[Congressional Record Volume 155, Number 170 (Tuesday, November 17, 2009)]
[House]
[Pages H13045-H13050]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore (Mr. McMahon). Under the Speaker's announced 
policy of January 6, 2009, the gentleman from Ohio (Mr. Ryan) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. RYAN of Ohio. Mr. Speaker, I appreciate the opportunity to try to 
clear the record here a bit and talk a little bit about our health care 
reform proposal that passed the House of Representatives a little more 
than a week ago and talk about the benefits to the American people.
  I would like to respond to a couple of the concerns that were made by 
the other side over the course of the last hour. It's very interesting 
to me because I was here over the last 7 years and was here during the 
last part of the Bush administration. I was here 2002, 2003, 2004, 
2005, 2006, 2007, 2008 and watched as our friends on the Republican 
side cut taxes for the top 1 percent, the wealthiest 1 percent of 
Americans, continued to spend money with a reckless disregard for the 
national debt, for deficits, started two wars, borrowed the money from 
China to pay for the wars, borrowed money from China to compensate for 
tax cuts that went to the top 1 percent of the wealthiest Americans. 
And here we are a couple of years later, and our friends on the other 
side are concerned about the deficit and the debt.
  It was President Bush's appointees to the SEC that gave a blind eye 
to what was happening on Wall Street. Wall Street collapses, and the 
$780 billion and $800 billion that we had to spend to stabilize the 
economy was under President Bush's watch. It wasn't under President 
Obama's watch. We've spent the last 9 months cleaning up the mess that 
was made over the last 8 years.
  Now, this is not to assess blame. We're all in this boat together. 
We're all in this together. I recognize that. But you can't cause all 
these problems, because the Republicans controlled the House, 
Republicans controlled the Senate, Republicans controlled the White 
House, Republicans controlled the Supreme Court. They pulled every 
lever of government, ran up the deficit, ran up the debt, started two 
wars, blowing money left and right, giving tax cuts to the wealthiest, 
and then we wonder why we ended up where we are today. No regulation of 
Wall Street. The economy collapses. Tax revenues go down.
  Now, I'm not saying that what we have done over the last 8 or 9 
months has been to wave some magic wand and all of these problems have 
gone away. I represent northeast Ohio. Our unemployment rate is at 15 
percent in some of our cities. But we can say very objectively that the 
money that was spent going to Wall Street, the stimulus package has at 
least stepped us away from the cliff that we were on--and we were on a 
cliff ready to fall off as a country--as an economy we have been able 
to stabilize that.
  Now, I'm not happy with what the banks are doing. I don't think 
anybody is. I think it's important to move more money back to community 
banks and let's stimulate lending at the local level. That's how we're 
going to recharge and revive our economy. And that would be the 
direction that ultimately we need to go in.
  But you certainly can see that we were losing jobs at 700,000 a month 
and now we're still losing jobs, still too many; but it's at 200,000-
plus a month. So we're at least trending in the right direction.
  But I've got to tell you, Mr. Speaker, I get a real kick out of these 
fellows on the other side who caused all of these problems and then now 
complain how we're trying to fix them.
  And make no mistake: this discussion about health care, as our 
friends earlier were talking about, their assumption and presumption 
was that the health care system is working just fine. It's not costing 
us a lot of money, not really hurting many people, everyone has access, 
no rationing today, all of which is not true.
  We have health care growing at a 9 percent clip. We have the GDP 
growing at a 3 percent clip. You continue to do the math, and you'll 
find out that in 10 years, $1 of every $5 in our economy will be spent 
on health care. You will find out that if you take that out another 
couple of decades, 30 years, $1 in every $3 will be spent on health 
care. That is unsustainable. Unsustainable. And to think if we do 
nothing, which is basically what the Republican proposal was, to just 
keep kind of doing what we're doing, it doesn't cover more people, 
doesn't take care of a lot of the human rights issues that were 
involved here--if we continue doing what we're doing, the average 
family in America will pay another $1,800 a year in health care next 
year and then another $1,800 the following year and another $2,000 the 
following year. And we will continue down a road where this continues 
to eat up the whole family budget.
  I have a member of my staff who has an Aetna 7-D health care plan. In 
2007 his copay was $237 a month. In 2008 it went up 22 percent. In 2009 
it went up 9.7 percent. And in 2010 it went up 80 percent. Now, this is 
a Federal employee; and this is happening all throughout our economy, 
all throughout our country. So from 2007 to 2010, a 142 percent 
increase for Gene Crockett from Niles, Ohio.
  Now, our friends on the other side: just keep doing what we're doing, 
things are okay, things are fine, we'll get to it.
  This is change. And this is obviously a difficult process, but we are 
moving forward, and it passed the House in a historic vote here a 
couple of weeks ago, and we will continue moving in that direction so 
that the Gene Crocketts of the world and the average people around the 
country who see this eating up more and more of their budget will get 
some relief.
  I was amazed over the last week I was home when I'd be at a 
restaurant and people, real quiet, would kind of look at me and say, 
Thanks for your vote on health care, Congressman. You know, real quiet. 
And that's how this debate has been in this country. And the polls are 
bearing it out. The AARP poll that just came out showed significant 
support for this. Another poll I was just looking at a little bit 
earlier, significant support for some of these provisions, because we 
take care of the bread-and-butter issues of the health care situation 
we have in this country.

  If you're a kid or you're 27 years old or younger, if this reform 
passes, if some of these provisions in the House version stay in, if 
you're 27 years old or under, you can stay on your parents' insurance. 
If you have ever been denied insurance coverage because you have some 
preexisting condition, this reform will end that practice. That will no 
longer happen to anyone in the United States of America ever again. And 
our friends on the other side voted against it.
  I was getting my hair cut last week and was talking to the owner of 
the hair salon, and she said, you know, you need to pass this health 
care reform. We need help. I heard the story about her daughter who 
just started working with her and the daughter had asthma growing up, 
went to get insurance, and she had to sign basically an agreement with 
the insurance company saying that if she goes to the hospital because 
of asthma that the insurance company will not pay for that hospital 
visit. So the girl has asthma. She's paying a lot of money a month, 
hundreds and hundreds and hundreds of dollars a month, to get 
insurance. And the one thing that she is probably going to need her 
insurance for the insurance won't cover.
  Now, does that make any sense, to continue with a system that takes 
your

[[Page H13046]]

money but will not cover you? That doesn't sound very fair. And that 
process, that provision, that practice will be eliminated. Done. No 
more. My friends on the other side voted against that.
  Also in the House version, the 27 years old and the preexisting 
condition provisions happen as the bill is passed; so that will start 
immediately. The exchange and some other things start in 2013, but 
those two provisions start immediately. So the American people will see 
the benefits of that rather quickly.
  Another provision in this bill says that there will be limits to the 
amount of money a person or family can spend a year. In the House bill 
it was about 12 percent of your income, which is still a lot. So if you 
make $50,000 or $60,000 a year, if you have a health care catastrophe 
in your family, after you pay $5,000 or $6,000 out of pocket in health 
care, you're done paying for the rest of that year. So families in 
America will no longer go bankrupt because they have a health care 
catastrophe in their family.

                              {time}  1700

  Now, if that is not a human rights issue, I don't know what a human 
rights issue is. And that is exactly what this bill does. So, no matter 
what, families in this country will not go bankrupt because of health 
care situations in their family.
  And if you look at my district alone, 17th Congressional District, it 
stretches from Akron through Kent, Ravenna in Portage County, Warren 
and Niles in Trumbull County, and Youngstown, Ohio, in Mahoning County, 
the old Steel Belt. Just last year, in my district, 1,700 families went 
bankrupt because of health care, 1,700 families. And what this 
provision will do is eliminate that. That will no longer happen as it 
happens here today in the United States of America.
  So, our friends on the other side are three for three now. They voted 
against extending insurance to kids or allowing kids to stay on their 
parents' insurance until they are 27 years old, they voted against 
that. We said that you can no longer be denied coverage because of a 
preexisting condition, diabetes, cancer, heart disease, asthma. We put 
an end to that practice. Republicans on the other side, except for one 
courageous soldier down in Louisiana, all voted against it. And those 
two provisions will start immediately upon this bill's going into 
effect. The limiting of 12 percent of your income that could be paid 
out of pocket per year on health care expenses, so that we don't have 
people go bankrupt, passed in the health care reform. Every Republican, 
save one courageous soldier down in Louisiana, voted against it.
  Our friends on the other side were talking about small business, 
small businesses being affected by this. Eighty-six percent of small 
businesses will be exempted from this legislation. But they will be 
able to go in to the health insurance exchange and all of a sudden have 
a lot more bargaining power than they had before, because they would 
call their health care folks up and say, what do you got? What's the 
package? How many employees do you have? Ten, 15, 20. An average 
increase, or the increase over the last 6 or 7 years, has been about 
120 percent increase for small businesses. This allows these small 
businesses, Mr. Murphy, to go into the exchange, to pool their numbers, 
to get better negotiating power, more negotiating power and better 
rates, because of their ability to pool with each other. And that will 
reduce health care costs for small businesses.
  At the end of the day, it's going to be the small business folks who 
will see this health care reform as a real step into trying to help 
them control health care costs so they can reinvest back into their 
company.
  I yield to the gentleman from Connecticut.
  Mr. MURPHY of Connecticut. Thank you, Mr. Ryan. I thank you for 
convening us down here again. And I think you're right to focus on the 
issue of small businesses because that is where the problem has laid 
for a very long time. Small business men and women with a couple of 
employees, maybe 10, 15, 20 employees, they want to do the right thing. 
They want to provide insurance for their employees, but with the kind 
of margins that they face normally, and in particular with the kind of 
margins they are facing in this tough economy, combined with their 
inability to access capital from the lenders in their community who 
might be providing them with loans, means they don't have the room to 
provide health care.
  In my district, it prompted one individual, a brave small businessman 
named Kevin Galvin who had had his own experience with confronting our 
very backwards health care system when his daughter got very sick, and 
it forced that family to go through layers of bureaucracy and layers of 
appeals to try to get their own insurance company to cover her. He runs 
a small business in Connecticut, a maintenance company that employs a 
handful of people. And their margins are so small that he can't afford 
to provide insurance for his employees. Now he has gone through it, the 
tragedy of trying to cobble together the money and the insurance claims 
in order to pay for the care of a sick loved one. And so, it has ripped 
him apart that he can't provide insurance for his employees.
  So he decided to go out and do something about it. He decided to go 
out in Connecticut and organize small businesses around the State for 
health care reform. And his group, Small Businesses for Health Care 
Reform, centered in Connecticut, has thousands, thousands of members 
amongst the Connecticut small-business community, all rallied around 
our effort to provide relief for those small employers that desperately 
want to get health care for their employees but they can't.
  They can't in part of because of the margins that they have. They 
can't also because they, on average, as you pointed out, Mr. Ryan, are 
paying about 15 to 20 percent more in premiums than large businesses 
are. It is just a matter of simple economics. If you're bargaining with 
the insurance companies on premiums for only a handful of employees, 
you're just going to get a worse deal and have to pay a higher price 
than you will if you're a big business that has a couple hundred 
employees.
  And so he and his group see the genius in what we are trying to do 
here, which is to not erase the private market, not substitute our 
current health care system with some other country's health care 
system, not engage in what the cable news talk show hosts claim is a 
government takeover, but simply to make the existing market work 
better, to allow Kevin Galvin and his handful of employees to join 
together with all of those other small businesses who are in the same 
position with all of those other uninsured individuals and sole 
proprietors who are negotiating on behalf of only themselves, to put 
them all in a pool and to allow them to negotiate for lower premiums 
against the insurance companies with the kind of bulk purchasing power 
that we know works.
  So we have small businesses throughout Connecticut that are standing 
up and screaming for health care reform because they want to provide 
health care for their employees. And those that already are are being 
crushed by the weight of those premiums. So when they look at this 
bill, when they see the health care exchange pooling all of their 
purchasing power together, when they see the tax credits in the bill, 
that in my district alone, Mr. Ryan, are going to mean that 17,000 
small businesses will now pay lower taxes because they are going to be 
able to offset their health care expenses against their tax obligation, 
they see a tremendous benefit.

  And if we want to point the way forward on the economic 
revitalization of this country, if we want to start to plot a real 
strategy about how we grow jobs, jobs in this country, small businesses 
are the solution. And picking up off of their shoulders the crushing 
weight of health care costs is one of the most effective strategies in 
allowing them to start growing jobs again, Mr. Ryan.
  Mr. RYAN of Ohio. I appreciate that. The gentleman makes the point 
that what this is all about is jobs. This is an economic development 
bill. This is about allowing these businesses to reinvest back into 
their small businesses. It is not a coincidence that as health care is 
eating up more and more of the businesses' budget, that wages have been 
stagnant over the last decade or two because the small business owner 
does not have the ability to both eat

[[Page H13047]]

the increases in health care and give the requisite amount of pay 
increases to the workers. It's either or.
  So over the last decade, it has been all health care, all the time. 
And sometimes they have passed on a smaller portion of that on to their 
employees where they are asking for more of a co-pay, higher premiums 
and the whole nine yards. But now, what we are saying is if we can get 
these costs under control, those small businesses can reinvest back 
into technology, back into the new machines, back into the wages, back 
into the training, back into more benefits and other kinds of benefits, 
maybe retirement benefits, for their workers instead of being stuck in 
this cycle of health care, health care, health care, health care and no 
reinvestment back into the business.
  Mr. MURPHY of Connecticut. Mr. Ryan, in Connecticut alone, our 
largest insurer, which insures over half the individuals in the State, 
announced earlier this year that they were going to be passing down a 
30 percent premium increase to small businesses, small group plans and 
individuals--30 percent. It's beyond me to figure out how on Earth 
health care costs changed so much from last year to this year that you 
can justify a 30 percent increase, but from a small business 
standpoint, that causes thousands of small businesses to walk away and 
say, that's too much.
  My business in a recession is dropping, and you're asking me to pay 
30 percent for one of my biggest line items? It causes individuals who 
were just being able to cobble together the money that they could to 
pay for insurance to walk away and say, listen, I have had my wages 
held flat this year. I can't go out and pay a 30 percent increase.
  And it causes our Republican friends to shutter their ears and close 
their eyes and pretend that all of those people and all of these 
employees who lose their health care because of the 30 percent increase 
are going to suddenly spend the rest of the year really, really super 
healthy and never need to get health care. They are going to get sick. 
Those employees are going to get sick. Those individuals who had to 
walk away from care because the premium increase was too high are going 
to get sick. And they are going to get so sick that they are going to 
end up in our emergency rooms. And then we are all going to pay for it. 
We are going to pay for it in higher taxes to subsidize emergency room 
care. We are going to pay for it in higher private premiums to make up 
for the uninsured that walk into the doors of those hospitals. And we 
are going to end up perpetuating our current system of sick care where 
we force people to go without insurance, wait until they are so sick 
that they show up at the emergency room for the most expensive, and 
frankly, most inhumane type of care, crisis care, which costs us all a 
lot more money in the long run, Mr. Ryan.
  Mr. RYAN of Ohio. Yes. And it has all been fear-based. One of our 
colleagues on the other side said the tea baggers are beyond, they're 
beyond scared; they're terrified now. They are terrified because of the 
budget. Where were these people when President Bush and the Republican 
Congress and House and Senate were cutting taxes for millionaires and 
starting two wars and spending money left and right and running up the 
deficit? And now they're terrified because we're saying we want to help 
small businesses, we want to help citizens in the United States be able 
to afford health care?
  We're taking on the insurance industry, Mr. Speaker. What is so 
difficult about this to understand? They have been ruling the roost in 
the country for how long? And we're stepping in after an election in 
2006 where the American people were fed up, an election in 2008 where 
President Obama won, and basically, a huge election, and he talked as a 
centerpiece of his campaign about health care reform. And here we are.
  I'm sure our districts aren't that much different, manufacturing, a 
lot of immigrants came over the last 100, 150 years to our States, and 
a lot of middle class people, and our people don't get on a bullhorn 
and scream about their problems that they have in their family. They 
have a lot of pride, but they just want to muscle through it. But they 
want an element of fairness in the system. And so they will, as I said, 
and I don't know if you were here or not, they will grab me at the 
restaurant and thank me for my vote and say, I hope it passes, or I 
hope it pulls through.
  But they are not going to call Rush Limbaugh and call in and talk 
about how their daughter is sick and the problems they had and go on 
and on. But when I stood at the Canfield Fair or, this weekend, going 
into a restaurant or getting my hair cut, whatever the situation was, 
they would grab me and they would quietly say, thank you. God, is this 
going to pass? Is this really going to happen? That's what average 
people are saying here today.
  These situations that go on all across our country, and to turn a 
blind eye to it, and the Republican proposal doesn't even cover 
everybody. It was like, here is our proposal. Great. You cover another 
million people. Boy, that is really going to bring down the pressure on 
the emergency rooms.

  And this is pretty simple. I talked about the reforms. If you make 
$89,000 a year or less, you are going to get credits, subsidies, to 
help you pay for your insurance so that family will have more money to 
spend in other parts of the economy. Instead of health care eating a 
huge chunk of the economy up, they will have money to pay for their 
kids' college education, to make investments to buy a new car, to keep 
the auto industry going, buy a new refrigerator, buy a new house.
  Literally, if you think about just an $1,800 increase next year in 
health care bills, if we get health care costs under control, imagine 
the amount of money these families and small businesses are going to 
have to spend in buying durable industrial goods.
  Mr. MURPHY of Connecticut. This is not my line; I think others have 
said this, but this is a consumer takeover of the health care system. 
That is what this is. This is putting consumers and patients and 
regular, average, ordinary Americans back in charge. And people were 
angry about a lot of things when President Bush was in charge and the 
Republicans controlled the House and Senate. They were angry that it 
seemed like the oil companies were running our energy policy. They were 
angry that the banks seemed to get whatever they wanted when it came to 
financial policy. And they were angry that the insurance companies and 
drug companies seemed to get everything they wanted when it came to 
health care policy.
  And they had a pretty good examples, Mr. Ryan, why that happened. I 
will add to your list of all of the deficit increases over the course 
of the Republican control of this Congress. Medicare part D, the one 
time that this House of Representatives woke up and decided to 
legislate on health care, they did it in a way that guaranteed enormous 
profits for the insurance and drug industry, in particular by inserting 
a provision into the Medicare part D law that specifically prohibited 
the Federal Government from negotiating deep discounts on behalf of all 
Medicare beneficiaries against the drug companies. And they paid for it 
all by borrowing.
  So this sudden conversion to fiscal responsibility by the Republicans 
is pretty transparent to people that have been caring about health care 
for long enough to remember when Republicans came here, proposed and 
passed a Medicare drug benefit that was written by the drug and 
insurance industry and paid for by borrowing.

                              {time}  1715

  So for all of those TEA baggers out there and all of those non-TEA 
partiers who are concerned about the deficits, this health care bill 
isn't just deficit neutral; it brings down the deficit by $30 billion 
over the course of 10 years. You can argue about the policy, but you 
can't argue with the CBO score. The Congressional Budget Office says 
that this bill, over the course of 10 years, will bring down the 
deficit, and actually tells us that in the second 10 years will bring 
down the deficit by even more, standing in contrast to the Republicans' 
sole effort at health care reform when they controlled this place, 
which handed more power to the industries that were running the joint 
to begin with, and did it all by borrowing.
  So, Mr. Ryan, it's the war, it's the tax cuts, but it's also the 
Republicans' policy on health care. And I don't have a lot of sympathy 
for our Republican friends who come down here and talk

[[Page H13048]]

to us about the health care implications for the deficit. Our bill 
lowers the deficit. Their one attempt at health care reform massively 
increased the deficit.
  Mr. RYAN of Ohio. It's not just Chris Murphy from Connecticut or me 
or Nancy Pelosi. Here's from the Business Roundtable. CEOs of the 
Nation's largest businesses released a report on the impact of health 
care legislation moving through Congress and that, ``Key components of 
health care reform could slow the growth of health care costs and offer 
real savings for companies and their employees.''
  According to the Business Roundtable Hewitt study, many of the 
legislative reforms currently in the health reform bill could reduce 
costs by as much as $3,000 per employee by 2019. This is the Business 
Roundtable. This is not the Democrats. This is the CEOs of the Nation's 
largest businesses.
  As you said, CBO, Business Roundtable, this is what we're trying to 
fix. And when you have the CEOs of the Nation's largest businesses 
saying that this reform will save us $3,000 per employee by 2019, and 
you have hundreds and hundreds and hundreds, if not thousands of 
employees, that money is going to go to wages, investments, technology. 
On and on and on these investments will be made, not sit around and do 
nothing.
  Republicans just came--in the last week, finally, they had a 
proposal. We've been debating about health care for all this time and 
they were in control of every major branch of government from 2000 to 
2006. Didn't do anything about health care. Now we're coming to try to 
fix it.
  Mr. KING of Iowa. Will the gentleman yield?
  Mr. RYAN of Ohio. I'd be happy to yield.
  Mr. KING of Iowa. I thank the gentleman from Ohio.
  I just recall that we were here together when we passed the 
litigation lawsuit abuse reform out of the House and it got stalled up 
in the Senate. That would be one thing I would point out that I think 
is important from an objective standpoint.
  Mr. RYAN of Ohio. Reclaiming my time, litigation has been projected 
to have only 1 percent effect on the costs of overall health care 
spending.
  Mr. KING of Iowa. If the gentleman would yield, $54 billion was the 
score on the bill introduced this year.
  Mr. RYAN of Ohio. Over 10 years.
  Mr. KING of Iowa. Yes.
  Mr. RYAN of Ohio. One percent of cost. And there is no real way to 
quantify--reclaiming my time--no real way to quantify this number. But 
when you're talking about billions and billions and billions of 
dollars, again, that's to my point, is that the Republican plan is to 
just kind of nibble around the edges and maybe we'll try to do this a 
little bit here and a little bit there, but at the end of the day 
here's the reality.
  Since we have gotten in office and with President Obama, but before 
that, we took on the banks and yanked them out of the student loan 
business because they had a sweetheart deal. As you said, with Medicare 
part D, where all of this money is going to the pharmaceutical 
companies, we are reforming that provision as well. Now we're taking on 
the insurance companies.
  With the energy bill, we took on the oil companies, where they're 
getting subsidies. And just a couple of years ago we spent $115 or $120 
billion dollars in escorting ExxonMobil ships in and out of the Middle 
East so that they would be safe to further supplement and subsidize the 
oil industry. We took on the oil industry.
  Increased minimum wage, increased Pell Grants. We made steps to make 
investments. But the bottom line is this health care reform bill is 
about economic development in the United States of America.
  Mr. MURPHY of Connecticut. And people have been crying out for it, 
Mr. Ryan, and I think that's why you and I both have families coming up 
to us and, as you said, kind of quietly expressing to us their stories. 
Folks in my district do it the same way. But you find them. You hear 
from them.
  I remember knocking on somebody's door this summer as I was going 
around a couple of neighborhoods to check in and hearing a guy talk 
about his illness. He had actually, I think, been injured, and his 
worker's comp didn't pay for the entirety of the care that he needed, 
so he had to go to his primary insurer. He had to pay for some of it 
out of his own pocket.
  It got so bad and his expenses got so high that the only place he 
could go without losing his house was the one main savings account he 
did own, and that was his child's college fund. And so he planned at 
first to only take a little bit out from his child's college fund 
because he figured he could get his insurer to pitch in a little bit, 
figured the economy might turn, he might be able to get a little better 
job, and then he had to go back again. And he had to go back again. By 
the time I saw him this summer, that college fund was gone. He had no 
money saved for college. The only way that his son, who by this time 
was in his teenage years and only a few years from going to college, 
the only way he was going to be able to go to college was if he got a 
full ride somewhere. His son's dreams have evaporated because of health 
care costs, because of illnesses.

  Now, this particular family had that money saved away for college and 
so it's not one of the thousands of families that went into bankruptcy. 
So we should remind ourselves that when we hear all these statistics 
about the thousands and thousands of families who go into bankruptcy 
every year just because Mom got cancer, that doesn't count all the 
families who did the responsible thing and were able to squirrel away a 
little bit of money and exhausted all of it, changing their plans 
forever. So layer on top of all of the bankruptcies the hundreds of 
thousands of families who were ruined without bankruptcy because of the 
crippling cost of medical care.
  So this is being celebrated by all of these families out there who 
have had their lives change for so many different reasons, because they 
do see that they're actually going to get some wages back from their 
employer who doesn't have to spend every dime on health care. But they 
also see that this bill is going to give them some security that a lot 
of people thought just came with being a citizen of the most powerful, 
the most affluent country in the world.
  You're right, Mr. Ryan. That does involve taking on the insurance 
industry. That does involve stepping up to the plate and telling them 
that they're wrong. For the life of me, it's beyond me why this 
Congress hasn't been able to do that. And I get that that invites the 
ire of the health care industry that has had their way for so long. I 
get that that means there's going to be a lot of commercials on the air 
criticizing Members who voted in favor of this and those that might 
vote in favor of it in the Senate. But it's been a long time coming for 
those families that we both know and those small businesses that have 
been calling for it.
  Mr. RYAN of Ohio. Think about it. Just in the 17th Congressional 
District, 14,000 small businesses will now be better off because 
they're going to be negotiating with more and other small businesses to 
try to bring down prices. And 12,300 small businesses in my 
congressional district will be getting tax credits as an incentive to 
compensate for this; 43,000 people will now have insurance that didn't 
have insurance.
  We have, in Youngstown, a hospital that just filed bankruptcy. Now 
all of a sudden every single person that walks through that door will 
have health insurance instead of that cost being passed on to everyone 
else.
  I can't help but to think about the gentleman that you were just 
talking about who had to spend through his kid's college fund. If these 
reforms were in place, that person's amount of out-of-pocket 
expenditures would be limited to 10 or 12 percent of that family's 
income. So they wouldn't have had to go into the college fund. Our 
friends on the other side voted against that.
  So we have got to go back to our constituents and defend every vote 
that we have made here. And that is, to me, significant. The 
preexisting condition, not being kicked off your insurance because you 
get sick, being able to stay on your parents' insurance until you're 27 
years old, all of those are significant steps in the right direction, 
not to mention on Medicare part D by extending and having consistent 
drug coverage throughout the course of the entire year instead of 
interrupted coverage, which is happening now.

[[Page H13049]]

  I got a letter from a doctor this summer who was telling me about a 
patient that he had that met her limit on part D. And I can't remember 
at this point exactly what the issue was with her, but they had to take 
her from the drug of choice to a cheaper drug because she couldn't 
afford it. So, in June or July when she met her cap, they had to switch 
prescriptions because she couldn't afford the one that he had her on. 
She ended up getting sick. They switched prescriptions again and again, 
and she ended up in the hospital for a week or two.
  It's the perfect example of why would you not just--how much cheaper 
would it have been for the taxpayer to consistently pay for those 
prescriptions throughout the course of the year instead of her going 
into the hospital for a week or 10 days or 2 weeks and having Medicare 
pay for that? It just doesn't seem like a very smart investment on 
behalf of the taxpayer.
  Mr. MURPHY of Connecticut. Listen, it's the reason, Mr. Ryan, why 
AARP has come out so strongly in favor of this bill, because they know 
that this is a good bill for seniors. Now, a lot of Democrats disagreed 
with the fact that AARP came out and supported the Medicare 
prescription drug bill when it did, but it, frankly, shows that this is 
a group that, when they think it's right for seniors, is going to 
support it whether it's a Republican or Democrat proposal. Because I've 
heard a lot of Republicans and conservative talk show hosts come out 
and say, Well, the AARP endorsement doesn't mean anything. They're 
friendly to Democrats. Well, they endorsed the Medicare prescription 
drug benefit, which was, I think, voted on almost solely by 
Republicans. So whether we agree or disagree with their support for 
that, they've played both sides of this debate.
  But AARP supports this bill because it gets rid of the doughnut hole. 
Now it takes a little while to fully get rid of it, but on day one 
after this bill is passed, the size of the doughnut hole gets reduced 
by $500, and for every senior that walks into the pharmacy when you're 
in that moment of exposure, the cost of a brand name drug is going to 
be cut in half. Every single brand name drug for seniors in the 
doughnut hole gets cut by 50 percent immediately with the passage of 
this bill.
  When you walk in to get your checkup, no longer does any senior have 
to come up with money out of their pocket. Medicare is going to pay for 
that now, because we know it just makes sense to have no barriers to 
preventative health care for seniors.
  So AARP, joining the American Medical Association, joining Consumer 
Reports, joining dozens of other specialty physician groups out there, 
has supported this legislation because they see the benefit for that 
senior that you're talking about on Medicare part D and millions more.

                              {time}  1730

  Mr. RYAN of Ohio. The idea here is that this is how this bill will 
extend Medicare's life an additional 5 years, in part because of cost 
savings and a variety of others. But we are going to have healthier 
people going into the Medicare program. Right now we have people that 
are 55, 60 years old, and we see a lot of them in our communities, the 
older manufacturing communities. You work until you're 55, you work 
until you're 60, and then all of a sudden, the company goes bankrupt or 
they lay you off or they move the factory to Mexico or to China or 
whatever the case may be.
  I have met several of them, have talked to them on telephone town 
halls. One woman I remember in particular was 60 years old. She did not 
lose her job, but lost her health care coverage. The company could no 
longer afford it. So now she is 60. She makes $32,000, $35,000 a year, 
can't make it, can't afford health care coverage. She said, I'm going 
to wait until I get on Medicare. So here you have someone who is 60 
years old, probably has some issues because everybody at 60 has issues. 
Now a physician won't manage those problems that she has. She is going 
to go without any care, any treatment, any kind of management 
whatsoever. So she is going to go into Medicare at 65 much sicker than 
she would have went in if she had decent health care where her problems 
could have been managed and not become chronic to the point where they 
could cost the Medicare system thousands and thousands, tens of 
thousands of dollars, hundreds of thousands possibly, depending on what 
the issue is.
  So you have a healthier person going into the Medicare program that's 
going to extend the life of Medicare. What kind of system is this, 60 
years old, you have worked your whole life, and they say, Sorry, you're 
on your own; we will pick you up at 65. Thanks for everything. You lost 
your health care. That is not right. That is not right, Mr. Speaker, 
and that is what this whole program is trying to fix.
  Mr. MURPHY of Connecticut. I will just add one last thing, Mr. Ryan. 
The people we're talking about--you know, the stories that we're 
telling, I don't think you or I know whether these people that have 
approached us are Republicans or Democrats. I have no idea whether that 
guy who had to drain his entire college savings watches MSNBC or 
watches FOX News. I have no idea because health care crises, health 
care-caused bankruptcies strike Republicans and Democrats, liberals and 
conservatives, people on the left and people on the right. This is a 
nonpartisan, nonpolitical issue.
  Maybe I was naive when I came here a couple of years ago, but I just 
thought that there was going to be a way with 50 million people 
uninsured, with health care costs rising 120 percent for the average 
small business in this country over the last 10 years, with 
bankruptcies caused by medical costs on the rise. I just figured that 
there would be a way for Republicans and Democrats to get together on 
this to say, Let's do something. I think for the longest time, I 
believed that there was still going to be a chance for Republicans to 
come to the table here. I don't want to believe that the Republicans' 
opposition to this bill is just about political gain. I don't want to 
believe that the reason that Members come down here and oppose every 
single thing the Democrats want to do and then propose an alternative 
bill that was a joke--which actually left more people uninsured at the 
end of its life than had the bill not gone into effect--I just don't 
want to believe that, but there is mounting evidence of that case.
  So listen, this thing is not over, Mr. Ryan. We're going to continue 
to come down here and press the case for reform. We're going to 
continue to come down here and press the need for both parties to be 
part of this compromise, to be part of this solution. But it is 
increasingly apparent that there is only one piece of this House and 
one piece of the Senate that is really pushing to get this done for the 
American people. I wish that wasn't the case, and we'll continue to try 
to press for a change, Mr. Ryan.
  Mr. RYAN of Ohio. The bottom line is this, the Business Roundtable, 
the top CEOs in the United States, say that our provisions in this bill 
will save them as much as $3,000 per employee by 2019. The top CEOs in 
our country are saying that this is going to be the case.
  But as we wrap things up here, Mr. Murphy, let's use some good common 
sense here. We're going to take 30 million people who wait until they 
get absolutely deathly sick and then go to the emergency room off and 
out of the emergency room rolls, get them preventive care, solve 
problems of $20 prescriptions instead of nights in the hospital, and 
reduce health care costs overall. Eliminate costs for preventive 
coverage so people in Medicare and others actually get preventive 
coverage as well.
  Help by raising taxes on millionaires and take some of that money to 
give health care credits and subsidies to middle class people so that 
they can afford their health care, get preventive care, stay healthier 
and become more productive. It all makes a great deal of sense. We're 
saying to parents that your children can stay on your insurance until 
they're 27 years old. We're saying that you can never be denied 
insurance coverage because you have a preexisting condition. You can't 
be kicked off your insurance because you get sick. You can only spend 
out of pocket 12 percent of your annual income so that you don't go 
bankrupt like 1,700 families went bankrupt in the 17th Congressional 
District of Ohio last year.
  Extend prescription drug coverage to seniors throughout the year, not 
any

[[Page H13050]]

kind of stoppage in the middle of the year, and make sure that we 
extend the life of Medicare by 5 more years because of these reforms. 
This is basic bread-and-butter commonsense reform. This is not the 
radical kind of reform our friends on the other side want people to 
believe. It's not what Glenn Beck and Rush Limbaugh and all the scare 
tactics, ``The government is coming to take you over.''
  It's not any of that. It's basic reforms that the American people 
want. And, lastly, let me just say that people still continue to talk 
about this being an issue of freedom, and our friends on the other side 
keep saying that this is about liberty and freedom. You know what, I 
agree with them. The person that goes bankrupt because they can't 
afford health care is not free in the United States of America, and the 
person who pays tons of money into the insurance industry and doesn't 
get any coverage, that doesn't seem like you're very free. When you're 
sick and you can't afford a doctor, you are not free.

  Let's talk about freedom in 2009 and 2010. It means being healthy, 
productive, getting what you pay for and being able to support your 
family and your business. That's freedom. How free is a businessman who 
has got to pay a 30-percent increase in health care costs every year? 
It doesn't seem very free to me.
  So, Mr. Speaker, we'll continue to talk about this and jobs and other 
issues that are facing this country. We appreciate the opportunity to 
be here.

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