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I have also supported programs at CDC which help children. CDC's childhood immunization program seeks to eliminate preventable diseases through immunization and to ensure that at least 90 percent of 2 year olds are vaccinated. The CDC also continues to educate parents and caregivers on the importance of immunization for children under two years. Along with my
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In recent years, we have also strengthened funding for Community Health Centers, which provide immunizations, health advice, and health professions training. These Centers, administered by the Health Resources and Services Administration, provide a critical primary care safety net to rural and medically underserved communities, as well as uninsured individuals, migrant workers, the homeless, residents of public housing, and Medicaid recipients. In 1996, 940 Health Centers provided comprehensive health care to 10 million children and adults across the United States. For fiscal year 1999, these Centers received $925 million, a $100 million increase over fiscal year 1998.
As Chairman of the Select Committee on Intelligence and Chairman of the Appropriations Subcommittee with jurisdiction over the Department of Health and Human Services, I have worked to transfer CIA imaging technology to the fight against breast cancer. Through the Office of Women's Health within the Department of Health and Human Services, I secured a $2 million contract in fiscal year 1996 for the University of Pennsylvania and a consortium to perform the first clinical trials testing the use of intelligence community technology for breast cancer detection. My Appropriations Subcommittee has continued to provide funds to continue the clinical trials.
I have also been a strong supporter of funding for AIDS research, education, and prevention programs. Funding for Ryan White AIDS programs has increased from $757.4 million in 1996 to $1.41 billion for fiscal year 1999. Within the fiscal year 1999 funding, $46 million was included for pediatric AIDS programs and $461 million for the AIDS Drug Assistance Program (ADAP). AIDS researc h at the NIH totaled $742.4 million in 1989, and has increased to $1.85 billion in fiscal year 1999. AIDS funding across the Department of Health and Human Services has steadily increased to over $3.9 billion for fiscal year 1999.
The health care community continues to recognize the importance of prevention in improving health status and reducing health care costs. In this bill, I have also included provisions which refine and strengthen preventive benefits within the Medicare program, including coverage of yearly pap smears, pelvic exams, and mammography screening for women, with no copayment or Part B deductible; and coverage of insulin pumps for certain Type I Diabetics.
The proposed expansions in preventive health services included
in Title IV of my bill are conservatively projected to save approximately $2.5 billion per year or $12.5 billion over five years. However, I believe the savings will be higher. It is clearly difficult to quantify today the savings that will surely be achieved tomorrow from future generations of children that are truly educated in a range of health-related subjects including hygiene, nutrition, physical and emotional health, drug and alcohol abuse, and accident prevention and safety.
TITLE V
Title V of my bill would establish a federal standard and create uniform national forms concerning a patient's right to decline medical treatment. Nothing in my bill mandates the use of uniform forms. Rather, the purpose of this provision is to make it easier for individuals to make their own choices and determination regarding their treatment during this vulnerable and highly personal time. Studies have also indicated that advance directives do not increase health care costs. Data indicate that end-of-life costs account for 10 percent of total health expenditures and 28 percent of total Medicare expenditures. Loose projections indicate that a 10 percent savings made in the final days of life would result in approximately $10 billion of savings in medical costs per year, and about $4.7 billion in savings for Medicare alone.
However, economic considerations are not and should not be the primary reasons for using advance directives. They provide a means for patients to exercise their autonomy over end-of-life decisions. A study done at the Thomas Jefferson University Medical College in Philadelphia cited research which found that about 90 percent of the American population has expressed interest in discussing advance directives. However, even more recent studies indicate that living wills would be used by many more Americans if they were better understood. My bill would provide information on an individual's rights regarding living wills and advanced directives, and would make it easier for people to have their wishes known and honored. In my view, no one has the right to decide for anyone else what constitutes appropriate medical treatment to prolong a person's life. Encouraging the use of advance directives will ensure that patients are not needlessly and unlawfully treated against their will. No health care provider would be permitted to treat an adult contrary to the adult's wishes as outlined in an advance directive. However, in no way would the use of advance directives condone assisted suicide or any affirmative act to end human life.
TITLE VI
The next title addresses the unique barriers to coverage which exist in both rural and urban medically underserved areas. Within my State of Pennsylvania, such barriers result from a lack of health care providers in rural areas, and other problems associated with the lack of coverage for indigent populations living in inner cities. Title VI of my bill improves access to health care services for these populations by: (1) expanding Public Health Service programs and training more primary care providers to serve in such areas; (2) increasing the utilization of non-physician providers, including nurse practitioners, clinical nurse specialists and physician assistants, through direct reimbursements under the Medicare and Medicaid programs; and (3) increasing support for education and outreach.
I believe these provisions will also yield substantial savings. A study of the Canadian health system utilizing nurse practitioners projected savings of 10 to 15 percent of all medical costs. While our system is dramatically different from that of Canada, it may not be unreasonable to project annual savings of five percent, or $55 billion, from an increased number of primary care providers in our system. Again, experience will raise or lower this projection. Assuming these savings, based on an average expenditure for health care of $3,821 per person in 1995, it seems reasonable that we could cover over 10 million uninsured persons with these savings.
TITLE VII
Outcomes research, included in title VII of my bill, is another area where we can achieve considerable long term health care savings while also improving the quality of care. According to most outcomes management experts, it is estimated that about 25 to 30 percent of medical care is inappropriate or unnecessary. Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, also stated that 20 to 30 percent of health care procedures are either inappropriate, ineffective or unnecessary. In 1997, health care expenditures totaled $1.1 trillion annually.
A well-funded program for outcomes research is therefore essential, and is supported by Dr. C. Everett Koop, former Surgeon General of the United States. Title VII of my bill would establish such a program by imposing a one-tenth of one cent surcharge on all health insurance premiums. Based on the Health Care Financing Administration's 1995 health spending review, private health insurance premiums totaled $325.4 billion. As provided in my bill, a surcharge would generate $325.4 million for an outcomes research fund.
Title VII also authorizes the Secretary of Health and Human Services to award grants to States to establish or improve a health care data information system. Currently, 38 States have a mandate to establish such a system, and 22 States are in various stages of implementation. In my own State, the Pennsylvania Health Care Cost Containment Council has received national
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TITLE VIII
Nursing home care is another significant issue which must be addressed. The cost of this care is exorbitant, averaging in excess of $40,000 annually. Public expenditures on nursing home care, largely through the Medicaid program, were over $33 billion in 1995. Despite these large public expenditures, the elderly face significant uncovered liability for long term care. Title VIII of my bill therefore would provide a tax credit for premiums paid to purchase private long-term care insurance. It also proposes home and community-based care benefits as less costly alternatives to institutional care. Other tax incentives and reforms provided in my bill to make long term care insurance more affordable include: (1) allowing employees to select long-term care insurance as part of a cafeteria plan and allowing employers to deduct this expense; (2) excluding from income tax the life insurance savings used to pay for long term care; and (3) setting standards for long term care insurance that reduce the bias that currently favors institutional care over community and home-based alternatives.
TITLE IX
The final title of my bill would create a national fund for health research within the Department of the Treasury, to supplement the monies appropriated for the National Institutes of Health. To capitalize this fund, health insurance companies would be required to contribute 1 percent of all health insurance premiums received. This creative proposal was first developed by my distinguished colleagues, Senators Mark Hatfield and TOM HARKIN. Their idea is a sound one and ought to be adopted. To this end, Senator HARKIN and I introduced the National Fund for Health Research Act of 1997 (S. 441) on March 13, 1997. I look forward to continuing to work together with Senator HARKIN to enact a biomedical research fund this Congress.
While precision is again impossible, it is reasonable to project that my proposal could achieve a net annual savings of between $90 and $100 billion. I arrive at this sum by totaling the projected savings of $90 to $100 billion annually--$9 billion in small employer market reforms coupled with employer purchasing groups; $2.5 billion for preventive health services; $22 to $33 billion for reducing inappropriate care through outcomes research; $10 billion from advanced directives; $55 billion from increasing primary care providers; and $2.9 billion by reducing administrative costs and netting this against the $2.8 billion for long term care. Although these estimates are not exact, I propose this bill as a starting point to address the remaining problems with our health care system. Experience will require modification of these projections, and I am prepared to work with my colleagues to develop implementing legislation and to press for further action in the important area of health care reform.
The provisions which I have outlined today contain the framework for providing affordable health care for all Americans. I am opposed to rationing health care. I do not want rationing for myself, for my family, or for America. In my judgment, we should not scrap, but rather we should build on our current health delivery system. We do not need the overwhelming bureaucracy that President Clinton and other Democratic leaders proposed in 1993 to accomplish this. I believe we can provide care for the 43.1 million Americans who are now not covered and reduce health care costs for those who are covered within the currently growing $1.1 trillion in health care spending.
This bill is a significant next step forward in obtaining the objective of reforming our health care system, although that reform will not be achieved immediately or easily. Mr. President, the time has come for concerted action in this arena.
I urge the Congressional leadership, including the appropriate committee chairmen, to move this legislation and other health care bills forward promptly.
I ask unanimous consent that a summary of the bill and a list of the 26 health care bills I have sponsored since 1983 be printed in the RECORD.
There being no objection, the material was ordered to be printed in the RECORD, as follows:
26 Health Care Bills Introduced by Senator Arlen Specter
98th Congress 1/3/83 until 1/2/85:
(1) S.811: The Health Care for Displaced Workers Act of 1983 (3/15/83)
(2) S.2051: The Health Care Cost Containment Act of 1983 (11/4/83)
99th Congress 1/3/85 until 1/2/87:
(3) S.379: The Health Care Cost Containment Act of 1985 (2/5/85)
(4) S.1873: The Community Based Disease Prevention and Health Promotion Projects Act of 1985 (11/21/85)
100th Congress 1/3/87 until 1/2/89:
(5) S.281: The Aid to Families and Employment Transition Act (1/6/87)
(6) S.1871: The Pediatric Acquired Immunodeficiency Syndrome (AIDS) Resource Centers Act (11/17/87)
(7) S.1872: The Minority Acquired Immunodeficiency Syndrome (AIDS) Awareness and Prevention Projects Act (11/17/87):
101st Congress 1/3/89 until 1/2/91
(8) S.896: The Pediatric AIDS Resource Centers Act (5/2/89)
(9) S.1607: Authorization of the Office of Minority Health (9/12/89):
102nd Congress 1/3/91 until 1/5/93:
(10) S.1122: The Long-Term Care Incentives Act of 1991 (5/22/91)
(11) S.1214: The Change in Designation of Lancaster County, PA, for Purposes of Medicare Services (6/4/91)
(12) S.1864: The Children's Hospital of Philadelphia Medical Research Facility Act (10/23/91)
(13) S.1995: The Health Care Access and Affordabililty Act of 1991 (11/20/91)
(14) S.2028: The Women Veteran's Health Equity Act of 1991 (11/22/91)
(15) S.2029: Self-Funding of Veteran's Administrative Health Care Act (11/22/91)
(16) S.2188: Rural Veterans Health Care Facilities Act (2/5/92)
(17) S.3176: The Health Care Affordabililty and Quality Improvement Act of 1992 (8/12/92)
(18) S.3353: The Deferred Acquisition Cost Act (10/6/92)
103rd Congress 1/5/93 until 12/11/94:
(19) S.18: The Comprehensive Health Care Act of 1993 (1/21/93)
(20) S.631: The Comprehensive Access and Affordabililty Health Care (3/23/93):
104th Congress 1/4/95 until 10/3/96:
(21) S.18: The Health Care Assurance Act of 1995 (1/4/95)
(22) S.1716: The Adolescent Family Life and Abstinence Education Act of 1996 (4/29/96)
105th Congress 1/7/97 to 10/21/98:
(23) S.24: The Health Care Assurance Act of 1997 (1/21/97)
(24) S.435: The Healthy Children's Pilot Program Act of 1997 (3/13/97)
(25) S.934: The Adolescent Family Life and Abstinence Education Act of 1997 (6/18/97)
(26) S.999: Authorizing the Department of Veteran's Affairs to Specify the Frequency of Screening Mammograms (7/9/97)
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Health Care assurance Act of 1999--Summary
TITLE I: Expanded State Child Health Insurance Program--This title will expand upon the State Child Health Insurance Program (S-CHIP), the new program established in the Balanced Budget Act of 1997 which allocates $24 billion/five years to increase health insurance coverage for children. The S-CHIP program gives States the option to use federally funded grants to provide vouchers to eligible families to purchase health insurance for their children, or to expand Medicaid coverage for those uninsured children, or a combination of both. These grants are distributed to participating States based on the number of uninsured children residing there. This title would increase the income eligibility to families with incomes at or below 235 percent of the Federal poverty level ($38,658 annually for a family of four), and would strengthen the States' ability to conduct Medicaid outreach to eligible children.
TITLE II: Expanded Health Services for Disabled Individuals:--Extension of Medicare Eligibility for Disabled Individuals Who Return to Work: Currently, disabled individuals, or recipients of Social Security Disability Income (SSDI), may receive health insurance coverage under the Medicare program for a short time after returning to work. This provision would extend to 24 months the period during which the individual may continue to receive Medicare benefits after returning to work, and allow the individual to ``buy-into'' Medicare at a reduced rate, subject to yearly review.
Expansion of Community-Based Attendant Care Services--Medicaid currently covers the costs associated with institutional care
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TITLE III: General Health Insurance Coverage Provisions--Tax Equity for the Self-Employed: Under current law, self-employed persons may deduct 60 percent of their health insurance costs through 2002, and those costs would be fully deductible in 2003. However, all other employees may already deduct 100 percent of such costs. Title III corrects this inequity for the self-employed, 2.9 million of whom are currently uninsured, by speeding up the phase-in to allow self-employed individuals and their families to deduct 100 percent of their health insurance costs beginning in 2001.
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