COMPREHENSIVE HEALTH INSURANCE LEGISLA- TION, INCLUDING H.R. 3205, THE "HEALTH INSURANCE COVERAGE AND COST CONTAINMENT ACT OF 1991" - = • " . . . i HEARINGS BEFORE THE COMMITTEE ON WAYS AND MEANS HOUSE OF REPRESENTATIVES ONE HUNDRED SECOND CONGRESS FIRST SESSION ON H.R. 3205 $• I s + 7 > \- / I'/ '•v i O -„ \\ \ V• i l 3 TO AMEND THE INTERNAL REVENUE CODE OF 1986 AND THE SOCIAL SECURITY ACT TO PROVIDE FOR HEALTH INSURANCE COVERAGE FOR WORKERS AND THE PUBLIC IN A MANNER THAT CONTAINS T)HE COSTS OF HEALTH CARE IN THE UNITED STATES OCTOBER 8, 9, 10, 22, 23, AND 24, 1991 PART OF 1 2 OCTOBER 8, 9, AND 10, 1991 Serial 102-79 Printed for the use of the Committee on Ways and Means - - COMPREHENSIVE HEALTH INSURANCE LEGISLA- TION, INCLUDING H.R. 3205, THE "HEALTH INSURANCE COVERAGE AND COST CONTAINMENT ACT OF 1991" HEARINGS BEFORE THE COMMITTEE ON WAYS AND MEANS HOUSE OF REPRESENTATIVES ONE HUNDRED SECOND CONGRESS FIRST SESSION ON H.R. 3205 TO AMEND THE INTERNAL REVENUE CODE OF 1986 AND THE SOCIAL SECURITY ACT TO PROVIDE FOR HEALTH INSURANCE COVERAGE FOR WORKERS AND THE PUBLIC IN A MANNER THAT CONTAINS THE COSTS OF HEALTH CARE IN THE UNITED STATES OCTOBER 8, 9, 10, 22, 23, AND 24, 1991 PART OF 1 2 OCTOBER 8, 9, AND 10, 1991 Serial 102-79 Printed for the use of the Committee on Ways and Means U.S. GOVERNMENT PRINTING OFFICE 53-020** WASHINGTON 1992 : ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402 ISBN 0-16-038697-7 COMMITTEE ON WAYS AND MEANS DAN ROSTENKOWSKI, Illinois, Chairman SAM M. GIBBONS, Florida BILL ARCHER, Texas J.J. PICKLE, Texas GUY VANDER JAGT, Michigan CHARLES B. RANGEL, New York PHILIP M. CRANE, Illinois FORTNEY PETE STARK, California DICK SCHULZE, Pennsylvania ANDYJACOBS, Jr., Indiana BILL GRADISON, Ohio HAROLD E. FORD, Tennessee BILL THOMAS, California ED JENKINS, Georgia RAYMONDJ. McGRATH, New York THOMAS J. DOWNEY, New York ROD CHANDLER, Washington FRANKJ. GUARINI, NewJersey E. CLAY SHAW, Jr., Florida MARTY RUSSO, Illinois DON SUNDQUIST, Tennessee DON J. PEASE, Ohio NANCY L. JOHNSON, Connecticut ROBERT T. MATSUI, California JIM BUNNING, Kentucky BERYL ANTHONY, Jr., Arkansas FRED GRANDY, Iowa BYRON L. DORGAN, North Dakota BARBARA B. KENNELLY, Connecticut BRIAN J. DONNELLY, Massachusetts WILLIAM J. COYNE, Pennsylvania MICHAEL A. ANDREWS, Texas SANDER M. LEVIN, Michigan JIM MOODY, Wisconsin BENJAMIN L. CARDIN, Maryland JIM McDERMOTT, Washington Robert J. Leonard, ChiefCounseland StaffDirector Phillip D. Moseley, Minority ChiefofStaff <n) CONTENTS Page Part 1 (October8, 9, 10, 1991) 1 Part2(October22, 23, 24, 1991) 891 Pressreleasesannouncingthehearings 2 H.R. 3205,text..... 6 WITNESSES CongressionalBudgetOffice,RobertD. Reischauer, Ph.D., Director 354 ProspectivePaymentAssessmentCommission, StuartH. Altman, Chairman... 463 Physician Payment Review Commission, Philip R. Lee, Chairman, and Paul Ginsburg, ExecutiveDirector 471 U.S. Department of Health and Human Services, Hon. Louis W. Sullivan, M.D., Secretary 684 OfficeofManagementandBudget, Hon. RichardG. Darman, Director 697 NationalCouncilonDisability, MaryMatthewsRaether, member 1378 Abernethy,IanB.,TowersPerrin 1169 Actors' EquityAssociation, RonSilver 533 Almon,Ted,HealthIndustryDistributorsAssociation, andClaflinCo 986 AmericanAcademyofChildandAdolescentPsychiatry, ElisabethRukeyser... 1236 AmericanAcademyofPediatrics, DanielW. Shea, M.D 836 AmericanAssociationofMarriageandFamilyTherapists, ElisabethRukeyser 1236 AmericanAssociationofNurseAnesthetists,KarenMorrow 1009 AmericanAssociationofPastoralCounselors, ElisabethRukeyser 1236 AmericanAssociationofRetiredPersons, BettyJaneLong 1270 AmericanChiropracticAssociation, R. ReeveAskew 1013 AmericanClinical LaboratoryAssociation, HopeS. Foster 969 AmericanCollegeofPhysicians, PaulS. Griner, M.D 830 AmericanFarmBureauFederation,JohnG. Laurie 1196 American FederationofLaborandCongressofIndustrialOrganizations, Lane Kirkland,KarenIgnagni, andRobertMcGlotten 892 American Federation of State, County & Municipal Employees, AFL-CIO, GeraldW. McEntee 940 AmericanGroupPracticeAssociation, AngeloP. Spoto,Jr., M.D 843 American HospitalAssociation, WilliamE. Welton 780 AmericanManagedCareandReviewAssociation,RonaldR. Dobbins 553 AmericanMedicalAssociation,JeraldR. Schenken, M.D 811 AmericanMedical StudentAssociation, EricE. Whitaker 996 AmericanNursesAssociation, BarbaraK. Redman 819 AmericanOrthopsychiatryAssociation, ElisabethRukeyser 1236 AmericanPsychiatricAssociation, ElisabethRukeyser 1236 American PsychologicalAssociation, ElisabethRukeyser 1236 AmericansforDemocraticAction, IreneJillson-Boostrom 1368 AmeritechCorp., AlanPeres 1074 Anderman, Mitchell J., Association of Private Pension and Welfare Plans, andSunCo., Inc 1155 ArgusHealth Systems, Inc., EdwardL. Porter 1020 Askew, R. Reeve, AmericanChiropracticAssociation 1013 AssociationofPrivatePension andWelfarePlans, MitchellJ. Anderman 1155 AuroraHealthPlan,ConradV. Schmitt 582 (HI) IV Page BectonDickinson&Co., RaymondV. Gilmartin 964 Beilenson, Hon. Anthony C, a Representative in Congress from the State of California 295 Bell,James, InterfaithImpactforJusticeandPeace 1411 Beltran,CelestinoM.,ComprehensiveTechnologiesInternational,Inc 1034 Bieber, Owen, International Union, United Automobile, Aerospace & Agricul- turalImplementWorkersofAmerica-UAW,AFL-CIO 919 BlueCrossandBlueShieldAssociation,BernardR. Tresnowski 488 BlueCrossandBlueShieldofMinnesota, MaryK. Brainerd 577 BluePlus, MaryK. Brainerd 577 Brainerd, MaryK., BlueCrossandBlueShieldofMinnesota, andBluePlus.... 577 BranchingFrank,GroupHealthInc 572 Brandon, RobertM.,CitizenAction 1304 Bromberg, Michael D., FederationofAmericanHealthSystems 873 BusinessRoundtable, RobertC. Winters 1067 Canner,Sharon, NationalAssociationofManufacturers 1074 Cardon, Douglas,CentralHealthCareServices, Inc 1395 Cathedral HealthcareSystem, Inc., MargaretJ. Straney, R.S.M 1047 CentralFloridaHealthCareCoalition,JonR. Reiker 1167 Central HealthCare Services, Inc., Merrill Osmond, Royana J. Stewart, Rich- ardShure, andDouglasCardon 1395 CitizenAction, RobertM. Brandon 1304 ClaflinCo., TedAlmon 986 CommunicatingforAgriculture, StephenF. Rufer 1202 CommunicationsWorkersofAmerica,AFL-CIO, BarbaraJ. Easterling 934 ComprehensiveTechnologiesInternational, Inc., CelestinoM. Beltran 1034 Confederated Salish and Kootenai Tribes of the Flathead Reservation, Lau- renceKenmille 597 ConsortiumforCitizenswithDisabilities, RobertGriss 1425 ConsumersUnion, Gail Shearer 1359 Conyers, Hon. John, Jr., a Representative in Congress from the State of Michigan 273 Dannemeyer, Hon. William E., aRepresentativeinCongressfromtheStateof California 313 Dobbins, Ronald R., American Managed Care and Review Association, and UnitedAmerican HealthcareCorp 553 Eagan,Jeff, WisconsinActionCoalition 1248 Easterling, BarbaraJ., CommunicationsWorkersofAmerica,AFL-CIO 934 FamiliesUSA, RonaldF. Pollack 1343 Fay,JohnF., NewJerseyAssemblyHealthCarePolicyStudyCommission 1231 FederationofAmerican HealthSystems, MichaelD. Bromberg 873 FederationofFamiliesforChildren'sMentalHealth, ElisabethRukeyser 1236 Foley, Hon. Thomas S., Speaker of the U.S. House of Representatives, a RepresentativeinCongressfromtheStateofWashington 206 Foster, HopeS., AmericanClinicalLaboratoryAssociation 969 Gage, LarryS., NationalAssociationofPublicHospitals 856 General MillsRestaurants,JonR. Reiker 1167 George, Boyd Lee, National-American Wholesale Grocers' Association, and MerchantsDistributors, Inc 1146 Gibbons, Hon. Sam M., a Representative in Congress from the State of Florida 219 Gilmartin, Raymond V., Health Industry Manufacturers Association, and BectonDickinson&Co 964 Glasse,Lou,OlderWomen'sLeague 1294 Gordon, Barry, ScreenActorsGuild 520 Grandy, Hon. Fred, aRepresentativeinCongressfromtheStateofIowa 318 Griner, Paul S., M.D., American College ofPhysicians, and Strong Memorial Hospital 830 Griss, Robert, Consortium for Citizens with Disabilities, and United Cerebral PalsyAssociations, Inc 1425 GroupHealthInc.,FrankBranchini 572 Hancock, Nolan W., Oil, Chemical & Atomic Workers International Union, AFL-CIO 944 HealthIndustryDistributorsAssociation, TedAlmon 986 HealthIndustryManufacturersAssociation, RaymondV. Gilmartin 964 HealthInsuranceAssociationofAmerica,CarlJ. Schramm 497 Health&WelfareCouncilofNassauCounty, Inc.,JohnT. O'Connell 1253 HealthcareEquityActionLeague, DirkVanDongen 1113