Access To Affordable Health Care Act
ACCESS TO AFFORDABLE HEALTH CARE ACT -- (Senate - January 08, 2007)
Ms. COLLINS. Mr. President, last week, on the very first day of this new Congress, I joined with my colleague from Louisiana, Senator Mary Landrieu, in introducing the Access to Affordable Health Care Act. This is a comprehensive plan which builds on the strengths of our current public programs and private health care system to make affordable health care available to millions more Americans. It is similar to legislation we introduced in the last Congress. I hope, given the urgency of dealing with the cost of health care and health insurance, that this will be the year this legislation moves forward.
One of my priorities in the Senate has long been to expand access to affordable health care. There are still far too many Americans without health insurance or with woefully inadequate coverage. As many as 46 million Americans are uninsured, and millions more are underinsured. The State of Maine is in the midst of a growing health insurance crisis, with insurance premiums rising at alarming rates. Whether I am talking to a self-employed fisherman, a displaced mill worker, the owner of a struggling small business, or the human resources manager of a large company, the soaring costs of health insurance are a common concern. These cost increases, double digit this past year, have been particularly burdensome for small businesses, the backbone of the Maine economy.
Maine's small business owners want to provide coverage for their employees, but they are caught in a cost squeeze. They know that if they pass on premium increases to their employees, more and more of them will decline coverage altogether because they simply can't afford their share. Yet these small businesses cannot continue to simply absorb the double-digit increases in their health insurance premiums year after year. The problem of rising costs is even more acute for individuals and families who must purchase health insurance on their own. Monthly health insurance premiums in my State often exceed a family's mortgage payment. Clearly, we must do more to make health insurance more available and more affordable.
The legislation Senator Landrieu and I are introducing is a seven-point plan that combines a variety of public and private approaches. The legislation's seven goals are, first, to expand access to affordable health care for small businesses; second, to make health insurance more affordable for individuals and families purchasing coverage on their own; third, to strengthen the health care safety net for those without coverage; fourth, to expand access to care in rural and underserved areas; fifth, to increase access to affordable long-term care, a major challenge as our population continues to age; sixth, to promote healthier lifestyles; and seventh, to provide more equitable Medicare payments to Maine providers to reduce the Medicare shortfall which has forced hospitals, physicians, and other health care providers to shift costs on to other payers in the form of higher charges, which, in turn, drives up the cost of health care premiums.
Let me discuss these points in greater detail.
First, expanding access for small businesses by helping small employers cope with rising health insurance costs. Since most Americans get their health insurance through the workplace, it is a common assumption, but a false one, that people without health insurance are unemployed. In fact, as many as 83 percent of Americans who do not have health insurance are in a family with a worker or are working themselves. Uninsured working Americans are most often the employees of small businesses. In fact, some 63 percent of uninsured workers are employed by small firms. Smaller firms generally face higher costs for health insurance than larger companies, which makes them again less likely to offer coverage.
The legislation we have introduced will help these employers cope with rising costs by creating a new tax credit for small businesses to make health insurance more affordable. It will also encourage small businesses that do not offer health insurance to start doing so with the help of this tax credit, and it will help employers that do offer insurance to continue coverage in the face of escalating premiums.
Our legislation would also provide grants to provide startup funding to States to help businesses join in purchasing co-ops. These co-ops would enable small businesses to band together to purchase health insurance jointly, but this part of the bill does not preempt State law, so it is a different approach than some have taken.
The legislation would also authorize the Small Business Administration grant program for States, local governments, and nonprofit organizations to provide information about benefits of health insurance to small employers, including tax benefits, increased productivity of employees, and decreased turnover. These would also be used to help make employers aware of current incentives under State and Federal laws. It is an interesting fact that one survey showed that 57 percent of small employers did not know they
could deduct 100 percent of their health insurance premiums as a business expense. I want to change that into a tax credit which is far more valuable, but many small businesses don't realize that there is a tax incentive even in our current tax laws.
The legislation would also create a new program to encourage innovation by awarding demonstration grants in up to 10 States conducting the innovative coverage expansions such as pooling arrangements or group market reforms, or subsidies to employers or individuals. We know the States are the laboratories for reform. Insurance is regulated at the State level. This would provide for some assistance in conducting some innovative projects to expand coverage.
The Access to Affordable Health Care Act would also expand access to affordable health insurance for individuals and families. One of the first bills I sponsored when I first came to the Senate in 1997 was legislation introduced by Senator Hatch and Senator Kennedy to create the State Children's Health Insurance Program, the SCHIP program, which provides insurance for children of low-income parents who cannot afford health insurance yet make too much money to qualify for the Medicaid Program. Since that time, this program has contributed to a one-third decline in the number of uninsured children in this country. Today, over 6 million children--including approximately 14,500 in Maine--are receiving health care coverage through this remarkably effective program.
Our legislation would shore up the looming shortfalls in the SCHIP program in 17 States, including Maine. We want to ensure that children currently enrolled in the program do not lose their coverage, and in order to achieve that goal, we need to make up that shortfall. Just prior to adjournment last month, Congress approved legislation which partially addressed that shortfall, but that provides only about one-fifth of the funds needed. Our legislation would help close that gap.
Our bill also builds on the success of the SCHIP program by giving States a number of new tools to increase participation. I won't go through all of the changes we would make, but let me mention one. We would allow the parents of those children enrolled in the SCHIP program to enroll in the health insurance program on a subsidized rate, depending on their income, if the State wants to take advantage of that option. The experts tell us that would help provide coverage for about 6 million more low-income Americans.
So what I am trying to do is take advantage of some existing programs such as SCHIP, expanding them, providing new tax incentives such as the tax credit for small businesses to help piece together a program that builds on the strengths of the existing program that still has a private sector approach and yet fills in the gaps in coverage and helps make health insurance more affordable. Part of that is providing for more funding for community health centers which operate in underserved urban as well as rural communities. They provide critical primary care services to millions of Americans regardless of their ability to pay.
We also know we need to deal with the problem of not enough physicians, physician assistants, nurse practitioners, and other primary care providers in underserved areas. We need to revamp the National Health Service Corps, which helps supply doctors, dentists, and other clinicians who serve in rural and inner-city areas. We want to revamp that program to make it more flexible. I was talking to physicians in Holten, ME, just recently who said that program used to be a source of physicians for rural Maine, but over the years it has become rigid and encrusted and not flexible enough and is no longer nearly as valuable as it once was. We would revamp that program.
As Senate cochair with Senator Clinton of the bipartisan Congressional Task Force on Alzheimer's Disease, I am particularly sensitive to the long-term needs of patients with chronic diseases such as Alzheimer's and of the impact on their families. Long-term care is the major catastrophic health expense faced by older Americans today, and these costs will only increase with the aging of the baby boomer generation--our generation.
I have been surprised that many Americans mistakenly believe that Medicare or their private health insurance policy will cover the cost of long-term care should they develop a chronic illness or a cognitive impairment such as Alzheimer's. Unfortunately, far too many do not discover they do not have coverage until they are confronted with the difficult decision of placing a much loved parent or spouse in a long-term care facility and facing the shocking realization that unless they have long-term care coverage, they have to cover the costs themselves. We need to encourage people to purchase long-term care insurance, to plan for this need.
The bill we are introducing provides a tax credit for long-term care expenses of up to $3,000 to provide some help to families struggling with that cost, and it would encourage more Americans to plan for their future long-term care needs by providing a tax deduction to help them purchase long-term care insurance.
Health insurance alone is not going to ensure good health. As noted author and physician Dr. Michael Crichton has observed, ``The future in medicine lies not in treating illness but in preventing it.' Many of our serious health problems are directly related to unhealthy behaviors: Smoking, the lack of regular exercise, poor diet. These three major risk factors alone have made my State the State with the fourth highest death rate, due to four largely preventable diseases--or at least you can delay their onset--cardiovascular disease, cancer, chronic lung disease, and diabetes. These diseases are responsible for 70 percent of the health care problems in Maine.
Our bill, therefore, contains a number of provisions designed to promote healthy lifestyles. It includes, for example, grants to allow States to assist small businesses in establishing worksite wellness programs for their employees. It also authorizes a grant program to support new and existing community partnerships. There is a great one in Franklin County, in Maine. It is the Healthy Community Coalition, and it has made a difference in promoting healthy lifestyles.
Finally, the Access to Affordable Health Care Act will promote greater equity in Medicare payments and help to ensure that the Medicare system rewards, rather than punishes, States such as Maine that deliver high-quality, cost-effective Medicare services to our elderly and disabled citizens. The Medicare Modernization Act of 2003 and subsequent legislation did take some significant steps toward promoting greater fairness by increasing Medicare payments to rural hospitals and by modifying geographic adjustment factors that discriminated against physicians and other providers in rural areas. Our legislation would build on these improvements by establishing pilot programs that reward providers of high-quality, cost-effective Medicare services.
The Access to Affordable Health Care Act outlines a blueprint for reform based on principles upon which I am hopeful that a bipartisan majority of Congress could agree. The plan takes significant strides toward the goal of access to health care coverage by bringing millions more Americans into the insurance system and by strengthening the health care safety net. Most of all, it helps address the No. 1 obstacle to health insurance--and that is its cost--through a variety of incentives.
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