Don Nickles

Mr. NICKLES

Mr. NICKLES. The Senator makes an excellent point. That is over and above whatever inflation is already anticipated for health care costs.

Mr. NICKLES. That is correct.

Mr. NICKLES. Mr. President, to respond to my colleague, we have had almost no quorum calls since the debate has begun. I am preparing to offer an amendment in a moment. That amendment will be ready. I will suggest the absence of a quorum and send the amendment to the desk momentarily.

Mr. NICKLES. Mr. President, I inform my colleagues, since we are on managed time, they are more than welcome to use time on the bill. They have that option, and I am sure the Senator from Nevada will yield to the Senator. I suggest the absence of a quorum.

Mr. NICKLES

Mr. NICKLES. I send an amendment to the desk and ask for its immediate consideration.

Mr. NICKLES. Mr. President, I ask unanimous consent that the second- degree amendment proposed by myself and Senator Bond and others be temporarily set aside.

Mr. NICKLES. Mr. President, I ask unanimous consent that both sides be allotted an additional 40 minutes on the underlying bill.

Mr. NICKLES. Mr. President, I ask unanimous consent that the Republican manager of the bill be allotted an additional 40 minutes on the bill itself.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. NICKLES. Mr. President, if my colleague from Nevada is yielding back the remainder of time on the amendment, we likewise yield the remainder of time on the amendment. I suggest the absence of a quorum.

Mr. NICKLES. Mr. President, I ask unanimous consent to yield back the remainder of our time on the last amendment.

Mr. NICKLES. I yield to my colleague from Wyoming 10 minutes on the amendment, and if he desires additional time on the bill, I will yield that as well.

Mr. NICKLES. No.

Mr. NICKLES. Mr. President, I suggest the absence of a quorum.

Mr. NICKLES. Mr. President, I was a little disappointed when I heard my colleague say the Republican amendment is a diversion. The Republican amendment is an effort to increase access to quality health care for the self-employed. We have 43 million Americans who are uninsured today. We want to help them get insurance. A large number of the people who are uninsured are self-employed. They are in small businesses. Small businesspeople who are just starting their businesses sometimes have a hard time getting quality fringe benefit packages. Almost all of the larger corporations have health insurance and pension benefits. But most job growth is in small businesses, and a lot of small businesses have not had time yet to develop and expand a fringe benefit program, including access to quality health care. When they find out they can deduct 100 percent of their wages but they cannot deduct but 45 percent of their health insurance cost, what do you think most self-employed people are going to do? They might tell their employees: I will just give you the money and you buy the insurance yourself; I cannot deduct it so why spend it? I want to spend my money in my business operations. Everything I spend should be deductible. It is not. We are trying to remedy that. I am glad my colleague from Illinois says we have bipartisan support. I know we passed a provision a year or two ago that phased it in gradually, but that is too long. We want to make it effective now. We want to make it where the self-employed get to deduct 100 percent of their health care costs just like corporations. Why not do it now? That is not a diversion. When we promote our bill, we say Patients' Bill of Rights Plus. What is the plus? We want to increase access. That is in stark contrast to the Kennedy bill which will decrease access. Their bill dramatically increases health care costs, and when you increase health care costs, you are going to be driving a lot of people into the ranks of the uninsured. We do not want to do that. That is not a diversion. It just happens to be a fact. We want to make health insurance more affordable. The people who cannot afford it, in many cases, are self-employed, and they get the short end of the stick in the Tax Code. They are not treated fairly in the Tax Code. We are trying to remedy that. That is what we have in our amendment. Also, we have in our amendment a finding of the Senate that, frankly, HCFA does not do a very good job in many cases. Despite what our colleagues say--we want all these people to have assurances and we want them to have all these guarantees. They are basically saying: We want the Health Care Financing Administration of the Federal Government to regulate insurance--we are saying no, that really should not be the prerogative of the Federal Government to duplicate, override, overrule State regulation of insurance plans. There is a difference. I am amazed that people keep making the comment: The Republican plan leaves all these people unprotected, as if the States are not doing anything. Every State has a regulatory regimen set up to regulate health insurance under their plans, and our colleagues evidently on Senator Kennedy's side seem to think whatever the States are doing is not good enough; we know better, in spite of the fact, if you look at HIPAA, the Health Insurance Portability and Accountability Act that Congress passed in 1996, there are five States that are not complying. HCFA is supposed to be regulating those plans, and they are not. They are not complying with the law that we passed 3 years ago. The State of Massachusetts is one of the States that is not complying. Maybe I have too much faith in the States, but I cannot help but think the State of Massachusetts is still interested in making sure employees have portability and continuity of coverage, so I am not really faulting the State. I just find it ironic that some people seem to think: Whatever the States are doing, it's not good enough. We know better. And HCFA, this grand almighty bureaucracy of the Federal Government, can do better than the States. I disagree with that. So the second-degree amendment that we have states two things: One, findings that the primary regulatory authority of insurance should be done and handled by the States, not the Federal Government; and, two, we should help the self-insured be able to have equitable tax treatment comparable to corporations; they should be able to deduct 100 percent of their health care costs. I just hope that our colleagues, if they agree in the primacy of States, if they believe in State regulation, if they believe in the 10th amendment to the Constitution that says all other rights and powers are reserved to the States and to the people, respectively, will adopt this amendment. I hope we will when we vote on this. For the information of our colleagues, I expect the vote will occur sometime tomorrow, most likely after the policy lunches. Mr. President, I yield the floor. Mr. GRAHAM addressed the Chair.

Mr. NICKLES. Mr. President, for the information of our colleagues, let me outline where we are procedurally. We notified Members under the unanimous consent request that we would lay down S. 6, the so-called Kennedy bill, to mark up. The Democrats offered a substitute to that, the Republican bill that passed out of the Labor Committee, S. 326. The Democrats then offered a first-degree perfecting amendment to the substitute, to the Republican bill. Their amendment dealt with scope. Their amendment says: We want the Federal Government to have far- ranging scope to overrule all State plans. All State plans must do such and such under their first-degree amendment. I am offering a second-degree amendment on behalf of my colleagues. The amendment would do two things. One, it is the sense of the Senate that the States are the primary providers of health care, for good reasons. States have hundreds of mandates. We don't think the Federal Government should come in and say: We know best; Senator Kennedy knows what is best; HCFA knows what is best; the Health Care Financing Administration should regulate all health care plans. We think that would be a mistake. We don't think that, many times, the Federal Government knows best. That doesn't mean all State plans are administered perfectly. It doesn't mean that they are not without problems. We just don't think HCFA--the Health Care Financing Administration--overruling States, dictating to the States, or this Congress, or Senator Kennedy, should be saying: States, here is what we know should be in your plan. We state that in the sense of the Senate. We also state some other things that come not just from Republicans but from the GAO. The Health Care Financing Administration has, in paragraph 16, stated: On April 13, 1999, the GAO office testified the Health Care Financing Administration failed to use its authority to ensure that Medicare beneficiaries were informed of their appeals rights under managed care plans. HCFA failed, according to the GAO. Yet Senator Kennedy's bill says: We want to give HCFA more power. Section 17 says the GAO testified in a July 1998 hearing in the Ways and Means Committee, House of Representatives, that the Health Care Financing Administration missed 25 percent of the implementation deadlines for consumer and quality improvements to the Medicare Program under the Balanced Budget Amendment of 1997. Senator Collins alluded to that earlier. Section 18 states the Health Care Financing Administration should not be given new, broad authority as they have not adequately met their current responsibilities. I could go on. Section 1 of this amendment states the States should maintain primary regulatory authority over health care. Section 2 states that self-employed individuals should be able to deduct 100 percent of their health care premiums. It is ironic that when we talk about health care we have such inadequate, inequitable treatment under the present Tax Code. Corporations deduct 100 percent of their health care costs; self- employed individuals deduct 45 percent. I personally am offended by that provision. I used to be self-employed, and I used to run a corporation. I wanted health care for my family in both circumstances. When I was self-employed, you could deduct almost nothing. Any person self-employed today can deduct 45 percent. Under the present Tax Code, in another 8 years they finally get to deduct 100 percent. That is a mistake. It needs to be remedied. We remedy it in this amendment. We provide 100 percent deductibility, beginning December 31, 1998--it would be effective immediately--100 percent deductibility for the self- employed. I want my colleagues to understand that under this provision we are correcting the fact that the self-employed can only deduct 45 percent of their health care costs. We are expanding access. We are making it possible for more people to buy health insurance. I hope we will have strong bipartisan support for this provision. This amendment is a second-degree amendment to the underlying amendment offered by Senator Kennedy and Senator Daschle that tries to expand the scope that says the Federal Government knows best. We say no, the States should be the primary regulator over health insurance, and self-employed individuals should be entitled to deduct 100 percent of their health care premium. I yield to my colleague from Arkansas such time as he desires.

Mr. NICKLES. Mr. President, I suggest the absence of a quorum.

Mr. NICKLES

Mr. NICKLES. Mr. President, if there is no further business to come before the Senate, I now ask unanimous consent that the Senate stand in recess under the previous order.

Mr. NICKLES

Mr. NICKLES. Mr. President, I ask unanimous consent that the concurrent resolution be agreed to, the preamble be agreed to, the motion to reconsider be laid upon the table, and that any statements relating to the resolution be printed in the Record.

Mr. NICKLES. Mr. President, I ask unanimous consent that the Senate now proceed to the immediate consideration of H. Con. Res. 144.

Mr. NICKLES

Mr. NICKLES. Mr. President, again I appreciate the clarification of my colleague from Nevada. I think it would be our intention to vote on the amendments. We now have a substitute offered. We have three amendments that are pending in line. I expect there will be additional amendments offered tomorrow and throughout the course of business. For the information of all of our colleagues, we expect to have several votes in the next few days. With Senator Smith's speech tomorrow afternoon, my guess is that we will be voting on the amendments as previously ordered sometime shortly after Senator Smith's statement.

Mr. NICKLES. Mr. President, I appreciate Senator Reid's suggestion. I think it is a good suggestion. It is certainly my intention to alternate. I think the unanimous consent request agreement that we have calls for alternating first-degree amendments and says that each side shall have a second-degree amendment. It didn't say we would be alternating from first-degree to second-degree amendments. I think the suggestion of my colleague from Nevada is a good one, and I will work with him to see that is the normal order of business. We may at some point have a unanimous consent agreement to do that but not at this time. I appreciate his suggestion, and as always, it is a pleasure for me to work with him to see if we can keep the Senate working together in a collegial and fair manner.

Mr. NICKLES. Mr. President, I ask unanimous consent that when the Senate completes its business today, it stand in recess until the hour of 9:30 a.m. on Tuesday, July 13. I further ask unanimous consent that on Tuesday, immediately following the prayer, the Journal of proceedings be approved to date, the morning hour be deemed to have expired, the time for the two leaders be reserved for their use later in the day, and the Senate then begin a period of morning business until 10 a.m. with Senators speaking for up to 5 minutes each with the following exceptions: Senator Ashcroft, or his designee, 20 minutes; Senator Daschle, or his designee, 10 minutes. Mr. President, I further ask unanimous consent that the Senate stand in recess from the hours of 12:30 to 2:15 p.m. for the weekly policy conferences to meet. I finally ask unanimous consent that when the Senate reconvenes at 2:15 p.m. Senator Smith of New Hampshire be recognized for a point of personal privilege for not to exceed 45 minutes.

Mr. NICKLES

Mr. NICKLES. Mr. President, I appreciate my colleague's thoughts on that. For the information of all Senators, we will be debating the emergency room amendment at 10 o'clock followed by subsequent amendments.

Mr. NICKLES. Mr. President, for the information of all Senators, the Senate will be in a period of morning business tomorrow until 10 a.m. Following morning business, the Senate will resume consideration of the Patients' Bill of Rights. Further amendments to the bill are expected to be offered and debated throughout Tuesday's session of the Senate. For the information of all Senators, votes can be expected on or in relation to the pending amendments throughout Tuesday's session.