[Congressional Record Volume 156, Number 41 (Friday, March 19, 2010)]
[House]
[Pages H1728-H1735]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     HEALTH CARE REFORM IN AMERICA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from Ohio (Mr. Ryan) is recognized for 
60 minutes as the designee of the majority leader.
  Mr. RYAN of Ohio. Mr. Speaker, I appreciate the opportunity to follow 
The Price is Right and my friends from Ohio, with whom we obviously 
disagree on this issue but consider ourselves friends and colleagues. 
And I appreciate their levity here tonight. We're going to talk a 
little bit about the substance of this health care bill that is now 
coming very, very close to being passed. But before we do, I just want 
to clarify the record a bit because throughout the course of the day 
today many people have been commenting on procedure and self-executing 
rules. And I just want to share with the House and put into the Record 
for the American people to be able to reference what the history of 
these self-executing rules has been.
  In the 104th and 105th Congress under Speaker Newt Gingrich, 
Republicans used 90 self-executing rules. In the 106th, 107th, and 
108th Congresses under Speaker Denny Hastert, Republicans used 112 
self-executing rules. In the 109th Congress, under Speaker Hastert, 
Republicans used self-executing rules more than 35 times. This is a 
common procedure used here in the House. It has been proven under the 
Gingrich-Hastert regime before the Democrats took over. I also would 
like to show

[[Page H1729]]

and read and ask to submit this for the Record.

[Prepared by the Office of Majority Leader Steny Hoyer, March 17, 2010]

  Experts Call Out GOP on Hypocrisy, GOP Owns Up to Legitimacy of Rule


Republicans Cry Crocodile Tears On Legislative Process to Distract From 
                        Unfair Insurance Process

       With final passage of health insurance reform quickly 
     approaching, Republicans are making another desperate attempt 
     to distract from the substance of the health care debate. The 
     GOP is hypocritically crying foul on a legislative process 
     that they used more than 200 times under the last two 
     Republican Speakers. Republicans clearly are trying to 
     distract from the unfair insurance process that they support 
     continuing:
       Process that allows insurance companies to cancel coverage 
     when a person gets sick;
       Process that allows insurance companies to filibuster 
     consumers' claims to fair coverage; and
       Process that makes Americans fight for their health 
     insurance even as they are fighting for their lives.
       If Republicans are so sensitive to fair process, they 
     should oppose those unfair insurance procedures and support 
     passage of health insurance reform. And if they don't do 
     that, then their record on using the same House rules to pass 
     major legislation should be enough to end the legislative 
     process debate.


     Republicans Use Self-Executing Rules to Pass Major Legislation

       When Republicans complain about process--whether on 
     reconciliation or self-executing rules--they conveniently 
     ignore their own record on using the same procedures to pass 
     major legislation. In fact, according to Don Wolfensberger, 
     former staff director under a Republican House Rules 
     Committee, Republicans have used self-executing rules 
     hundreds of times in recent history:
       104th & 105th Congresses: Under Speaker Newt Gingrich (R-
     GA), Republicans used 90 self-executing rules.
       106th, 107th & 108th Congresses: Under Speaker Dennis 
     Hastert (R-IL), Republicans used 112 self-executing rules.
       109th Congress: Under Speaker Hastert and Rules Committee 
     Chairman David Dreier (R-CA), Republicans used self-executing 
     rules more than 35 times. [Norm Ornstein, 3/16/10]


          Republicans, Experts Acknowledge Legitimacy of Rule

       ``[D]espite Republican claims that such parliamentary 
     gymnastics as reconciliation and self-executing rules are 
     somehow in violation of House rules or rare, neither is the 
     case, says congressional scholar Thomas Mann of the Brookings 
     Institution. `On the self-executing rule, Republicans in 
     their last Congress that they controlled, the 109th, used it 
     36 times; the Democrats, in the next Congress they 
     controlled, used it 49 times,' Mann said. And in many cases, 
     Mann says, they were on some pretty major bills. `The 
     reauthorization of the Patriot Act, the Tax Relief 
     Reconciliation Act, the Deficit Control Conference Report; 
     all kinds of major measures have been approved through self-
     executing rules, which means the House votes indirectly 
     rather than separately on these measures.' '' [NPR, 3/17/10]

     [Prepared by Offices of Democratic Leadership, March 18, 2010]


                            HYPOCRISY ALERT

       This practice has been in use since at least 1933--and has 
     been commonly used under both Republicans and Democrats.
       In 1948, the Republican-controlled House passed a 
     resolution to consider as adopted Senate amendments to a bill 
     to change tax rates.
       In 1993, the House adopted a resolution to consider as 
     adopted the Senate amendment to the Family and Medical Leave 
     Act.
       In 1996, the Republican-controlled House adopted a 
     resolution to consider as adopted the conference report on 
     Line Item Veto.
       Separately, beginning in 1980--and most years thereafter--
     the House has had in place a standing rule that approves 
     automatically a joint resolution to increase the public debt 
     limit upon adoption of a Budget Resolution that contemplates 
     such an increase. Such a resolution has occurred 20 times in 
     the last 30 years.


                          OPEN AND TRANSPARENT

       The Senate bill has been publicly available for almost 
     three months. The Reconciliation bill that improves it has 
     been publicly discussed for weeks, and will be available 
     online 72 hours before any House Member will be asked to vote 
     on it.


                              AMICUS BRIEF

       Some health care opponents are comparing this procedure to 
     an amicus brief filed in a lawsuit challenging the 
     constitutionality of the Deficit Reduction Act of 2005. 
     Speaker Pelosi, Chairman Waxman, and Chairwoman Slaughter all 
     signed onto that amicus brief. That court challenge arose due 
     to the House and Senate passing two different final versions 
     of a bill, President George W. Bush signing one of them (the 
     Senate version) into law, and the significant constitutional 
     questions it raised. It had nothing to do with this process.

  Congressional scholar Norm Ornstein of the American Enterprise 
Institute, who's really the guru here for how Congress operates, wrote 
this in his March 16, 2010, column: ``I can't recall a level of feigned 
indignation nearly as great as what we are seeing now from 
congressional Republicans and their acolytes at The Wall Street 
Journal, and on blogs, talk radio, and cable news. It reached a 
ridiculous level of misinformation and disinformation over the use of 
reconciliation, and now threatens to top that level over the projected 
use of a self-executing rule by House Speaker Nancy Pelosi. In the last 
Congress that Republicans controlled, from 2005 to 2006, Rules 
Committee Chairman David Dreier used the self-executing rule more than 
35 times, and was no stranger to the concept of `deem and pass.' That 
strategy was defended by House Republicans in court, and upheld. Is 
there no shame anymore?''
  So let's set this aside.
  Obviously, as I'm going to be joined here by my friend here from 
Ohio, my other friend from California, if the substance of the bill is 
going to benefit the other side, I wouldn't talk about the substance of 
the bill either, Mr. Speaker. I would stay focused on smoke and 
mirrors, and bells and whistles, and distractions that would move the 
debate off of the centerpiece, off the meat and potatoes, which is 
this: our government has a moral mission. And that moral mission is, 
this Government, as designed by the Framers of the United States 
Constitution, has a moral mission to protect its citizens from 
terrorists, from foreign powers if they are aggressive. This government 
has a moral mission to protect its citizens with issues of crime, 
workplace safety, should unruly corporations behave in a manner that 
would hurt individual citizens in the United States of America. The 
documents that founded this country, that created this country, give 
the United States Congress that moral mission--to act on behalf of 
individual citizens. So the health care reform proposal that we are 
talking about today is an attempt by the Congress of the United States. 
The elected representatives of the American people should step in, 
because they are being hurt by the current health care system. They are 
being hurt by the practices of the health care industry, of the 
insurance industry.

                              {time}  2030

  And what is going to happen this weekend as we pass health care 
reform, something that this country has been trying to do for 100 
years, what will happen is the government will come in and not run 
health care. This isn't about the insurance company running health care 
or the government running health care. This is about the government 
stepping in and saying to the insurance industry, You are no longer 
allowed to kick people off of their policies just because they got 
sick. The insurance industry is no longer allowed to tell kids and 
their parents that they are denied insurance coverage because they have 
a preexisting condition. The insurance industry will no longer be able 
to tell adults that they can no longer get health insurance because 
they have a preexisting condition. That's what this bill does. It 
protects the American people.
  To an American family who may be dealing with a catastrophic health 
care issue for their family, this bill is going to step in and say to 
the insurance company, Back off. You are no longer allowed to say to a 
family who's going through a health care crisis, Sorry, we're out of 
money. You hit your lifetime limit. You're on your own. This is going 
to come in and say on behalf of the American people, If you are 26 
years old or younger, you will be able to stay on your parents' 
insurance so that young people will have an opportunity to do that. 
This is going to say to small business people--because the government 
also has a moral mission not only to protect from unsavory underhanded 
business practices but the government also has a moral mission to 
empower people in the United States of America. What this bill does 
through a series of tax incentives and in an exchange will provide the 
greatest tax cut for health care purposes in decades in the United 
States of America.
  If you are a small business in the United States of America, you will 
receive up to a 50 percent tax credit in order to provide health care 
to your workers as well as go into the exchange and be able to 
negotiate with other small businesses and people around the country to 
drive down health care

[[Page H1730]]

costs. That is going to significantly reduce costs for small business 
people in the United States of America. And as we slowly begin to move 
out of the economic collapse that our friends on the other side and 
President Bush handed the American people, this reform will bring some 
stability to the market. This reform will allow small business people 
to take those savings and reinvest them back into their company, in the 
machinery, in the capital, in the technology, in the wages for their 
workers.
  You can talk to any small business person--and I was just on the 
phone with one today who had an increase of 40 percent in their health 
care. And he said, You know what, I negotiated with the drug company. I 
negotiated it down to a 30 percent increase. This is a person who had 
30 employees just a few years ago and now is down to just a handful, 
six or seven employees. But if you reduce the health care costs for 
this business, and thousands across the country, they will have more 
money to reinvest back into their company.
  You talk to many union members when they go in and negotiate union 
contracts with businesses, they don't get a wage increase because the 
business person says to the union, You know, I've got $5 an hour. Here 
it is. You can use it any way you want, but this is all I've got. And 
the unions, as they negotiate those contracts, have to put that money 
into health care. So wages have been stagnant now for decades. And this 
bill will allow those small businesses and big businesses to reinvest 
back into their companies and help us as we get out of the economic 
morass, as things start to open up, as we see they are now. We'll 
accelerate that and allow us to have some sustained long-term growth.
  And before I yield to any of our friends here--Mr. Boccieri is here 
from Ohio--I want to make one final point. This bill will extend the 
life of the Medicare program. That's why AARP has endorsed this 
program. And our friends on the other side--I love it, they say, Well, 
the seniors are against it, but AARP endorsed it. The docs are against 
it, but the American Medical Association has endorsed the bill. This is 
a pro-abortion bill, but yet 60,000 Catholic nuns and 6,000 Catholic 
hospitals and 1,400 Catholic nursing homes have endorsed this bill. The 
National Catholic Reporter endorsed this bill. They wouldn't endorse a 
bill that is pro-abortion, giving Federal money for abortions.
  But this is another distraction because our friends on the other side 
certainly don't want to compete with tax credits for small businesses, 
certainly don't want to say, you know, get rid of the preexisting 
conditions. We want to keep that in there. They don't want to have that 
campaign. They don't want to have that debate, and I don't blame them.
  But the facts of the matter are this: this bill is good for the 
American people. It probably should have happened 30 or 40 years ago. 
But for seniors, it extends the life of Medicare. It invests into the 
Medicare part D program so that if you have prescription drug coverage 
from Medicare part D, you'll get a $250 stipend this year, a rebate 
this year. And next year, because of the negotiations, the average 
Medicare part D recipient will save $700 on their prescription drugs 
that they're getting from Medicare Part D. We will eventually close the 
doughnut hole. No senior will ever have to pay for preventive coverage 
again. No citizen will ever have to pay for preventive coverage ever 
again.
  So this, through the savings, extends the life of the Medicare 
program, reduces costs, makes insurance affordable for everyone in our 
country. The next day or so, Mr. Boccieri, we are moving in the 
direction of a historic vote. And I just want to say to you, my friend, 
that I appreciate what you have done, today came out and said that you 
are voting ``yes'' on this bill after a lot of consideration, a lot of 
thought because you feel it is the best thing for the American people. 
I want to say thank you for standing up for your constituents. We 
represent very similar districts, and I believe that history will 
vindicate you and your vote and what we're doing here. So with that, I 
yield to my friend from Ohio.
  Mr. BOCCIERI. Well, I thank the gentleman from my adjoining district, 
the 17th Congressional District in Ohio. The 16th Congressional 
District of Ohio has had its share of people who are without health 
insurance. And in fact, nearly 39,000 people in my district right now 
are wondering how they're going to pay for coverage, how they're going 
to pay their doctors' bills should they have an emergency now. There 
are 9,800 residents in the 16th Congressional District who have 
preexisting conditions. As we speak right now, they will not be able to 
get health care coverage.
  Let me speak to you about the face of this national debate because 
our friends on the other side like to make this national debate about 
Speaker Pelosi or Leader Reid or even the President of the United 
States.
  At the end of the day, the face of this issue is about Natoma 
Canfield. Natoma Canfield right now is sitting at the Cleveland Clinic, 
hanging on for dear life, getting blood transfusions every day for the 
next 30 days without health care insurance. Now her story moved me so 
because she brought me back to a place that I haven't been in a long, 
long time. I remember as a young boy standing at the bed of my mom--I 
was the oldest son--and she was telling me that she had breast 
cancer, and she didn't know what the future had in store for her. She 
was going to get treatment but wanted us to be prepared.

  Now, she had health care insurance, and she survives today. But I 
wonder now as a father of four children what would have happened to my 
life if my mom didn't have health care insurance. What would have 
happened to her? Would I have been able to go to college? Would I have 
had to work? How would we have paid for her treatments? My life could 
have been considerably different based upon this situation.
  That story is played out hundreds of thousands of times not only 
across the 16th Congressional District but across this country. Too 
many of our citizens are one accident, one medical emergency, one 
diagnosis away from complete and utter bankruptcy, financial ruin. And 
in fact, in 2007, they said nearly 70 percent of all bankruptcies in 
the United States were because they had no insurance.
  Now, I would remind my friend from Ohio, in 2004 our Secretary of 
Health and Human Services, Tommy Thompson, flew to Iraq with billion-
dollar checks in hand to make sure that every man, woman and child in 
Iraq had universal access to the doctor that they wanted to see. Now, 
why is that good for Iraqis and not for Americans? Why do Americans 
have to pay for Iraqis to see their physician anytime they wanted to, 
but that's not good enough for our own people? Well, the time has come, 
the hour is at hand. Too many politicians are worried about their 
futures and not about the futures of the people that we represent. 
They're worried about the reelection. They're worried about their job 
security instead of the job security and the health security of the 
families that we represent.
  I know a lot of people are angry. They watch the display of back and 
forth here in Washington. They become frustrated, frustrated because of 
all the blocking and stiff arms. You know, I would remind my colleagues 
on the other side, the bill that we have before us today and that we 
will vote on this weekend, the bill that is before the House of 
Representatives, when the components are added from the President's 
bipartisan summit and the four Republican ideas are added into this 
bill, this bill will be identical, if not completely identical, to the 
bill that was introduced by Lincoln Chafee and Bob Dole in 1993 as a 
Republican counterproposal to the Clinton administration's health care 
debate.
  Leadership doesn't need to be worrying about who's going to control 
this House. They need to be making sure that Natoma Canfield can keep 
her house because without health care insurance--she told me on the 
phone the other day that she's worried about her home going into 
foreclosure.
  Now, I know that a lot of people are uneasy about this process that 
we have here in Washington. I know a lot of people are suggesting that 
we ought to stop and start over, but the insurance companies aren't 
starting over. We see broad increases in insurance premiums, 40 
percent, 50 percent sometimes. Where does this end? Where does it stop? 
Where do the most abusive practices stop? When you can block someone 
from seeing their doctor because

[[Page H1731]]

they had a preexisting condition, when you can deny someone coverage 
because they got sick, when you can tell somebody that they have 
reached their lifetime cap, and they can no longer be insured, that is 
what this debate is about, about the faces of our constituents.
  Let me tell you, before I turn it over to my friend, about a young 
boy who made the journey to Washington, D.C. I couldn't be in Ohio 
today because we had votes, so I brought Ohio to Washington. I had a 
family here, a young boy by the name of Jay. Jay was here, and this 
young boy has autism. He is uninsurable. He has a preexisting condition 
because he has autism.
  I was walking down the hall with his mother Esther, and she was in 
tears after our announcement. She said that, you know, I know this is a 
tough decision for you and the country, but it's one that is very 
necessary. And I told her, I said, If we don't succeed at this task in 
front of us, Jay will never be able to obtain health care insurance 
unless we vote on this bill, unless we say enough. Because on day one 
when this bill passes, Jay will be able to get health care insurance. 
We will no longer allow the insurance industry to deny people because 
they had a preexisting condition. I think this is a fight worth having. 
I do, Mr. Ryan, and that's why I'm here today.

                              {time}  2045

  Mr. RYAN of Ohio. I tell you, what a cute kid he was. He was just the 
cutest little kid. You get caught up in this debate with numbers and 
statistics and whatnot, but he really was the poster child for why we 
need to do this.
  With that, we are blessed with someone who has come from the great 
State of New Jersey and has been in the middle of all of the 
negotiations on behalf of our leadership and who chairs the 
subcommittee on the Education Committee which handles these issues. I 
yield to my friend, Rob Andrews.
  Mr. ANDREWS. I thank my friend for yielding and for being here night 
after night talking about what is really in this bill and doing a great 
job on it. I thank him for his friendship. I would like to thank and 
congratulate Mr. Boccieri's courageous decision to vote in favor of 
this bill on behalf of the families that he talked about.
  And to my friend from Ohio, I would also like to thank someone who we 
wouldn't usually hear about being thanked, and that is the millions of 
Americans who have contacted us who oppose this bill. And I have heard 
from my constituents who oppose this bill, and they are worried. They 
are very worried, and they should be, because if the things that they 
have been told were in this bill were true, not only would I be worried 
about it, but I would not vote for it.
  Our constituents are not simply entitled to know where their 
Representatives stand, they are entitled to know where their 
Representatives stand on the facts that are actually before us.
  I want to take a few minutes tonight to talk about the things that I 
have heard from my neighbors and constituents that worry them and then 
lay out the facts.
  I have heard from my senior citizen constituents that they don't want 
any cuts in their Medicare benefits. The fact is this bill does not cut 
anyone's Medicare benefits. The opposite is true. To those seniors who 
enrolled in the Medicare part D prescription drug program, the amount 
of their prescriptions that Medicare pays for goes up, the amount of 
drugs that they pay for goes down, and eventually, by the end of this 
process, 75 percent, at least, of all prescription costs will be paid 
by Medicare and 25 percent by the seniors. It is the closure of the so-
called doughnut hole. It is one of the main reasons that the AARP is 
supporting this bill.
  When a senior goes to the family doctor or the OB-GYN for an annual 
checkup, when this bill becomes law, that senior won't pay any copay. 
Medicare will pay the entire cost of that visit. Those are the only 
changes in Medicare that affect people's benefits. The benefits 
increase.
  We have heard the outrageous statement that Americans who are elderly 
or disabled will be denied health care because there will be death 
panels in the bill. The answer can be found in section 1302 of the 
underlying text that we will be considering on Sunday. That text 
directs the Secretary of Health and Human Services, ``to ensure that 
health benefits established as essential not be subject to denial to 
individuals against their wishes on the basis of the individual's age 
or expected length of life or the individual's present or predicted 
disability.'' That's the fact that is in the bill.
  We have heard people say that they do not want to be forced to join a 
government health plan or any other health plan. They don't want to 
wait in a health clinic like the British do, like they say they do. 
They don't want to be in the Canadian system, and they are not. The 
fact is that section 1312 of the text that we will consider on Sunday 
says the following: ``Nothing in this title shall be construed to 
restrict the choice of a qualified individual,'' that is anyone, ``to 
enroll or not to enroll in a qualified health plan or to participate in 
the exchange.'' It goes on to say ``nothing in this title shall be 
construed to compel an individual to enroll in a qualified health 
plan.'' Nothing. That's what the bill says.
  We have heard many Americans of good conscience say they do not wish 
to see their tax dollars pay for abortion services. My friend, Mr. 
Ryan, who is staunchly pro-life and has stood to that position 
irrespective of the political consequences, has eloquently described 
what the bill says. For those who wish to read it for themselves, go to 
section 10104 and read it. It says that no public funds may be used to 
pay for an abortion for anyone.
  I hear constituents say, quite understandably, they do not want 
undocumented people to receive health care benefits or subsidies under 
this bill, what are sometimes referred to as illegal aliens. Neither do 
the authors of the bill. So if you go to section 1312f, a qualified 
individual is defined, and a qualified individual is someone who is a 
U.S. citizen or is here legally on a green card or other legal 
document. That's what the bill says.
  We hear that the bill will destroy small businesses across the 
country. Small businesses do create three out of every four private 
sector jobs in this country. The bill does have a substantial effect on 
small business. Here is what it isn't and here is what it is. What it 
isn't is a crushing mandate on small businesses, because section 1304 
of the bill says, if a business has 50 or fewer full-time employees, 
the business is required to do nothing. No mandate, no requirement, no 
tax, nothing. The person who is running a gas station, a deli, a barber 
shop, a small firm, nothing.
  What the bill does say about small business is this: That the same 
deal that General Electric or Lockheed Martin or a huge company can 
get, so can the small business by joining a purchasing exchange set up 
in each State. And it says that the smallest of businesses will get a 
tax cut effective immediately this year for insuring their employees 
voluntarily. If you have 50 or fewer employees, you are not required to 
do anything and you probably qualify for a tax cut as a result of 
hiring more people.
  Finally, we hear that this bill will dramatically increase the 
country's deficit and debt. And as a father of two daughters who are 15 
and 17, I worry about a lot of things unrelated to politics and the 
debt, but I also worry about the debt because they are going to have to 
pay it off. I think the American people need to know a fact about the 
debt before they consider this bill. The debt is everyone's fault. I 
have had the privilege of serving here quite a long time. Both parties 
share a blame. I own my share of the responsibility. But we need to 
know this: 70 percent of the national debt was run up during the 
administrations of President Reagan, the first President Bush, and the 
second President Bush. Seven out of every $10 of debt came from them.
  Now, what does this bill do to the national debt and deficit? You 
should not believe the Democratic Party or the Republican Party or any 
political person on this issue. Mr. Speaker, our constituents, for 
those who wonder what this does to the national deficit and debt, look 
at the accounting by the neutral, nonpartisan scorekeeper, the 
Congressional Budget Office, which for a long time around here has been 
recognized as the gold standard and authority. Here is what they say. 
They say that if this bill becomes law, the deficit will be reduced by 
$138 billion over the next 10 years, and, in the second 10 years, it 
will be reduced by $1.2 trillion.

[[Page H1732]]

  Everyone in this Congress is entitled to his or her own opinion, but 
the American people are entitled to the facts. Everyone is entitled to 
his or her own opinion, but not everyone is entitled to their own 
facts. The facts are that this is what is in the bill. The things that 
people have been told about this bill are not true, and, Mr. Speaker, I 
would invite those who wonder to go to the Internet, to read the bill 
and draw their own conclusions and then frankly evaluate the criticisms 
of people who will continue to mislead about this bill.
  We are fortunate that people of good faith have made legitimate 
criticisms about this bill. We tried to listen and improve the bill, 
and on Sunday we look forward to a clear, on-the-record vote to adopt 
this legislation.
  I thank my friend for yielding.
  Mr. RYAN of Ohio. I thank the gentleman from New Jersey. I always 
learn something when he is around.
  This bill, we ask: How does it affect the country? And it only makes 
good sense that if we are reducing health care costs over time, that 
will reduce the deficit; because the government is so intertwined with 
Medicare and Medicaid and veterans' benefits and everything else, 
taking the health care system and putting in these fixes and including 
everybody in the system so that they don't run up health care costs, 
and fixing the waste in Medicare and those kinds of things, at the end 
of the day will be very, very beneficial for the deficit.
  I have got a district in northeast Ohio. Very specifically, Mr. 
Speaker, I just want to state what this bill is going to do for those 
people in Ohio who have been for 30 years in a recession, for the most 
part. They lost the steel industry, lost the rubber industry, and lost 
a lot of the manufacturing in the United States and have been hurt 
very, very badly. I wish this was in place 30 or 40 years ago and it 
would have saved a lot of people from a lot of suffering over time.
  This bill alone will improve coverage for 355,000 citizens in the 
17th Congressional District. This particular bill will give tax credits 
and other assistance for up to 180,000 people. There a lot of people in 
my district who have a family of four, make about $50,000 a year. That 
family, under this bill, will get a $5,800 tax cut for them to be able 
to afford health insurance.
  Last year alone in the 17th Congressional District, we had 1,700 
families, neighbors of mine--this is all throughout the country--who 
went bankrupt because of the health care system. Because of health care 
issues, they went bankrupt, and many of those people had health 
insurance. They actually had health insurance and still went bankrupt. 
How many kids, how many families, how many parents had to file for 
bankruptcy in this country last year because of the current health care 
system that we have here?
  So 53,000 young adults in the 17th Congressional District will be 
able to stay on their parents' health insurance because we extend it up 
to 26 years old. This bill will guarantee 9,300 people in the 17th 
Congressional District will no longer be able to be denied health 
insurance because of a preexisting condition. This is where the rubber 
meets the road.
  I mentioned about the $250 that the Medicare part D recipients will 
get this year, a $700 savings in Medicare part D next year. They will 
save $3,000 by 2020. So this is a bill that has great significance.
  We will have enough money in this bill, just in my congressional 
district, for four new community health clinics. We already have a few 
sprinkled around, but four new community health clinics so people can 
go and get the kind of preventive care that we are focused on in this 
bill. Hospitals will save $11 million.
  This bill is a good bill. Is it a perfect bill; not even close. 
Nothing is perfect. We are all imperfect here, so why would we create 
something that is perfect? But we have extended it. We implement things 
over time so we have an opportunity to tweak things.
  As the gentleman from New Jersey said, this reduces the deficit by 
$1.2 trillion over the next couple of decades. That's what this is all 
about for our kids and our grandkids, to have the kind of future that 
we want. So I think it is an important piece of legislation. I am 
excited about it.
  If I can say lastly--because the Ohio State Buckeye's basketball game 
is coming on and we have to do our part, Mr. Boccieri and I, to make 
sure that we root them in as much as we are rooting in the health care 
bill this weekend--I want to say this, and I don't mean to be glib or 
arrogant, but I want to be honest.
  I look forward to the campaign in November. I looked forward to going 
out and talking to the constituents in my district and around the State 
of Ohio about what is in this bill. And I very much look forward to the 
Republican Party running on a platform of repealing this bill, 
repealing the ban on preexisting conditions for children, repealing the 
ban for preexisting conditions on adults, repealing the tax credits for 
small businesses, repealing the tax credits for someone in Niles, Ohio, 
who makes $50,000 a year and will get $5,800. I want to have that 
debate.
  I want to have the debate where the Republicans come up and they say 
we need to repeal that and we need to make sure that our seniors, we 
continue to keep the doughnut hole wide open. We don't want to close 
it. I look forward to that debate and look forward to the debate saying 
that we should keep the lifetime caps in and keep the status quo.

                              {time}  2100

  So it is going to be an exciting time in our country. And as I heard 
one of my colleagues say, we are debating real issues here. And we have 
an opportunity to talk about what is in this bill and how it is going 
to benefit the American people.
  I will then yield back the balance of my time.
  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentleman from California (Mr. Garamendi) is 
recognized for the remainder of the hour as the designee of the 
majority leader.
  Mr. GARAMENDI. Thank you very much, Mr. Speaker.
  I would like to enter into a colloquy with my colleague from New 
Jersey who earlier spoke of the truth, what is actually in the bill. 
One of the things that is not in the bill but is actually a fact is 
that in America about 45,000 people a year die because they lack health 
insurance. They don't have the opportunity to see a doctor on a regular 
basis, and they wind up in the emergency room very, very sick.
  The truth is that under this legislation, 32 million Americans will 
be able to get health insurance, and poor people will see an expansion 
of the Medicaid program so that they get in under that program. That is 
in the legislation, is it not?
  Mr. ANDREWS. It is. I would like to thank the gentleman for being 
here, for being the former insurance commissioner of California, really 
knowing these issues and doing a great job. I want to talk about one of 
the people who would be helped by this.
  A few years ago, I was in my best friend's wedding, and I was in the 
bridal party, and there was a beautiful young lady who was also in the 
bridal party as a bridesmaid. The wedding was in June. We all had a 
great time; all of our families there. My wife and I had a wonderful 
time. A few months later, around Thanksgiving, she started to feel 
sick. Now, she was a part-time cafeteria aide in a public school. Her 
husband was a truck driver who lost his job. So they had no health 
insurance.
  She started to feel some stomach discomfort. She went to the 
emergency room. They decided to admit her to the hospital. They said 
they were going to run a series of tests over the next couple of days. 
And she was terrified that if she stayed in the hospital for that time 
that she would run up a huge bill that she couldn't afford. So she 
checked herself out. She continued to have some stomach problems, and 
again afraid to go see a doctor because she couldn't pay the bill. This 
is around Thanksgiving. She died the day after Christmas, leaving her 
kids behind.
  A lot of politics on this floor, I say to the gentleman from 
California. She is not here today to hear those politics. Her kids 
don't have a mother because someone who worked hard for a living, who 
was in a rough time in their life, could not afford health care. She is 
the issue and her children are the issue on Sunday.

[[Page H1733]]

  Mr. GARAMENDI. Mr. Andrews, I believe that every one of the 433 
Members, or 432 who are still here in the House, know the exact same 
experience. All of us, and virtually every family in America has that 
experience where they have found one of their friends or one of their 
family without health insurance and facing the reality of bankruptcy, 
the reality of losing their life because they were unable to get the 
care that they need.
  I will never forget a visit that I made to a carpenter who had worked 
his entire life and had come down with lung cancer. He was about 63 at 
the time. I visited him in his home, a trailer home out in the back 
part of the district. His wife was there. She had emphysema. And she 
was about 62. He told me, ``I have to hang on. I have to hang on. I 
cannot die because she will be left without insurance. And then she too 
will die.'' That doesn't have to happen in America.
  What we are doing today, as we prepare for this historic vote on 
Sunday, is to lay out before the American people why this is so 
important. It is important to the individual, it is important to that 
family, that person lying in their sick bed trying to hang on for 
another year-and-a-half so that the wife would qualify for Medicare.
  Now, that's the reality of life. But the reality of this bill is it 
deals with that problem. Because if that gentleman lived next week, 
after the President signs this bill, he would have the confidence of 
knowing that there is a special program created specifically for he and 
his wife. The gentlemen and the women between the age of 55 and 65 who 
have lost their job, who are unemployed without insurance, there is a 
special high risk program specifically for them so that if he is to 
die, he can die with the confidence of knowing that his wife will have 
health insurance.
  Now, that is really important because so many Americans and so many 
in my district have lost their job, they fall into that age group. That 
is a tough place to get a job because of the discrimination that the 
insurance industry now puts upon people in that age group.
  Mr. ANDREWS. If the gentleman will yield, I know the person you are 
talking about. Shortly before the holidays this year, on a very snowy 
Saturday, my wife and I went to a large department store to pick up 
some last-minute items. A lady in Audubon, New Jersey, was working at 
the store and talked about what a long day for her it was. She was in 
the eighth or ninth hour of her shift. And she had no health insurance 
because she conveniently fit underneath the full-time worker category, 
working for a huge corporation. She was not yet 65, so she didn't have 
Medicare. And she was really worried that she was going to get sick, 
because if she got sick she also had a preexisting condition which 
would make it all the worse. Couldn't buy insurance.
  Here is what this bill says, as the gentleman knows, to that lady. 
First of all, because she works for a large firm, her employer is going 
to have to either insure her or contribute toward the cost of insuring 
her. And she is going to be able to get insured for 3 or 4 percent of 
her income, maybe $15 or $20 a week, which is affordable for her. A lot 
of people say, well, this is an unfair mandate on business. They don't 
understand. When a huge corporation like that one doesn't pay its fair 
share, the rest of us all do. She will get insurance, it will be paid 
for fairly, and I think she is the lady the gentleman is talking about.
  Mr. GARAMENDI. As you said at the outset, I was the insurance 
commissioner in California for 8 years, '91 to '95 and 2003 to 2007. I 
saw this problem over and over again, where corporations push aside, 
literally discriminate against people because they may be more 
expensive. A particular problem in the smaller companies, where the 
risk cannot be spread out. This piece of legislation provides an 
opportunity for those risks to be adjusted, to be smoothed out among 
all of the people that are insured, all of the companies, thereby 
reducing the incentive for companies to discriminate in their hiring, 
discriminate against people that have a sickness or who may become sick 
because they happen to be 50, 55 years of age.
  There is another thing in this legislation that is extremely 
important to every single qualified, to use your term earlier, 
qualified American, or qualified person in this country.
  Mr. ANDREWS. Will the gentleman yield?
  Mr. GARAMENDI. Let's talk about that.
  Mr. ANDREWS. Define what ``qualified'' means so people understand. 
Qualified means you are a citizen or you are here legally. That is what 
it means.
  Mr. GARAMENDI. Let me get that straight. Qualified means that you are 
a citizen or you are legally in the country with the appropriate 
immigration papers.
  Mr. ANDREWS. Right.
  Mr. GARAMENDI. Green card or H-1B visa, et cetera. So if you are 
illegal, you don't qualify.
  Mr. ANDREWS. Right.
  Mr. GARAMENDI. Now, back to the point I was making is that insurance 
companies discriminate against individuals. We all, if we think about 
it, know the examples here. I am going to give one. Twenty-three-year-
old girl had been insured by the same insurance company for 23 years, 
from her conception, birth, all the way through teenage years, all the 
way to 23. She becomes 23. She is no longer on her parents' insurance. 
She goes back to the very same company and says, I'd like to carry on 
insurance.
  No. Not available to you.
  Why?
  Well, you had acne when you were 16.
  The fact of the matter is she also happens to be a woman and in those 
child-bearing years. So the company says, well, you know, you might get 
pregnant, might get married; might get pregnant and not be married. In 
any case, you're going to cost us a lot of money, and, therefore, no 
insurance.
  That kind of discrimination is over when the President signs this 
bill, be it discrimination against people who have a preexisting 
condition--and who doesn't? Who didn't have acne when they were a kid? 
Who didn't have asthma? Who didn't have a broken arm? Who in our 
society does not have a preexisting condition? Very few of us. Under 
the current situation, the insurance companies are able to pick and 
choose. Only the healthy or likely to be healthy do they want. Those 
who might be expensive they push aside.
  The message to the insurance industry is this: The President signs 
this bill, your discrimination is over. No longer will you discriminate 
against women, young or old, whether they are in their fifties or 
sixties. You will not discriminate against a person who has a 
preexisting condition. And you will not be able any longer to cancel a 
policy when somebody becomes sick.
  Now, I have got to tell you, I went after Blue Cross of California 
and a couple other companies out there with a vengeance because what 
they did, people had been buying insurance from them for years and 
years, they get an illness, maybe they have a cancer, and suddenly the 
company goes back and says, oh, you didn't tell us when you were 3 
years old that you had a tonsillectomy and had to take antibiotics. 
Therefore, we're going to cancel your policy because you didn't tell 
us. That is finished the day the President signs this bill. So in the 
insurance field, the era of discrimination on all of these methods is 
over and the insurance companies will take all comers.
  Mr. ANDREWS. I think the gentleman's point, Mr. Speaker, is so well 
taken, because a lot of times people hear about this legislation and 
say, Well, okay, what does this really have to do with me? I have 
insurance, I'm employed, I don't run a small business, so I'm concerned 
about this because I think I'm going to pay higher taxes and get 
nothing for this.
  Let me deal with that. First of all, if you live in a family that has 
an income of less than a quarter of a million dollars a year, there is 
no tax on your family. If you are an individual that earns less than 
$200,000 a year, there is no new tax on your family. So let's get that 
straight.
  Secondly, who is the next person who is going to find out that they 
are diabetic, or they are asthmatic, or God forbid they are diagnosed 
with a malignancy, or there is some other condition, as you said, that 
is relatively trivial as acne or eczema or something like this. The 
record is filled with people who are denied coverage or who face huge 
premium increases.

[[Page H1734]]

  Because I am sure, Mr. Speaker and my friend from California, there 
are people watching this tonight who thought today was their lucky day, 
that they got a job offer. This happened to someone I know very well in 
my family. She got a job offer. She had been looking for a long time 
for a job, and this is the job she wanted. The employer called back the 
next day and said, We're sorry, but we have to rescind our offer 
because you cost too much to insure because she's diabetic and has a 
family history of breast cancer. So her punishment for conditions that 
are beyond her control is that she is now unemployable if she wants 
health insurance.
  Now, people say that in this country everybody should work their way 
up the ladder. I completely agree with that. How can you work your way 
up the ladder if you can't get an employer to offer you a job because 
you are not insurable? That is over when this bill becomes law.
  Mr. GARAMENDI. The gentleman could not be more correct. And those are 
very, very common. Along the same lines, we often consider America to 
be the country of entrepreneurs. We know the statistics are clear, the 
evidence is there, the polling has indicated that tens of thousands, 
perhaps even hundreds of thousands of Americans do not begin their own 
small businesses because they fear that they will be unable to get 
insurance. They don't want to leave the big corporate family. I know a 
specific fact of a fellow that worked at the university and wanted to 
start his own business. He and his wife wanted to start their own 
business for 10 years, and yet with small children and she with a 
preexisting condition, they did not do so. And so that entrepreneurial 
spirit was stifled by the insurance system we have in America.
  Under this legislation they will be able to get insurance, either 
directly with an insurance company or as soon as in this case the State 
of California develops its exchange, which is a pooling. You talked 
about this when you spoke earlier. And we really ought to have a better 
discussion and a more thorough discussion about the exchanges, which is 
a method of setting up a mechanism in which standard benefit insurance 
policies will be available from different companies, the information 
will be readily available, and the insurance companies will be forced 
to compete with each other on quality and price and availability. Those 
exchanges are an extremely important way to create competition and 
availability of insurance.
  Mr. ANDREWS. If the gentleman will yield, it is not a terribly exotic 
concept. My family has two kittens, so we buy a lot of food for them 
and the other things that they need.

                              {time}  2115

  We buy them at one of these discount centers. I won't name the brand 
name. But we buy them at one of the centers because you can buy these 
products a lot cheaper than you can at retail because there is a 
purchasing group that gets a better deal on these products. This is a 
concept Americans understand very well. The larger the volume of the 
group of buyers, the better the discount.
  The problem for those small entrepreneurs that the gentleman talks 
about is they're out there on their own. They're out there with 5, or 
6, or 7, or 20 people, and they get whatever they can get. But when 
they join an exchange--if they want to--it is voluntary. When they join 
an exchange, they join a buy-in club, that just like our family is able 
to buy our pet supplies at a cheaper price. They're going to buy health 
insurance at a price at a Lockheed Martin, or a General Electric, or 
the United States of America.
  And listen, their employees are going to get the same choices of 
health plans that we do as Members of Congress. It's long overdue.
  Mr. GARAMENDI. I'm relatively new here, and I don't know everything 
about the health systems here. But when I signed up, I was given an 
array of options. I could go to Blue Cross-Blue Shield, or I can get 
Aetna, or Kaiser. It turns out that Federal Government employees, 
including every Member of Congress, have access to an exchange. And if 
you happen to be in California and you're a public employee at the 
State or county, many of the counties and cities, you are already in an 
exchange called CalPers, California Public Employees Retirement System. 
Those are exchanges. This is nothing new. What we're doing is making 
that exchange available to everybody.
  Mr. Andrews, you have been here some time, and I know you're very 
familiar and indeed an expert on the American economy. Let us talk a 
little bit about the American economy and why this legislation is 
extremely important to the American economy.
  Right now we rank 19th in our health, in how healthy we are. And 
we're actually ranking below Colombia. The fact of the matter is we 
also spend nearly 17 percent of our total wealth, our GDP, on health 
care. Our competitors in Europe, Japan, Korea, spend no more than 11 
percent--most of them are 10 percent and below. So you know in your 
economy, we have an enormous disadvantage.
  I remember actually it was President Clinton talking about this, and 
it's as though we took a check every year for about $800 billion and 
gave it to our competitors. We're giving that advantage to our 
competitors because our health care system is so expensive and consumes 
so much of our economy and leaves us not at the top of the heap, but at 
the bottom.
  Mr. ANDREWS. Thank you for calling me an expert on the U.S. economy. 
That is hardly the case. That is the one inaccurate thing the gentleman 
said.
  I do know this from listening to my neighbors: The economy is in 
deplorable, horrible shape. It's the worst economy, I think, in my 
life.
  And the number one issue today is not health care; it is the economy, 
but it's important to understand how this issue plays into jobs and the 
economy.
  Businesses can't create jobs as their premiums skyrocket. As an 
employer pays more and more and more in health care, what he or she has 
to do is either hire fewer people or offer narrower health benefits. 
The auto manufacturers tell us that the price of health care for their 
employees in making a car costs more than the price of steel that goes 
into the car.
  A young entrepreneur starting a software company is likely to not 
even make it at all or crash and burn from the beginning because of 
these costs.
  One of the ways to help businesses create more jobs--and by the way, 
an independent estimate shows that over time, the savings that this 
health care bill will generate will create 4 million jobs in the United 
States--is to fix health care.
  So I do say one thing. Our opponents do have a track record, because 
I hear their rhetoric. They say that well, the taxes that are required 
on families making more than a quarter million of dollars to help pay 
for this--by the way; it's about 55 percent spending cuts, 45 percent 
new revenues to pay for this--but that those taxes will have a 
catastrophic effect on job creation. We will hear that ceaselessly this 
weekend. And they're consistent, if nothing else.
  I want to read you a statement that was made, as an echo, not about 
this plan, but another plan 17 years ago. Here's the quote. ``It is a 
recipe for disaster. It is not a recipe for more jobs. Taxes will go 
up. The economy will sputter along. Dreams will be put off, and all 
this for the hollow promise of deficit reduction, of lower interest 
rates''
  The plan was not this health care plan. It was the Clinton economic 
plan in 1993. The Speaker was former majority leader Dick Armey, one of 
the leading critics of this plan. He was wrong then, and he is wrong 
now.
  Mr. GARAMENDI. What happened, if I recall in the 1990s after he said 
that, the Balanced Budget Act did pass. You were here. I think you were 
here at the time.
  Mr. ANDREWS. I was, and I will confess I didn't vote for that plan, 
and I regret that vote. I think it was a mistake because I frankly 
didn't understand it as well as I should. It was a mistake on my part.
  Mr. GARAMENDI. That is one of the wonderful things about life. You 
can come back and do it a second time.
  In this case we're looking at a situation where in the Clinton 
balanced budget plan, it led to the longest sustained economic growth 
in America's history. And we created--I forget the number of jobs----
  Mr. ANDREWS. Twenty-three million new jobs.

[[Page H1735]]

  Mr. GARAMENDI. Twenty-three million jobs were created during that 
period of time.
  Excuse me. Do you remember the statistics for the Bush, George W. 
Bush years?
  Mr. ANDREWS. I do. For every private-sector job created during the 
George W. Bush years, during the Clinton years we created 140. Let me 
say that again. For every one private-sector job that the Bush 
administration with its policies created, 140 were created during the 
Clinton administration.
  Now, the reason I make this point is that the same rhetoric that 
we're hearing this weekend, that these taxes which affect the top 3 or 
4 percent of people in America, are going to have a catastrophic effect 
on jobs, this is an echo chamber.
  One other quote I want to read you again about the 1993 plan: ``This 
plan puts the economy in the gutter. If it was to work, then I would 
have to become a Democrat.'' The person who said that was former 
Representative John Kasich, a very dear friend of mine, budget 
chairman, who unfortunately--depending on how you look at it--is not a 
Democrat; he's still a Republican, even though it did not put the 
economy in the gutter; it created 23 million new jobs.
  So we will hear this tired old refrain this weekend, but the facts 
dictate differently.
  Mr. GARAMENDI. I want to take up another subject that you broached 
earlier in the conversation, and that is of seniors.
  The senior population spent the good part of the summer being totally 
scared, frightened, purposely so, with a pack of incorrect, or shall I 
just call them lies. Death panels, Medicare is going to be cut, other 
things were put out there to scare seniors into opposing this. When in 
fact--and you went through some of this; I want you to drive this 
home--when in fact, this piece of legislation that we will vote on 
Sunday strengthens the Medicare program and provides significant 
benefits and increases.

  So, please.
  Mr. ANDREWS. I thank the gentleman again.
  What does that plan mean for seniors? It means no cuts in benefits 
for any senior. It means an expansion of benefits to cover more 
prescription drugs as well as preventative care visits. It means that 
the life of the Medicare trust fund will be extended for 7 or 8 more 
years, and it emphatically does not mean that any senior, any disabled 
person, will ever be denied coverage because of their age or 
disability. It's not the truth.
  Mr. GARAMENDI. And you cited the specific code sections, and you also 
cited the fact that this will reduce the deficit of America over the 
next 10 years by some $300 billion.
  Mr. ANDREWS. The parties do have a record on entitlement health care 
spending. The erstwhile majority increased health care entitlements by 
$800 billion in deficit spending. We're going to decrease it by $1.2 
trillion. That's a $2 trillion difference between the rhetoric of the 
other side and the facts of this bill.
  Mr. GARAMENDI. And that was the Medicare Part D.
  Thank you very much, Mr. Andrews.

                          ____________________