[Congressional Record Volume 155, Number 138 (Tuesday, September 29, 2009)]
[House]
[Page H10046]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1945
                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from South Carolina (Mr. Inglis) is recognized for 5 minutes.
  Mr. INGLIS. Madam Speaker, the gentleman just before me was speaking 
about the public option. And I, like him, am happy that the Senate 
Finance Committee has turned down the public option. But I don't think 
the snake is dead yet here on the House floor because it seems that the 
Speaker is working over the CBO numbers in trying to persuade some 
folks there is some $85 billion worth of savings if we just set the 
reimbursement rate at 5 percent above Medicare.
  Well, let's think that through. Here is what we've got. We've already 
got two public programs that under-reimburse providers. In fact, for 
hospitalizations, Medicaid, which is a Federal and State program, 
reimburses typically at 87 percent of actual cost for hospitalizations. 
Medicare reimburses at 92 percent of actual cost. So if you go 5 
percent higher than Medicare, if I'm doing the math right, it means 
that maybe the new public option would reimburse maybe 93, 94 percent 
of actual cost, which means that you have got a 13 percent cost shift 
in Medicaid, a 7 percent cost shift in Medicare; and now if a public 
option comes to be, a 6 percent or so cost shift there. The result is 
that private payers have to pay 129 percent of actual cost, on average, 
when they go into the hospital. Now that's a problem because if it's 
129 percent of actual cost, it means that premiums go up.
  So the public option, far from solving the problem of cost shift, 
actually is going to add to the problem of cost shift by giving us a 
third Federal program that adds to the problem. So it's clear that this 
is not a solution, and the $85 billion worth of savings is not a real 
savings. It's a savings only if you can go pull money out of the pocket 
of anybody that walks into the hospital with an insurance card in their 
pocket, because again, they pay 129 percent of actual costs.
  So somehow what we have to do here in this health care reform 
business is figure out how to stop that cost shift, how to be 
accountable here at the Federal Government so that we're not paying 
just 87 percent of actual cost for Medicaid patients, not just paying 
92 percent of actual costs for Medicare patients, and certainly not 
creating a third program that will under-reimburse hospitals.
  So our challenge, the challenge before us, is to figure out how to 
stop the cost shift and how to be accountable from here in Washington, 
from our State capitals, and surely not to create a public option that 
just adds to the problem.

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