Senator Michael B. Enzi Monday Interview

July 12, 1999

Dave Perry, the Rawlins Daily Times and Janine Jordan, KOWB Radio in Laramie

Michael B. Enzi: This week will be dedicated to debating the Patients Bill of Rights. There's a Democrat version and a Republican version Plus. The Democrats kept inserting this bill every time we had anything come up. We're trying to get appropriations done -- there are 13 appropriations bills that have to be finished by Oct. 1, or we leave the negotiating up to the president. We think that's a legislative responsibility and that we ought to try and get those through. Meanwhile we're getting an amendment on every one of the bills dealing with the Patients Bill of Rights. We said we would limit the debate and get it done, so that's what we're in the process of doing right now. I'm working very hard to protect Wyoming's interest in rural health care. We want to make sure that the folks in Wyoming continue to get health care. We don't want people driven out of plans. This Democratic plan, nationwide, will drive out about 1.8 million people who will no longer be insured as it drives up health care costs about 14 percent each year. We find those to be unacceptable numbers, losing insurance, and also unacceptable annual costs. This deals mainly with HMOs so it only has an effect on six counties as far as Wyoming goes with HMOs, but the companies that have the HMOs also have the fee for service plans that we have in Wyoming. If the HMO costs go up, that spreads across their whole range of customers which include the Wyoming customers. What we have to look at is a threat of additional health care costs for which we receive absolutely no benefit. We're trying to make sure that Wyoming folks get the kind of care they need, maintain state jurisdiction so you can call someone in Wyoming, talk to the same person everyday instead of wade yourself through a national bureaucracy. That's kind of the gist of what's happening with this debate. With that I'll open it up to any questions.

Dave Perry: Which six counties are affected, Senator - with the HMOs?

ME: The peripheral ones - the ones that are served out of Salt Lake, Ft. Collins and Billings (Lincoln, Uinta, Sweetwater, Carbon, Albany and Laramie). It's primarily the southern border counties, and not all the folks in those counties. It's been an interesting process on this bill because I serve of the Health, Education, Labor and Pensions committee, and on the subcommittee of that committee, which is where this bill came from and also where the markup was done. I've been debating each of the issues as this has come up and I've stopped several amendments from happening that would have eliminated service to those people that want HMOs that are from Wyoming. Some of them would have required that they should be excluded because of the additional cost that would have been forced on the HMO.

Janine Johnson: What's the cost increase come from - you said a 14 percent increase - as far as this bill goes, it should just protect confidentiality rights, from what I understand?

ME: No. Confidentiality is one of the smaller portions of it. The biggest cost increase would be from the liability provisions that are put in it. This is a trial lawyers dream. It allows a very extensive procedure for suing your doctor. That's the Democrats version. The Republican version, the Patients Bill of Rights Plus, has a procedure where they make sure that you get your appeals through in a hurry with doctors making the decisions so you get your care and then still have the right to sue. Rather then putting the emphasis on the law suit, we put the emphasis on the health care. Part of the bill is designed to be sure that people get the care they need quickly. Another big cost that comes into the bill is from the bureaucracy that gets built. We will have to build a new administration -- this isn't' a lot different from the 1993 presidential plan for national health care. In fact, it's a step on the road to it if the Democrat Plan is adopted.

JJ: A lot of health care professionals on the privacy issue are backing this bill -- do you think that's been misleading to some degree, being that it's a minor part of it?

ME: An interesting part of the president's bill is that he put in a provision that would appeal to a number of different groups, to get their backing on the bill. But they're provisions that have difficulty with some of the other groups backing the bill. In order to get the backing, he's included some things like that. The patient's privacy is an important issue, but it covers a wider range of people and ought to be addressed in a separate bill.

DP: I see the AP is reporting on the President's proposal on optional prescription drug coverage under Medicare. What do you think about that, Senator?

ME: I'm interested in everybody having as low cost health care possible and I would like for everybody to have a prescription drug benefit. There's a cost involved with those things. One of the things we have to be sure of is that we're not driving people out of the market with the cost, or as the president's plan does, putting price restrictions on the drugs with the thought that will keep the price down. What it will actually do is eliminate a lot of the research that's finding for new drugs that will take care of problems people have today. We've tried doing health care limitations on price before, and price controls, as far as I know, have never worked on any product yet. One of the things we have to do with prescription drugs is be sure that first we fix Medicare. The president keeps saying 'fix medicare.' Then he never gives us a plan to fix Medicare. Then at the same time he looks at the polls and sees these things that would help people, and they would, but he then bypasses fixing Medicare and throws out these other proposals, like to bring the age down on Medicare. We don't even have the solution for fixing it for those who are older than 65. He's talking about bringing it down to 55 and adding prescription drugs. I really think he ought to do what he said he was going to do: fix Medicare, then add prescription drugs. We're looking at different formulas for being able to add that. But I'd like to fix Medicare first and save Social Security.

DP: What's the biggest problem with Medicare? I've heard from our local hospital here that the Medicare reimbursement doesn't come close to covering their costs, and they are very concerned and threatened by that. Is that one of the things you talk about repairing?

ME: Yes, it is. In fact, we have a separate bill that takes care of that. HCFA (Health Care Financing Administration) haven't been able to do the notifications that they're supposed to to seniors, let alone handle the job that they're doing right now. That's one of the reasons we're addressing the Patients Bill of Rights. They would then be in charge of this new federal bureaucracy Patients Bill of Rights. They can't even handle the job they have now. Part of it is in the administration. Part of it is in not having adequate funds to handle the costs. It's not just the hospitals -- home health care is another area where we're trying to change the funding.

JJ: The AARP spokesperson in Laramie said that the national AARP had said the prescription coverage -- they were hesitantly backing it depending on how much it will cost per person. Most of what I've read about this says that it will be targeted mostly those with disabilities and the poor.

ME: Well, the devil's always in the details. We'd certainly like to see some details on the president's plan. He's been touting what the polls say are popular, and nobody has any argument with that, but being able to pay for it is a real key. He's thrown out some numbers on what he thinks the increase in premium ought to be to seniors, and I think that's probably why AARP has been a little hesitant on it. Those figures don't agree with some of the estimates. Once you get a plan like that in place, you drive the price up later.

JJ: How do you feel about prescription coverage with elderly. That's somewhat of a problem with elderly people retired on a limited income.

ME: Oh, it absolutely is. It was recognized by the special Medicare commission that was reviewing how to save Medicare. They addressed how to get prescription drugs for the most needy then extending it as the system was capable of handling it, and that's the version that I prefer. That's a bipartisan decision. The Democrats and Republicans agree that there ought to be prescription drugs but it ought to be limited to the most needy while we're fixing the system and making sure that it will work.

JJ: Endangered Species Act -- The Wyoming Delegation and Gov. Geringer had signed and sent a letter to U.S. Fish and Wildlife on the Prebles Meadow Jumping Mouse, which has been listed in many counties, including Albany where I'm at. Have you heard anything back on that?

ME: What we have heard informally isn't very encouraging. They're taking the approach that any place it could exist it could exist in the future, so the habitat ought to be preserved. They really don't have a scientific basis on where it is and where it can survive. One of the things that we want to have put into the endangered species legislation is some scientific review where people talk about a specific plan on how a species can survive and have that reviewed by people who are knowledgeable on that species to see if that plan will actually work and then it also includes some levels on which they become de-listed. This would take care of some of the grizzly bear problems in Wyoming had that been done on the front end of the process. Right now they're guessing on a lot of things with the Prebles mouse, and we'd like them to be a lot more scientific on it which would limit the area considerably.

JJ: Speaking of the reformat -- I think it was Sen. Thomas that introduced that, didn't he?

ME: Yes, he has a bill that our delegation is cosponsoring, and we have a number of other cosponsors.

JJ: How is support for that in the senate?

ME: We'll find out as the process goes along. We have several cosponsors on it, but most of them are Western senators. One of the biggest jobs that I have back here is educating the Easterners on what it's really like out in the West. They have no way of visualizing the open space we have out there. They know how little there is out here (in the East). Consequently, they think we're in the same situation with the same restrictions and constraints, and the same occupations they have out here. They don't realize what a change of life they sometimes thrust on people with inaccurate solutions.

JJ: If this reformat goes through, it looks to me that it will eliminate a large amount of the openendedness of listing an animal. There's no clearly defined goal in sight, and a point where you can say, 'okay, we met our goal, let's take the animal off the list.' Do you see it that way as well? Do you think this will make it a more finite process?

ME: It absolutely will make it more finite. It will have more scientific value. I think it will make people more enthusiastic about following a plan when they know it will work. Hopefully they'll include in that some incentives for those people that are most affected by the problem. Some incentives that will get them involved in the problem. Another big thing that it will do is cover some of the conflicts before they happen. With some of the endangered species, saving one affects another. Those conflicts ought to be addressed before somebody's fined for them.

DP: Senator, I was picking somebody up at the Casper airport around the holiday, and Barbara Cubin was there. She had just flown in from Salt Lake where she got skunked on a flight the previous night and missed her niece's wedding that day. Then she got to Salt Lake and had no baggage, it had been left behind. I made a crack to her - I said, "Makes you want to re-regulate the airlines, doesn't it Barbara?" Then I started thinking about that, and I said, what is the federal rule. We've been talking a great deal about air service in this state. We've struck a deal with an airline that's moving part of it's operation here and giving some line of service guarantee. What do you think about a federal role with regard to regulating or enhancing, or whatever it might be, the airline industry in the state?

ME: I can tell you that our delegation is really interested in the best possible service to Wyoming. (Laughing) We all come back to Wyoming most weekends and try to get in and travel around the state, so we experience the same frustrations that the other people in Wyoming do.

DP: You can do something about it.

ME: Well, (laughing). We've found that businesses usually work best when less regulated. The threat of regulation is often a good tool. We meet with the airline folks frequently and talk about the possibilities for improving air service for getting more coverage to more places in Wyoming, getting more seats into the areas that really need it. They talk to us about the quality of service they want to have. We've already gone through one change of airlines where United took away the service from one airline because the quality of service wasn't good enough. So the airlines are putting forward some real expectations and pressure to the carriers that they interact with. Hopefully that will serve the state and provide the lowest cost possible air transportation we can get. We're also looking at some of the other states that have air transportation, and in some cases lower cost air transportation, to see if there's some suggestions to our airlines to do the same thing.

DP: Are you finding anything out from looking at these other states?

ME: There's obviously a tie between higher populations and more service (laughing). Yes, we are finding out some of the things they're having success with on getting more flights.

Break in the tape

ME: It's a numbers thing to have the majority, so there's some interest in doing that by the Democrats. There are a lot of people that are appalled that somebody can run from another state. But New York has allowed that to happen a number of times. I'm not sure that the First Lady understands that nobody provides us with a house, nobody provides us with a car, nobody provides us with a driver. There's a seniority system here. Those will all be terrible shocks to her.

DP: Do you think you could work with her yourself if she were elected there?

ME: I've found that I've been able to work with every senator, if they're willing to sit down and meet with me, and work with me. I like to do the work that I do not through the debate process back here, but through one-on-one provision, talking about specific legislation. So far I haven't found anybody that isn't willing to meet with me, that won't sit down and go through my bills in great detail even though they always say nobody does this back here.