[Congressional Record Volume 153, Number 23 (Wednesday, February 7, 2007)]
[House]
[Pages H1329-H1336]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore (Mr. Hill). Under the Speaker's announced 
policy of January 18, 2007, the gentleman from New Jersey (Mr. Pallone) 
is recognized for 60 minutes.
  Mr. PALLONE. Mr. Speaker, this evening I am joined by some of my 
colleagues who are new Members, and we are going to talk about the 
President's health care proposals and also what he articulated both in 
his State of the Union Address, and more recently last Monday when he 
gave us his budget message.
  And my concern, as always, is that President Bush has prioritized, or 
says he wants to prioritize, health care as an issue and particularly 
deal with the problem of the uninsured. And we certainly recognize that 
under his watch as President for the last 6 or 7 years that the problem 
of the uninsured has grown greater in this country. There are more 
uninsured than ever. But at the same time the proposals that the 
President puts forward, in particular the amount of money that has been 
allocated in his budget for some of these health care needs, does not 
go along, essentially, with the rhetoric that he has been using, saying 
that he wants to cover the uninsured and prioritize the concerns of the 
uninsured.
  And, again, I always say my effort is not to chastise the President. 
I appreciate the fact that President Bush is prioritizing health care 
and talking about it, because he has the bully pulpit, and to the 
extent that he is out there talking about health care, it gives us an 
opportunity in the Congress to address the issue.

                              {time}  1815

  But it is unfortunate that the proposals in the budget that he 
proposes

[[Page H1330]]

do not really go along with any kind of concerted effort that would be 
meaningful to address those health care concerns, and particularly the 
problems of the uninsured.
  Before I begin, I wanted to yield to my colleague from Colorado. I 
know he and I were both watching the debate by our Republican 
colleagues in the last hour. I know he would like to address some of 
those concerns.
  I yield to the gentleman from Colorado.
  Mr. PERLMUTTER. Mr. Speaker, I thank my friend, Congressman Pallone.
  We did have a chance to hear our friends from the Republican side of 
the aisle. They talked about how they could manage the budget, how this 
President's budget was great and good for America. But last November, 
the people of this country cut through the smoke and mirrors of the 
Republican budgets, and they asked for and voted for a change in 
direction of this country.
  Let's just start with where this Republican President and the 
Republican Congress left off last fall when we had the elections. Under 
George Bush, under this presidency, we have had another $3.9 trillion 
added to the debt of this country. The debt on each one of us now is 
about $29,000 per person and rising every day under this White House 
and the Republican Congress. There was nowhere near a balanced budget 
at any time over the last few years, just continuing to dig us deeper 
and deeper and deeper into debt.
  The people of this country saw it. They didn't want anymore of that, 
because they understand that, right now, because of that debt that has 
been incurred over the last few years, the interest that we pay on our 
debt now dwarfs what we spend on education, veterans' benefits and 
homeland security, to just name a few, because we are spending so much, 
because we borrowed so much. The President and White House has proposed 
a budget where we continue to borrow and spend and drive our country 
farther and farther into debt.
  They talked about how they could manage the budget so much better. My 
friends here know they didn't even finish the budget. We had to take a 
mess that was left over by the Republican Congress and really the White 
House where they didn't finish their business. We had to deal with it 
last week to try to get our budget in order.
  The Democratic Congress really is changing the way business is being 
done here in our Nation's Capital because we are addressing budget 
problems. And we are going to show that we really do believe in making 
health care a priority and not just giving lip service to it.
  So I would like to yield back to Mr. Pallone or to our friend, 
Representative Castor, for their comments, and then I would like to 
talk about how the President's health care budget affects the people in 
Colorado, my fair State.
  Mr. PALLONE. Mr. Speaker, I appreciate the gentleman's comments. This 
does directly relate to the health care debate, because if you are in a 
State where your deficit continues to climb, as we face now under the 
years of the Republican majority, it is very difficult to address any 
unmet needs, whether it be health care or whatever, because of the 
deficit and the constant having to pay back on the debt.
  I wanted to say something about what you mentioned in response to our 
Republican colleagues. I have been here a long time, almost 20 years 
now, I am in my 19th year. When I first started in 1988, the Democrats 
were in the majority.
  There were a group of Republicans who used to come down every night 
doing special orders, just like we are, and they would have the pages 
bring this huge digital clock that literally was the whole length of 
the well, from this chart over to where my colleague from Colorado is, 
and there would be two or three pages that would bring this big digital 
clock down. They would go on and rail about the deficit and the deficit 
was going up so much a day. This literally went on for like 6 years 
while I was down here, from when I first started in 1988 until 1994.
  In 1994, the Republicans took the majority under Newt Gingrich. The 
digital clock disappeared, and all we heard were constant spending and 
going deeper into debt, and nobody in the Republican Party ever 
mentioned the deficit again as it continued to climb in those years, 
and particularly now under President Bush. For the life of me, I don't 
understand where this whole traditional Republican philosophy, which 
was to care how you spent the money and you didn't want to go into 
debt, just disappeared from their ideology.
  In fact, I have to say, in the last campaign, because you mentioned 
it, President Clinton was actually at an event that I attended in New 
Jersey, and I am not sure I can repeat exactly what he said. But 
essentially he said that he watched the Republican party under their 
congressional majority in the 12 years or so that they were in the 
majority go from this party of principles that was worried about not 
getting involved in wars that were not in the interest of the United 
States, worrying about the debt and spending money, to a party that 
just abandoned all these ideals.
  He actually said, right now, the Democrats cover both the left and 
right ideologically, because we are still concerned about the problems 
of the average person in that we want to cover people who don't have 
health insurance. We want to make sure people can afford to send their 
kids to college. But at the same time, we have covered the area where 
we don't want to get involved in foreign wars or foreign entanglements 
that are not in our interest. And, most importantly, we are the ones 
most worried about the debt and trying to make sure we are not spending 
a lot of money.
  Now, all of a sudden, we are in the majority, and they are starting 
to talk about the deficit that they have grown so much in the last 12 
years. It is unbelievable.
  When you talk about the health care debate, this goes to the heart of 
it, because the bottom line is, if you want to expand and deal with the 
problem of the uninsured, some of them are people that are not going to 
be able to afford to buy their own health insurance. If you don't have 
any money because you just keep racking up this huge debt, you are not 
going to be able to cover the people. So it directly relates.
  I just wanted to give these statistics about where we have been in 
the last few years. If you look at this, the point I have been trying 
to make is under the President's watch for the last 6 or 7 years, not 
only have the number of uninsured gone up, but the cost of health care 
and health insurance keeps rising. Therefore, it has just become 
unaffordable for a lot of Americans.
  This chart says that workers are now paying an average of $1,094 more 
in annual health care premiums for their families than they did in the 
year 2000. You can see the problem with the affordability of health 
care.
  Then the next chart has the number of uninsured in 2001, 41.2 
million, and the number of uninsured in 2006, 47 million. One million 
more Americans become uninsured each year under the President's watch.
  The chart over there, I will leave to the gentleman to explain.
  Mr. PERLMUTTER. Our chart in this instance shows the number of 
uninsured now exceeds the cumulative population of 24 States plus the 
District of Columbia, so all of those States that are in red and the 
District of Columbia, we have more people who don't have insurance. 
Under the budgets that have been proposed by the President and have 
been passed or just sort of glossed over by the prior Congresses, we 
have seen an assist to the wealthiest people in this country, while at 
the same time the people in the middle, the hardworking people of this 
country, have found themselves finding it harder and harder to make 
ends meet and have health insurance for themselves and their families.

  Mr. PALLONE. Just briefly, I want to yield to the gentlewoman, and I 
have my colleague from the Virgin Islands here, too. The problem with 
what the President has proposed, both in the State of the Union and the 
budget message on Monday, there are really two major ways to cover more 
of these uninsured. One is, you do something with the employer-based 
system, which is traditionally the way most people get their insurance, 
on the job, so it is easier for employers to provide health insurance 
and for their employees to contribute to it.
  The other, of course, is to build on existing Federal programs, 
whether it be Medicaid or Medicare or SCHIP, the program for kids, to 
expand eligibility

[[Page H1331]]

and make it so more people can sign up for them.
  The problem that I wanted to point out tonight, and we will get into 
it more, is that between the State of the Union address and the budget 
message, what the President has proposed totally really does nothing to 
affect either of those areas. He is basically talking about taxing 
employer-sponsored benefits, group plans, if they are a good plan, and 
sending people into the individual market with some kind of a tax 
break. Generally speaking, that is not very helpful because it is going 
to penalize the people who have a good employer-sponsored plan and at 
the same time push people into the individual market where they 
probably cannot afford to buy a good policy. Then with the budget 
message on Monday, we got all these cuts in Medicaid, SCHIP, the 
government programs that we would like to see expanded to cover more of 
the uninsured.
  So, between the two, he is addressing the problem but coming with 
proposals that, in my opinion, actually make it worse.
  I yield now to the gentlewoman from Florida. I am glad she is with us 
tonight.
  Ms. CASTOR. I thank my colleague from New Jersey, who has been such a 
leader for the American people for access to better health care. He is 
absolutely right, that the President's actions don't match his words. I 
have also been combing through the Presidential budget proposal. One of 
my hometown newspapers said that the Presidential budget should begin 
with these words: ``Once upon a time,'' as in a fairy tale. I am a mom 
with two young daughters at home. We do a lot of reading at night and 
try to get the homework done. We will do reading of fairy tales. This, 
what the White House has sent over, is a political fairy tale. 
Unfortunately, it is going to hurt a lot of folks. It is going to hurt 
a lot of our constituents back home. I thought we could explain that a 
little bit.
  Oftentimes we talk in such technical terms in government. When we 
talk of Medicaid and people say Medicaid, sometimes they get Medicaid 
and Medicare mixed up.
  Medicaid, these are pregnant women, infants, children in families 
earning about $25,000 a year, foster kids, medically needy adults, a 
lot of our senior citizens in nursing homes. So when you hear there are 
Medicaid cuts, I would like us to really put a face on that and say 
they are going after the most vulnerable in this country, infants, poor 
kids, foster kids and seniors in nursing homes.
  Also the budget sent over from the White House will hurt our seniors. 
The White House proposes to cut Medicare. Now, I am from Florida, and a 
lot of folks retire down to Florida. They have worked hard all their 
lives, and this is really one of the only benefits that we can give 
them, in addition to Social Security. So what the White House budget is 
proposing to do is ask them to pay even more. They are asking our 
hardworking doctors to take a cut as well.
  What that does in my community in Tampa Bay is it discourages the 
best doctors from participating in Medicare. You see, I want my seniors 
to have the best medical care. I want them to see the best doctors, and 
I want those good doctors to stay in the Medicare system.
  This would also hurt our children, our kids back home. My colleague 
from New Jersey knows this very well, that under the State Children's 
Health Insurance Program, we have a lot of needs. The States, our local 
communities, the Feds, we have been doing a pretty good job. But, do 
you know what? We can do a whole lot better. We must do a lot better.
  So it was very disappointing to receive this budget from the White 
House that says: Do you know what? Even though we are making such 
progress, and we have such tremendous needs in this country for 
children to be able to go in and see a doctor, get their immunizations, 
get some advice on how to take care of themselves, they say we are not 
going to do that.
  Their priorities are out of whack. Instead, I think it is a blatant 
political statement that we are going to continue these tax cuts for 
the wealthiest among us, and we are going to sock it to the most 
vulnerable, our seniors and our kids.
  Mr. PALLONE. Mr. Speaker, I appreciate the gentlewoman's remarks. You 
brought it home. It is hard sometimes to talk about the budget. The 
budget at the Federal level is a very complex thing. But we have to 
give an explanation, I think, about what the President's proposal is 
doing, which is really the opposite. It is not going to make it easier 
to cover the uninsured, it is going to make it more difficult.
  I now yield to the gentlewoman from the Virgin Islands, who is a 
physician and who has been very active in the whole health care issue 
for a number of years here in the Congress, particularly on the whole 
health care disparities issue, which is another thing that we haven't 
really talked about so much in this Congress, but has to be addressed.

                              {time}  1830

  I thank my colleague for yielding, and I want to thank Congressman 
Pallone for his leadership on health care for a number of years. And we 
are really happy that you are going to be chairing the Health 
Subcommittee, and we look forward to addressing all these issues with 
you.
  But certainly, as you were saying, as we look at how we can expand 
access to health care and bring more Americans under coverage, we can't 
start by cutting what has been the backbone of health care, Medicare 
and Medicaid, SCHIP. Those need to be really strengthened.
  As we look at the President's budget, which is very disappointing and 
one fairy tale that is not going to end, ``and they lived happily ever 
after,'' because the cuts that we are seeing are leaving our seniors, 
our disabled, and our children and pregnant women who are about to 
bring children into the world without the access to the kind of health 
care that they need.
  Beyond that, as we look at health disparities for people of color, 
African Americans, Latino Americans, Native Americans, Asian Pacific 
Islanders, there is nothing in the budget that addresses the gaps in 
health care for these populations. And certainly, if we are ever going 
to reduce the skyrocketing cost of health care, we need to focus on 
prevention and comprehensive systems of care that help people to stay 
healthy. And we also have to look at the social determinants of health 
care. You can't live in rundown housing and polluted neighborhoods and 
be healthy. So we have a lot of things to address.
  And going beyond the cuts that you have already talked about in 
Medicare and Medicaid and SCHIP, there are so many other areas that are 
being cut as well that further undermines what we need to do to provide 
good quality comprehensive health care for people in this country. Some 
of them, funding for training: In the President's budget, again, 
nursing training is cut $88 million; the National Health Service Corps 
is cut; health profession training programs that bring some of the 
underrepresented minorities to serve our increasingly diverse 
population are cut $135 million, and it has already been cut in 2006; 
$143 million for children's vaccines is cut, vaccines, one of the 
bulwarks of prevention in this country; mental health programs cut $159 
million; rural health cut $143 million.
  So instead of helping, and you rightly point out that the proposal, 
the only proposal that we have heard with respect to health care in 
this country, the President's proposal and tax credits does more to 
harm the system than help the system. And then, in addition to that, 
undermining the safety net of Medicaid, Medicare, and SCHIP, as well as 
cutting some of the programs that provide the services that would be 
there to keep people healthy.
  So this budget is a terrible budget. I know that we are under very, 
very tight fiscal constraints with huge unprecedented deficits, huge 
debts, but somehow the people are counting on us to improve health care 
in this country. And improving health care in this country really 
improves productivity. It keeps our country strong, and it is a matter 
of national security. And the health of our people is the health of our 
Nation, and we have to find a way to restore these cuts in the budget 
and close the gaps in health care, expand access to more Americans; and 
in doing so, we really will be helping our country.
  Mr. PALLONE. I appreciate the gentlewoman's comments, and I know how 
much you have worked on this issue

[[Page H1332]]

and, in particular, the disparities issues. I could go on, too, with 
some of these things. We have worked a lot on health care for American 
Indians and the Indian Health Service. Now, there is a slight increase 
for the Indian Health Service, but he took out the whole urban Indian 
issue. And we find a lot of American Indians now gravitating toward 
urban areas, and he just cut out the whole program for them.
  I want to yield to some of the other Members. But if we could just, 
because it is hard to explain this whole thing with the President's tax 
initiatives, but I think we should spend a little time on it. In his 
State of the Union Address, what he basically said is that, for the 
people who are in employer-sponsored health insurance, which still most 
Americans get their health insurance that way, a lot of them either 
through their union or individually with their employers have 
bargained, if you will, to have a very good health care package that is 
comprehensive; and what basically he is saying is, if it is too good, I 
will call it the Cadillac proposal, then we are going to tax you 
because you don't need such great health coverage. And then, at the 
same time, whatever money we are going to save on that, we are going to 
use by giving a tax break for those who go and try to buy insurance 
through the individual market. But the problem with that is, you know, 
the individual market is very volatile, very insecure, no guarantee 
that you can even buy a policy. So most of these people that are 
uninsured are not in a position to buy a policy in the individual 
market. So even if they get a break, it is probably not going to mean 
that much to them that they would actually be able to buy a good 
policy. So why would you sacrifice people who have a good policy and 
tax them to pay for people to go into the individual market, which is 
one that you may not be able to even get into anyway because it is 
expensive or there are all kinds of problems with eligibility. So that 
is the biggest concern. I don't know if anybody wants to talk about 
that, but that is why I think his proposal for employer sponsored care 
just makes no sense. If anybody wants to address that, otherwise, I 
will yield to you, and you talk about whatever you would like. The 
gentleman from Wisconsin.
  Mr. KAGEN. I thank you for yielding and thank you for putting on this 
opportunity, making it possible for some of us to express not just our 
views but the views of the people back home that we represent.
  Mr. PALLONE. I should mention that you are a physician as well.
  Mr. KAGEN. But I don't want you to hold it against me. And I won't 
hold it against Mrs. Christensen that you have ``M.D.'' behind your 
name.
  But if you ask around the Chamber and ask around back home, everyone 
that I know understands that how you spend your money and where you 
spend your money is a reflection of your values. And the current 
administration has shown us where their values are, and they are not 
with people. They are not really helping us to provide care to millions 
of people, 48 million, who don't have access to affordable health care, 
in this country.
  His State of the Union was very uplifting. He should be commended for 
bringing up the subject of providing access to health care for 
everyone. But his policy, as we talked about last week, raises taxes 
and offers no hope of lowering the cost of health care for insurance 
costs or prescription drug costs. And, more recently, with his 2,500 
page budget, which I haven't finished all the fine print yet, he has 
shown us his values once again.
  The first thing he did was to cut benefits to veterans and make it 
much more difficult for veterans to get the well-deserved benefits that 
they have earned and that they deserve.
  What did he do? He is asking for $3.4 billion to come from veterans 
who have already earned their benefits, but now they have to kick it 
in. They are going to have to pay for their benefits that they have 
already earned. There are increasing copayments for veterans in their 
budget. I don't know where he is coming from on this, but he can't be 
coming from Wisconsin.
  Mr. PERLMUTTER. My friend from Wisconsin is so right on this subject. 
It really is, where are your values? They are reflected in a budget. 
Now, as I said earlier, they didn't pass a budget last year. But last 
week, we passed a budget, and we wanted to show this country how much 
veterans mean to this country. And instead of cutting benefits, we 
raise benefits for our veterans.
  We are changing the direction of this Nation because we know what the 
values of this Nation are, and they aren't reflected in the President's 
budget. They weren't reflected by the Republican's failure to deal with 
a budget last year. But they were reflected in what we did last week in 
taking a budget that hadn't been dealt with by the prior Congress and 
showing the world, showing this country, showing your State, my 
district, that we care about our veterans. And in this budget that the 
President has given to us for next year, again, this President has cut 
veterans benefits and medical benefits over the next 5 years.
  I would like to yield back to my friend from Wisconsin.
  Mr. PALLONE. If you could just yield to me for a second. I really 
appreciate you bringing this up because I think it is so much on point. 
And I know there is a lot of confusion.
  We have a fiscal year that goes from October to October. Last year, 
when the Republicans were in the majority, they didn't deal with the 
budget at all. They literally left at the end of the session in their 
lame duck in December and said, we can't pass the budget, we can't deal 
with the appropriations, so we are going to go home, and we will leave 
it to the next Congress. So literally last week, we had to adopt the 
budget of the appropriations of the previous year that had already 
began October 1st, and it was level funding. In other words, it was 
basically a continuing resolution that didn't add any money and used 
the previous year's budget as a baseline. And even with that, we were 
able to increase money for veterans' health, for Ryan White, which 
deals with HIV, for global AIDS, for the National Institutes of Health. 
The emphasis and the priority was on trying to provide more money for 
health care even as we were cutting other things, and we did that.
  The reality is that President Bush's budget that we got this week, 
which is for next year, because the last year's budget has not been 
passed in the Senate and gone to his desk yet, didn't even take into 
consideration, and in many of the cases, those health care items that 
he put in this budget are less than what we adopted in that continuing 
resolution.
  So here we are trying to make everything right, and we are not 
getting any help either from the Republicans last year when they were 
in the majority or now from the President and the Republicans on the 
other side. And for them to even come down here tonight and talk about 
the budget or the deficit is absurd given their record.
  I yield back.
  Mr. KAGEN. Thank you very much, Congressman Pallone. And what 
Congressman Perlmutter says is true. Really, let's ask the right 
question. A lot of times in your career, being an attorney, you have to 
ask the right question to get the truth out of somebody. So what kind 
of Nation are we, and in which direction shall we move? Are we a Nation 
that values and treasures those who have served in harm's way in our 
military? I think we are. Are we a Nation that values the health and 
education of our children and the mothers that care for them? I think 
that we are. And that is really where Democrats differ from our 
opposition party. I really believe that our core values resonate with 
everyone, not just in Wisconsin where I come from but everywhere, in 
Florida as well.
  I yield to Congresswoman Castor.
  Ms. CASTOR. We talked earlier about how the White House budget 
proposal we received this week is a fairy tale, but its impact on our 
veterans really is a nightmare. The State of Florida where I am from, 
we have the second highest number of veterans in the country, and in my 
district, I have the busiest VA center in the country, the James Haley 
Center, which saw over 1.5 million vets last year. That is more than 
the population of the State of Kansas we saw at the Haley Center in 
Tampa.
  The Haley Center is specialized for current Iraq war vets injured, 
coming back, that are suffering the IED blasts, spinal cord injuries, 
brain injuries. And in Florida, out of all the VA medical centers, 
Haley, the busiest, we have

[[Page H1333]]

gone now over the past 10 years from 2 million visits to over 5 million 
visits. And how can we say this is a reflection of values? How can we 
say we are going to step back from that responsibility? How can the 
White House send us a budget that steps back, at a time where they are 
escalating the war in Iraq, they are going to deescalate the commitment 
to our veterans? I don't think so.
  In this Democratic Congress, we are going to take a new direction. 
There is new leadership in Washington, DC. And I am proud to be joined 
by some of the new Members, my colleagues, tonight, and also join with 
the efforts of leaders like my colleague from New Jersey. And I yield 
back.
  Mr. PALLONE. I appreciate your comments. And I really think it is 
important that we keep stressing how we want to prioritize these health 
care needs, and there are so many, whether it is veterans or children 
or whatever it is.
  I just want to give you a couple statistics. And I know it gets so 
bureaucratic to say, what is he doing up here with these statistics?

                              {time}  1845

  When we talk about the uninsured, the biggest groups still are the 
kids, and the gentlewoman from the Virgin Islands knows how much over 
the years what this SCHIP or kid care program, that we have tried to 
prioritize that, send the money back to the States, use their help to 
try to insure a lot of these kids.
  I just use my State, but you could use any State. In my State right 
now for this SCHIP or kid care program, we have more kids that are 
eligible, meaning that they could theoretically sign up, or their 
parents could sign up, for this program than are currently enrolled, 
even though the program has been around for a while, and that is true 
in almost every State.
  What we were hoping was that the President, in saying he wanted to 
deal with the uninsured, and knowing that the biggest group of 
uninsured is children, believe it or not, that he would simply provide 
funding to at least enroll those kids that are not enrolled who are 
currently eligible for the program. I am not even talking about 
expanding eligibility to kids who would not be eligible right now.
  We got some statistics because we had a hearing with the Secretary of 
Health and Human Services earlier this week, and the number of 
children, if you want to just enroll those who are currently eligible, 
we figure it would take about $12- to $14 billion over 5 years to keep 
up with medical inflation to prevent current enrolled children from 
losing their coverage. I am talking about the ones that are now in the 
SCHIP program, $12- to $14 billion over 5 years just to make sure that 
they are still funded, those that are in it, and then at least another 
$35- to $45 billion over 5 years to reach eligible but uninsured 
children. These are the ones that could enroll, but they just have not 
for some reason. Their parents do not know about the program, the 
application is difficult, who knows.
  So you are talking about what, maybe $60 billion over the next 5 
years if you want to keep, to keep those that are in the program and 
expand it to those who are eligible, and we are not even talking about 
expanding eligibility.
  He comes in, the President, in his budget with $5 billion. That would 
not even allow us to keep up with the kids that are currently in the 
program. These are not kids that are really poor and the parents are 
not working. These are working parents. I think the eligibility is up 
to like $38,000 for a family of four. They are working, but they cannot 
get health insurance on the job. We went into that before, and so they 
try to tap into this Federal program.
  Well, the Secretary said, well, we think $5 billion is enough, and if 
it is not, well, then the States will have to take care of it. You 
know, the States are not in a position, I mean, they already have a 
hard enough time coming up with the money under the current match 
without having to go beyond that. So I just use that as an example.
  The SCHIP, the kids health care program, is for those kids whose 
parents are working and who are making a little more money and are not 
eligible for Medicaid, which is for kids that are actually at the 
poverty level, like less than $20,000 for a family of four.
  Mr. PERLMUTTER. Would the gentleman yield? I think the gentlewoman 
from Virgin Islands has something to say on this, too, but a couple of 
things.
  In Colorado, on the point you are talking about, the SCHIP for kids, 
we have 176,000 kids who are at risk in this instance, and based on the 
President's budget, we cannot keep up with them. We cannot continue to 
provide them with the care that they deserve.
  And as some of you know, I have a daughter with a chronic illness, 
and luckily, through my law firm, we had a good insurance program for 
all the trips to the emergency room and the different things like that. 
So we see on the one hand poorer kids, uninsured kids that are at risk, 
they are not going to be served, and under this President's budget, as 
you were saying, those of us who were fortunate enough to have a good 
insurance policy for kids with chronic illnesses or whatever might 
affect us, we are going to be taxed on this.
  The President has said this budget, and some of his people have said 
this is a balanced budget with no new taxes over a 5-year period. Well, 
it is not a balanced budget, and there are new taxes on a lot of 
people, as you said, who have contracted for, worked for good insurance 
policies, and at the same time he says we are going to help the 
underinsured and the uninsured. What we see under the budget, it gets 
cut as well.
  Mrs. CHRISTENSEN. I go back to the day that we were sworn in and our 
Speaker saying that this was going to be a Congress that was dedicated 
to our children, and certainly, as everybody has pointed out, this 
budget that the President has sent out is just going in the opposite 
direction.
  I would say, too, that in the Virgin Islands we do not get full 
SCHIP, we do not get full Medicare, and therefore, a lot of the 
services that even, meanwhile limited in the States, you take for 
granted, we are not even able to provide to our residents. Our veterans 
as well have to travel to Puerto Rico for their veterans care, and the 
cuts will cut deeply into their ability to travel to Puerto Rico to get 
the care that they need.
  So, having just laid to rest two soldiers in the Virgin Islands, we 
are very sensitive to this issue, and we really have to sit down and 
work on this budget and ensure that our children, our veterans, our 
seniors receive the kind of health care that they need and deserve, and 
that we put that investment also to close the gaps in health care for 
people in our rural communities and people of color in this country.
  Mr. PALLONE. I appreciate the gentlewoman's comments.
  I just wanted to mention one more thing. The President in his budget 
message highlighted this SCHIP program, this kid care program, saying 
they are going to get another $5 billion, which, as I said, is not 
enough to keep up with the kids currently in the program.
  But at the same time the Medicaid program, which deals with those who 
really are in poverty and whose parents probably are not working 
because they are disabled or whatever their situation is, covers even 
more kids than the SCHIP, because SCHIP was put in place to try to 
supplement Medicaid.
  So I asked this question of the Secretary. I did not even get a 
response, because in the President's budget Medicaid, which covers 23 
million children, SCHIP only covers 6.6-. So Medicaid covers 23-, SCHIP 
covers 6.6-. They herald the fact that they are giving $5 billion in 
extra dollars to SCHIP which does not even keep up with inflation, but 
in the same time over the 5 years, they cut Federal funding for 
Medicaid by $25.7 billion, and Medicaid covers, what did we say, five 
times as many kids and five times the cut. So we are not even talking 
about the poor kids here. He is just saying, well, forget them. I mean, 
I am not even addressing the problem of the poor kids and what happens 
to them.
  I yield to the gentleman.
  Mr. KAGEN. Well, the question then comes up, it is not just about 
values; it is about choices. So, if we are not going to be spending our 
hard-earned tax dollars for the good health of children, children who 
are in need, where are we going to spend that money? Where does the 
budget choose to spend it? Not here in our country, but in the sands of 
Iraq.

[[Page H1334]]

  And I would suggest to you and everyone listening that we really 
cannot solve our health care problems, we really cannot solve many of 
the problems we are facing until we begin to bring an end to that 
involvement in that civil war in Iraq. I do not think any day should go 
by that we do not all stand up and ask the question where do you want 
to spend your hard-earned money, here at home or in the sands of Iraq?
  You are quite correct; the budget the President has proposed is 
deficient, is neglectful to those who are most at risk, the children in 
poverty, and if you are not healthy, if you are not well fed, you 
cannot go to school and learn anything. If you do not get your 
education, you are not going to build a better future that we all 
require.
  Mr. PALLONE. Can I just ask you, because I know you are a physician, 
when we talk about some of these programs like Medicaid, SCHIP, 
Medicare, and I know the gentlewoman from Florida brought it up. I know 
it is hard a lot of times when you are on the floor and you talk about 
doctors and they are not getting enough money for Medicare. They will 
say the doctors are all making a lot of money; why are you bringing 
that up?
  The reality is we are getting to a crisis now where many physicians 
simply will not accept payment from some of these programs because the 
reimbursement rate has gotten so low.
  Now, you mentioned Medicare, because that is the big one for seniors 
and the disabled, and how a lot of doctors now are not even looking to 
take Medicare, but when you talk about Medicaid, which I mentioned 
before, that has gotten to the point of no return.
  Could I yield to you? Do doctors even take Medicaid in Wisconsin 
anymore?
  Mr. KAGEN. Yes, they do. We go into medicine, most of us, because we 
care about people. We seek to solve problems for people.
  The model at our clinic was how can we help you today. So we take 
people, and we take all people, but the real question is this: Is 
Medicare able to pay for the cost of producing the service at an 
institution? They do not. So that cost is shifted to others who can 
afford to pay, and those prices are sky high.
  So many of the problems that we face, government has not really had 
its feet put to the fire saying, you know, you should pay for the cost 
of producing the service, at least for the overhead plus a margin of 
profit; you should pay for the entire cost of producing a medication or 
a vaccine, or it will not be there.
  There are two ways to get rid of anything. Let us take cigarettes as 
the example. If you want to get rid of cigarettes, tax the heck out of 
it or do not pay for it. It will be gone. The same is true in health 
care. If you do not pay for the service, the institution at the 
hospital, it cannot stand. It cannot balance its budgets.
  Most hospitals that I am familiar with in Wisconsin are running 
margins of profit anywhere from 3 to 5 percent, if they are profitable. 
So it is very difficult to make it.
  But to summarize Medicare, it is over 40,000 pages of rules and 
regulations. I do not know that there is anyone that fully understands 
it, and just think of it as a mess, and it does need to be repaired. 
But I think the more important point is institutions, hospitals, 
research centers, educational facilities are not being compensated, and 
the people that will suffer are those yet to become aged, because we 
are not really adequately funding higher education for the physicians' 
training and their fellowships and the nurses' positions.
  So there are a lot of problem to go after. I will not put you to 
sleep with the data.
  Mr. PALLONE. Well, the one thing that I keep hearing, of course, with 
the hospitals is their ability to care for what they call uncompensated 
care. One of the things that the President proposed both in the State 
of the Union and his budget was to take money from the hospitals that 
get what they call disproportionate share, DSH. I hate to use these 
acronyms because it gets so bureaucratic, but your hospitals that have 
a disproportionate share of people that do not have health insurance, 
the uncompensated care.
  Over the years, we have provided more funding for those hospitals 
through Medicare and other Federal programs so that they can cover the 
uninsured. Again, the President says we will give the States more money 
by cutting the payments to these disproportionate share hospitals.
  In my home State of New Jersey, I mean, that is absurd. We have State 
legislators and the Governor now that are talking about trying to 
provide some kind of comprehensive health insurance so nobody in New 
Jersey goes without health insurance. The only way to do that is if the 
Federal Government provides some additional help in some of the ways we 
discussed tonight, but if you start cutting back on the funding that is 
going to these hospitals that cover all these uninsured people, it is 
like robbing Peter to pay Paul, I guess is the expression. It just does 
not work.
  So I yield to the gentleman.
  Mr. KAGEN. It does not have to be that way. With the money we have 
already spent in Iraq, we could immunize every human on Earth with 
every vaccine that we know about for the next 95 years. We could have 
sent 14 million children, our children, to a college education. We 
could have built over 100, maybe 150, hospitals in each and every State 
in the Union. There is a lot we could be doing with the money we are 
spending overseas in Iraq, and it is all about values, and it is all 
about choices, and we are really getting to a tipping point, I believe, 
not just in our economy, but people feel it in their gut that we are 
headed in the wrong direction still, even though the difference makers, 
the three of us that just got the opportunity to serve here in 
Congress, have arrived.
  Ms. CASTOR. You all are absolutely right. It is very difficult to 
understand why the White House wants to sock it to our safety net 
hospitals. Have you all been to the emergency room lately, tried to get 
in? The long lines? People are ending up in our emergency rooms for 
their primary care because they have the flu. They are clogging the 
emergency rooms.
  I was a county commissioner before I was elected to Congress, and the 
brave men and women in fire rescue said they would transport to the 
emergency room. It would be so busy and so full, they would have to 
stay with the emergency patient in the EMS truck for hours because the 
emergency room was clogged.
  We have a crisis in this country, and it is inexplicable that the 
Bush administration would say by administrative rule and through this 
budget that has been sent to the Congress this week that we are going 
to cut money to those hospitals that provide the charity care in our 
country.

                              {time}  1900

  In my district, in the Tampa Bay area, the impact on Tampa General 
Hospital, which is a level one trauma center, $64 million. The great 
All Children's Hospital across the bay in Saint Petersburg, $31 
million; the great St. Joseph's Hospital, another $20 million.
  I would like to go back to SCHIP and also talk about the real-world, 
children's health insurance, because a few months ago, I ran into a 
friend of mine from high school, haven't seen her since I graduated 20-
something years ago, and I saw her at a children's health insurance 
discussion.
  She told me her story. Her name is Nan Dorton, and she lives in 
Tampa. She is married and has three kids. Her husband went through a 
tough time, and he lost his job, so they lost their health insurance. 
They didn't know what to do. It was very, very tough times. They didn't 
know about children's health insurance in Florida called KidCare or 
Healthy Kids, because the State has cut back under Governor Jeb Bush 
and the Republican legislature and they don't do any more outreach, so 
it is hard to find out about it.
  Fortunately, he got a job. They were provided with health insurance 
through the employer. But you know how much it costs for that family to 
have the kids covered, $700 a month. She said it was hard to choose 
whether to put food on the table or take the kids to the doctor and 
sign them up for health insurance. She said, you live in constant fear 
of your child having to go to the hospital.
  But then she found out about children's health insurance and KidCare, 
and signed them up. She said it revolutionized their lives because 
under these

[[Page H1335]]

health services, they pay a $20-per-month copayment for all three kids, 
and they don't have any copays for hospital visits or prescriptions. 
You know how much money that is saving us because they are not showing 
up in the emergency room, which is passed on to all of us in our health 
insurance? That is going to save us because that family is healthier 
today, and we are going to save that money later on down the road.
  Mr. PALLONE. You are absolutely right. I appreciate the fact that you 
talk about how, by covering kids or even adults, you save money in the 
emergency room or in hospitalization or whatever it is. But also, you 
mentioned the outreach, because I talked earlier about how you have 
more kids that are eligible for this children's health care program 
than are even in it. The reason is because a lot of States have cut 
back on outreach, so they don't tell people that they can apply. They 
don't even know about it. Some States may even be doing it on purpose 
because they want to save money in the short run. So that is why we 
talk about reauthorizing this and expanding it. You even need money for 
the outreach, which is clearly not in the budget.
  I yield to the gentleman from Colorado.
  Mr. PERLMUTTER. I thank my friend from New Jersey. Just for me, this 
past election was, the people wanted a new direction. They wanted 
checks and balances back in this country. They wanted a different 
perspective to be brought to the values of this Nation. As my friend 
from Wisconsin and my friend from New Jersey, my friend from Florida 
said, this budget that the President has presented reflects his values, 
but I don't think it reflects the values of this country.
  Just as we did last week with the concurrent, with the continuing 
resolution, with the budget that we passed last week, we are going to 
reflect what I believe are the values of this country, whether it is 
with veterans. And I just notice, in the President's proposed budget, 
he is increasing medical care fees for military retirees. The budget 
increases enrollment fees and deductibles under TRICARE. I can tell 
you, as I have gone around, my area, Golden, Colorado, Brighton, 
Aurora, wherever it might be in the suburbs of Denver, those military 
retirees are already complaining about increases in TRICARE and cuts in 
benefits that come with respect to that, that we haven't fulfilled the 
promises that we have made for the great service that we have received 
from these men and women in our Armed Services.
  Now, you know, what are our troops in Afghanistan and Iraq to expect? 
We are going to provide them with the best care and the best service 
that we can. And we have got to show prior military retirees that same 
respect. We have got to do it for our troops now. I question the 
President's budget on these things. We are going to change the 
direction of this Nation. We are going to show what our values are, and 
they are the values of the people of this country. I am glad to be 
here, to be a check and balance on this current administration.
  Mr. PALLONE. I appreciate the gentleman's comments.
  I yield to the gentleman from Wisconsin again.
  Mr. KAGEN. Would my colleague agree with me that we will never cut 
and run from our veterans?
  Mr. PERLMUTTER. Absolutely, I will agree. We are not going to cut and 
run from our veterans. We are going to fulfill the promises that we 
have made to them for the services that they provided to our country.
  Mr. KAGEN. Would my colleague agree that we will support the troops, 
but not this failed policy?
  Mr. PERLMUTTER. Your colleague would agree with that, that our troops 
are giving us the greatest service, the greatest sacrifices, and they 
deserve better policies from those who are leading them, particularly, 
the White House and the administration. Our military is doing great, 
and we have got to live up to that greatness that they are providing.
  Mr. KAGEN. One of the things that I learned by listening to people on 
the campaign trail, perhaps the greatest lesson, came from a Native 
American, an outspoken woman, Gwenn Carr, who said, Dr. Kagen, it is 
not doctors that determine who lives and who dies, it is politicians. 
It is politicians that take us to war based on lies and deception. It 
is politicians that prevent people from having access to affordable 
health care that they require.
  I will share with you a story of Jerry Gajeske. Jerry Gajeske I 
discovered by knocking on his door. It was not even on his door. It was 
in Waupaca, Wisconsin, with a college student who 2 days earlier in a 
dialysis center fainted because of the blood that was available for the 
eye to see.
  We were at the door, and I knocked, a gentleman came and said, ha, 
are you a real doctor? I said, yes, sir, I am, but I am running for 
Congress now. He said, well, if you are a real doctor, would you take a 
look at my cousin?
  I said, sure. Because there were barking dogs, I asked him to come 
out on the porch. While he went out to retrieve his cousin, I turned to 
my assistant, I said, Katie, are you going to be okay with this because 
you don't know what this is going to be. ``Doc, what could it be''?
  Well, his cousin came to the door and stepped out into the sunlight 
and had an obvious tumor protruding like a softball at the side of his 
sinus pushing his eye into the orbit. I said, sir, I can tell you it is 
not an allergy because I am an allergist, but what did your doctor say? 
He said, well, I saw my doctor several months ago. I could afford him, 
but I couldn't afford the tests. The tests were going to cost thousands 
of dollars. But I had lost my job. I had no coverage. I didn't get the 
tests. I have been hanging out here. I have 75 bucks to my name hanging 
out here with my cousin.
  Well, I said, that ends right now.
  I took him to the local hospital and asked one of my colleagues to 
see him. We referred him to a tertiary care center. Several weeks ago, 
he died of a cancer of the sinus.
  It is not bad enough that you have to find these people knocking on 
doors, trying to get elected to office to change things. It is not bad 
enough that he died without any money or by getting care delayed.
  To me, the bad thing was he died of the same cancer that my golden 
retriever did. But my golden retriever got better health care than 
Jerry in this country at this time. Jerry didn't make it.
  We will never know if by being seen early and diagnosed early, having 
the availability of the tests, the radiation, the chemotherapy, if he 
would not be here today. Don't think that it was opportunistic for me 
to tell this story, he didn't even live in my district.
  Jerry is like many, many other people today, who have just fallen off 
the edge into the crack of the sidewalk; is not being forgotten. Our 
party, this time, will change health care, not State by State, but 
across the country and guarantee access to care for everyone.
  I will share with you this story that I tell often about Jenny, a 
single mother of two asthmatic children, who came to see me, and I 
wrote some prescriptions for the children to get medicine for their 
asthma. They were missing school.
  When she returned a month later, the children were still sick. I 
said, Jenny, you know, this is good medicine but it only works if you 
put it in their mouth. She took the same prescriptions out of her purse 
and said, here they are. I went to the pharmacy, I stood at the 
counter, and I could see the medicine, but I couldn't afford to put it 
in their mouth. What are you going to do? I said, well, I am going to 
run for Congress because I couldn't help her in the office.
  I think, by working together, we can build a better future and a 
better Nation for everyone by changing our health care system now, not 
later.
  Mr. PALLONE. I appreciate your comments, because I know, as a 
physician and someone so caring, that you really understand how these 
problems relate to individuals.
  I also appreciate the fact that you brought up the issue of 
priorities, because when we spend so much on the war in Iraq, as you 
say, we don't have the money, and the gentleman from Colorado talked 
about the deficit. The fact of the matter is that the President and the 
Republicans built up this deficit for so long, and now it makes it more 
difficult for us to find the funds to pay to cover the uninsured in the 
same way that we are spending all this

[[Page H1336]]

money in Iraq, and it means that we don't have the money left.
  If I could just conclude, because I know we are running out of time, 
I do appreciate the fact that, in his State of the Union Address and 
also in the budget message, that the President was prioritizing health 
care and pointing out that we have a big problem with the uninsured.
  But unless the solutions and the money are there to lead us down the 
path of covering the uninsured or lowering health care costs, then it 
is not going to be good enough to just say that is a problem.
  I think, as you say, when we talk about going in a new direction, it 
means that the Democrats and the Democratic majority are determined to 
not only highlight that these problems exist and that we need to cover 
the uninsured to reduce cost, but to come up with solutions that 
practically are going to make a difference. That is why I am so happy 
that not only are you both here tonight speaking, but just that you are 
here, because all the new Members and particularly the new Democratic 
Members, I think, are going to make it possible to address these 
problems in a practical way.
  I would conclude, again, by thanking both of you and everyone who 
joined us tonight, because we are moving in a new direction, and it is 
going to make a difference. Thank you.

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