[Congressional Record Volume 155, Number 15 (Monday, January 26, 2009)]
[House]
[Pages H516-H522]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Texas (Mr. Burgess) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. BURGESS. Mr. Speaker, I thought I would come to the House floor 
and talk a little bit about health care, because for better or for 
worse, this Congress is likely to be remembered for some time as the 
Congress that did tackle health care. And the question that's on 
everyone's mind is will we help or will we make things worse?
  Now, 2 weeks ago Congress was sworn in for the 111th Congress, we 
took to the floor of the House and we passed, under what is called 
suspension of the rules, we passed an expansion of the State Children's 
Health Insurance Program. Now, passing under a suspension of the rules 
is a special case--usually that's reserved for noncontroversial items--
but anyone who followed the activities of the 110th Congress knows that 
this bill was far from noncontroversial. In fact, it had several 
provisions that created a good deal of controversy in the fall of 2007 
and on into the spring of 2008.
  But we passed the bill under suspension of the rules because the 
Democratic leadership told us we didn't need to debate the bill any 
more because we had worked on it in the Congress before. But a lot of 
things were different in this bill, things we hadn't talked about in 
previous Congresses.
  And, in fact, there are 54 new Members of Congress, that means that 
greater than 12 percent of the Congress is new this year. That means 
that between 30 and 40 million Americans did not have representation in 
Congress when that bill was discussed in the 110th Congress, and their 
representatives were effectively cut out of the process.
  But when it comes to constructing a health care plan for America's 
children, I think it's important for us to do it right. Remember that 
the State Children's Health Insurance Program was started in 1997 by a 
then Republican Congress, it was authorized for 10 years. Everyone who 
was sworn in the last Congress knew that prior to September 30 of 2007 
we would have to reauthorize the bill.
  What did we do? We waited till the last minute, had a big fight, had 
to extend it. The President vetoed it, it came back, the veto was 
sustained, fought some more. Sent it back down to the President, he 
vetoed it, sent it back, the veto was again sustained. And then we 
reauthorized the continuation of the State Children's Health Insurance 
Program for 18 months, bringing us to the end of March of this year.
  So, to their credit, the majority leadership, the Democratic 
leadership of the House did not wait till the last minute as they did 2 
years ago, but they tackled it the first week of the session but, 
again, tackled it in an odd way. We didn't have a single hearing.
  We didn't have what's called a markup in either subcommittee or full 
committee on the Committee of Energy and Commerce or the Committee on 
Ways and Means. A markup is where you go through a draft of the bill 
and see if there are any improvements that either side can make. We 
went through a 12\1/2\ hour markup last Thursday night on this so-
called stimulus bill.
  I am not sure we got a great amount of work done in that 12\1/2\ 
hours but, nevertheless, the minority and the majority, members on the 
committee who sit way down on the front who lack seniority were able to 
have their voices heard as this legislation worked its way through the 
committee, but not so with the State Children's Health Insurance 
Program. So I guess the question I would have, and this is my fourth 
term, perhaps I should be getting used to such things at this point, 
but I still find them odd.
  If the Members on the Democratic side are so confident in their 
ability to legislate and so confident on the merits of their 
legislation, why seek to stifle the opposition? What are you afraid of? 
Bring the bill to committee. Let's have a hearing or two, let's have a 
markup. Let's bring it to the Rules Committee, let's bring it to the 
floor like we do with bills all the time.
  What is the reason to hide behind a suspension of the rules of this 
very, very important legislation. And, again, I would stress, 54 
Members of Congress here in the 111th Congress were not present in the 
last Congress. So it's all well and good to say, oh, it's old stuff, we 
have debated it before, we have worked it out before, it's just a 
rehash of something that has gone on previously. Even if that were 
true, and it's not, but even if it were true, Mr. Speaker, those 54 new 
Members didn't have an opportunity to weigh in one way or the other, 
and they may have had some good ideas.
  That's why we have elections every 2 years. That's why there is 
turnover in this Congress, because new Americans sign up to offer 
themselves in service of their country. They go through the rigors of 
an election, they are elected. They come to this Congress, they are 
full of good ideas, why turn them out?
  Why say ``no,'' what you are bringing to this Congress is unimportant 
because we talked about it last year. We talked about it the year 
before. You couldn't possibly have anything to add to this near-perfect 
bill that was vetoed twice by the previous President.
  Well, lack of input into the bill has led to a number of problems in 
the current bill. The bill was passed by the House. It has gone over to 
the Senate. The Senate is taking it under consideration at some point. 
We will likely get it back, whether it's an identical bill to what we 
sent over there, or whether it will have to come back to a conference 
committee remains to be seen. But, nevertheless, the bill has gone from 
the House over to the Senate and awaits its fate over in the Senate.
  One of the things that was most disappointing about this legislation, 
remember that this is the State Children's Health Insurance Program to 
enroll children of families who earn at or below 200 percent of the 
Federal poverty level. In round numbers, that's about families of four 
who earn around $41,000 to $42,000 a year. So those are the families, 
the children of those families are the ones that would be eligible for 
coverage.
  But there are a number of children in those families that are 
eligible for coverage that are not covered, about 800,000. And wouldn't 
it be reasonable to take the steps to cover those children first before 
we expand coverage to children in higher income brackets. Many of us 
thought so 2 years ago, a year ago. Many of us still feel that way 
today, but this was a concept that was not allowed to be debated on the 
floor of the House.
  Oddly, and I don't know that I have ever seen legislation quite 
crafted in this way, we picked the ending numbers, and then we weren't 
going to build the legislation around it. This

[[Page H517]]

bill had to cover 10 million children, we heard it several times from 
the Speaker of the House on the various Sunday shows, she wanted 10 
million children covered under this bill, and she wanted to spend $35 
billion.
  Regardless, instead of the policy informing the numbers, the numbers 
dictated the policy in this case. The problem is, under their own 
Congressional Budget Office estimate, the only way to get to 10 million 
children to be covered under the State Children's Health Insurance 
Program was to displace 2 million children off of private coverage and 
put them on to State programs. You might wonder, well, what's the 
problem with that, one insurance is just as good as the next.

  But talk to your pediatrician in practice in your town. I don't mean 
your academic pediatrician at the medical center, at the big medical 
school in the big metropolitan area, I mean your pediatrician on the 
street corner, your pediatrician who works in your community. Find out 
if the State Children's Health Insurance Program reimburses at the same 
rate as, oh, I don't know, Mr. Speaker, Cigna, Aetna, United, 
regardless of the private insurance company, may differ some from 
community to community.
  But I know in my home State of Texas numbers are vastly different. 
The State Children's Health Insurance Program reimburses at about a 50 
cents on the dollar rate compared to private health insurance.
  That's a significant change for the practicing pediatrician, because 
pediatricians, after all, function very close to the margin every 
month. They don't have a lot of excess in their cash flow every month.
  So the effect of displacing 2 million children and essentially 
cutting the reimbursement rates for 2 million children is, in fact, one 
big significance, to say nothing of the fact that now the child is on a 
different insurance than the parent, and that creates some difficulties 
with just getting care when the time comes to get care.
  Now, the other thing this bill did, which I am really questioning 
whether it was a good idea, it weakened the requirements to verify 
citizenship. There is a concept known as ``at a station,'' that is 
simply a test for citizenship rather than having to show proof of 
citizenship, like some type of identification card. So if someone comes 
into the office where you would enroll in this program and simply say, 
``I am a U.S. citizen,'' that is going to be, under the new Democratic 
bill, that is going to be proof positive that that person is, indeed, 
eligible to sign up for the insurance.
  Now, many Americans, tax-paying Americans--and I know the Secretary 
of the Treasury doesn't pay taxes--but many Americans do pay taxes, and 
it's of concern to them. The tax-paying Americans are now going to be 
paying the freight for people where we are not even sure if they are in 
this country legally. If that's what we want to do, we at least need to 
be honest with the American people and tell them that, say we are not 
really even going to check as to whether or not these individuals are 
citizens as they sign up.
  And it may be for the best of intentions, we want to be kind to their 
children, we want to provide them with health insurance. After all, 
it's cheaper to provide health insurance at the front end than high-
dollar care at the far end, but we need at least to be honest with the 
American people and tell them that's what we have done. But I don't 
know that that information has actually made it out into middle 
America. I rather suspect that some people will be upset with that 
information when they find that out. But the bottom line is, as the 
bill stands, as it left the House of Representatives, the government 
will end up covering children that may or may not be United States' 
citizens.
  Another problem with the bill, as written, is the funding is not 
provided by any sort of stable funding source. Regardless of how you 
feel about taxes on cigarettes, or so-called sin taxes, excise taxes, 
regardless of how you feel about that, what happens as a practical 
matter when you fund a bill like this with a sin tax, with a tax on 
tobacco.
  If you are successful, you drive down smoking rates, which arguably 
is a good thing, but if you are successful, you reduce the funding 
available to fund the program, and that would be a bad thing. And this 
discrepancy is not reconciled within the bill that we passed in the 
House and sent to the Senate. You have a real problem with the stable 
funding source, because this funding source, in this bill that we 
passed out of the floor of the House, funds the bill for 4\1/2\ years 
on a 5-year authorization.
  So that means after 4\1/2\ years everybody falls off a cliff because 
there is no more money. What happens then is anyone's guess. I suspect, 
as Congress always does, it will find someplace else to gather the 
money, but that means we do take it from some other source.
  A twist that actually borders on the bizarre, you wonder what it was 
even doing in the bill. The State Children's Health Insurance Program 
bill, as passed the House of Representatives 2 weeks ago, prohibits 
building physician-owned hospitals or expanding existing physician-
owned facilities. Let me just say that again, because it is so 
incredibly, incredibly bizarre, the bill prohibits building physician-
owned hospitals or expanding existing physician-owned facilities.
  Now, where else, where else, what other government in the world would 
prohibit someone from a lawful business practice simply because of the 
type of professional degree that they have? You go to medical school, 
you can't build a hospital. What an odd bizarre twist, and what an odd 
thing to put this in a bill for funding State children's health 
insurance.
  So, State children's health insurance, a good cause. I supported the 
original concept of SCHIP, I supported the original reauthorization, 
the 18-month extension we did in December of 2007. I would have 
supported a reasonable reauthorization in this Congress, but this was 
anything but reasonable. It was a badly written bill. It badly needed 
to be improved, and, again, it just begs the question, are we going to 
be helpful or are we going to foul things up in this Congress, 
particularly when it comes to health care.
  Now, I already alluded to the so-called stimulus bill that came 
through the House Energy and Commerce Committee last Thursday. We 
debated the bill. We marked up the bill for a 12\1/2\ hour session. It 
wasn't just health care. We had a lot of stuff thrown in that day. We 
had energy, we had all kinds of things that were heaped into that bill, 
but we did debate health care.
  Oddly enough, the health care part of that debate, you heard Mr. 
Kucinich talk for an hour earlier, he thought that was a pretty 
important part of the stimulus bill. So, oddly a very important part of 
the stimulus bill was left right until the very end, and then our time 
was severely curtailed. We were allowed to talk for 2 minutes instead 
of the normal 5 on any amendment that we had to this bill.
  One of the amendments was proposed by Mr. Whitfield of Kentucky. You 
know, we have a problem in Medicare. Every year we come in and we say, 
well, you haven't got quite enough money, so we are going to cut doctor 
reimbursement rates just a little bit this year and a little bit next 
year, and over time you begin to talk about real money.

                              {time}  2100

  So we are facing a reduction in physician reimbursement rates in 
December of 2009, 11 months from now, and that reduction of 
reimbursement is going to be 20 percent. Well, what is the practical 
effect of that? It makes it harder for people to find a doctor who 
takes Medicare. Mr. Whitfield's district is in Kentucky. This has been 
a particular problem for him. And he had an insightful amendment to try 
to correct this problem.
  Now, you look at the stimulus bill as drawn. We don't have to justify 
paying for anything in the stimulus bill. It's all money that just 
comes from somewhere. One of the headlines in one of the magazines up 
here a few weeks ago was, ``It's raining money.'' Well, if it's raining 
money and we perennially have a hard time finding the funds to do away 
with this physician reimbursement nick that we put in every year, why 
not just repeal that part of the Medicare law? Why not repeal the so-
called sustainable growth rate formula just outright. Since cost is no 
object, it doesn't matter how much money we spend, there is no upper 
limit. Truth be told, this isn't really money anyway. It's already been 
reimbursed to the doctors.

[[Page H518]]

  But, because of a funny budget gimmick in the Medicare law, we have 
got to go back for well over a decade, well back to the early nineties, 
every year, and capture all the savings we should have gotten had we 
enforced this every year, and tack that on to the end.
  So they are not real dollars. They have already been dispensed. In 
fact, if we were a private company and did this, we'd look just like--
well, I won't go into it. But we'd probably have an ankle bracelet if 
we did this in the real world.
  But, nevertheless, we had an opportunity in amending this bill to 
repeal the sustainable growth rate formula outright, since money is no 
object, we've got all kinds of money to spend, and the amendment was 
defeated. Every Democrat in committee that evening voted against 
repealing the sustainable growth rate formula. No hesitation; no, Can I 
ask you one more question about that? It was simply a straight ``no'' 
to the amendment.
  Well, suffice it to say, I was pretty disappointed by that, but 
undaunted. I thought, Well, maybe, maybe we could offer an amendment--
and, in fact, this was an amendment offered by Mr. Dingell during the 
Deficit Reduction Act a few years ago. This would have stopped the cuts 
in the sustainable growth rate formula for 2 years. Not a great heavy 
lift. Again, we've got plenty of money in this bill. It seems like 
money is no object because we can buy grass for the Mall. All kinds of 
things are in this bill. Why not pay for a 2-year moratorium and at 
least give our physician community a little bit of stability in 
planning their businesses?
  Again, turned down. Every Democrat in committee voted against that 
amendment. Oddly enough, every Democrat had voted for that amendment 
when their ranking member, Mr. Dingell--when they were in the minority 
when that amendment was proposed by Mr. Dingell.
  Well, we also had some information technology contained within that 
stimulus bill. Again, you heard Mr. Kucinich talk about it. Information 
technology is going to deliver untold promise to the practice of 
medicine. There will be no problem with money in future because of the 
benefit brought by information technology. In fact, we are going to 
give our doctors a bonus for implementing information technology. It's 
not a big bonus, but it's a bonus nevertheless. This bonus is going to 
go into effect in 2011.
  Wait a minute. It's a stimulus bill. It's 2009. So I offered an 
amendment to accelerate those bonus payments. Let's start paying them 
in June of this year, rather than waiting until 2011. Almost everyone 
in this body hopes that the recession will be done by 2011. So that 
bonus will have no positive effect on the recession. Let's go ahead and 
provide that money to the physicians now. Again, that amendment was 
defeated. Every Democrat in the committee room voted ``no.''
  Mr. Barton, the ranking member of the committee, also offered one 
more chance to allow doctors to own hospitals and surgery centers. 
Again, that amendment was turned down. Every, every Democrat voted 
``no'' on that bill.
  Now there are a lot of things we can talk about in health care, and I 
see I have been joined by some of my friends. Just three quick things I 
want to mention when we talk about going forward and what perhaps we'd 
like to see in any sort of health care legislation that is crafted.
  There's no question that the way the current tax code is drawn, it 
does discriminate against individuals who want to own their own 
insurance. It does load the system to those who earn at the upper end 
of the income scale. So at some point someone is going to have to look 
at that inequity and see if there's not a better way to approach it.
  But, in the meantime, just keeping it very, very simple, why not 
allow someone who purchases their own health insurance, why not allow 
that to be deductible from their income tax? If they are working and 
they want to purchase their own insurance policy but they don't really 
make enough money to pay much income tax, provide them a tax credit. 
Give them a little help.
  That is the people that Mr. Kucinich was talking about. The working 
poor. Sure enough, let's give them a little bit of help. If we wanted 
to go one step further and help those who were without health 
insurance, why not provide--called it a voucher, call it a tax credit, 
a prefundable credit, advanceable tax credit, call it what you will--
but why not perhaps incorporate that into the tax code.
  These are three relatively simple things we could do tomorrow and 
vastly have a significant effect on the ability of individuals to have 
health insurance in this country.
  We are going to hear a lot of discussion over, I suspect, over the 
next months and even years on the whole issue of are we going to have 
to mandate coverage or do we have some other way to get people the 
coverage they need without requiring a mandate?
  Now some people may recall we faced that same dilemma in the Medicare 
Part D. In Medicare Part D, many people wanted a mandate you're going 
to have to buy this prescription drug coverage on Medicare. Dr. Mark 
McClellan, who was the head of CMS at the time, and Secretary Mike 
Levitt over at Health and Human Services decided they were going to 
take a different track, and I am so grateful that they did. They said, 
We are going to create programs that people actually want rather than 
forcing them into a program that may be of limited utility for them. So 
they did.
  They spent a great deal of time crafting programs that would actually 
help people. They had six protected classes of drugs. There had to be 
at least two options in each protected class of drugs. Now I have been 
so far removed, I don't remember them off the top of my head. But it 
was a brilliant strategy.
  As a consequence, as a consequence, the signup for Medicare Part D, 
the percentage of seniors who now have some type of credible coverage 
for prescription drugs is in excess of 90 percent and, more 
importantly, the satisfaction rate is in excess of 90 percent, and 
perhaps most importantly is it didn't cost nearly what the projections 
said it would cost initially.
  The initial premiums for part D were set by the Center for Medicare 
and Medicaid services at nearly $39 per member per month. The actual 
cost has come in somewhere between $22 and $24. It's gone down a little 
bit in subsequent years, but a significant decrease over what was 
projected by both the Congressional Budget Office, CMS, and even the 
Office of Management and the Budget down at the White House.

  So a much more reasonable way to approach things rather than telling 
people what they must do, and that is always hard in a free society. 
Always hard. My home State of Texas has an individual mandate for 
automobile insurance. But not everybody signs up for it. In fact, the 
city of Dallas just started a program where if you're stopped for 
whatever, taillight busted or ran a red light, and you don't have car 
insurance, your car is towed. See you later. You're on the street. Find 
another way to get home.
  Well, we really can't do that in health insurance, but that just 
underscores the difficulty that you have with enforcing a mandate. But, 
creating programs that people want--remember, over 90 percent of 
seniors now have credible prescription drug coverage because someone 
took the pains to find out what people wanted. Find a way to make it 
cost effective and find a way to make it available to them.
  I would stress for both sides of the aisle, when we talk about health 
care in this Congress, do remember, it's more about cost than coverage. 
This is about caring for people. Medicine, and I can say this because I 
spent a lifetime practicing medicine, it is both an art and a science. 
It's constantly evolving and transforming. We are on the cusp of one of 
the most transformational times that has been seen in medicine, ever. 
The human genome has been sequenced. We can know more about people 
before it happens to them than at any time for any group of healers 
that never had that kind of power in their hand in the past.
  Dr. Elias Zerhouni recently left as the Director of the National 
Institute Of Health. And he used to talk about medicine. Because of the 
discoveries of the human genome, medicine is going to become a great 
deal more personalized. Well, that's a good thing, personalized 
medicine. We'd all like to see that.
  Medicine more personalized, it's going to become more predictive. 
Because it's more predictive, that leads

[[Page H519]]

to more prediction. But part of the key is going to have to be a lot 
more participatory. You cannot be a passive actor in tomorrow's health 
care environment and expect to get the rewards that it is capable of 
delivering.
  But how ironic. As we stand upon in this transformational time in 
medicine, what is the one thing, what is the one thing that could 
divert from this path? It's the United States House of Representatives.
  We are inherently transactional, not transformational. We take from 
one group and we give to the next. And we have the power within our 
hands to derail the transformation that is, even today, taking place in 
medicine.
  For all of the faults of American medicine, for all of the faults of 
private insurers--and Mr. Kucinich detailed them in laborious detail--
for all of those faults, things are beginning to move in a positive 
direction.
  Information technology, health insurance technology. Do we really 
need the government to write the code for medical information 
technology? Wouldn't we be better to just simply set some parameters 
and get out of the way and let the people who know what they are doing 
actually do that?
  No. We are going to try to write every jot and piddle of the code so 
that we control it from start to finish. But the reality is across the 
country, and I know this because I have spent the last 6 months going 
across the country, people are incorporating electronic medical records 
into their individual physician practices, into their larger hospitals, 
into their health maintenance organizations, into their insurance 
regimes. It's happening already.
  Part of the challenge for us is to make sure that all those part 
interconnect properly and there is proper communication, proper 
transparency, so the patient who goes to one large multispecialty 
clinic in the Midwest and transfers to another large multispecialty 
clinic in the gentleman from Ohio's hometown, that those two clinics, 
the record from those two clinics can talk to each other.
  But that is just a technical problem. That can be solved. And it 
doesn't require the United States Congress writing the computer code in 
order to make that happen. In fact, if we'd relax a little bit on our 
regulatory laws, the so-called Stark laws that were written back in 
1981. It's the 21st century, for crying out loud. That's nearly 30 
years ago. And we are still putting the same constraints on medical 
practices today that they were back in 1981.
  If we define privacy once and for all, tell people what we mean by 
privacy, and then not change our minds every 3 months, maybe they could 
get this done. But there is a transformational change taking place. And 
you can see it in the insurance companies, the physician practices, 
hospitals and clinics, Federally-qualified health centers across the 
land. And the only thing that can stop this evolution in health care is 
the United States Congress. So that is kind of a daunting possibility.
  When we hear people talk from the floor of this body about all the 
wonderful and great things that they want to do with health care, we do 
always need to remember that we have it within our power to allow that 
transformation to blossom or stop it dead in its tracks.
  Now I have been joined by some of my colleagues, and I think we still 
have about half the time left, so I will yield as much time as he may 
consume to the gentleman from Georgia, Dr. Gingrey, the other Dr. Phil.
  Mr. GINGREY of Georgia. I might say the real Dr. Phil, as a matter of 
fact. I am certainly pleased tonight to join my colleague, my colleague 
that I have just joined on the Energy and Commerce Committee in this 
111th Congress, and I am proud to have the opportunity to do that, to 
really have a seat at the table of one of the two main committees of 
the House that deal with health care, deal with all of Medicare and 
Medicaid and SCHIP, many of the things that the gentleman from Texas, 
Dr. Burgess, Mr. Speaker, had been speaking about during the initial 
part of this hour.
  These are very important things, as he talked about the recent 
passage of the expanded reauthorization of the SCHIP program, the State 
Children's Health Insurance Program, what I am referencing, and brought 
out the fact that there were so many things in that reauthorization and 
expansion over the next 4\1/2\ years that caused Dr. Burgess and myself 
and many of my colleagues on this side of the aisle to vote ``no'' on 
something that, quite honestly, we really had hoped to be able to vote 
``yes'' because this idea that was originated back in 1997 for this 
legislation to help families who are not poor enough to be eligible for 
Medicaid.

                              {time}  2115

  And that is at 100 percent of the Federal poverty level, about 
$22,000, $23,000 a year for a family of four. They are not below that 
level of income, but yet not making enough money to really be able to 
afford to provide health insurance for their children.
  So that is what the original SCHIP bill was all about it. It was 
authorized for 10 years; it was a $40 billion bill, as I recall, and it 
would cover those children whose family income was above 100,000 but 
under 200,000. So you are talking about $44,000, $45,000 a year for a 
family of four. And, clearly, providing health insurance on that kind 
of income is a strain, is a struggle, and of course many of those 
youngsters were not insured.
  So the program was good; and of course it expired. It was time for 
reauthorization. Former President Bush realized that more money needed 
to be appropriated for this program. There were a significant number of 
children, maybe as many as 2 million or 3 million, that were not being 
covered who were in that income category, their family income, between 
100 and 200 percent of the Federal poverty level. And I certainly was 
in favor of a 25 percent, 30 percent, maybe even a 40 percent expansion 
of the program to make sure that we reached as close as possible to a 
100 percent saturation level, Mr. Speaker, and my colleagues, for those 
children. I think everyone on both sides of the aisle would agree that 
that clearly needs to be done. But, unfortunately, for some reason the 
Democratic majority wanted to expand this program. When you extrapolate 
from the 4\1/2\ year amount of expenditure to a 10-year program, it 
would be a 100 percent increase in the amount of funding.
  The thing about it is that there are things in the bill that allowed 
the abuses that existed to continue and even worsening that situation. 
And I want, Mr. Speaker, to mention a couple of those, because I think 
it is very important for people to understand why a physician member of 
this body, indeed two right here on the floor this evening, who 
delivered babies as a profession, brought little children into the 
world, would vote against this program. And here are some of the 
reasons:
  One of the changes in the reauthorization said that no longer would 
an immigrant have to have a 5-year waiting period before they would 
become eligible. Well, indeed, our immigration laws have been on the 
books for a long time. They get changed periodically. But in the last 
significant change of immigration law, it basically said: We don't want 
to have a magnet here in this country and to say to everybody across 
the world, come one, come all, to come to this country and get on the 
government dole, the freebies. No, that is not the reason we want 
immigrants to come to the country. We want them to come, to assimilate 
into our society, to contribute to our society, to, yes, enjoy the 
American dream. But that provision says that as a legal person comes 
into this country, they have to have a sponsor. They have to have 
someone who is willing to say that that won't happen, that they will 
not become a ward of the state, certainly not within 5 years. So this 
reauthorization says: Oh, no, we are going to do away with that. States 
don't have to abide by that anymore. They can spend SCHIP money on 
someone that has been here 6 months.
  Even worse than that, Mr. Speaker, is the provision in regard to 
illegals. It says specifically in the language of the bill that no 
illegal immigrant is eligible; but yet, then it goes on to say that the 
verification system for an immigrant, whether or not they are here 
legally, is so watered down that it is almost like a wink and a nod to 
say, ``Come on, it is okay. All you have to do is give a nine-digit 
number for your Social Security number. You don't have to show a Social 
Security card, but you have to give a number. Yeah, that is nine 
digits; you are eligible.''

[[Page H520]]

  These kind of things were bad enough, but I want to point out 
something else, Mr. Speaker, and that is a little game that some States 
I think 13 or 14, and my colleagues are aware of this, a little game 
that some States have been using to disregard, to actually disregard 
blocks of income, to say, ``Oh, you are making 350 percent of the 
Federal poverty level. So you wouldn't normally be eligible, but we are 
just going to simply not count that money that your parents have earned 
above 200 percent. We are not going to count that. We are just going to 
simply disregard it.'' And they are getting away with that. And so in 
some States there are indeed, and it will continue, that children of 
families making up to 350 percent of the Federal poverty level, I think 
we are talking now about $80,000 a year for a family of four, where 
they can indeed afford to pay for private health insurance for their 
children, and they are insured in many instances. So naturally, if they 
get an opportunity like this, a once-in-a-lifetime opportunity to drop 
that private coverage and get on the freebie government trough, who 
wouldn't? Well, I wouldn't. But a lot of people would and a lot of 
people did and do.
  So I had an amendment, a very straightforward amendment that said we 
are going to end the shenanigans of income disregard both for the 
Medicaid program and for the SCHIP program.
  Why would I want to do that, Mr. Speaker? I would want to do it so 
that those children who truly have the need, for whom the program was 
designed, for who we are willing to spend taxpayer money, that they get 
coverage, and it doesn't go to the upper middle income who clearly 
don't need it.
  So there are a lot of little things that I could go on, on that, but 
I know that we have got others who want to speak tonight on health care 
and I want to make sure there is plenty of time for others. And 
hopefully during the hour, time permitting, I would like to come back 
to some of the other issues that Dr. Burgess was talking about, Mr. 
Speaker, in regard to this economic stimulus package that we are about 
to vote on tomorrow and why I think that it is not going to work. I 
wish it would work. I hope and pray that it does work. But I have grave 
misgivings about it, and I would like to have an opportunity later on 
in the hour to discuss that further, as I know that my colleagues will, 
also.
  Mr. BURGESS. I thank the gentleman. We will probably go for about 
another 7 or 8 minutes on health care, and then I am going to yield the 
balance of the time to Judge Louie Gohmert from Texas, who wants to 
talk about some other things related to the economy and perhaps some 
issues related to the confirmation of the Secretary of the Treasury 
today.
  One of the things that when we talk about health care in the broad 
perspective, and it comes up periodically, is some of the difficulties 
encountered in our system because of the onerous burden placed by our 
medical justice system, cost of medical liability insurance. I just 
bring that up to point out how, in my home State of Texas recently was 
passed a bill that placed limits on noneconomic damages, and we have 
seen a dramatic reduction in premiums for liability insurance. Last 
Congress, I offered a bill that would incorporate the Texas plan 
countrywide, to coin a phrase. That bill did attract significant 
cosponsors, and I will be introducing that bill again.
  We hear other proposals for lightening the load of medical liability. 
Certainly some people like medical courts. Certainly that should be 
worth some scrutiny and study by our committee. I hear other people 
talk about early offer, and in fact several years ago we heard 
testimony in our committee how a concept like early offer and 
arbitration might work and might lighten the load.
  But here is a different concept that I would like my colleagues to 
consider that maybe is a little bit of out-of-the-box thinking; and let 
me give credit to the ranking member on our health subcommittee, Nathan 
Deal, because this idea largely originated with him. But we have a very 
large Medicare system in this country paying $300 million, $400 million 
a year in health care for the Nation's seniors. Now, this is not a 
State program, it is a Federal program, so it is administered equally 
across the land.
  Since it is a broad Federal program, what if we had some requirements 
to be met, to be sure. But if a physician fulfilled those requirements 
as set out, that we would allow that individual to have their liability 
coverage under the Federal Tort Claims Act as we would in a federally 
qualified health center.
  Now, some of the parameters that we might ask for in return would be 
certainly full deployment of health information technology, electronic 
medical records in that physician's or hospital's practice record. That 
seems pretty straightforward. There was a demonstration project done at 
the Center for Medicare and Medicaid Services that is now 2 years into 
the study looking at some of the things that is called the Physician 
Group Practice Demonstration Project. It is looking at some things like 
medical homes care coordination, and they have come up with some 
interesting data.
  For example, a patient who is admitted into the hospital with 
congestive heart failure, if that patient is given a slip with an 
appointment within 5 days back to their primary care doctor, their risk 
of readmission is very low. If they do not have such an arrangement 
made, their risk of readmission goes up significantly. What do you 
think the cost of that readmission looks like? It is pretty steep, much 
more than the original admission. So a very simple, simple task to 
undertake to ensure that everyone who leaves the hospital after this 
diagnosis for uncompensated congestive heart failure has a 5-day 
follow-up in their family physician or primary internal medicine 
doctor's office to ensure that they are complying with their 
medications, that they are indeed on the path to recovery that everyone 
thought they were on when they left the hospital.
  Other things, like during that ``welcome to Medicare'' physical, even 
just a brief episode of patient education about things like advanced 
directives, not to require the patient to sign up for an advanced 
directive, but just to make them available so that when heart decisions 
come up later on in life, that they have at least already been 
approached; because, as we all know, some of the most expensive care is 
that care that we pay for in the last 2 weeks of life, and oftentimes 
that is care that really has no hope of delivering a good result and 
may in fact even be deleterious. So worthwhile to have these 
discussions at the front end. And, they might save some money, but more 
importantly, it might be a better way of taking care of people. 
Remember, I alluded to it is not all about cost and coverage, it is 
about taking care of people in the right way.
  If we set out these parameters, and if a physician group or an 
individual physician or individual practice agreed to abide by these 
restrictions, then cover them under the Federal Tort Claims Act. Can 
you imagine the relief from having to carry that on the individual 
physician's balance sheets. That is like $100,000 a year in real money 
in that physician's office. I suspect, rather than having doctors leave 
the Medicare system, we would have doctors who would say, ``You know 
what? I'll just take care of Medicare patients if we are going to be 
under those kinds of rules, because it is a lot easier than having to 
put up with that grief in the other parts of my practice.'' Something 
we should think about, some out-of-the-box thinking to provide a little 
bit of relief, a modicum of relief in the arena of liability reform.
  Medicaid, we haven't really talked about that much. There is going to 
be a push for a vast expansion of Medicaid in this Congress; indeed, it 
is already upon us in the stimulus bill, because we don't have to worry 
about how we are going to pay for it, we don't have to worry about what 
tomorrow looks like. But shouldn't we at least ask that there be a 
little bit of transparency in the system so that someone can look and 
see how many MRIs are done on a particular diagnostic group of 
patients, to have some idea as to whether or not these services are 
being utilized in a wise fashion?
  Similarly, should we not have someone who is responsible for 
coordination of benefits? Medicaid, if it exists in conjunction with a 
private insurance, always is supposed to be secondary; that is, the 
private insurance should be the insurer of first resort, Medicare 
should be the insurer of last resort. But in about 13 to 15 percent of 
Medicaid

[[Page H521]]

cases across the country, there is in fact a primary insurer who just 
has not paid. Medicaid then goes from secondary to primary, and that 
bill is put on to the American citizens when in fact that bill actually 
was the responsibility of a private insurance company.

                              {time}  2130

  And why does that happen? It is because of the lack of reciprocity. 
And we get into this in a lot of different areas. But it is that 
inability of insurance companies to function across State lines. Some 
of that State reciprocity could actually go a long way. Again, when you 
are talking about a program that spends upwards of almost $600 billion 
a year, a 15 percent savings starts to look like real money. So I just 
offer those as a couple of things that we might consider as we go 
through this process, Mr. Speaker.
  I do know that Judge Gohmert from Texas, Louie Gohmert from Texas, 
did want to talk to us a little bit about the financial bailout package 
and the rescue package. Let me see if the gentleman from Georgia, Dr. 
Gingrey, had some final thoughts on the health care aspect before we 
leave that and go to the economy.
  Mr. GINGREY of Georgia. Dr. Burgess, thank you. And I also want to 
hear, Mr. Speaker, from Judge Gohmert on this very important subject. I 
just want to mention one other thing, Mr. Speaker, in regard to this 
so-called rescue, or economic stimulus package, that we marked up in 
the Energy and Commerce Committee last Thursday in a 12-hour markup. 
Dr. Burgess initially was talking about a couple of amendments that he 
and Mr. Whitfield from Kentucky had in regard to a sustainable growth 
rate. And this was a golden opportunity to fix that. Unfortunately, 
along party lines, Mr. Speaker, both of those very good amendments were 
voted down. And then finally, yours truly, Dr. Gingrey, had an 
amendment that said, okay, if you won't do that, how about just simply 
freezing the reimbursement rate for physicians at 2009 levels for 2010? 
No update, no upgrade whatsoever, just simply freeze it. And Mr. 
Speaker, unfortunately, the chairman's response was, we want to do 
that, but not in this bill. It's not time. And I think I said, well, if 
not us, who? And if not now, when? And so we went back and forth. And 
unfortunately, along party lines, my simple amendment failed as well. 
And I was very, very disappointed.
  But I want to thank the gentleman, again, from Texas, Dr. Burgess, 
for giving me an opportunity to join with him tonight and give me some 
time. And I yield back to him so that we can hear from Louie Gohmert, 
Judge Gohmert, from Texas.
  Mr. BURGESS. I thank the gentleman for yielding.
  May I ask the Speaker, may I inquire as to the remaining time.
  The SPEAKER pro tempore. The gentleman has 14 minutes remaining.
  Mr. BURGESS. I yield to the gentleman from Texas.
  Mr. GOHMERT. I thank my friend from Texas, as well, Dr. Burgess and 
Dr. Gingrey. And I thank you, Mr. Speaker.
  But this all ties in together, when we're talking about health care, 
I had my staff pull the last numbers they could get. And for the year 
2006, if you add together all of the Federal tax dollars that are spent 
on health care, and you add that to the State tax dollars that are 
spent on health care in the year 2006 per household, it was right 
around $8,400.
  Well, $8,400 per household in America? You know, we have talked about 
health savings accounts and how that could restore power into the hands 
of the American public. That could restore the good old doctor-patient 
relationship. Because what we have right now is not a doctor-patient 
relationship. What we have is a doctor either insurance company or 
government patient relationship, because either the insurance companies 
or governments are between the doctor and the patient.
  Well, man, some people, I have had retired folks say, well, I can't 
ever have a health savings account. I can never accumulate that money 
because I'm too old and I'm too sick to ever accumulate that money. But 
if you look at it, and you go, wow, $8,400, that was in 2006. Now it is 
even more than that. But you could give every household in America a 
$3,000 health savings account. And if you establish this relationship 
with you and your doctor, and then here is another $2,000 or $3,000 on 
top of that to buy your catastrophic care insurance, then you get back 
to a doctor-patient relationship.
  But why would we not want to do that? Well, I would submit to you 
it's because there is a culture of arrogance in Washington, D.C., and 
it has been here for a while. It's not a new thing. It has been 
building. And I think it is one of the things that actually turned 
voters off about the Republican administration. I think the world of 
George W. Bush. I like that man. He is a good man. But he got some bad 
advice from some arrogant people. And look at what was done and the 
advice that was given. Heck, back in September, the advice was, well, 
we may have a depression, but if you will give me starting off $350 
billion but maybe get to $700 billion, start with $350 billion, I can 
fix it. That is arrogance. The people in America are not smart enough 
to fix this. Give me the money, and I will fix it.
  It permeates this town. It permeates this capital. It's an arrogance 
that says, ``the American people are just not smart enough. They 
wouldn't be able to go back to the doctor-patient relationship the way 
it used to be. They wouldn't be able to help the economy by spending 
their own money properly. Let's make them give it to us through taxes. 
And then we will spend it. Because they're just not smart enough to 
know how to spend it in a way that is best for them.''
  And that is what we've got. So you have the Bush administration that 
took $350 billion, and Secretary Paulson, King Henry, was going to 
spend that in such a way that it would encourage lending and get the 
credit flowing and so people who had fallen behind on their mortgage 
could come forward and refinance and borrow more money to catch up. 
This was going to help fix that. Well, they gave all that money to the 
banks. And now it's even harder to get a loan than it was before they 
squandered all that $350 billion. So what have we gotten? Well, now, 
frankly I have had, and I'm still holding out, hope for the Obama 
administration. They come right in. They say, Bush, before you leave, 
why don't you go ahead and request that other $350 billion? Because we 
are going to want to spend that. And then on top of that, we're going 
to ask for another $800 billion or so. And you know what? We may need 
$1.2 trillion before it's all over.
  Now that is interesting. Of course, as my friends here from Georgia 
and Texas know, I filed a 2-month tax holiday bill that just says, we 
don't need the arrogant bureaucrats in Washington to spend our money 
because we are too stupid to spend it ourselves. What we need is to 
give the American people the strength of this country, the American 
people, let them have their own tax dollars for 2 months. If you let 
them keep every dime of withholding for Federal income tax and every 
dime for FICA withholding, if you let the American people keep their 
own money for 2 months, then it comes up to around $334 billion. That 
would jump-start this economy.
  Now, we've been saying that for a couple of months. And here, lo and 
behold, within the last 10 days, Moody's Economy came out with a study 
that showed of all the tax proposals--and that included tax proposals 
that I know my friends here agree with, like cutting capital gains and 
cutting corporate taxes. I get sick and tired of hearing people say 
that we will never get manufacturing jobs back in America. Because some 
of us went and talked to CEOs in China and asked, why did you move over 
here? I figured they would say because labor is cheap. They said, you 
know, we had a lot better quality control in the United States with our 
products. But the corporate tax is less than half here, and they cut us 
deals on corporate tax.
  So we agree. We need to drop the corporate tax and drop capital 
gains. That will get jobs flooding back in here. But when it comes down 
to the American money, the thing that will get the economy going the 
quickest and that will increase the gross domestic product faster in 1 
year than any of these tax proposals, it is the tax holiday proposal 
giving the American people their own money.
  Now, it's interesting to me that President Obama is now saying, do 
you

[[Page H522]]

know what? We may need $1.2 trillion to really get the American economy 
going. Do you know why that triggered something special in me? It is 
because, I know, I asked for the numbers, the amount of money that the 
American individual taxpayers paid per year this last year is right at 
$1.2 trillion in individual income tax. Wow. Can you imagine? Can you 
get your mind, Mr. Speaker, around the thought of not paying income tax 
for a whole year? Can you imagine if the American public were told, do 
you know what? We had wanted a $1.2 trillion stimulus package to try 
the best we can to get the economy going. But then it hit us. Do you 
know the American people are not as stupid as we have characterized 
them as being? So let's let the American public have that $1.2 trillion 
for this year. They won't pay any income tax for the whole year. It 
would be the same thing. No individual income tax or giving Washington 
$1.2 trillion and let them try to spend their way into helping the 
American public. Well, the American public is not as stupid as this 
town has cast them as being. They can figure out good ways to spend the 
money that they earned and getting this economy going.
  Because what are they trying to do? Well, we want to help Detroit. We 
want to help with jobs. Can you imagine if everybody in America had 
their own withholding and FICA withholding for a year, the cars that 
would be bought, the stock that would be bought, the homes that would 
be bought, the homes that would be built and the businesses that would 
be built with their own money? They don't need some arrogant bureaucrat 
in Washington saying, give me $1.2 trillion, and I will try to spend it 
the right way to get the economy going.
  If you let the American people have $1.2 trillion with no individual 
income tax for a year, this economy would explode. It would be going so 
good, people would want to rush back into America with these jobs, 
because this is where it's all happening.
  So, I'm still holding out great hope, because one of the things, and 
Mr. Speaker, I know, I feel sure that President Obama inspires you as 
he does me, I sat there listening to that inaugural address. And I was 
inspired. And I know there are critics out there who say, well, I was 
expecting a better speech from him. I really was. That was a great 
speech.

                              {time}  2145

  The problem that President Obama has is he is so good at speech 
making, people have come to set the bar so high that he can give a 
great speech and people are not impressed. Well, I was impressed. Of 
course he talked about Washington, and that struck a chord with me. 
When he said: ``With hope and virtue, let us brave the icy currents,'' 
well, I agree with him. With hope, we have got that. Virtue, well, we 
just approved a new Treasury Secretary that wasn't virtuous enough to 
pay his income tax, but apparently we are going to overlook that kind 
of virtue requirement. Yes, we have some conflict of interest problems 
with some other appointments. Maybe we will just go forward with hope 
because we are losing the virtue issue here with some of the recent 
appointments.
  But I am hopeful that this President will understand some of the 
things that some of the people around President Bush did not, and that 
is the American people are not as stupid as this town has cast them. 
They are smart enough to know how to spend their own money, smart 
enough to get the economy going if we let them have their own money to 
do it. I am still holding out hope. As the poet says, there is the hope 
that springs eternal in the human breast. I have got it and I know you 
guys have it too, Mr. Speaker. We have that hope that springs eternal, 
but we need to recognize that the arrogance in this town, the arrogance 
of this capital is much too pervasive and that the hope for this 
country does not arrive on Air Force One, but we need to take 
responsibility. We need to let the American public get the economy 
going with their own money, cut the arrogance and recognize the 
American people for the backbones of this country that they are. I 
appreciate the opportunity to vent a little bit from my friend, Dr. 
Burgess.
  Mr. BURGESS. I thank the gentleman. This proposal that you've put 
forth is terribly intriguing, and I suspect we will get a lot of 
interest. I know we have to direct our comments to the Chair and not to 
the cameras, but I would be curious if the gentleman has a bill to that 
effect.
  Mr. GOHMERT. The bill is H.R. 143. It is a two-month tax holiday that 
lets people keep all of their own withholding and all of their FICA for 
two months. And all it takes is passage and the next paycheck, it is 
not six months down the road, it is all of their withholding in the 
check as soon as we pass the bill. That is what H.R. 143 is about. I 
hope people call the White House and say President Obama, you have 
inspired me so please, let us have our own money. H.R. 143 is the way 
to do it and the way that the President can keep his promise.
  Mr. BURGESS. I thank the gentleman for that insight. Am I recorded as 
a cosponsor on H.R. 143?
  Mr. GOHMERT. The gentleman is. The gentleman has been a confidante 
and adviser and has been here longer than I have. I have greatly 
appreciated the advice and wisdom of Dr. Burgess.
  Mr. GINGREY of Georgia. I also would like to inquire if I too am a 
cosponsor of that excellent piece of legislation.
  Mr. GOHMERT. Dr. Gingrey is a cosponsor and trusted confidante and 
adviser.

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