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Congressional Record—Senate S379

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Congressional Record—Senate S379 January 21, 1997 CONGRESSIONAL RECORD Ð SENATE S379 the subsidy program will be so success- provide less health insurance coverage Health insurance plans offered through ful it will be used as a model for reform than larger businesses or the public the purchasing groups would be re- of the Medicaid program. Savings sector. About 73 percent of employees quired to meet basic, comprehensive through other health care reforms de- in the public sector are provided with standards with respect to benefits. tailed later in this statement will pro- health insurance; while 55.5 percent of Such benefits must include a variation vide the funds needed to implement the employees in the private sector are of benefits permitted among actuari- essential effort to take care of the covered. Both levels are far higher than ally equivalent plans to be developed health of our Nation's children. businesses with fewer than 10 employ- by the National Association of Insur- I have also added a new title VIII to ees (25.8%); with 10 to 24 employees ance Commissioners. The standard plan establish a national fund for health re- (38.8%); or with 25 to 99 employees would consist of the following services search within the Department of Treas- (54.4%). when medically necessary or appro- ury. This fund will supplement the As I mentioned previously, title I of priate: First, Medical and surgical de- moneys appropriated for the National the bill gives federal subsidies to pro- vices; second, medical equipment; third Institutes of Health. It is to be on vide health care coverage for our Na- preventive services; and fourth, emer- budget, but the financing mechanism is tion's children. Early estimates are gency transportation in frontier areas. not specified. This proposal was first that the total cost of these vouchers It is estimated that for businesses with developed by my distinguished col- will be approximately $24 billion over 5 fewer than 50 employees, voluntary leagues, Senators Mark Hatfield and years. This $24 billion is a worthwhile purchasing cooperatives such as those TOM HARKIN. Senator Hatfield, who re- investment because it will mean included in my legislation could cover tired after the 104th Congress, worked healthier children and substantially re- up to 10 million people who are cur- closely with me on medical research duced anxiety for millions of parents rently uninsured. funding issues. The concept of a na- who cannot afford to pay for needed My bill would also create individual tional fund for health research was in- medical care for their children. health insurance purchasing groups for corporated into the National Institutes Title II contains provisions to make individuals wishing to purchase health of Health Revitalization Act of 1996, it easier for small businesses to buy insurance on their own. In today's mar- which was passed by the Senate, but health insurance for their workers by ket, such individuals often face a mar- not by the House. establishing voluntary purchasing ket where coverage options are not af- Responding to decreases in discre- groups. It also obligates employers to fordable. Purchasing groups will allow tionary funding, in the 104th Congress, offer, but not pay for, at least two small businesses and individuals to buy Senators Hatfield and HARKIN intro- health insurance plans that protect in- coverage by pooling together within duced S. 1251, the National Fund for dividual freedom of choice and that purchasing groups, and choose from Health Research Act. They wisely an- meet a standard minimum benefits among insurance plans that provide ticipated that we cannot continue to package. It extends COBRA benefits comprehensive benefits, with guaran- look solely to the appropriations proc- and coverage options to provide port- teed enrollment and renewability, and ess for the necessary resources to sus- ability and security of affordable cov- equal pricing through community rat- tain sufficient growth in biomedical re- erage between jobs. While it is not pos- ing adjusted by age and family size. search. The great advancements made sible to predict with certainty how Community rating will assure that no by the United States in biomedical re- many additional Americans will be one small business or individual will be search are part of what makes this covered as a result of the reforms in singularly priced out of being able to country among the best in the world title II, a reasonable expectation would buy comprehensive health coverage be- when it comes to medical care. Their be that these reforms will cover ap- cause of health status. With commu- idea is a sound one and ought to be proximately 10 million Americans. nity rating, a small group of individ- adopted. I look forward to working to- This estimate encompasses the provi- uals and businesses can join together, gether with Senator HARKIN to enact a sions included in title II which I will spread the risk, and have the same pur- biomedical research fund this Congress. discuss in further detail. chasing power that larger companies Taken together, I believe the reforms Specifically, title II extends the have today. proposed in this bill will both improve COBRA benefit option from 18 months For example, Pennsylvania has the the quality of health care delivery and to 24 months. COBRA refers to a meas- ninth lowest rate of uninsured in the will bring down the escalating costs of ure which was enacted in 1985 as part of Nation, with 90 percent of all Penn- health care in this country. These pro- the Consolidated Omnibus Budget Rec- sylvanians enrolled in some form of posals represent a blueprint which can onciliation Act [COBRA '85] to allow health coverage. Lewin and Associates be modified, improved and expanded. In employees who leave their job, either found that one of the factors enabling total, I believe this bill can signifi- through a layoff or by choice, to con- Pennsylvania to achieve this low rate cantly reduce the number of uninsured tinue receiving their health care bene- of uninsured persons is that Pennsylva- Americans, improve the affordability fits by paying the full cost of such cov- nia's Blue Cross-Blue Shield plans pro- of care, ensure the portability and se- erage. By extending this option, such vide guaranteed enrollment and renew- curity of coverage between jobs, and unemployed persons will have en- ability, an open enrollment period, yield cost savings of billions of dollars hanced coverage options. community rating, and coverage for to the Federal Government, which can In addition, options under COBRA persons with preexisting conditions. be used to cover the remaining unin- are expanded to include plans with My legislation seeks to enact reforms sured and underinsured Americans. lower premiums and higher deductibles to provide for more of these types of f of either $1,000 or $3,000. This provision practices. The purchasing groups, as is incorporated from legislation intro- developed and administered on a local INCREASING COVERAGE duced in the 103d Congress by Senator level, will provide small businesses and According to the U.S. Bureau of the PHIL GRAMM and will provide an extra all individuals with affordable health Census, in 1995, 224 million Americans cushion of coverage options for people coverage options. derived their health insurance cov- in transition. According to Senator Unique barriers to coverage exist in erage as follows: approximately 64 per- GRAMM, with these options, the typical both rural and urban medically under- cent from employer plans; 14.3 percent monthly premium paid for a family of served areas. Within my State of Penn- from Medicare and Medicaid; 4 percent four would drop by as much as 20 per- sylvania, such barriers result from a from other public sources; and about 7 cent when switching to a $1,000 deduct- lack of health care providers in rural percent from other private insurance. ible and as much as 52 percent when areas, and other problems associated However, 40.3 million people were not switching to a $3,000 deductible. with the lack of coverage for indigent covered by any type of health insur- With respect to the uninsured and populations living in inner cities. This ance. underinsured, my bill would permit in- bill improves access to health care Statistics from the Employment Ben- dividuals and families to purchase services for these populations by: First, efit Research Institute November 1996 guaranteed, comprehensive health cov- Expanding Public Health Service pro- show that small businesses generally erage through purchasing groups. grams and training more primary care S380 CONGRESSIONAL RECORD Ð SENATE January 21, 1997 providers to serve in such areas; sec- though our existing health care system estimated that between $1.1 billion and ond, increasing the utilization of non- suffers from very serious structural $2.5 billion per year could be saved if physician providers, including nurse problems, commonsense steps can be the number of low birth weight chil- practitioners, clinical nurse special- taken to head off the remaining prob- dren were reduced by 82,000 births. ists, and physician assistants, through lems before they reach crisis propor- We know that in most instances, pre- direct reimbursements under the Medi- tions. Title III of my bill includes three natal care is effective in preventing care and Medicaid Programs; and third, initiatives which will enhance primary low birth weight babies. Numerous increasing support for education and and preventive care services aimed at studies have demonstrated that low outreach. preventing disease and ill-health. birth weight that does not have a ge- Title II of my bill also includes an Each year about 7 percent, or 273,000, netic link is most often associated with important provision to give the self- of the approximately 3.9 million babies inadequate prenatal care or the lack of employed 100-percent deductibility of born in the United States are born with prenatal care.
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