at an Indian hospital. I noticed
sitting in the audience a very, very handsome Indian woman. My guess is
that she was probably 55, 58 years of age. And she stood up and said,
``Thank you, Mr. Domenici.''
I said, ``What are you thanking me for?'' And she began to cry.
When she finished, she said, ``Thank you for asking the Indian Health
Service to give the modern drug called Clozaril to my schizophrenic
son. He has been catatonic for 22 years. And thank you for giving him
back to me. He is home now, and he is performing on almost a hundred
percent in my house.''
Frankly, I did not deserve the accolade, but I was on a TV show just
yesterday about the issue of ``should we stop discriminating against
people like that young Indian boy who is not on Indian health
coverage,'' and a representative of business said to me, ``Well, you
just want to provide money for all these ladies that want to go see
their shrinks.''
To which I said, ``You have not read my amendment, and most of the
mentally ill people that I am seeing and have become friends with over
the last 15 years, whose children have manic depression, deep
depression, schizophrenia or one of the serious, serious mental
diseases which are almost universally accepted as being diseases of the
brain--you would not be talking about shrinks when it comes to the kind
of treatment and care that psychiatrists, who have already disavowed
Freud''--and I might say to my friend from New York, I am not reluctant
to tell the psychiatrists in America that I believe Freud is dead and
that the treatment of mentally ill people does not require 50 visits to
the ``shrink,'' so to speak, but it does require that qualified doctors
and health care centers diagnose and treat the severe mental illnesses
as diseases.
All we ask for in this bill, of all the things we could have asked
them to provide, we asked for two things, and listen carefully, I say
to my fellow Senators, because we are going to do this sooner or later.
We said, if you provide mental health coverage, you must provide the
same lifetime coverage as you do for everybody else covered, the same
total lifetime coverage and the same annual coverage. That is all we
asked for.
We did not ask, nor did we say, that for those who are worried about
the shrink, we did not say that you had to cover that. In fact, it is
clear that they could require any kind of copayments they want. They
could require a number of visits being exempt from coverage, if that is
what worries them. All we said is if you cover them, don't discriminate
against them, and then when they are in the fourth year of a serious
illness say, ``Oops, there's no more coverage, we only gave you $50,000
worth of lifetime coverage.''
Incidentally, that is ordinary for American insurance today. While
they cover the other ones for $1 million if you have cancer or heart
trouble or you have a transplant--$1 million--in the same policy, they
cover mental illness, however, $50,000 for your life. If that is not
discrimination, I have never seen it, and if that is not a denial by
our community of a reality and hiding your head, then I cannot believe
it.
I honestly believe that the mentally ill should get more protection
than these two components of what we offered the conferees by way of
resolution, and I might say, none of my remarks are directed to Senator
Kennedy, Senator Moynihan, or Senator Kassebaum. I believe we would
have received this treatment had they been the ones making the
decision.
But I will say to the American business community, you have some
lobbyists representing you that it seems to me, at least, when they
once get a set of facts in their heads, they forget to use their
brains. And so what they say is, what Domenici offered with Wellstone
on the floor cost too much.
[[Page S9508]]
And then I say, ``Did you look at what we offered in compromise?''
``What compromise?'' While they have been saying in the newspapers it
will bankrupt them.
Frankly, there are many great American businesses toward which these
comments are not directed. There already are major ones that cover with
full parity, not just parity of annual and lifetime caps, and I do not
address these remarks at them. But I submit, you have to face up to
reality and get away from the fear that comes with talking about people
who have severe mental illness and the trepidation and consternation.
Just look around your neighborhood, for the CEO's of American
companies, look among the hierarchy of your company, and if you don't
find somebody who has a relative with schizophrenia or severe manic
depression or severe clinical depression or bipolar illness, then you
are a rare, rare exception to the society of the United States, because
that is the way it really is.
I have been privileged to meet thousands of relatives of the severely
mentally ill of this Nation. We think at any given time there are
between 3 and 5 million people with severe illnesses. Frankly, I want
to send them a little ray of hope. I don't want them to think we are
going to remain as we have been forever.
So, today, with the Senate's permission, I ask unanimous consent that
I be permitted to send a bill to the desk and that it be reported to
the appropriate committee. I do not ask for any special favors today.
But it is very simple.
All it says is if employers and the insurance community cover the
mentally ill, they can set whatever standards they want. They can deny
coverage for the first 10 visits to a medical doctor psychiatrist if
they choose, but they cannot say that your total lifetime coverage is
any different than the coverage for the other more well-known and
longer defined physical ailments, and the same with the annual payment.
That is the bill I am sending, with my observations. This is for
Senator Wellstone and about eight other Senators who join me, and
Senator Moynihan joins now. I am asking Senator Kassebaum and Senator
Kennedy to hold hearings as soon as we come back in September, and I
believe they are going to.
That means we are going to bring this little bill out of that
committee, hopefully with their support, and we are going to present it
again, even in September, when we are trying to get out of here.
So for those in the business community who think they have seen the
last of this, just get those fellows ready for September so they will
have something to do around here.
Mr. DODD. Will my colleague yield?
Mr. DOMENICI. Yes, I yield.
Mr. DODD. Will you allow the Senator from Connecticut, the insurance
capital of this country, to be listed as a cosponsor?
Mr. DOMENICI. You have it.
Mr. KENNEDY. Will you be kind enough to include me as a cosponsor?
Mr. DOMENICI. Senator Kennedy, Senator Grassley, Senator Kassebaum, I
am delighted.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DOMENICI. Mr. President, I send the bill to the desk and ask it
be referred to the appropriate committee.
The PRESIDING OFFICER. Without objection, the bill will be received
and will be referred.
Mr. DOMENICI. I would be remiss if I did not thank a lot of Senators,
because many have been asked about this and many are going to support
this.
I want to say this is a great bill, the bill we are going to pass
today.
I just want to make one reminder again to those who oppose the bill
that I sent to the desk. There are some representing the business and
insurance who say they do not want any mandates. What is the bill we
are passing today? What is the bill we are passing today? Is it not a
mandate? Of course it is a mandate.
Let me tell you, nobody is even talking about the cost anymore
because it is so right. But it will cost a lot more than what that
little bill Domenici sent to the desk will cost. To spread the risk of
preexisting conditions is going to cost a lot of money, but we think it
is the right thing to do. Somehow they do too, the business community
and the insurance community. So let me now yield the floor and say, I
am very, very grateful for the chance to present this again, soon. And
I thank Senator Kassebaum for yielding me time.
The PRESIDING OFFICER. Who yields time?
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, I just want to join what I know is the
overwhelming number of Members here in saluting the Senator from New
Mexico as well as our good friend from Minnesota, Senator Wellstone. I
think many of us still remember the eloquence with which the Senator
made his impassioned plea when the Senate debated his amendment. He has
been committed and dedicated to the sensible and responsible health
policy that includes mental illness. And he is absolutely correct.
I look forward to working closely with the Chair, Senator Kassebaum,
to move that legislation out and look forward to standing side by side
with him as we hopefully will pass that legislation. I think he has
done a great service for the Senate. I join in commending him for his
eloquence, as well as Senator Wellstone. I see the Senator from West
Virginia, Senator Rockefeller. I yield the Senator 3 minutes.
The PRESIDING OFFICER. The Senator from West Virginia is recognized
for 3 minutes.
Mr. ROCKEFELLER. I thank the Senator from Massachusetts.
I just simply say this. This is not small, this legislation, Mr.
President. It is not universal health coverage, but it is going to
affect between 25 and 30 million Americans, and about 300,000 West
Virginians. And it is extraordinary that it is being done.
Usually, in the past, we have passed a bill or tried to, and then
failed. We have backed away from action. This year we did not. Because
of Senator Kassebaum and Senator Kennedy, we came forward and we took
on a hard job. And they did it. And they deserve enormous praise.
It means that I am going to be able to call Karen McPeak, who I spoke
with today. She and her husband have two children, two boys. They have
hepatitis and hemophilia. They were making $80,000 a year between them,
had two cars, a house, savings, the rest of it.
Because they could not get their two boys insured because they had
preexisting conditions, they went through their savings, they then lost
their house, they lost both their cars, they then gave up their jobs.
They went on Medicaid in order to take care of their two sons, all of
this because they are good parents. And that is the only way open to
them in the system today.
This bill will change forever what will happen with the McPeak
family. The children will be covered. The parents will be able to go
back to the life that they knew. This couple is only one of those in
West Virginia. And I rejoice along with them.
I close by simply saying this. I can report back to West Virginians
now that we have branded a preexisting condition something which
insurance companies will insure. The portability of health insurance
from one job to another is something which we will vote on and make the
law of the land.
I know there have been difficulties. I know there have been disputes.
But today I think it is important to celebrate what it is that we in
fact have actually done. And then tomorrow let us move on to the
broader field of universal health care coverage in one way or another.
But let us do that.
I have no way of expressing my respect to the Senator from
Massachusetts and the Senator from Kansas, both of them giants on this.
And America and West Virginia are better off. And I am very proud to be
associated with voting for this bill. I thank the senior Senator from
Massachusetts and yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. KENNEDY. I yield 3 minutes to the Senator from Connecticut.
The PRESIDING OFFICER. The Senator from Connecticut is recognized.
Mr. DODD. Thank you, Mr. President.
Mr. President, let me begin by quickly commending our colleague from
New Mexico, who has now left the floor. But
[[Page S9509]]
I just want to associate myself with his remarks and, as he mentioned
at the time, to become a cosponsor of his bill. And I deeply appreciate
his efforts and the efforts of Senator Wellstone on behalf of the
mentally ill in this country and their families.
I am sure I speak for many of our colleagues here when we commit to
him and others that worked so hard on this that this will be a
priority, and as the Senator from New Mexico stated so eloquently, it
will happen, and will pass. We regret that it is not happening today.
Second, Mr. President, while we are still a number of weeks away from
this Congress adjourning sine die, I want to use the opportunity here
today to say to our colleague from Kansas--and I do this with some
reluctance because I do not want her career to be placed in jeopardy by
having the general chairman of the Democratic National Committee
commending her too flowingly and put her in some jeopardy with her
constituency--but this is yet one more example of her leadership, this
piece of legislation.
It is entirely fitting and proper that, in fact, her name is so
closely associated with this bill, as it has been with so many pieces
of legislation over her career that have benefited so many millions of
people in this country and abroad. I am very proud of the fact that
this last day before we adjourn for several weeks that we are
completing a piece of legislation that bears her name, and that
millions of people, millions and millions of people, will be benefited
as a result of this effort.
Second, Mr. President, it is hard to mention the subject of health
care at any point over the last three decades and not mention the name
of the cosponsor of this bill. For more than 30 years every single
major effort, every single major effort that I can think of that
involved improving the quality of health care for Americans has borne
the name of Edward M. Kennedy.
It is certainly no accident that this piece of legislation bears his
name as well. It is not an abstraction, this effort. He knows painfully
with his own family and children how difficult these issues can be. I
am just proud that this body finally acted after so many months, months
that in my view should not have been wasted in dealing with an issue
that should have joined every Member of this body, regardless of party
and ideology, to support the simple propositions that people with
preexisting conditions, that people who lose jobs ought to be able to
carry with them the basic kind of health care that would relieve them
and their families of the stark fear of being caught in the cracks, of
being uncovered, at the time of a medical crisis.
It was 31 years ago, Mr. President, that Medicare became the law of
the land. Obviously, that piece of legislation was in many ways far
more comprehensive than the Kassebaum-Kennedy legislation. But there is
a similarity between these two proposals and bills. By the stroke of a
pen, Lyndon Baines Johnson, on that day in 1965, by the stroke of a
pen, he literally placed millions and millions of people beyond the
fear of a health care crisis. The mere stoke of his pen enfranchised
millions of people and protected them from health care crises.
Today when we pass this bill--and within days or hours, I hope, the
President of the United States, President Clinton, who has been such a
strong supporter of this effort, will sign this legislation into law,
and 25 million Americans immediately will be protected, immediately
protected. There is no requirement that we go through a lot of agency
activity and bureaucracy and regulations. But merely by passing this
law and signing his name, we will relieve the fear and burden for 25
million Americans. And for that I say, a deep sense of thank you to
Senators Kassebaum and Kennedy for their efforts and their battle.
Thank you.
Mrs. KASSEBAUM. Mr. President, I very much appreciate the thoughtful
comments of the Senator from Connecticut who has been a very dedicated
member of the Labor Committee, who has worked to get this accomplished
from the very beginning. I appreciate his valuable support and efforts.
I now yield 3 minutes to the Senator from Wyoming, Senator Simpson.
The PRESIDING OFFICER. The Senator from Wyoming is recognized for 3
minutes.
Mr. SIMPSON. Mr. President, I thank my colleague from Kansas who came
here when I did. We exit together as we entered together. It has been a
great privilege to serve with this remarkable woman and see the
legislative history that she leaves; and my friend from Massachusetts,
too, who I have enjoyed thoroughly in my time here, even though
certainly there are times when he tests every bit of my patience, and
on more than many occasions. But I will miss him, too. I commend them
both.
I just want to briefly follow up on the comments of the Senator from
New Mexico. I had made some comments yesterday about my disappointment
with one aspect of this conference report. We have had such a
productive week here, and on so many things. But I do feel a sense of
real hollowness over the failure to include even some modest version of
the mental health parity in this bill.
I am a cosponsor and I spoke on the bill originally when it passed
here 68-30, a sweeping definition there, when it was approved. Senators
Domenici and Wellstone worked doggedly trying to assure that at least
some limited form of that amendment came through this process. It had
been my privilege to assist them in that cause. They have worked very
hard.
The events of the last few days show again that the wall of
discrimination against the mentally ill is very real. It is still too
powerful for any of us to overcome, apparently. That is a very sobering
fact.
I know my colleagues will not give up this fight, none of us will,
even though this singular battle has been lost. I pledge I will
continue to assist them. There is a great deal of work to be done in
educating and enlightening the American people on the realities of
mental illness.
It is troubling and disturbing to me that there still continues to be
this stigma associated with mental illness. The unspoken message here
is that people afflicted with mental illness are somehow not as worthy
of treatment as those afflicted with cancer or heart disease or other
physical ailments. No one in this Chamber would consciously ever say
such a thing, but this is the message we are sending through our
actions.
That is why it is so important for this Congress to revisit this
important issue. We should certainly not let this bill and its silence
with respect to mental health be any kind of final word on this issue.
We will revisit this one in September.
I commend my colleague from New Mexico, and again thank Senator
Kassebaum and Senator Kennedy for this remarkable work product which we
all deeply appreciate.
Mr. KENNEDY. Mr. President, how much time remains?
The PRESIDING OFFICER. The Senator has 5 minutes and 19 seconds.
Mr. KENNEDY. I yield 3 minutes to the Senator.
Mr. CONRAD. I thank the Chair.
Kennedy-Kassebaum--what a team. What an achievement--25 million
people protected because, working together in a bipartisan way, they
have broken the gridlock here in Washington.
Nancy Kassebaum, who always exhibits grace, civility, and decency,
and Ted Kennedy, an absolute lion in this Chamber on whatever issue he
decides to weigh in on, thank goodness they weighed in on these issues
of portability, so the people, when they change jobs, can take their
health insurance policy with them. And preexisting conditions--millions
of Americans will no longer be precluded from coverage because of a
preexisting condition. This Senate should thank you both. America
should thank you both.
I would be remiss if I did not register disappointment, as well,
because we did pass on the floor of the U.S. Senate by a vote of 68 to
30, a sweeping change, to say that those who suffer from mental illness
will not be discriminated against. A mental illness should be treated
the same way as a physical illness.
Mr. President, 68 to 30, this Senate spoke with their votes and said,
``No more discrimination.'' Yet, when we look at what came back from
conference, through no fault of the Senator from Massachusetts and
through no fault of the Senator from Kansas, what came back from the
conference
[[Page S9510]]
committee on mental health is the square root of zero--nothing, not
even the most modest achievement, not even the most modest advancement.
I am very pleased to join Senator Domenici and Senator Wellstone in
cosponsoring a bill that seeks to address this question when we return
in the fall. Let me just say again, Senator Kennedy and Senator
Kassebaum, I am confident, will be lions in that effort, as well.
I thank the Chair. I yield the floor.
Ms. MIKULSKI. Mr. President, I rise in strong support of the Health
Insurance Reform Act. There are three reasons why I support this bill.
It makes health insurance portable--people can take it with them from
job to job. It provides health insurance to people with preexisting
medical conditions. And it makes health insurance more available to
working Americans. I am pleased to vote for this bill.
Health insurance is a priority for Maryland's families. It's a top
priority for me. I strongly support this commonsense health insurance
reform. It's a safety net for working Americans and their families.
This bill ends ``job lock.'' Working Americans won't be afraid to
change jobs. They no longer have to fear that they'll lose their health
insurance coverage if they do.
I know a mother in Baltimore who supports her family in a
manufacturing job. Her husband stays home and cares for their disabled
child. She has been offered a higher paying job. But she can't take it.
I think that's outrageous. She knows if she changes jobs that her son
will lose the health coverage he so desperately needs. This bill is
good news for people like her. She could make that job change under
this bill.
This bill helps people who have preexisting medical conditions. They
won't be penalized any longer by insurance companies. They can now get
health insurance if they have a disease like diabetes. I am pleased
that the bill has the potential to help millions of women and their
families. The legislation will help a woman who starts a new job with
an employer who provides health insurance.
Under the Health Insurance Reform Act, a woman or her family can't be
denied insurance coverage. She and her family can't be denied coverage
for a preexisting condition. A woman who is pregnant will get immediate
coverage for pregnancy care even if she is already pregnant. Her
newborn or adopted child will also receive health insurance coverage.
This just isn't good for families. It makes good business sense.
The bill makes health insurance more available to working Americans.
It goes along way to eliminating barriers to coverage. There are more
than 40 million Americans without health insurance. More than 1 million
working Americans lost their insurance over the last 2 years. Workers
who are self-employed will be able to take a greater tax deduction for
health expenses. It treats long-term care expenses as medical expenses
for the purposes of tax deductibility. This bill helps those who
practice self-help.
I was disappointed that we were not able to enact comprehensive
health insurance reform. After that debate came to a close, I pledged
to continue the fight to reform health care--day after day and month
after month. This is an important first step in that direction. I thank
my colleagues Senator Kassebaum and Senator Kennedy for their hard work
in bringing us this far. But didn't get here without tremendous
struggle.
Despite broad bipartisan support, this bill has been held up for
weeks and months. But we persevered. I wanted to get this bill passed
this year. And now we have done that. We have won the day. And helped
many Americans gain accessibility and portability to health insurance
coverage.
There is much more that I would like to be able to do to make
insurance coverage affordable, accessible, portable and undeniable. I
would like to see coverage for long-term care. I would like to see a
comprehensive benefit package for women and children. But this is a
very important step. We have a tremendous opportunity to improve the
lives ofmany Americans. I am pleased to support this bill.
Mr. PELL. Mr. President, I am delighted that the Senate will today
approve the conference agreement on S. 1028, the Health Insurance
Reform Act. Since the House of Representatives has already acted
favorably on this legislation, it will be only days before President
Clinton can sign this important legislation into law. This new law will
have been a very long time in coming.
We need not review the circuitous path that these health reforms have
taken since the Clinton administration took over in 1993. But I believe
it is fair to say that even these limited reforms could never have
happened without the leadership of the President and First Lady, who
brought into virtually every American home their passionate and
persuasive pleas to reform our Nation's health care system. And without
effective and devoted legislative warriors, led over the decades by
Senator Kennedy and joined in recent years by our distinguished
Chairwoman, Senator Kassebaum, I believe that we would not be here
today passing this bill.
Mr. President, as my 36 years on the Senate Labor and Human Resources
Committee draw to an end, I could not be more pleased that we will
finally see the fruition of so many years of work on health insurance
reform issues. The bill before us will correct many of the flaws of our
current system, including enhancing portability of insurance from job
to job, and limiting the current practice of permitting exclusions for
preexisting medical conditions. But, as I have said many times before,
this bill does not accomplish many other things that need to be done.
Most notably, the bill does nothing to make insurance more affordable
to people who need it, including those with preexisting medical
conditions. Just today, I got a phone call from a constituent from
Pawtucket, RI, who has a thyroid condition and who wants to know
whether under this legislation, her insurer will be able to charge her
more. I regret very much that I will have to tell her that her insurers
can, indeed, charge her more. And I regret very much that I will have
to report to the many Rhode Islanders who support the Domenici-
Wellstone mental health parity provision that opposing forces prevailed
in deleting this provision from the conference agreement.
Health care reform being the lightning rod issue that it is, I
recognize--and I hope that the American people recognize--that while
this bill represents only incremental change, it is an important step
forward. We all know that much, much more needs to be done if every
American is to have access to high quality, affordable health care. And
I hope that my colleagues who will remain in the Senate and that those
who succeed me will take up the challenge as early as possible in the
next Congress.
In the meantime, Mr. President, I want to thank all of my colleagues
on the Senate Labor and Human Resources Committee, who approved this
bill unanimously just 1 year ago. And I would like to take this
opportunity to thank the many committee staffers who assisted us so
ably in crafting this important legislation. I offer a special tip of
the hat to Senator Kennedy's senior health adviser, David Nexon, who
has been of such great assistance to me and to my staff over these many
years.
I look forward to voting for this legislation and even more, to its
becoming law.
Mr. COHEN. Mr. President, in the spring of 1995, the Medicare
trustees, on a bipartisan basis, issued an urgent warning that the
Medicare hospital trust fund will go broke by the year 2002, unless
major changes are made to protect the system. Since that alarm was
sounded, the Congress has been wrestling with ways to bring Medicare
spending under control, in order to forestall impending bankruptcy and
to strengthen Medicare for both current and future beneficiaries. This
year the situation is even more critical. The 1996 trustees' report
projects bankruptcy for the trust fund by the year 2001.
I stated at the time of the trustees warning that, at a minimum, we
should pass legislation to crack down on the fraud and abuse that
drives up the costs of health care for senior citizens and taxpayers.
Estimates are that Medicare loses over $18 billion each year to fraud
and abuse, and that fraudulent schemes cost the entire health care
system and our economy as much as $100 billion each year.
Today, we are reaching a historic milestone by passing one of the
most comprehensive and tough anti-fraud
[[Page S9511]]
packages ever contemplated by Congress. It has been a long road--over 3
years to be exact--but as the author of the antifraud and abuse
provisions I am proud that this Congress, in a bipartisan way, did the
right thing.
Specifically, my proposal creates tough new criminal statutes to help
prosecutors pursue health care fraud more swiftly and efficiently,
increases fines and penalties for billing Medicare and Medicaid for
unnecessary services, over billing, and for other frauds against these
and all Federal health care programs, and makes it easier to kick
fraudulent providers out of the Medicare and Medicaid program, so they
do not continue to rip off the system. Most importantly, the bill
establishes an antifraud and abuse program to coordinate Federal and
State efforts against health care fraud, and substantially increases
funding for investigative efforts, auditors, and prosecutors.
In early 1993, I first embarked upon writing an antifraud bill. This
was based on the recommendations of a health care fraud task force set
up by the Bush administration and on an investigation by the Senate
Special Committee on Aging, which I chair. That legislation became the
basis for the fraud and abuse section of all the Republican health care
reform bills proposed in 1993 and 1994 as well as for the
administration's proposal. It was one of the few truly bipartisan
issues contemplated during that contentious debate. In late 1993, the
criminal provisions of my bill passed the Senate unanimously as part of
the crime bill but were deleted during conference. Last year, my
proposal passed Congress as part of the budget reconciliation bill and
were also used as framework by the administration in its budget
reconciliation proposal. As we all know, the President vetoed that
bill. Today, it stands as an integral part of the Kassebaum-Kennedy
health insurance reform proposal, finally on its way to the President
for signature.
Health care fraud is an equal opportunity employer that does not
discriminate against any part of the system. All Government health care
programs--Medicare, Medicaid, CHAMPUS, and other Federal and State
health plans, as well as private sector health plans, are ravaged by
fraud and abuse.
Similarly, no one type of health care provider or provider group
corners the market on health care fraud. Scams against the system run
the gamut from small companies or practitioners who occasionally pad
their Medicare billings because they know they'll never get caught, to
large criminal organizations that systematically steal millions of
dollars from Medicare, Medicaid, and other insurers. According to the
FBI, health care fraud is growing much faster than law enforcement ever
anticipated, and even cocaine distributors are switching from drug
dealing to health care fraud schemes because the chances of being
caught are so small--and the profits so big.
The inspector general of the Department of Health and Human Services,
for example, has cited problems in home health care, nursing home, and
medical supplier industries as significant trends in Medicare and
Medicaid fraud and abuse. Padding claims and cost reports, charging the
Government and patients outrageous prices for unbundled services, and
billing Medicare for costs that have nothing to do with patient care
are just a few of the schemes that are occurring in these industries.
It is time that we crack down--and shut down--these schemes that are
bilking billions of dollars from Medicare and other health care
programs. If we have asked honest health care providers to take cuts in
reimbursement and asked Medicare and Medicaid recipients to pay more
out-of-pocket costs to bring spending under control, we have an
absolute duty to ensure the American public that their health care
dollars are not lining the pockets of criminals and greedy providers
who are manipulating the system through fraud and abuse.
The proponents of strong anti-fraud proposals responded to a mandate
from beneficiaries that we need to control spending and ease the burden
on taxpayers. The anti-fraud provisions in the Kassebaum-Kennedy bill
did precisely that in a reasonable, measured manner that did not
infringe on personal liberties nor penalize innocent mistakes.
The fraud provisions substantially mirror existing fraud statutes and
are designed to give enforcement more precise tools to protect
consumers against fraud and abuse. The proposal simply provides
adequate resources for prosecutors and investigators, long strapped by
budget cuts and under staffing, to go after serious patterns and cases
of abuse. The bill closes loopholes in current law and provides
criminal penalties for a defined set of serious and egregious
violations, such as embezzlement and misappropriation of assets.
Prosecutors would continue to have an extremely high burden to prove
that the violations were committed knowingly and willfully.
Despite such a reasoned approach, we were inundated at the last
moment by scare tactics and blatant mischaracterizations. There were
full page ads depicting a doctor shackled in stocks claiming that
doctors would land in jail for committing honest mistakes. There were
editorials that grossly distorted the intent and scope of the
provisions in a fashion that minimized the very real threat that fraud
poses to our health care system and, indeed, to the solvency of
Medicare. I am sympathetic to the concerns of physicians and other
health care providers that the practice of medicine has become
excessively regulated. I also believe that physicians raise legitimate
concerns that too often managed care plans manage costs alone at the
expense of quality of care for patients and unduly limit physicians'
decisions on how to best treat their patients. To blame all of these
trends on the health care fraud provisions, particularly at the last
stage in the negotiation process, was misguided and inaccurate. I am
proud that my Republican and Democratic colleagues were not intimidated
by these falsehoods and proceeded on a straight path to passing strong
legislation.
As the author of these provisions, and as someone who has been
involved in the negotiations of these provisions over a 3-year span,
there are a couple of issues I wish to clarify as we debate final
passage of the conference report.
First, the fraud and abuse control program established in the bill
contemplates increased collaboration between the Department of Justice
and the Office of the Inspector General [OIG] in health care law
enforcement. It was not my intention, however, to expand the legal
responsibility of the Office of Inspector General to private health
plans. The jurisdiction of the OIG remains as it exists today, with
only those augmentations of its authority specifically authorized in
the bill.
Second, it was my intention that the costs covered by the funds
appropriated to the Federal Bureau of Investigation provided for in the
mandatory appropriation section include those associated with the
hiring of additional agents and support resources as supplemental
funding to address the burgeoning health care fraud problem.
Third, the moneys from the control account which are directed to the
Office of the Inspector General are primarily intended to increase the
ability of that office to investigate health care fraud and ensure that
Medicare funds are properly spent. If the Office of the Inspector
General is assigned the duty of preparing the advisory opinions, I
would expect the Secretary and the Attorney General to consider a
specific grant of funds for this purpose from any discretionary moneys
in the control account as an addition to the amounts already available
to the OIG. We would not want to see a reduction in the effort to
investigate fraud, in order to provide staff for the advisory opinion
function.
Finally, as the author of the original enhanced guidance to providers
section, I would like to make some affirmative and declarative
statements on the actual advisory opinion language. Although advisory
opinions are an appropriate means of giving guidance to the industry on
some issues, it is clearly unwise to have the agencies in the position
of opining on the intent of the person requesting the opinion. To have
a Government agency make an independent determination of what is in
someone's head, based solely upon what that person chooses to tell the
agency, is a highly questionable Government function.
That is why I want it clearly stated for the record of debate what
has been
[[Page S9512]]
stated during conference and indeed what has been stated by advisory
opinion proponents for the last 3 years that this issue has been
debated. Advisory opinion advocates have stated definitively and
consistently in conference and during many lengthy negotiations that
the advisory opinion provision does not require a finding of intent.
Not only do I adhere to that view, I will do everything possible to
ensure while I am still here, and while this provision will be reviewed
prior to implementation by the agencies, that such an expectation is
followed. I will also ensure that after I am gone those who have
oversight authority here in Congress, and those who are in the
leadership, make sure that such an expectation is followed.
I know that the Attorney General has spoken to the Speaker of the
House, the Senate Majority Leader, the chairmen of the House and Senate
Judiciary Committees as well as numerous members of the Ways and Means
Committee and Finance Committee about her concerns relating to the
issuance of advisory opinions. None of the existing advisory
opinion mechanisms available to the Federal Government require an
independent determination of intent. To reiterate, statements were made
by the conferees that this was the expectation here as well. I,
therefore, expect the agencies to design a process for advisory
opinions which does not require such a determination. I also expect
that this advisory opinion process will sunset 4 years after the date
of enactment of this bill as is required by the bill.
Mr. President, in conclusion, I would like to applaud members for
this major antifraud victory. According to the Congressional Budget
Office, these provisions will yield billions in scorable savings. I am
convinced that the long-term savings are much greater, and that
billions more will be saved once dishonest providers realize that we
are cracking down on fraud, and that they can no longer get away with
illegally padding their bills to pad their own pockets. For years, I
have been saying that Federal law enforcement often feel like the mouse
has outsmarted the mousetrap, because they lack adequate tools and
resources to penalize egregious cases of fraud. While I know that this
bill does not solve this enormous and complicated problem, I can state
today that the mousetrap has sprung.
I would like to thank Senators Roth and Dole, for all of their
steadfast support and assistance over the years; Alec Vachon of the
Finance Committee and Harry Damelin of the Permanent Subcommittee on
Investigations, for all their hard work and perseverance; Sue Nestor,
formerly of the Finance Committee, for all her hard work before she
left the Senate; and Helen Albert, Mary Gerwin, and Priscilla Hanley,
of my staff, for their dedication to passage of this important
legislation.
mental health parity
Mr. INOUYE. Mr. President, when we in the Senate unanimously passed
the health insurance reform bill in April, we included an amendment
offered by Senators Domenici and Wellstone that provided for parity
coverage for mental health services.
I was proud of our vote. We did the right thing by ensuring that
persons who suffer mental illness are treated fairly by insurance
companies.
The conferees stripped the Domenici-Wellstone amendment out of the
bill. However, by our April vote, this Chamber made a commitment to
fairness in insurance coverage for persons with mental illness.
The health insurance reform bill is about fairness. Just as the bill
now prevents insurers from dropping people's coverage when they change
jobs or for other reasons, the bill should also have prevented insurers
from discriminating against persons suffering mental illness. Leaving
the Domenici-Wellstone mental health parity amendment out of the bill
is wrong.
I know that the business and insurance communities raised some
concerns about the cost and impact of the Domenici-Wellstone amendment
with the conferees. I also know that Senators Domenici and Wellstone
answered every concern raised.
While I view the CBO estimate for the cost of the original amendment
as extremely reasonable, I understand that Senators Domenici and
Wellstone offered a compromise to the conferees that would have
provided parity coverage only for annual and lifetime caps.
This compromise slashed the cost of the original amendment by 90
percent. CBO determined that the compromise would increase private
insurance premiums by four-tenths of 1 percent, of which employers
would pay only sixteen one-hundredths of 1 percent.
My fellow colleagues, these figures are so low, that employers could
meet this slight premium increase by raising their deductible by a mere
$5 per year.
I understand that insurance and business interests also raised
concerns about the loss of workers' insurance due to the compromises'
cost. Considering CBO's extremely low cost estimate, no one could
possibly contend that passage of the compromise would cause workers to
lose their insurance.
The compromise went even further. It permitted businesses to deliver
mental health services through ``carveout'' arrangements and to adjust
deductibles, copayments, and visit limits for mental health services as
they saw fit. Small businesses would have been completely exempt from
the parity standard.
I believe that Senators Domenici and Wellstone should be commended
for developing a compromise that the conferees should have accepted.
Now, we have made a promise to persons suffering mental illness in
this country. We have promised they will treated fairly, just as this
bill promises fairer health care coverage for other Americans.
I will personally join with Senators Domenici and Wellstone to ensure
that we make good on our promise.
Mr. GREGG. Mr. President, to our citizens outside of the beltway,
Washington politics seem to be the cause of all that ails us. The
disease is easy to diagnose: Washington politics getting in the way of
real cures. However, I am pleased to stand up today and say that
maybe--just maybe--the games have paused as Congress finally passes
this incremental step in health care reform.
Health care reform. Three words that have become part of many's
vocabulary over the last 3\1/2\ years. Obviously, health care reform
efforts have been going on since the delivery of health care became
something of an organized system. But Federal health care reform has
never seemed so necessary as it has in the past few years, and so
viable as it is right now, for two critical reasons.
First--because the American public has been bombarded with rhetoric
about all of the things that are wrong with their health care system.
Obviously, the U.S. health care system is not without flaws, but I
think it is important that the treatment not be worse than the
ailments. The ``shot in the arm'' posed by the Administration during
the 103rd Congress in 1993 and 1994 was roundly rejected by the
American public. The Health Security Act, drafted by the First Lady and
her team of elite health care reform gurus, was 1,342 pages of promises
for ``universal coverage'' for American citizens under a federal
program of limited mandated benefits, price controls and tax increases.
The tome sent up to Capitol Hill prescribed that centralized
bureaucracies run this national program, that the Federal Government
regulate medical schools, and that Washington decide what
pharmaceuticals and medical procedures would be paid for.
This proposal would have resulted in a further disconnect between the
patient and the payer. We have seen through other Federal programs that
separating those making demands on the system from those paying for the
care ends up both driving up costs and limiting the availability of
services. This is not what the American public had in mind as it got
involved in asking Washington for positive change in federal policies.
Once the glitter and hype was peeled away, Americans realized
this proposal meant no choice in benefits or providers, higher taxes to
generate revenue that would be shifted to pay for business subsidies
and the like, and the inevitable result of government rationing of
health care services. After a year of intense debate, the Health
Security Act died a painful, but appropriate, death.
Second, having determined during the debate over President Clinton's
Health Security Act what the American public does not want, we were
given the opportunity to provide the people with what they do need. And
what they need is the Health Insurance
[[Page S9513]]
Portability and Accountability Act of 1996--the legislation that has
become known as the Kassebaum-Kennedy bill.
This legislation grew out of the testimony that was heard in
countless Senate hearings on health care reform. It grew out of the
recognition that some basic flaws in the regulation of health care
caused American families monumental problems: workers are unable to
carry their health insurance from one job to the next--portability.
Individuals are subject to unfair discrimination in their access to
health insurance if they have a medical condition that has required
treatment before they joined that health plan.
These are simple, clear concepts. We know how to address them.
However, we also know that it took us 3 years of policy development to
get to the point where there was a bill that was appropriate in scope,
and met the majority of needs our constituents told us they had. A long
and arduous process had resulted in legislation that also obtained
support from our Democratic colleagues--it looks as though we are close
to allowing policy to triumph over politics.
This legislation was further improved with cultivation. During
consideration of the bill on the Floor of the Senate, Members decided
to act on some other ideas that had been long discussed as part of
health care reform on both sides of the aisle. Medical savings accounts
are not a new idea. More favorable tax treatment of long term care
insurance is not a new idea. Increasing the self-employed tax deduction
to 80% to provide equity is not a new idea. But these are all important
ideas, that have received support on both sides of the aisle during the
last several years of debate.
Why are important aspects of health insurance reform like MSA's
suddenly so controversial? Because once again Washington politics got
in the way of good policy work. Some Washington politicians have
decided it is more important to score a political victory than to pass
the type of health care policy that the American public wants: policy
based on freedom of choice; policy that ends discrimination and
promotes fairness and equity; and policy that forges a stronger
relationship between patients, their physicians, and those who are
payers for medical services, whether that payer be the individual
controlling their own health care dollar, the Government, or an insurer
who has offered a plan tailored to best meet the consumers' needs.
Mr. President, I believe that through a great investment of time and
a tremendous amount of research we have found a cure for a great deal
of what ails the American health care insurance system, and American
citizens can begin to benefit from these long sought after changes to
the health care system in the United States.
Mr. ROCKEFELLER. Mr. President, today hope is restored as we turn the
desire for health care reform into reality. When the Kassebaum-Kennedy
bill is signed into law, which will happen very soon, some of the most
maddening, often cruel problems with America's health care system will
begin to get fixed.
When you look at all the hard work that went into getting this bill
hammered out and on the brink of enactment, we could fill Olympic
Stadium with the people who deserve some of the credit. But two
individuals win the health reform gold medals in achieving this victory
for millions and millions of Americans. The senior Senators from Kansas
and Massachusetts have been true champions in leading what turned into
a legislative marathon for health care reform. On behalf of the people
of my State, and from my own heart, I thank both colleagues for their
incredible feat.
Over the past few years, Americans had every reason to wonder if
Congress would ever be capable of doing anything ever again about the
health care problems that cause them so much pain. When the fight for
comprehensive health reform failed, it was hard to see how we could
ever get out of the ditch of partisan politics, special interests, and
fear that did us in.
But while plenty of special interests and politicians wanted health
care reform to die, millions of Americans were still waiting
desperately for something to be done.
The Senators from Kansas and Massachusetts realized that we had to
take a different tack. We had to target just a few of the most serious
problems in the health care system, and offer solutions that made
obvious sense.
It took persistence, patience, cooperation, and compassion to get
this bill to this point today. With this legislation, millions of
Americans will be able to get the health insurance they desperately
want and need--or I should say that this will happen soon, since one of
the compromises was that the insurance reforms won't be effective until
July of next year.
When that date is reached, the rules will change. Working Americans
will be freed from the trap that locks them into jobs and situations
solely because a change will mean losing their health insurance.
Preexisting conditions will no longer mean an endless nightmare for the
millions of children and adults who have some illness or medical
problem that's the very reason they need health care. Small employers
won't be shut out from the health insurance marketplace.
When I talk about the Kassebaum-Kennedy bill, I can picture the West
Virginians--parents, children, small business owners, health care
professionals--who have begged for help.
Now, I can report back to the West Virginian who shared his agony
over not being able to get coverage for his cancer, because it was
branded a pre-existing condition, that the law will soon require an
insurance company to sell him that coverage. Now, I can send word to
West Virginians who want to switch jobs, move to a different community,
or even start their own business that they can hold onto their health
insurance while they pursue any of these goals for themselves and their
families.
And most importantly, now I can tell all West Virginians, and we can
tell all Americans, that health care reform is not dead, it's not code
for gridlock, and it's not a pipedream.
The Kassebaum-Kennedy bill also represents the art and necessity of
compromise. Some proposals that would have helped numerous families
were dropped, because opposition just couldn't be overcome.
And one proposal, to open the door for medical savings accounts,
worries me. It is labeled a ``demonstration,'' and I just hope that
Congress will be honest and responsible about taking a true look at how
people do when they turn from conventional insurance to tax breaks and
catastrophic-only coverage. I know that most people don't plan on
getting sick or having an accident or developing a serious disease, and
I fear that an MSA will go from being a financial benefit into an
overwhelming burden for many Americans when the unexpected happens.
But I also know that we won't achieve any positive health reforms
without making concessions. And the work will always be difficult.
There are too many insurance companies that want to chase after healthy
customers, and avoid the sick. There will always be ideology that gets
in the way of telling the private sector to do anything differently, no
matter how many families are hurting. There will always be fear of the
unknown, no matter how many problems exist in the present.
Today, however, let's celebrate what is getting done. And then
tomorrow, let's move on to the next round of health care reform. Today,
let's thank Senator Kassebaum and Senator Kennedy for their gift to at
least 25 million Americans, and many thousands of West Virginians. And
then tomorrow, let's be inspired by their leadership to get even more
done for millions more who still suffer because they can't get or
afford decent health care.
Ms. MOSELEY-BRAUN. Mr. President, 3 years ago, this Senate blocked
attempts to act on comprehensive health care reform. While that year's
effort to achieve the major reforms that are so needed and so long
overdue did not succeed, the problems that led the President to make
that proposal have not disappeared. Far from it.
As a nation, we spend 15 percent of our gross domestic product on
health care, over $1 trillion. No other industrialized nation spends
more than 10 percent of their GDP and the gap is widening. Yet today,
there are over 40 million Americans without health insurance, and over
23 million of those Americans are employed. Over 1 million working
Americans have lost health care coverage over the past 2
[[Page S9514]]
years. And 60 percent or more of all Americans worry about losing their
current health insurance coverage. The case for reform, therefore, is
perhaps even more compelling now than it was 3 years ago.
I am proud that today the Senate is taking a significant step toward
reforming the health care system. The Kassebaum-Kennedy Health
Insurance Reform Act is not the panacea for our health problems, but it
does represent progress. It is an important step in the right
direction.
This bill has many good features. Perhaps the most important is the
limits on exclusions for preexisting conditions. This bill says that no
one can be denied health insurance coverage for more than 1 year due to
a medical condition. If there is any concern which every person has
about health insurance, it is the ``trap'' of preexisting conditions.
All too often, individuals find themselves excluded from coverage
because of a preexisting condition. Some 81 million Americans have
preexisting conditions that could affect their insurability. And more
than half of all American workers are enrolled in health insurance
plans that impose some form of preexisting condition exclusion. When
you consider that most Americans will have seven or more jobs in the
course of their working life, the preexisting condition problem affects
virtually every American family. The General Accounting Office [GAO]
estimates that 21 million Americans will be helped by the limits on
exclusions for preexisting conditions included in this health care
bill.
In my own State of Illinois, almost 8 million people have private
health insurance and almost 2 million are uninsured. This bill will
make a critical difference in their lives, and in the lives of
similarly situated people all across the Nation.
This bill also includes portability provisions which will end ``job
lock'' by making health coverage portable between jobs. For Americans
who might want to leave their jobs to start their own businesses--or
who might have to leave their jobs because of corporate restructuring--
but who might have a preexisting condition or a family medical history
that would currently make it difficult to impossible for them to
purchase an individual health policy, this bill will make a huge
difference. It will guarantee their access to health insurance.
Families with a small child suffering serious health problems will no
longer face the prospect of being unable to obtain health insurance if
the parents change jobs. It is tough enough for families to deal with a
serious health problem affecting one of their children without having
to face the additional problem of losing access to health insurance if
they are laid off, restructured out of their jobs, or want to change
jobs for new or better paying jobs.
Similarly, this bill will guarantee that small businesses with only a
few employees will not lose their group health coverage because one of
their employees develops a serious health problem, as is the case now.
Moreover, it will help make health insurance more affordable for those
small groups, making it more likely that more small businesses will
provide health insurance benefits for their employees. Furthermore, the
increase in the deductibility of health insurance expenses from 30
percent to 80 percent for self-employed individuals will make health
insurance more affordable for those thousands of people who operate
their own businesses.
I am also pleased that members have been able to reach a bipartisan
agreement on medical savings accounts [MSA]. Issues surrounding the
availability of MSAs have held up movement on this important
legislation too long. The compromise provision would provide many small
businesses and self-employed individuals access to more affordable
health insurance options. The MSA options will provide valuable
information as to the impact of broader scale high-deductible health
plans on cost control and general insurability.
The Health Insurance Reform Act represents a practical, caring
attempt to deal with the real health care problems facing so many
Americans, based on their everyday realities. This bill is all about
incremental reform--but nonetheless real reform. It will help virtually
every working American, as well as millions of Americans who are
temporarily out of the work force. And it will work because it is based
on what is actually going on in the world of people who need health
care.
It's worth thinking a bit about those everyday realities of life.
Statistics tell us that the average American works at a job about 4\1/
2\ years. As I stated earlier, over the course of a working career, an
average American working person could hold seven or more jobs. That
fact alone makes it all too clear just how important it is for
Americans to have portable health care coverage. And that fact alone is
a good indication of how necessary it is to end preexisting condition
restrictions that result in Americans having to pay enormous sums for
new health care policies, losing access to health insurance altogether,
or having to avoid--at virtually all costs--changing jobs in order to
retain affordable health care.
Access to affordable health care is no less important to the American
people than pension planning, not only because Americans can't enjoy
their retirement if they are in poor health, but because they face
being bankrupted by health care costs if they are not able to retain
access to affordable health insurance. Being able to roll over
insurance coverage, therefore, is just as important as being able to
roll over pension savings. Maintaining health security, therefore,
deserves the same level of attention we give retirement security, any
measures that protect and enhance that health security deserve the same
kind of consensus support.
Facing the loss of health insurance is a debilitating fear for all
too many Americans, and without reform, it is all too great a risk for
every American. This bill will end that fear, and it does so in a
manner that makes sense and will work. It is far from the total answer
to our health problems, but I do not think we should underestimate the
importance we will be achieving once this bill becomes law.
I want to conclude by congratulating the chairman of the Labor and
Human Resources, Senator Kassebaum, and the ranking democratic member
of that committee, Senator Kennedy, for their leadership and for all
the hard work they have put in to bring the bill to this point. I want
to particularly congratulate them for the bipartisanship they displayed
in putting this bill together.
Mr. DASCHLE. Mr. President, I am delighted to cast my vote for this
bill--it is an important first step in ensuring health security for
working Americans.
Health security has always been, and always will be, a Democratic
priority. It is at the top of our agenda, and we won't give up until
every American has access to meaningful, affordable coverage.
Unfortunately, even this small step was controversial.
Senator Dole promised 2 years ago that health reform would be the
first thing Republicans would focus on if they controlled Congress. As
it turns out, health reform was nearly the last thing they focused on.
And only because we insisted they finally act.
This bill was approved unanimously in the Senate Labor Committee
exactly 1 year ago on August 2, 1995. But for 8 months, secret
Republican ``holds'' delayed it.
When the bill finally reached the Senate floor on April 18 1996, the
Republican leadership tried to attach to the bill poison pills, like
MSA's to kill it. Then, 4 more months passed as the Republican
leadership tried to stack the conference committee to ensure that MSA's
were included in the final bill.
In the meantime, the Republican leadership tried to water down the
bill's portability provisions to guarantee that health insurance can be
carried from job to job. But they did not succeed.
I am delighted and relieved these ``delay and destroy'' tactics were
finally abandoned and that Republicans joined us in fixing the most
badly broken parts of health system. Make no mistake--this bill is
badly needed.
One Republican Senator told the Washington Post last year that
``Health care is not very bright on anybody's radar screen, if it shows
up at all.'' That's not what I hear in South Dakota and across the
country. This issue is still very much on the minds of Americans.
When health reform failed in 1994, Americans' problems securing
coverage
[[Page S9515]]
didn't go away. The problems fueling the health care and insurance
crisis still exist today. Forty million people are without insurance,
and insurance remains prohibitively expensive for far too many people.
The public expects and wants us to tackle this issue.
The bill before us breathed new life into health reform efforts.
Still, it does not come close to solving all our health care problems--
it is a modest, incremental downpayment on reform.
But this bill does deal with one of the most pressing problems in our
system--portability. Indeed, GAO says this legislation could help up to
25 million Americans each year, at no cost to taxpayers. This bill
gives workers dismissed from their jobs or looking for better jobs
peace of mind.
This bill means that never again will fear of losing their insurance
trap people in their jobs.
Still, passage of this bill is the beginning of the debate, not the
end of it.
Every single day in this country, 60,000 people lose their health
insurance. Unfortunately, only a small fraction of that group will be
helped by this legislation. We must do more to provide real health
security to every American.
As we celebrate this bill's passage, let us pledge to tackle even
more difficult issues. We must ensure that every child has health
coverage. We must eliminate barriers to pregnant women getting prenatal
care. We must make coverage more affordable for small businesses. We
must ensure every child is immunized appropriately. We must end cherry
picking by insurance companies. We must ensure rural Americans have the
same access to quality care their urban neighbors enjoy.
In sum, we must guarantee every American access to affordable,
quality coverage. This will be on the top of the Democrats' agenda in
the next Congress.
Despite its limitations, this is an important bill. It's a victory
for the President, who put this issue on our collective radar screens.
It's a victory for Senators Kennedy and Kassebaum, who worked so hard
to make this happen. It's a victory for Democrats, who consider this a
priority item.
Most importantly, it's a victory for America's working families.
Mr. KERRY. Mr. President, I am delighted that Americans will finally
receive the benefits of the health care reforms contained in the
Kennedy-Kassebaum bill--benefits which the General Accounting Offices
estimates will help over 21 million people.
But I want to talk today about one particular person who will benefit
from this bill, a woman from Florence, MA, who wrote me recently about
her daughter. She supports this bill, she said, because her daughter
has diabetes and the family had a terrible time finding health
insurance that would cover her. In her letter she told me, ``I think
it's immoral for health insurance companies to cut off coverage even
while the people they cover are paying their premiums. No health
insurance company should have the power to do this to their clients.''
Millions of Americans have medical histories or preexisting
conditions that make it difficult to get comprehensive insurance
coverage. As many as 81 million Americans have preexisting medical
conditions that could affect their insurability. Many people are locked
in their jobs because they fear they will be unable to obtain
comprehensive insurance in new jobs. And many people who work in small
businesses often have trouble getting insurance especially if 1
employee has medical problems.
This bill takes very important steps forward to correct these
problems. But we must do more so that ultimately we have coverage for
all Americans. Currently, 40 million Americans live without health
insurance, and 23 million of the 40 million are workers, according to a
study by the Tulane University School of Public Health. Furthermore, an
average of more than 1 million children a year have been losing private
health insurance since 1987. In Massachusetts alone, there are more
than 130,000 children--one-tenth of all the children in my State--who
are without any health insurance, private or public, for the entire
year. And many more children lack health insurance for part of the
year. A recent study in the Journal of the American Medical Association
reported that almost one-quarter of U.S. 3-year-olds in 1991 lacked
health insurance for at least a month during their first 3 years, and
almost 60 percent of those lacked insurance for 6 or more months. It is
time that we help the American people get the health insurance they
rightfully deserve.
Mr. President, this Congress continues to have an unacceptable record
when it comes to addressing the real needs of American workers and
families. Political divisions and Presidential politics have become an
everyday feature of Senate floor action, making it impossible for us to
do much of the people's business. Fortunately, this bill is a notable
exception.
Finally, I want to applaud the vision, commitment, and political
savvy of the distinguished chairman of the Labor and Human Resources
Committee, Senator Kassebaum, whom I greatly admire, and the
distinguished ranking member of that committee, the senior Senator from
my State, who has been a leader for his entire career on health care
issues. To a very considerable extent we all are in their debt as we
send this legislation to the President, because it was their
commitment, stamina, and statesmanship that worked past what again and
again appeared to be intractable differences of opinion among 535
members of the House and Senate. This is a tremendous victory for the
American people, but it is also a richly deserved personal victory for
both Senator Kassebaum and Senator Kennedy. I will proudly vote to send
this bill to the President's desk for his signature.
Mr. FAIRCLOTH. Mr. President, Yesterday, when the Senate passed
welfare legislation we took an important first step toward reforming
our failed welfare system. Similarly, the health care reform bill
before us today takes another important first step toward addressing
some of the serious flaws that exist in our Nation's health care
system.
We must ensure that this health care bill becomes a step in the right
direction, a step away from excessive government regulation and a step
toward a health care system based on free-market principles that
benefits and empowers individuals.
I am very pleased that the conference report includes the foundation
for the full implementation of Medical Savings Accounts, this is the
single most important feature of this legislation.
When we debated medical savings accounts in April, opponents of the
provision argued that anyone who want to include MSA's really wanted
just to kill the Kassebaum bill. I believe that the conference
agreement has proven them wrong.
This real issue behind medical savings accounts is a question of
whether health care reform should move toward greater government
control of our health care system, as President Clinton advocates, or
whether health care reform should place more decision making authority
in the hands of individuals. Once individual Americans have the power
to control how their own health care dollars are spent, they will never
allow the government to take that power back.
I am certain that when the four year trial period for medical savings
accounts ends successfully, the Congress will overwhelmingly endorse
MSA's as an unlimited nation-wide policy.
Mr. President, while this conference report is a first step, it is
not too soon to consider what our next steps should be. We badly need
meaningful reform of our medical malpractice and antitrust laws as well
as full deductibility of health care expenses for the self-employed.
The health care reform conference report will improve the health care
coverage available to individual Americans. But to preserve those
gains, we must make sure that future health care legislation seeks
free-market solutions, not big-government solutions.
Mr. SIMON. Mr. President, like most bills, the Health Insurance
Portability and Accountability Act contains both good and more
worrisome provisions. Some of the better provisions, such as
portability, are not perfect and others of importance, such as mental
health parity, are now completely absent.
One important provision in this bill that has not received much
attention is administrative simplification. It sounds innocuous enough.
It aims to
[[Page S9516]]
cut administrative costs by standardizing the way medical information
is electronically stored and transmitted. No one is against cutting
health care costs.
This standardization, however, accelerates the creation of large data
bases containing personally identifiable information. All this
information is transmitted over electronic networks. We need to be very
careful about how safe and secure that information is from prying eyes.
Some of it may be extremely sensitive and could be used in a malicious
or discriminatory manner.
Not only do we need to hold this information securely, we also need
to give individuals control over who actually has access to their
medical records. We have been working in this Congress this year to try
to come up with federal privacy laws for medical records. Senators
Bennett, Leahy, Kassebaum, Kennedy, Domenici, Wellstone and Mack have
all been concerned with the need to craft meaningful privacy
legislation. I commend their efforts in this area. It has been
extremely difficult legislation to craft, however.
The States themselves have enacted some medical privacy laws. For
instance, several States have passed laws that protect the
confidentiality of mental health records or HIV status. We should not
preempt such protections. I am glad to see that the preemption of State
law in this area has been removed from this bill. I commend the Finance
Committee, and particularly Anne Marie Murphy of my own staff, for
their work in helping to rectify this problem.
I am still troubled by the possible time lag between the enactment of
standardization and the development of privacy regulations by the
Secretary of HHS. The way this provision is currently drafted,
standards will be developed by standard setting organizations that are
mainly business groups, solely on the basis of cost, within 18 months
of enactment of this Act. HHS will submit to Congress detailed
recommendations on standards with respect to the privacy of
individually identifiable health information within 12 months of
enactment of this Act. If Congress does not act on these
recommendations within 36 months of enactment, the Secretary of HHS
will promulgate privacy regulations within 42 months of enactment.
There is, therefore, a possible time lag of 36 months between standard
setting and privacy regulations.
This puts the cart before the horse. Obviously, privacy should come
first. I don t think there is one Senator here who would like to have
his or her own medical privacy play second fiddle to business costs.
Furthermore, this order of cost first, privacy later, may in fact be
much more disruptive to business. For example, it does not make good
privacy sense to use social security numbers as a unique health
identifier; it would be far too easy for others to decode these. It
might, however, make for easy, cost-effective, standardization. If the
standards developed need to be fully revised to take account of privacy
concerns, then business will be forced to standardize twice, with
probably twice the expense.
It makes much more sense to have the standards developed with both
privacy and cost in mind and for the standards to be enacted after and
in accordance with the privacy regulations. I would urge my colleagues
to alter these dates and modify this section to couple these two very
admirable goals of cost reduction and medical records privacy.
In general, although there are weaknesses in this bill and it is far,
far less reform than we need, I am pleased that we are finally moving
ahead with modest initiatives in the area of access to health
insurance. Many Americans will be helped by this legislation. It should
be clear, however, to anyone who looks at what is happening to health
insurance coverage in this country that this bill is just a first step
of many we need to take to meet the health care needs of our Nation.
This is especially true in regard to children, where we will fall even
farther behind as a result of the Welfare bill we just passed, and in
regard to equitable coverage of people with mental illnesses.
Senator Domenici and Senator Wellstone deserve great credit for
fighting for equitable treatment in coverage for the mentally ill. I
hope they will win this fight in the near future. I will do everything
I can to help in this effort before the end of this Congress.
I hope it will also not be long before the Senate acts to ensure
universal access to health care coverage for all children and pregnant
women. More than 9.3 million children and half a million expectant
mothers in our Nation have no health insurance of any kind. Projections
are that by the year 2002 we will have 12.6 million children without
coverage and nearly 5 million more may be added to that as a result of
proposed changes in Medicaid. When we passed the Kennedy-Kassebaum bill
earlier this year, the Senate accepted a sense of the Senate resolution
I offered stating that the issue of adequate health care for our
mothers and children is important to our nation's future and that the
Senate should pass health care legislation ensuring health care
coverage for all of our nation's pregnant women and children. The
Senate must be held to account on this resolution.
It is unacceptable in our rich country to permit these inequities to
continue and to permit so many of the most vulnerable in our society to
be denied assurance of even basic health care. While I applaud everyone
who worked so hard to bring this agreement to the floor, I hope those
who follow us in the next Congress will move on from here to make more
fundamental progress toward the fair, just and accessible health care
system all of our citizens deserve in this great Nation.
Mr. DODD. Mr. President, the legislation before us today--the
conference report on the Kassebaum/Kennedy Health Insurance Reform
Act--gives this body a unique and historic opportunity--to pass a
sensible, incremental and common-sense health reform measure that will
help millions of Americans.
Our actions today will give an estimated 25 million Americans a much
needed and deserving helping hand.
This bill would guarantee to American working families--if you change
your job you will not lose access to health insurance. This bill will
limit pre-existing condition exclusions. It will guarantee renewability
of health insurance policies. And it will help self-employed
individuals, by increasing the deduction for health insurance expenses.
It's been a long difficult process to reach this point. But, finally
these most basic health insurance reforms will become law, exactly 1
year after the Labor and Human Resources Committee unanimously reported
the bill.
This bill will not solve every problem in our health care system, but
it's an important first step. It is good public policy and it deserves
the support of every member of this body.
Frankly, I feared that the majority party would prevent this day from
happening.
This legislation passed in the Labor Committee 1 year ago, but
objections by members of the majority party prevented this bill from
receiving consideration by the Senate until the following April.
President Clinton came to the Congress in January and in his State of
the Union address urged us to quickly pass this legislation. But still
it took 4 months for the majority party to respond.
Finally, when the Senate was allowed to consider the bill it passed
100-0. These days, not too much in this body is agreed upon in a
bipartisan manner. But the unanimous support for the Kassebaum/Kennedy
bill is a clear indication that this legislation is an effective, fair,
and most important, bipartisan measure.
But again, even after this unanimous vote, the majority tried to load
the bill with controversial provisions, rather than move to quickly
pass a bill we could all agree upon.
Mr. President, this legislation should have passed last year and if
we had done so, the American people would already be reaping the
benefits. However, I am pleased that reason prevailed and today we can
finally deliver these important protections to the American people.
While this bill is an important step forward, I consider it only a
first step in an ongoing process. Many problems remain in our health
system. I won't
[[Page S9517]]
go into all of them today. But I do want to talk briefly about
continuing problems in guaranteeing children access to health care.
Our system simply does not work for millions of America's children.
We all lose when the worker of tomorrow is crippled for life by the
untreated illness of today. We all lose when completely preventable
diseases like measles ripple through the child population.
The General Accounting Office, in a series of reports issued to me
this summer have reported on trends in children's health insurance that
are cause for genuine alarm.
In 1994, the percentage of children with private insurance coverage
reached its lowest point since the census began consistently tracking
coverage.
In 1987, almost 74 percent of our Nation's children had private
coverage. By 1994, that number had dropped to 65 percent.
While Medicaid has certainly helped millions of children who would
otherwise be without coverage, the number of children without any
insurance rose to its highest point in 1994. Ten million children under
age 18, or 14.2 percent, were uninsured in 1994.
In States such as Alabama, Arizona, California, New Mexico, Oklahoma,
and Texas, almost 20 percent or more of children are without health
care coverage. That means 1 out of every 5 children in these States are
lacking coverage.
Too many of our children do not have access to basic health. So, I
hope, Mr. President, that no one thinks that we've made the health care
system right, because we still have a long way to go.
Let us not forget that approximately 40 million Americans continue to
lack health care coverage. Of those, 12 million are children under the
age of 21. We still have a commitment to those people to make this
measure the first, not the last, step on the road to meaningful health
care reform.
So today, we have a historic opportunity to help millions of
America's working families keep their health care coverage. It is a
chance that must not slip away, and so I urge all my colleagues to join
me in supporting this common sense and sensible reform measure.
Mr. LAUTENBERG. Mr. President, I rise in support of this conference
report. This is a good first step in trying to provide affordable
health care coverage to all Americans. This bill will ensure that
people who move from job to job will be able to keep their health
insurance, even if they have a pre-existing condition. It also will
give the same protection to people who lose their jobs and must get
health insurance on their own.
This bill also provides some tax incentives for families to better
afford health care. The legislation increases the health insurance
deduction for self-employed individuals from 30 percent to 80 percent,
bringing health care coverage within reach of many more Americans.
This bill also expands the tax deduction for nursing home and long
term care coverage. This will help families better cope with the
staggering costs of nursing home coverage for their loved ones. In some
facilities, a year in a nursing home can cost over $30,000.
This bill also includes an experiment in Medical Savings Accounts
(MSA's). The Senate originally rejected the concept of MSA's by a bi-
partisan vote. But the House Republicans insisted on a full blown
implementation MSA's even though we have never even evaluated the
efficacy of such health policies. Fortunately, this conference report
only includes a limited demonstration of MSA's. This makes sense
because this concept is untested. I am concerned that MSA's could drain
the young, healthy and wealthy out of the traditional insurance system.
This could leave old and sick people to cope with escalating insurance
premiums, making it even tougher to afford health insurance. Therefore,
I am pleased that this is only a time limited experiment.
Mr. President, unfortunately, this bill does not include the so-
called mental health parity amendment authored by the Senators Domenici
and Wellstone. This amendment passed overwhelmingly in the Senate but
was completely dropped in conference. I hope that some day this
amendment will become law so that we can do away with insurance
policies that provide more coverage for physical illnesses than for
mental illnesses. Families with members who have mental illnesses
deserve this much.
Mr. President, while this bill makes improvements in our health care
system, we must remember that this is only a first step. We have much
more work to do in the next Congress to move toward providing health
care coverage for all Americans. This should continue to be our goal.
Tragically, there are now 41 million Americans who do not have health
insurance, up from 37 million in 1993. For the most part, these are
working Americans. Eighty-four percent of the uninsured work, but they
do not get health insurance at their jobs.
We must do something to rectify this. We must continue to enact
legislation so that one day no family is without health security.
I yield the floor.
Mr. GLENN. Mr. President, I support the conference agreement on H.R.
3103, the Health Insurance Reform Bill. I am pleased that the Congress
is taking long overdue final action on this legislation which is so
important to working Americans and their families. As you know, it was
approved by the Senate Labor and Human Resources Committee 1 year ago
today, and it passed the Senate in April. Once again, I would like to
commend Senator Kassebaum and Senator Kennedy for their untiring
efforts to work with our colleagues and all interested parties to forge
the bipartisan bill we will pass today and send to the President for
his signature.
The bill we are passing today is not comprehensive health care
reform, but it is an important step forward in addressing problems in
our current health insurance system. People who maintain continuous
health insurance coverage will not be denied insurance for preexisting
conditions, after one initial 12-month exclusion, even if they change
jobs or insurance plans; and individuals who lose their jobs or change
jobs will be guaranteed the opportunity to continue their insurance
through a group or individual plan.
A compromise was made on medical savings account [MSA] provisions
passed by the House of Representatives but rejected by the Senate. The
bill provides for a four year pilot program in which up to 750,000
taxpayers with high-deductible health insurance plans can make tax
deductible contributions to a medical savings account. At the end of
the 4-year period, Congress would have to vote to expand the MSA
program.
This legislation also increases the health insurance deduction for
self-employed individuals from 30 percent to 80 percent over a 10-year
period, provides for a medical expense deduction for long term care
insurance, and allows terminally ill individuals to receive tax free
benefits from their life insurance.
I regret that the Domenici-Wellstone amendment, which passed the
Senate, was not included in this conference report nor was any
compromise that the sponsors proposed. This amendment would require
private health plans to provide medically necessary mental health
services that are equal to the medical services provided. A great deal
of progress has been made in diagnosing and treating mental illnesses,
and I believe that we should provide health insurance coverage that
will make this care affordable to people who need it. I will work with
my colleagues during the remainder of this Congress to ensure that in
the future people with mental illnesses have equal access to the care
they need.
The Health Insurance Reform Act will provide peace of mind to many
working Americans who have health insurance but fear losing it, and it
is a major improvement in our current health insurance system.
providing tax exemption to state high risk health insurance pools
Mr. COCHRAN. I am pleased that the conference report for the Health
Insurance Reform Act includes a provision which confirms the
availability of the Federal tax exemption for State health insurance
risk pools which has been pending in Congress for the last several
years. The purpose of a health risk pool is to make available health
and accident insurance coverage to individuals
[[Page S9518]]
who, because of health conditions, would otherwise not be able to
secure health insurance coverage. Health risk pools are one option
contemplated by the Health Insurance Reform Act that States could
implement as part of their health care reform efforts to seek to ensure
access to health insurance.
Since 1976, 28 States have enacted legislation establishing a health
insurance pool aimed at protecting uninsurable and high-risk
individuals. Most of the pools were established in the last 10 years.
For example, the Comprehensive Health Insurance Risk Pool Association
Act was enacted by the Mississippi State Legislature during the 1991
legislative session and became effective April 15, 1991. At that time
Mississippi became the 25th State to enact such legislation. This act
created the Mississippi Comprehensive Health Insurance Risk Pool
Association to implement such a health insurance program. Members of
the association include insurance companies, nonprofit health care
organizations and health maintenance organizations [HMO's] which are
authorized to write direct health insurance policies and contracts
supplemental to health insurance policies in Mississippi. The
association also includes third-party administrators who are paying and
processing health insurance claims for Mississippi residents.
Over the past 4 years, the association has issued medical insurance
policies to approximately 1,200 Mississippians. The association is
funded by premiums paid by policyholders and quarterly assessments
against members of the association. The assessments are necessary to
supplement the premiums and operate the program on a financially sound
basis. There is no public funding--State or Federal--involved.
Currently, over 100,000 individuals nationwide are members of a State
health risk pool. Nationally, there are an additional 1 to 3 million
people who are uninsured and uninsurable, and who could be eligible for
inclusion in a State health risk pool.
As my colleague knows, unfortunately, several State health risk
pools, including the Mississippi Comprehensive Health Insurance Risk
Pool Association, have applied for and have been denied exemption for
Federal taxation under Internal Revenue Code sections 501(c)(4) and/or
501(c)(6). Generally, the Internal Revenue Service's [IRS] rationale
for such denial has been that the sole activity of the health risk
pools is the provision of health insurance for individual
policyholders. The IRS perceives health risk pools as a regular
business ordinarily carried on for profit, which primarily provide
commercial type insurance. Moreover, the IRS takes the position that
health risk pools are primarily serving the private interests of its
members and not the common interest of the community as a whole.
Would my colleague agree that the IRS's position is incorrect?
Mrs. KASSEBAUM. I would agree with the Senator.
Mr. COCHRAN. Is it not the case that health risk pools have been
created by statute in the several States to serve a public function of
relieving the hardship of those who, for health reasons, are unable to
obtain health insurance coverage? Additionally, that these pools do not
carry on an activity ordinarily carried on by insurance companies and
not designed to make a profit? Further, that they are established by
State statute and none of the net earnings benefit any private
shareholder, member, or individual?
Mrs. KASSEBAUM. I would agree with the Senator.
Mr. COCHRAN. The Federal Government should serve as an impetus for,
not an impediment to, State health care reform. We should do all we can
to increase the ability of States to help the uninsured. The Health
Insurance Reform Act recognizes the value of health risk pools and
includes vital roles for health risk pools in their health care reform
legislation.
Would my colleague not agree that in order to allow States
flexibility in designing effective health care plans, State health risk
pools should be exempt from taxation and that it was never the intent
of Congress that health risk pools be subject to taxation?
Mrs. KASSEBAUM. I would agree with the Senator.
Mr. COCHRAN. Would my colleague agree that it is the intent of
Congress through this legislation to clarify that health risk pools be
exempt from taxation?
Mrs. KASSEBAUM. The Senator is correct. This legislation will clarify
the intent of Congress that health risk pools should not be subject to
taxation.
Mr. COCHRAN. I thank my colleague for her assistance. By passing this
legislation, we will promote State-based health care reform by
expressly confirming that State health risk pools are exempt from
Federal taxation, notwithstanding the IRS' position. By clarifying the
intent of Congress, the IRS should recognize this legislation as
confirming the interpretation of existing law, and not creating new
law, and accordingly grant tax exempt organization status to all health
risk pools that have applied for such status.
organ donation insert card
Mr. DORGAN. I am pleased that the conference committee on the Health
Insurance Reform Act has included a small, but lifesaving provision
that Senator Frist and I offered as an amendment to the Senate bill. I
am referring to the organ donation insert card provision.
This measure, which I first introduced in 1994, would require the
Secretary of the Treasury to send out information about organ and
tissue donation with each tax refund mailed in 1997. This provision
will help give a new chance at life to the more than 46,000 Americans
who are desperately waiting right now for an organ or tissue
transplant.
Many opportunities for a lifesaving organ donation are missed each
year because family members hesitate to authorize organ or tissue
donation when their loved one dies. By providing information to 70
million Americans next year, we can raise awareness about the need for
donors and, in the process, we will save lives.
I do want to mention a concern I have about one of two technical
changes made to the organ donation insert card amendment during
conference. At this time, I would like to engage in a colloquy with
Senator Frist, a cosponsor of this Amendment, and Senator Roth, the
chairman of the Finance Committee, to clarify Congress' intent with
regard to this provision.
The conference agreement alters my original provision to read that
organ donation information will be included with tax refunds mailed in
1997 to quote ``the extent practicable'' unquote. I want to make it
clear that I feel strongly that providing this information to millions
of Americans is not only a cost effective way to save lives but is also
a practical measure that does not pose an unreasonable burden on the
Department of the Treasury.
Mr. FRIST. Senator Dorgan, is it true that the Treasury Department
regularly includes insert cards with the refunds it mails each year?
Mr. DORGAN. The Senator from Tennessee is absolutely correct. This
year, for example, taxpayers who receive a refund also received
information about how to purchase Olympic commemorative coins. In 1994,
an advertisement for World Cup Soccer commemorative coins was mailed
along with refunds.
Mr. FRIST. It is my understanding that the cost to the Treasury
Department of printing and inserting this information is negligible.
Since the Federal Government already incurs this cost on an annual
basis, I do not believe this would create a burden. Is that also your
belief?
Mr. DORGAN. Yes, it is. I would like to ask the distinguished
gentleman from Delaware [Senator Roth], to clarify for us what the
conference committee intended by making this technical change to the
Senate's amendment.
Mr. ROTH. The conference committee's intent regarding this change was
to ensure that there be no delay in the mailing of refund checks
because of this provision. The language ``to the extent practicable''
originally read ``to the maximum extent practicable'' to address any
potential administrative issues that may arise. For example, if the
Internal Revenue Service ran out of organ donor cards we would not want
to insinuate that the check could only go out if a donor card was
enclosed. The Treasury Department specifically asked us to delete
``maximum'' from the language.
It was not the conference committee's belief that this provision
should
[[Page S9519]]
cause a delay, and we fully expect that the Treasury Department will
make every effort to ensure that all of the individual taxpayers who
are mailed refunds in 1997 will also receive organ donation
information.
Mr. DORGAN. Thank you Senator Roth and Frist. I want to again thank
Senators Kennedy, Kassebaum, and Frist, Congressman Richard Durbin, and
the many supportive organizations who have worked with me to get this
provision enacted.
Mr. President, I rise today in support of final passage of the Health
Insurance Reform Act. It has not been an easy road to agreement on this
bill, but for the sake of the American people, I am glad we were able
to put aside our differences and reach a compromise on those issues
where we do agree.
We are fortunate in our country to have one of the finest health care
systems in the world. But unfortunately, not all Americans have access
to that health care system or can afford the escalating prices of care.
This bill is not the total answer to those issues. In fact, compared
to the health care plan proposed by President Clinton several years
ago, which I did not support because I thought it was too bureaucratic,
this bill is very, very modest.
Having said that, the Health Insurance Reform Act is a significant
step forward in helping Americans who are routinely denied health
insurance coverage through no fault of their own, and I am pleased to
be a cosponsor and supporter.
Earlier this year, I received a heartbreaking letter from a mother in
Williston, ND whose infant son was born with a rare disease called
myelamacia. He often stops breathing and doctors have no idea how long
he will live or what his quality of life will be. Michael is actually
lucky because, right now, he is covered under his mother's employer-
based health insurance plan.
But Michael's mother is desperately worried about how long his
coverage will last. For one thing, Michael currently must live at the
Anne Carlsen Center for Children in Jamestown, ND, which is quite a
long distance from Williston. Michael's parents would like to move
closer to their son so they can spend more time with him, but they are
justifiably afraid that if Michael's mom switches jobs, Michael will
lose his insurance coverage.
Michael's parents are not alone. A survey has found that one-quarter
of Americans who would have otherwise switched jobs did not because
they feared losing their health insurance coverage.
This legislation basically says to insurance companies, if someone
has been a good customer of yours, paying their premiums regularly for
years, you cannot drop their coverage simply because he or she gets
sick or switches jobs.
This bill puts limits on the amount of time that insurance companies
can deny coverage for individuals with preexisting medical conditions,
even for those who change jobs or whose employer switches insurance
companies. It also requires insurance companies to renew the health
insurance coverage of individuals or groups as long as they pay their
premiums. The bill will also help to ensure that those with preexisting
conditions will be able to purchase affordable individual insurance
policies if they lose their group health coverage.
This bill also contains provisions which will help many of North
Dakota's small business owners and sole proprietors. I have been
fighting for one of these provisions ever since I came to Congress, so
I am particularly pleased that we are acting to level the playing field
for sole proprietors.
Under this bill, farmers and other self-employed individuals will be
able to deduct a higher percentage of their health insurance premiums.
Right now, large corporations can deduct 100 percent of their health
insurance expenses, but sole proprietors may only deduct 30 percent of
their health insurance premiums. This bill will gradually increase the
amount that the self-employed can deduct to 50 percent by 2003 and to
80 percent by 2006. I would prefer that they be allowed to deduct all
of their insurance costs, as corporations already can, but this will go
a long way toward making health insurance more affordable for farmers
and other self-employed individuals.
This bill also will allow some small employers and their employees to
experiment with medical savings accounts, or MSA's. This is a highly
controversial issue, and I'm glad we were able to reach an agreement
that allows us to move forward on this legislation.
I think MSA's are an intriguing idea. Common sense tells you that
making health care consumers think more carefully about the type and
cost of care they receive will likely have some positive impact on
overall costs.
At the same time, however, I do have concerns about the impact that
MSA's could have on the traditional insurance pool. The trial approach
taken in this bill will minimize any negative effects on the insurance
market while allowing us to evaluate the value of MSA's.
Finally, I want to mention one more provision included in this bill.
It is a small, easily overlooked provision which I offered, but it is
one that will save lives, and I want to thank Senators Frist, Kennedy,
Kassebaum, and the many other Senators, Members of the House of
Representatives and supportive organizations who have worked with me to
get this provision included. I am referring to the organ donation
insert card provision.
This measure, which I first introduced in 1994, would require the
Secretary of the Treasury to send out information about organ and
tissue donation with each tax refund mailed in 1997. This provision
will help give a new chance at life to the more than 46,000 Americans
who are desperately waiting right now for an organ or tissue
transplant.
Many opportunities for a lifesaving organ donation are missed each
year because family members hesitate to authorize organ or tissue
donation when their loved one dies. By providing information to 70
million Americans next year, we can raise awareness about the need for
donors and, in the process, we will save lives.
In closing, I want to thank Senators Kennedy and Kassebaum and both
of the leaders for their tireless work to move this worthwhile
legislation to this point. I am pleased to be a cosponsor of the Health
Insurance Reform Act and to finally have this opportunity to vote to
send it to the President for his signature.
Mr. BURNS. Mr. President, I rise today to speak about this health
insurance reform legislation now before us. After months of gridlock on
this bill, I am glad that the Senate finally has a chance to once again
consider and pass this straightforward legislation. I must confess,
however, that I find it puzzling that this bill has been held up for 3
months over the issue of medical savings accounts--particularly in
light of what we are trying to accomplish by passing this legislation.
I am a strong supporter of medical savings accounts. I truly believe
MSA's empower health care consumers by giving them the freedom to
choose how they spend their health care dollar. Medical savings
accounts provide the competitive choice which not only enables folks to
keep pace with inflation, but counters the increases that will result
from the guaranteed-issue component of this legislation. Nonetheless, I
am pleased that this bill creates at least a full-blown test for the
MSA.
Though it disturbs me to know that we could have sent this meaningful
legislation to the President for his signature months ago, the delay on
this bill has given me the opportunity to hear the thoughts of
literally thousands of Montanans on this issue, folks who have written
to me, folks who have called me, and folks I've seen while traveling in
the State. Given all the input I have received on this legislation over
these last few months, one thing is certain, the folks in Montana are
reaffirming what they have been telling me for years--that they want
the commonsense measures contained in this bill passed into law.
It is no secret that the health insurance system in this country is
in need of some fine tuning. And I know that many of my colleagues on
both sides of the aisle and in both Chambers of Congress would agree
with that assessment. It is estimated that 43 million Americans went
without health insurance in 1995 and roughly 23 million of those are
workers. Though we can't guarantee every American health care
coverage--nor would I ever support a
[[Page S9520]]
plan to do so--we can address the barriers that keep health insurance
out of the reach of most of these folks; access and affordability. And
this health insurance reform legislation does just that.
There is little doubt in my mind that the Health Insurance and
Portability Act will greatly reduce the barriers to obtaining health
insurance coverage for millions of Americans by: one, limiting an
insurer's ability to withhold coverage for people with pre-existing
medical conditions; two, making it easier for workers to get and
maintain health coverage; and three, because of its provisions
guaranteeing coverage, this legislation will make it easier for workers
to change jobs or start their own businesses without fear of losing
health care coverage.
This bill also contains many other important provisions. I am
especially pleased with the significant improvements in coverage for
pregnant women, newborns, and adopted children. This bill will also
make health care more affordable by providing the government with the
means to crack down on health care fraud and abuse in the health care
system, specifically in the Medicare and Medicaid programs. What's
more, self-employed people will be able to deduct from their taxes 80
percent of their health insurance premiums by the year 2006, up from
the 30 percent which current law allows. In addition, this bill
increases tax breaks for small companies. Those provisions are
especially important for my State, where 98 percent of our businesses
are considered small businesses and have fewer than 50 employees.
What so personally excites me about this bill is a provision that I
introduced to this bill that requires reimbursement for telemedicine
services under Medicare. As many of my colleagues know, I have been a
strong advocate of telemedicine since my election to the Senate. I
truly believe that establishing a telecommunications infrastructure is
a part of the solution to providing affordable and accessible health
care. Telemedicine is being used now in Montana, and across the United
States, to bring health care services to those who currently don't have
access. Getting health care services can be a challenge, especially
when folks in my State and in other rural areas face situations where
they are 180 miles away from a specialist. But even if specialists are
willing and able to visit their patients via telemedicine, the Health
Care Financing Administration will not reimburse them for those
services.
Mr. President, HCFA has been reviewing demonstration projects to
analyze the cost effectiveness of providing health care services via
telecommunications and how to reimburse the health care providers. The
HCFA study has no expected deadline, but the provision contained in
this bill will require HCFA to complete its study and report back to
Congress by March 1, 1997. If we pass this bill today, that gives HCFA
almost 8 months, in addition to the time they have already spent
studying the issue, to determine the reimbursement of services provided
via telemedicine. I don't feel this proposal is unreasonable. In fact,
since this study is already ongoing, there is no cost associated with
this. I am simply asking that HCFA finish the study and let rural areas
and urban residents access the health care services that are currently
out of reach geographically.
I realize that there are many Americans, including a number of folks
in Montana, who have serious concerns with this legislation. Folks in
my State seem to be particularly concerned that this legislation is
just a step toward implementing the failed Clinton health care plan and
will turn our health care system over to the Government. What's more, I
have heard from a number of Montanans who are concerned about health
insurance costs going up for all health care consumers. I appreciate
and understand these concerns--I don't want to see either of these
things take place. In fact, like most Americans, I am completely
opposed, and I opposed then, the type of big-government, big-
bureaucracy health care agenda that the Clinton administration proposed
in 1994. Most people don't want a single-payer, government-controlled
health insurance system deciding what is best for them and neither do
I. That is why this bill only addresses those aspects of health
insurance reform that folks have identified as important and necessary,
and want to see passed.
Though I realize that this bill will not solve all the problems with
our Nation's health care system--and I have concerns with certain
aspects of the act as well--this legislation does take a giant step
toward eliminating many of the worst abuses that exist in the private
insurance market. Most important, it does all this without
substantially raising costs for current health insurance policyholders,
without meddling with those parts of the system that work, and without
taking away the ability of States or the private sector to initiate
their own reforms.
Mr. President, the Republican-led 104th Congress has once again given
us an opportunity to change a system that has consistently failed
millions of Americans and American families. I want to take a moment to
thank the Republican leadership and all of those who have worked so
hard, in both parties, to bring this legislation back to the floor. I
also want to commend Senators Domenici and Wellstone for their work on
mental health parity. Though this provision has been stripped from the
bill, I believe their efforts will help move our country forward in
treating the nearly 5 million Americans suffering from severe mental
illness. I particularly want to commend the senior Senator from Kansas
for leading the way on this issue. I also want to thank Senator
Kassebaum for the time and dedication she has given over the years to
the citizens of our country. I am truly sorry that Senator Kassebaum
will be leaving us at the end of the 104th Congress. Not only will the
U.S. Senate lose a fine legislator but a fine person. On that note,
because of Senator Kassebaum's efforts, and with the overwhelming
bipartisan support this bill received in the House yesterday, it looks
as though we are going to see our way clear and bring about these much
needed reforms to our health insurance system.
In closing, Mr. President, I believe this health insurance reform
legislation is the best hope we have to help America's--particularly
Montana's--families and small businesses cope with burdensome health
care costs. Not only will this legislation end job lock and the
misfortune of pre-existing conditions that prevent thousands of
Americans from buying coverage but it will also strengthen our health
care system for years to come. In short, because this health insurance
reform bill contains so many commonsense measures, I was pleased to
support this bill when it first came before this body in April. And
because the legislation that is again before us today will immediately
and measurably improve the lives and protect the health of millions of
American workers and families without putting folks out of business,
raising taxes or turning the health care system over to the government,
I am going to vote to send this bill to the President. I hope my
colleagues in the Senate will do the same. This bill's time has come.
Let's not squander the opportunity we have today.
Mr. CHAFEE. Mr. President, I am pleased to support the conference
report accompanying the health care reform legislation. Members of
Congress have worked for many years to pass health care reform
legislation, and it has been a long road. I would like to congratulate
the co-sponsors of this legislation, Senators Kassebaum and Kennedy. At
a time when most would have doubted that any health care reform bill
could pass this year, they persevered. And this legislation is a
fitting tribute to the senior Senator from Kansas who retires at the
end of this year.
In recent years, we have fought to reduce the number of Americans
without access to health insurance and slow the rate of growth in
health care costs. Two years ago we had a nationwide debate on health
care reform. There were many competing proposals, and ultimately we
failed to reach a consensus on comprehensive health reform legislation.
In the wake of that failure, we have put aside our differences and
taken a more incremental approach to health care reform. Rather than
forcing dramatic change in our health care system, we are making small,
yet important changes in the health insurance market which will give
working Americans something very important--peace of mind.
[[Page S9521]]
Once this legislation is enacted, Americans will know that if they
change jobs they will be able to move from one group health insurance
plan to another without worrying that preexisting conditions will limit
or exclude them from coverage. Once this bill is enacted, families will
no longer face being locked into their jobs for fear of losing health
insurance coverage. This bill would also assure that if a worker lost
his or her job or accepted a job without health insurance coverage,
they would have the opportunity to purchase a health insurance policy
without limitations or exclusions for preexisting conditions.
This legislation also includes provisions introduced by Senator
Cohen, to crack down on individuals who knowingly commit fraud in or
health care system. Not only will this help to control health care
costs in the private insurance market, but it will also reduce the
fraud which plagues the Medicare Program. The bill includes provisions,
authored by Senator Bond, to create uniform, standards for the
electronic transmission of health care information in an effort to
streamline and lower administrative costs.
Finally, the language includes important tax provisions to make
health insurance more affordable for the self-employed by allowing them
to deduct a greater percentage of their health insurance costs. It also
clarifies that the cost of long-term care insurance is deductible--
encouraging more Americans to purchase private long-term care
insurance. I am hopeful that this provision will lessen the burden of
long-term care costs on our Medicaid Program, which many seniors fall
back on once they exhaust their life-savings on nursing home care.
I recognize that there are those who are disappointed in the final
outcome of some of the provisions in this legislation. Probably the
most glaring is the omission of the Domenici-Wellstone provision
providing parity for mental illness. During Senate consideration of the
health reform proposal, I voted against the mental health parity
amendment as well as other key provisions. I did so to assist the
managers of the bill in trying to keep the bill free of controversial
provisions that could have slowed down the process. I also had concerns
that the amendment was too encompassing. I am hopeful that Congress
will act in the near future on a narrower version of this important
legislation.
In conclusion, no one got exactly what they wanted on every aspect of
this bill, myself included. Nonetheless, I think we all should take
satisfaction in the passage of this legislation and recognize that
great things often come form humble beginning. Thank you Mr. President.
clarifying certain definitions
Mr. HATCH. Mr. President, with respect to the corporate-owned life
insurance provision in the conference agreement to the Health Insurance
Portability and Accountability Act of 1996, I would like to clarify the
definition of a fixed and variable rate of interest as it relates to
the deduction of interest on pre-1986 life insurance contracts.
It is my understanding that a life insurance contract with an option
to elect a variable rate of interest, which has borne the same rate of
interest since its date of issuance, is considered a contract with a
fixed rate of interest. If the interest rate under this contract is
changed to a variable rate as the result of the exercise of an election
under the contract, the contract would then be considered a contract
with a variable rate of interest.
Mr. ROTH. Yes, the Senator's understanding is correct.
Mrs. FEINSTEIN. In 1945, President Harry Truman proposed universal
health insurance, putting on the public agenda, the goal of universal
health insurance, a goal that still eludes us. Too many Americans find
that just when they most need health insurance, it is not there. It is
terminated. They are denied its purchase, because they are sick. They
are determined to be uninsurable.
The bipartisan bill before us today does not provide health insurance
to every American. We still face that challenge. But the bill before us
today takes an important step toward making health insurance more
secure.
This bill provides some health security in several ways:
No Arbitrary Terminations: Insurers will not be able to impose
preexisting condition limitations for more than an initial 12-month
period. This means that employees can change jobs without fear or
facing a new preexisting condition exclusion.
Guaranteed Access: Insurers will be required to offer insurance to
all groups, regardless of the health status of any member of the group
and employees could not be denied group coverage based on their health
status.
Guaranteed Insurance Renewal: Groups and individuals who have
insurance will be able to renew their policies as long as they have
paid their premiums.
Individual Coverage Guaranteed: People who leave their job where they
have had 18 months of prior employer group coverage and who have
exhausted their extended [COBRA] coverage would be guaranteed access to
an individual policy.
need for the bill
The problems this bill addresses are real:
Twenty-three million Americans lose their insurance every year; 18
million people change insurance policies annually when someone in the
family changes jobs.
Over 9 million Americans changed jobs in 1995; millions more wanted
to. The General Accounting Office estimates that as many as 4 million
employees are locked into their jobs because they fear that the insurer
for the next employer will refuse to insure them because of their
health condition, something the industry has called a preexisting
condition. GAO has said that 21 million Americans could benefit by
prohibiting preexisting condition exclusions.
Small employers are often unable to get insurance because a few of
the employees are ill; insurers refuse to insure. Small employers lack
the leverage of big employers in negotiating good prices and policies.
In California, 84 percent of the uninsured are in working families.
Fifty-two percent of uninsured employees work in small firms.
And finally, there are 10 to 20 million Americans seeking to buy
insurance on their own--individual policies. These individuals, who are
not part of a large pool where risk can be spread out, find that
insurers refuse to sell to them or price the policies so high they are
unaffordable.
genetic discrimination
I especially appreciate the inclusion of provisions barring genetic
discrimination in health insurance, along the lines of S. 1600, a bill
I introduced with Senator Mack.
Last fall, as cochairs of the Senate Cancer Coalition, Senator Mack
and I held a hearing on the status of genetics research and use of
genetic tests. We learned we are all carrying around between 50,000 and
100,000 genes scattered on 23 pairs of chromosomes and that every
person has between 5 and 10 defective genes, often not manifested.
Approximately 3 percent of all children are born with a severe
condition that is primarily genetic in origin. By age 24, genetic
disease strikes 5 percent of Americans. Genetic disorders account for
one-fifth of adult hospital occupancy, two-thirds of childhood hospital
occupancy, one-third of pregnancy loss and one-third of mental
retardation.
About 15 million people are affected by one or more of the over 4,000
currently identified genetic disorders.
We are learning virtually everyday about the explosion of knowledge
in genetic science. We know that certain diseases have genetic links,
like cancer, Alzheimer's disease, Huntington's disease, cystic
fibrosis, neurofibromatosis, and Lou Gehrig's disease.
But understanding genetics brings a new set of problems. Witness
after witness at our hearing raised fears of health insurance
discrimination. And it is not just fear. It is also reality. We heard
about insurers denying coverage, refusing to renew coverage, or denying
coverage of a particular condition.
In a 1992 study, the Office of Technology Assessment found that 17 of
29 insurers would not sell insurance to individuals when presymptomatic
testing revealed the likelihood of a serious, chronic future disease.
Fifteen of thirty-seven commercial insurers that cover groups said they
would decline the applicant. Underwriters at 11 of 25 Blue Cross-Blue
Shield plans said they would turn down an applicant if
[[Page S9522]]
presymptomatic testing revealed the likelihood of disease. The study
found that insurers price plans higher--or even out of reach--based on
genetic information. Another study conducted by Dr. Paul Billings at
the California Pacific Medical Center, reached similar conclusions.
Here are a few examples, real-life cases:
An individual with hereditary hemochromatosis--excessive iron--who
runs 10K races regularly, but who had no symptoms of the disease, could
not get insurance because of the disease.
A health maintenance organization that had covered a child since
birth, denied therapy after the child was diagnoses with
mucopolysaccharidoses [MPS].
A Colorado insurer terminated the policy of the family of a 3-year-
old with the same disease.
An 8-year-old girl was diagnosed at 14 days of age with PKI
[phenylketonuria], a rare inherited disease, which if left untreated,
leads to retardation. Most States require testing for this disease at
birth. Her growth and development proceeded normally and she was
healthy. She was insured on her father's employment-based policy, but
when the father changed jobs, the insurer at the new job told him that
his daughter was considered to be a high risk patient and uninsurable.
The mother of an elementary school student had her son tested for a
learning disability. The tests revealed that the son had Fragile X
Syndrome, an inherited form of mental retardation. Her insurer dropped
her son's coverage. After searching unsuccessfully for a company that
would be willing to insure her son, the mother quit her job so she
could impoverish herself and become eligible for Medicaid as insurance
for her son.
Another man worked as a financial officer for a large national
company. His son had a genetic condition which left him severely
disabled. The father was tested an found to be an asymptomatic carrier
of the gene which caused his son's illness. His wife and other sons
were healthy. His insurer initially disputed claims filed for the son's
care, then paid them, but then refused to renew the employer's group
coverage. The company then offered two plans. All employees except this
father were offered a choice of the two. He was allowed only the
managed care plan.
A woman was denied health insurance because her nephew had been
diagnosed as having cystic fibrosis and she inquired whether she should
be tested to see if she was a carrier. After she was found to carry the
gene that causes the disease, the insurer told her that neither she nor
any children she might have would be covered unless her husband was
determined not to carry the CF gene. She went for several months
without health insurance because she sought genetic information about
herself.
These denials not only deprive Americans of health insurance, they
affect people's health. If people fear retaliation by their insurer,
they may be less likely to provide their physician with full
information. They may be reluctant to be tested. This reluctance means
that physicians might not have all the information they need to make a
solid diagnosis or decide on a treatment.
All of us are at risk of illness. We all have defective genes. I hope
that the addition of my language can help ease the fears of many
Americans and discourage insurers from using genetics as a reason to
deny insurance.
AN IMPORTANT STEP
This bill, while it does not address all the problems, does take an
important step. As a measure of its importance, yesterday morning when
agreement on the bill reached the public, my staff got a call at 9:15
a.m.--6:15 a.m. California time--from a worried constituent, asking,
``Will it help me?''
This bill can help make health insurance available to those Americans
who want to buy it. It can bring peace of mind to millions of
Americans. It can restore to insurance what insurance is supposed to
be.
I hope we will promptly send this bill to the President for his
signature and close this loophole in our erratic patchwork of health
insurance.
Mr. HELMS. Mr. President, H.R. 3103, the Health Coverage Availability
and Affordability Act of 1996, could very well sound the death knell
for the past years of liberal efforts to socialize medicine. The truth
is, it puts us well on our way to providing a meaningful health care
reform for millions of working Americans.
H.R. 3103 guarantees that American workers can keep their health
coverage if they change or lose their jobs, which will be greatly
reassuring to millions of American workers having pre-existing
conditions. Now they will be able to change jobs without fear of losing
their health insurance. The portability provision, as it is called,
enables employees to be covered immediately upon taking another job--
regardless of their health status.
Mr. President, American dissatisfaction with the existing health care
system has gained much of its momentum from the spiraling costs of
medical care in the United States. In 1993, nearly $940 billion was
spent on health care, more than 14 percent of the GDP; this percentage
has been rising steadily for years. Tax relief and medical savings
accounts provide the best of all solutions by enabling patients to make
their own choices with their own money. Workers and their families--not
government bureaucrats--should decide how much to spend on health care
and which health care benefits best meet their needs.
This bill, H.R. 3103, will partially correct a senseless disparity in
the Tax Code concerning the deductibility of health insurance premiums.
Whereas under current law businesses are allowed to deduct such
premiums, fully, as a business expense, self-employed workers receive
only a 30-percent deduction--thereby increasing the cost of doing
business. This bill raises to 80 percent the amount of health insurance
they can deduct from their Federal income taxes, it allows the
deductibility of premiums for long-term care policies.
Medical savings accounts [MSA's] expand consumer choice and
ultimately will reduce health care costs by spurring competition and
greater cost-consciousness in the use of health care. MSA's confer upon
individuals financial incentive to spend their health care dollars
wisely by turning part of the savings over to employees, in effect
rewarding efficiency.
Mr. President, many private businesses are already using cash
incentives to reduce health care costs while, at the same time,
achieving great employee satisfaction with the health care afforded
them. MSA's provide workers with a great deal of choice and freedom. A
study by the Rand Corp. estimates that MSA's could help low-income
workers reduce health care spending by up to 13 percent.
In a truly American way, MSA's harness free enterprise to promote
sorely-needed efficiencies in the health care economy.
The fight over MSA's is fundamentally about power. MSA's return power
to the American worker. Proponents of socialized medicine recognize
that once MSA's are passed, they will dramatically become a bulwark
against the liberals' hopes for a government-controlled health care
system. Although this limited MSA program will not and cannot instantly
solve the problem of the affordability and availability of health
insurance, it will be a major step in the right direction.
Mr. President, the majority of Americans are calling for health care
reform. I believe further progress can be made by further changes in
the Tax Code. But this legislation puts us on the right track.
Mr. LEAHY. Mr. President, today over 62,000 Vermonters are included
in the 40 million Americans who are without health insurance.
Unfortunately, this number is increasing every year. Health insurance
has simply become less available and affordable.
The health insurance reform bill before us today is a small step, but
a step in the right direction. It puts an end to the practices of
denying health insurance to people with chronic illness and denying the
renewal of policies of people that become ill. It makes health care
more affordable by increasing the health insurance tax deduction for
self-employed individuals from the current 30 percent to 80 percent
over the next 10 years and makes the cost of long-term care, such as
expenses for nursing home and home health care, tax deductible just as
other medical expenses are today.
[[Page S9523]]
The passage of this bill is a hard-won battle. I do have concerns,
however, about the magnitude of the experimental provision to allow
750,000 health care policies to be withdrawn from traditional insurance
system to create a medical tax shelter for routine medical bills. I
plan to watch this demonstration closely to make sure that it does what
it is intended to do--increase the number of insured--and not just
increase premiums for people that have traditional health insurance
policies.
While, as I said, this bill moves us in the right direction, I have
to be clear that its passage is bittersweet. This bill does not address
the larger issue of the skyrocketing cost of health care which will
continue to be a looming problem that Americans face. And I am
disappointed that the final bill does not include a provision to end
discrimination against people with mental illness by requiring insurers
to treat mental illness coverage the same as coverage for physical
conditions.
I am also very concerned that the bill before us today calls for
nationwide data networks for health information to be established
within 18 months but contemplates delay of the promulgation of any
privacy protection for 42 months. That is not the way to proceed. When
the American people become aware of what this law requires and allows
by way of computer transmission of individually identifiable health
information without effective privacy protection, they should demand,
as I do, prompt enactment of privacy protection.
Despite these concerns, the steps that this bill takes are long
overdue. Two years ago, Congress was engaged in a great battle over how
to get health care costs under control and make health care services
available to all Americans. That battle heeded few results and left
millions of Americans frustrated and disappointed that health care
would continue to be out of their reach. The obstacles that prevented
Americans from buying health insurance have not gone away and Congress
now owes it to Americans to pass this bill to address some of the
issues that these individuals face.
Mr. KERREY. Mr. President, I strongly support Senate passage of H.R.
3103, the Health Insurance Portability and Accountability Act of 1996.
I am proud to have been an original cosponsor of its predecessor, S.
1028, the Kennedy-Kassebaum proposal that was originally introduced in
July of last year. Although I do not believe that this legislation is
as strong as the bill that passed the Senate last April, these changes
are still long overdue. As many as 25 million Americans will benefit
from these modest yet meaningful reforms to the insurance market--as,
for example, they move from job to job or lose employer-sponsored
coverage as the result of corporate downsizing.
This bill takes an incremental approach to health care reform by
fixing the most egregious flaws in our employer-based health insurance
system. I believe that we must move far beyond this bill, to
comprehensive health care reform, in order to ensure that every
American and legal resident knows that they have health insurance
coverage. However, we must do what we can, now, to make the first
needed changes to the American health care system.
Right now, we can help the many Americans who are currently excluded
from meaningful health coverage because they are subject to preexisting
condition exclusions or are unable to purchase an individual policy.
This bill will address these significant problems.
This bill's great strength is that it will enable American workers to
respond to our changing economy. Today, workers risk losing their
existing coverage when they seek new skills or new opportunities. If
they can find a replacement policy through a new employer or in the
individual market, it may leave them under-insured. They can be subject
to a preexisting condition exclusion that excludes a part of their
body, or a significant health problem, from coverage, even though they
have maintained insurance coverage for many years. Because of these
constraints, many Americans don't dare switch employers or career-
paths. This job-lock phenomenon, which has reportedly affected 25
percent of all Americans, would be eliminated by this bill.
In addition, the portability and renewability protections in this
bill will give more Americans the health coverage flexibility they need
to survive in our changing economy. This bill takes a responsible
approach to ensuring continued access to health care--in the individual
market if necessary--for workers who are displaced by corporate
downsizing and other lay-offs. Because our economy is fluid and
unpredictable, we need to fix these flaws in our employer-based health
insurance system.
I believe that this is critically important legislation, but I also
believe that this legislation could have been better. It should have
included provisions requiring equitable treatment for mental health
care--if not the parity provision originally championed by Senators
Domenici and Wellstone, then the compromise proposal on benefit limits
that Senator Domenici introduced today. I am also concerned that the
portability provisions for group to individual coverage were weakened
by the conference committee. I think that the original bill's
guarantees for individuals who lose group coverage and seek insurance
in the individual market took the right approach. Insurers should be
required to offer a broad range of insurance policies to these
customers. The conference agreement will allow insurance companies to
offer only two policies--and even though the bill includes some
requirements for these plans, I am concerned that insurers may be able
to charge these individuals exorbitant rates.
I also can't pretend that this proposal will fix all of the problems
in the American health care system. Many Americans will benefit from
this proposal. But many of the 40 million Americans who are currently
uninsured will not be among them. I am particularly concerned that so
many children continue to be uninsured. In a recent study, the GAO
analyzed the recent decline in health insurance among children and
concluded that this decline in coverage has been concentrated among
low-income children. This report also noted that the proportion of
children who are uninsured--14.2 percent, or 10 million children--is at
the highest level since 1987. I believe that all children should have
health insurance, and that this insurance should cover children's
complete developmental needs.
In addition, health insurance premiums will continue to be
unaffordable for many, and the significant individual insurance market
reforms will not affect people who are already uninsured. Our
population will continue to age and Medicare and Medicaid spending will
therefore continue to escalate. Overall health expenditures--Federal
and State programs, private insurance and out-of-pocket spending which
already consume more than 12 percent of GDP--will continue to grow.
We need to recognize that these insurance reforms represent an
important step, but only a first step. Until all Americans are
guaranteed health coverage, we cannot claim to have fixed the health
care crisis. We clearly failed 2 years ago. We need to ensure that
every American, regardless of their ability to pay or the generosity of
their employer, maintains a meaningful right to health care. We also
need to ensure that every American bears their individual
responsibility pay for their health care--to the extent possible--and
the information they need to make informed decisions about the quality
and price of their care.
I applaud Senators Kassebaum and Kennedy for their determination and
hard work on this bill. Their efforts, over a number of months, to
bring this proposal up before the Senate, and their perseverance since
the Senate passed this bill in April, have been remarkable. I believe
that the compromises included in the conference report reflect the
legislation's original intent to improve access to health insurance for
millions of working Americans. We still have worked to do, but this
bill is a meaningful first step.
Mr. HATCH. Mr. President, it has been a long journey to this moment
in history, as we prepare to approve the conference agreement on H.R.
3103, the Kassebaum/Kennedy Health Insurance Reform Act of 1996, and
send it to the President for his signature. What we thought would be a
sprint because the ideas made so much sense turned out to be a
marathon.
As one of the original cosponsors of this important legislation, I am
[[Page S9524]]
pleased the impasse which prevented this bill from moving forward has
been resolved.
After months of delay, the American people will soon realize the
benefits of the time and energy that have been devoted in making this
legislation a reality.
The Republican leadership in the House and Senate are to be commended
for their steadfast commitment to reach an agreement with the White
House on such contentious issues as medical savings accounts, insurance
portability, mental health parity, and advisory opinions.
Overall, this legislation embraces many key elements of health care
reform that have been pending in Congress for over five years, even
before the 1994 health care overhaul proposal by President and Mrs.
Clinton.
In my opinion, H.R. 3103 is a good bill. It represents meaningful,
workable, and targeted health care reform that will provide a
significant measure of assistance to millions of Americans.
The underlying insurance reforms included in the bill have now been
enhanced by additional provisions that strengthen and improve the scope
of the legislation.
Although much of the controversy over the past several months
centered on issues unrelated to the insurance provisions, it is
important that we not lose sight on the importance of the insurance
reforms.
This bill will provide greater assurance to an estimated 25 million
Americans that they can carry their health insurance coverage from job
to job, without losing that protection, as well as obtain health
insurance irregardless of preexisting health problems.
These protections are clearly the hallmark of the Kassebaum/Kennedy
bill.
These protections are important because access to health insurance
remains one of the fundamental problems facing Americans in today's
health insurance market. The unfortunate fact of today's insurance
market is that there is too little protection for individuals and
families with significant health problems.
This legislation is clearly aimed at correcting that problem.
By restricting the use of preexisting limitations or exclusions on
individuals, H.R. 3103 will increase access to health coverage as well
as provide portability of insurance coverage for those wishing to
change jobs.
Although these changes have been described as incremental by some,
they are significant improvements in the manner in which Americans
obtain health insurance. Through the enactment of this bill, Congress
is sending a message that the status quo is unacceptable.
This bill will help a significant number of people and for that
reason alone it is worthy of passage.
Aside from the insurance reforms, there are a number of other
provisions added in the House and on the Senate floor to the underlying
insurance bill.
For example, the bill creates a newly coordinated Federal, State and
local health care antifraud and abuse program that will dramatically
increase the enforcement authority of the Departments of Health and
Human Services and Justice.
As Chairman of the Senate Judiciary Committee, I have been
particularly interested in the development of the antifraud provisions.
It is clear from the hearings conducted in the Judiciary Committee as
well as other committees in Congress that more effective law
enforcement tools are needed to fight health care fraud.
The problems have been well-documented by the distinguished Senator
from Maine, Senator Cohen, who developed the underlying legislation
from which many of the fraud provisions of H.R. 3103 were developed.
I strongly support tough and effective measures to address fraud and
abuse. But in our efforts to deter, detect and prosecute fraudulent
behavior, we need to ensure that these efforts do not penalize innocent
behavior or unintentionally bog down the delivery of health care.
The practice and delivery of health care is overwhelmingly conducted
by honest and well meaning individuals who should not be suspected of
wrongdoing merely because they are physicians, hospital administrators
or other health care providers.
Creating a cloud of suspension over the entire health care community
will not solve the fraud problem when only a few are guilty of
wrongdoing.
We need to ensure that new antifraud and abuse provisions provide
clear and unambiguous guidance on what constitutes fraudulent behavior.
Equally important is that antifraud provisions avoid penalizing
innocent individuals for inadvertent or clearly innocent behavior.
I would remind my colleagues that antifraud proposals over the past
several years have essentially proposed to expand the scope of existing
antifraud and abuse laws applicable to health care providers. A clear
case is the application of the antikickback laws which are, at best,
complex and confusing and are not easily conveyed in the context of
managed care.
Overly broad applications of these laws are particularly worrisome.
As an example, the legislation creates a new Federal criminal statute
under title 18 of the U.S. Code against health care fraud. Fines and
imprisonment for up to 10 years can be imposed for violating provisions
of the new statute.
Within the practice of health care, legitimate disagreements
regarding medical judgment and treatment decisions should not be cause
for imposing legal penalties. It is critical that the antifraud
provisions be carefully crafted to avoid punishing unintentional acts
by health professions.
Accordingly, I am pleased the conference report contains language I
proposed that specifically defines any new Federal health care offense
to include both a knowing and willful standard of intent.
The addition of willful in this standard is essential to ensure that
inadvertent or accidental conduct is not deemed criminal. The standard
is now clear that criminal liability will be imposed only on an
individual who knows of a legal duty and, intentionally, violates that
duty.
Without this clarification, legitimate disagreements regarding a
physician's medical judgment and treatment decisions could have been
the basis for imposing criminal penalties.
Another issue which surfaced during consideration of the antifraud
provisions concerned the impact on the provision of alternative and
complementary health care.
As my colleagues know, I have championed the cause of alternative and
complementary medicine. I am sensitive to concerns within this
community regarding unintended negative implications of the fraud
language on the provision and practice of nontraditional and nonmedical
forms of health care.
I want to make it clear to my friends in the alternative and
complementary medicine community that under this bill the practice of
complementary, alternative, innovative, experimental or investigational
medical or health care itself, will not constitute fraud.
I have specifically addressed these concerns in the legislative and
conference report language to clarify any misunderstandings or
ambiguity arising from the implementation of the fraud provisions.
In this regard, I want to thank the National Nutritional Foods
Association, the American Chiropractic Association and the American
Preventive Medical Association for their input.
While it is easy to focus only on the laudable benefits of the
insurance provisions in this bill, because they are so important, we
must not lose sight of the very significant tax provisions that are
also included in this legislation. These provisions will work to make
health insurance more affordable, to ease the financial burdens of
long-term care, and to allow individuals to use individual retirement
account funds for catastrophic health expenses without penalty.
Mr. President, I am very pleased that this bill increases the
percentage of health insurance costs that can be deducted by the self-
employed to 80 percent. This provision takes a huge step toward
correcting what has long been a gross inequity. No one has ever been
able to defend the policy of allowing corporations to fully deduct
health insurance expenses, but allowing the self-employed to deduct
only a small portion. At a time when we are trying to encourage the
creation of new businesses, especially by those who have
[[Page S9525]]
been laid off from large corporations over the past few years, this
lack of full deductibility has been a real disincentive.
Although this bill takes us most of the way there by getting to 80
percent deductibility, I want to note that our job is far from finished
in this area. First, 80 percent is not enough. We must find a way to go
the rest of the way and allow for full deductibility.
Second, under this bill, it takes us 10 years to go from the 35
percent that is deductible under the current law to the 80 percent
level that this bill finally provides. I urge my colleagues to not sit
back and relax on this issue. I hope that in the next Congress, we can
find a way to get to full deductibility and sooner.
The long-term care provisions of this bill are also very important,
Mr. President. As our population ages, millions of families will find
themselves facing the problem of how to pay for needed health care for
aged loved ones. Up until now, the Medicaid program has borne the brunt
of these expenses in cases where the individual or family did not have
the resources to cover the often very significant cost of nursing home
care or skilled nursing assistance.
It is clear, however, that our Medicaid system will simply not be
adequate to cover such expenses as we move into the next century and
the public's capacity to pay for these huge expenses are pushed beyond
the limit.
The bill before us begins to address this problem by making it easier
for individuals and families to pay for long-term care insurance,
easier for insurance companies to provide such coverage, and more
beneficial to employees of companies that provide such insurance as
part of an employee benefit package. These changes are key in moving
the majority of the responsibility for long-term care expenses from the
public sector to families and individuals.
Many of these tax provisions are very similar to changes I have long
advocated in long-term care legislation. These provisions are, in fact,
comparable to the long-term care provisions included in the quality
care for life legislation I introduced earlier in this Congress. I
believe these provisions will serve to begin to shift public attitude
from one largely of government dependence to one of personal
responsibility. Private insurance is vital to making this shift, and
these provisions will all make it much easier for insurance to be a
viable alternative.
Mr. President, I also want to comment on a small, but important,
provision, that will help thousands of Americans who are hit by high
medical expenses. This bill allows for penalty-free withdrawals from
individual retirement accounts to pay medical expenses that exceed 7.5
percent of the taxpayer's adjusted gross income.
When the IRA concept was first enacted into our tax law, penalties
were placed on early withdrawals to discourage any use of the money
beside that for which it is mainly intended--to provide funds for
retirement. This was wise, Mr. President.
However, we also need to recognize that when devastating illness
strikes a family, the need for cash is immediate. This provision helps
in cases where a family is hard hit with medical expenses but has the
means to help pay them in IRA funds. I also commend the provision that
allows IRA funds to be used to pay for health insurance premiums in
cases of unemployment. This provisions should help many families who
might face the ugly choice of dropping health care coverage when the
paycheck temporarily stops.
Also included in the conference report is a four year pilot project
for medical savings accounts, or MSA's.
Beginning in 1997, MSA's are available to employees covered under an
employ-sponsored high deductible plan of a small employer or self-
employed individual. Taxpayers (including the self-employed) will be
allowed to make tax-deductible contributions within limits of an MSA.
The number of taxpayers benefiting annually from an MSA contribution
would be limited to a threshold level of 750,000 taxpayers.
I strongly support MSA's. I believe they will provide needed
incentives for Americans to become more cost conscious as purchasers of
medical services. MSA's will clearly give people more control over
their health care dollars with the opportunity to save unspent MSA
dollars for future health and long-term care needs.
Mr. President, overall this legislation represents an appropriate
balance between the role of the Federal Government with the private
insurance market in addressing the health-related problems currently
facing many of our citizens.
However, we must recognize that we are breaking new ground with the
enactment of this bill. The level of Federal involvement proposed in
H.R. 3103 in the affairs of the historically private marketplace of
insurance products does indeed raise concerns. We will not ignore these
concerns in the implementation of this new legislation, and we will
review carefully the long-term impact of these provisions.
Mr. President, I would also like to say to the gentleman from New
Mexico, Senator Domenici, that I, too, am disappointed that the
conferees could not work out language on mental health.
I voted for that amendment, because I strongly believe we need to do
more to address the problem of mental health insurance coverage for the
millions of Americans who suffer from mental illnesses that are as
devastating to individuals and families as physical ones.
During our preconference sessions, I worked with my colleagues to see
if there were alternatives to parity which could be pursued in this
legislation, because I truly believe that we are not doing enough on
mental health. One idea I put forward was to direct increased resources
to mental health through the Substance Abuse and Mental Health Services
Administration.
I put this proposal forward in a good-faith effort to increase our
federal presence on mental health. I understand the concerns of my
colleagues that this would not go far enough when compared to the
Domenici amendment, but nevertheless I regret that the bill does not
contain any mental health provision. I will continue to work with my
colleagues on this issue.
Nevertheless, on balance, I am convinced that this bill will serve
the interests of the American people who have long sought responsible
health insurance reform.
Finally, Mr. President, I would be remiss if I did not take this
opportunity to recognize the efforts of the distinguished Chairman of
the Committee on Labor and Human Resources, Senator Kassebaum, who is
to be commended for her leadership and perseverence, in developing this
legislation.
I can think of no fitting tribute to her than the enactment of this
health reform bill.
Her dedication, hard work, and common sense have been hallmarks of
her career in the U.S. Senate.
Let me also thank the ranking minority member, Senator Kennedy, who
has also been an instrumental player and leader in the development of
this legislation.
I urge my colleagues to support the conference report to H.R. 3103.
Mr. KENNEDY. Mr. President, I yield myself the remaining 2 minutes.
Today, in spite of 18 months of Republican attempts to deny a pay
increase to the most underpaid American workers, Congress will, at long
last, send the President legislation to raise the minimum wage.
Finally, 5\1/2\ years after the minimum wage was last increased,
Congress is taking steps to ensure that all workers can earn a living
wage.
This day has been a long time coming; 18 months ago, in February
1995, I introduced legislation to raise the minimum wage to $5.65 an
hour in three 50-cent increments, and joined Senator Daschle 1 month
later to introduce S. 413, which would have raised the minimum wage by
90 cents in two increments--on July 1, 1995 and July 1, 1996.
A year ago, on July 31, 1995, I offered a resolution expressing the
sense of the Senate that the Senate should take up the minimum wage
increase before the end of last year. It received only two Republican
votes and was defeated.
I was unable to get a hearing on our bill until December, and--month
after month--the Republican chairman of the Labor Committee refused to
schedule a markup session to consider it.
Finally, with the very skillful assistance of the Democratic leader,
Senator Daschle, I was able to offer our bill as
[[Page S9526]]
an amendment to another bill in March, and obtained a strong vote in
favor of a 90-cent increase in the minimum wage. The Republican leader
at the time, Senator Dole, responded by pulling the parks bill from the
floor of the Senate. He then tied the Senate in procedural knots for
weeks, rather than allow a second vote on our bill.
It was only after Senator Dole left the Senate to campaign for the
Presidency that we succeeded in scheduling a vote on our bill, and only
after threatening to shut down the Senate. I hope every American
remembers that this victory for the working poor became possible only
after Senator Dole left Washington to become a private citizen.
Now 13 months have passed since the first of the increases in our
original bill would have taken effect. The Republicans' delaying
tactics have cost minimum wage workers almost $4 billion. I hope every
American remembers how tenaciously and how long the Republicans have
fought to prevent this increase in the minimum wage.
By contrast, in vote after vote, my Democratic colleagues have been
united in their support of fair wages for all workers. I want to salute
them for that unity and thank them for their support throughout this
long fight.
Thanks to the perseverance of my Democratic colleagues, the poorest
American workers will see their incomes increase by 22 percent. By the
time next year that the second increase takes effect, they will see
their incomes increase by $1,800 a year, enough to pay for 7 months of
groceries or a year of community college.
Unlike the punitive welfare reform bill Congress has just passed,
this raise in the minimum wage will actually improve the lives of
millions of people. It will lift 300,000 people out of poverty,
including 100,000 children, and save families across the Nation from
having to make cruel economic decisions, such as choosing between
keeping the utilities turned on and paying for groceries or medicine.
The real problem for much of the welfare population is their
inability to find jobs that pay enough to support them and their
families. If work does not pay a living wage, requiring welfare mothers
to work will do nothing to end their poverty.
It is unfortunate that this good legislation for low-wage workers was
coupled with a package of tax giveaways to large and small businesses.
I regret that many objectionable changes to our tax laws are being made
under the cover of raising the minimum wage.
On balance though, H.R. 3448 is legislation that should be passed.
This long awaited raise in the minimum wage should be delayed no
longer.
These are important factors for hard-working men and women in this
country. This is an extremely important achievement and accomplishment.
I look forward to casting my vote in favor of the increase in the
minimum wage.
Mrs. KASSEBAUM. Mr. President, I say how very grateful I am to so
many for all of the efforts that have gone into making the passage of
the House insurance reform possible tonight.
It is not possible to name all the names, and I ask unanimous consent
they be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Labor Committee: Dean Rosen, Susan Hattan, Anne Rufo, David
Nexon, Lauren Ewers.
Finance Committee Majority: Lindy Paull, Frank Polk, Julie
James, Mark Prater, Doug Fisher, Gioia Bonmartini, Alex
Vachon, Brig Gulya, Sam Olchyk, Donna Ridenour.
Minority: John Talisman, Patti McClanahan, David Podoff,
Laird Burnett, Keith Lind.
Majority Leader: Annette Guarisco, Vicki Hart, Susan
Connell.
Minority Leader: Rima Cohen.
Joint Committee on Taxation: Ken Kies, Mary Schmitt,
Carolyn Smith, Cecily Rock, Brian Graff, Judy Xanthopoulos.
Congressional Research Service: Beth Fuchs, Madeleine
Smith, Kathleen Swendiman, Jennifer O'Sullivan, Celinda
Franco.
Thanks to the staff of: House Ways and Means Committee--
particularly Chip Kahn, Elise Gemeinhardt, and Kathy Means;
House Commerce Committee--Howard Cohan, Melody Harned; House
Economic Opportunities Committee--Russ Mueller; Congressional
Budget Office Staff; House and Senate Legislative Counsels--
particularly Bill Baird, Ed Grossman, John Goetcheus, and
Julie Miller.
Mrs. KASSEBAUM. Without the dedicated efforts of our staff, it would
not have been possible. I mention Dean Rosen, Susan Hattan of my staff,
and David Nexon and Lauren Ewers of Senator Kennedy's staff, and many
others who have spent countless time and effort.
It is an important piece of legislation. I am very proud we have
accomplished it in a bipartisan fashion. It could not have been done
without them.
Senator Kennedy mentioned the minimum wage legislation which we will
be voting on as well, in back-to-back votes. I will speak after those
votes on something I regard very important to the success of both
welfare reform and the minimum wage, and that is job training programs.
Without our willingness to be more innovative and skillful in how we
handle job training problems, we will not succeed with the type of
welfare reform or minimum wage that enables us to have skilled young
people and retrained older people entering our job markets. I think
that is an important component of the success of those bills.
I yield any remaining time, but say again how proud and grateful I am
to all who have had a hand in the passage of this legislation.
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