Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. I yield the Senator 30 seconds.

Mr. KENNEDY. Mr. President, I yield 2\1/2\ minutes to the Senator from New York.

Mr. KENNEDY. I yield the Senator from Iowa 15 seconds.

Mr. KENNEDY. Mr. President, I yield 30 seconds to the Senator from Iowa.

Mr. KENNEDY. I yield the Senator from California 30 seconds.

Mr. KENNEDY. Mr. President, I yield 5 minutes to the Senator from California.

Mr. KENNEDY. Yes.

Mr. KENNEDY. The Senator is correct. But let me mention an additional fact you will hear from the other side. They will say: We want to cover these 48 million individuals, but the States are covering all the others; therefore, you have an empty argument, Democrats have an empty argument. Do you know the answer to that? There is no State in this country that provides all the protections provided in the Democratic proposal-- not one State. There is no State in the country that guarantees pediatric specialty care for children who may have cancer or other kinds of serious illness--not one. You can pick and choose and find out that there are 18 States that have require some type of external appeal; almost all reject the kinds of appeal the Republicans have, the self-serving appeals where the HMO appoints the reviewer. They can fly-speck all afternoon and say we have this here and this here, but there is not a State that provides all the protections we provide. I ask any of my colleagues who are on their feet if they differ with the concept that we ought to provide a basic floor of protections for all Americans. Then, if the States of New York, California, Massachusetts, or Maryland want to build on those protections, we may do so. This is the model used in the bipartisan legislation Senator Kassebaum and I sponsored which passed the Senate that allows employees to move from job to job while retaining health care coverage. We follow that pattern very closely with this legislation. We follow the same type of model--a federal floor--in COBRA legislation. We follow the same model for mental health programs. We have followed that model with bipartisan support on 10 different programs, and I will have them printed in the Record this afternoon, and yet we have the Republicans saying no to the model on this legislation. Why? The answer is, the insurance companies will not let them. That is the answer. There is no other answer. We challenge our Republican friends. They are not here. We challenge them. How do you justify following the same type of process and procedure we have used in 10 different programs that have bipartisan support and yet now saying no, no, no, we are not going to do it on this bill? Can they give me an answer? Can they give us a clear answer on why they will not do that? I do not know. I think it is important, however, in giving a complete answer to the Senator, to at least know what they are saying and how inaccurate and implausible their explanation is.

Mr. KENNEDY. I see my friend and colleague from Massachusetts.

Mr. KENNEDY. Mr. President, we have put into the Record the letter from the General Accounting Office that said it is 4.8 percent over 5 years. That figure was used by the majority leader, Senator Trent Lott, on ``Meet The Press.'' He basically subscribed to that cost over a period of 5 years. If you take the average program, it averages about $2,000 for an individual; $1,000 for a child; about $5,000 for a reasonably good family plan. Maybe it is somewhat more costly in the Northeast than it is in the South. If you look at a 5 percent cost, it would be $250 over 5 years; that is $50 a year. If you look at the percentage paid for by the worker, it is typically about 20%. If you do that for 12 months, do that over 1 year, it is less than $2 a month, it is a Big Mac. I see a number of my colleagues. I think all of them would agree, every time we talk about family and medical leave we get a study done by the Chamber of Commerce. When we talk about minimum wage, we get those studies that are done by the restaurant association on the increase in the minimum wage. They talk about the escalation of costs and how it is going to put everybody out of business. The studies about cost used in this debate are studies that are bought and paid for by the insurance companies--bought and paid for by the insurance companies. We have heard from our Republican friends for months and years, as the President of the United States said yesterday: We always rely on the CBO figures. Now we have a CBO figure, and they do not like it. Their second point is that all those people are going to lose their health insurance. The fact is that the individuals and groups which have fought for expansion of health insurance coverage for years support our bill. Now we have the insurance industry saying pass this bill because it is going to mean the loss of health insurance coverage. That is poppycock. That is wrong. The facts, again, is that the General Accounting Office--and I have put in the Record the particular provision--has said there may very well be an expansion in total coverage because there will be good benefits and good protections. The line I like is the one that was stated so well by our good friend from Maryland earlier today at a press conference: Around here it used to be when you bought insurance, it was what you were buying, what you could expect; what you paid for is what you were going to get. Now when you give your money and buy insurance, it is what the insurance company is prepared to give you. That is what has happened in the United States of America. It is what the insurance company is going to give you. As a result, it fails to give adequate coverage to those children and women, the disabled and people who have bought the insurance and deserve appropriate coverage. That is what is happening. When they talk about costs, I wish they at least had the decency to address who picks up the cost when people fall through the cracks? It is charity care in the States. It is taxpayers who pick up the costs. What about the cost of all that advertising we see every day? Mr. President, the profits of the top 10 HMOs total $1.5 billion. There are tens of millions of dollars spent for CEO salaries. Who is paying for all that? That is going to result in higher premiums for American workers, and that is what they should be outraged about. I will take a couple more questions, and then I will be glad to yield the floor. Can I finish with my colleague?

Mr. KENNEDY. I find that has been the question for a long time. We had hoped to work in a bipartisan way as we did to get coverage for 5 to 10 million children with the Republicans on our committee. We had hoped to work in a bipartisan way as we did with Senator Kassebaum to allow health insurance to become more portable. We are hopeful of working some of the privacy issues out in a bipartisan way. Yet when it comes to the Patients' Bill of Rights, the wall came down. The insurance companies said absolutely not, not an inch. I was listening to my colleagues say this is a regrettable situation; I wish we could get together. The insurance companies will not let them get together with us. They will not let them. This bill has been bought and paid for by the insurance industry; no question about it. I yield to the Senator from North Dakota.

Mr. KENNEDY. Not knowing whether those particular programs are self- funded offhand, it would be difficult to respond concerning particular companies. However, only the larger companies self-fund. They are the only companies that have the resources to self-fund. It is generally the major companies and corporations that have the adequate resources to self-fund health coverage. The people buying individual policies are the farmer, and the small shopkeeper. It is the men, women and children on Main Street who are not protected under the Republican plan. When we talk about State and local government employees, we are talking about policemen and firefighters putting their lives on the line every day, their spouses, their children, their parents. They are the State and local government employees. About 75 percent are covered by an HMO--they are getting no protections under the Republican plan. I am reminded by my staff that 89 percent of the people in Delaware who have privately purchased health insurance will not be covered under the Republican plan.

Mr. KENNEDY. The Senator is correct. Generally around here it is a pretty good test to take a piece of legislation and ask who is supporting it and who is going to benefit. That is not a bad test for the American public: Who is supporting the legislation--which groups, which people--and who is going to benefit. What you find out is that our plan has the support of every health professional and every patient group. They are the ones supporting our bill. Who is opposing it? The insurance industry. Who is supporting the opposition program? The insurance industry. As this debate goes on and we get involved in technicalities, people ought to know at the bottom line of each and every one of these issues who supports our plan. On the OB/GYN issues, the medical professionals support our proposal in spite of the misrepresentations put forth in this Chamber. That is what is happening. The reason for that, as the Senator understands, is we have worked this out with consumers and health professionals. We tried to find out what is needed from the consumers-- the people who have suffered--and also the health professionals who have tried to protect the consumers. We were out there listening. I will take these last two and yield the floor.

Mr. KENNEDY. The Senator is quite correct. That raises the question about supporting that plan. It is a legitimate question--whether we ought to be representing to American families that we are doing something to protect them when we are not, we are failing. By failing to provide universal protection, if the Republican proposal comes before the Senate and Members support it, we are failing 70 percent of the American people. It is a fraud to represent that we are providing them with protections when we are not. This is why I think we are putting the Senate to the test this afternoon. We are testing the seriousness Members have for ensuring that whatever is passed will apply to everyone in this country who has insurance.

Mr. KENNEDY. I yield.

Mr. KENNEDY. It just so happens I have that information: 18 million privately insured persons, 18.6 million; 14,477,000, 77 percent of the people of California will not be covered if our amendment is not successful--77 percent of the people in California.

Mr. KENNEDY. As the Senator knows, the kinds of protections for children are included, including the preventive programs, specialty programs, the clinical trial programs, and the specialty care programs. Our good friend, Senator Reed, is one of our real experts on these issues. The range of different protections and guarantees is out there for children. That is why every child's health group supports our program. But let me mention something of interest that is on point. The Senate has just accepted the amendment of the Senator from Maine on the issue of mastectomies. In her amendment it says: [I]n order to provide for uniform treatment of health care providers and patients among the States, it is necessary to cover health plans operating in 1 State as well as health plans operating among [all] States. So perhaps we could find a distinction. I know the Senator believes strongly that is the kind of coverage we should have for women. But could the Senator possibly explain to me how we could justify supporting that particular provision and not say we need similar protection for children? Are we missing something on this? They will say: We will do it for this. Right above that it says: [H]ealth care providers located in a State serve patients who reside in the State and [also] patients who reside in other States. . . . What they are acknowledging is, people move from State to State, so they are going to provide for them. It talks about the amendment covering all health plans. What is the rationale? Can the Senator tell me?

Mr. KENNEDY. The Senator is correct. That is why this debate has been rather empty until now. We heard much stated by the principal supporters of the other side's bill about all the benefits of the Republican bill. Now we have found out that the benefits do not apply to two-thirds of all those with insurance coverage, and most of those it may protect are not enrolled in HMOs. (Mr. GREGG assumed the Chair.)

Mr. KENNEDY. I believe it is. This chart clearly reflects the point the Senator has made. The 48 million who are covered are covered through self-funded plans. The largest group of persons receiving health care through HMOs are the 75 million where the employer purchases coverage through an insurance policy or an HMO; about 85 percent of the 75 million are enrolled in HMOs. This bill does not cover them. This bill doesn't cover State and local workers, and it does not cover people buying individual policies. The bill supported by the Republicans, which is a bill allegedly dealing with the problems occurring in HMOs, covers few if any of the members of Health Maintenance Organizations. Is it any wonder the insurance industry is supporting their particular proposal and is opposed to the proposals we have supported? Isn't it understandable that the major medical groups and professions, the doctors and nurses who are concerned about managed care abuses--who understand the abuses happen to those with employer-provided plans, State and local government plans, and individual plans--uniformly support our legislation?

Mr. KENNEDY. Yes. I yield for that purpose.

Mr. KENNEDY. I yield.

Mr. KENNEDY. Mr. President, I yield myself 7 minutes. All patients, regardless of where they live or how they purchase their insurance, deserve to know that their health plan will cover the benefits they need when they are ill or injured. When we say ``all,'' we mean all. That is a fundamental principle of HMO reform. But it is a fundamental principle that is ignored in the Republican minimal alternative. The amendment that Senator Daschle, I, and others are offering makes clear that every provision of the Patients' Bill of Rights should apply to all 161 million Americans with private insurance coverage. No patient should be turned away at the emergency room door, denied access to the specialist they need to save their life, or be told that they will not get the prescription drug they need to treat their illness because they live in Mississippi instead of Massachusetts or in Oklahoma instead of Ohio. No child or parent or grandparent should be denied the medical care they need because they happen to work for a small business instead of a large corporation or because they are a teacher in a public school instead of an executive on Wall Street. Of the 161 million Americans with private insurance, only 48 million are covered under the Republican plan; 113 million Americans are left out or are left behind. The Republican plan limits protections to those who receive their coverage from an employer who self-insures their health plan rather than purchasing an insurance policy. Only the largest corporations self-fund their insurance plan. However, many employees of even the largest employers get their coverage through an fully-funded health plan. These employees would not be protected by the Republican bill. What an incredible irony. Much of the public desire for patient protection legislation comes from the concern about the abusive practices of HMOs. But virtually no one enrolled in an HMO is covered by the Republican bill because HMOs are rarely part of self-funded arrangements. These reforms are supposed to protect patients against HMO and insurance company abuses. But people with coverage from insurance companies and HMOs are not protected by the Republican bill. Nothing more clearly demonstrates that the Republican bill is an industry protection act, not a patient protection act. It is no wonder insurance companies support the Republican bill. It is no wonder that over 200 groups of doctors, nurses, patients, and advocates for women, children, and families oppose the Republican bill. The ``dishonor role'' of those left out under the Republican plan is long. We are talking about 75 million Americans who work for businesses that purchase insurance. We are talking about 15 million Americans who are small business men and women, self-employed salesmen, home day-care workers, early retirees, farmers, or others who purchase their own insurance instead of receiving it through their employer. We are talking about 23 million schoolteachers, police officers, librarians, nurses, and other employees of State and local government. Why are these people excluded? This chart indicates exactly the point that we are making. The Republican bill covers 48 million people. These are the people who receive health insurance through self-insured employer plans. These are the plans in which the company self-insures and, therefore, pays for the various medical treatments. It doesn't cover the 75 million persons whose employers provide coverage through an insurance policy or HMO even though approximately 85 percent of the 75 million are enrolled in HMOs. It doesn't cover the 23 million State and local government workers. It doesn't include the people buying individual health insurance policies. Those are the very small businessmen, the farmers, and others. Why are these people excluded, even though the Republican plan in the House of Representatives includes most of these individuals?

Mr. KENNEDY. Mr. President, I ask unanimous consent to have printed in the Record a letter from the National Partnership for Women & Families and a letter from the National Breast Cancer Coalition. Both of these organizations support the Dodd amendment, and they urge opposition to the Snowe amendment because it strikes the underlying Dodd amendment on clinical trials. The letter from the National Partnership for Women & Families says: It is essential that women and families have access to clinical trials. We oppose any effort to deny such access. I ask unanimous consent that both these letters be printed in the Record.

Mr. KENNEDY. I yield myself 1 minute off the bill.

Mr. KENNEDY. Mr. President, do we still have a minute and a half on the amendment?