Madam Speaker, I thank the gentleman from New Jersey for yielding me this time and also commend him for his leadership and the energy he has shown on this subject, as well as the ranking member, the gentleman from California (Mr. George…
Madam Speaker, I thank the gentleman from New Jersey for yielding me this time and also commend him for his leadership and the energy he has shown on this subject, as well as the ranking member, the gentleman from California (Mr. George Miller).
Madam Speaker, there is a serious problem throughout America in regards to the rising cost of health insurance, double-digit premium increases. As I travel around my congressional district in western Wisconsin visiting businesses large and small alike, it is the number one topic on their lips, the difficulty of being able to provide health insurance coverage for their employees with the double-digit increases that they are facing today.
Part of the problem in western Wisconsin deals with the inadequacy of Medicare reimbursement rates, which then is cost-shifted on to the private plans; but also part of the problem is the number of uninsured and the cost shifting that occurs when they receive treatment. We saw the statistics a little earlier, 41 million uninsured. Those numbers are going up. Between 50 and 60 percent of the uninsured are employees working in small businesses. It is a crisis situation out there, and I have not met a small business owner yet that is happy with the fact when they cannot provide some basic health coverage for their employees. Unless we deal with it in an honest and, I think, straightforward plan, the numbers will only get worse.
There are some here today that think H.R. 660 is the answer to the crisis we are all experiencing in our own districts. I happen to disagree. I think there are some serious flaws with H.R. 660. I believe that, at best, the underlying legislation would do very little to address the plight of the uninsured. There is a recent CBO analysis that said that, at best, we might be able to extend additional coverage for half a million Americans, a far cry from the 41 million who are currently uninsured or the 25 million who are working right now in small businesses. At worst, there is a Mercer report that shows that because of the premium increases in other health plans, we could see another million Americans losing their health insurance coverage because of H.R. 660.
What also is a major problem is that it exempts State laws. These are community value judgments made in each of our States in regards to what health care practices should be covered for the citizens. Yet the legislation today is calling for a preemption of that State law, an eradication of the federalism that has existed in this country for a very long period of time. It is one of the reasons why we have so many people opposing the legislation, from the National Governors' Association, from the Democratic Governors' Association and Republican Governors' Association, the State Attorneys General Association, not to mention the Association of Insurance Plans, as well as the National Conference of State Legislatures.
Why would you, if you believe in the free market, as I think most of us do, and believe in price competition, try to set up an uneven system where you have two different sets of plans playing by two different sets of rules? It does not make sense. If you are going to force price competition in the free market system, you need to have everyone playing on a level playing field playing by the same set of rules, such as the State laws that exist right now, rather than exempting a whole category of people.
I think our substitute offers a better alternative, and I would encourage our colleagues to support that.
Madam Speaker, I offer an amendment in the nature of a substitute.
Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, we have had I think a very enlightening discussion so far today in regards to the real impact of these associated health plans, what they are potentially capable of doing and what the danger of them are. As the gentleman from New Jersey (Mr. Andrews) has been citing repeatedly, there is an objective study there indicating the potential impact if this legislation enacted of increasing the ranks of the uninsured throughout the country by an additional million people. That is heading in the wrong direction considering we have 41 million uninsured today, many of them, between 50 and 60 percent of that 41 million, working in small businesses throughout our Nation.
We have a serious issue that requires a serious response and a serious plan to provide some real relief for small business employers to their employees. These are people who wake up every morning. They go to work. They play by the rules. They are asking for basic health care coverage like their neighbors next to them.
Unfortunately, H.R. 660 pulls up a little bit short in a couple of respects. First of all, it creates a current two-tiered system exempting the health care plans from currently State-regulated requirements. These are decisions made by State legislatures reflecting community values in regards to what type of health care coverage is important for their citizens, for their communities, for the society at large. And what is being proposed now is exempting a whole category of health insurance plans from basic health coverage such as cancer screening, mammographies, prenatal care, maternity care, diabetes, autism coverage in some States, and for those whoever worked with autistic children understand the importance of treating autism is early recognition, early intervention, and a lot of times that will not occur unless there are health plans that provide such coverage, and if we do not intervene early in these children's lives, there are exponentially greater costs for society at large down the road.
We offer a substitute, which I believe addresses the challenge that we are facing as a Nation more honestly and more fairly. The Democratic alternative that I have worked on with the gentleman from New Jersey (Mr. Andrews) and others on the committee would provide direct assistance to small businesses and their employees, another shortcoming of H.R. 660. There is no incentive, there is no help financially to enable employers to provide this type of coverage for their employees. And everyone I know is familiar with the small business employer that is operating on the margin, oftentimes losing money rather than making money.
And if there is not some type of financial incentive that our substitute bill offers it is unlikely that they are going to be able to extend their health insurance coverage to their employees who currently do not have them.
What our substitute would do is it would direct the Department of Labor to establish a small employer health benefit plan similar to the Federal Employee Health Benefits Plan. Many of the Members of Congress here today are members of the Federal Employee Health Benefits Plan. I have not encountered too much criticism of the health plan that Members of Congress are receiving. I think small business owners and their employees should be given the same opportunity on an affordable basis. The program would contract with State license insurers to offer a minimum insurance package for all employees of businesses of fewer than 100 people. Small businesses would be eligible for a premium assistance under our plan as would employees earning below 200 percent of the poverty level.
This alternative has the potential of providing health insurance coverage to 33 million Americans who currently go without it today. The number stands in stark contrast to the estimated 550,000 that the Congressional Budget Office has calculated under H.R. 660.
Perhaps most importantly, our plan is paid for under the budget resolution that the majority party has passed earlier this year. It fits within the budget confines by providing these premium assistance to small business employers, and to those employees at 200 percent less of poverty, providing financial assistance and the financial means to actually access health plans and provide coverage for their employees. H.R. 660 does not provide any of those means.
What we may see under their budget resolution coming back at us shortly is some form of tax credit or some type of tax deduction, which is not going to help the numerous employees and small businesses operating at 200 percent or less poverty level, who are paying very little Federal income taxes in order to qualify for such credits, unless they are willing to extend that coverage to those employees. But wait a minute. We are right now engaged in a heated debate over a child tax credit on these very same principles; so it is doubtful that they are going to be able to provide that type of tax relief to employees who need it and cannot afford health plans generally.
I mean there is a reason why the National Governors Association, Republican and Democratic governors alike, are in opposition, why the State Attorney Generals Association is opposing, why the State legislatures throughout the country are opposing, why many consumer interest groups and health care providers are opposing H.R. 660, because they fear that the ultimate income will be expanding the ranks of
the uninsured rather than reducing that number.
I think we all have the best intentions in the plans that we are advocating here today to try to reverse course on the 41 million, to try to provide small businesses with an opportunity of providing some health care coverage for their employees, but we believe there is a right and there is a wrong way of doing it. We believe that the Democratic substitute being offered which does not preempt State law, which does provide some financial assistance, premium assistance for small employers, which is paid for under the budget resolution is the way to go if we are truly interested in reducing the number of the uninsured in this country, and thereby affecting the premiums that other health plans have to pay.
Because if the uninsured get sick or get hurt, they still go in, they still access, they still get care, but those costs are then shifted on to those plans that pay for it. Our plan would reduce the number of uninsured and thereby save costs and help reduce the premium increases that so many of our employers, large and small, are experiencing today. And with that, I encourage my colleagues to support the substitute. Vote no on the H.R. 660.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, this is modeled after the Federal employee health plan.
Mr. Speaker, I yield 2 minutes to the distinguished gentlewoman from California (Ms. Woolsey), a very knowledgeable member of the Committee on Education and the Workforce.
Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, let me quickly dispel a couple of myths. We have heard a couple of occasions new mandates are going to add costs to the employers.
First of all, there are no new mandates under the substitute. We merely respect State law. We do not require compliance. It is a voluntary program. If small business employers do not think it is a good financial deal for them, they do not have to join. There is nothing mandating their requirement.
We have also heard the word ``taxes'' being used, too. Let me reiterate, this is paid for in their own budget resolution. So there is no new taxes that we are talking about with respect to this substitute.
Mr. Speaker, I yield such time as he may consume to the gentleman from New Jersey (Mr. Andrews), the coauthor of this alternative bill.
(Mr. ANDREWS asked and was given permission to revise and extend his remarks.)
Mr. Speaker, I shudder to think we may be making major policy based on a few phone calls here today.
Mr. Speaker, I yield 1 minute to the gentleman from New Jersey (Mr. Andrews).
Mr. Speaker, would the gentleman yield?
Mr. Speaker, with all due respect to the gentleman from Illinois, my good friend, that is why our substitute is much better. We have one comprehensive pool that small businesses can buy into if they choose, therefore leveraging their bargaining power.
Mr. Speaker, would the gentleman yield?
Mr. Speaker, one of the strengths of the labor union is they are there representing the workers. They leverage the number of workers there, and they are representing their interests, and they oftentimes reduce wages in order to get a better health care plan.
Mr. Speaker, I yield such time as she may consume for the purposes of a colloquy to the gentlewoman from Minnesota (Ms. McCollum), a former State legislator and a colleague on the Committee on Education and the Workforce.
Mr. Speaker, would the gentlewoman yield?
Mr. Speaker, it would be, because we respect existing State law.
Again, it is not mandated unless the State offers that right now.
That would be covered.
That would also be covered under our substitute.
That would be covered.
That is right.
Yes, it would.
It would, indeed.
Mr. Speaker, will the gentlewoman yield?
One other significant difference between our substitute and H.R. 660 is ours would have a uniform premium rate for all employees. Employees could not be discriminated against with higher premium rates because they happen to be sicker than their fellow employees in the workforce. Ours would establish a uniform insurance premium rate for them so there would not be that type of price discrimination against the sicker in our population.
Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, again, we state that our substitute is fully paid for under the budget resolution, so we are not asking for new money. And with due respect to my friend from Georgia, we would hope a lot of employers would continue to offer the basic health care coverage that exists today. But the reason there were so many State battles throughout the country in State legislatures is because many of them were not. That is why these hard-fought battles need to be respected, and our substitute does.
Mr. Speaker, I yield 3 minutes to the gentlewoman from the Virgin Islands (Mrs. Christensen).
Mr. Speaker, I yield 2 minutes to the gentlewoman from New York (Mrs. McCarthy), a distinguished member of the Committee on Education and the Workforce.
Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Hinojosa), a distinguished member of the Committee on Education and the Workforce.
(Mr. HINOJOSA asked and was given permission to revise and extend his remarks.)
Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, this is a very important debate that we are having today. Just to correct one of the things just stated by the previous speaker, the Department of Labor, just like H.R. 660, would be in charge of administering the substitute plan that we have before us today. They would actually contract with state-licensed insurers to offer basic insurance plans.
The significant difference, though, is that we are asking everyone to play on a level playing field, to respect States' rights, and to not have Federal preemption. Because for those who believe in the free market system, which I think most of us do, it can only work if everyone is playing by the same rules instead of trying to establish a two-tier system. And that, I believe, is going to be the best hope we have, through price competition, of keeping a check on rising premium costs.
There has been a lot of citing of statistics throughout the afternoon, a lot from the Congressional Budget Office, and so I will provide for the Record a letter from the Congressional Budget Office stating their analysis of H.R. 660.
Mr. Speaker, I would encourage our colleagues, in conclusion, to support the substitute, one that does provide an opportunity for more small employers to provide health care coverage to their employees, one that respects State law, one that provides some premium assistance so they can afford it. I encourage support of the substitute and a ``no'' vote on H.R. 660.
Mr. Speaker, the letter referred to above is as follows:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 18, 2003.
Hon. George Miller,
Senior Democratic Member, Committee on Education and the
Workforce, House of Representatives, Washington, DC.
Dear Congressman: This letter responds to your request of
June 17, 2003, for additional information on CBO's estimate
of the impact of H.R. 660 on enrollment in the health
insurance markets for small employers and self-employed
workers. We expect that the effects of the bill would be
fully reflected in those markets by 2008, and all of the
following numbers refer to that year.
Under current law, CBO estimates that approximately 30.1
million people will be enrolled in health insurance offered
by plans in the state-regulated small group insurance
market. Under the bill, CBO estimates that combined
enrollment in state-regulated plans and association health
plans (AHPs) would rise by about 550,000 people to a total of
30.7 million people. Of this, approximately 23.2 million
people would retain coverage in the state-regulated market.
About 7.5 million people would be enrolled in AHPs, including
the additional 550,000 people who would not have been covered
by any small-employer plan under current law, and 6.9 million
people who would have been covered in the state-regulated
market.
The same consideration apply to self-employed people. We
estimate that approximately 4.7 million people will be
enrolled in state-regulated coverage purchased by self-
employed workers under current law. Under H.R. 660, CBO
estimates that combined enrollment through state-regulated
insurers and AHPs would rise by about 70,000 people to 4.8
million people. Of this, approximately 3.8 million people
would retain state-regulated coverage. About 1.0 million
people would obtain coverage through AHPs, including the
additional 70,000 people who would not have been insured
under current law, and 0.9 million people who would have been
covered in the state-regulated market.
If you would like additional information on this estimate,
the CBO staff contact is Stuart Hagen, who can be reached at
225-2644.
Sincerely,
Douglas Holtz-Eakin,
Director.
Mr. Speaker, on that I demand the yeas and nays.