Tim Hutchinson

Mr. HUTCHINSON

Mr. HUTCHINSON. Mr. President, may I first express my appreciation to the distinguished Senator from Missouri for his leadership, not only on the issue of 100-percent deductibility for the self-employed but for his strong advocacy for small business. He has been one of the great champions for small business in this country, and he continues to be as the cosponsor of the amendment. I am pleased to be associated with him on this important effort. If I might say in response to the concerns of my good friend, the distinguished Senator from South Carolina, about the Finance Committee's jurisdiction, in fact, no Senate committee ever reviewed S. 1052 before we proceeded to it on the floor of the Senate. While it is true that there have been other Patients' Bill of Rights legislation debated in the past, the fact is that this bill contains several provisions within the jurisdiction of the Finance Committee, including customs user fees, Medicare payment shifts, Social Security transfers--all of which come under the jurisdiction of the Finance Committee, which has never marked up this bill. In fact, this amendment is most appropriate for this bill because the concern of many on this side of the aisle--and I think many on the other side of the aisle--has been that the Kennedy-McCain version of the Patients' Bill of Rights, because of the liability provisions and some of the other concerns in it, but particularly the liability provisions--the wide open right to sue provisions, the ability to circumvent the internal and external appeals process and go straight to court, and the impact that liability will have upon increasing premiums, increasing costs of health care, and increasing, in fact, the number of uninsured--that dealing with an access amendment is the most appropriate way we could start the amendment process on the Patients' Bill of Rights. This is the most germane, most appropriate amendment with which we could begin. There are going to be many very important amendments and a lot of important issues addressed, but what could be more important than ensuring that there are going to be literally millions more people who will be able to get insurance because we are giving 100-percent deductibility a year sooner than they would get under current law? So the Senate has spoken, saying this is a matter of fairness. We have voted in the past in favor of 100-percent deductibility. There is no need for us to phase that in, particularly in light of a bill that promises to increase the number of uninsured. I want us to put a human face on those people. We talk about a 1- percent increase in premiums. That is 300,000 more uninsured; 4.2 percent. That is 1.3 million more people who lose their insurance. If you think about the number--1.3 million--it becomes very impersonal, but every one is a human being. And those are people who currently have health insurance, currently are covered, currently have the assurance and the confidence each day that when they get up, if something happens--if an illness strikes--they are covered, protected in this employer-based health insurance system. And they are not going to have it when we pass the Kennedy-McCain bill. We need to keep that in mind. We need to keep the focus upon those uninsured. I would like to share with my colleagues an important statement of administration policy which was just issued today. I have just been handed this. This is a June 21 ``Statement of Administration Policy'' regarding the Kennedy-McCain Patients' Bill of Rights. All who have followed this issue know the President wants to sign a good Patients' Bill of Rights. He signed a bill in Texas. He campaigned in support of a Patients' Bill of Rights. He outlined his principles. He is on record as not only supporting this, but enthusiastically believing we need to do it. But he has expressed deep concerns about this Kennedy-McCain bill. The ``Statement of Administration Policy'' reads as follows: The President strongly supports passage of a patients' bill of rights this year and has been working with members of both parties since the first week of the Administration to forge a compromise. Congress has been divided on this issue for far too long at the expense of patients and their families. The President strongly urges Congress to pass a strong patients' bill of rights this year that provides meaningful protections for patients, not a windfall for trial lawyers or a threat to Americans' ability to obtain and afford quality health care. On February 7, 2001, the President transmitted to Congress his principles for a bipartisan patients' bill of rights and urged Congress to move quickly on this important issue. The President's principles called for passage of a patients' bill of rights that ensures all Americans enjoy strong patient protections, including: access to emergency room and specialty care; direct access to obstetricians, gynecologists, and pediatricians; access to needed prescription drugs and approved clinical trials; access to health plan information; a prohibition of ``gag clauses''; consumer choice provisions; and continuity of care protections. The President also recognizes, however, that many States have passed strong patient protection laws already, some of which have been in force for over a decade. To the extent possible, a Federal patients' bill of rights should give deference to these effective State laws. The President's principles emphasized the importance of providing patients who have been denied medical care with the right to a fair, prompt, and independent medical review, which will ensure that disputes are resolved quickly and inexpensively and that patients receive the quality care they deserve. The President stated that only after this independent review decision is rendered should we resort to the costlier, time-consuming remedy of litigation in Federal courts to ensure that health plans are held liable for wrongful decisions. The President's principles also reminded Congress of the necessity of avoiding unnecessary and frivolous lawsuits, which will only serve to drive up costs and leave more individuals without insurance coverage. S. 1052-- That is the Kennedy-McCain bill. will significantly increase health insurance premiums and the number of uninsured. According to the Congressional Budget Office, health insurance premiums under S. 1052 as originally drafted would increase by over 4%. If the effects of litigation risk on the practice of medicine and of the reduced ability of health plans to negotiate lower rates were included, CBO's estimated cost impact could be much higher, by 4-5% or more. This is in addition to the estimated 10-12% premium increases employers are already facing in 2001. Further, leading economists have predicted that employers drop coverage for approximately 500,000 individuals when health care premiums increase by 1%. According to these estimates, S. 1052 could cause at least 4-6 million Americans to lose health coverage provided by their employers. The President is encouraged by efforts in the Senate, Like those of Senators Frist, Breaux, and Jeffords, to develop a common sense compromise that forges a middle ground on this issue and meets the President's principles. While the President strongly supports a comprehensive and enforceable patients' bill of rights and has been working with members of both parties to enact legislation this year, he believes that S. 1052 would encourage costly and unnecessary litigation that would seriously jeopardize the ability of many Americans to afford health care coverage. The President objects to the liability provisions of S. 1052. The President will veto the bill unless significant changes are made to address his major concerns. In particular, the serious flaws in S. 1052 include: S. 1052 circumvents the independent medical review process in favor of litigation. The President believes that patients should be given care first--litigation should be the last resort. Patients should exhaust the medical review process first, allowing doctors, not trial lawyers, to make decisions about medical care. S. 1052 jeopardizes health care coverage for workers and their families by failing to avoid costly litigation. S. 1052 overturns more than 25 years of Federal law that provides uniformity and certainty for employers who voluntarily offer health care benefits for millions of Americans across the country. The liability provisions of S. 1052 would, for the first time, expose employers and unions to at least 50 different, inconsistent State-law standards. The result will inevitably be that employers and unions will be forced to pay for different benefits from State to State, even within a particular State, based on varying precedents set in State courts and leading to inconsistent standards of care of patients. Further, S. 1052 imposes no limitations on State court damages, and it is not clear whether existing State-law caps would apply to the broad, new causes of action in State courts that S. 1052 creates. S. 1052 also would allow causes of action in Federal court for a violation of any duty under the plan, creating open- ended and unpredictable lawsuits against employers for administrative errors. These new Federal claims do not have any limitations on the amount of noneconomic damages, creating virtually unrestrained damage awards that are limited only by an excessive $5 million cap on punitive damages. Moreover, S. 1052 would subject employers and unions to frequent litigation in State and Federal court under a vague ``direct participation'' standard, which would require employers and unions to defend themselves in court in virtually every case against allegations that they ``directly participated'' in a denial of benefits decision. Because such determinations are inherently fact-specific, any such allegation will force a costly and time-consuming court process and result in varying State interpretations of ``direct participation,'' forcing employers to adhere to different standards in every State. S. 1052 fails to provide a fair and comprehensive remedy to all patients. The President believes the new Federal law should establish a comprehensive set of rights and remedies for patients. S. 1052 instead encourages costly litigation by providing no effective limitations on frivolous class action suits and allows trial lawyers to go on fishing expeditions to seek remedies under other Federal statutes. S. 1052 subjects physicians and all health care professionals to great liability risk. S. 1052 would expand liability for physicians and all health care professionals in State courts well beyond traditional medical malpractice by permitting new, undefined causes of action in State courts for denials of medical benefits. This expanded litigation against physicians and all health professionals will create an opportunity to circumvent State medical malpractice caps that may not apply to these new causes of action. Extraneous User Fee Provision. The Administration objects to inclusion in S. 1052 of an extraneous revenue-raising provision (section 502), which extends for multiple years Customs charges on transportation, passengers, and merchandise arriving in the country. pay-as-you-go-scoring S. 1052 would affect direct spending; therefore, it is subject to the pay-as-you-go requirement of the Omnibus Budget Reconciliation Act of 1990. OMB's preliminary scoring estimate of the bill is under development. Just before I yield the floor to our distinguished deputy minority leader, I will re-cite the President's Statement of Administration Policy in which the President says he will veto the bill unless significant changes are made to address his major concerns. The amendment before us, providing 100-percent deductibility, is one step in addressing the concerns of our President, by increasing the availability and affordability of health insurance to those who have faced an inequitable Tax Code in the past. Mr. President, I yield the floor.

Mr. HUTCHINSON. Madam President, I thank the Senator from Oklahoma for his fine statement and, even more, I express my gratitude for the leadership he has demonstrated over the last 2 or 3 years on the issue of the patients' rights legislation. It was a privilege to serve on the conference committee on the Patients' Bill of Rights. I saw the Senator from Oklahoma work day and night as he chaired that conference committee. He worked arduously in trying to forge a compromise that was acceptable to the various interests and factions to ensure that millions and millions of Americans who do not currently have protections under managed care organizations and insurance plans would receive that. I know many of us regret that we didn't achieve that ultimate goal. It is not because of any lack of effort on the part of the distinguished Senator from Oklahoma. Madam President, previously in my remarks, I quoted from the statement of the administration policy regarding S. 1052, the Kennedy- McCain legislation, and I ask unanimous consent to have that statement of administration policy printed in the Record.

Mr. HUTCHINSON. As the Senator from Oklahoma very rightly said, this amendment provides 100-percent deductibility for the self-employed beginning in January of next year, and accelerating that 100-percent deductibility, which the Senate has been on record in support of, is very germane and relevant to this bill. I think at the heart of this bill is the question of access. At the heart of this bill is, are we doing more damage than we are good? In our efforts to provide patient protection, are we increasing by millions the number who have no patient protections because they have no health insurance? That is, to me, a core fundamental question in this debate. I believe this amendment that I have offered with Senator Bond is a significant step--though far from all that is needed--in improving access. It is something we should do and indeed we must do. Sometimes, as we deal with the issue of liability, we forget exactly what kind of impact that liability will have. The President, in his statement of administration policy, really homed in on the impact of a wide-open lawsuit provision such as he believes and I believe exists in the Kennedy-McCain bill, what impact it would have on the uninsured. I think he cites very accurate numbers as to the millions of people who could well lose their health insurance were the Kennedy-McCain bill to pass as it currently exists. One survey found that roughly half of employers reported that they would likely get out of the business of providing health care coverage if exposed to increased liability. Some people say these employers aren't going to do that. How can they do that? This is essential to offer that benefit. You have to offer that to employees if you are going to be competitive. Well, many small businesses in particular and, for that matter, large corporations who are self-insuring today and are providing good health benefits to employees or their associates, when faced with the prospect of going to Federal court or State court on a host of actions, costly actions, are going to question seriously, understandably, whether they can operate in that kind of environment. Similarly, this study found that 48 percent said that expanded liability would hinder care management, and 80 percent said it would increase consumer costs. The point is that even those employers who are able to continue to offer health insurance are going to find their costs going up and those costs--they are not going to be able to absorb all of those costs, and they are going to be passed on to employees and consumers. That is going to have a detrimental impact upon, I believe, the health care system in this country. Sometimes cartoons can simplify a very complex issue down to something that is quite understandable to the average American or to the average Senator. Today, in our statewide newspaper in the State of Arkansas, the Arkansas Democratic Gazette, this cartoon appeared. It is a Vic Harville cartoon. It sums up the concern a lot of us have about the liability provisions in the Kennedy-McCain bill: ``Who will benefit the most from a Patients' Bill of Rights?'' There is a gleeful, happy attorney with a nameplate: Will Cheat 'Em Attorney At Law. There are going to be a lot of smiling attorneys, I am afraid, with the Kennedy-McCain bill, as it is currently framed. I have a number of concerns with the liability impact. The McCain-Edwards-Kennedy bill has been called the Trial Lawyers' Bill Of Opportunities. We all want a Patients' Bill of Rights. The President, in the Statement of Administration Policy, outlines specifically the patient protections he believes are essential that we provide millions of Americans. I think we would have a 100-0 vote on those patient protections. That is not good enough. Instead of finding a consensus bill that will provide patient protections for millions who do not have those kinds of protections today, we have a bill that has a liability provision, a right to sue not at the end of the road where there is an insurance company that has abused their clients, but at any point circumventing the internal-external appeal, the ability to go right into court after 180 days and tie up not only the court system, but spend literally hundreds of millions of dollars in the defense of those suits, whether they are meritorious or not. This chart expresses some of my concerns with liability. It bypasses external review and brings lawsuits at any time. It allows forum shopping between State courts. So while there is agreement--I certainly believe a right to sue should be included at some point. When an employee believes the insurance company has not treated them properly or has overridden a proper medical decision by that doctor, that individual ought to have a right of appeal. They should have an internal appeal that is accelerated, expedited. If at that point they are not satisfied, they should be able to go outside the insurance company, have an expert independent review to look at the issue and make a determination. If at that point the insurance company says, we are going to ignore it, we are still not going to comply with the decision of the external reviewer, at that point I think it is certainly appropriate there be a remedy. The McCain-Edwards-Kennedy bill allows lawsuits in Federal and State courts relating to the same injury; it allows forum shopping; it allows frivolous suits against employers for merely offering health insurance to their employees; that is, an employer is willing to take the risk of providing health insurance, is willing to invest the cost, some 60 percent, some 75 percent, some paying entirely for those premiums. What do they get for their willingness to provide that benefit? They get the possibility of frivolous lawsuits. Frivolous? Yes, because they need not go through the internal- external appeals process. If they are willing to wait 180 days after they discover the injury, they can go into court and leverage those frivolous suits for some kind of negotiated agreement. Those settlements will benefit trial lawyers. This is a bill of opportunities for trial lawyers. They collect large contingency fees on unlimited noneconomic and punitive damages. There is no limit; the sky is the limit. Whatever a good trial lawyer can convince a jury should be the damages and the sky is the limit on that. It abuses the class action lawsuits because there is no limit on class action lawsuits in the McCain-Edwards-Kennedy bill. All of these are great concerns to me. Americans will pay for trial lawyers' opportunities. It is not a Patients' Bill of Rights so much as it is a lawyer's right to sue. At least 1.2 million Americans will lose their health insurance. We have heard that figure 1.2, 1.3. That figure is based upon very conservative estimates by the Congressional Budget Office. Their estimate is that the McCain-Edwards-Kennedy bill will increase premiums by 4.2 percent. The President in his Statement of Administration Policy said he believes they are overly conservative. I believe they are overly conservative. The impact is going to be far greater. At least 1.2 million Americans will lose their health insurance at a time the number of uninsured has been increasing. The 43 million number goes up, and that is a huge number of Americans who are uninsured. Perhaps that is what some want. Maybe some want to increase the uninsured with a separate agenda to come back with radical changes in a health care system that I believe is the envy of the world. The evidence is people from all over the world come here to get the best quality health care. Millions of Americans will lose their health insurance. The average American family will pay at least $300 more in annual premiums. The Senate, in its wisdom, collectively and on a bipartisan basis, just passed a tax relief bill, only the third time since World War II in the sixties under President Kennedy, the eighties under President Reagan, and now under President George W. Bush we passed tax relief for the American people. We are going to give a rebate check. This $300 increase in the annual premium will quickly eat that up. It will consume that little bit of tax rebate we were able to give in the tax package this year. Americans will pay $200 billion more in extra premium costs over 10 years. Over half of America's employers will increase health plan deductibles and copays. It is not only that we are going to have 1.2 million or more lose health coverage altogether, but those who are able to stay insured are going to find their copays will increase; they are going to find their premiums will increase; that those are going to be passed on; their deductibles are going to be higher; and then the result of this legislation will be thousands of new lawsuits clogging our already overcrowded courts. This is often the case. If we have an unlimited, unbridled right to sue, the result will be that creative trial lawyers will find a way to get a case into court. Our goal should not be to go to court. Our goal should be to ensure patients are protected, forgetting quality health care. We do not have to have a circumvention of the appeals process, the review process to assure that. The gaping flaw in the Kennedy-McCain bill is that it allows thousands of new lawsuits to be filed in State court and Federal court without an exhaustion of the appeals process. Unlimited liability could bankrupt small businesses or force them to drop health coverage altogether. Those are, in fact, some of my deep concerns about this legislation, and those concerns should drive us to amendments such as the one Senator Bond and I have proposed. The Hutchinson-Bond amendment provides 100-percent deductibility beginning next year, not in 2003, and will save small employers, self-employed individuals millions of dollars. There is no justification for us continuing to delay what we have recognized in this body on a bipartisan basis is an issue of equity. The Wall Street Journal sometime back in one of their editorials wrote: In the 18th century, doctors believed they could cure patients by bleeding them with cuts or leeches. Modern equipment is politicians who want to improve American health care by unleashing the trial lawyers. I note that not because anybody would be surprised that the Wall Street Journal editorial page would have this, but the analogy is not far off. My concern is we would pass a Patients' Bill of Rights. Ask the American people that broad question, Do you favor a Patients' Bill of Rights? and you will get an overwhelming yes. Probably three- quarters of Americans would say yes. Who could be against rights? Who could be against patients? But it's different when asked, If you knew your employer would have to raise your copay, your premium, your deductible, are you still for that Patients' Bill of Rights? if you knew your employer might not be able to continue to provide health insurance coverage, are you still for that Patients' Bill of Rights? My concern is we would pass a bill they say ``cures'' the problem of patients in health care plans with their rights not being protected, and the reality is we have made the malady worse. The problem we have created in exacerbating the problem of the uninsured is worse than the problem we are trying to address. I believe the biggest hoax perpetrated in the course of the debate over the last couple of years on a Patients' Bill of Rights is that a bill such as the Kennedy-McCain bill covers all Americans. To those who have argued most States have enacted patient protection laws and we should provide proper deference to those State patient bills of rights, those States and situations are different. We have argued our proper responsibility is to address the ERISA plans, the self-insured plans that States cannot touch. States cannot provide protections for those. People in those plans are left unprotected unless we do something. The response on the other side has been, you are leaving millions out, you are not protecting them. The great hoax has been to say that the Kennedy-McCain bill covers all Americans. It doesn't cover all Americans. It surely does not cover the 43 million Americans who do not have insurance today. They don't get a thing out of the Patients' Bill of Rights except less chance they will be able to receive health insurance. I quoted the Wall Street Journal, and one might expect their sentiments on this subject. But listeners may be interested to know that last month the Washington Post wrote on this subject: Our instinct has been and remains that increasing access to the courts should be a last resort, that Congress should first try in this bill to create a credible and mainly medical appellate system short of the courts for adjudicating the denial of care. To the extent it can be avoided, it seems to us not in the national interest to have the practice of medicine governed by the fear of lawsuits. It will add to the cost of care, though how much is in question. It is not clear to us that it will add comparably to the quality. The higher the costs, the larger the number of uninsured. From the Washington Post to the Wall Street Journal, they are right: The liability provisions in the Kennedy-McCain bill will result in thousands of new lawsuits, higher costs on premiums, higher costs on copay and deductibles for consumers, and millions more people in the ranks of the uninsured. The Washington Post is right, we should have a remedy that is mainly a medical appellate system, short of the courts, for adjudicating denial of care. It is in the national interest to avoid having the practice of medicine governed by the fear of lawsuit. They go on to say it will add to the cost. They are absolutely right. Imagine--under the Kennedy-McCain bill one is allowed after 180 days, at the 181st day, to go straight to court. You are not required to appeal internally whatever the question is you are contesting--the decision of the insurance company to not provide coverage. Perhaps the insurance company says the contract is clear and that is not covered, or perhaps the insurance company does say it is not medically justified. As a patient and as an insuree, you object to that. You question that, but you don't bother to appeal it. And you wait. You don't use the internal appeals process, which most managed care companies have already established and which by law we would, under the Patients' Bill of Rights, establish. They never bother to go through the external appeals court, even though under the proposed bills that would be expedited. You would get quick care, a quick decision on the external appeals. They don't do that. Instead, they wait. And they wait. After 180 days, a very creative, very enterprising lawyer talks to that patient and says: Haven't you just discovered that you were wronged? Without any requirement under this legislation to go through the appeals process, that individual, with his creative, enterprising lawyer, can go straight to court. One would think if they were wronged, they would have a remedy, even after 6 months, a year, or 10 years, because there is no limit when that individual can file the lawsuit after disregarding the appeals process. One would think perhaps after that long length of time they could have a remedy. As I have said before, studies indicate medical malpractice claims take an average of 16 months to file. Even after the 6 months of waiting, on the 181st day the lawsuit is processed, you have another long period of time--on average, 16 months--to have the lawsuit filed. On average, it requires 25 months to resolve the lawsuit. That is another 2 years. And then after there is a decision made of a lawsuit, it requires on average another 5 years to receive payment. That is what we are doing in the Kennedy-McCain bill. In the open-ended lawsuit provision, we are in the end going to reward the process and the lawyers. The tort system returns less than 50 cents on the dollar to the very people it is designed to help and less than 25 cents on the dollar for actual economic loss. Even if one figures 50 cents on the dollar, months, years, you file it, years more to get to court, decisions rendered, years more to collect the payment--what, I ask my colleagues, what does that have to do with quality health care? What does that have to do with ensuring that a patient is getting the best possible health care provision under their insurance policy? I suggest it has very little, if anything. The right to sue should exist. But it should only exist after the appeals process has been exhausted. When we talk about this being an opportunity for trial lawyers, it is exactly that. It is the trial lawyers who are the big winners. I offer this amendment today to address this access issue. There will be other amendments that will address more clearly the liability concerns I have expressed. Because the liability alone, we know, and the CBO says, it is the second leading component increasing costs in the Kennedy-McCain legislation. This is the big contributor to increased premium costs, the big contributor to loss of insurance by hundreds of thousands of Americans. The amendment I have offered providing 100-percent deductibility helps address this access issue and the concern about the uninsured. I reiterate, because I think it is very important as we look at the amendment and consider how important it is, who are the self-employed? Who are the people to whom we are trying to provide relief? We know there are a lot of them. According to the Employee Benefit Research Institute, there are 12.5 million self-employed individuals in this country and 3.1 million of those self-employed individuals are uninsured. That means they don't have a spouse who is employed somewhere with an insurance plan. It means they aren't working part- time. They are simply uninsured. They are unprotected. That is almost one out of four in this pool of self-employed individuals. Nearly 70 percent of these individuals earn less than $50,000 annually. I think that is an important point to make because many think of self-employed and equate self-employed with business people, and they are usually. They think of those business people as being affluent, wealthy individuals. According to the Congressional Research Service, based on the 1998 current population survey, 70 percent of these self-employed individuals are hardly high income. They make less than $50,000 a year. So think about those who can't afford the insurance. Think about people who make less than $35,000 a year not receiving equal treatment for what they can deduct on their health care premiums and one out of four of them cannot afford to buy to really get the picture. To understand the importance of this amendment, you have to look not just at the 3.1 million who are uninsured but you have to look at their family members. When you count the number of family members with self- employed family heads, we are now talking about 21.6 million Americans who would benefit from the Hutchinson-Bond amendment, including 6.4 million children. Now, of those 6.4 million children who are going to benefit because you get 100 percent deductibility, currently 1 million are uninsured. So I ask my colleagues to think about 1 million children who are without insurance today whose parents would perhaps be able to purchase that insurance under the 100 percent deductibility provision. So I think it is critically important that be adopted. Madam President, I have one correction to make in my remarks. I referred earlier to a cartoon that appeared in a Statewide newspaper. It was from the Don Rey Media, not the Democratic Gazette. I give a plug for the Gazette, but, in fact, the cartoon was in the Don Rey Media, and it did very well portray what faces us today. If you are paying $6,000 a year in premiums, and you are able to deduct 60 percent of your premiums, that is $3,600, and you will have a savings of $972. If this amendment that is pending before the Senate right now passes, instead of $972, 100 percent deductibility will turn that into $1,620 and that will be an additional savings of $648. At least for the self- employed, that will offset the additional costs that the Kennedy-McCain bill will have upon premiums. So it is worth supporting from the standpoint that it has been a battle fought for years. It has been something recognized for a long time; that we have unfairness; we have a disparity, an inequity in the Tax Code. Senator Bond, to his credit, and Senator Nickles worked and worked to clip away at that disparity, and we got 60 percent of the way there. There is no reason, there is no excuse for us not to immediately go to the 100 percent deductibility and in so doing save millions of dollars for those who are out there trying to keep this economy going. I know that there has been broad support for this concept in the past. I believe there will be broad support as this amendment is debated. I talked to a number of my colleagues on the floor about the importance of this amendment. I believe that access is going to be the center of debate as we go through the Kennedy-McCain bill. If we cannot address the access issue, if we cannot address a wide-open lawsuit issue and put some real restraints in what is currently an unbridled prospect for thousands of new lawsuits, then we will have done a disservice and we really have been disingenuous with the American people. We will have passed a bill saying it is a Patients' Bill of Rights without a real understanding by the American people of what the impact is going to be on their day-to- day lives. Nothing illustrates that more than the kind of push polls that have been done in which the questions have been posed in terms of raising premiums, raising the cost of health insurance, the possibility of losing health insurance and how that affects attitude towards a Patients' Bill of Rights. So access to emergency rooms, I will agree on that. The President has supported that. The McCain-Kennedy bill has emergency room access provisions. The Nickles bill last year had emergency room access provisions. The Frist legislation covers that concern. Many of the stories that have been portrayed in this Chamber have dealt with the horrors of those who were denied immediate access to an emergency room. We have heard examples about tragedies that have occurred because of that. These tragedies would be addressed in any one of the patients' bill of rights. That is not the core of the debate before us. Access to pediatricians, access to OB/GYNs--the President listed those commonly agreed upon patient protection provisions. That is not what is at issue. That is not what is at debate in this Chamber. What is at debate is not access to ERs, access to pediatricians or OB/GYNs. The debate is access to health insurance. I am determined, and I know my colleagues are as well, that we not lose focus of what an ill-conceived patients' bill of rights is, which is the Kennedy-McCain bill as it is currently constructed, and what it would do to access to health insurance. We are going to keep the focus upon not only the 43 million who do not have it now but the millions more who would lose their health insurance were this bill to pass in its current form. My colleague from Oklahoma pointed out some of the provisions in this Kennedy-McCain bill that address issues that come before the Finance Committee. The Senator from South Carolina expressed that, while being a previous cosponsor of the 100 percent deductibility, he could not support this amendment because of the jurisdictional issue. Perhaps there are other Senators who share that concern. So I want to remind my colleagues on both sides of the aisle, those who are members of the HELP Committee, as I am, and those who are members of the Finance Committee, that there are a number of provisions within the jurisdiction of the Finance Committee that are already in the bill. The provisions were never debated before the Finance Committee, but they are in the bill. It is kind of disingenuous when you have something that is going to benefit taxpayers, going to provide full deductibility for the self-employed, to say we don't want that in the bill when there are already a horde of provisions in the bill that come under the jurisdiction of the Finance Committee. I am sure at some point there is going to be an explanation as to why custom user fees is in this Patients' Bill of Rights, why the custom user fees, Medicare payment shifts, and Social Security transfers are included. We talk a lot about the sanctity of the Social Security trust fund. There are some issues regarding Social Security. All of those come under the jurisdiction of the Finance Committee and were never debated by the committee. There were no witnesses, no hearings, no people to come in and explain why they are going to be in this hugely important bill, but they are there. And so for those who may be concerned that we have a provision that would normally go to the Finance Committee, I say, well, let's take a look at all of these. At least this one is going to increase access, not decrease it; at least this one is going to ensure that more people are going to buy more health insurance and those million people who are currently in households in which the head of the household is self- employed that is not eligible for the 100 percent deductibility is going to be addressed. Now, the bill reduces revenues. I have alluded to that. And some may question about having those kinds of provisions in the bill. In fact, the McCain-Kennedy bill reduces the Social Security tax revenues by nearly $7 billion over 10 years. So it is going to have a pretty significant impact upon revenues--$7 billion in Social Security. That is the estimated impact of passing this bill. If you pass this bill, that is the impact it will have upon payments into the Social Security System. It ought to concern us if it is going to have that kind of impact upon employment in this country. So we have a bill that we have to work on. We are going to have a lot of amendments in the days to come, and we have a good one to start with, one that will provide that 100 percent deductibility and increase accessibility. I see my colleague from the State of Kentucky has come to the floor, and I know he has expressed interest in this amendment. He has been a long-time supporter of small business and of providing 100 percent deductibility as quickly as is possible for these who have been treated unfairly in our Tax Code. He has expressed interest not only in supporting it but speaking in behalf of the amendment. I yield for the Senator from Kentucky.

Mr. HUTCHINSON. Boy, I have to smile. I am sincere about this, and I resent it being portrayed as, I believe, a ``cheap trick.'' It was called a ploy, an effort to derail. It is none of that. It is a sincere concern about those who are self-employed and who do not get equal treatment. It is a sincere concern that this legislation does not empower anybody but trial lawyers, and that the big issue in this whole debate is access. I am sincerely trying to address an issue about which I have been concerned, and I know the Senator from Illinois has, but it is no effort to derail. If I had been on the conference committee, I assure the Senator from Illinois I would have fought as hard as I could have with every fiber of my being to ensure this very important provision was included in the tax bill. Unfortunately, I was not on the tax conference committee, and so my alternative was to come to this Chamber and try to do the right thing. I assure the Senator from Illinois that is what I am trying to do. I also remind him that every Patients' Bill of Rights that has ever passed the House of Representatives has included tax incentives for health care. Every Patients' Bill of Rights that has ever passed the Senate has included tax incentives for health care. The bill the House of Representatives is likely to pass within the next few weeks will undoubtedly, will with a certainty contain tax access provisions, as it should. If the Senate does not adopt its own tax incentives and access provisions, we will be at a distinct disadvantage as we go into the House conference on this legislation. If the Senator wants to face the American people and explain that he opposed this on the basis of a blue slip problem, please, I am sure, they are going to appreciate that explanation. This is something that has had broad support in the past. It is without question something we should do. We have an opportunity to do it, and we should. I yield to the distinguished Senator from Maine who has been such an advocate for small business in this country and has fought hard for full deductibility for the self-employed.

Mr. HUTCHINSON. Mr. President, I thank the distinguished Senator from Maine for her excellent statement, for her cosponsorship of this amendment, for her leadership in advocacy for small business in this country. I now yield to the Senator from New Hampshire for such time as he might need.

Mr. HUTCHINSON. Mr. President, might I inquire as to the time remaining on each side?

Mr. HUTCHINSON. I yield to the Senator from Texas such time as he might require.

Mr. HUTCHINSON. Mr. President, I think it is unfortunate if we allow the debate--legitimate debate on legitimate issues--on this bill to degenerate into finger pointing and partisan accusations that one party or another does not favor patients' rights, does not care about people, that there is some insidious plot to bury a Patients' Bill of Rights. The reality is, over the last 2 years there have been over 20 votes in this Senate Chamber on versions of the Patients' Bill of Rights. There has been plenty of debate and scores of votes. So to say that somehow this Patients' Bill of Rights legislation has been hidden, buried in a committee and not been allowed to have free and open debate on it and to be amended and debated in this Senate Chamber is simply to mislead the American people and to mislead the Senate. We have debated this. I have spent a year myself on the conference committee trying diligently to reach a consensus, at least a compromise, so we could have a Patients' Bill of Rights that would serve the American people. I think it is very unfortunate when we start judging motivations and judging individuals as to what they want to do. I know the Presiding Officer has his own concerns about portions of the Kennedy-McCain bill. Those are legitimate concerns. People may agree or disagree on various aspects, but to point the finger and say that there is some kind of partisan plot to bury a bill or to be the ally of any particular industry--I will speak for one Senator; and I think I speak for a lot on my side of the aisle--I want a Patients' Bill of Rights. I want a good one. I want one that will provide protections for those who do not have those protections today. I want to have respect for States that have already acted upon it, but I believe we have a responsibility to act on the Federal level. I hope we have a bill, but I do not want to pass a bill that, in the words of the Senator from Texas, plays a bait-and-switch game, where it says it is doing one thing and then has an exception, where it says here is the rule and then comes back with an exception to the rule that consumes the rule itself. So let's have an honest debate. Let's avoid judging one another's motivations. At least I hope that will characterize more of the remaining debate. My colleagues seem to equate accountability with getting to court, that the only way an insurance company can be held accountable is if you have the right to sue them, and sue them immediately. There are those of us who think--and I am one of them--lawsuits are not necessarily the best way to resolve a dispute. That is why an internal appeal is an appropriate step, an external appeal is a right process, and that only at the point that those appeals are exhausted should there be a right to go to court to redress a wrong. I think if we have that kind of restrained appeals process, we will minimize the amount of lawsuits that are necessary. This is a legitimate debate, but we need not say that anyone is using cheap tricks, ploys, or that there is some kind of insidious effort to derail the Patients' Bill of Rights. One of the critical issues in this bill is how much we are going to increase costs and how many people are going to lose their insurance. How many small businesses are going to say: I can't afford to do it anymore? Exactly how many people are going to join the ranks of the uninsured? What kind of impact is it going to have? Those are real questions. So there can be no amendment more relevant than the amendment that is before us; and that is one that, most assuredly, by all who assess its impact, will decrease the number of the uninsured, will take those who are currently in the ranks of the self-employed who cannot afford to buy insurance and enable them to do it. This is very relevant. This whole blue slip statement, in my opinion, is a red herring. You are either for it or not. You are either for giving 100-percent deductibility or you are not. You say we should have done it in the tax bill. I would have liked us to have done a lot more things in that tax bill.

Mr. HUTCHINSON. No. I am giving a statement right now. I ask the Senator, is this for a UC?

Mr. HUTCHINSON. I am glad to yield.

Mr. HUTCHINSON. Mr. President, I yield on the Senator's time.

Mr. HUTCHINSON. Reclaiming my time, I say to Senator Kennedy, you are not arguing with me; you are arguing with objective studies that indicate that with every 1 percent----

Mr. HUTCHINSON. Every 1-percent increase in insurance premium costs equates to about 300,000 people losing their insurance.

Mr. HUTCHINSON. Mr. President, reclaiming my time.

Mr. HUTCHINSON. It is the Lewin study that came out with those statistics. I think it has been borne out over time that, in fact, as premiums go up, the rates of the uninsured go up. While you may find a slight blip of it going down over the past year, if you look back over the course of the last 5 years, the last 10 years, the number of uninsured have dramatically increased in this country as premiums have increased. I think it defies logic--I do not believe it is going to sell with the American people--that increased costs are not going to result in more people being in the ranks of the uninsured. That, to me, not only is borne out by studies, but is borne out by practical experience. As costs go up, more people are unable to afford insurance. And it is the Congressional Budget Office that has said the Kennedy-McCain bill will, at the least, increase premiums by an additional 4.2 percent, in addition to premium increases that are occurring naturally with medical care inflation. So I will leave that to my colleagues to make their own conclusions as to whether higher prices on premiums, higher prices on insurance, will not, in fact, result in more people going into the ranks of the uninsured. Mr. President, I ask unanimous consent to add Senator Conrad Burns as a cosponsor of the amendment.

Mr. HUTCHINSON. I am glad to yield.

Mr. HUTCHINSON. I have no objection.

Mr. HUTCHINSON. Mr. President, I know on our side we have a number of other Senators who want to speak on this amendment. I will be glad to yield to them as they come to the floor. I believe Senator Voinovich will be in the Chamber in a few moments. But let me just pick up on a few points that Mr. Gramm, the Senator from Texas, made during his speech. I think what we need, during the course of the debate on this bill, is the kind of careful analysis that Professor Gramm brings to this issue. I think as Members of the Senate actually read this bill, as the American people hear the contents of the bill and hear the kind of passionate expression and concern for a Patients' Bill of Rights in general, it will give way to concern about the impact that the bill itself would have. So the Senator from Texas called it bait and switch. It could also be called the exceptions swallow the rule. Let me review some of those examples where the exception swallows the rule. On page 35 of the bill, paragraph (C), ``No coverage for excluded benefits.'' The point in that very plain statement is that the contract is to be sacred. It is to be honored. The contract means what it says. That statement, though, doesn't mean what it says, ``no coverage for excluded benefits.'' If you turn to page 36, at the top of the page, it says, ``except to the extent that the application or interpretation of the exclusion or limitation involves a determination described in paragraph (2).'' So this is one of the examples in the area of excluded benefits. Paragraph (2) on page 33 includes anything that is a medically reviewable decision. So, in fact, the exception does swallow up the rule. Anything that is a medically reviewable decision--in other words, when you go to the independent review panel, they have virtually carte blanche in overturning the very provisions of the contract. If you don't have a binding contract, how in the world can you make projections, how in the world can anybody provide health care plans with any assurance of what costs are going to be? Another example is on page 144 in this rather lengthy Patients' Bill of Rights legislation. On line 16, it says: ``Exclusion of employers and other plan sponsors. Causes of action against employers and plan sponsors precluded.'' That sounds good. That is a concern a lot of us who have questions about this legislation have raised. Are you going to be able to sue your employer? Are employees going to have a means by which they can sue their employer? What impact is that going to have on an employer's willingness and ability to provide health insurance? The statement sounds good: ``Causes of action against employers and plan sponsors precluded.'' But if you turn over to the next page, you find in section (B) and (C), ``Certain causes of action permitted.'' Then it goes on and talks about direct participation, another example of exceptions swallowing the rule. You can't sue your employer, except there are some suits that are permitted. Then another example of the exception swallowing the rule is on page 122. On line 19 of page 122, it says: ``Preemption; State flexibility. Continued applicability of State law with respect to health insurance issuers.'' That sounds good. At least it sounds good to me. I know a lot of States have done very good work in the area of patient protections. So the clear statement is: State law with respect to health insurance issuers will be continued and will be applicable. That sounds very good until you find that the rule is, once again, swallowed up by the exception. That was page 122. Turn to page 123. On line 4 it says: ``Except to the extent that such standard or requirement prevents the application of a requirement of this title.'' In other words, it is going to be the Federal patient prescriptions that are going to supersede any State laws, and to the extent they are not in compliance with and follow very prescriptively the Federal standard, they then will be null and void. They will be superseded by Federal. ``Application of substantially equivalent State laws''--that is a standard that undermines what the States have already done in this area. So we find, once again, that the exception swallows up the rule. The same thing is true on the appeals process. The rule claims all appeals must be exhausted. It is very clear the way it states that. Those procedures that are put in place on internal/external must be honored. You must exhaust those. But then you find exceptions that allow going straight to court for dollars even if the appeal has not been filed, if the injury first appears after the time has elapsed for filing an appeal. Go straight to court for dollars if immediate irreparable harm prior to completion of appeals process, if you allege that, allow the 180 days to run and go straight to court without having used the appeals process. You really don't have an exhaustion of appeals. I find example after example of where there is a bait-and-switch occurring. There is a rule that is being swallowed up by the exception to the rule. Another point the distinguished Senator from Texas made--a point that needs to be thoroughly debated on the Kennedy-McCain bill--is the area of scope. I read that wonderful title where it says State laws will apply and then, unfortunately, there is the clear exception that really swallows up that rule. The Kennedy-McCain bill would allow the Federal Government to overturn patient protection laws in every State. The States have done, quite frankly, a lot. Here is all of our 50 States, various areas of patient protections, emergency medical care. You can see Arkansas has that, Arizona, State after State. Very few States have not acted upon emergency medical care. They may do it in a different way than we would do it. Are they less concerned than we are? Are we the only ones who can establish the precise standard for emergency medical care? These patient protections have been enacted by State legislatures all over the country. Access to OB/GYNs, once again, you can see overwhelmingly the States have already acted. They have already provided patient protections. Continuity of care, gag provisions, almost every State in the Union, with the exception of Mississippi, have acted upon the gag provisions. Formulary exceptions, clinical trials, a number of States have decided they are not going to mandate clinical trials. They have legitimate reasons why that should or should not be included in a State action on a Patients' Bill of Rights. On the internal appeals, virtually every State in the Nation, all 50 of them, now have an internal appeals process that has been mandated in State patient protections. Forty-one States have an external appeals requirement. Why should we have the right to go beyond what is clearly our responsibility on the ERISA plans, the federally unprotected plans right now, but to go beyond that and go back to all of the States that have, through their own legislatures, enacted patient protection laws and overrule them? I think that is an error. In the State of Arkansas, the following protection laws would be superseded by this Patients' Bill of Rights: the emergency room provision, the point-of-service provision, the access to OB/GYNs, continuity of care, the gag prohibition, drug formulary exceptions, patient information, all of those would be preempted by this Federal legislation. That is why the National Association of Insurance Commissioners have written us as a Congress expressing their opposition to what we are about to do if we enact this McCain-Kennedy bill as currently drafted. They wrote to us: States have faced the challenges and have produced laws that balance the two-part objectives of protecting consumer rights and preserving the availability and affordability of coverage. For the federal government to unilaterally impose its one-size-fits-all standards on the states could be devastating to state insurance markets. That is a very legitimate concern they have expressed. And the President, in his statement from the administration on their position on this bill, expressed similar concern about not showing proper deference to what States have already done. Under Kennedy-McCain, at least 297 patient protection laws that are already on the books would be potentially erased leaving millions of patients unprotected as the States have enacted them. Forty-four ER laws, 20 point-of-service laws, 37 OB/GYN laws, 48 gag clause laws, 26 drug formulary laws, 12 clinical trial laws, 47 prompt payment laws, 30 financial incentive laws, all of these potentially would be erased by the one sweeping action in the Kennedy-McCain bill. Kennedy-McCain would further force States with minimal or no managed care penetration to adopt Federal standards, or else HCFA would come into those States and take over the regulation of health insurance. Managed care penetration in a number of States is minimal. Alaska is 0 percent. In Wyoming, my good friend from Wyoming, Senator Enzi, has been concerned about this kind of blanket takeover, when there is only 1.2 percent penetration in Wyoming. In Arkansas, it is 11.8 percent. In Idaho, it is 6.3 percent. The point is that these States vary. They are widely different in the impact of managed care. For us to have a one-size-fits-all approach, I think, is ill-conceived and is something that we need to reconsider. Of the six States which haven't enacted emergency room legislation, five of these have less than 10-percent managed care penetration. So there is a reason why they have not acted upon them. I think we should show proper respect for the wisdom of some of these State legislatures for having real reasons for not acting on some of these patient protections. At least 11 States have rejected clinical trial mandates, California being one of them, with Florida, Indiana, Massachusetts. At least five States have rejected access to specialist mandates. At least eight States have rejected drug formulary exception mandates, including Florida, Hawaii, Illinois, Massachusetts, Minnesota, North Dakota, Utah, and West Virginia. Kennedy-McCain would force these States to adopt these provisions even if they rejected them in their State legislatures for good reason. I hope my colleagues will think about what we are doing in this preemption of State laws in this very important area. The amendment that I have offered is a small step in expanding access. My concern about Kennedy-McCain is that it is going to shrink access to insurance, that we are going to have an awful lot of people, families and children, who are not going to be able to access health care insurance because of the impact of this legislation on premium costs. I have offered this amendment that would provide 100-percent deductibility for the self-employed. I think apart from raising extraneous issues that are really germane to the value of this amendment and to what it will do, this amendment has support. Support has been indicated in the past in this body. This is an opportunity for us to do it. And to say it should have been in the tax bill--every time the House of Representatives produced a Patients' Bill of Rights--they passed one that had access provisions, to expand access, and they are going to do that again when this passes in a few weeks, or sooner, and I hope they will. We can be as certain as you can be that it will have tax provisions in it. It is a red herring to say we are not going to pass this--because we believe it is equitable, it is going to right a wrong--because of a blue-slip potential. I think that is going to be hard to explain to people. One of my constituents in Arkansas wrote me and my colleague in Arkansas. I think this really expresses why this amendment is important. It says: I am a small business owner in Springdale, AR. Our company has always made an effort to provide, at no expense to our employees, full family health insurance coverage. Again, they have made the effort to provide it at no expense to employees. So they are paying 100 percent of the health insurance premiums for their employees for full family health insurance coverage--and not just for the employee, but the family receives the benefits. That is something we ought to encourage, something that is good. He goes on: A couple of months ago, we were forced to begin sharing some of the cost of the health plan with the employees because of 40 percent plus increases. Those who would argue that somehow there is no relationship between increased insurance premiums and availability of insurance to people in this country, that somehow increasing premiums is not going to increase the number of uninsured--we have seen a lot of examples on the floor. We have heard stories and anecdotes told. Here is a prime case in my State: . . . we were forced to begin sharing some of the cost of the health plan with the employees because of 40 percent plus increases. The monthly cost climbed to over $4,000 a month for our relatively young group. I fear passing [Kennedy- McCain] because it will not only cause greater increases, but subject our company to possible legal actions because of our offering health insurance. We could be at the mercy of whoever decides to pay a claim or not--and open the door for the company to be liable. I think this bill has a lot of danger in it. I take that concern very seriously. I think this person who took time to e-mail us from Springdale, AR, is typical of a lot of small businesses that are struggling, that have a few employees, that are trying to pay insurance for those employees and are facing a very large increase in premiums. We are going to exacerbate that, I believe, if we have this bill with all of its liability provisions included in it. This is one small thing we can do to make it a little easier for the self-employed--give them 100-percent deductibility, and give it to them now, not wait until 2003. I ask unanimous consent to have this e-mail printed in the Record.

Mr. HUTCHINSON. Then I received this letter from a different kind of employer. This is McKee Foods Corporation, a large company that is not headquartered in Arkansas. It is in Tennessee, I think, but they are a large employer in Arkansas, in Gentry, AR. I think they employ about 1,400. It is not an insignificant employer. They write: Dear Senator Hutchinson: The Senate will soon consider a proposal that will give Americans the right to use their insurance provider in state and federal court for coverage decisions. As a business owner, this prospect has me worried. McKee Foods has voluntarily sponsored its own health plan for more than 30 years. All of our employees and their families have the option to take part in our group coverage, including the 1,420 employees who work at our Gentry, Ark., manufacturing facility. In 2000, McKee Foods and its employees spent $25 million to provide health care benefits for all 6,100 of our employees and their families. The company directly paid for more than 75 percent of this amount. Over the last two years our group insurance benefit costs are up about 26 percent and our prescription drug benefit cost has nearly doubled. The company has absorbed most of the cost increases, but employee premiums have also risen by 10 percent. That is what the employees are paying and we are going to make that worse if we open this to unbridled lawsuits. It's important to note that none of the proposals presently under consideration have protections in place to protect the health care purchaser, whether individual or company, from the increased cost of coverage due to insurer liability. A health care bill containing additional costs will simply compound the problem of rising costs. Our health plan, which is governed by ERISA, is self- insured, self-funded, and self-administered. Maintaining an ERISA plan allows McKee Foods to provide uniform health care benefits to our employees in all contiguous 48 states. We've reviewed the various proposals put forth by both the Senate and the House of Representatives and have come to conclusion that McKee Foods can be sued for voluntary providing health care benefits. Each of the major bills under consideration contains language that defines the liability trigger as ``direct participation'' or ``discretionary authority'' over the decision. This standard directly implicates ERISA's fiduciary responsibility duty. For employers who offer a health plan governed by ERISA, liability is real. I believe that legislation containing liability for companies will certainly lead to more uninsured Americans. I also believe that many employers want to offer health care benefits because this type of benefit helps us attract and retain high quality employees. Please remember that the voluntary employer-based health care system in our country provides coverage for more than 172 million Americans. I'm asking you to support a health care bill that sets up a strong system for binding external review instead of lawsuits. Let's get patients the medical treatment they need, when they need it. Reaching a conclusion later in a court only benefits the attorneys. Then he asks for opposition to this bill. Are they greedy? Are they an uncaring company; they do not care about their employees and their welfare? I suggest that 30 years have put the lie to any such allegation. This company for 30 years has paid 75 percent of the premiums for their employees and their families, and they write not out of a spirit of greed or lost profits. I suspect it will not affect their profit line. What this legislation will affect is their ability to provide affordable health insurance for their employees. So many times we do the right thing in the wrong way when we pass legislation in the Senate. We have the greatest motivations. Patients' Bill of Rights--we hear these heartrending stories. They are real and there is a need for legislation, but then trial lawyers get into it, the clever attorneys who can write a rule and write an exception bigger than the rule, and the goal of providing legitimate patients protection suddenly is lost and its impact raises insurance premiums, causing employers to question whether they can even afford to offer that benefit to their employees. I hope as we continue to debate we will address these issues and we will also adopt this amendment which will help provide greater access. I did not realize Senator Voinovich has been patiently waiting. I could not see behind this chart. I extend my apology for going over the time. I thank Senator Voinovich, the distinguished Senator from Ohio, for his strong commitment to better health care in this country, for patient protections, and for also ensuring access is there and that it is affordable. I appreciate his support of this amendment. I yield such time as he might require.

Mr. HUTCHINSON. Mr. President, I thank the Senator from Ohio for his work in the State of Ohio and for his work in the U.S. Senate. I yield to my cosponsor, Mr. Bond, the Senator from Missouri.

Mr. HUTCHINSON. I thank my colleague from Missouri for his excellent statement. I yield such time as we have remaining to the Senator from Nevada.

Mr. HUTCHINSON. Mr. President, I commend the Senator from Nevada for his excellent statement, that spirit of cooperation that will ensure we really can get a good Patients' Bill of Rights passed and enacted into law this year. I reserve the remainder of my time.

Mr. HUTCHINSON. I yield such time as he might require to the Senator from New Hampshire. How much time remains?

Mr. HUTCHINSON. Mr. President, how much time remains?

Mr. HUTCHINSON. I thank the Chair, and I thank the Senator from New Hampshire for his good statement regarding the blue slip issue. He called it a red herring. It is a red herring. It is clear, if we want to adopt this, we can. If we want to enact this, we can. The whole blue slip smokescreen is a distraction from the reality. This is something we should do. Most of us know we should do it. It is something we can do. It is not an effort to subvert or derail this bill. It is an effort to improve it. It is most definitely relevant to this legislation because this legislation will increase the uninsured. It is going to do that. I do not think there is any doubt about that. The CBO says it is going to increase costs and, as a result of that 4.2 percent increase in cost in premiums, at least on top of the inflation that is already occurring in the health care industry, we are going to see at least 1.3 million more uninsured. Any effort we can make in this legislation to reduce the uninsured is most relevant. This legislation will do that. The National Association of Manufacturers is going to key vote this. I do not blame them. This is a key vote. This is an important vote. This is one that deals directly with access to health care. I remind my colleagues as well, every bill the House of Representatives has passed dealing with a Patients' Bill of Rights has had a tax provision. This is a figleaf that is being held up on a blue slip, and I do not believe the American people will buy that. Current law discriminates against the self-employed. Corporations are allowed 100-percent deduction. Employees receive 100-percent exclusion for health insurance paid by their employers, but self-employed individuals still are not treated equally. We can, with a very modest expense, very low expense, move this up a year, give them 100-percent deductibility beginning January of next year. We should do so. We heard a lot about the liability concerns in this legislation. They are very legitimate concerns. These are not special interests talking: Chicago Tribune: Better to put teeth in administrative review than allow malpractice lawyers to tear the entire health insurance system to shreds. The Arizona Republic: The cost of these reforms is uncertain, but it will be borne by businesses that provide health care coverage perhaps by their employees in the form of higher deductibles or copayments and by employees who may find themselves uninsured if their employer no longer provides coverage as a result of increasing costs. The Washington Post: The threat of a lawsuit should not be what governs health care in this country. To the extent Congress can avoid or contain that awful possibility, we think it should. Those are not special interests. Those are legitimate concerns about what this bill will do to lawsuits and litigation across the board. Who are the self-employed we want to help? There are 12.5 million self-employed, and 3.1 million of them are uninsured. We want to minimize the impact on the insured. This is one way we can do it. One out of four of those self-employed in this country are uninsured, almost one out of four. This will make insurance closer to a reality for those people. Seventy percent of these individuals earn less than $50,000. More than two-thirds of those who are self-employed are not affluent, are not rich. They are making less than $50,000 a year. Then I want my colleagues to think as they vote on this amendment not just about the 3.1 million who are uninsured, who are self-employed, but I want them to think about their children, those who are family heads. The Hutchinson-Bond amendment will provide the possibility of insurance not only for 6.4 million children who are going to have their situation made better, but for the 1 million children absolutely uninsured right now. That I know is a concern of every Member of this body. This is a means by which we can help that situation. I ask my colleagues to join in an overwhelming vote in support of this amendment. Do not pretend that a technicality somehow justifies a ``no'' vote. This is a sincere effort to access more people to insurance. Mr. President, I ask for the yeas and nays.