[Congressional Record Volume 156, Number 24 (Wednesday, February 24, 2010)]
[House]
[Pages H771-H791]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH INSURANCE INDUSTRY FAIR COMPETITION ACT
Mr. CONYERS. Madam Speaker, pursuant to House Resolution 1098, I call
up the bill (H.R. 4626) to restore the application of the Federal
antitrust laws to the business of health insurance to protect
competition and consumers, and ask for its immediate consideration.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 4626
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Insurance Industry
Fair Competition Act''.
SEC. 2. RESTORING THE APPLICATION OF ANTITRUST LAWS TO HEALTH
SECTOR INSURERS.
(a) Amendment to McCarran-Ferguson Act.--Section 3 of the
Act of March 9, 1945 (15 U.S.C. 1013), commonly known as the
McCarran-Ferguson Act, is amended by adding at the end the
following:
``(c) Nothing contained in this Act shall modify, impair,
or supersede the operation of any of the antitrust laws with
respect to the business of health insurance. For purposes of
the preceding sentence, the term `antitrust laws' has the
meaning given it in subsection (a) of the first section of
the Clayton Act, except that such term includes section 5 of
the Federal Trade Commission Act to the extent that such
section 5 applies to unfair methods of competition.''.
(b) Related Provision.--For purposes of section 5 of the
Federal Trade Commission Act (15 U.S.C. 45) to the extent
such section applies to unfair methods of competition,
section 3(c) of the McCarran-Ferguson Act shall apply with
respect to the business of health insurance without regard to
whether such business is carried on for profit,
notwithstanding the definition of ``Corporation'' contained
in section 4 of the Federal Trade Commission Act.
The SPEAKER pro tempore. Pursuant to House Resolution 1098, the
gentleman from Michigan (Mr. Conyers) and the gentleman from Texas (Mr.
Smith) each will control 60 minutes.
The Chair recognizes the gentleman from Michigan.
General Leave
Mr. CONYERS. Madam Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their remarks
and insert extraneous material on H.R. 4626.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Michigan?
There was no objection.
Mr. CONYERS. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker and my colleagues, the bill before us will allow, for
the first time, competition to take hold in the health insurance
marketplace, an important and vital step in the road to fixing our
broken health insurance system and containing costs. I want to commend,
in particular, my colleagues Tom Perriello of Virginia and Betsy Markey
of Colorado for working with our committee on this important effort.
Experience has shown that Congress--and we hate to admit having made
mistakes in the past, but we did make an error in 1945 in adding an
antitrust exemption into the McCarran-Ferguson Act at the last minute
during the debate. Not many of you were here at that time, and neither
was I, but leading consumer groups and senior citizen groups, State
attorneys general and others for years have been urging that we in the
legislature fix this error that has been made so long ago.
The bipartisan Antitrust Modernization Commission established by this
body and President Bush in 2002 echoed this call in its 2007 report.
And now, as we work to fix what everyone mostly agrees is a broken
health insurance market, it is about time to bring into that market
what is an essential ingredient of any well-functioning market--
competition. And the way we make sure that happens here is the same way
we made sure it happens in every other industry--to have the antitrust
laws apply. These laws are the principal protector of free market
competition and the prosperity it provides, the principal guarantee
that businesses who want to offer choice and value to consumers can do
so.
The blanket antitrust exemption in the McCarran-Ferguson Act shields
health insurance companies from legal accountability for fixing prices,
dividing up markets and customers they serve so as to deny meaningful
choice, and using monopoly power to sabotage anyone who seeks to offer
meaningful competitive choice to consumers. This, ladies and gentlemen,
must end.
Antitrust court actions alleging each of these practices, and more,
have been blocked routinely in the courts by invoking the McCarran-
Ferguson antitrust exemption, and that is what we are here to repair
today.
Now, an antitrust expert attorney, David Balto, with antitrust
enforcement experience acquired both at the United States Justice
Department and the Federal Trade Commission, has found that State
insurance commissioners have not brought any actions in any State
against health insurers for anticompetitive conduct during at least the
last 5 years.
Health insurance premiums continue to spiral ever-upward each year,
and copayments and deductibles keep taking further bites out of tight
family budgets. Those families have a right to know that they are not
being victimized by insurers any longer who should be competing to
offer them choice and value but, instead, are, unfortunately,
conspiring against them.
In its famous Topco ruling, the United States Supreme Court refers to
the antitrust laws as the Magna Carta of free enterprise. The health
insurance industry should not be exempt from them.
The Judiciary Committee has been working to remove this harmful
exemption for a number of years. We made a lot of headway under the
distinguished chairman, our former colleague, Jack Brooks of Texas, who
[[Page H772]]
headed the committee after Peter Rodino and after Emanuel ``Manny''
Celler, and it is time to complete this effort in the area of health
insurance since this is the number one subject, legislatively, before
us being watched carefully by everyone in the Nation.
Last fall, our Judiciary Committee reported a similar bill which was
incorporated into the comprehensive health care bill passed by the
House. And so I commend my colleagues, Representatives Perriello and
Markey, for their leadership in bringing this effort back to the House
floor today as a freestanding measure.
With more and more people having to choose between having health
insurance or food on the table, isn't it about time the health
insurance companies' cozy antitrust exemption be taken off the books?
So I urge all my colleagues to support this long-overdue, pro-
consumer legislation that will affect citizens and families in every
State.
Madam Speaker, I reserve the balance of my time.
Mr. SMITH of Texas. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, H.R. 4626, the Health Insurance Industry Fair
Competition Act, unfortunately doesn't do much. In fact, it has all the
substance of a soup made by boiling the shadow of a chicken.
In his State of the Union address on January 27, President Obama
challenged Congress to create a plan that ``will bring down premiums,
bring down the deficit, cover the uninsured, strengthen Medicare for
seniors, and stop insurance company abuses.'' The administration's
health care plan does just the opposite. It increases premiums,
increases taxes, and reduces Medicare benefits for seniors.
Will today's McCarran-Ferguson repeal bring down insurance premiums?
No. The Congressional Budget Office says that ``whether premiums would
increase or decrease as a result of this legislation is difficult to
determine, but in either case the magnitude of the effects is likely to
be quite small.''
{time} 1245
So what's the point of the bill?
The CBO goes on to say that premium reductions from this bill are
likely to be small because ``State laws already bar the activities that
would be prohibited under Federal law if this bill was enacted.''
So what's the point of the bill?
The National Association of Insurance Commissioners pointed out that
bid-rigging, price-fixing, and market allocation ``are not permitted
under the McCarran-Ferguson Act, and are not tolerated under State law.
Indeed, State insurance regulators actively enforce prohibitions in
these areas.''
So, again, what's the point of the bill?
The McCarran-Ferguson Act's Federal antitrust exemption simply allows
small and medium-sized insurers to aggregate information for
underwriting purposes so they can compete effectively against larger
companies. In other words, McCarran-Ferguson helps to promote
competition by making small and medium-sized underwriters viable.
Eliminating the exchange of data provision that was included in
earlier versions of this bill likely will impede new entry into the
health insurance markets. This means that there could be less
competition among health insurers.
That said, I believe, as does the Antitrust Modernization Commission,
that antitrust exemptions should be rarely granted or created. Yet, if
they are necessary, they should be written in as limited a way as
necessary to meet a compelling public policy goal.
I can understand why some of my colleagues may want to support this
bill, and given that it will have no meaningful impact, I don't oppose
it. However, when repealing an existing antitrust exemption, we should
be careful of the unintended consequences of our actions.
The majority has avoided one unintended consequence of this
legislation by limiting its application solely to health insurers.
Eliminating malpractice insurers goes a long way toward making this
bill more reasonable. However, the majority should adopt further
changes to this bill to demonstrate that they are more interested in
legislating than in targeting an unpopular industry for no real policy
reason.
Specifically, this legislation should be amended to define the term
``business of health insurance.'' Second, we should reinsert the
exchange of data provision that was added to the bill in committee.
Finally, we should clarify that this bill will not impinge upon State
insurance regulations. None of these concepts are revolutionary. They
were all included in earlier versions of this legislation that were
passed by the House.
That said, if the majority really wants to help consumers, we should
consider a measure that could actually achieve savings for patients:
medical malpractice tort reform.
According to a study by the Harvard School of Public Health, 40
percent of all medical malpractice suits against doctors and hospitals
are ``without merit.'' So every doctor must purchase malpractice
insurance at great expense to protect themselves from frivolous
lawsuits.
A Department of Health and Human Services study found that unlimited
excessive damages add $70 billion to $126 billion annually to health
care costs. Doctors are so concerned about frivolous lawsuits that they
have to practice defensive medicine and order unnecessary tests and
procedures. HHS estimates the national cost of defensive medicine is
now more than $60 billion.
All of these expenses are then passed on to patients in the costs of
health care. That is why some States, including my home State of Texas,
have enacted tort reform, which limits the amount of excessive damages
awarded in frivolous lawsuits. The result? Insurance premiums have
fallen, and the availability of medical care has expanded. But this
bill will do nothing to reduce the costs of health care.
Congress should set aside this bill, and it should take up lawsuit
abuse reform, which could reduce health care costs for our
constituents.
Madam Speaker, I reluctantly support this, unfortunately, ineffective
bill.
I reserve the balance of my time.
Mr. CONYERS. Madam Speaker, before I yield to Sheila Jackson Lee, I
yield myself 1 minute because my dear friend, the ranking member,
asked, What is the point of this legislation?
We have made a long list of points of this legislation. To begin
with, it is to increase competition in the health care industry. It
also is to shine a light on industry practices that are currently
unavailable and undetectable because of the exemption. That's why we
are on the floor today.
I yield 3 minutes to a distinguished member of the committee, the
gentlewoman from Houston, Texas, Sheila Jackson Lee.
Ms. JACKSON LEE of Texas. I thank the distinguished chairman.
Madam Speaker, I rise to announce to the American public and to this
body that, as we stand here today, over a year's time, 45,000 Americans
die because they don't have health insurance. They don't have health
insurance because the premiums have literally spiraled beyond any
imagination. So, today, we are rising to create an opportunity for
Americans to live and for lives to be saved because competition is the
engine, not only of the economy, but it is the engine of better health
care for all Americans.
Here is an example that shows how increased premiums are the complete
opposite of commitment and service to our constituency: When the State
of California passed a law in 1988 that eliminated the State antitrust
exemption for the auto insurance industry, auto premiums for consumers
in California rose 9.8 percent when the rest of the premiums in the
Nation were going down. The Consumer Federation of America said that
consumers would save over $50 billion in insurance premiums by
repealing the 1945 McCarran-Ferguson Act.
I thank the distinguished colleague from our Judiciary Committee, Mr.
Perriello, for his leadership, along with many others.
Removing the antitrust exemption will not only enable appropriate
enforcement against these unjust practices when they are uncovered, but
it will also give all health insurance companies healthy competitive
incentives so you as a family of four, as a grandmother, as a single
parent can get the
[[Page H773]]
insurance possible as we move forward in health insurance.
The attorney general of New York, in his investigation, found that
insurance companies engage in collusion. That's why we need this. We
want to break the rules so we can help doctors with lower premiums and
medical malpractice and with shielding our constituency from these
Godforsaken prices.
Let me tell you that we have seen this in action in the Ocean State
Physicians Health Plan v. Blue Cross and Blue Shield. Citing this act,
this antitrust prevention act, the First Circuit overturned a jury
verdict against the dominant health insurer for using its monopoly
power to put financial pressure on area employers to refuse to do
business with a competing HMO. The First Circuit, because of the
exemption, blocked any opportunity for competition. We need to change
this, and we have found that this collusion is hurting us.
So, Madam Speaker, I would say to you that, in order to save lives,
like the lives in my 18th Congressional District, where Texas is the
poster child for the most uninsured, 1.1 million--it has the dubious
honor of being the largest uninsured State in the Nation. My county,
Harris County, as we fight over and over for health insurance, does not
have people who are insured. So this will help bring, along with the
health reform that we will pass in the next couple of weeks, the idea
of saving lives and of providing for our children and our families.
Chairman Conyers had the single-payer bill. That was the initiative
that should have gone forward, but now we have a way of saving lives.
This is fiscally secure, and it provides security to those who are in
need. I ask that you support this legislation to, again, save lives.
Madam Speaker, I rise in support of H.R. 4626, Health Insurance
Industry Fair Competition Act, a bill designed to restore competition
and transparency to the health insurance market--by repealing the
blanket antitrust exemption afforded to health insurance companies by
the McCarran-Ferguson Act of 1945. Today 45,000 people a year die
without health insurance and they die because they do not have health
insurance! This is a matter of life and death.
Madam Speaker, competition is the engine that drives our economy,
spurs innovation, and ensures that the American consumer receives a
fair deal on goods and services. There is significant evidence that
removing the antitrust exemption will increase competition in the
insurance industry and will result in lower prices and other benefits
for consumers. In fact, experience has shown time and time again the
benefits of increased competition in the form of lower prices,
increased choice, and greater innovation.
A healthy and competitive health insurance market will drive prices
down in the health insurance industry, just as we have seen it do in so
many other industries where competition is allowed to take hold. For
example, since the state of California passed a law in 1988 that
eliminated the state antitrust exemption for the auto insurance
industry, auto premiums for consumers in California have risen by only
9.8% while the rest of the country has seen auto premiums rise by over
48 percent. The Consumer Federation of America has said that consumers
would save over $50 billion in insurance premiums by repealing the 1945
McCarran-Ferguson Act for all lines of insurance. Further, it is
estimated that subjecting health insurance companies to federal
antitrust laws would lower premiums by 10% or more.
Removing this antitrust exemption will not only enable appropriate
enforcement against these unjust practices when they are uncovered; it
will also give all health insurance companies healthy competitive
incentives that will promote better affordability, improved quality,
increased innovation, and greater consumer choice, as the antitrust
laws have done throughout the rest of the economy for over a century.
The antitrust exemption was enacted in 1945, as part of legislation
whose main purpose was simply to reaffirm the authority of States to
regulate insurance for the protection of their citizens. The antitrust
exemption was quietly inserted at the end of the legislative process,
in conference committee. As a result, insurance companies have been
shielded from legal accountability for price fixing, dividing up
territories among themselves, sabotaging their competitors in the
marketplace in order to gain monopoly power, and other practices that
unjustly harm consumers. Moreover, antitrust court actions alleging
each of these practices, and more, have been blocked by invoking the
McCarran-Ferguson antitrust exemption.
For far too long, the health insurance industry has played by a
different set of rules. Shielding health and medical malpractice
insurance companies from federal antitrust laws is a practice that must
end.
Madam Speaker, the American public agrees that the special treatment
the anti-trust exemption affords insurance companies must come to an
end. A recent Rasmussen poll found that 65% of Americans favored
removing the anti-trust exemption for health insurance companies. Of
those polled, Democrats supported subjecting insurance companies to
antitrust laws by a seven-to-one margin. Sixty-four percent (64%) of
independent voters and 58% of Republicans also believe insurers should
abide by antitrust laws. This data demonstrates that there is bi-
partisan public support for demanding that health insurance companies
play by the same rules as other companies in America.
Madam Speaker, I agree with the majority of the American public that
shielding health and medical malpractice insurance companies from
federal antitrust laws is a practice that must end. Eliminating the
anti-trust exemption for the health care industry is a vital step
toward reforming health care, lowering prices for consumers and
doctors, and leveling the playing field for American businesses.
The Consumer Federation of America has said that consumers would save
over $50 billion in insurance premiums by repealing the 1945 McCarran-
Ferguson Act for all lines of insurance. Further, it is estimated that
subjecting health insurance companies to federal antitrust laws would
lower premiums by 10% or more. Moreover, in addition to bi-partisan
support amongst the American public, repealing anti-trust exemptions
for all health insurance is supported by conservative political leaders
as well such as Governor Bobby Jindal of Louisiana, Senator Joseph
Lieberman, and former Majority Leader Trent Lott.
This bill is also necessary because, over the years, health insurers
have been able to use this antitrust exemption to block court actions
regarding anti-competitive behavior. For example, in Ocean State
Physicians Health Plan, Inc. v. Blue Cross & Blue Shield of Rhode
Island, the First Circuit Court--citing the McCarran-Ferguson antitrust
exemption--overturned a jury verdict against the dominant health
insurer for using its monopoly power to put financial pressure on area
employers to refuse to do business with a competing HMO.
Removing this antitrust exemption is supported by key law enforcement
groups, including the National Association of Attorneys General. In
2007, the National Association of Attorneys General--representing both
Democratic and Republican State Attorneys General--overwhelmingly
adopted a resolution calling for repealing this exemption. As the
resolution pointed out, ``the National Association of Attorneys General
consistently has opposed legislation that weakens antitrust standards
for specific industries because there is no evidence that such
exemptions promote competition or serve the public interest.''
In addition, in a recent letter to Congress, nine State Attorneys
General pointed out, ``Since 1977, and most recently in 2007, antitrust
experts and enforcers have concluded that repealing the McCarran-
Ferguson exemption would result in enhancing competition while allowing
standard industry practices necessary for the proper functioning of
these markets, such as sharing loss and other insured risk
information.''
Removing this antitrust exemption is also supported by leading
consumer groups. Numerous consumer groups--including the Consumers
Union, Consumer Federation of America, U.S. PIRG, Center for Justice
and Democracy, and Public Citizen--strongly support removing this
antitrust exemption. In a joint letter to Congress, consumer groups
pointed out that, under this legislation, health insurance companies
``would be required to play by the same rules of competition as
virtually all other commercial enterprises operating in America's
economy.''
In closing, I want to also take this time to reiterate my support for
a public health care plan that covers every one of the 47 million
people who live in our great nation without health insurance. Madam
Speaker, my state of Texas has the dubious honor of being the uninsured
capital of the nation. Further, with more than 1.1 million of the
nation's uninsured living in my own county, Harris County, I represent
what some have labeled as ground zero of the health care debate. Thus,
the issue of universal health care coverage--something that would have
been achieved by Chairman Conyers' Single Payer bill, which I
supported, is more than an empty slogan; it's a matter of fiscal and
physical life and death to the people of the 18th Congressional
District. Therefore, no matter how the pending debate over the details
of the health reform bill winds up, my constituents can count on me to
continue fighting and continue working together with my colleagues of
both parties, to ensure that everyone in my district, in Houston, in
Texas, and in America has access to affordable and quality health care.
[[Page H774]]
Mr. SMITH of Texas. I yield myself 1 minute.
Madam Speaker, let me say that I always appreciate what my colleagues
state on the House floor, and I appreciate their good comments during
debate. To the extent that they want to increase competition among
insurance companies and want to reduce insurance premiums, I completely
agree with them, but we should not think that any of those comments or
any of those desires or any of those goals have anything to do with the
bill that we are considering here today.
Once again, in case some of my colleagues missed it, let me read what
the Congressional Budget Office said about this legislation. They said,
``Whether premiums would increase or decrease as a result (of this
legislation) is difficult to determine, but in either case, the
magnitude of the effects is likely to be quite small.'' So this bill
has no point.
Madam Speaker, I yield 3 minutes to the gentleman from Wisconsin, the
former chairman of the Judiciary Committee, Mr. Sensenbrenner.
Mr. SENSENBRENNER. Madam Speaker, listening to the arguments that
have been advanced by the proponents of the bill, all I can say is what
you hear is not what you are going to get if this bill is enacted into
law.
There is a reason this antitrust exemption has survived now for 65
years, which is that it actually has encouraged competition because it
allows smaller insurers to use the actuarial data that larger insurers
are able to amass. If the smaller insurers can't get this actuarial
data, which is what will happen if this bill is enacted into law, then
they will either be gobbled up by the larger insurers, which get the
data in-house, or they will go out of business. As a result, there will
be less competition rather than more. So what you hear today about
competition is not what you are going to get if this exemption is
repealed.
Now, repealing the limited exemption that health insurance carriers
have under the McCarran-Ferguson Act is, at best, going to change
little and, at worst, is going to be counterproductive. As the CBO
concluded in October, repealing the exemption would have little or no
effect on insurance premiums because State laws already bar the
activities that would be prohibited under Federal law should the bill
be enacted. Instead, additional regulatory burdens on insurers will
likely be passed on to the policyholders in the form of higher
premiums.
This, my friends, is the majority's higher health insurance premium
bill in the name of competition. It's not going to happen. The bill
would subject to new Federal enforcement a variety of ongoing
collaborative practices among health insurers which are currently
permitted by the States because they allow the small insurers to
compete.
Now, shouldn't we be for small insurers? Shouldn't we be for having
new companies enter the market? This bill will prohibit that.
Small insurance companies rely on the data collected from their
larger competitors, and share it industrywide in order to accurately
set their rates. However, this would be forbidden under the bill. If
small insurers can't get the data, further consolidation is likely.
Small insurance will either merge to gain a competitive edge or get
swallowed up by the big insurance giants. Again, the majority is
putting together an insurance company consolidation bill--less
competition rather than more. Worse, a repeal could result in the small
insurers' going out of business altogether. Meanwhile, for the big
insurance companies, the big, bad insurance companies with the means to
collect and analyze this data in-house, it would simply be business as
usual.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. SMITH of Texas. I yield the gentleman an additional 2 minutes.
Mr. SENSENBRENNER. This legislation attempts to solve a problem that
doesn't exist.
First, there is no evidence that the exemption has increased health
insurance prices or profits or that it has contributed to higher market
concentration. Second, the effort to repeal McCarran-Ferguson is based
on the belief that it allows individual insurers to collude on prices
and policy coverage.
State laws prohibit insurers from bid-rigging, price-fixing and
market allocation to restrain competition. State insurance regulators
actively enforce the prohibition in these areas, and this legislation
would only add another layer of Federal regulation and litigation to an
industry that operates under a robust and well-established State
regulatory regime.
There are ways, however, to promote competition in the health
insurance market. One change Congress should consider is permitting
individuals and businesses to buy their health insurance policies from
any willing provider in any State. Under current law, an insurance firm
registered in one State may not cover individuals in another without
registering in the second State and being subject to all its taxes and
laws. This raises the cost of doing business across State lines, and it
prevents many smaller or mid-sized companies from entering the markets
to compete. Simply put, this is not the type of reform that is needed,
and it is not the type of reform that Americans were promised.
{time} 1300
I challenge my colleagues on the other side of the aisle, Madam
Speaker, to come up with commonsense reforms, one that will do in fact
what appears in speech. This bill fails on both counts.
Mr. CONYERS. Madam Speaker, the former chairman emeritus has raised a
number of points that amount to verbal jujitsu that I will be
addressing very shortly, but for now I yield 3 minutes to the
distinguished chairman of the Judiciary Subcommittee on Courts and
Antitrusts, a former magistrate in the courts of Georgia himself,
Subcommittee Chair Hank Johnson.
Mr. JOHNSON of Georgia. I thank the chairman for yielding.
Madam Speaker, last week I was shocked to learn that in the middle of
the great recession, which was caused by the deregulation, hands-off
policies of the prior administration, and during this time when
families across my district and across the Nation are struggling with
rising unemployment and while health insurance companies have recently
announced that last year was their best year on record as far as
profits are concerned, $12 billion last year in profits for the
insurance industry, and while that's the case, they are announcing
plans to raise insurance premiums by 40 percent in some markets. During
this time of hurt and pain and also making money by the insurance
industry off these people who are hurting and in pain, we are
considering today removing the antitrust exemption that insurance
companies have enjoyed for over 60 years. And it's time for this
protection and immunity from antitrust law and this anticompetitive
behavior, it's time for it to come to an end.
This insurance industry which delivers health care to the people has
been broken for a long time. We all know it, and it's time to change
it. And this is a good place to change it. It will help with
competition if we pass this law today. That will happen only if we
start applying anticompetitive, antitrust legislation to the insurance
industry. There's simply no reason why they should continue to benefit
from it.
Don't listen as the health insurance industry tries to tell you that
they can't live under the antitrust laws. Every other industry does.
It's high time that they do too. Consumers will benefit, the economy
will benefit, and health insurance insurers who want to compete
honestly will too.
Let's give struggling American families an honest health insurance
market by enacting this important bill.
Mr. SMITH of Texas. Madam Speaker, I yield 5 minutes to the gentleman
from California (Mr. Daniel E. Lungren), a senior member of the
Judiciary Committee.
Mr. DANIEL E. LUNGREN of California. I thank the ranking member for
the time.
Let me say at the outset, I do not believe that health insurance
companies should be exempt from our Nation's antitrust laws. As one of
those who believes and hopes that those applauding would join me in
supporting the idea of buying health insurance across State lines, when
we reach that accomplishment, I think it is appropriate for us not to
have a Federal antitrust exemption.
When health care has been primarily and in a very real sense
exclusively the
[[Page H775]]
province of the States, under their jurisdiction, the attorney generals
of the States have retained the ability to enforce the antitrust laws
of those States. So we're entering a new era, I would hope, where we
would be able to, if, in fact, this one Republican idea finds its way
into legislative enactment, find an opportunity to extend the universe
of decisions that might be accessed by individuals or their employers
by way of insurance policies that may be available in other States.
My intention is to vote in favor of this bill. However, my concern is
that the bill before us is not nearly as good as it should be because
normal bipartisan committee process has been circumvented.
As has been noted by some in advancing this bill, I did vote in favor
of the Health Insurance Industry Antitrust Enforcement Act of 2009 when
it marked up in the Judiciary Committee. At that time, I offered an
amendment to the bill to allow the sharing of historical data and the
performance of actuarial services by insurance companies. Not future
trending data but rather looking-backward historical data. At that
time, it was adopted unanimously by the committee, therefore, on a
bipartisan basis. Our distinguished chairman of the committee supported
my amendment, which he described at the time as ``a helpful
clarification.''
If there's one thing that we ought to understand when we have this
downturn in the economy, if you want to make sure things don't happen
in the private economy, insert uncertainty. If you want to make sure
that things cost more than they otherwise would, insert uncertainty.
And that's what we are doing by not allowing that in the bill before
us.
In fact, I should point out to my friends on the other side, section
262 of your health care bill, your health care bill, adopted on this
floor, allowed for the sharing of such information. It contained the
language of my amendment. Unfortunately, for whatever reason, it has
been held out of the bill before us.
Unless anyone thinks I have risen to speak because of sour grapes
because my amendment with my name on it was not included in this bill,
let me clarify the case. I can give you assurance that is not the case
for the simple reason that I cannot take personal credit for the guts
or the contents of this amendment.
The truth of the matter is that the hard work done to repeal the
McCarran-Ferguson Act began with the efforts of then Chairman Jack
Brooks, Democratic chairman, in the 101st, 102d, and 103d Congresses.
Ironically, at the beginning of our committee markup, our chairman
described the repeal of McCarran-Ferguson ``as a tribute to Jack
Brooks.'' So if we really wish to pay tribute to Jack Brooks, and I
believe we should, perhaps a good place to start would have been to
allow an amendment to include Chairman Brooks's language in any
legislation before us. I'm hopeful that the motion to recommit might
contain that language, and I would hope that people would set aside
partisan differences and support it.
So aside from the issue of the denigration of the committee process--
and I think that's an important thing we ought to take into
consideration. The subcommittee, committee, you act on this bill. You
debate it. You consider amendments. You vote out the amendment on a
unanimous bipartisan vote. Then you have bipartisan support for the
bill as it comes out of committee. And then what happens? It's changed
before it comes to the floor. And we had one of the members of the
Rules Committee say she wasn't going to engage me in debate because,
she said, I don't have the expertise on this issue. So I presume that
means if you have expertise, and that's what committees are supposed to
have, you ignore that so you can come to the floor and not allow debate
utilizing that expertise because you prohibit that amendment from being
considered on the floor.
H.R. 4626 will have precisely the opposite effect of its stated
intention if, in fact, the notion of sharing historical data is not
considered appropriate and legal. The economics of the insurance
industry are such that companies depend on information. Why? In order
to enable them to price their products. They have to base it on
something.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. SMITH of Texas. Madam Speaker, I yield the gentleman 2 additional
minutes.
Mr. DANIEL E. LUNGREN of California. I thank the gentleman.
It is better if they have actual data upon which to make their
decisions.
And here's the rub: As was mentioned by the gentleman from Wisconsin,
it is the small companies which depend on the availability of
information the most. Smaller companies simply do not have a
sufficiently large volume of information to price their products
efficiently. So it's for this reason that it is of the utmost
importance that insurers have the ability to share historical data.
Now, am I just saying this? No. In this record, a Congressional
Research Service report raises the possibility that were such data not
available to small insurance companies, we might see the ironic outcome
of further concentration in the insurance industry. Again, not my
conclusion; the conclusion of the Congressional Research report done
most recently.
So, yesterday I did approach the Rules Committee to ask my amendment,
the Brooks amendment, as I call it, be restored to the health insurance
antitrust bill. And even though it was approved unanimously by my
colleagues on the Judiciary Committee, my request was inexplicably
rejected by the Rules Committee.
This is not the way, I would say, Madam Speaker, that this body
should do business. Let's respect the integrity of the institution and
the work that has been done in the duly established committee process.
I would hope that when this part of the recommittal motion is
discussed, we'll discuss it in light of the history of this bill--the
language taken from the Jack Brooks bill; the language taken from the
majority's health care bill passed just this year.
Mr. CONYERS. Madam Speaker, I yield myself 2 minutes.
I want to respond to the senior member of the Judiciary Committee, a
former attorney general of California and a friend of all of us on the
committee, an effective member, and all I want him to know is that we
approved his provision in the Judiciary Committee because we thought it
was a good provision. It was unanimous. I don't recall that anyone
voted against it or spoke against it. The problem, though, is that when
we got to the Rules Committee, our leadership on both sides of the
aisle, I hope, had come up with another bill and that bill omitted it.
We were not able to get that put back in.
We think that their reasoning is not altogether strange or out of
order or violating any procedure, but here's what it was. This is what
they told me: They said, if there are no antitrust exemptions in this
measure, then you don't need to specifically retain a part of the
antitrust exemption relating to the safe harbors provision, because if
it isn't an antitrust provision, they aren't going to be affected
anyway.
So it's in that spirit that I appreciate the comments of the
gentleman from California, and I hope that we can continue to work
together as much as we can, and perhaps the final vote here will be
more bipartisan than many thought that it would.
Madam Speaker, I now would like to yield 2 minutes to a senior member
of the Congress from Iowa (Mr. Boswell).
(Mr. BOSWELL asked and was given permission to revise and extend his
remarks.)
Mr. BOSWELL. I thank the chairman for this opportunity. I appreciate
it.
Madam Speaker, I rise today in support of the Health Insurance
Industry Fair Competition Act.
An original cosponsor of this legislation, I believe that our health
insurance companies need to be held to the competitive standard our
free market demands.
For too long, these companies have told our constituents what they
will insure and what they will be paid. Just recently, 80,000 Iowans
were told that their insurance rates would jump by an average of 18
percent, with many facing increases of as much as 25 percent. These
same individuals have seen their rates increase by 10\1/2\ percent each
year since 2005.
I insist that light be shed on the pricing of health care costs and
that consumers have access to how their premiums and copays are
determined. I
[[Page H776]]
would particularly like this information for my constituents whose
premium increase is twice what it was in 2009.
Iowans in the Third District are struggling to make ends meet. They
deserve to know how a company can spend as much as perhaps $200 million
on a new headquarters and turn around and double their premium
increases from 2009 to 2010 and then claim these two things have
nothing to do with one another.
{time} 1315
Our support for this legislation will make it illegal for companies
to price fix, practice bid rigging, and market allocation simply to
drive up costs on American consumers.
Mr. SMITH of Texas. Madam Speaker, first of all, I just want to say
that I appreciated what the chairman of the Judiciary Committee just
said a minute ago to Mr. Lungren. I understood him to make very
positive comments about the so-called Brooks-Lungren amendment. And I
hope that that augurs well for the majority's accepting our motion to
recommit at the end of this debate. At least I would expect that.
At this point, Madam Speaker, I will yield 3 minutes to the gentleman
from New Jersey (Mr. Garrett), a member of the Budget Committee and the
Financial Services Committee.
Mr. GARRETT of New Jersey. Madam Speaker, I rise in opposition to the
bill for a number of substantive reasons. But also, quite honestly,
after hearing the comment from the gentleman from California, I also
was about to say I rise with concerns as to the process as well.
I appreciate the ranking member's comment as far as potentially
moving forward on this. I too have been there in the past, where we do
things in committee, in the relevant committees I serve on, serve on
Financial Services Committee and have agreements with the other side of
the aisle and with the chairman specifically of Financial Services,
with Chairman Frank, and then things go to the Rules Committee, and I
don't know whether it was a bipartisan obstacle in this case, but be it
as it may, problems happen with Rules Committee. And I can tell you
with my working with Chairman Frank, he was able to actually get things
done then on the floor as far as the substantive amendments done here
to get it done. So I hope that we see similar action with regard to
this as well that we have seen in other committees.
But I do rise in opposition or concern about this bill with regard to
the repeal of the McCarran-Ferguson aspect. And I do so for three
points. One has been touched upon, but I want to go into a little bit
more detail with regard to the CBO. CBO, Congressional Budget Office,
nonpartisan entity, has noted the States already have the laws on the
books to prevent what we are really trying to deal with here, price
fixing and bid rigging, et cetera.
Furthermore, State insurance commissioners already typically review
the rates charged by insurance companies. So what does this basically
mean in a nutshell? Basically, States are working in this direction
already, and that the passage of this legislation will have a minimal
positive impact.
Just a side note. When we talk about State insurance regulation in
general, you have to remember when we are talking about the financial
situation that we are in right now, it was not the fault of the State
regulators of the financial marketplaces that brought us to where we
are, it is the fault largely to errors and omissions in the Federal
regulators. So if we are trying to cast blame or aspersion on any
regulators out there, it should not be on the State regulators, because
in essence they have done their jobs, and we should not be throwing
other impediments to that getting done.
Second point, someone already mentioned about a report out of the
CBO. Let me go into a little bit more specifics about what the CBO said
with regard to costs. CBO said, and I quote, ``To the extent that
insurers would become subject to additional litigation, their costs and
thus their premiums might increase.'' Let me repeat that. Their
premiums might increase. So to all the points of the other side of the
aisle saying that we are doing this with the good intention of trying
to get premiums to come down, what do the experts, the nonpartisan CBO,
say? Just the opposite, premiums might go up. So the conclusion there
is here is a case where increased litigation costs would actually drive
up the cost of insurance, and not bring it down.
Third and final point, touched upon a little bit, and let me go in
more detail. This legislation could have the effect of shutting out new
entrants, not folks already there, but shutting out new entrants into
the marketplace.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. SMITH of Texas. Madam Speaker, I yield the gentleman 2 additional
minutes.
Mr. GARRETT of New Jersey. Thank you.
This legislation would have the effect of shutting out new entrants
into the marketplace. The other side of the aisle has already talked
about the fact that they want to have greater competition in this area
of health insurance, and I am assuming insurance across the board. But
what this will do, as the gentleman and others have already said on the
floor, is basically say to the new entrants, to the small companies who
want to get into this marketplace, to be able to compete against the
large entrenched companies that are already there, you are pushed out,
you are locked out. So is that what we want to do with this
legislation? That will be the impact.
Let me conclude then. In a letter to Speaker Pelosi, the National
Association of State Insurance Commissioners says the following: ``The
business of insurance, while exempted from Federal antitrust law, is
still subject to State antitrust enforcement actions.'' That is
important. ``In fact, even if the McCarran-Ferguson antitrust
exemptions were repealed, the State action doctrine exempting them
would continue to apply. The most likely result of this repeal would
therefore not be increased competition, but a series of lawsuits
testing the limits of the State action doctrine, with associated
litigation costs being passed along to the consumers in the form of
higher premiums.''
The conclusion, Madam Speaker, is more litigation, more harmful
consolidation, and more increase to the cost to the consumer, all
things that we should be working to oppose. And that is why I do not
support the underlying legislation.
Mr. CONYERS. Madam Speaker, no one has worked harder on this measure
that is not a member of the Judiciary Committee than Peter DeFazio of
Oregon. And I yield to him 3 minutes.
Mr. DeFAZIO. I thank the distinguished chairman for bringing this
issue before us.
We have heard on the Republican side this is just about the little
guys. They only want to help the little guys. Except that the loopholes
that they would create with the Lungren provisions could be used by the
big guys. So if you like the status quo, if you like the fact that some
of the largest insurance companies in America saw their profits go up
by 56 percent last year, if you like the fact that in many States we
are seeing huge, double-digit increases, over 50 percent in Michigan,
40 percent in California, 20 percent in my State, if you think the
system's working today, then you should support Mr. Lungren's idea,
preserve the status quo. That is what they are saying. Keep the
loopholes. Allow them to continue to collude and price fix.
Now, there are a few other people who disagree with them. In fact, we
had a bipartisan commission created by the Republican Congress when
they controlled the House and the Senate and signed into law by
President George Bush. The members were appointed by George Bush, the
Republican heads of the House and the Senate. And their conclusions
considered Mr. Lungren's arguments and they rejected them.
A bipartisan, professional commission created by the Republicans and
George Bush said, after saying, yes, there are these arguments being
made, but they say, ``Like all potentially beneficial competitor
collaboration generally, however, such data sharing would be assessed
by antitrust enforcers and the courts under a rule of reason analysis
that would fully consider the potential procompetitive effects of such
conduct and condemn it only if, on balance, it was anticompetitive.''
They don't want the Justice Department to have that capability. They
[[Page H777]]
don't want any additional levels of review.
Mr. DANIEL E. LUNGREN of California. Will the gentleman yield?
Mr. DeFAZIO. There are many States that are totally incapable of
dealing with these issues, particularly with multistate, multinational
companies that operate outside their borders, set rates outside their
borders, and then import those rates into the State saying, well, that
was our experience. We operate in 27 States after all, and you are part
of our system.
So if you like the status quo, if you like the double-digit rate
increases, if you like the limits on market competition, if you like
the concentration that has been going on in the industry, then you
would support the status quo, which is essentially what Mr. Lungren has
offered. And I don't. And I don't think the American people do either.
I think we have tremendous consensus around the country that it is time
for this abusive industry to play by the same rules as every other. And
the small companies will still be able to obtain the data as long as
they don't use it in a collusive manner. But it is always just about
the small companies, except that the exceptions they want to provide
are for the big companies also.
We have expert testimony from the director of the Center for Health
Law Studies, St. Louis University, saying that is not the case, it will
not disadvantage small companies. We have Mr. David Balto, an antitrust
expert, saying it will not disadvantage the small companies. But the
Republicans are purporting that it would.
Finally, on the CBO report that it won't lower premiums, that was
based on the Lungren language. Without the Lungren language, it will
save money, $10 billion for consumers.
Mr. SMITH of Texas. Madam Speaker, I yield 2 minutes to the gentleman
from California (Mr. Daniel E. Lungren).
Parliamentary Inquiry
Mr. DANIEL E. LUNGREN of California. Madam Speaker, I would like to
make an inquiry of the Chair.
The SPEAKER pro tempore. The gentleman will state his inquiry.
Mr. DANIEL E. LUNGREN of California. Is it not correct that Members
are supposed to address the Chair?
The SPEAKER pro tempore. The gentleman is correct.
Mr. DANIEL E. LUNGREN of California. Thank you.
Since the gentleman refused to yield when I asked him to, despite the
fact he was using my name and attributing motivations to me that are
questionable under the rules of the House, I might say this. The
gentleman is absolutely incorrect in his analysis. The report said that
it would harm the small insurance companies if they were not able to
get this historical data, number one.
Number two, the gentleman conflates two completely different things:
one is historical data and the other is trending data. And they are two
different things. My amendment does nothing about allowing insurance
companies to work together and compare trending data, which is data
going forward, despite the fact that some in the insurance industry
wish that is the case. The dirty little secret is that some in the
insurance industry don't want to have my amendment, they want it to be
silent so that in addition to historical data, they can also have
trending data. But the gentleman hasn't looked at the data in that way,
hasn't examined or, I presume the gentleman would not have examined the
reports to know the difference that was in that and my specific
decision not to include trending data in my amendment.
Secondly, I find it interesting that the gentleman suggests that I am
trying to do something other than what I say that I am doing. This is
an interesting argument made on this floor, that if you disagree with
someone you suggest that what they say can't possibly be true. The fact
of the matter is I have quoted outside reports to support my position,
number one. The fact of the matter is I have used the language from the
Jack Brooks legislation, I have used language from the gentleman's
party's health care bill, and I have used the language that was adopted
on a bipartisan basis in Judiciary Committee unanimously.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. SMITH of Texas. Madam Speaker, I yield the gentleman an
additional 2 minutes.
Mr. DANIEL E. LUNGREN of California. Perhaps the gentleman is
suggesting that all the Members on his side of the aisle who supported
this amendment share in his description of the motivation of those of
us who have presented it. I thought maybe we were above that. I thought
maybe we were engaged in civil discourse here. But rather, if the
gentleman or any gentleman wishes to talk about the motivations of
others, I will tell you any idea about bipartisanship is lost in this
House. The suggestion that all you have to do is shout louder than
somebody else and accuse them of motivations other than what they
articulated is just absolute nonsense.
The fact of the matter is, properly done, the sharing of historical
data is not anticompetitive. The fact of the matter is the underlying
bill, with my amendment, would still allow actions taken by the Justice
Department and the various States Attorney General if there was bid
rigging, if there was price setting, if there was determination before
the hand of which markets you would act in and which markets you would
not act in.
And so this is a lot of sound and fury signifying nothing,
essentially. I have never seen such an attack on an amendment that was
adopted on a bipartisan basis in the committee. Now, I realize it is
only the committee of jurisdiction that has expertise in this area. I
understand that those of us who have done antitrust law ought not to be
listened to because those who have said on this floor that they have no
expertise in this and they don't understand it, therefore, they don't
want to debate it, should have the upper hand in the Rules Committee.
But frankly, I will say once again at some point in time you have to
accept yes for an answer. I support the bill. I am trying to help the
bill. I am trying to get it back to where it was when Jack Brooks
introduced it. And in response to that, rather than saying hurray for
bipartisanship, I hear from other people, well, we got to question your
motivations. Hardly a high point in this Chamber.
{time} 1330
Mr. CONYERS. Madam Speaker, I am inclined to yield to the gentleman
from Oregon (Mr. DeFazio) 1\1/2\ minutes.
Mr. DeFAZIO. Madam Speaker, you know, the law has evolved over time,
and the law has evolved significantly since the era of Jack Brooks in
terms of decisions regarding antitrust, antitrust immunity.
And as the current Assistant Attorney General of the Antitrust
Division says, it says, moreover, the application of antitrust law's
potentially to pro-competitive collective activity has become far more
sophisticated in the 62 years since the industry was exempted from the
law. And some forms of joint activity that might have been prohibited
under earlier, more restrictive doctrines are now clearly permissible,
or at least, very least, analyzed under a rule of reason that takes
appropriate account of the circumstances.
So what we're saying is, let's, you know--you're saying, oh, the
States can take care of it. Let's say, the State of Montana can oversee
an industry, a multistate, multinational, you know, conglomerate, and
they can get into their books and they can examine and see that the
rates that were imported from outside the State were set fairly. No. We
need the help of the Federal Antitrust Division. They should not have
their hands tied only in respect to the industry of insurance. Every
other industry in America has learned to live with truly free markets
with antitrust law. This industry can do the same, and it will benefit
consumers. This is a false argument that somehow they need this special
privilege, this special exemption, and that somehow this will hurt only
little companies, not the big guys.
We've seen tremendous consolidation already under the existing total
exemption. And if we continue a partial exemption, we'll only see more.
Mr. SMITH of Texas. Madam Speaker, I yield 2 minutes to the gentleman
from California (Mr. Daniel E. Lungren).
Mr. DANIEL E. LUNGREN of California. Madam Speaker, once again I
[[Page H778]]
know I run the risk of trying to introduce some expertise into this
debate. For that, I apologize. But the American Bar Association
appeared before the subcommittee of Judiciary dealing with the
underlying bill, or the bill that was presented before our committee,
and in there, they voice support, as they have for decades, for removal
of the McCarran-Ferguson antitrust exemption for the health care
insurance industry.
However, they said, as point number one of the five major points they
made, insurers should be authorized to cooperate in the collection and
dissemination of past loss-experience data so long as these activities
do not unreasonably restrain competition, but insurers should not be
authorized to cooperate in the construction of advisory rates or the
projection of loss experience in the future in such a manner as to
interfere with competitive pricing. That second part deals with
trending data. I do not allow that under my amendment.
And as I presented my effort to have my amendment considered in the
Rules Committee, I was told by the representative of the American Bar
Association, they did support my position, they supported my amendment,
and they supported the arguments that I made before the committee.
Now, maybe they're wrong because they have some expertise in this
area, but perhaps this is one time we might look to them. The ABA has
not been known as a Republican, conservative, pro-insurance company
operation. Last time I looked, they have a major element of the bar
association that's involved with antitrust law.
Mr. CONYERS. Madam Speaker, I am pleased to recognize a senior member
of the House Judiciary Committee from Los Angeles, Ms. Maxine Waters,
for 3 minutes.
Ms. WATERS. Madam Speaker, the consumers of this country are finally
getting the attention they deserve. For far too long, consumers have
been ripped off by collusion and concentration of the health insurance
industry. For far too long, public policymakers have turned a blind eye
to the special antitrust exemption that health insurers have enjoyed,
to the detriment of the American people.
We must pass this legislation, the Health Insurance Industry Fair
Competition Act. This bill finally, after 65 years, amends the
McCarran-Ferguson Act. Health insurers will be investigated and held
accountable for price fixes, dividing up territories among themselves,
sabotaging their competitors in order to gain monopoly power, and all
anticompetitive practices. The Justice Department will have a mandate
to prosecute this criminal activity.
And finally, the health insurance industry will have to compete. No
more legally protected collusion. Let the marketplace work. No more
protection for health insurance companies from the very people who have
been elected to protect the best interests of the people. That's us.
The health insurance industry has gouged us long enough. They have
increased premiums, higher copayments, higher deductibles. The health
insurance industry, to add insult to injury, have thumbed their noses
at both the consumers and legislators and left too many families at
risk. In the middle of our debate about health insurance reform, health
insurers are raising the premiums. They're denying lifesaving
procedures. They're dropping too many of the insured who have been
paying premiums for years if they deem the cost of their health care
too costly. The CEOs of some of the biggest insurance companies are
paying themselves unreasonably high salaries. Most of them are earning
$10 million or more per year.
Ladies and gentlemen, it is time to put an end to the practices of
the health insurance companies. That time is now. Let us stand up for
the consumers. Let us do what the consumers elected us to do--come here
and give some protection from these kinds of practices. Sixty-five
years is too much, too long. The time is now. Let's get the job done.
Let's pass this legislation.
Mr. SMITH of Texas. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, the bipartisan and very credible Congressional Budget
Office has said that this bill will have little or no effect on
insurance premiums. It further says that if there is any effect, it
will be ``quite small.''
So I do appreciate all the comments that Members are making today,
and I agree with a lot of them. But we should not think that any of
them pertain to this bill, or that this bill is going to have any kind
of a major impact on premiums.
However, I would like to discuss one subject that will have a major
impact on insurance premiums, and that is health care tort reform.
The American medical liability system, quite frankly, is broken.
According to one study, 40 percent of claims are meritless; either no
injury or no error occurred. Attorneys' fees and administrative costs
amount to 54 percent of the compensation paid to plaintiffs. The study
found that completely meritless claims account for nearly a quarter of
total administrative costs.
The American civil litigation system is the most expensive in the
world, more than twice as expensive as nearly any other country.
Defensive medicine is widely practiced and it is very costly.
Skyrocketing medical liability insurance rates have distorted the
practice of medicine. Costly but unnecessary tests have become routine
as doctors try to protect themselves from lawsuits.
According to a 2008 survey conducted by the Massachusetts Medical
Society, 83 percent of Massachusetts physicians reported that they
practiced defensive medicine. Another study in Pennsylvania put that
figure at an astounding 93 percent.
While estimates vary, the Pacific Research Institute has put the cost
of defensive medicine at $124 billion. Others have arrived at even
higher figures. A new study by the Pacific Research Institute estimates
that defensive medicine costs $191 billion a year, while a separate
study by PricewaterhouseCoopers puts the number even higher, $239
billion every year.
Lawsuit abuse drives doctors out of practice. There is a well-
documented record of doctors leaving the practice of medicine and
hospitals shutting down, particularly practices that have high
liability exposure. This problem has been particularly acute in several
fields as well as in the rural areas of our country.
The absence of doctors in vital practice areas is, at best, an
inconvenience; at worst, it can have deadly consequences. Hundreds or
even thousands of patients may die annually due to a lack of doctors.
According to the Massachusetts study, 38 percent of physicians have
reduced the number of higher risk procedures they provide, and 28
percent have reduced the number of higher risk patients they serve out
of fear of liability. The American College of Obstetricians and
Gynecologists have concluded that the ``current medico-legal
environment continues to deprive women of all ages, especially pregnant
women, of their most educated and experienced women's health care
providers.''
Excessive litigation damages the doctor-patient relationship and
impairs care. Beyond the dollars and cents, when doctors begin to see
their clients as potential litigants, the quality of care patients
receive is seriously compromised. In a recent survey, 76 percent of
doctors said that their concern about being sued has hurt their ability
to provide quality patient care. Nearly half of nurses say they are
prohibited or discouraged from providing needed care by rules set up to
avoid lawsuits.
The States have proven that legal reform works. While some in
Washington talk about the need to study the problem, States have
actually acted to address it. Several States have limited noneconomic
damages such as those for pain and suffering and dramatically lessened
the burden of lawsuits. In States with such limits, premiums are 17
percent lower than they are in States without them.
Madam Speaker, I'll reserve the balance of my time.
Mr. CONYERS. Madam Speaker, no one comes before the Judiciary
Committee that I can think of offhand more frequently than Bill
Pascrell of New Jersey. He's worked with us on a number of other issues
besides this one, and we welcome his counsel. We yield him 2 minutes.
Mr. PASCRELL. Thank you, Mr. Chairman, and thank you for your
[[Page H779]]
leadership and persistence on this critical matter.
``Mischaracterization,'' I think, is the word of the day. When you
look back at the beginning of the discussions of health care, there's
been more mischaracterizations of what was in the bill.
But this bill that is before us, H.R. 4626, is only two pages--not
2,000, not 2 million--two pages, very clear and to the point. So what
this bill seems to do--if I had my way, I would have brought this bill
up when we discussed the beginning, back last summer. But I'm one
person. To call them out, to call out the other side, and to call out
the other end of the building.
I mean, we've passed 290 pieces of legislation that they haven't even
looked at yet. And this is critical. This is to end the
anticompetitive, antitrust exemption. Now we have a new administration.
Talk is cheap about how we're going to bolster antitrust laws. I
haven't seen anything yet so far, but I'm hopeful.
In all the industries in America, there are only two that have
antitrust exemptions--baseball, America's pastime; and the health
insurance industry, America's nightmare--and I think it's long past
time we get rid of their exemption.
Now, I've heard so many terms since the parties last summer, through
the fall, through the winter, about uncompetitiveness. We want open
markets.
Now we look at the system, and it's price fixing and collusion over
and over and over again. Ninety-four percent of the health insurance
markets are concentrated.
Here's what that means, Mr. Chairman. In every State of the Union,
maybe, through the Chair, there's three or four companies that are
selling insurance, that are writing insurance. This is why we are where
we are today. No other reason. Because there is a lack of insurance. We
have been accused of socialism. That is the biggest joke.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. CONYERS. I yield the gentleman another 30 seconds.
Mr. PASCRELL. We're talking about the biggest profits ever, just like
Wall Street declared the biggest profit year they've ever had in 2009.
That's interesting.
We talk about we want to save the smaller insurance companies. We've
saved nobody. In the last 60 years, all that we've done is concentrate
power, and the result of it is higher cost to the average citizen that
lives in my district and every district here on the floor.
I thank you, Mr. Chairman. Be persistent. Call the other folks out at
the other end of the building and we'll see who really cares about the
policyholders in this country.
{time} 1345
Mr. SMITH of Texas. Madam Speaker, may I ask how much time remains on
each side?
The SPEAKER pro tempore. The gentleman from Texas has 27 minutes, and
the gentleman from Michigan has 33\1/2\ minutes.
Mr. SMITH of Texas. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, on October 9, the Congressional Budget Office
pronounced that a tort reform or civil justice reform package would
reduce the Federal budget deficit by an estimated $54 billion over 10
years.
CBO recognizes that civil justice reforms also have an impact on the
practice of defensive medicine. Defensive medicine is when doctors
order more tests or procedures than are necessary just to protect
themselves from frivolous lawsuits. Studies show that defensive
medicine does not advance patients' care or enhance a physician's
capabilities, that billions of dollars in savings from tort reform
could be used to provide health insurance for the uninsured without
raising taxes on those who already have insurance policies.
As the administration rushes to enact a massive government takeover
of health care, Congress must remember that there is the option of
saving between $54 billion and more than $200 billion by embracing tort
reform, but it will take the leadership to stand up to personal injury
lawyers instead of taxing Americans and cutting Medicare benefits.
According to CBO, under the HEALTH Act, which includes tort reform,
premiums for medical malpractice insurance ultimately would be an
average of 25 percent to 30 percent below what they would be under
current law.
Also, the Government Accountability Office, GAO, found that rising
litigation awards are responsible for skyrocketing medical professional
liability premiums. The report stated that GAO found that losses on
medical malpractice claims--which make up the largest part of insurers'
costs--appear to be the primary driver of rate increases in the long
run.
The GAO also concluded that insurer profits are not increasing,
indicating that insurers are not charging and profiting from
excessively high premium rates, and that in most States insurance
regulators have the authority to deny premium rate increases they deem
excessive.
The reason the administration continues to refuse to add serious
medical lawsuit reform to their health care legislation remains purely
political, as was recently revealed by former Democratic National
Committee Chair Howard Dean. At a recent health care town hall meeting,
Mr. Dean responded to an angry constituent who wondered why a
supposedly comprehensive reform of the health care system doesn't
include tort reform to lower costs of malpractice insurance and reduce
defensive medicine.
Mr. Dean responded, being remarkably candid, as follows: ``This is
the answer from a doctor and a politician. Here is why tort reform is
not in the bill. When you go to pass a really enormous bill like that,
the more stuff you put in, the more enemies you make, right? And the
reason why tort reform is not in the bill is because the people who
wrote it did not want to take on the trial lawyers in addition to
everybody else they were taking on, and that is the plain and simple
truth.''
Medical malpractice premiums have risen more than 80 percent each
year in some parts of the country and can cost almost half a million
dollars a year in some specialties.
Regarding the offer of HHS demonstration projects--and this is what
the administration has proposed--that offer rings hollow given that the
Cabinet Secretary tasked with implementing this proposal for
demonstration projects is Kathleen Sebelius. Before she was Governor of
Kansas and the Insurance Commissioner of Kansas, she spent 8 years as
the head of the Kansas Trial Lawyers Association, now the Kansas
Association for Justice. And she is also the State executive who,
according to The New York Times, ``failed to make significant
improvement in health coverage or costs during her two terms as
Governor.''
The top contributor to President Obama's Presidential campaign was
the legal industry, whose donations came to more than $43 million. More
than 80 percent of the money given to Congress by lawyers, mostly from
the plaintiff's bar, went to the Democrats--almost $22 million.
More recently, when President Obama spoke to the American Medical
Association in June of this year, he told the audience, ``I'm not
advocating caps on malpractice awards.''
But the American people are demanding legal reform. A recent survey
found that 83 percent of Americans believe that reforming the legal
system needs to be part of any health care reform plan. As the
Associated Press recently reported, most Americans want Congress to
deal with malpractice lawsuits driving up the costs of medical care.
Yet, Democrats are reluctant to press forward on an issue that would
upset a valuable political constituency, trial lawyers, even if
President Barack Obama says he's open to changes. The AP poll found
that 54 percent of Americans favor making it harder to sue doctors and
hospitals for mistakes made while taking care of patients.
Support for limits on malpractice lawsuits cuts across political
lines, with 58 percent of Independents and 61 percent of Republicans in
favor. Democrats are more divided. Still, 47 percent said they favor
making it harder to sue. The survey was conducted by Stanford
University with the nonprofit Robert Wood Johnson Foundation. In the
poll, 59 percent said they thought
[[Page H780]]
at least half the tests doctors order are unnecessary and ordered only
because of fear of lawsuits.
That is the end of the AP story.
Madam Speaker, the USA Today editorial board also came out in support
of tort reform, and USA Today wrote, A study last month by the
Massachusetts Medical Society found that 83 percent of its doctors
practice defensive medicine at a cost of at least $1.4 billion a year.
Nationally, the cost is $60 billion-plus every year, according to the
Health and Human Services Department--and that's the HHS of this
administration. And a 2005 study in The Journal of the American Medical
Association found that 93 percent of Pennsylvania doctors practice
defensive medicine.
The liability system is too often a lottery; excessive compensation
is awarded to some patients and little or none to others. As much as 60
percent of awards are spent on attorneys, expert witnesses, and
administrative expenses. The current system is arbitrary, inefficient,
and results in years of delay.
Madam Speaker, discussing the need for tort reform, the president of
the American Medical Association said, If the health care bill doesn't
have medical liability reform in it, then we don't see how it is going
to be successful in controlling costs.
Madam Speaker, I reserve the balance of my time.
Mr. CONYERS. Madam Speaker, I am pleased now to recognize David
Scott, the gentleman from Georgia, who has been waiting patiently to
get time here on this. I yield him 2 minutes at the point.
Mr. SCOTT of Georgia. Thank you, Mr. Chairman. Let me commend you for
the excellent leadership that you have provided on this issue.
In this debate today, the one point that has been missing is this:
What about the American people? That's what this debate should be
about.
As we speak, 14,000 American citizens and families are losing their
health care insurance every single day. And the number one reason
they're losing it is because of the high costs of health care
insurance. And one of the major reasons why we have the high cost of
health care insurance is because the insurance companies do not have
competition. And the biggest reason they don't have competition is
because they have this shield. They are exempt from competition. That's
why we passed the antitrust laws in the very beginning. Go back to John
D. Rockefeller and the American Standard Oil companies. That's what it
was all about. It was so we could have that competition.
Now, there has been much argument on the other side about the sharing
of this information. Madam Speaker, I call to your point and the point
of this Congress what the Supreme Court said about the sharing of the
information in the 1925 case of Maple Flooring Manufacturers'
Association v. The United States. It said the pooling of statistics
does not violate the antitrust laws. As a matter of fact, it's there,
and it helps both small and large businesses. He said it's legitimate.
But they said the collusive joint coordination of future pricing, of
output, of marketing decisions to take meaningful choice away from
customers, to rob the American people of the benefits they would
receive from competition, must not be allowed.
That's what the antitrust provision prohibits. That's why it's
important to us to remove it today for the American people.
Mr. SMITH of Texas. Madam Speaker, I will reserve my time.
Mr. CONYERS. Madam Speaker, I am pleased now to recognize the
gentleman from Rhode Island, Jim Langevin, a former Secretary of State,
for 2 minutes.
(Mr. LANGEVIN asked and was given permission to revise and extend his
remarks.)
Mr. LANGEVIN. I thank the gentleman for yielding.
Madam Speaker, I rise in strong support of H.R. 4626, the Health
Insurance Industry Fair Competition Act, which will finally require the
health insurance industry to comply with the same Federal antitrust
laws as virtually every other industry in the United States.
The recent economic recession dealt a crushing blow to Rhode
Islanders. Many are out of work and simply don't have insurance
coverage. The ones who do are struggling to afford the perpetual rate
increases year after year. Although Rhode Island is a State with strong
health insurance consumer protections, this fact provides little
comfort to the thousands of people who will lose their coverage because
it's simply too expensive.
Madam Speaker, we must do everything in our power to hold down the
rising costs of insurance premiums, which includes ensuring healthy
market competition. After all, competition is the driving force of
economic prosperity. And even in the time of FDR and numerous Supreme
Court decisions, it established the fact that there is a legitimate
public policy interest in ensuring competition.
But for over 65 years, the health insurance industry has played by a
different set of rules, allowing them to engage in anticompetitive
practices which drive up the costs of premiums.
Well, this bill before us today will outlaw existing health insurance
practices like price-fixing, bid-rigging, and market allocations that
drive up costs for all Americans. It will protect honest competition
from collusion and other destructive practices within the health
insurance industry so we can achieve greater affordability, improve
quality, increase innovation, and more consumer choice, just as the
antitrust laws have done for the rest of the economy for over a
century.
Madam Speaker, Americans can no longer afford to give insurance
companies special treatment. I urge my colleagues to vote in favor of
the Health Insurance Industry Fair Competition Act so that we can
finally break the vise grip that the insurance companies have on the
lives of the American people and their health care.
Mr. SMITH of Texas. Madam Speaker, how much time remains on each
side?
The SPEAKER pro tempore. The gentleman from Texas has 20 minutes. The
gentleman from Michigan has 29\1/2\ minutes.
Mr. SMITH of Texas. I will reserve my time.
Mr. CONYERS. Madam Speaker, I am very pleased to recognize the most
experienced member of the civil rights struggle in the 20th century,
the gentleman from Georgia, John Lewis, a strong advocate of universal
health care, and I yield him 2 minutes.
{time} 1400
Mr. LEWIS of Georgia. Thank you, Mr. Chairman, for yielding.
Madam Speaker, I still believe that health care is a right and not a
privilege, and this Congress must not rest until we make health care a
reality for all Americans. I know we will get the job done for the
American people, but until that day comes, we must do what we can to
make health insurance work for people who depend on it.
This bill, this piece of legislation is long overdue. The health
insurance industry has been treated differently for over 60 years, and
they have abused that privilege. In too many States there is no
competition and no choice for consumers.
Insurance companies are raising rates, denying care, and dropping
people when they get sick, all the while making record profits. We need
to put people first and not profits.
For too long, insurance companies have had the upper hand. It is not
fair, it is not just, and it is not right. Today, at this hour, we
said, ``No more.'' It is time to repeal the antitrust exemption and put
the American people first.
Mr. SMITH of Texas. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, President Obama's own doctor of over two decades also
supports medical tort reform. David Scheiner was Mr. Obama's doctor
from 1987 until he entered the White House. He vouched for the then-
candidate's excellent health in a letter last year. This was recently
reported in Forbes Magazine. Dr. Scheiner worries about whether the
health care legislation currently making its way through Congress will
actually do any good, particularly for doctors like himself who
practice general medicine. ``I am not sure Obama really understands
what we face in primary care,'' Dr. Scheiner says.
One of the Nation's top surgeons, with credibility and acclaim the
world over for the pioneering surgeries he has
[[Page H781]]
and his personal story of overcoming hardship, recently severely
criticized the health care legislation before Congress. Benjamin
Carson, Director of Pediatric Neurosurgery at the Johns Hopkins
Children's Center in Baltimore, Maryland, and recipient of numerous
awards, including the Presidential Medal of Freedom, criticized, in a
recent interview, the current bill's lack of malpractice liability
reform.
He pointed to excessive litigation, pointing out how much malpractice
insurance and other forms of defensive medicine to protect against
lawsuits add to medical costs. In an interview with a local television
station, Carson insisted that tort reform must go hand in hand as part
of any true health care reform.
``We have to bring a rational approach to medical litigation. We're
the only nation in the world that really has this problem. Why is it
that everybody else has been able to solve this problem but us? Simple.
Special interest groups like the trial lawyers association. They don't
want a solution.''
As Stanley Goldfarb, MD, and Associate Dean of Clinical Education at
the Pennsylvania School of Medicine has written: ``The President points
to for-profit insurance companies, but for-profit insurance companies
only make up 25 percent of the system, and they are not that
profitable, ranking 85th among all U.S. industries. `Reform' will
redistribute the money, not reduce the overall costs. There is much
that can be done to make our system more efficient. Tort reform is a
great place to start.''
Even prominent Democrat strategist Bob Beckel has conceded medical
tort reform is essential, recently writing that CBO has reviewed the
few credible reports that do exist and concluded: ``A number of those
studies have found that State-level tort reforms have decreased the
number of lawsuits filed, lowered the value of claims and damage awards
. . . thereby reducing general insurance premiums. Indeed, premiums
fell by 40 percent for some commercial policies.''
From a CBO report in June 2004, one irrefutable fact remains: Between
1997 and 2007, medical tort costs, including insurance premiums, have
risen from $15 billion to $30 billion a year. That fact alone should
ensure that yearly savings in the billions for medical tort reform
would pass the credibility test.''
As Kimberley Strassel has written in The Wall Street Journal: Tort
reform is a policy no-brainer. Experts on left and right agree that
defensive medicine--ordering tests and procedures solely to protect
against Joe Lawyer--adds enormously to health costs. The estimated
dollar benefits of reform range from a conservative $65 billion a year
to perhaps $200 billion a year. In context, Mr. Obama's plan would cost
about $100 billion annually. That the President won't embrace even
modest change that would do so much, so quickly, to lower costs has
left Americans suspicious of his real ambitions.
It's also a political no-brainer. Americans are on board. Polls
routinely show that between 70 percent and 80 percent of Americans
believe the country suffers from excess litigation. The entire health
community is on board. Republicans and swing-State Democrats are on
board. State and local governments, which have struggled to clean up
their own civil justice systems, are also on board.
Mr. Speaker, Republican-sponsored legislation would make Federal law
the same legal reforms California implemented over 30 years ago. That
legislation, called the HEALTH Act, remains the gold standard for
health care legal reform, and it continues to be supported by every
major medical association.
The HEALTH Act does not limit in any way an award of ``economic
damages'' from anyone responsible for harm. Economic damages include
anything whose value can be quantified, including lost wages or home
services, including lost services provided by stay-at-home mothers,
medical costs, the cost of pain-reducing drugs, therapy and lifetime
rehabilitation care, and anything else to which a receipt can be
attached.
Only economic damages, which the Federal legislation does not limit,
can be used to pay for drugs and services that actually reduce pain.
So, nothing in the HEALTH Act prevents juries from awarding very large
amounts to victims of medical malpractice, including stay-at-home
mothers and children. California's legal reforms, just like the HEALTH
Act, cap noneconomic damages at $250,000 but do not cap quantifiable
economic damages.
The administration's health care bill not only fails to contain any
of the tort reforms that CBO concluded would save at least $54 billion
in health care costs, but it also contains a provision that actually
deters States from enacting such reforms in the future by explicitly
prohibiting tort reform ``demonstration project'' funds to States that
enact limits on damages or attorneys' fees.
One section of an earlier bill states that ``the Secretary of HHS
shall make an incentive payment . . . to each State that has an
alternative medical liability law in compliance with this section,''
but then goes on to say a State can take advantage of such funds only
if ``the law does not limit attorneys' fees or impose caps on
damages,'' which are precisely the tort reforms the CBO concluded yield
real health care cost savings.
Mr. Speaker, so not only does the administration's bill fail to
contain any of the tort reforms we know bring health care costs down
from decades of experience, but it even prohibits States that want to
try such reforms from taking part in the government-funded tort reform
demonstration projects. This is not only a blow to State reform
efforts, it is a federally funded bribe discouraging States from
enacting real reform, and, of course, it is a giant bailout for trial
lawyers.
Mr. Speaker, I reserve the balance of my time.
The SPEAKER pro tempore (Mr. Serrano). The Chair will note that the
gentleman from Texas has 13 minutes remaining and the gentleman from
Michigan has 28 minutes remaining.
Mr. CONYERS. Mr. Speaker, I am pleased now to recognize the
distinguished Member of the House who has had insurance experience as a
State commissioner, Earl Pomeroy of North Dakota, for 2 minutes.
Mr. POMEROY. I thank the chairman for yielding for the purpose of a
colloquy.
I would like to thank Chairman Conyers, Congressman Tom Perriello of
Virginia, Congresswoman Betsy Markey of Colorado, and others for their
leadership in bringing to the floor this important bill aimed at
creating greater competition in the health insurance marketplace in
order to promote greater affordability, improve quality, and greater
consumer choice.
In particular, I appreciate that the bill is narrowly tailored to
repeal the McCarran-Ferguson antitrust exemption only for the business
of health insurance. But despite the clear wording of the bill, I have
heard concerns from some that courts might somehow interpret the bill
broadly to include nonhealth lines of insurance such as life insurance,
long-term care insurance, disability income insurance, even property/
casualty insurance.
As one of only two former State insurance commissioners in the U.S.
House of Representatives, I know health insurance is different than
these other insurance lines. I would appreciate, Mr. Chairman, your
confirmation of my understanding that the bill we are now debating does
not apply to any insurance except for health insurance, and your
expectation that courts will interpret it properly to not include
nonhealth lines of insurance.
Is the gentleman's understanding of my expectation correct?
Mr. CONYERS. If the gentleman will yield, I want to commend him for
clearing up something that perhaps in more reasonable circumstances
should not need to be cleared up.
I still have confidence in the courts that they can read the simple
understanding that when we say ``health insurance,'' we don't mean life
insurance. I mean, this is getting pretty fundamental here. But, of
course, you are correct, Mr. Pomeroy. It's health insurance only; no
disability income insurance, no long-term care insurance, no property
insurance.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. CONYERS. I yield the gentleman an additional 1 minute.
Mr. POMEROY. I yield to the chairman.
Mr. CONYERS. No casualty insurance, no other kind of insurance but
the one plainly listed in a two-page
[[Page H782]]
bill. So my confidence in the courts is unrestricted that they can get
this right.
The lack of a statutory definition is intended solely to give the
courts the ability to ensure that all forms of health insurance are
appropriately included so that unreasonable and artificial distinctions
do not arise between two essentially equivalent kinds of insurance
products and how they are treated under antitrust laws.
I am glad that the gentleman raised this issue in the hearings.
Mr. POMEROY. I thank the chairman.
Reclaiming the time, I believe the chairman's words are very clear
and will make a very clear part of the legislative record on this bill.
Mr. SMITH of Texas. Mr. Speaker, I reserve the balance of my time.
Mr. CONYERS. Mr. Speaker, I yield 3 minutes to the gentleman from
Virginia who has done so much in working with the committee on this
bill, Mr. Perriello, who has been great.
Mr. PERRIELLO. Thank you, Mr. Chairman, thank you to Chairwoman
Slaughter, as well, for their great leadership on this bill. This is a
great day.
It's a great day for consumers, it's a great day for competition, and
it's a great day for common sense. I am new to Washington, and I know
this is a town full of grays, but sometimes things are as simple as
black and white. This is a chance for people to decide whether they
stand for patients or whether they stand for the profiteering of health
insurance monopolies, whether they stand for competition or for
collusion.
This is a victory for common sense in the midst of the health care
reform debate. Only inside the beltway would those people argue that
the best way to protect competition is to protect monopolies. Only
inside the beltway would people try to argue that the best way to help
the little guy is to make sure that we protect monopolies.
The status quo is not working for the small insurers. There are those
with very good intentions who want to talk about safe harbors, but I
have not had constituents come up to me and say, Congress, please have
more carve-outs. Congress, please have more exemptions and exceptions,
please make the bills even longer. Here we have a two-page bill, 24
lines long--one that is supported by conservatives and liberals alike
in my district--that makes a simple rule that health insurance
companies should have to play by the same rules as everyone else.
If two plumbers in my district get together and start to collude and
set prices, they will go to jail. Why should the biggest health
insurance companies in the country not have to play by the same rules?
People say to us, How about a shorter bill? Two pages. People say to
us, What about bipartisanship? Well, in 2007, all of the attorneys
general across the country, without a single dissenting vote across
party lines, said we want this bill. We want more Federal power for us
to be able to go after these monopolies that are sticking it to
consumers.
{time} 1415
This will not solve every problem in the health care debate, but if
we can't come together and agree on something this simple--pro-
competition, pro-consumer, two pages long--how will we ever come
together on anything?
It is estimated to save consumers $10 billion. In States that have
removed such protections before, premiums have risen at one-fifth the
rate of other folks. This means real money in the pockets of working
and middle class Americans. Voters say, who is standing up for us--
working and middle class Americans who play by the rules--instead of
for the interest groups? Here is a chance for a victory for common
sense and for consumers.
If you are a health insurance company and you are not engaged in
monopolistic practices, you're not colluding, you have nothing to worry
about. But if you are, be afraid, be very afraid, because you are no
longer going to enjoy the monopoly protections you have enjoyed for 65
years.
We are going to stand up for patients today with no loopholes and no
monopolies to ensure a basic sense of accountability, competition, and
Main Street values, and maybe take one step forward towards
bipartisanship and common sense in this health care reform debate.
Mr. SMITH of Texas. Mr. Speaker, I reserve the balance of my time.
Mr. CONYERS. Mr. Speaker, I would like to yield to Paul Kanjorski of
Pennsylvania for a unanimous consent request.
(Mr. KANJORSKI asked and was given permission to revise and extend
his remarks.)
Mr. KANJORSKI. Mr. Speaker, I rise in support of H.R. 4626.
Mr. Speaker, as the Chairman of the House Financial Services
Subcommittee on Capital Markets, Insurance and Government Sponsored
Enterprises and on behalf of the Financial Services Committee and its
Chairman (the gentleman from Massachusetts, Mr. Frank), I would like to
thank the Chairman of the Judiciary Committee (the gentleman from
Michigan, Mr. Conyers), the gentleman from Virginia (Mr. Perriello),
the gentlewoman from Colorado (Ms. Markey), and others for their
leadership in bringing this important legislation to the floor. I also
appreciate their cooperation with the Financial Services Committee--
which has primary jurisdiction over most insurance regulatory issues,
except for health insurance matters--in developing this bill. In
particular, I appreciate that the legislation before us is narrowly
tailored to repeal the McCarran-Ferguson antitrust exemption only for
the business of health insurance.
Today, Congress is engaged in robust debate on reforming the health
insurance marketplace for the nation. There are also many additional
types of insurance that impact citizens' lives on a daily basis. When
looking broader at insurance regulatory reform and allowing insurers to
cross state lines, Congress should look at these matters
comprehensively across all lines of insurance. I look forward to
working together with House leadership and multiple committees on these
important matters in the future.
Mr. CONYERS. Mr. Speaker, I recognize the distinguished Member who
allowed us to testify in his subcommittee on universal single-payer
legislation, Rob Andrews of New Jersey, and I yield him 2 minutes.
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. ANDREWS. Mr. Chairman, thank you for your leadership on this
bill. I would like to thank and congratulate Mr. Perriello, Ms. Markey
and Ms. Slaughter for their leadership.
Members of the House have a choice to make this afternoon: If you
believe that the Members of the two parties can work together to solve
a problem in our health care system, then the correct vote is ``yes'';
if you believe that there can be simple and clear solutions that do not
involve thousands of pages of legislative language, then the correct
vote is ``yes''; if you believe that health insurance companies should
be held to the same standard that car dealers, supermarkets, television
networks, candy stores, all kinds of people are held to in this
country, then the correct vote is ``yes.''
The choice here is competition versus crony capitalism. Competition
means the best competitors get the market share and get the business.
It means that health insurance companies cannot meet behind closed
doors and fix the prices of their product. We've seen enough of crony
capitalism on Wall Street, we have seen enough of crony capitalism in
our banking industry, and I think we've seen more than enough of crony
capitalism in health insurance.
This is the chance for the Members to come together and say we want
the health insurance industry to compete for the business of the
American people the same way everybody else does. It is pro-consumer,
it is pro-competition. It should be profound evidence that the two
parties can work together and start to solve the health care problem.
I congratulate the authors. I would urge my friends on both sides to
vote ``yes'' in favor of this bill.
Mr. SMITH of Texas. Mr. Speaker, I reserve the balance of my time.
Mr. CONYERS. Mr. Speaker, I am now pleased to recognize Betsy Markey
of Colorado. She has done yeoman's work on this measure in her first
term, and I will yield her 3 minutes.
Ms. MARKEY of Colorado. Thank you, Mr. Chairman, for your work on
this very important bill.
A few years ago, before I ever even decided to run for Congress, I
owned a small coffee shop in Old Town, Fort Collins. As a business
owner, I knew that my success or failure depended on my business plan
and my ability to
[[Page H783]]
compete. None of the other shopowners needed the government to offer
them some sort of special protection in order to survive. Capitalism is
the basis of our democracy, and a competitive marketplace is at the
heart of capitalism.
Since 1945, just two industries have enjoyed special protection from
antitrust laws by the United States Government: Major League Baseball
and the health insurance industry. Since Americans don't rely on
baseball tickets to vaccinate their children or get cancer screenings,
the gentleman from Virginia and I felt it important that we tackle the
special protections offered to the health insurance industry today.
I consider myself a pragmatic person. I think companies should be
left alone to succeed or fail based on the fitness of their business
plan and on the quality of the products they offer to consumers, not
because they got a special deal from Washington.
I believe that consumer protection laws keep our markets competitive
and are crucial to our democracy and economy, and that the exceptions
offered to the insurance industry for over half a century leave the
doors wide open to price-fixing that can't be regulated.
If any Member of this body were to come and suggest that the United
States Government give one industry immunity from protection and from
price-fixing, the outrage from the American public would be swift and
heartfelt. It is not fair that small business owners across America--
many of them struggling to survive in today's economy--have to play by
a separate set of rules.
The underlying premise of this bill is not a partisan issue.
Prominent Members of both parties have advocated removal of McCarran-
Ferguson for 2 years. In 2007, Senator Trent Lott cosponsored
legislation with Patrick Leahy that would have repealed an even broader
swath of antitrust exemptions benefiting the entire insurance industry.
At the same time, Senator Lott made the astute point that if the
industry were not engaging in price-fixing, it wouldn't have to worry
about losing its antitrust exemption.
When Lott testified before the Judiciary Committee in 2007, he said,
``I cannot for the life of me understand why we have allowed this
exemption to stay in place so long.'' Perhaps even more telling, the
National Association of Attorneys General strongly supports the repeal
of McCarran-Ferguson. One assistant attorney general noted, ``The most
egregiously anticompetitive claims, such as naked agreements, fixing
price, or reducing coverage, are virtually always found immune'' from
prosecution under the law.
The SPEAKER pro tempore. The gentlewoman's time has expired.
Mr. CONYERS. I yield the gentlewoman an additional 30 seconds.
Ms. MARKEY of Colorado. For years, one industry has enjoyed an unfair
advantage over every other business in the United States. I don't think
this has anything to do with being a Republican or a Democrat, I think
it has to do with being fair.
Mr. SMITH of Texas. Mr. Speaker, I yield myself 1 minute.
Mr. Speaker, we have heard several speakers in the last few minutes
say that there are only two industries exempted from the antitrust
laws, insurance and baseball. This, of course, is not true. There are
more than 20 such exemptions. If the majority is intent on eliminating
simple exemptions, perhaps they would be willing to eliminate the labor
union's antitrust exemption as well.
I reserve the balance of my time.
Mr. CONYERS. Mr. Speaker, Mary Jo Kilroy of Ohio has worked hard on
this legislation, and I would like to recognize her for 2 minutes.
Ms. KILROY. Thank you, Chairman Conyers, for allowing me this
opportunity. Also, I want to give thanks to the work of my freshman
colleagues, Tom Perriello and Betsy Markey, for their work on this
important piece of legislation that I am very proud to be a cosponsor
of.
I have been listening to this debate this afternoon, and it is very
surprising--and actually highly ironic--to hear the opposition from the
Republican side of the aisle to a bill that would simply make the
health insurance industry operate fairly in a competitive marketplace.
After all, it was a great Republican President, Teddy Roosevelt, who
was the great trust buster, the one who brought antitrust principles
into American jurisprudence and legislation. And as we have heard this
afternoon from others, versions of this bill have had bipartisan
support over the course of the years when there have been attempts to
introduce antitrust legislation addressing this issue with respect to
the health insurance industry. After all, competition is the engine
that drives our economy, spurs innovation, and ensures that the
American consumer would receive a fair deal. But for far too long the
insurance industry has been able to avoid accountability by dividing up
the territories among themselves like the robber barons once did on the
backs of ordinary Americans.
I also serve with several of my colleagues on the Competitiveness
Task Force, and I know that for our economy to regain its footing, we
need central Ohio and American business to be competitive, something
this bill will help to ensure.
This bill is needed because the health insurance industry is sick,
and we need to fix it. We know that we have an unhealthy insurance
system because we see that the signs and symptoms are there. Ninety-six
percent of all health insurance markets are highly concentrated,
meaning consumers have little or no choice between insurers, and it is
too easy for insurance industries to conspire on practices.
I urge my colleagues to support passage of the Health Insurance
Industry Fair Competition Act.
Mr. SMITH of Texas. Mr. Speaker, I yield 5 minutes to the gentleman
from California, the former Attorney General of that State, Mr.
Lungren.
Mr. DANIEL E. LUNGREN of California. I thank the gentleman for
yielding.
Mr. Speaker, as I've said repeatedly--and perhaps the gentlelady from
Ohio who just spoke didn't hear--I support the bill. I think she also
heard--well, maybe she wasn't here to hear the ranking Republican say
he is not going to oppose the bill, so let's be clear about what we're
talking about here.
While I do support this bill and while I do think it could be
perfected and while I hope that the motion to recommit will be adopted
to actually make it a better bill, I would say, however, this is not
the first bill we should have on the floor dealing with the overall
issue of health care. The first one should be the one the American
people have asked us to look at, and that is reform of the medical
malpractice system.
The interesting thing is, as the gentleman from Texas pointed out,
that in the bill that we have in the Senate and the House, there is
reference, as the President of the United States said, to medical
malpractice litigation alternatives. That bill does give incentives,
financial incentives, Federal moneys from the Federal Government to the
States if they will engage in alternatives to the litigation system in
areas of medical malpractice. But as the gentleman from Texas pointed
out, there is a kicker in there, and it says that if your State dares
to in any way put any limitations on attorneys fees or on any part of
the recovery in medical malpractice cases, that State will be
ineligible for the funds; in other words, you will be punished relative
to other States.
Now, the gentleman from Texas referred to the landmark legislation we
had in California called MICRA, which was adopted in the mid-1970s at a
time when we had a crisis in medical malpractice premiums. We actually
had an exodus of doctors, particularly in the specialties.
Neurosurgeons, I remember anesthesiologists, other high specialties
with high-risk practices were actually leaving the State of California
because of the significant increase in premiums on a yearly basis as a
result of the true historical data of what was happening in the courts.
{time} 1430
I recall at this time, because I actually did some representation in
the courts of doctors and hospitals and of even a couple of plaintiff
cases--but primarily defense cases--that it was becoming a crisis.
So, in California, it came together on a bipartisan basis, and we
passed legislation better known as MICRA. In there, we have a
limitation on a sliding scale on the amount of money that can go to the
attorneys, and it's a slightly higher percentage at the lower
recoveries. As the recovery gets larger and
[[Page H784]]
larger, the percentage of return to the attorneys, percentage-wise for
that segment of the recovery, is less.
While putting no limitation whatsoever on recovery for loss of income
and for all medical costs, there was a cap put on noneconomic damages.
As one who has been in the courtroom and has seen what happens, that is
logical because the one area in which you saw extraordinary amounts of
money that really were not truly indicative of approvable damage--I'm
not saying there isn't pain and suffering, but trying to quantify it is
extremely difficult, and it proved to be impossible, and it proved to
be the area in which you had the outrageous jury verdicts that had the
impact of distorting the system. So California adopted both of those.
In other words, the bill that has been presented by the President and
Democrats in the House and the Senate not only does not really deal
with reform of the medical malpractice system, but it takes us back
more than 30 years to the position in which we were then when we had
not an academic exercise about the possibility of a crisis but a true
crisis. We literally had a crisis in medical care in the State of
California until we enacted this change.
So that is why it is at least as strange to ask and to see why we
don't have some litigation reform moving through our Judiciary
Committee and through the other committees that may have jurisdiction
in the House of Representatives and placed on the floor. That's why it
was very important for the gentleman from Texas to make reference to
the California system, because that is one that has worked, and it
specifically is the one that is singled out in the legislation that the
President supports to be punished. Now, if that is not irony, I don't
know what is.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. SMITH of Texas. Mr. Speaker, I yield the gentleman an additional
1 minute.
Mr. DANIEL E. LUNGREN of California. So I would just hope that people
would understand, as important as this bill is, that we should be at
least listening to the American people, who have said number one on
their issue list in dealing with this problem, as they see it, as they
understand it, as they are affected by it, is the reform of the medical
malpractice litigation system as it currently exists.
So it is somewhat disappointing that we don't have that even on the
horizon. I think the gentleman, the ranking member on the committee,
would agree we haven't seen anything on this subject that has been
scheduled for our committee.
While I support this legislation--and let me repeat that--I support
this legislation. I think it is good legislation. I think it may have a
slightly bigger impact than, maybe, my ranking member thinks it will
have, although not as large an impact as suggested by the other side. I
would hope that the other side would look with open eyes and would
listen with open ears to our motion to recommit because I think it will
make a better bill, will clear up some definitions that are not defined
in this bill and will help us move in the right direction.
Mr. CONYERS. Mr. Speaker, I yield 2 minutes to the leader of the
Progressive Caucus in the House for so many years, the gentlewoman from
California, Lynn Woolsey.
Ms. WOOLSEY. Thank you, Congressman Conyers, for your great
leadership.
Mr. Speaker, can you imagine the health care industry being exempt
from the McCarran-Ferguson antitrust rules right now, particularly
after Anthem raised their rates 39 percent a couple of weeks ago when
their parent company had just announced that they had had--I believe it
was 2.9--around a $2 billion profit last quarter, and when one of their
subsidiaries has to raise their rates 39 to 40 percent?
H.R. 4626 will lift the antitrust exemptions that health insurance
companies have enjoyed for far too long. It will protect us from the
Anthems of the world. These exemptions have given the companies a near
monopoly control of health insurance markets--preventing meaningful
competition, competition that would bring down the cost of premiums and
competition that would make health care affordable for all Americans,
which we know is not right now. Through the lifting of the insurance
companies' antitrust exemptions and through the creation of an
exchange, we will increase competition. The insurance industry will
then have to control their costs, control their premiums and control
their copays because they will have competition.
Another important way to increase competition is to give the American
people a choice, a choice of a public health insurance option--an
option that will compete with private health insurance companies and
will bring down the costs of premiums and the costs of coverage.
The CBO, the Congressional Budget Office, has stated that a public
option would save at least $25 billion if we included that right now in
our health care bill. That $25 billion could be used for subsidies to
ensure the affordability of all health insurance plans.
Mr. SMITH of Texas. Mr. Speaker, I have no further requests for time
on this side, and I am prepared to close at the appropriate time.
I reserve the balance of my time.
Mr. CONYERS. Mr. Speaker, I yield 2 minutes to the distinguished
gentleman from California (Mr. Garamendi).
Mr. GARAMENDI. Chairman Conyers, thank you so very much.
Mr. Speaker, I keep thinking about that movie ``Casablanca.'' The guy
says, I am shocked to learn that the Republican Party that has
championed itself with the free market economy would oppose a measure
that would, in fact, allow for competition.
Now, a lot has been said on the floor today, but the fact of the
matter is--and I spent 8 years of my life as the insurance commissioner
in California, and I am here to tell you that the insurance companies,
using the exemption from the antitrust laws, are able to conspire to
fix prices on premiums and on payments to doctors. That has been proved
in cases, national cases, brought by States and by private attorneys as
well as by the attorney general of New York.
Similarly, they are able to vertically integrate. In a case that took
place in New York, where UnitedHealthcare owns a company called
Ingenix, which actually sets the reimbursement rates, they are able to
have a serious conflict of interest. The lower the normal reimbursement
rates, the more the copay to consumers.
So there are varieties of practices that take place in the insurance
industry, practices which are anticompetitive and anticonsumer. What we
are doing here is very simple and very, very straightforward. It is
this:
Under the antitrust laws that have been in place since Teddy
Roosevelt is a long history of people pushing back against the powerful
interest groups--in this case, the powerful interest groups of the
insurance industry. It is time for us to simply say, You must compete
as every other part of the American economy must. Vertical integration
to the detriment of consumers: not allowed. Price-fixing on selling the
products: not allowed. Not able to use that market power to set prices
on the payment to doctors and hospitals. All of those things have taken
place. The proof is there.
With regard to the States' ability to do this, yes, many States do
have antitrust laws, and we are thankful for that, but the Federal
Government, the Federal Attorney General, is precluded from involving
in the matter of competition in this industry.
Mr. CONYERS. Mr. Speaker, I yield 2 minutes to a former member of the
House Judiciary Committee, the gentlewoman from Ohio, Betty Sutton.
Ms. SUTTON. Thank you, Mr. Chairman, for the time.
Mr. Speaker, I rise in strong support of this bill, to repeal the
antitrust exemption for health insurance companies.
For far too long, the health insurance industry has been exempted
from playing by the rules that most other American businesses must live
by. Since 1945, they have been operating beyond the reach of these
important consumer protection laws. The result has been excessive
consolidation in the health insurance industry and the insurance
companies taking advantage of honest, ordinary Americans. This
legislation will finally put an end to insurance company collusion, and
it will bring much needed competition to the industry.
[[Page H785]]
According to the Consumer Federation of America, repealing these
antitrust exemptions will save consumers more than $40 billion in
insurance premiums. I, for one, want consumers to save that money. The
families that I proudly represent have the right to be confident that
the cost of their insurance and the actions of their health insurance
providers are reflective of competitive market conditions, not of
collusion.
This bill is a historic step to ensure competition in the insurance
industry and to provide access to quality, affordable health care for
all Americans. Now, who would be against that?
The choice is clear and easy. It is a two-page bill, easily
understood, hard to mischaracterize. A vote for the bill is a vote for
our constituents. A vote against the bill is doing exactly what the
insurance industry wants. Let's think about that. For our constituents
versus for the health insurance industry. It's an easy choice. Because
the American people need all of us to be on their side, I urge people
on both sides of the aisle to vote for this bill.
Mr. CONYERS. Mr. Speaker, I yield 2 minutes to the gentleman from
Canton, Ohio, John Boccieri.
Mr. BOCCIERI. Thank you, Mr. Chairman.
Mr. Speaker, the American people have asked for common sense in their
government, but all too often it is just not that common.
You see, our friends on the other side have asked for simplicity, for
substance, and for competition in the health care debate, but only in
Washington will we argue that competition doesn't reduce costs. Only in
Washington will we argue that we haven't had time to read a two-page
bill. Only in Washington will we argue process over results for
consumers.
What does it mean for consumers in Ohio?
Well, let me tell you, small businesses in Ohio, their premiums have
risen about 129 percent. There are 7.4 million people in Ohio who get
their insurance on the job, averaging about $13,000. Small businesses
make up 72 percent of all business in Ohio, while only 47 percent of
them can afford to offer health insurance for their people.
We have seen 400 mergers in the health care industry over the last 14
years, so 95 percent. According to the Department of Justice, health
insurance markets are highly concentrated. It means there is collusion.
It is simple economics. We increase competition. We lower prices.
On this matter, we have to know who we will stand with at this hour.
Are we going to stand for families or are we going to stand for
monopolies? Are we going to stand for competition or are we going to
stand for price-fixing and collusion? Are we going to be Congress men
and women who stand for consumers and for open markets or are we going
to be Congress men and women who stand for collusion and corruption in
the industry? There are not all bad actors out there, but on this day,
at this hour, we need to stand with consumers.
Mr. CONYERS. Mr. Speaker, this has been an important debate, and I
would like to take this opportunity to commend the leader of the
Republicans in the House, and especially one Member on the Judiciary
Committee, Lamar Smith.
We have had a very civil debate. I think, in the course of the
incredible amount of time that we have been allotted for this bill,
that we have reached closure on some issues. There are now more things
that we agree to on both sides of the aisle than there are things that
we may have differences about.
{time} 1445
I attribute it to the goodwill and the cooperation of my Republican
colleagues on the House Judiciary Committee. I also solicit their vote,
but I will respect any way that they may choose to dispose of this
matter and our friendship will not be diminished or impaired in any way
whatsoever.
Now, Lamar Smith mentioned the fact that there were other exemptions,
and to be perfectly candid, I did not know that there were more than
two exemptions, and it turned out that there are. As a matter of fact,
there are 27. But many of them--and I haven't researched this yet. Many
of them are partial exemptions. Many of them are very small exemptions
that are very limited in terms of the economic scope of our reach in
the United States. But they, nevertheless, exist.
Mr. Smith may remember that the baseball antitrust exemption was
given very close scrutiny only 2 or 3 years ago, and it reminded them
of the fact that their conduct hadn't always been such that deserved a
continuation of the exemption, and I'm hopeful that baseball will still
deserve it.
But here in the field of health care, I think it's hard to defend any
argument that the health insurance industry deserves or requires or
needs an exemption, and for that reason I am urging all of my
colleagues to examine this two-page bill and scrutinize it. Let's see
if we can get a refreshingly large bipartisan vote that could lead the
American people to reflect on the fact that we can be liberals and
conservatives without rancor or animosity or personalizing our
philosophical differences, and that's the appeal that I offer to my
colleagues on the other side.
There are those that wonder if this would create some kind of a chill
or curtailment of creativity if this exemption were removed, and I
don't think that that is very logical. We think that the antitrust laws
are fairly elementary. They don't conspire against competition. They
don't try to reserve creativity. We want competition, and it is the
exemption from antitrust liability that this becomes very, very
critical.
Mr. Speaker, I reserve the balance of my time.
Mr. SMITH of Texas. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, first of all, let me thank Chairman Conyers for his
comments. He is always gracious in making those. He is right. We have
had a good discussion today about this particular piece of legislation.
And I also want to say that he and I have a very good working
relationship on the Judiciary Committee as well.
In regard to this bill, Mr. Speaker, I have to say that as much as
some might hope that it did something or hope that it accomplished
something or might wish that the bill did something or might pretend
that the bill did something, in point of fact, the Congressional Budget
Office disagrees. Members are free to wish upon a star, but this bill
is a dim bulb.
Mr. Speaker, the Congressional Budget Office says that ``whether
premiums would increase or decrease as a result of this legislation is
difficult to determine, but in either case, the magnitude of the
effects is likely to be quite small.'' ``Quite small.''
So, Mr. Speaker, what's the point of this bill? CBO goes on to say
that premium reductions from this bill are likely to be small because
``State laws already bar the activities that would be prohibited under
Federal law if this bill was enacted.''
So again, Mr. Speaker, what's the point of this bill?
I could list all the reasons why this bill is ineffective, useless,
unproductive, pointless, futile, and meaningless. Instead, I would like
to highlight something we could do to actually drive down health care
costs.
Last October, the CBO concluded that a tort reform package consisting
of reasonable limits on frivolous lawsuits would reduce the Federal
budget deficit by an estimated $54 billion over the next 10 years. That
$54 billion in savings from tort reform could be used to provide health
insurance for many of the uninsured without raising taxes on those who
already have health insurance policies.
Also, according to the CBO, under a Republican-sponsored health care
tort reform bill called the HEALTH Act, ``premiums for medical
malpractice insurance ultimately would be an average of 25 percent to
30 percent below what they would be under current law.''
And a GAO report stated that ``losses on medical malpractice claims,
which make up the largest part of insurers' costs, appear to be the
primary driver of rate increases in the long run.''
Mr. Speaker, rather than spend time on a bill that the CBO said would
yield a ``quite small,'' if any, change in health care premiums, we
should instead take up a bill the CBO concluded would save us $54
billion. The American people deserve real health care reform, not a
feeble and feckless substitute.
[[Page H786]]
Mr. Speaker, I yield back the balance of my time.
Mr. CONYERS. Mr. Speaker, I yield 1 minute to the gentleman from
Maryland, Mr. Frank Kratovil.
Mr. KRATOVIL. Mr. Speaker, for months we have been debating how to
improve the health care system. We have focused on two major goals: One
is increasing the number of those who have coverage, and the second
major goal is doing what we can to reduce the costs for those that do.
One way, obviously, to accomplish these goals is to increase
competition. In fact, it's one of the few areas where, in this debate,
we have seen bipartisanship. There have been recommendations, various
recommendations, on how to do that. One is the bill that we have today.
There have been other suggestions, allowing for competition across
State lines.
The point is we all know that one of the ways to accomplish the major
goals that we seek to accomplish is to create competition, and that is
what this bill does. We need to ask the question: Why would we allow
this exemption to continue when we do not do that for other industries?
Why would we do that when no public interest is served by doing so?
Now, this may not be the silver bullet, but certainly everyone agrees
that in order to improve our health care system, we must increase
competition. That's not a partisan issue. That's what this bill does.
And for that reason, I ask my colleagues to support it.
Mr. CONYERS. Mr. Speaker, Nancy Pelosi is the first female Speaker of
the House in American history. She is the third ranking person in our
Federal Government. And we are all honored to recognize her for 1
minute at this time.
Ms. PELOSI. I thank the chairman for his generous remarks and for his
tremendous leadership in bringing this important legislation to the
floor. Mr. Conyers is well known as a champion of the people, and today
he demonstrates that once again.
This House of Representatives, Mr. Chairman, is called the people's
House, and you are a leader in the people's House. Today we live up to
that name by passing legislation that increases leverage for people. By
changing the playing field, a playing field that has been dominated by
the insurance industry for over 65 years. And now it's the people's
turn. The insurance companies will now be playing on the people's
field.
Mr. Conyers, thank you for your ongoing leadership, for fairness, for
competition, for a better deal for the American people.
I also want to commend chairwoman of the Rules Committee, Louise
Slaughter, for her ongoing and persistent insistence that this
legislation come to the floor. When she served in the State legislature
in New York, she was fighting this fight.
This antitrust exemption was passed, again, over 60 years ago and it
was supposed to last 3 years. Sixty-five years later we are on the
floor of the House to finally repeal the special exemption that
insurance companies have that no other industry, except Major League
Baseball, has in our country.
I also want to commend Mr. DeFazio, who has been a champion on this
issue, Congressman DeFazio from Oregon. He has worked with our new
Members of Congress, and they have been a source of energy to move this
legislation: Congresswoman Betsy Markey of Colorado; Congressman Tom
Perriello of Virginia, the author of this bill. We're grateful to them
for their courage and their leadership, because the insurance companies
don't want this bill but the American people do, and I commend those
who have worked so hard.
Another new Member of Congress, Congressman Garamendi, a former
insurance commissioner of the State of California, played a role
effective from the start as soon as he arrived to get this legislation
to the floor. And, again, I believe that the legislation has many
Republican supporters as well. So that, of course, is really a source
of confidence to us as we go forward into the health care debate.
One year ago, we began this debate on health care, quality,
affordable health care for all Americans. We got a running start on it
in the recovery package with big investments in basic biomedical
research and health information technology, so we were on the cutting
edge of science and technology for this. We had a running start on it
by passing the SCHIP in a bipartisan way, State Children's Health
Insurance Program, insuring 11 million children in America. And then
the debate has gone on from the summit the President had a year ago in
a bipartisan way to a summit he will have tomorrow as well. But in the
meantime, this very important piece of legislation is before us today.
I have always said that any health care reform had to make the AAA
test. It had to have affordability for the middle class, accessibility
for many more people, and accountability for the insurance companies.
Accountability for the insurance companies. No longer would they have
it all their way. And that's what this legislation does.
We had this on the agenda, and then the snows came and we had to put
it off. And in between the time when we all got snowed out or snowed
in, Anthem in California announced that it was going to raise its rates
39 percent: 39 percent, Anthem Insurance Company; 39 percent for health
insurance.
{time} 1500
Over the past decade, insurance rates have gone up over 150 percent.
And this continues in Michigan, Kansas, other places in the country
these insurance rates have gone up because the insurance companies
simply have not been accountable. And this has worked to the
disadvantage of the American people.
So again, I commend all of those who played a part in bringing this
to the floor, to the bipartisan discussion that took place in committee
that has been mentioned, and for hopefully the strong bipartisan
support we will see today.
But again I want to come back to Chairman Conyers, because he is the
person when it comes to speaking out for the people, chairman of the
Judiciary Committee, a very prestigious position, one with a great deal
of responsibility to make sure that the pledge we take each day, with
liberty and justice for all, is lived up to. And today we are providing
much more competition, much more freedom for the American people by
expanding their choices with this important legislation.
I urge our colleagues to support the legislation, once again salute
all those who made it possible to bring this before the people's House
today. Thank you, Mr. Chairman.
Mr. VAN HOLLEN. Mr. Speaker, as an original cosponsor, I rise in
strong support of legislation that will end the unfair advantages that
health insurance companies currently enjoy today. I want to commend my
colleagues Representatives Perriello and Betsy Markey for their
leadership and advocacy on this very important issue.
I hope most of us would agree that health insurance companies should
play by the same rules as every other industry in America. For far too
long, the health insurance industry has been exempt from the Federal
antitrust laws that govern other businesses. As a result, they are not
subject to Federal laws banning price fixing, market manipulation,
collusion, or other anticompetitive business practices.
It is apparent that there is no real competition in parts of the
health insurance market. In the last few weeks, we have seen health
insurance companies impose huge premium increases on consumers. Anthem
Blue Cross of California announced a 39 percent price hike in premiums
for their consumers. The Department of Health and Human Services has
reported that several large health insurance companies across the
country have requested premium increases of anywhere between 16 percent
and 56 percent. These huge premium increases come after a year of
record profits for the top five health insurance companies in America.
Last year, as Americans struggled to pay their health insurance costs,
insurance companies' profits jumped by 56 percent.
Quite simply, the legislation we are considering today will repeal
the blanket antitrust exemption afforded to health insurance companies
under the McCarran-Ferguson Act. We must hold health insurers
accountable when they engage in anti-competitive behaviors that benefit
their profit margins at the expense of American families.
Mr. Speaker, we are taking a small but very critical step towards
health insurance reform and fixing a part of our broken health care
system while Congress continues to work on comprehensive health care
reform to bring more affordable and accessible care for all Americans.
I urge my colleagues to support this much-needed bill.
Mr. HOLT. Mr. Speaker, I rise in strong support of the Health
Insurance Industry Fair Competition Act, H.R. 4626, legislation that
[[Page H787]]
would remove the health insurance industry's antitrust exemption. As a
cosponsor of this important legislation, I urge my colleagues to join
me in supporting this bill to expand competition, improve the
affordability of health insurance, and give families more choices.
I have heard from many hard-working New Jerseyans, who are struggling
under the current insurance system. The system is too expensive and
leaves too many people without good, secure coverage. Families are
paying higher and higher premiums for less coverage. Our businesses are
struggling to afford health care for their employees and find
themselves at a competitive disadvantage compared to companies in other
countries. Those problems have not gone away and must be addressed.
The legislation we are considering today would lower costs and
provide new insurance options for families by repealing the insurance
special exemption to antitrust law. This exemption was created by the
1945 McCarran-Ferguson Act with the intention of helping new small
insurance companies by allowing them to access historical insurance
data for setting their premiums and left all antitrust regulation to
the states.
Instead of encouraging new small insurance companies, this antitrust
exemption has stifled competition. A single insurance company controls
more than half the insurance market in 16 states, while in New Jersey
the top two companies control almost 60 percent of the market. Lack of
competition has led to growing insurer profits, increased costs and
reduced coverage for patients, and an epidemic of deceptive and
fraudulent conduct.
By repealing the special antitrust exemption for health insurance
companies, health insurers would be held accountable for fixing prices,
dividing up market territories, using predatory pricing, or rigging
bids. This bill makes the federal government a partner with states who
lack the resources to go after insurance companies that have violated
the law.
This bill is one part of reform needed to improve the health care
that all Americans receive by holding health insurance companies to the
same good-competition rules that other industries face. I encourage my
colleagues to vote in favor of this bill to lower costs and provide new
options for patients.
Mr. LOEBSACK. Mr. Speaker, I am submitting the following statement
for the record in support of the Health Insurance Industry Fair
Competition Act, which would end the anti-trust exemption that
currently gives special privileges to health insurance companies.
If we do not pass this legislation, American consumers will continue
to pay more for health insurance, if they can afford it at all, because
of a lack of competition in the insurance market.
According to the AFL-CIO, profits at 10 of the country's largest
publicly traded health insurance companies rose 428 percent from 2000
to 2007. At the same time, consumers paid more for less coverage. At
the root of this problem is the growing lack of competition in the
private health insurance industry that has led to near monopoly
conditions in many markets.
There is no reason why health insurance companies should continue to
receive this favored treatment from the federal government while
millions of Americans pay the price.
Mr. GENE GREEN of Texas. Mr. Speaker, I rise today as an original
cosponsor and strong supporter of H.R. 4626 the Health Insurance
Industry Fair Competition Act.
Since 1940s, the McCarran-Ferguson Act has exempted the insurance
industry from all federal antitrust laws giving health insurers freedom
to raise premium prices, deny coverage for preexisting conditions, and
change their reimbursement rates.
Right now millions of Americans are at the mercy of the health
insurance companies with premium increases going up in the double digit
percentage points across the country. These premium increases are not
to enhance insurance plans, but to add to the extremely large profit
margins of insurance companies.
Seemingly, there is no end in sight to this business practice because
there is little competition in the health insurance market that
benefits the consumer. If this continues health insurance premiums will
continue to rise as long as we allow the insurance companies to control
markets.
We know that competition in the marketplace leads to lower prices and
more options that benefit the consumer. There is no reason why the
health insurance industry, with their outrageous spending on lavish
retreats and executive salaries at the expense of the consumer, should
not be forced to compete for business on a level playing field and
control their costs and spending on non-health care related items.
Right now, health insurance costs are out of control and if
individuals cannot afford health insurance they end up in emergency
rooms forcing the health care system and the taxpayer to pay for their
expenses. Yet, the insurance companies continue to see increased
profits while making it nearly impossible for individuals to gain
access to or afford a policy.
H.R. 4626 is one way we can fix the monopolies the health insurance
industry has over the consumer and will make insurance coverage more
affordable for individuals and small businesses.
This is a step in the right direction, but we desperately need health
reform in this country. All individuals should have access to quality
and affordable health insurance and we will not accomplish that without
reforms throughout our health care system.
I strongly support H.R. 4626 because insurance anti-trust reform is
one piece of the pie as we move forward.
Ms. DeLAURO. Mr. Speaker, this past summer, in my home state of
Connecticut, Anthem tried to raise health insurance premiums by up to
32 percent. Right now, in California, the same company is trying to
pull the same trick--trying to increase their rates by as much as 39
percent.
Unfortunately, we now know that the top five insurers in America saw
record-breaking profits in 2009. We have seen increases in profits of
91 percent at WeIlPoint, and a whopping 346 percent at Cigna.
How is this happening, in the midst of an historic recession? A lot
of reasons, and central among them the fact that, according to long-
established antitrust standards, there is no real competition in the
insurance market today. In fact, there have been more than 400 mergers
among health insurers in the past 14 years. So, insurers get away with
price-gouging mainly because they can.
We have coddled this industry far too long. It is time to remove
insurers' special antitrust exemption and to make them play on the same
level playing field as every other business in America. I hope that all
my colleagues who consistently espouse the virtues of a free market
will join us in passing this bill today.
Mr. CONYERS. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. All time has expired.
Pursuant to House Resolution 1098, the previous question is ordered.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
Motion to Recommit
Mr. SMITH of Texas. Mr. Speaker, I have a motion to recommit at the
desk.
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. SMITH of Texas. I am in its current form.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. Smith of Texas moves to recommit the bill (H.R. 4626)
to the Committee on the Judiciary, with instructions to
report the bill back to the House forthwith with the
following amendments:
Strike subsection (a) of section 2 of the bill and insert
the following (and make such technical and conforming changes
as may be appropriate):
(a) Amendment to McCarran-Ferguson Act.--Section 3 of the
Act of March 9, 1945 (15 U.S.C. 1013), commonly known as the
McCarran-Ferguson Act, is amended by adding at the end the
following:
``(c)(1) Nothing contained in this Act shall modify,
impair, or supersede the operation of any of the antitrust
laws with respect to the business of health insurance. For
purposes of the preceding sentence, the term `antitrust laws'
has the meaning given it in subsection (a) of the first
section of the Clayton Act, except that such term includes
section 5 of the Federal Trade Commission Act to the extent
that such section 5 applies to unfair methods of competition.
``(2) Paragraph (1) shall apply only to health insurance
issuer (as that term is defined in section 2791 of the Public
Health Service Act (42 U.S.C. Sec. 300gg-91) to the extent
that the issuer engages in the business of health insurance.
``(3)(A) Paragraph (1) shall not apply to--
``(i) collecting, compiling, classifying, or disseminating
historical loss data;
``(ii) determining a loss development factor applicable to
historical loss data;
``(iii) performing actuarial services if doing so does not
involve a restraint of trade, or
``(iv) information gathering and rate setting activities of
a State insurance commission or other State regulatory entity
with authority to set insurance rates.
``(B) The term `historical loss data' means information
respecting claims paid, or reserves held for claims reported,
by any person engaged in the business of insurance.
``(C) The term `loss development factor' means an
adjustment to be made to the aggregate of losses incurred
during a prior period of time that have been paid, or for
which claims have been received and reserves are being held,
in order to estimate the aggregate of the losses incurred
during such period that will ultimately be paid.''.
At the end of the bill, add the following (and make such
technical and conforming changes as may be appropriate):
[[Page H788]]
SEC. 3. GAO REPORT.
Three years after date of enactment of this Act, the
Government Accountability Office shall submit, to the
Committee on the Judiciary of the House of Representatives
and the Committee on the Judiciary of the Senate, a report on
whether this Act has reduced unfair competition in the health
insurance market in each of the 50 States. Such report shall
specify whether, as a result of this Act, the reduction in
unfair competition, if any, has resulted in increased price
competition in the business of health insurance.
Mr. SMITH of Texas (during the reading). Mr. Speaker, I ask unanimous
consent that the motion be considered as read.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
Mr. DeFAZIO. Mr. Speaker, reserving the right to object, is this the
one previously noticed and delivered a couple hours ago? Is that the
motion to recommit? I just want to make sure it is exactly the same
language.
The SPEAKER pro tempore. The pending motion is at the desk.
Mr. DeFAZIO. I withdraw my reservation.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Texas is recognized for 5 minutes in support of the motion.
Mr. SMITH of Texas. Mr. Speaker, I support this motion to recommit on
H.R. 4626, the Health Insurance Industry Fair Competition Act. As I
stated in my earlier comments, this legislation does little, if
anything. However, if you are going to do nothing, you might as well do
it better.
This motion corrects three drafting errors that create problems with
the bill. First, it adds a definition for health insurers that was
absent from the base bill. If we are going to eliminate McCarran-
Ferguson for a limited subset of insurers, then we should clarify who
those insurers are.
Second, this motion to recommit includes the exchange of data
provision that Mr. Lungren added at the Judiciary Committee markup of a
similar bill. It is necessary to ensure that small and medium health
insurers can in fact compete in the marketplace.
Third, the motion to recommit includes language that protects the
rate gathering and rate setting activities of State insurance
commissions. The majority assumes this will be protected by the State
action doctrine. But if Congress is going to repeal a 65-year-old law,
shouldn't we make clear that we do not want this to undermine State
insurance commissions?
Finally, the motion to recommit includes a GAO study on the impact of
this legislation on competition in the health insurance market.
Specifically, the GAO must report on whether or not this legislation
has enhanced competition, resulting in lower prices and new competitors
in the market. Let's put political rhetoric aside and see what the bill
really does. We shouldn't be afraid of the truth.
In short, this motion to recommit includes definitions and
clarifications that the majority has already included in earlier
versions of this legislation that either were reported favorably by the
Judiciary Committee or were passed by the full House. This isn't much
of a bill, but let's try to improve what little there is.
I yield to the gentleman from California, a senior member of the
Judiciary Committee.
Mr. DANIEL E. LUNGREN of California. Mr. Speaker, I would like to
refer to that part of the motion to recommit that deals with the
amendment that I offered and that was contained in the bill that passed
out of the Judiciary Committee. It simply allows historical data to be
utilized by insurance companies large and small. This is something that
is requested by the small insurance companies, this is something
supported by the American Bar Association. Their representative who
testified before our subcommittee on behalf of or in support of the
underlying legislation supported this amendment so that in fact small
insurers would not be disadvantaged.
Let's get this right. There are some who have told me on the other
side that, well, we don't need this because it will be allowed by the
U.S. Justice Department or by the courts. We ought not to wait for
that. We ought to give some real solid certainty to insurance
companies, particularly the small insurance carriers. So if we wish to
permit the collection of historical data, let's make it clear what we
intend. Just because we haven't brought forward on this floor some
answer to the medical malpractice litigation issue is no reason for us
to commit legislative malpractice here. We ought to do our job. We
ought to not pass it on.
Now, there are a few people who don't think that historical data
should even be allowed. If that is the way they feel, I understand it.
Most Members I have spoken to believe it ought to be allowed. They
understand the absolute essence of it in terms of the continued
existence of small insurers across the country.
Let's get it right. I have the language virtually the same that was
contained in the majority's health care bill that passed just a couple
of months ago. It is the same as contained in the bipartisan bill that
came out of our committee. And most importantly, it is the same
language contained in the various bills presented to this House by the
late great Jack Brooks, chairman at that time of the House Judiciary
Committee, about whom Members on the other side have waxed eloquently.
And in tribute to him, I would hope they would support the gentleman's
motion to recommit that contains my amendment.
Mr. SMITH of Texas. I yield back the balance of my time.
Mr. DeFAZIO. Mr. Speaker, I rise in opposition to the motion to
recommit.
The SPEAKER pro tempore. The gentleman is recognized for 5 minutes.
Mr. DeFAZIO. I thank the Speaker.
Simple question before the House today. Should the health insurance
industry live under the same antitrust rules and have the same consumer
protections as are provided for every other major industry in America
without special exception, without carve-outs, without loopholes? No
more collusion to get together, to conspire to limit markets, coverage,
and drive up rates. The American people want and they need this
protection.
Now, they say there is a study throughout that says this won't save
money. That study was actually based on the language they are offering.
Yes, if we provide these loopholes it well may not bring down rates.
But if we don't vote for their loopholes, we will bring down rates. The
Consumer Federation of America says we will save $10 billion in
ratepayer premiums next year if we adopt this amendment straight up
without their loopholes.
With that, I yield to the gentleman from California.
Mr. GARAMENDI. Thank you.
Mr. Speaker, directly to Mr. Lungren's proposed amendments, actually
there are three major elements. If you look at those major elements,
they do in fact give the insurance industry the opportunity to collude,
because that is the data that sets future prices for consumers as well
as payments for doctors.
I know this business. I was the Insurance Commissioner in California
for 8 years. And I know that if an insurance company is able to collude
in collecting, compiling, classifying, or disseminating historic data
and determining a loss development factor, and finally, using actuarial
services, they have the power to collude. This is an incredible
loophole. It should never be allowed.
And the final point having to do with the insurance commissioners
collecting data, nowhere in any antitrust laws are States precluded
from any collection of data. This ought not be put forth. I ask for a
``no'' vote.
Mr. DeFAZIO. I yield to the gentleman from New York.
Mr. WEINER. You know, you got to love these Republicans. I mean, you
guys have chutzpah. The Republican Party is . . . That is the fact.
They say that, well, this isn't going to do enough, but when we propose
an alternative to provide competition, they are against it. They say
that, well, we want to strengthen State insurance commissioners, and
they will do the job. But when we did that in our national health care
bill, they said we are against it. They said they want to have
competition, and when we proposed requiring competition, the
Republicans are against it. They are . . . That is the fact.
Mr. DANIEL E. LUNGREN of California. Mr. Speaker, I ask that the
gentleman's words be taken down.
[[Page H789]]
The SPEAKER pro tempore. The gentleman will suspend. The gentleman
from New York will be seated.
The Clerk will report the words.
Mr. WEINER. Mr. Speaker, I ask unanimous consent to address the House
for the purpose of amending my remarks.
The SPEAKER pro tempore. Does the gentleman seek unanimous consent to
withdraw his words?
Mr. WEINER. I would request unanimous consent to substitute other
words.
The SPEAKER pro tempore. That would require a withdrawal.
Mr. WEINER. I ask unanimous consent to withdraw my words.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New York?
There was no objection.
Mr. WEINER. How much time do I have remaining?
The SPEAKER pro tempore. The gentleman from Oregon has 3 minutes
remaining.
The gentleman from New York is recognized.
Mr. WEINER. Make no mistake about it: . . .
Mr. DANIEL E. LUNGREN of California. Mr. Speaker, I ask the
gentleman's words be taken down once more.
The SPEAKER pro tempore. The gentleman will suspend. The gentleman
from New York will be seated.
The Clerk will report the words.
Mr. WEINER. Mr. Speaker, I ask unanimous consent to withdraw the
offending comments.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New York?
Mr. DANIEL E. LUNGREN of California. Reserving the right to object,
has the Chair ruled as to whether the gentleman's words are
inappropriate under the rules of the House and the precedents of the
House?
The SPEAKER pro tempore. There has been no ruling at this time. The
gentleman has offered to withdraw the words.
Mr. DANIEL E. LUNGREN of California. I withdraw my reservation.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New York?
There was no objection.
Mr. DeFAZIO. May I inquire as to the time now that is left?
The SPEAKER pro tempore. The gentleman from Oregon has 2 minutes and
50 seconds remaining.
Mr. DeFAZIO. I yield to the gentleman from New York.
Mr. WEINER. I thank you very much. But the point is very simple.
There are inequities in the present way we distribute insurance, the
way we distribute health care. There are winners, and there are losers.
The winners are the insurance industry. And our efforts to reel in the
insurance profits, not just because they shouldn't make profits--
they're doing what they're supposed to. But what they're doing is
driving up taxes, they're driving our economy into the ground, and we
need competition and choice to deal with that. That's what this
legislation does, and the motion to recommit undermines it.
I've heard a couple of times today, well, we have an effort for
bipartisanship here. No, there is not bipartisanship on this
fundamental issue; and that is, the people who sit on this side, at the
risk of offending anyone, generally support the idea of standing up for
the American people in their daily battles against high insurance. And
the people, generally speaking, who sit on this side of the Chamber,
and specifically speaking as well, in a lot of cases, simply won't
permit that to happen and haven't for a generation.
That's going to end now. That is going to end because we are going to
have competition. We are going to make sure that there are regulations,
and we're going to make sure that the American people aren't gouged.
That's what the American people stand for. And time and time again
people say, well, I don't really want to undermine this bill, I just
want to weaken it to the point that it's meaningless.
And then I've heard my good friend from Texas say, well, this doesn't
do anything. But every single time we've tried to do something, like a
tiny sliver of competition called the public option, they've said, no;
we can't withstand competition. We can't have that.
Enough of the phoniness. We are going to solve this problem because
for years our Republican friends have been unable to and unwilling to.
Deal with it.
Mr. DeFAZIO. I thank the gentleman for those remarks.
The SPEAKER pro tempore. The gentleman from Oregon has 1\1/2\ minutes
remaining.
Mr. DeFAZIO. We have before us a simple question: Will we repeal a
62-year old artifact that is a special favor for the insurance
industry, an exemption from the laws of the land of antitrust, which
are designed to promote competition, to protect consumers, and for a
free market economy.
You can't have a free market economy when people can collude, when
they can get together to limit markets and competition, when companies
become so huge they dominate urban areas and entire States; one
company. Consumers have virtually no choice in much of America. They
have to eat those huge rate increases or not. We can take a meaningful
step here today to bring down the cost of health insurance for all
Americans. The Consumer Federation of America says this will save
consumers $10 billion next year, and they say that's nothing. Well, say
that to your consumers at home if you vote against this bill.
Creating these loopholes undermines the entire effort here today. We
do not need these loopholes. We need this industry to play by the same
rules as every other industry in America.
Vote against the motion to recommit, and vote for competition and
consumer protection for all Americans in health insurance.
With that, I yield back the balance of my time.
Mr. DANIEL E. LUNGREN of California. Mr. Speaker, I would like to ask
unanimous consent if I might revise my remarks. I referred to Jack
Brooks as the late great. I didn't mean to suggest that he is no longer
with us. He is great but he is not late.
The SPEAKER pro tempore. Without objection.
There was no objection.
The SPEAKER pro tempore. All time has expired.
Without objection, the previous question is ordered on the motion to
recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. SMITH of Texas. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule
XX, this 15-minute vote on the motion to recommit will be followed by
5-minute votes on passage of H.R. 4626, if ordered; and suspension of
the rules with regard to House Resolution 1085.
The vote was taken by electronic device, and there were--yeas 170,
nays 249, not voting 13, as follows:
[Roll No. 63]
YEAS--170
Aderholt
Adler (NJ)
Akin
Alexander
Austria
Bachmann
Bachus
Bartlett
Barton (TX)
Biggert
Bilbray
Bilirakis
Bishop (UT)
Blackburn
Boehner
Bonner
Bono Mack
Boozman
Boustany
Brady (TX)
Bright
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Buchanan
Burgess
Burton (IN)
Calvert
Camp
Campbell
Cantor
Capito
Carter
Cassidy
Castle
Chaffetz
Coble
Coffman (CO)
Cole
Conaway
Crenshaw
Culberson
Deal (GA)
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Dreier
Duncan
Ehlers
Emerson
Fallin
Flake
Fleming
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gingrey (GA)
Gohmert
Goodlatte
Granger
Graves
Griffith
Guthrie
Hall (TX)
Harper
Hastings (WA)
Heller
Hensarling
Herger
Hunter
Inglis
Issa
Jenkins
Johnson (IL)
Johnson, Sam
Jordan (OH)
Kilroy
King (IA)
King (NY)
Kingston
Kirk
Kline (MN)
Lamborn
Lance
Latham
LaTourette
Latta
Lee (NY)
Lewis (CA)
Linder
LoBiondo
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
McCarthy (CA)
McCaul
McCotter
McHenry
McKeon
McMorris Rodgers
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Murphy, Tim
Myrick
Neugebauer
Nunes
Olson
Paul
Paulsen
Pence
Petri
Platts
Poe (TX)
Posey
Price (GA)
Putnam
Rehberg
Roe (TN)
Rogers (AL)
[[Page H790]]
Rogers (KY)
Rogers (MI)
Rohrabacher
Rooney
Ros-Lehtinen
Roskam
Royce
Ryan (WI)
Scalise
Schmidt
Sensenbrenner
Sessions
Shadegg
Shimkus
Shuster
Simpson
Smith (NE)
Smith (NJ)
Smith (TX)
Souder
Stearns
Sullivan
Teague
Terry
Thompson (PA)
Thornberry
Tiahrt
Tiberi
Turner
Upton
Walden
Wamp
Westmoreland
Whitfield
Wittman
Wolf
Young (AK)
Young (FL)
NAYS--249
Abercrombie
Ackerman
Altmire
Andrews
Arcuri
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Boccieri
Boren
Boswell
Boucher
Boyd
Brady (PA)
Braley (IA)
Brown, Corrine
Butterfield
Cao
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chandler
Childers
Chu
Clarke
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Cooper
Costa
Costello
Courtney
Crowley
Cuellar
Cummings
Dahlkemper
Davis (AL)
Davis (CA)
Davis (IL)
Davis (TN)
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Doggett
Donnelly (IN)
Doyle
Driehaus
Edwards (MD)
Edwards (TX)
Ellison
Ellsworth
Engel
Eshoo
Etheridge
Farr
Fattah
Filner
Foster
Frank (MA)
Fudge
Garamendi
Giffords
Gonzalez
Gordon (TN)
Grayson
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Halvorson
Hare
Harman
Hastings (FL)
Heinrich
Herseth Sandlin
Higgins
Hill
Himes
Hinchey
Hinojosa
Hirono
Hodes
Holden
Holt
Honda
Hoyer
Inslee
Israel
Jackson (IL)
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Jones
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick (MI)
Kind
Kirkpatrick (AZ)
Kissell
Klein (FL)
Kosmas
Kratovil
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maffei
Markey (CO)
Markey (MA)
Massa
Matheson
Matsui
McCarthy (NY)
McClintock
McCollum
McDermott
McGovern
McIntyre
McMahon
McNerney
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (NC)
Miller, George
Minnick
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy (NY)
Murphy, Patrick
Nadler (NY)
Napolitano
Neal (MA)
Nye
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor (AZ)
Payne
Perlmutter
Perriello
Peters
Peterson
Pingree (ME)
Polis (CO)
Pomeroy
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richardson
Rodriguez
Ross
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schauer
Schiff
Schrader
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shea-Porter
Sherman
Shuler
Sires
Skelton
Slaughter
Smith (WA)
Snyder
Space
Speier
Spratt
Stupak
Sutton
Tanner
Taylor
Thompson (CA)
Thompson (MS)
Tierney
Titus
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch
Wilson (OH)
Woolsey
Wu
Yarmuth
NOT VOTING--13
Barrett (SC)
Blunt
Buyer
Davis (KY)
Dingell
Hoekstra
Maloney
Pitts
Radanovich
Reichert
Schock
Stark
Wilson (SC)
{time} 1545
Ms. ESHOO, Messrs. BERRY, BOSWELL, GONZALEZ, BUTTERFIELD, Ms.
BERKLEY, Messrs. CLEAVER, GEORGE MILLER of California, ORTIZ, WALZ,
GUTIERREZ, Ms. VELAZQUEZ, Ms. ROYBAL-ALLARD, Mr. CROWLEY, Ms. SUTTON,
and Mr. CHILDERS changed their vote from ``yea'' to ``nay.''
Messrs. GINGREY of Georgia and COLE changed their vote from ``nay''
to ``yea.''
So the motion to motion to recommit was rejected.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. SMITH of Texas. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--yeas 406,
nays 19, not voting 8, as follows:
[Roll No. 64]
YEAS--406
Abercrombie
Ackerman
Aderholt
Adler (NJ)
Alexander
Altmire
Andrews
Arcuri
Austria
Baca
Bachmann
Bachus
Baird
Baldwin
Barrow
Bartlett
Barton (TX)
Bean
Becerra
Berkley
Berman
Berry
Biggert
Bilbray
Bilirakis
Bishop (GA)
Bishop (NY)
Bishop (UT)
Blackburn
Blumenauer
Boccieri
Bonner
Bono Mack
Boozman
Boren
Boswell
Boucher
Boustany
Boyd
Brady (PA)
Braley (IA)
Bright
Brown (SC)
Brown, Corrine
Brown-Waite, Ginny
Buchanan
Burgess
Burton (IN)
Butterfield
Calvert
Camp
Campbell
Cantor
Cao
Capito
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Carter
Cassidy
Castle
Castor (FL)
Chaffetz
Chandler
Childers
Chu
Clarke
Clay
Cleaver
Clyburn
Coble
Coffman (CO)
Cohen
Cole
Conaway
Connolly (VA)
Conyers
Cooper
Costa
Costello
Courtney
Crenshaw
Crowley
Cuellar
Culberson
Cummings
Dahlkemper
Davis (AL)
Davis (CA)
Davis (IL)
Davis (KY)
Davis (TN)
Deal (GA)
DeFazio
DeGette
Delahunt
DeLauro
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Dicks
Doggett
Donnelly (IN)
Doyle
Dreier
Driehaus
Duncan
Edwards (MD)
Edwards (TX)
Ehlers
Ellison
Ellsworth
Emerson
Engel
Eshoo
Etheridge
Fallin
Farr
Fattah
Filner
Flake
Fleming
Forbes
Fortenberry
Foster
Foxx
Frank (MA)
Frelinghuysen
Fudge
Gallegly
Garamendi
Gerlach
Giffords
Gingrey (GA)
Gohmert
Gonzalez
Goodlatte
Gordon (TN)
Granger
Graves
Grayson
Green, Al
Green, Gene
Griffith
Grijalva
Guthrie
Gutierrez
Hall (NY)
Hall (TX)
Halvorson
Hare
Harman
Harper
Hastings (FL)
Hastings (WA)
Heinrich
Heller
Hensarling
Herger
Herseth Sandlin
Higgins
Hill
Himes
Hinchey
Hinojosa
Hirono
Hodes
Holden
Holt
Honda
Hoyer
Hunter
Inglis
Inslee
Israel
Issa
Jackson (IL)
Jackson Lee (TX)
Johnson (GA)
Johnson (IL)
Johnson, E. B.
Johnson, Sam
Jones
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick (MI)
Kilroy
Kind
King (NY)
Kingston
Kirk
Kirkpatrick (AZ)
Kissell
Klein (FL)
Kline (MN)
Kosmas
Kratovil
Kucinich
Lance
Langevin
Larsen (WA)
Larson (CT)
Latham
LaTourette
Latta
Lee (CA)
Lee (NY)
Levin
Lewis (CA)
Lewis (GA)
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lucas
Luetkemeyer
Lujan
Lummis
Lungren, Daniel E.
Lynch
Mack
Maffei
Maloney
Manzullo
Marchant
Markey (CO)
Markey (MA)
Marshall
Massa
Matheson
Matsui
McCarthy (CA)
McCarthy (NY)
McCaul
McClintock
McCollum
McCotter
McDermott
McGovern
McHenry
McIntyre
McKeon
McMahon
McMorris Rodgers
McNerney
Meek (FL)
Meeks (NY)
Melancon
Mica
Michaud
Miller (FL)
Miller (MI)
Miller (NC)
Miller, Gary
Miller, George
Minnick
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy (NY)
Murphy, Patrick
Murphy, Tim
Myrick
Nadler (NY)
Napolitano
Neal (MA)
Neugebauer
Nunes
Nye
Oberstar
Obey
Olson
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor (AZ)
Paulsen
Payne
Pelosi
Pence
Perlmutter
Perriello
Peters
Peterson
Petri
Pingree (ME)
Platts
Poe (TX)
Polis (CO)
Pomeroy
Posey
Price (NC)
Putnam
Quigley
Rahall
Rangel
Rehberg
Reyes
Richardson
Rodriguez
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rooney
Ros-Lehtinen
Roskam
Ross
Rothman (NJ)
Roybal-Allard
Royce
Ruppersberger
Rush
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Scalise
Schakowsky
Schauer
Schiff
Schmidt
Schock
Schrader
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sessions
Sestak
Shadegg
Shea-Porter
Sherman
Shimkus
Shuler
Shuster
Simpson
Sires
Skelton
Slaughter
Smith (NE)
Smith (NJ)
Smith (TX)
Smith (WA)
Snyder
Souder
Space
Speier
Spratt
Stearns
Stupak
Sullivan
Sutton
Tanner
Taylor
Teague
Terry
Thompson (CA)
Thompson (MS)
Thompson (PA)
Thornberry
Tiberi
Tierney
Titus
Tonko
Towns
Tsongas
Turner
Upton
Van Hollen
Velazquez
Visclosky
Walden
Walz
Wamp
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch
Whitfield
Wilson (OH)
Wilson (SC)
Wittman
Wolf
Woolsey
Wu
Yarmuth
Young (AK)
Young (FL)
NAYS--19
Akin
Boehner
Brady (TX)
Broun (GA)
Buyer
Franks (AZ)
Garrett (NJ)
Jenkins
Jordan (OH)
King (IA)
Lamborn
Linder
Moran (KS)
Paul
Price (GA)
Ryan (WI)
Sensenbrenner
Tiahrt
Westmoreland
[[Page H791]]
NOT VOTING--8
Barrett (SC)
Blunt
Dingell
Hoekstra
Pitts
Radanovich
Reichert
Stark
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). There are 2 minutes
remaining in the vote.
{time} 1555
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________