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ACCESS TO HEALTH INSURANCE -- (House of Representatives - October 18, 2000)

So when he says that insurance is a Washington thing, does that mean that he does not really care that much about the kids in Texas, that they should not be able to take advantage of

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the Federal program and Federal dollars that are allowing them to be covered by health insurance?

   When it comes to insuring adults, Governor Bush's record is really no better than it is with the kids. Texas has the highest percentage of uninsured low-income adults, 51 percent, in the Nation. Its Medicaid eligibility level is just a paltry $4,728 in annual income for parents of three-person families.

   A little later I am going to get into the proposals that Vice President GORE and President Clinton and the Democrats in the House have put forward to try to get more adults insured. We care deeply to try to end the problem of the uninsured in this country. If that is a Washington thing, so be it. But I would maintain it is an American thing, that kids are suffering because they do not have health insurance, parents are suffering because they do not have health insurance.

   When it comes to overall spending on health in the State of Texas, the Governor has distorted his own record. He made it look like health care is a much bigger priority for him than it really is.

   In last week's debate, the previous debate prior to last night, Governor Bush said Texas had spent $4.7 billion on health care under his administration when in fact that is simply not true. Something like $3.5 billion of that money came from private and local sources and not the State expenditure.

   I am trying to make the point, Mr. Speaker, that access to health insurance is simply not a priority for the Governor, not a priority in terms of spending, not a priority in terms of trying to get the State of Texas to cover more kids and more adults.

   The lack of health insurance in the United States is not a problem that should be cavalierly dismissed as a Washington thing by any policymaker or any politician, let alone a candidate for the President of the United States. It is a very real problem that affects real Americans with real consequences.

   Let me just give some statistics about why I say that, and why it is true that health insurance is not just a Washington thing, but something that everyone in the country has to be worried about.

   There are millions of American parents who are unable to take sick and suffering children to the doctor because they simply cannot afford it. There are 27,000 uninsured women who are diagnosed with breast cancer every year, and are 50 percent more likely to die from it because they are uninsured. There are older couples whose hopes for a dignified retirement after a lifetime of work are swept away in an instant by an unexpected avalanche of medical debt. There are young families whose hopes for the future are destroyed when a breadwinner dies or is disabled because an illness was not diagnosed and treated in a timely fashion.

   Eighty-three thousand Americans die each year because they do not have insurance, and as a result, do not get adequate or timely care. I can assure the Members, Mr. Speaker, that to them, insurance is far more than just a Washington term to their families.

   The Federal government and State governments across the country have spent the last 10 years trying to stem the tide of people turning to the emergency room for their medical care.

   I know Governor Bush throughout the debates has talked about the fact that, you know, you can go to an emergency room in Texas, you can go to a hospital emergency room. The problem with that is that that is not really good health care because there is no prevention. If we have preventative care and take measures before we have to go to an emergency room, our likelihood of doing well and living longer and not being disabled are much greater.

   Preventative care does not just save lives and stop tragedies before they occur, it is also more efficient and less expensive for everybody, including the Federal government. Those facts are understood by health experts, but not a lot of times by politicians.

   I would say the same thing to the Governor: Rather than talk about the fact that people in Texas have access to an emergency room, put programs in effect so people can get health insurance and can take the preventative measures so they do not have to wait until they get so sick that they have to go to an emergency room.

   Governor Bush's view that insurance is a Washington term may be a view that is held by wealthy people who have insurance and can foot the bill easily for any medical emergency that may arise, but it is definitely a view that is clearly out of touch with the American mainstream.

   It is a view every American, particularly those without insurance, should be aware of in this political season. It is a view that, if followed, will throw a monkey wrench in both private sector and public efforts to bring down the cost of health care, and it is a view that nobody who is interested in addressing the problems of the uninsured in this country should for a single second take seriously.

   I know it sounds very critical of me to talk about the Governor in this light, but it really annoyed me to hear the term ``insurance'' somehow referred to as a Washington term, as if the rest of the country or the average person was not concerned about it. I know that they are.

   I want to spend some time also this evening contrasting, if you will, not only the presidential candidates but the parties on the issue of health care. I know it sounds very political, but the bottom line is that this Congress only has another week or so before it adjourns.

   The Democrats, including myself, over the last 2 years that this Congress has been in session have put forth a number of proposals, whether it is a prescription drug benefit under Medicare or it is HMO reform with the Patients' Bill of Rights , or it is the idea that whatever surplus is available should be primarily used to shore up social security and Medicare, or it is the idea of trying to cover more kids or more parents.

   We have been out there putting forth, with President Clinton and Vice President GORE's support, many proposals that would address some of the problems that Americans face with health insurance, whether they are uninsured or they have some type of insurance that is inadequate.

   It really galls me to think that we are here at the 11th hour and most of these problems have not been addressed by the Republican leadership on the other side of the aisle, and will not be addressed if Governor Bush is elected president.

   So I think it is important to contrast the candidates and the parties on health care. I am just going to take a little time tonight if I could to give my own view, and then give the view of an independent group that has analyzed the proposals that have been put forth by both sides.

   I want to start with the issue of prescription drugs, because I think right now the fact that so many seniors and disabled people who have Medicare are not able to access prescription drugs is a major problem, almost a crisis in the country.

   If we listen to what George Bush has been saying, what Governor Bush has been saying, he is saying that he wants to provide some sort of prescription drug program that would provide coverage initially through State-based low-income-only programs, and then through HMOs and insurance companies.

   I say that because what the Governor has proposed is not to bring prescription drugs under the rubric of Medicare, but rather, to give a subsidy or a voucher, if you will, to low-income people so they can go out and try to buy prescription drug policies in the open market, in the private market.

   That is very different from what Vice President Gore and the Democrats have been saying. I think it was clearly defined in last night's debate. What Vice President Al Gore has been saying is that Medicare is a successful program that provides coverage for one's hospital care and for one's doctor's care, and it would not be that difficult and would not cost that much money, particularly if we have a surplus, for the Federal government to provide prescription drug benefits under Medicare, as well.

   So that is the major difference between the Democrat and the Republican proposals. The Democrats are saying they want to expand Medicare to include prescription drugs. The Republicans are saying they do not want to use Medicare as the vehicle, they want to give a subsidy or they want to

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give a voucher, or in the case of Governor Bush's proposal, a voucher essentially just for low-income people.

   There are a lot of other differences, but I just want to say, Members do not have to take my word for it. There is an organization called Families USA which just put out a report on health care and the 2000 election.

   I just want to describe Families USA. Families USA is a nonprofit, nonpartisan consumer health organization established under section 501(c)(4) of the Internal Revenue Code that has never endorsed, supported, nor opposed any political candidate, and they are not doing it now.

   In addition, Families USA has spent two decades working on various aspects of our health care system, and has amassed considerable expertise on health issues. The Democrats and myself have cited them many times, and the Republicans as well.

   On the issue of prescription drugs, and I just want to run through this, if I could, in their report that just came out they say, ``There is a marked contrast between the two candidates on this issue.''


[Time: 21:15]

   Vice President GORE intends to establish a voluntary prescription drug benefit in the Medicare program, and I stress in the Medicare program. This would ensure that all seniors and people with disabilities gain access to prescription drug coverage. It would also enable Medicare to bring its considerable market clout on behalf of program beneficiaries to the bargaining table.

   Now, that sounds a little bureaucratic, but let me explain what that means. One of the biggest problems with prescription drugs right now is the cost for seniors. If they do not have some kind of coverage through their employer or through some sort of coverage that they are able to purchase, which many do not, then they have to go buy it on the open market at the local pharmacy, and the cost is prohibitive.

   There is a price discrimination between seniors who have to just go buy the prescription at the local pharmacy out-of-pocket versus seniors who happen to be fortunate to be in some sort of plan, either through their employer or in some other way.

   But what Vice President GORE does and what the Democrats do with their Medicare prescription drug proposal is they give the seniors who are now part of this plan clout with regard to prices, because they establish a benefit provider in each region of the country that will bargain for the best price, just like an HMO does, for example, for the prescription drugs, and that brings the price down. So that is what they are talking about here when Families USA says that the Democratic plan is better.

   Then they say in the Families USA report, they contrast Governor Bush's approach by way of contrast. Initially he relies on State-run pharmaceutical programs and subsequently on insurance companies, HMOs, to offer prescription drug coverage.

   To date, however, State pharmaceutical programs reach only a tiny portion of seniors who need drug coverage, and such assistance is usually confined to seniors with very low incomes.

   The point is that the Republican plan is only going to help seniors with low incomes. It is not going to help the vast majority of seniors with middle incomes, which basically are the people that are crying out for some sort of help.

   In addition, in analyzing the Bush plan, Families USA's assessment says that private health plans and insurance companies have very limited success in providing drug coverage for seniors.

   I mention that because what they are basically saying here is that, if one gives the senior or the disabled person the voucher, the way Governor Bush has proposed, to go out and try to buy prescription drug coverage in the open market, not under Medicare, they are not going to be able to find it. They are not going to find an insurance company that will offer that for the price of the subsidy that the Bush plan proposes.

   Now, additionally, what Families USA says about the GORE plan, the Democratic Medicare prescription drug plan, is that it is very specific in detailing the drug coverage that is guaranteed to every Medicare beneficiary as well as the cost sharing that seniors would have to pay.

   So what we are saying in the Democratic plan is that we are going to be able to guarantee one to have any drug that is medically necessary. We are going to tell one exactly what the premium is, exactly what one is going to get.

   Under the Bush proposal, on the other hand, decision making about the specifics of the drug benefit as well as out-of-pocket costs are left to the private insurance companies and the HMOs. So, again, one does not really know what one is getting.

   But I want to stress again the difference here, the difference is the Bush Republican plan is a voucher plan. It does not come under the rubric of Medicare. The Democratic plan, the Gore plan, is an expansion of Medicare that covers prescription drugs just in the same way that hospital care and physician care is provided under Medicare right now.

   Now, let me go to a second category here because I want to cover each of these health care issues because I think they are so important in terms of contrasting the difference between the parties.

   The second one is the future of Medicare itself. Medicare, as we know, in the next, maybe, 10, 20 years, not right away, but at some point in the future will start to run out of money because there are going to be so many baby boomers that become 65, that become seniors, that there is not enough money to pay for it.

   Now, what President Clinton and Vice President GORE have been saying is that they want to use most of the surplus to shore up the Social Security program and the Medicare program.

   But what we see is that, instead, by contrast, Governor Bush talks about restructuring the Medicare program in ways that I believe that will increasingly privatize and encourage people to opt out of Medicare or go to private insurance.

   I do not want to dwell on that too much because I want to get to the next issue, which is I think so important and, again, became an issue in last night's debate, right at the beginning of the debate.

   That is HMO reform. HMO reform is clearly something that so many Americans are concerned about because more and more people are in HMOs, and they find that they are victims of various abuses, primarily because what they find is that decisions about what kind of Medicare they get, whether they get a particular operation, whether they get to stay in the hospital a particular length of time is determined, not by their physician and themselves as a patient, but by the insurance companies. Naturally they do not like it because it lends itself to all kinds of abuse.

   Well, it was interesting last night because, during the debate, Governor Bush said that he was in support of HMO reform and that he mentioned that, in the State of Texas, his home State, that they actually had passed legislation that would provide for certain patient protections if one was in an HMO.

   But the interesting thing about it is Governor Bush used the example of HMO reform to say he would be successful if he were to be elected President because, in Texas, he was able to bring both parties together and everyone together to pass patient protections.

   Well, I have to point out that, when the issue of patients' rights in the context of HMO reform first came up in the tax legislature and the bill was passed in 1995, Governor Bush actually vetoed the legislation.

   So he talked about playing a role and bringing people together, the Texas legislature decided they wanted HMO reform, he vetoes the bill . Well, a couple years later, in 1997, there was again passed in the Texas legislature legislation to protect patients in the context of HMOs. This was a very comprehensive HMO reform that Governor Bush referred to in last night's debate. Well, this time, even though he opposed the legislation and refused to sign it, he let it become law.

   That is hardly an advocate for patients' rights . That is hardly someone who, as he says, is trying to bring people together to pass legislation. You veto it once and then you say, okay, I do not like it, but I will let it become law without my signature.

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   What it means is this was happening despite what Governor Bush wanted. He did not want it to happen, but he did not want to stop it probably because he was afraid of the political consequences if he vetoed it again.

   By contrast, Vice President GORE last night and throughout the 7 years now that he has been the Vice President, with the support of Democrats and some Republicans as well in Congress, has been an advocate on a Federal level for a comprehensive HMO reform bill which Vice President GORE mentioned last night, the Norwood-Dingell bill .

   He was very specific about bringing up that legislation in the debate last evening and asking Governor Bush repeatedly whether he supported the Norwood-Dingell bill and, of course, Governor Bush would not say whether he supported it or not. If he would not admit he supported it, I would say we have to assume he does not support it.

   It is a much stronger bill than even what the Texas legislature passed without Governor Bush's signature. It is a bill that is vehemently opposed by the HMOs and the health insurance industry and all of the special interests and very much supported by the majority of the American people.

   We passed the Patients' Bill of Rights , the Norwood-Dingell bill here in the House of Representatives. Almost every Democrat voted for it, and some Republicans voted for it too, otherwise it wouldn't have passed. In fact, the gentleman from Georgia (Mr. NORWOOD), one of the sponsors, is a Republican, the lead sponsor.

   But the bottom line is that the Republicans both here, the Republican leadership, both here in this House as well as in the other body, have tried to kill this bill ever since it passed. It went to conference. I was part of the conference committee. It has never come out of conference.

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