[Congressional Record Volume 156, Number 38 (Tuesday, March 16, 2010)]
[House]
[Pages H1499-H1505]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE REFORM
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 2009, the gentleman from Texas (Mr. Burgess) is recognized
for 60 minutes as the designee of the minority leader.
Mr. BURGESS. I thank the Speaker for the recognition. Well, here we
are, Tuesday night, Washington, D.C., 20 minutes until eight o'clock in
the evening. What a day we have had here in the Capitol. Mr. Speaker,
many of your constituents and my constituents probably tried to call
our offices today to register how they felt about this health care
bill. I know I have been encouraging people, whether they agree with me
or not, whether they think I'm spot on or all wet, I have been
encouraging people to call and let Congress know what you think about
this massive government takeover of one-seventh of our Nation's
economy. And people have responded. They have been calling.
But today they were met with either busy signals or interminable
rings, because apparently the House switchboard was overwhelmed with
the calls that were coming in. I will tell you I was concerned because
I called my number for my office and got a busy signal, and yet walking
around in the office, certainly not all of the phones were in use. So
apparently this problem that Americans have encountered all afternoon
has been one that has at its root and its cause in the antiquated House
switchboard. I do hope the Speaker, I hope the Architect of the
Capitol, and the Capitol business manager, will take that into account,
because clearly, clearly we need to be able to hear from our
constituents when we have such important legislation coming up to the
floor.
So where are we as we work through this? Are we in the last throes?
Are we still in for a long, hard slog? We have heard terms like the
final push, the final stretch, the 5-yard line. President Obama,
Speaker Pelosi, and Majority Leader Reid have ignored calls by
certainly every Republican, by many Democrats, many independent
Americans, and just the American people in general, to really put the
breaks on this current bill and to look at some of those things that
people really want to see done, and do those.
We don't have a lot of credibility right now in the United States
Congress. Recent polls I think today put it around 17 percent. No one
trusts us with a 1,000-page bill that we passed out of committee last
July 31. They darn sure didn't trust us with a 2,000-page bill that the
Speaker's office came up with in October and that we passed in this
House in early November. They darn sure didn't trust the 2,700-page
bill that passed in the Senate on Christmas Eve. And they sure don't
trust what they see as a very difficult, tortured process that is now
working its way through the House. And the reason they're having to
resort to such legislative hijinks is because fundamentally this is a
flawed bill. This is a bad bill. And it didn't have to be this way.
Look, most of us went home during August. We did our summer town
halls, as we always do. We were all, I think, somewhat astonished at
the outpouring of the American people just showing up on a hot Saturday
morning in Texas to stand in a parking lot and listen to their
Representative and question their Representative about what they saw
happening up on Capitol Hill. To be sure, cap-and-trade was in the news
those days; to be sure, the stimulus bill was in the news those days.
But they were most concerned about this massive takeover of health
care. Most of the questions dealt with that. And it wasn't like they
didn't want to see anything done. But they didn't trust us to overhaul
the entire system with one massive bill.
{time} 1945
Sure, they want some help with preexisting conditions. Yeah, they'd
like to see people be able to buy across State lines and bring some
cost down. Maybe some liability reform would be nice. Boy, wouldn't it
be great if COBRA was a little more flexible. These were the things we
heard. When we came back in September, I thought, okay, rewind, pause,
slow this thing down, and let's look at it. Maybe let's work together.
Maybe Republicans and Democrats can kind of come to some common ground
because every Democrat was hearing the same stuff I was hearing. And I
know that because I saw it on the evening news. I saw the YouTube
clips. Their town halls in Florida, their town halls in Arkansas, their
town halls in Michigan were exactly the same as the town halls that
were going on in north Texas. There was no difference.
But instead in September, we come to a joint session of the House and
the Senate. The President came and addressed us, and it was nothing of
the sort that we're going to rework this process. We weren't going to
check the weather. We're going to fly anyway, full speed ahead. Let's
get this thing done. I think I heard it said again tonight in the
discussion that just preceded us, A crisis is a terrible thing to
waste; so let's take this economic crisis that we're in and force this
health care bill on the American people. They don't know what's good
for them, but we do; and this is what they're going to get.
It is a terrible bill. It's a flawed bill. It's a very tortured
process. I'm going to do everything in my power to stop it, but it may
become law. And if it does, we need to know what's in it, and we need
to know then what our next steps are to deal with those bad provisions
that are contained within the bill.
I've been joined tonight on the floor by a gentleman that I've come
to admire during my time in Congress. He has been a leader on this
issue and on the committee in which we jointly serve, Energy and
Commerce, and here on the House floor. John, did you have some thoughts
you wanted to share with us tonight?
Mr. SHADEGG. I do. I want to thank the gentleman for conducting this
special hour, and I want to talk about a number of issues that you have
already referenced. Number one, health care reform: I certainly think
we need health care reform. I know you do. I know that we believe that
while the current system provides very high-quality health care, it
often denies people access. But I want to talk a little bit about
what's in the bill as well. The gentleman talked about this massive
takeover.
One of the things that stuns me more than anything else--and I know
that you find this confusing--is that the proponents of this bill say
that Republicans are defending the health insurance companies in
America. Really? Really? This bill says that we're going to enact a
mandate, an individual mandate compelling every American to buy health
insurance from the health insurance companies that are selling them
health insurance now. Huh? I'm sorry, I find that a little confusing.
There is an individual mandate that says if this bill passes and
becomes law, as the Speaker would like to do this week, you--every
single American, every American listening tonight--must go out and buy
health insurance from the very health insurance companies that are
ripping us off right now. Why? Why in God's name would we want to force
Americans to buy health insurance from the same health insurance
companies that are ripping us off right now?
This is a massive subsidy to those health insurance companies. It's a
law. It will be the law of the land that says, you must, whether you
want to or not, buy a government-approved health insurance plan from
one of the companies selling health insurance right now. If they were
doing a great job of selling health insurance right now, wouldn't the
cost be affordable? Wouldn't they be holding down cost? Wouldn't they
be giving us good service? Wouldn't they not be cheating us? I've got
to tell you, I don't know any Republican who thinks that it's a great
idea to compel people to buy health insurance from the same insurance
companies that are selling us health insurance now. And yet that's what
the individual mandate in this bill does.
I guess they like it because it has been applied in Massachusetts. In
Massachusetts they passed a mandate like this. They said that every
single person
[[Page H1500]]
in Massachusetts, by gosh, we're going to force you to buy a health
insurance plan from some health insurance plan offered from a health
insurance company in Massachusetts, and that will fix the problem. Did
it fix the problem, Doc?
Mr. BURGESS. Not entirely. And what they found was, since you have to
buy the insurance, the cost may have gone up a little bit.
Mr. SHADEGG. Oh, the cost went up. Wait, the cost went up? They have
forced everybody in Massachusetts, like this bill would do, to buy a
health insurance plan on the premise that the cost would go down. But
in Massachusetts where they did it, the cost went up.
Mr. BURGESS. Up. Because you've got to buy it, or you get a fine.
Mr. SHADEGG. Ah, so it's Republicans who oppose this bill that are
the pals of the health insurance industry? I don't think so. And you're
telling me that in the one State where we've already tried this, a
mandate that you must buy health insurance, costs did not go down, but
costs went up. The cost of health insurance for the people in
Massachusetts from before they enacted the mandate to after they
enacted the mandate went up?
Mr. BURGESS. That's my understanding from the reports that have been
done by Heritage and other groups. But interestingly, if Massachusetts
wants to enact a mandate, they are a State. And if their residents say,
Okay, we are happy with you, Governor. We are happy with you, State
legislator or State senator, for enacting this mandate and they reelect
them to office, that's all well and good. But here we're talking about
the 50 States and various territories, a mandate applied across the
board. This has never been done in this country before because there's
a document called the Constitution that says we shouldn't be doing
this.
Mr. SHADEGG. Wait, the gentleman's telling me that never before in
Federal law have we ordered people to buy a particular product, that we
don't do that in Federal law as a routine matter?
Mr. BURGESS. Just as a coincident fact for being born and living in
the United States, no.
Mr. SHADEGG. No, we don't force people to do that. I guess we do say
that if you want to drive in some places, you have to buy auto
insurance to insure against damage to somebody else. Right?
Mr. BURGESS. Correct. And still, that is a State mandate.
Mr. SHADEGG. That's not a Federal mandate?
Mr. BURGESS. Correct. And there are some States who don't have the
mandate.
Mr. SHADEGG. So this would be the first Federal mandate saying you
must buy a product because the Federal Government tells you you must
buy a product?
Mr. BURGESS. That's my understanding. It is such a good idea, as you
correctly pointed out in your very graphic demonstration. The strong
arm of enforcement here is the already existing Federal agency that
collects our income taxes every year.
Mr. SHADEGG. You are referring to the sign I have next to me.
Mr. BURGESS. Yes.
Mr. SHADEGG. That's the IRS. The IRS is going to force you and me to
buy health insurance from an approved health insurance company,
federally approved health insurance. Maybe you can answer the question
that is posited on this graphic: Why does the Democrats' bill subsidize
health insurance companies? I don't quite get that. Why is it that
Democrats are so adamant that we subsidize America's health insurance
companies, those companies that are already ripping us off,
overcharging us, undercompensating, don't pay our claims when we submit
them, make the doctors turn in 46 copies of every form, then kick it
back, then kick it back again? Can you tell me why the Democrats want
to subsidize America's health insurance plans by ordering every
American to buy one of those plans? Because I don't get it.
Mr. BURGESS. If the gentleman will recall in May and June of this
year, six groups met down at the White House. It was a great photo-op.
My AMA was there. The Hospital Association was there; PhRMA showed up;
AdvaMed, the people who make medical devices; AHIP, America's Health
Insurance Plans; and the Service Employees International Union all
gathered at the White House. The President came out after this meeting
and said that these groups have offered up $2 trillion in savings to
the American people in order to get this health care bill done. So I
don't know. I wasn't there. I can't get information on these meetings.
Mr. SHADEGG. Wait, wait, wait. Are you telling me this is a deal?
You're telling me these health insurance companies went into the White
House and struck a deal, and the deal says, If you'll pass a bill
forcing everyone in America to buy our product, we, the health
insurance industry, will support your bill. That's a pretty good deal.
Can I take, like, maybe some other company, a lumber company or an auto
company, into the White House and say, Hey, if you'll strike a deal,
we'll support some bill you want. You just have to force every American
to buy our product. Right? Because, what the heck, let's strike a deal.
It seems to me the health insurance companies must have very good
lobbyists closed tight, very closely to the Democrat Party. Because if
I remember correctly, the health insurance industry wanted two things.
They wanted a mandate. They wanted you and me to be forced to
buy government-approved health insurance from these health insurance
companies and to have the IRS enforce it. They wanted it. They got it.
They did not want a so-called public plan to compete with those health
insurance companies. The health plans said, No, no, no. Competition,
no, no, no. We health insurance plans don't want to have to compete. So
we don't want to compete with a public plan. We don't want to have to
compete across State lines. We don't want to have to compete for the
business of individuals. We don't like that thing about competition.
As I understand it, those health insurance plans get out of this bill
a mandate that you and I have to buy their plan, and there is no public
plan to compete with them. That's good lobbying, I guess. If the
Democrats will carry your water and say, We're going to enact a law
that says that every American must buy health insurance from these
health insurance plans and, oh, by the way, those health insurance
plans don't have to face any competition.
They don't have to compete with a public plan. They don't have to
compete across State lines. They don't have to even compete for your
business and my business because right now, the Tax Code says that if
we get it from our employer, it's tax free; but if you and I want to go
out and buy it alone, if we made poor United or poor Aetna have to
compete with each other for Dr. Burgess' business or for John Shadegg's
business, oh, they wouldn't like that. That might drive down costs.
That might drive their profits down. That might drive down profits or
the salary of their executives.
Well, they didn't want that. And in the Democrats' bill, you know
what, they don't have to. There's no competition across State lines.
There's no competition under the Tax Code letting you and I buy health
insurance on the same tax-free basis that our bosses can buy at the
companies. Boy, I'll tell you, those health insurance plans got good
lobbyists in the White House. And that was a meeting, that was a deal
that was struck down at the White House?
Mr. BURGESS. Well, we don't know because the White House refuses to
provide us with any information, even though they've been asked nicely.
They were asked more forcefully with the resolution of inquiry in our
committee. Chairman Waxman and Ranking Member Barton did send a
correspondence down to the White House asking for that information to
be supplied to our committee. To date, what we've gotten back is a
series of press releases and reprints of pages off of Web sites, but no
real information.
It would be fascinating to know if it's part of that $2 trillion
deal: okay, you're going to get a mandate. Maybe we'll leave out the
public option. But, oh, by the way, we're going to trash you every day
during this process, so get ready for the next year and a half. We will
vilify your industry six ways to Sunday because they certainly have
done a good job of doing that.
The gentleman points out an excellent point: if an individual is able
to
[[Page H1501]]
buy a policy with the same breaks that a company gets, and that
individual is able to keep that insurance over time, a longitudinal
relationship with a health insurance company, what a novel concept.
I've had the same car insurance since I was 18 years old. I can't tell
you how many different health plans I've had because when I was in
business for myself, I was always trying to find a better deal because
that was one of the number one line-item expenses on my budget every
year, providing insurance for my employees. So you were always looking
to see if there wasn't a better deal somewhere.
And as a consequence, I frequently changed health insurances until I
discovered what was then the medical savings account and now is the
health savings account.
So kind of through the back door, I have now developed a longitudinal
relationship with an insurance company. They send me emails, and they
ask me to do certain things to keep myself healthy, and it works well
between us. Why we didn't embrace that sort of model going into this, I
just, frankly, don't understand.
Mr. SHADEGG. The gentleman raises one of the things that makes me so
upset in this debate. And quite frankly, as you've pointed out, I've
worked on health care reform since 1995. It seems to me morally
indefensible, morally indefensible to say to the American people, If
you work for a big, big, big employer--like you and I do, the Federal
Government--or like we'll say, General Motors or Intel or Motorola or
AT&T or any of those big employers, you work for a big employer, you're
a lucky guy or a lucky gal because your health insurance is tax free.
Your employer buys the health insurance and writes off the cost of
buying that health insurance. Your employer then gives that health
insurance coverage to you, and it's not income to you. So the tax on--
we'll say a $5,000 insurance policy--zero, zip, zero, nothing because
you were lucky enough to go to work for a big employer.
{time} 2000
But the law in America--and I think this is what is morally
indefensible. And the law in America, even after this bill passes, says
to the little guy, to the least among us, to those who are just barely
getting by, to that person who works for, we'll say, a small garage or
maybe, in my State of Arizona, a small lawn service company----
Mr. BURGESS. Or a doctor's office.
Mr. SHADEGG. Or maybe even a small doctor's office. If their employer
doesn't give them employer-paid health care coverage, here's what we do
the little guy. Here's what we do to the least among us. We say, Oh,
you really ought to be insured, but we're going to smack you down.
We're going to make you pay income tax first before you buy that health
insurance; that is to say, we're going to punish you if you decide to
spend your money on health insurance.
So the $5,000 health insurance policy that this guy over here got
from his employer that cost him zero in taxes, maybe it cost him or his
employer $5,000, that plan for the little guy who doesn't work from an
employer that provides health care coverage, that plan costs $5,000,
we'll say, plus another third, or another, close to a third, we'll say
another 15 or $1,800. That plan costs the little guy $6,800, because he
has to go out and earn the $5,000, then he has to go out and earn
$1,800 in income taxes on top of that and spend the total $6,800--
$5,000 on insurance, $1,800 on income tax--to get the same policy that
the guy that worked for the big employer got for free.
How can we morally justify that in this Nation? How can we say that
it is right to treat those people lucky enough to work for the Federal
Government or a big employer, Intel, Motorola, you name it, UPS, you
get essentially free health care paid for by your employer and not
taxed to your employer or you, but this little guy who works, or woman
who works for a small day care company or who works for a small sewing
shop, she gets no health care for free, and she has to pay income tax
on her income before she even gets to go buy a health insurance policy?
How can that be justified, and why isn't that fixed in this bill?
Mr. BURGESS. Great point. And another point that is so often missed
in this discussion, let's take the example of the National Football
League. You've got the Arizona Cardinals; I've got the Dallas Cowboys.
A player who is lucky enough to be traded from Arizona to Dallas--I'm
thinking it's an upgrade--their health insurance goes with them. If
they had a knee injury in Arizona, they're covered for that knee injury
day one in Dallas on the new team.
But if the fan who wants to follow their favorite player moves from
Arizona to Dallas, they cannot take that insurance policy with them,
necessarily, across State lines. And, oh, by the way, that new policy
you're buying in Texas, that knee injury may be excluded because, after
all, it was a preexisting condition. We will not apply the same degree
of portability for the little guy that we do for the person who's
covered under the large multi-State plans, the ERISA plans that the
multi-State corporations can provide for their employees.
Make no mistake. I think that is wonderful that the large employers
do that, and I don't think there is anyone among us who would want to
see that system changed. But you are correct. We should provide the
same breaks across the board.
Mr. SHADEGG. Going back to my board here, why don't Democrats want to
force United to have to compete with Aetna for the business of that
little guy so that he or she can buy health insurance, tax-free, like
Intel can or Motorola can or the Federal Government can?
Why is it that America's politicians, about to pass this bill perhaps
as early as this weekend, don't want to force those health insurance
companies to compete? What's wrong with competition?
You mentioned auto insurance. I turn on the TV at night and I see TV
commercials for every single auto insurance company I can imagine. I
see one for GEICO. They've got their little gecko. I see Progressive. I
see Allstate. I see State Farm. I see Farmers. I see all these
insurance companies. They're all pounding me with their ads, and every
ad says, Come buy your auto insurance from our company, and we will
charge you less and give you better service.
And yet, there's not a single ad like that I've ever seen on TV where
Aetna or United or any of those health insurance companies who, by the
way, don't want competition from a public plan but do want an
individual mandate compelling us to buy their product, I never see them
advertise to me and say, Hey, John, come buy our health insurance
policy, and we'll charge you less and give you better service. Could
that be because they don't have to compete for our business? Because
under the Tax Code that we're not fixing in this bill, you and I can't
afford to buy health insurance directly from them, so they don't have
to compete. They're protected from competition. They just want an
individual mandate. Since they don't have to compete with each other,
they complain that not enough people buy their policies. I think it's
because their policies are too expensive. Since they don't have to
compete, now they need a mandate to force us to buy their policies.
Why don't they have to compete like the auto insurance companies do?
Mr. BURGESS. Well, of course, the life insurance business, the
premiums for life insurance plummeted with the introduction of the
Internet with these companies that would advertise and then sell their
policies on the Internet.
Mr. SHADEGG. So competition brought down the cost of that kind of
insurance.
Mr. BURGESS. Yes. And the power of the Internet could apply to health
insurance as well. But, as you know, there is some difficulty selling
in the individual market across State lines, and therein is where the
regulatory part of what we--the regulatory environment that we set here
in Congress that we're not fixing in this bill, as you point out.
Mr. SHADEGG. Not fixing in this bill?
Mr. BURGESS. Not, not fixing in this bill, that that will continue to
exist.
There are sites you can go to. You can go to Google and type in
``health savings account'' and get a variety of plans that will come
up. And I encourage people who are looking for individual insurance,
that is a reasonable thing to do. Yes, you have to pay with after-tax
dollars. Some of those policies can be quite affordable if you're
[[Page H1502]]
willing to accept the fact that it will be a high deductible type of
policy.
But, realistically, when you look at health care expenses--and I'm a
physician. I've watched people spend their money in health care for
years. Some expenses are so small that they're actually financed out of
cash flow: aspirin and Band-Aids. Some expenses are predictable but
larger: braces, having a baby, maybe arthroscopy on that knee injury.
Those could be saved for or borrowed for if we allowed the correct
flexibility within the health savings account, for example. And then
there are the ``Boy, I hope that never happens to me'' events: the
leukemia, the heart attack. Those are the ones where this catastrophic
insurance really is a godsend when people have that.
But, again, we did nothing. We had--we both sit in the committee that
deals with this. Did we have a hearing on how to provide more
flexibility, more competition with the insurance market? No. It was, if
you want everyone covered, it is an individual mandate. That really was
the only offering. We never had a hearing to ask the question: Is there
a way to cover people with preexisting conditions without an individual
mandate? We never asked that question, so it's not surprising that we
don't know the answer to that.
Mr. SHADEGG. You know, it stuns me that you just said that, under
current law in America, if you work for an employer who gives you
health care through your employment, it's tax free. There's no income
tax paid on it by your employer, no tax paid on it by you when you
receive it. But you can go on the Internet and you can buy health
insurance on your own, but you've got to buy it with after-tax dollars,
making it a third more expensive. Isn't it shocking?
Then, or more accurately, not to be cynical about it, isn't it pretty
logical then that the health insurance companies don't compete? They
don't care about our individual business because they know you and I
can't afford to buy with after-tax dollars what we can get from our
employer for free.
Tell me, I guess I just do not understand why we wouldn't want to fix
the Tax Code so that every single American could buy their health
insurance tax-free just like their employer, so they could hire it and
fire it and hold it accountable.
The gentleman mentioned preexisting conditions and the Commerce
Committee. I think the gentleman knows full well that, in 2006, we
passed legislation through that Commerce Committee which dealt with the
problem of preexisting conditions. We, as Republicans, in 2006, said,
You know what? No one in America should go uninsured or go without care
because they don't--because they have a preexisting condition. So we
passed legislation encouraging all 50 States to create a State high-
risk pool. Under a State high-risk pool, the State would be required to
accept and insure anyone that had a preexisting condition.
I happen to have an older sister who is a breast cancer survivor.
She's now lived 20 years beyond her breast cancer. She has a
preexisting condition. If Arizona had taken advantage of that
legislation, the State would have created a high-risk pool and she
could have, if she was denied coverage, or if she was told her premium
would cost too much, she could have applied to the State high-risk
pool. She would have been entitled to be admitted to the State high-
risk pool. She could not have been charged more than 110 percent or 120
percent of the cost of health insurance for a healthy person. But all
of her care would have been paid for, and the extra cost of her care,
as a member of that State high-risk pool, would have been shared; that
is, would have been spread, the extra cost would have been spread
amongst every single person in the State of Arizona who purchased
health insurance, or would have been spread over the State tax base and
subsidized by State revenues.
That legislation passed the Commerce Committee, passed the floor of
this House by voice vote, passed the United States Senate by unanimous
consent, and was signed into law, and is the law today. It didn't force
the States to create high-risk pools, but 33 States have.
Now, we can improve upon that. I'd like to make them mandatory. But
we've already dealt, or we can deal with preexisting conditions without
a mandate, an individual mandate compelling people to buy health
insurance from the same health insurance companies that are already
doing a lousy job of offering us health insurance. And yet, when the
President of the United States--this is very important. When the
President of the United States held his health care summit--and I note
you didn't get to go and I didn't get to go. But at the health care
summit, the President misdescribed, and so did Secretary Sebelius, a
high-risk pool. Both of them said, if you put all the sick people in
and give them no help, of course their premiums are going to go up. But
no State high-risk pool in America puts the sick people in and says to
them, Now pay your own premiums.
What high-risk pools do is they put in the sick people; they
guarantee them coverage; they cover their preexisting conditions, and
then they spread the extra cost amongst all the taxpayers or all the
people who buy health insurance in that State. And the reason people
are willing to do that is because, but for the grace of God, you and I
don't know that tomorrow we won't need to be in that high-risk pool.
And I know you've dealt with high-risk pools.
Mr. BURGESS. That's correct. Thirty-four States do have the high-risk
pools. Nathan Deal, the ranking member on our Health Subcommittee, and
I tried to put some further refinements out there this year during the
health care debate.
I don't like mandates. I know we had that discussion in committee
today. I don't like mandates. So what if we allowed States either a
high-risk pool or an option for reinsurance, provided some Federal
subsidy to the State. They don't have to take it, but if they do take
it, then whatever they decide they want to do, they need to then set up
that high-risk pool or that reinsurance for that set of business that
is otherwise likely to go without insurance coverage. Because we all
know, folks our age, employer-sponsored insurance, we're in a
recession. You lose your job, you have the heart attack, you didn't
keep up with the COBRA payments, boom, you're in that category and now
there's nothing you can do to extract yourself.
And the only option we were given was an individual mandate, or let
the government take everything under their control.
Mr. SHADEGG. Federal legislation already passed in 2006 offered all
50 States some Federal money to help set up the State high-risk pool to
care for those people with preexisting conditions and offered Federal
money to subsidize or to underwrite the cost of those high-risk pools.
The reality is, every Republican plan, every Democrat plan deals with
preexisting conditions because it's something that we, as a society,
have already decided that we should do. Every single one of us knows
that any moment we could be struck with a heart condition or diabetes
or, like my oldest sister, breast cancer. We might be in the position
and we oppose the, even, concept of someone being denied care because
of a preexisting condition.
But I don't think the answer is a mandate. You said you don't like
mandates. Okay. Some people may like mandates. I guess the issue is do
they work. And of course the answer is, in Massachusetts, they worked
to provide coverage, but the cost of care goes up.
Mr. BURGESS. Well, they may not be constitutional at our level. And
the other thing to remember about a mandate, for a mandate to work, you
have to know that it's in existence, and you have to know what the
penalty is, and the penalty has to be pretty stiff.
You alluded to the IRS already. The IRS has a mandate on every one of
us that we'll pay Federal income taxes. Every single one of us knows,
we may not know exactly what bad thing happens, but we know it's bad,
and most of us know we don't want it to happen to us.
So what is the compliance rate with the IRS in filing tax returns?
Well, it's about 85 percent. What do we have as uninsured in this
country right now? About 15 percent. How much more are we going to get
coverage if we give up that much freedom by allowing us, us, Congress,
to set a mandate as a condition for living in the United States of
America? How much more coverage are we going to get?
[[Page H1503]]
I mean, the point is arguable, but just at first glance, it might not
be that much.
{time} 2015
Now, on the issue of the preexisting conditions bill, I know when
Nathan Deal and I looked into this and the Congressional Budget Office
scored and said what would it require in the additional Federal subsidy
to make these things really work for people, the Congressional Budget
Office came back with a score of $20 billion over 10 years. Real money
to be sure, but at the same time it is nowhere near the $1 or $2
trillion that is on the table today if the House takes up and passes
this Senate bill that they passed on Christmas Eve.
I do have to make one point about the public option. The Senate bill
does not have a public option per se, but there is language in the
Senate bill that allows the Office of Personnel Management to oversee
the exchanges and guarantee that there is one for-profit and one not-
for-profit insurance company available in every exchange. If an
exchange does not have an insurance product available, OPM will set up
either a for-profit or a not-for-profit in that exchange.
Well, suddenly you are going down the road of a public option because
what is the Office of Personnel Management? Well, it is a Federal
agency. It is not used to doing that much work, because they oversee
what goes on in the Federal Employee Health Benefit Plan, but now they
are going to be tasked with this vast new set of powers, and it's
anyone's guess how that will actually work out.
Mr. SHADEGG. The gentleman started by commenting about the shutting
down of the switchboards and whether or not individual citizens could
get through to their Member of Congress today and express their
feelings, and I would suggest right now maybe their intensely felt
feelings in opposition to or in support of this bill. It seems to me
that the American people, who are frustrated by that process, maybe
ought to think about what organizations or groups they are a member of
that might be able to get through.
I am a little concerned that individual Members of this body maybe
aren't taking phone calls right now, maybe aren't reading the faxes or
the emails they are getting right now. But everybody who sits on this
floor listens to the big organizations in their district. They listen
to the Chamber of Commerce in their district. They listen to the farm
bureau in their district. They listen to the cattle growers in their
district. They might listen to the homebuilders, who by the way under
the Senate bill are singled out for particularly mean or unfair
treatment, high taxes, in this bill. They might listen to the
contractors association.
It seems to me that anybody who wants to make their voice heard and
is a member of any kind of a professional association or a political
association that has contact with Members of Congress, if you can't get
through to your Member of Congress, maybe you ought to call the local
Chamber of Commerce and say, hey, I read where Congressman Smith or
Congresswoman Jones is going to vote ``yes'' or ``no''. That is not
what I want. You supported that, Congressman. Why don't you call him or
call her and say, hey, I want a ``yes'' vote or I want a ``no'' vote.
Because I will bet those Members of Congress will take calls from, for
example, the local Chamber of Commerce or the local farm bureau or the
local cattle growers association or some other organization in their
congressional district that has spoken to them in the past, maybe
supported them in the past. It seems to me that now is the time that
you can use those organizations to reach out and talk about some of the
issues in this bill.
You and I haven't talked so far tonight about some of the procedures.
We haven't talked about the Slaughter solution, under which it appears
the majority is going to push this bill through and try to say that
they are really not voting for the Senate bill, or, for that matter,
some of the special deals in the Senate bill. I find it interesting,
yesterday apparently Speaker Pelosi said, quote, ``Nobody wants to vote
for the Senate bill.'' She actually held a meeting with the press and
said, quote, ``Nobody wants to vote for the Senate bill.'' I guess that
is why they have come up with the Slaughter solution.
Let me ask you this question. Doesn't the Constitution say that for
the Senate bill to pass the House, Members of the House have to
actually vote for it or vote on it? Don't they have to pass that bill?
Mr. BURGESS. Certainly that is my understanding. And we both have to
pass the same bill.
Mr. SHADEGG. The exact same bill.
Mr. BURGESS. The exact same bill. We learned that in December of
2005. The Deficit Reduction Act had one word different between the
House and Senate bills, and the whole thing was held up.
Mr. SHADEGG. Because of one word difference? One word difference. The
Senate has already passed the Senate bill, the House has to pass that
exact bill word for word. It can't have one word missing?
Mr. BURGESS. Actually, that is a House bill that the Senate passed.
So we would simply have to concur with the Senate amendment, and that
would be the identical bill. But in this case the Slaughter rule would
say we don't even have to bring that bill to the floor, we just deem
it--Deem me up, Scotty--we just deem it as passed and then go on to the
reconciliation process to try to fix some of the problems with the
bill. No guarantee that they will be fixed.
Mr. SHADEGG. I kind of think the American people are fairly bright. I
think they see through this. If you are deeming a bill passed in a
rule, aren't you actually passing that bill and aren't you voting for
that bill? And isn't this just a trick or a scheme to get around the
requirement that Members actually vote for the Senate bill? I guess Ms.
Pelosi says, this is a quote, it is right here, ``Nobody wants to vote
for the Senate bill.'' But when they vote for a rule that says it's
deemed passed, aren't they voting for the Senate bill?
Mr. BURGESS. There is no question that they are. You are right, the
American people can see through that. It's an elaborate charade. It
will provide no protection.
Mr. SHADEGG. An elaborate charade. Trickery. If the American people
think we are engaged in trickery, why not engage in trickery.
Mr. BURGESS. But, and I am sure the gentleman feels the same way, I
would not want to stand in front of the 2,000 people on a hot August
morning in a town hall in Denton, Texas, and say, you know what, I
never voted for that bill. I voted for the rule that deemed the bill.
Mr. SHADEGG. There we go. So the reason you wouldn't want to stand on
the floor and vote for that Senate bill is not just because of the
policy in it, it is because that bill will contain the Cornhusker
Kickback, right?
Mr. BURGESS. Correct.
Mr. SHADEGG. It will contain the Louisiana Purchase.
Mr. BURGESS. And Gator Aid.
Mr. SHADEGG. Right. It will contain Gator Aid. It apparently contains
$100 million for a local hospital in Connecticut that Chris Dodd got
in. It contains $1.1 billion for Medicaid in Vermont and Massachusetts.
I guess not Arizona or Texas. Our States didn't get that deal, right?
No, just those States got the deals because Dodd or Sanders and Kerry
got them in, right? It contains, I like this one, $1 billion that
Senator Bob Menendez got in for New Jersey drug companies. Pretty good
deal. I am not sure I would want to vote for that. My constituents
might say, well, Congressman, why didn't you get a billion dollars for
some companies in Arizona?
It contains $1 billion for Menendez. We are talking serious money
when you go to John Kerry and Debbie Stabenow. They got in $5 billion
for union health care plans in Massachusetts and Michigan. You already
talked about the provision, the Florida Gator Aid, I guess, Medicare
Advantage. I will tell you this is one that my constituents find
offensive. Arizona has lots of people on Medicare Advantage. Apparently
Senator Bill Nelson of Florida got in a provision saying Medicare
Advantage won't be cut in Florida. I don't know how I go home and
explain to my Arizona colleagues that it will be cut in Arizona. But I
really don't know, since I am going to vote against this bill, how my
Arizona colleagues go home--by the way, the press reported that the
President wanted some of these special deals taken out.
[[Page H1504]]
But AP reported over the weekend that these Senators don't want those
special deals taken out.
I think I agree with Nancy Pelosi. She said nobody wants to vote for
the Senate bill because of all this junk, all of these secret special
deals. So somehow they are going to not vote for it but they are still
going to pass it? How do you do that under the Constitution? Maybe our
colleague from Texas can tell us how you can pass something without
voting on it.
I guess Newt said it today, there was a point in time when Members of
Congress didn't read the bills that they passed. Now they are not going
to vote on the bills that they pass. So what do we need to be here for?
Mr. BURGESS. I would just go back, too, to that instance with the
Deficit Reduction Act, where a small difference in the House- and
Senate-passed bills led to a court challenge, and we came back in
January. We left on December 21st or whatever day it was when we passed
that bill out of the House, it went over to the Senate, there was a
problem, they couldn't fix it under unanimous consent because of an
objection, and we had to repass the bill in January.
The reason I know this is because there was one of those doc fixes in
that bill. And the doc fix did not go into effect December 31 and every
doctor who saw Medicare patients across the country took a 6 percent
ding in their Medicare reimbursement rates because we had not passed
the bill by January 1.
Now, Dr. McClellan, Mark McClellan, to his credit, who at the time
was Director of the Center for Medicare and Medicaid Services, came
back and said, you don't have to refile those claims, we will take care
of them if Congress passes the bill within a month or two of coming
back, which we did. So they went back and reimbursed. But a terribly,
terribly complicated process. All of it was brought up because one or
two words different in the bills, because the Constitution says we
shall pass the same bill and then it goes down to the President for
signature.
Mr. SHADEGG. I am trying to understand this. So if the Medicare
Advantage participants in Arizona who are having their Medicare
Advantage cut, and the Medicare Advantage participants in Florida who
are not, under the Gator Aid that Senator Bill Nelson cut, that special
deal, having their Medicare Advantage cut, if the House only deems the
bill passed, can they sue and can they win? Or will the courts say,
well, no, no, no, your Congressman may have said he didn't vote for the
bill, he just deemed it passed, but trust me, we, the courts say he did
vote for the bill. And so Arizona taxpayers on Medicare Advantage lose
out, Florida taxpayers because of Bill Nelson and the special deal he
cut currently in the Senate bill, which you say can't have a word
changed when it comes here, they win out. Pretty good deal.
By the way, I look at some of these other deals, there is special
funding for coal miners in Montana. There is just provision after
provision. In North Dakota there are special provisions providing
higher Medicare payments there. There are special provisions for Hawaii
that apparently the two Hawaii Senators got in. There are special
provisions for longshoremen in Oregon. You know, this thing looks to me
like it is chockablock full of special deals for special Members,
special Senators who say, well, you know, I want a special deal or I
won't vote for it. No wonder Ms. Pelosi says, and I quote, ``Nobody
wants to vote for the Senate bill.'' But doesn't the Constitution say
they either got to vote for it or it don't pass?
Mr. BURGESS. So we have two problems. The Constitution says we have
to vote on the bill. We say the mandates may be extraconstitutional in
their scope. And then the whole question of equal protection under the
law. We have a constitutional scholar with us, so we turn to the
gentleman from Texas, the judge from east Texas, for perhaps his
rendition of this complicated process that faces us.
Mr. GOHMERT. Well, clearly the majority leadership thinks that the
American people are so stupid that if you have a rule that says, you
know what, if you vote for the rule, then the bill automatically is
deemed passed. I just don't know anybody in the American public that
can't figure out when you voted for the rule, I don't care what you
say, you voted to pass the bill.
As far as it passing constitutional muster, who knows anymore with
this Court. But I do know, as the gentlemen, both of you have been
talking about the deals and Medicare Advantage, and I have got the
Senate bill here, this lovely thing, and the truth is the only people
that ought to pass this bill are people that eat it. A little digestive
humor there. If you eat it, then yes, you should pass it. But otherwise
this bill should not be passed.
But if you look at page 904 of part one of two parts of the Senate
health care bill, and you wonder, gee, I wonder why AARP came out a
couple weeks ago and said, oh, yes, we like the proposal, we are all on
board. Well, you look at the Senate bill, it says that nothing in this
section shall be construed as requiring the Secretary to accept every
bid submitted by a Medicare Advantage organization. And so also the
Secretary may deny a bid submitted by a Medicare Advantage organization
for a Medicare Advantage plan if it proposes significant increases. But
the bottom line here is the Secretary doesn't have to accept a bid.
And what is the consequence of saying we are not going to allow any
more Medicare Advantage bids, we are just going to cut that out? Do you
know what retirement organization is in the business of selling a kind
of supplemental insurance?
Mr. SHADEGG. Wait. Wait. Let me guess. Could it be AARP?
Mr. GOHMERT. Well, it seems like maybe they do sell some supplemental
medical insurance. So by golly----
Mr. SHADEGG. Maybe they got a better deal out of this.
Mr. GOHMERT. Maybe 904 is one of several reasons AARP said, you know
what, this could be all right. We could get millions and millions of
dollars in new insurance sales.
{time} 2030
But did you see that the pharmaceutical industry says they like this
bill, they are okay? And I read a headline today that the
pharmaceutical industry was going to spend millions trying to get
people to vote for it.
Mr. SHADEGG. So AARP likes it and PhRMA, which are big drug
companies, like it. All of the big insurance companies like it because
you're mandated to buy their product. And there is no public option
competing with them, and they don't have to compete across State lines.
Looks to me like all of the big guys really like this bill. They like
the fact that they are getting lots out of it. What does Joe Six-Pack
get?
Let me make a point. I put up a quote here from Speaker Pelosi. She
said it on March 9. ``But we have to pass the bill so that you can find
out what is in it, away from the fog of the controversy.'' Wow. Pretty
stunning quote. Maybe those are things she doesn't want you to find out
until after we pass it.
I know the gentleman has a point to make. I just want to point out.
Talking about deals in the bill and special deals for health insurance
companies. According to The Boston Globe of December 22, 2009, the
Senate bill waives from any annual fee on health insurance companies
certain additional fees, and this provision exempts two insurance
companies, Blue Shield-Blue Cross of Nebraska and Blue Cross-Blue
Shield of Michigan. That might be one more of those special deals put
in there by a couple of powerful Senators, Ben Nelson of Nebraska and
Debbie Stabenow of Michigan, cut a little deal for a couple of Blue
Cross-Blue Shield Nebraska and Michigan companies--maybe that is what
Mrs. Pelosi meant when she said, But we have to pass the bill so that
you can find out what is in it.
Mr. GOHMERT. I appreciate the gentleman yielding.
If you look at page 1,957, along the same lines of what kind of deals
that are in this bill, this has to do with health savings accounts. We
know that there are millions and millions of dollars in health savings
accounts that only can be used for health care. Well, I know I have an
HSA, and if I can get an over-the-counter drug, a generic drug, that is
what I buy.
Well, good deal for the pharmaceutical industry here beginning at
page 1,957, because it says that such terms shall include an amount
paid for medicine or drug only if such medicine or drug is a prescribed
drug.
So you may want--like in my case, I have hay fever. I've had since it
since I
[[Page H1505]]
was a little kid. I go and get a generic for like $2.50. And now if I
want to spend my HSA on it, I can't go spend $2.50. I've got to go pay
megabucks to the pharmaceutical companies in order to get a
prescription drug.
Wow, maybe that is part of the deal that made them think, You know
what? You know Joe Six-Pack, as my friend from Arizona says, may not
get anything out of it, but by golly, we're going to make a lot of
money on this bill. Let's throw our support behind it, and the
President will love us for it, too.
Mr. BURGESS. One interesting point. You have these groups that went
down to the White House in May and June--and I'm not going to criticize
them for going down and advocating on behalf of their industries, on
behalf of their groups. But what is so onerous about this is the
President has proclaimed this Sunshine Week. Transparency is going to
be the watchword of his administration. Remember? We heard it over and
over again. Everything will be up on C-SPAN, everybody will be able to
see it--except for these deals that were struck down in the White House
in May and June. And now they come back and say, Well, there really
wasn't anything written down. Two trillion dollars in savings and you
didn't write a word of it down?
Now, in Texas, as the gentleman knows, we trust each other. A
handshake is as good as a signature a lot of times. But when it's $2
trillion, you're probably going to need a little more than a handshake
even in Texas, because are people going to perform as they said they
were going to perform?
When Senator McCain wanted to push an amendment that dealt with
reimportation in the markup of the Senate bill, in the debate of the
Senate bill at Christmastime--I don't agree with reimportation. I think
it's unsafe. I think it's unwise. But Senator McCain was prevented from
offering that amendment because, to quote somebody at the time, That
wasn't part of the deal that we had.
Well, wait a minute. If there is a deal that someone knows about, is
it written down somewhere? Could we please see what else is in that
deal? We're the legislative body. If there are deals struck at the
White House--and it is Sunshine Week--if there are deals struck at the
White House, let us see what those deals are.
I'm not criticizing the groups that went down there and advocated on
behalf of those groups. That is fine. They should have done that. But
we, as the legislative body, should have been privy to any of that
information as we tried to craft the legislation that would have to
either enact or confirm or deal with those deals.
Mr. SHADEGG. Well, it seems to me that while we do not know what the
quid pro quo was for any given deal, we know a couple of things: We
know the insurance companies went in first and foremost and said, We
want an individual mandate. We want the government to compel every
American to buy federally approved, Federal Government approved health
insurance, and we want the IRS to enforce that mandate. You must buy
Federal Government approved health insurance. That is what the
insurance companies wanted going into the deal. Funny, that is what
they got. They got an agreement that there would be an individual
mandate.
So if this becomes law, every single American will be required to buy
a government-approved health insurance plan. And if they don't, the IRS
will tax them. Huh.
We also know, although the gentleman points out, there is no
individual mandate in the Senate bill--there are some things that are
pretty close to it--the insurance companies didn't want competition.
They certainly didn't want across-the-State-line competition, they
didn't want the State tax code to say you and I could buy it tax-free
so they would have to compete with each other like the auto insurance
companies. It sounds to me like we can kind of decipher some of the
outlines of the deal that occurred.
Mr. BURGESS. And I can be as critical of the insurance companies as
anyone else, but they take the path of least resistance. Their capital
is not necessarily any more courageous than anyone else's. The easiest
way to get to what they want is an individual mandate.
But I suspect if we set up pretaxed expenses, buying across State
lines, if we develop that market for them, I'll bet they'd find a way
to compete, I'd bet they'd find a way to work in that market and win in
that market.
Mr. SHADEGG. I think the gentleman makes an excellent point.
The truth is America's health insurance companies are playing under
the rules we set, and the rules we set say they really don't have to
compete for my individual business, for John Shadegg as an individual
customer, or yours, or our colleague from Texas because the Tax Code
says we cannot buy health insurance like our employers can. We can't
buy it tax-free, but our employers can.
I think the gentleman is absolutely correct. I think the reason that
the auto insurance industry competes every day, day-in and day-out,
pounding us on TV saying, you buy our plan from GEICO or Progressive or
Allstate or Farmers, we will give you better service for a lower cost;
and the health insurance companies don't compete day-in and day-out
saying, you buy our health insurance plan from United or from Aetna or
from Blue Cross-Blue Shield, and we will give you a better price at a
lower cost.
The reason they don't compete like that is because the government
sets the rules. And the rules say that they sell pretty much
exclusively to big companies, and we say to the poor working stiff who
can't get employer-based health care, too bad, pal. You kind of don't
count in the system. The insurance companies don't really want their
business, they don't market to you, and if you buy their product, you
have to buy it with after-tax dollars. Tragically not fixed in this
bill.
Mr. BURGESS. Let me point out just one thing.
We hear over and over again Republicans have no solutions for health
care. HealthCaucus.org is a Web site that deals only with health care
policy. On that Web site, Dr. Burgess's prescription for health care
reform, the seven or nine things that I heard consistently in my town
halls this summer are up there. People can download that and look at
that themselves.
Suffice it to say that we really have been frozen out of this process
from the beginning. They were not interested in our input last year
because they had a supermajority in the House of Representatives. You
can't pass a bill with 40 extra votes? What's the matter with you?
Well, now, the entire argument, the entire argument is within the
Democratic Caucus. They don't have the votes on their side because it
is a badly flawed product and a badly flawed process that they are
trying to push through on the American people.
People do need to understand this bill has nothing to do with health
care any longer. This bill has, as has been pointed out tonight, if we
wanted to fix these things, we would have fixed them. This bill is
about higher political power for the party in charge, and they want to
obligate the American citizenry to re-up their contract every 2 years
in order to not lose the benefits that they are ostensibly going to get
with the bill.
The bill is a bad deal, Mr. Speaker. I would submit that the American
people need to continue to weigh in on this. All is not lost. Time is
not up. There is time to make a difference.
I'll yield to the gentleman for a final thought.
Mr. GOHMERT. I just appreciate all the work you've done. There are
several bills that have been proposed by Republicans.
Mr. BURGESS. I thank the gentlemen for their time this evening.
____________________