Don Nickles

Mr. NICKLES

Mr. NICKLES. Mr. President, I yield back the remainder of my time.

Mr. NICKLES. Just to clarify, I think my colleague from Massachusetts spoke incorrectly. The insurance industry does not support our amendment. I think he said that they do. He happens to be factually wrong. I would like to have the Record be clear. We ought to be stating facts and we ought to be stating the truth. What he said was not correct. They do not like our bill, either. They have not supported our bill. My colleague from Massachusetts earlier said they wrote our bill. He is absolutely wrong. I just want to make sure people have the facts. Mr. President, I will yield back the remainder of our time. First, I ask unanimous consent that at the expiration of debate time on the pending amendment, votes occur on the following pending amendments: amendment No. 1238, medical necessity, that is the pending amendment; the next amendment would be amendment No. 1236, which is the cost cap, limiting it to 1 percent; the next amendment would be amendment No. 1235 which deals with emergency rooms, by Senator Graham; the next amendment would be amendment No. 1234, deductibility for the self-employed; and the next amendment would be amendment No. 1233, dealing with the scope. I further ask unanimous consent that following the first vote, there be 4 minutes equally divided for closing remarks prior to the beginning of each vote. Mr. KENNEDY addressed the Chair.

Mr. NICKLES. Mr. President, I was trying to make sure our colleagues understand the procedure in the Senate. When you have colloquies, you go through the Chair. I have noticed some colloquies on this side have bypassed the Chair. Some colloquies on that side have bypassed the Chair. That is not the rule of the Senate. It is important we have discussions according to the rules of the Senate. That is the way we should do it. That way, we do not freeze out other colleagues who want to participate in colloquies. I was not trying to get under my colleagues' skin. It is important we follow the rules of the Senate. I want to point out that a couple of the statements made by our colleagues are actually very inaccurate. Actually who pays for the plans and entities are very similar in both bills. Under the Democrat bill, S. 6, on page 66: A plan or insurer shall be conducted under contract between the plan or insurer in one or more qualified external appeals entities. That is page 66. Under the Republican bill, it is the same thing, the plan selects the entity. They do not select the person who does the review, they select the entity. The entity is licensed by the State, or it is a State agency established for that purpose, or it is an entity with a contract with the Federal Government and they have the reviewers. My point is, both the Democrat plan and the Republican plan select the entities. They are the same. For them to say, oh, the Republican plan selects the reviewer is false. The Democrat plan, as well as the Republican plan pay for the entities, they select the entities, and the entities themselves are independent, and the entities select the individual reviewer. There is a little--I do not want to use the word ``hypocrisy''; it is not a word I often use on the floor. But to be railing against the Republican plan, not stating the facts, and then say, oh, by the way; oh, the Democrat plan, the plan selects the entities as well, I just find it to be very inconsistent. I urge my colleagues to see that in the Republican plan, the proposal we have before us, we say the plans select the entity, and the entity is a qualified entity if it is an independent external reviewer and credentialed by the State or a State agency established for the purpose of conducting the external review, or it is an entity under contract with the Federal Government, or it is an entity accredited as an independent external review entity by an accrediting body recognized by the Secretary of HHS. I just mention that. It is important we be consistent and that people understand on both sides, the Democrat proposal selects an entity very similar to that of the Republican proposal. I yield the floor.

Mr. NICKLES. Mr. President, I yield myself 5 minutes on the bill.

Mr. NICKLES. The Senator from North Carolina----

Mr. NICKLES. Parliamentary inquiry. Aren't Senators supposed to go through the Chair?

Mr. NICKLES. Mr. President, regular order.

Mr. NICKLES. Will the Senator yield?

Mr. NICKLES. Mr. President, how much time remains on both sides?

Mr. NICKLES. Mr. President, for the information of our colleagues, we have now disposed of the Democrats' second-degree amendment to the first-degree amendment proposed by the Republicans, which first-degree amendment would limit the cost of the Kennedy health care bill to 1 percent. Now I have sent a second-degree amendment up under the unanimous consent agreement. Each side could offer a second-degree. The amendment I sent to the desk on behalf of Senators Frist, Jeffords, and others, is a very important amendment, so I hope all of our colleagues will listen to it. The amendment would strike the medical necessity definition that was in the Kennedy bill and replace it with the grievance/appeals process we have in our bill. In other words, it is a very significant amendment, one that we had significant discussion on last week. Some of our colleagues said they really wanted to vote on it last week. We will get to vote on it, depending on the majority leader's intention. If the time runs on this amendment, all time would be used, and we would probably be ready for a vote at about 6:40. Of course, it would be the majority leader's call whether or not to have a vote. The amendment deals with medical necessity. It replaces the definition in the Kennedy bill with the grievance and appeals process that we have in the Republican package, which I think is a far superior package as far as improving the quality of care. I compliment Senator Jeffords, Senator Frist, and others for putting this together. I yield the floor.

Mr. NICKLES. Mr. President, I send an amendment to the desk on behalf of Senator Frist, Senator Jeffords, and others, and ask for its immediate consideration.

Mr. NICKLES. Mr. President, I move to reconsider the vote.

Mr. NICKLES. Mr. President, I yield myself 1 minute on the bill. The Senator from Pennsylvania is right. The whole essence of the second-degree amendment is to kill the underlying amendment because the Senator from Massachusetts does not want to say we will not increase costs by more than 1 percent, because, frankly, he wants to, and expects to, increase costs by 5 or 6 percent. The net result of that will be to uninsure a couple million people, half of which could be women, half of which will not get those exams, half of which will not get those screenings, half of which will not get the care they need. That is the purpose of the amendment. In the process, he also increases Superfund taxes and also comes up with general transfers of money from the general revenue fund to the Social Security fund. That is a mistake. I urge my colleagues to vote no and keep in mind that in dealing with breast cancer, Senator Snowe, Senator Frist, and Senator Abraham will offer a much better proposal later in this debate. I yield the floor.

Mr. NICKLES. I appreciate my colleague's comment. I yield back the remainder of my time and ask for the yeas and nays on the amendment.

Mr. NICKLES. I yield the floor.

Mr. NICKLES. Mr. President, for the information of our colleagues, we were in the process of debating the Robb amendment dealing with mandatory length of stays for mastectomies. That is a second-degree amendment to an amendment I offered on behalf of myself, Senator Gramm, and Senator Collins that had a limitation on the cost. The cost of the underlying bill cannot exceed 1 percent, nor could it increase the costs or increase the number of uninsured by over 100,000 or the bill would not be in effect. Senator Robb's amendment strikes the amendment that limits the 1- percent cost. It is our intention to finish the debate on the Robb amendment. We will vote on the Robb amendment, and it will be our intention for the Republican side to offer a second-degree amendment. We will debate that amendment and vote on it and work our way through the amendments that have been stacked today. I ask the Parliamentarian how much time remains on the Robb amendment?

Mr. NICKLES

Mr. NICKLES. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. NICKLES

Mr. NICKLES. I thank my friend and colleague. He makes an excellent point. Again, this is CBO saying if we do this, employers are going to drop health insurance or they are going to drop the quality of the package. He makes an excellent point. Mr. President, I yield the floor.

Mr. NICKLES. Mr. President, I want to make a couple more comments. I think some people have been loose with facts on saying the Kennedy bill would only cost $1 a month. One Member said it would only cost one Big Mac a month. That is absolutely, totally false. I have been looking at the Congressional Budget Office cost estimate of the Kennedy bill, S. 6, the Patients' Bill of Rights of 1999. I will read a couple of provisions. If this report is wrong, I wish to be corrected. Members are making statements that it will only cost $2 a month, or one hamburger a month--unless they are buying that hamburger in Cape Cod or Hyannis Port. Maybe that is $30 a month. It is not a Big Mac in Oklahoma. Page 3 of the CBO report says most of the provisions would reach the full effect within the first 3 years after enactment. CBO estimates the premiums for employer-sponsored health care plans would rise by an average of 6.1 percent in the absence of any compensating changes on the part of employers. What would the compensating changes be? CBO says, on page 4, employers could drop health insurance entirely if we pass the Kennedy bill. Employers could drop health insurance entirely, which I am afraid many would do. They could reduce the generosity of the benefit package, according to CBO, increase the cost sharing by beneficiaries, or increase the employee's share of the premium. This is CBO. This is not just Don Nickles. This is not some right- wing conspiracy. They are saying if health care costs are increased this much, some employers will drop plans. Some employers will say employees have to pay a lot more. Some employers will come up with cheaper plans. CBO said some will reduce the generosity of the benefit package, come up with cheaper plans, not cover so much. I thought the purpose of the bill was to improve health care quality, not come up with cheaper plans, not come up with fewer plans, not come up with greater uninsured. That is what CBO is saying increased costs would be. How much would it cost? Again, I am a stickler for having facts. What is the estimated budgetary impact of the Kennedy bill? CBO says it would reduce Social Security payroll taxes by about $8 billion over the next 10 years, reducing Social Security payroll taxes by $8 billion. That means total payroll goes down by $64 billion. That is a big reduction. That is a lot of money coming out. That is a lot of money that people won't receive in wages, according to the CBO, because Congress passed a bill. Congress said: We know better; we should micromanage health care from Washington, DC. The net result is lost wages of $64 billion. That is not one Big Mac per month. What is the cost per month? Family premium for health insurance, according to Peat Marwick: $5,826 in 1998; 6.1 percent of that is $355 per year. That is right at $30 per month an employer would pay. What does CBO say the employer would do if they were saddled with those kinds of increases? They would drop plans, drop health insurance entirely, reduce the generosity of the benefit package, increase cost sharing by beneficiaries, or increase the employees' share of the premium. We should use facts. The cost of the Kennedy bill is not one Big Mac; it is about $30 a month for a family plan. According to CBO, I am afraid a couple of million people, at least 1.8 million people, would lose the insurance they already have. We should not do that. That would be a serious mistake.

Mr. NICKLES. Mr. President, I want to respond just a little bit to our colleague from North Dakota who said: Well, the Democrat bill would only increase costs by $1 a month. CBO says --I just read the CBO report. CBO does not say it. Or if my colleague would show me where it says that, I would be happy to maybe consume that page on the floor of the Senate. I don't know, but I read rather quickly. Maybe I missed it. I read fairly fast. But the section I am looking at in CBO says--this is talking about the Patients' Bill of Rights, S. 6: Most of the provisions would reach their full effect within the first 3 years after enactment. CBO estimates the premiums for employer-sponsored health care plans would rise by an average of 6.1 percent in the absence of any compensating changes on the part of employers. That is 6.1 percent. The annual premium for health insurance for a family, according to Peat Marwick, in 1998, in an employer survey, was $5,800. And 6.1 percent of that is $355 per year. If you divide that by 12, it is almost $30 a month--not $1 a month; $30 a month. That is not even close. So I make mention of this. Again, I think people are entitled to their own opinion; they are not entitled to their own facts. If CBO says this Kennedy bill only increases costs by $1 a month, I would like to see where it is. I just read the report--April 23, 1999. It says: 6.1 percent. That is a fairly big difference. When I am saying the cost is almost $30 a month--$29.50 a month--versus $1 a month, we have a little difference. I am using CBO. Maybe my colleague from North Dakota reads it a little differently. I think that is a rather significant difference: $30 a month will price a lot of people out of health insurance. This additional 6- percent increase, on top of the 9-percent increase which is already projected, is going to put a lot of people in the uninsured category. We don't want to do that. We should do no harm. We shouldn't put millions of people in the uninsured category. I refer, again, to the CBO report, because I heard my colleague from Massachusetts assert that this will only cost a family one Big Mac a month. I don't know if he is using CBO, but we are using CBO. CBO says S. 6, the Patients' Bill of Rights, the Kennedy bill, will increase health care premiums by 6.1 percent, resulting in an $8 billion reduction in Social Security payroll taxes over the next 10 years. This is in the report. If Social Security taxes are going down by $8 billion, that means total payroll goes down over that same period of time by $64 billion, total payroll reduction. Employers are going to say: Wait a minute, if you are driving up my health care costs, I can't pay you as much. I am going to pay you less or we will offset this reduction. That is CBO. That is not the Republican organization. That is not Don Nickles penciling it in. This is CBO, a nonpartisan group, saying there is $64 billion in lost wages if we pass the Kennedy bill. That is a whole lot of Big Macs. That is 32 billion Big Macs, if they cost $2 apiece. That isn't one Big Mac. As Senator Gramm said, you can buy the McDonald's franchises for that. I expect you could. For people who say the cost impact of the Kennedy bill is trivial and it would do no damage, if they believe that, have them vote for this amendment. I hope they will vote for this amendment. We should do no harm. We should not increase the cost of health care by more than 1 percent. Shame on us if we do. We should do no harm. We should not increase the number of uninsured. We should not be passing bills that make matters worse. Let's work on quality. Let's improve access. Let's make sure more people have health care. Let's not do just the opposite. Let's not uninsure a couple million people by increasing the cost of health care so dramatically, as the Kennedy bill would do. That is the purpose of our amendment. I compliment my colleague from Texas, who has been working on this amendment as the principal cosponsor with me, and also my colleague from Maine who spoke so eloquently on it earlier. I yield the floor.

Mr. NICKLES. I am happy to yield.

Mr. NICKLES. Mr. President, let me back up a little bit and bring our colleagues, and maybe the public, up to speed as far as where we are because, from a parliamentary procedure standpoint, this is getting maybe a little bit confusing. The Republicans offered as the underlying vehicle the so-called Kennedy bill, S. 6, the Patients' Bill of Rights. We did it because we wanted to expose that it has a lot of expensive provisions that, frankly, need to be deleted. The Democrats offered a substitute yesterday, the Republicans' Patients' Bill of Rights Plus that was reported out of the HELP Committee. They offered that as a substitute. Then Senator Daschle, on behalf of Senator Kennedy, offered a perfecting amendment to the substitute--``the substitute'' being the Republican bill--that said that should apply in scope to all plans. The Republican plan basically applies to self-insured plans. It does not duplicate State insurance, unlike the Democrats' bill that says we do not care what the States have done; we are going to insist you do everything we have dictated. They expanded the scope. That was a first- degree perfecting amendment. The Republicans offered a second-degree amendment yesterday to the underlying first-degree amendment of the Democrats on scope that says two things: One, we think the primary function of regulating insurance should be maintained by the States. That was in the findings of the bill. And then in the legislative language: We should expand access and coverage to health care plans. When the Democrats were so kind as to offer the Republican bill as a substitute, they forgot to offer our tax provisions. We included one of the tax provisions which we included in our Patients' Bill of Rights Plus, and that is 100 percent deductibility for the self-employed. We will be voting on that, and that will be the first vote this afternoon. We will probably be voting on that at the conclusion of Senator Smith's statement or shortly thereafter. I expect that votes will occur on that sometime after 3 o'clock, maybe closer to 3:30. The Democrats then were entitled to a second-degree amendment, and Senator Graham of Florida offered a second-degree amendment dealing with emergency rooms. Senator Hutchinson and Senator Frist debated against that and stated they would come up with an alternative dealing with emergency rooms. That will be voted on at some later point in the debate. This afternoon we will have a debate on the Republican amendment dealing with 100-percent deductibility of self-employed persons, and we will have a vote on the Graham amendment dealing with the emergency room provision, and then the next amendment we will actually vote on, depending on whether or not either of these second-degree amendments is adopted, will be to the amendment tree or the side to which I just sent an amendment. I sent an amendment to the first-degree amendment on the so-called Kennedy bill. This amendment says, whatever we do, let's not increase health care costs by more than 1 percent or increase the number of uninsured by over 100,000. It is very simple and very plain: Congress, don't do it; whatever you do, whatever mandates you are considering-- and we recognize and applaud everybody for having good intentions-- let's do no harm; let's not increase health care costs by more than 1 percent; let's not increase the number of uninsured by over 100,000. If the Secretary of Health and Human Services determines that it would increase costs by that amount or increase the number of uninsured by that amount, then the underlying bill will not take effect. Those are the basic provisions of the bill. I hope and expect all of our colleagues will support this amendment. I urge its adoption. Mr. President, I yield the floor. The PRESIDING OFFICER (Mr. Enzi) Who yields time? If neither side yields time, time runs equally.

Mr. NICKLES. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. NICKLES. Mr. President, one of the big concerns many of us have with the underlying legislation of the so-called Kennedy bill is its cost. How much will it cost employers? How much will it cost employees? What will it cost employees in lost wages? If employers have to pay increased costs for health insurance, are they not paying their employees as much as they would pay them? Health care costs a lot. Many of us would say health care already costs too much. It is unaffordable for millions of Americans. They would like to have it. We have 43 million uninsured Americans today. Most of those Americans, I imagine, would like to be insured but they cannot afford it. So health care already costs too much. Unfortunately, the bill proposed by Senator Kennedy and many of the Democrats would make it worse. They would make the insurance a lot more expensive and therefore less affordable. As a result, millions of Americans would probably lose their health care insurance. We think that would be a mistake. I said yesterday we should make sure we do no harm. We should not increase the number of uninsured. I am afraid the Kennedy bill, with its estimated increase of cost of 6.1 percent over and above the inflation already expected, would increase the number of uninsured by what is estimated to be about 1.8 million persons. That is too many. That is far too many. So the amendment I will be sending to the desk, as soon as I get a copy of it, will say we should not increase the cost of health insurance by more than 1 percent. If we do, the provisions of the bill are null and void. Let's not do any damage. Let's make sure at the outset we say very plainly we are not going to increase the cost of health care by more than 1 percent. Let's not increase the number of uninsured by over 100,000. If we do that, we have done harm, we have done damage, we have done more damage than good. Mr. President, I send an amendment to the desk on behalf of myself, Senator Gramm, and Senator Collins, and I ask for its immediate consideration.

Mr. NICKLES. Mr. President, momentarily I will send an amendment to the desk. I ask consent the time be charged on this amendment.