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Floor Statement of Michael B. Enzi
Wrangling Health Care Costs:
A 10 Step Plan by Senator Mike Enzi
April 29, 2008

Mr. ENZI.  Mr. President, I rise today to talk about health care.  I’ve been talking to a lot of folks about health care—which isn’t difficult—because health care is on everyone’s mind these days.  During the last work period, I went on a Ten Steps Ten Stops Tour of Wyoming.  In just over 3 days, we drove over 1200 miles, visited 10 towns, and met with at least 400 Wyomingites.  I even spoke with people at several stops who live outside those 10 communities but drove miles and miles to come to our meetings.  Their dedication and passion about this issue strengthens my commitment to get something done about health care!

A lot of folks feel more economically secure when they have health insurance.  They know that if they have health insurance and something happens, and they get sick, they will be able to get the care they need without mortgaging their home or going bankrupt.  No one should have to worry about that.  Everyone should be able to carry a health insurance card in their wallets. 

The news isn’t all bad, however.  There have been plenty of wonderful things that have come from our health care system in recent years.  Every year, new technologies are being invented and new drugs are created that allow people to live longer, healthier lives.  Researchers are finding cures to diseases.  New ways of getting care are popping up all across the country and parents are able to take sick children to clinics in shopping centers and pharmacies to get throat cultures and flu shots.  Plenty of good things are happening, but we can do better.   

Now on most weekends and Wyoming work periods, my wife Diana and I travel around Wyoming and talk with folks about health care.  I listen to what they tell me about the problems they are having and then I take that information back to Washington.  One of the things I do a lot is teach the East about the West.  So when I am in DC I usually have to explain to folks about how Wyoming is different.  How a plan designed around New York or Massachusetts won’t work for Wyoming.  I have to tell them that it can be hard to get doctors and nurses to come to Wyoming—in some towns it is harder than other towns to attract good people.  I remind the people in the East that we have a lot of people who work at the mines and in the oil patch and the natural gas fields.  They work hard for their hourly wages doing difficult and dangerous tasks and the type of health care they need is different than the type of health care someone working at a computer needs.  How do we help the construction worker and the computer technician both get better health care that fits their unique needs at a more reasonable price?  My position on the Senate Health Committee has enabled me to do a lot of research on this subject.  I’ve talked with a lot of people—patients, health care providers, scientists, financial advisors, you name it and we came up with a plan that I think is flexible enough to work for everybody. 

The bill I have put together is called Ten Steps to Transform Health Care in America. The bill would get everyone an insurance card to carry in their wallets and purses.  If you already have an insurance card, the bill will make sure you can keep the card by wrangling in health care costs until they are affordable. 

Why ten steps? Well, I have discovered over the course of the years I have been in the Senate that if you try to put together one massive comprehensive bill that solves everything, you will have one piece that 5 people don't like, another piece 8 people don't like, another 11 people don't like, and another 3 people don't like, until pretty quickly you are at 51 votes against you and you can't get the bill done. When you try to do something comprehensively, it often looks revolutionary. And we don't do things revolutionarily in the U.S. Senate; we do them evolutionarily. So I put together 10 pieces.  If we don’t get all 10 or even if we only get one, no problem because any one step gets us closer to having every American insured. All 10 together would get every American insured—and I will briefly walk through all Ten Steps.

In order to understand how the bill works, it is important to review a few facts about the history of health insurance in our country.  Right now about 60 percent of folks under age 65 are getting their health insurance through their job.  The question is, why?  Why are 60 percent of Americans getting their health insurance through their job?  Well, the short answer to that question is because of the way employer sponsored health insurance is treated for tax purposes. 

Our current health insurance system is biased toward employer-based coverage due to a historical accident.  The wage controls of World War II increased competition among employers for recruiting the best employees and incentivized employers to offer health benefits instead of increased wages.  In 1954, Congress codified a provision declaring that such a contribution would not count as taxable income.  This tax policy made it very favorable for individuals to get their health benefits through their employers and consequently has penalized individuals that get coverage through the individual market. 

The Joint Committee on Taxation estimated that removing this tax bias and a few related health care tax policies will save the federal government $3.6 trillion over the next ten years—now that’s real money, even in Washington.  That is a lot of money that can and should be used to expand choices and access and give individuals more control over their health care.  Ten Steps ensures every American can benefit from this savings—whether they get their health care from their employer, from the individual insurance market, or they decide they want to get off Medicaid and switch to private insurance. 

So how does the bill do this?  The plan gives all Americans that have at least a certain amount of health insurance a standard tax deduction.  The national, above-the-line Standard Deduction for Health Insurance will equal $15,000 for a family and $7,500 for an individual.  The bill also gives low income folks a tax credit equal to $5,000 for a family, $2,500 for an individual.  The subsidy amount phases out as income gets higher, so some folks won’t be eligible for the subsidy, but everyone is eligible for the standard deduction.  The bill takes this hybrid approach of coupling the standard deduction proposal with the tax credit proposal, because I think it is the best way to ensure no particular group of people is adversely affected.  I know some folks are advocating for just a standard deduction and other folks are advocating for just a tax credit.  My plan does both—but I am supportive of all approaches and I am pleased that so many of my colleagues agree that we need to fix the flawed tax code.  The bottom line is that we need to get something done!  Correcting a flawed tax code would make it easier for working Americans to buy health insurance. Jobs don’t need health insurance – people do.

The fourth step gives small businesses greater purchasing power to reduce the cost of insurance plans.  Right now, a lot of rules are in place that prohibit groups of businesses from getting together and pooling their purchasing power across State lines so they can negotiate better deals on insurance cards.  This doesn’t make sense.  If a group of shoe store owners in Wyoming wants to get together with shoe store owners in Montana and Colorado and band together so they can get greater discounts on health insurance, they should be allowed to do so. 

I already mentioned this a bit earlier, but jobs don’t need health insurance, people do!  Right now when a small business wants to get health insurance for its employees, they contact a health insurance agent and they tell the agent how many employees work for the business and give some information about the employees and then the agent quotes a price for offering health insurance to those employees.  Well right now there are some Federal rules in place that govern that process for small groups of employees and make sure the groups are treated fairly by the insurance companies.  The protections provide assurances to consumers that insurers will deal with pre-existing conditions fairly and provide coverage (even to small groups).  This has helped keep costs down for small businesses, but more needs to be done.  Especially given that none of these rules apply to individuals that purchase health insurance on their own.  At a minimum, we need to make sure individuals get treated the same way groups of people get treated.  The fifth step blends the individual and group market to extend important HIPAA portability protections to the individual market so that insurance security can better move with you from job to job.

The sixth step is possibly the most critical step and one we must take to reduce medical costs across the board—this step moves our system from one that provides sick care to one that provides health care. As Ben Franklin said, an ounce of prevention is worth a pound of cure. We need an innovative system that will do more to help Americans prevent and manage chronic illness, so that they can live healthy lives with fewer medical costs.  The Ten Steps plan would put us on track to do that.

The seventh step gives individuals the choice to convert the value of their Medicaid and SCHIP program benefits into private health insurance, putting them in control of their health care, not the federal government.  The rationale for this step is simple.  If the market can provide better coverage at a lower price, then why not allow Americans to access that care?  This gives low-income individuals more options about where they receive their care and what care is available  It’s time for people to start making decisions about their care – let’s get the government out of the doctor’s office. 

The eighth step is one that Congress has come close to passing in years past--a bipartisan plan to encourage the adoption of cutting-edge-information technologies in health care.  The health care industry is the last industry to go digital.  Think about what technology has done to revolutionize every other industry, and how this has led to a more efficient use of time and resources.  The health care industry shouldn’t continue to lag behind.  The time has come for health information to go digital so we can save thousands of lives and billions of dollars.  

Some are concerned about the impact of health IT and electronic health records on the security of personal data.  Let me assure you, protecting patient information is a very high priority of mine and nearly every section of this bill demonstrates that.  The Health IT bill does a lot to build upon the protections we already have in place.  The bill establishes the American Health Information Community (AHIC), which is made up of experts representing a complete cross-section of the health care, consumer, and technology communities.  AHIC is charged with providing the Secretary of Health and Human Services recommendations concerning national policies for adoption by the Federal Government to ensure that patient data remains secure.

The ninth step of the bill is one of the most important steps for frontier areas like Wyoming.  An insurance card in your wallet won’t do you any good if there isn’t a doctor or hospital around for you to go to when you need care.  If there aren’t enough nurses working in that hospital, or no one is working at the desk to admit you, a health insurance card won’t help you very much.  The Ten Step plan addresses this problem by helping future providers and nurses pay for their education and encouraging them to serve in areas with great need. 

The plan provides competitive matching grants for states to encourage nurses to return to the profession after having left the workforce for three years or more.  The plan also boosts the current programs we have that are working well-- the Community Health Centers program and the loan repayment programs of the National Health Service Corps. 

Another piece that is critical to Wyoming, the Ten Step plan builds upon the successes of current rural health programs, by ensuring appropriate development of rural health systems and access to care for rural residents.

One of the things that continues to be very important to me as I work on this Ten Step plan is listening to real folks about what they want from their health care.  One thing I heard over and over is that seniors want to stay in their homes longer.  They don’t want to go to nursing homes if they don’t have to.  Sadly, because of the ways our laws are written and the way our reimbursement policies are structured, folks are sometimes left with no option but to go to a nursing home.  If the policies were different and there were more options, and there was more flexibility, seniors could stay in their homes longer.  My plan works to do just that by putting the emphasis on community- and home-based care, which is often much preferred, less costly, and proven to increase quality of life.  One way to do this is by supporting programs like the Greenhouse project, which creates a community setting rather than an institutional setting.   

The final step of the Ten Step plan decreases the sky-rocketing costs of health care by restoring reliability in our medical justice system through State-based solutions.  No one – not patients or health care providers – are appropriately served by our current medical litigation procedures.  Right now, many patients who are hurt by negligent actions receive no compensation for their loss. Those who do, receive a mere 40 cents of every premium dollar, given the high costs of legal fees and administrative costs.  That is simply is a waste of medical resources. Additionally, the likelihood and the outcomes of lawsuits and settlements bear little relation to whether or not a health care provider was at fault. Consequently, we are not learning from our mistakes.  Rather, we are simply diverting our doctors and they are spending more time in the court room.  When someone has a medical emergency, they want to see a doctor in an operating room, not a court room. 

Well, those are the Ten Steps, and as I mentioned before, I worked on Ten Steps so that we can break the steps up into separate bills and move them one at a time.  Despite the intentions of Congress, we have to work in incremental doses rather than monumental doses in order to get anything done.  Now some of the steps I mentioned today are newer ideas that still need some time to be worked out and still need some tinkering around the edges.  But some of the steps I went over today are ready to go—that is they are already drafted as standalone bills that are ready to move through Congress at anytime. 

Clearly, health care is an issue that is of such great concern to the American people that it transcends politics as usual.  That will give us an opening to get something done that will really help patients and their doctors by using my 80/20 rule.  I went to Washington as a firm believer in the 80/20 rule.  We can reach agreement on 80 percent of the issues—and we’re probably never going to reach agreement on the other 20 percent.  By focusing on the 80 percent of this issue that we can all agree on we can get something done.  If we continue to let that 20 percent we disagree on serve as a roadblock we’ll let great opportunities pass – something we can’t afford to let happen – again and again!

I truly hope this is the year that we stop talking about health care and start doing something about it, because Americans can’t wait another year.  They don’t want to wait for an election to see some changes. They certainly don’t want to wait another year to stop their health care costs from going up and up and up. They want to see change and they want to see change now. Our small business owners, working families, and millions of uninsured cannot afford to wait.