Casey Highlights Some HELP Provisions to Preserve in Final Health Care Bill

WASHINGTON, DC- U.S. Senator Bob Casey (D-PA), a member of the Senate Health, Education, Labor and Pensions Committee, gave the following remarks on the Senate floor concerning health insurance reform:

Remarks of U.S. Senator Bob Casey
October 19, 2009

I rise this afternoon to talk about health care, in about three ways, three different subjects, that are all I think are vitally important in making sure we get the job done in the next couple of weeks. 

As many Americans know, in the Senate at least right now, you have the Health, Education, Labor and Pensions Committee (HELP) bill passed in July. The recent passage of the Finance Committee bill coming together in a merger process, which is, I guess, days away from completion, or certainly in the near future. And as that process unfolds, there are aspects to this issue in parts of our bill, meaning the committee I happen to serve on, the Health, Education, Labor and Pensions Committee, parts of that bill that I hope remain intact or at least in large measure are left as part of the final Senate bill. And I'll talk about three areas:

One is on the issue of children's health insurance. We had an important debate, not just over the last couple of years about this program, which thank goodness was re-authorized in 2009, so that within the next several years -- really within the next four years, maybe by the end of four years, we'll have as many as 14 million children across America covered by that program. A tremendous advancement from where we were even just ten years ago with regard to that program. And it's shown results in a lot of places in America. It's a well-tested program now.

One of the debates we had more recently -- and it was in the Finance Committee -- was whether or not children in the Children's Health Insurance Program (CHIP), whether that program itself would be stand alone, as I believe and as I am glad that the Finance Committee agreed with me and with others, on whether that program would be folded into the exchange. They didn't do that in the Finance Committee. I'm glad they didn't. Because in this instance, we have a CHIP program which started in states like Pennsylvania back in the early 1990's and then became a national program in the mid 1990's, about 1997. And what we've seen in our state, in Pennsylvania, are tremendous results. I'll ask consent to submit for the record a one-page survey by the Pennsylvania Insurance Department from 2008 about uninsured numbers ages 0-18 and then 19-64.

What this chart shows by way of a survey, when you compare individuals who happen to be zero-18 in age versus 19-64, you find that in Pennsylvania, across the 67 counties, a big state, we have an uninsured rate, according to this one survey, of 5% among children. Ages 0-18, 5% uninsured. Still too high. We want to bring that down to zero. That's got to be the goal, but much lower than it had been.

Among the age category, 19-64, meaning everyone above the age of 18 prior to the time they have an opportunity to receive Medicare, age 19-64, 12% uninsured in Pennsylvania. I doubt that's much different across the country. And one of the results or one of the lessons from that is that when we take concerted action to focus, whether it's public resources or private dollars, but have a strategy for health care, we can bring the numbers down dramatically. So children's health insurance in Pennsylvania is in much better shape than it was 10 or 15 and certainly 20-25 years ago.

But we haven't as a country begun to focus on that age category 19-64. It's probably very similar across the country, because there has been no strategy for people in that age category, comprising our work force. So I think we have to bear that in mind, when you have one category with an uninsured rate of 5% versus another age category, it's more than double that at 12%, we have to continue to focus strategies in this debate on that age category. And in this debate, in this process of coming to a bill, I believe there are -- there are several policies and several strategies that will get us to the point where ages 19-64, that that rate will come down as well. As many Americans know that the Affordable Health Choices Act, our bill in the HELP committee, has as its goal and premised upon the idea of covering as many as 97% of the American people.

So we finally at long last is a strategy for every age group.

In addition to what we have tried to do for children to help them and what we have done to help older citizens over more than 40 years now over the age of 65, or 65 and up. One of the parts of the HELP committee bill which doesn't get a lot of attention is a part of the bill which is set forth in sections -- in sections 3201 to 3210. It starts about page 228 of the HELP committee bill. I know these bills are big, well more than 800 pages. But this section on the Community Living Assistance Services and Support Act, so-called the CLASS act, is a breakthrough, I think that is an understatement. Because what it does is it provides individual Americans who have functional limitations the ability to continue working but also to provide some of the help that goes into providing them the wherewithal to continue working.

And here's what the fundamental purpose is. And I’m reading from a summary. The fundamental purpose of the bill is to establish a national voluntary --voluntary -- program for purchasing community living assistance services and supports in order to provide individuals with functional limitations with tools that allow them to maintain their personal and financial independence. Probably the most important word in that paragraph. And live in the community through a new financing strategy for community living assistance services and supports, and to establish the infrastructure to help address the nation's community living assistance services and support needs and alleviate burden on family caregivers.

What we have now, unfortunately, in many places is two or three major problems: the individual themselves aren't able to work sometimes, or they have limitations or inability to work because of limitations, and they're not able to pay for the kind of care that they need. That's one -- the main problem.

The second problem is in many families caregivers try to make up for that. If the family member with limitations can't pay for services, family members provide the kind of services that they would hope to get from some other person or entity. So what we're doing here is relieving a burden on individuals so they can be fully functional and independent because of the support and help that they get, whether it's someone coming into their home in the morning and helping them get off to work and to be able to meet them at the end of the day and help them with so-called  activities of daily living, the basic things that all of us take for granted in our daily lives, everything from feeding and bathing and other fundamental things that all of us have to do every day. Just with a little bit of help from someone, many Americans can lead a life of employment, a life of dignity and a life of contribution to our economy. And it also gives some real help to family members. So we'll talk more about the details of how this works.

But the other part about this CLASS  Act -- and I should mention that the person who was the driving force, and he and his staff worked on this for years, and  that's the late Senator Kennedy. He spent many years developing this program, developing the CLASS Act and making sure it was part of our bill. That's why we wanted to make sure it is part of the Affordable Health Choices Act, and it should be part of the final health care legislation that we enact.  If we're going to do the right thing, then it will be in the bill. And I think people here want to do the right thing as it relates to people with functional limitations that can contribute more to their workplace and contribute more to our economy. Senator Kennedy’s work was focused not just on providing a program to give people that opportunity, his focus was also on how can we do it in a way that's fiscally responsible. This program provides not just a lot of help for people with limitations and their families, but it also doesn't cost the federal government in the process because people will be paying in overtime and then have the opportunity to use those resources when they need them.

Let me finally move, in the remaining time that I have, in addition to the importance of preserving the Children's Health Insurance Program as the way it is right now, which I think was a great advancement in the Finance Committee, in addition to enacting legislation which will have the CLASS act as part of it, the third thing I’m going to mention today is an issue that's  received a lot of attention but sometimes we don't highlight some of the elements that are very important to the American   people, and I speak of the so-called public option, which in the -- our Senate health care bill, the HELP committee bill is entitled "The Community Health Insurance Option."

One of the most important parts of the bill -- in fact, I think it's the first word in the section, is the word "voluntary." when I was going across Pennsylvania talking to people about our health care bill -- our bill passed in July, so I was on the road in August -- we had a chance to actually talk about a bill. Not just a concept, but a bill we had already passed out of committee. And some people who were opposed to the public   option would ask that question or make a statement. And often   they would say to me, "well, I don't want -- I don't want to be forced into some government program and lose my ability to choose, or lose some of the rights that I have now." and I would point to the Community Health Insurance Option section of the bill, and I’d say the first word is "voluntary." there is no requirement here. I think that mythology kind of got ahead of the truth. So it is voluntary. That is voluntary as it relates to an individual, but also voluntary as it relates to a provider.

Second, the benefit package, as we wrote it in our bill in the HELP committee, would meet the so-called a gateway standard. In the other bills they call it an exchange. It meets the gateway standard by offering coverage that has an essential benefit package, including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rebel -- rehabilitative services and devices and pediatric services. States can offer additional services beyond that essential benefits package with any costs of such additional benefits being assumed by the state.

So that's what the public option in our bill, the Community Health Insurance Option, would offer as a benefit package. The premium rates will be set by the Secretary of Health and Human Services at an amount sufficient to cover expected local costs. So you're going to have a lot of impact and relevance to what's happening in a local community.

And also -- and this is very important -- the Community Health Insurance Option has to meet solvency standards. It can't just operate and worry about standards that involve solvency. And if there are states that have higher levels or higher requirements as to solvency, the public option would have to meet that. The reimbursement rates would be negotiated by the secretary and shall not be higher than the average of all local -- local – gateway reimbursement rates.

I mentioned the importance of solvency as a requirement. Start-up funds are provided by the Treasury to cover costs of initial operations and cover costs for the first 90 days of a plan's operation. Then that public entity, which is state-based, would have to pay the money back over time. And I think that's critically important to point out.

Finally, the state-based advisory councils would provide recommendations to the Secretary on operations and policies regarding the Community Health Insurance Option to take advantage of local innovation efforts and meet local concerns. So this isn't some entity that's going to operate in Washington. It's an entity that will have not just public input and local input and local relevance, but actually take advantage of local innovation efforts that we see all across the country. I know in Pennsylvania, there are hospitals or hospital systems or communities that do things a different way, and are very successful. And we have to be giving them the opportunity to have that kind of, that kind of flexibility.

So I believe it's the right thing to do, to have as part of the final bill a public option. I believe that our bill that we passed out of committee is the right way to do it. Others might have another version of it. But I believe the Community Health Insurance Option is a voluntary focused way to make sure that we're injecting real competition and, thereby, lowering costs, but also enhancing choice. One thing we don't want to do at the end of this road is to limit -- limit -- choices we have. A lot of people will stay with their private insurance policy or the private plan. They'll want to stay there. But others may say, "I’m in such a predicament, or I’m in such a cost situation that I need to choose a public option."

Finally, Mr. President, I’ll wrap up with this. I believe that this debate has been critically important to the American people, even the debates that get a little, a little heated. It's very important we get this right, and it's very important that we spend the time that we have spent over these many weeks and months. We're reaching the point now we're down to weeks, thank goodness, not months.

I believe we can get this right and we can put in place strategies that give people peace of mind so when they go to work in the morning, they don't have to worry as they do about health care, the cost of it, the burden of it being denied, not being covered because of a preexisting condition, or having a child denied coverage because of that, or a loved one. I believe we can also begin to wrestle the costs to the ground and not have them spiraling upward as they have been doing for 10 or 15 or more years. And I also believe we can enhance choice and quality.

Even with all the debates we're having, all the disagreements that we sometimes have here in Washington, there's a lot of consensus about the need to pass a bill, about the need to enhance prevention efforts and quality efforts. And I believe we can get there. But we'll continue to highlight some major aspects of the bill. And we're going to continue to fight hard for these fundamental priorities of health insurance reform.

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