[Congressional Record Volume 156, Number 42 (Saturday, March 20, 2010)]
[House]
[Pages H1798-H1803]
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 New York (Mr. Garamendi) is
recognized for 60 minutes as the designee of the majority leader.
Mr. GARAMENDI. Mr. Speaker, I request that we enter into a colloquy
with our colleagues from the Democratic side.
Earlier today, I had the opportunity to exit the Chamber and go out
to the veranda overlooking the east lawn of the Capitol, and there were
a couple thousand folks out there protesting this legislation. And in
their chanting they were saying: Kill Obama bill. I suspect they're
referring to the health care bill, not to the President. And I was
thinking about what does it mean to kill the bill. What is the effect
of killing this legislation and letting time go on with the current
situation in the United States?
Next to me here is what is happening in the United States today.
Forty-five thousand Americans die each year because they are uninsured.
They lack health insurance. Forty-five thousand. That's about twice the
number that are found in any of the arenas today as March Madness
continues. Forty-five thousand. But that's not the end of it.
So we start with 45,000 Americans. What about the rest of the
Americans? We rank 19th among the industrialized nations of the world
in the health of our citizenry. Our children die earlier. All Americans
die earlier than the other 18 industrialized countries. The rate of
increase in the health care market for the individual market in
California and in many other States was nearly a hundred percent within
a 1-year period. Some 50 percent last year and a similar amount this
year, an unaffordable rate increase.
In California, the average number of claims denied by the insurance
companies was 21 percent, and the range was from 39 to 17 percent. You
talk about a death panel. Here's where the real death panel is. It is
in the insurance companies themselves, denying benefits, denying
claims, denying treatment for illnesses and for afflictions that cause
death. This has to end. On Sunday, we will bring this kind of
unacceptable situation to an end, because on Sunday we will pass
affordable, available health care for America.
I'd like now to call upon my colleague from New York (Mr. Tonko).
Mr. TONKO. Thank you, Representative Garamendi.
It is important, I believe, for us to recognize, as you're
suggesting, the benefits that we're bringing because of this reform for
Americans across this great country. Now, the chants that we heard
today were concerned about taking away freedoms. I would suggest that
as we look at the dynamics of this legislation, we're going to see
great improvements--great improvements to access, to affordability, and
to the quality of care, all of which are, indeed, important to our
families, our individuals, and certainly to our businesses, as they
continue to struggle with the cost of health care insurance.
As we think of these dynamics, it's important to know--and I look at
the benefits personalized to my congressional district in upstate New
York, in the capital region, and amongst those benefits is an
improvement where 1,100 to 1,200 families will be spared the pain of
bankruptcy. When you think of the growing dynamic that health care
costs have as they relate to bankruptcy, it's staggering. It's
staggering. Eleven hundred to 1,200 families will be saved from the
ravages of bankruptcy driven by medical costs, health care costs.
I'm reminded with recent data that 62 percent of bankruptcies in this
country are caused by exorbitant medical fees, health care that is not
covered even though in some cases people are insured. In fact, I'm
reminded that of that 62 percent, 78 percent had insurance when they
were impacted by this illness, by the catastrophic situation. That
tells us something.
So we want to talk about freedoms. Yes, I want to provide for the
freedom from bankruptcy, the freedom from claims being denied by
insurance companies when you are insured. And as you indicated,
Representative, in your home State of California, the number is
staggering. I want to promote freedom--freedom from the greed of
insurance executives who say the sky is the limit for compensation and
the profit column rules the day.
These are the freedoms that we believe are important to the American
public: freedom from bankruptcy; freedom from denied claims; freedom
from ever-rising costs, premiums that are escalating beyond belief;
freedom from grief. That's what we're talking about here.
And tomorrow will be an historic day as we look to change that
situation and to strengthen the fabric of our American families and our
business community as we continue with this employer-based health care
delivery system that will allow us to go forward with a sense of
access, affordability, and quality of care.
Thank you for bringing us together this evening, Representative
Garamendi.
Mr. GARAMENDI. Mr. Tonko, thank you very much. You raised the issue
of the insurance companies and how they act in the marketplace. I was
insurance commissioner in California 1991 to 1995 and again 2003 to
2007, and I can tell you horror stories about what the insurance
companies do, and I will tell this to the insurance companies.
When the President signs the bills tomorrow, the era of the insurance
companies discriminating against Americans because they have a
preexisting condition, it's over, folks. It's over. No longer will the
insurance companies be able to say to you, No, I will not give you
insurance because you had acne when you were a child or because you may
have taken some asthma medicine early in your life or you have any of
the four pages of preexisting conditions. The insurance companies will
end their discrimination because the law will make it illegal for them
to do so.
And the issue of bankruptcy. The policies that will be available
through the networks will provide, by law, that there is no longer
lifetime maximum payments so that the bankruptcies that you
specifically spoke to will no longer be existing.
{time} 2030
The maximum lifetime limitations that the insurance companies have
used for years will be over, and shortly the annual limitations will
also be over, and the benefit packages will be full because there will
be national standards for benefits. The kind of cheap, useless policies
that plague Americans when they can't afford a standard policy, they
seek something that ultimately will not provide them with the care they
need. So that is one of the major reforms in this. This is an insurance
reform of extraordinary importance.
Let me now yield to our colleague, the gentlewoman from Texas.
Ms. JACKSON LEE of Texas. Let me thank both the distinguished
gentleman from California for the background that he brings to the
United States Congress as an insurance commissioner of a State and the
distinguished gentleman from New York who made some very valid points.
As a member of the House Judiciary Committee, in fact, we have lived
with this for now almost 10 years. I remember trying to reform the
bankruptcy code to protect people from things like alimony payments or
women being denied the ability to receive alimony payments because
credit card companies wanted to stand in front of the alimony payments
and take first in line. So we have seen people being destroyed in a
number of ways, and we do know that by catastrophic illnesses they are
destroyed.
I just want to focus on two or three points. One, the big sign, about
45,000 Americans dying every year. I don't know why that doesn't send
out a clarion call. We should not be so insensitive to life that 45,000
people dying does not impact our colleagues on the other side of the
aisle. We've been saying this over and over again, 45,000 people. That
means somebody is dying as we speak because they did not have health
insurance or that they were denied.
I want to remind our colleagues of some horrible stories. I remember
one of a young girl who had leukemia, and it was on national
television. I think the company was CIGNA where the family actually
went to the insurance company and begged for this young girl to be able
to have this very special blood procedure. They were turned away, and
they were turned away, and
[[Page H1799]]
they were turned away until finally public embarrassment--the news
media. And the family went again. The tragedy is that when the company
finally approved the right of this young girl, 11 years old, it was too
late. The doctors could not perform the procedure. And so we have seen
any number of incidences where because of lack of insurance, we have
not been able to save a life.
What about the recommendation of Goldman Sachs that said just a
couple of weeks ago, If you want to make a buck, the best place to put
your money is the Nation's health insurers, the Nation's insurers.
You'll never have to worry about them going out of business. You will
never have to worry about them trying to save you any dollars, and
you'll always know and count on them raising the premiums over and over
again. What did you say, 94 percent of the premiums are raised. A
family of four will see their premiums go up $2,000 to $3,000 a year.
Mr. GARAMENDI. It's interesting to observe the effect of that. This
is Blue Cross of California. Two years ago, their profit was almost
$300 million. The effect of those rate increases--the first rate
increase, not the second one, but the first one which was around 50
percent--was to increase their profits to $2.3 billion, and now they
want to add another about 30 percent average on top of that. So what
will their profits be after all of that? It's shameful.
What the legislation does is to reign in the excessive increases in
the insurance companies' premiums. It does that by requiring that a
higher percentage of their total premiums go to medical services. Now
if you want, go check Wall Street, go on Charles Schwab, check the Wall
Street thing. If you want to make an investment, they will say, Invest
in the companies whose medical loss ratio is low and trending downward.
That simply means that they're paying less for medical care and more
for profit. We're going to turn that on its head. We're going to force
the insurance companies to pay for medical services and less for
profits.
Ms. JACKSON LEE of Texas. Let me just make one final point so I can
close. The final point is, and what this bill will do as well, is
provide competition. I mentioned that a good friend came on the floor
and talked about a State where there is only one company. My State--a
big State and is soon to gain in population through the Census, Texas--
has three. So this bill, once it passes, will open up the doors of
choice for those who have insurance or those with employer-based
insurance, because we're not taking away employer-based insurance. I
think that we're moving in the right direction, and I hope that this
story will be told tomorrow in the right way.
Mr. GARAMENDI. And we should also remember in that competition model,
we will be creating exchanges in which insurance companies will be
there, they'll have to compete, and they'll compete on a standard
policy.
Let me now call on our colleague from Ohio (Mr. Ryan).
Mr. RYAN of Ohio. I appreciate it, and I appreciate the gentleman
from California and our other colleagues here.
I have got a nephew at home who is like 3 years old I think. You know
how these kids have different little cute things that they say. His new
thing is that if you ask him, you know, Why are you going in this room,
and he'll say, Well, I'm going in here because of X, Y or Z, that's
why. So he finishes all of his sentences with ``That's why.'' You ask
him why, he says, ``That's why.''
So I was thinking about this debate, and people say, Well, why are
you supporting this legislation? Well, so kids can stay on their
parents' insurance until they're 26 years old. That's why. You know, we
have got kids that are getting denied because they have a preexisting
condition. The insurance company says, We won't cover you. I'm
supporting this bill because that's going to change. The other
provisions that you're highlighting here, tax credits for small
businesses, up to 35 percent, and it's actually in some instances 50
percent of a tax credit for our small businesses for people who are
providing tax relief to small business men and women who are providing
health insurance. That's why I'm supporting this bill. If you get sick,
and you try to get coverage, and all of a sudden the insurance
industry, the insurance company says, Well, we can't cover you anymore,
that's going to be done with.
Think about these significant investments, these significant
protections that we are making as a country. I love the idea of all the
tea baggers that were down here today talking about these concepts of
liberty. I would ask them today, Tell me, what do you mean? What
liberty are we taking from you? And let me compare it to the person in
my district, the 1,700 families last year in my district that went
bankrupt. Are they free? They are not free. They are trapped in an
economic system that buries them because someone in their family got
sick.
My goodness gracious, what did our Founding Fathers mean when they
gave us these ideas of life and liberty and the pursuit of happiness?
Who can pursue happiness when they're bankrupt? Because of nothing that
they did--it wasn't bad financing; it was bad luck. And if we don't
start to recognize in America that some people in our country just have
bad luck, and if the government doesn't step in and push back the
insurance industry to say, We're going to carve out--we're going to box
out the insurance industry so this family will have some freedom, have
some protections, that's what this is about.
I've got no interest in stymieing business growth. I come from
Youngstown, Ohio, for God's sake. We've been in a recession for 30
years. You think I have an interest in stymieing business development?
I want to help it. You've tried yours. They've tried their side, I
would say to my friends. I was here. I'm not that old, but I've been
here 8 years now. I sat here, and I watched while Bush jammed through
his tax policy, cut taxes for the rich. They said, This is going to
trickle down and help the poor. It didn't help anybody but the rich.
I sat here and watched while he passed a prescription drug bill,
didn't negotiate prices, didn't do anything, didn't pay for it,
borrowed the money, started wars, didn't have money for the wars that
he started. I sat here and watched while the Republican rubberstamp
Congress rubberstamped all of those policies. The economy didn't
improve. Wages didn't go up. They had control of every single thing.
They had a chance to implement their health care strategy. It didn't
work because they didn't do anything. They had a chance to implement
their energy strategy. And when gas goes to $4 a gallon again this
summer, we're going to feel it again. This is significant stuff we're
talking about, and Democrats are stepping up to bat for the American
people. We are taking on the insurance industry.
Mr. GARAMENDI. Thank you. We've discussed here the issue of
bankruptcy, and I got a call from my daughter this afternoon. She said,
Dad, thank God I'm a nurse and I have insurance. Matteo's arm, which
was badly broken and required surgery, will probably be a $70,000
event. She said, If I didn't have insurance, we would have lost our
house. That's the situation that's faced by every family. Thankfully
this was not the situation that my daughter and grandson faced, but it
is faced by tens of thousands, if not hundreds of thousands of
Americans. And it's right here. The insurance companies dominate these
markets. Lifetime benefits. She probably has already run through her
lifetime benefit. That child is probably going to be uninsurable
because he has a preexisting condition, a badly broken arm. Those days
are over.
I would like now to yield to my colleague from California, a
magnificent Representative with whom I have worked with for more than
34 years. She was a California State senator and took over my position
when I left the chairmanship at the California State Senate Health and
Welfare Committee, Representative Watson.
Ms. WATSON. I just want to say to my colleague and those here on the
floor this evening, I am so proud to share the space in this Chamber
with the likes of you. And particularly you, Congressman Garamendi. And
he was correct in saying that, yes, when I got into the Senate, he
relinquished his committee, and I held it for 17 years. I think he
probably is aware of my feelings at this moment.
I have viewed the ugliness of today, Congressman Garamendi, that is
so
[[Page H1800]]
reminiscent of what I went through when I was on the school board in
the 1970s, and we had to integrate our schools. I was the only person
there who was an African American, and I had to endure the slurs that
were heard today. It was absolutely ugly. The use of the ``N'' word,
spitting, the ranting, the distortions, the slurs, and the deceitful
references to our health care reform. I felt it was despicable. I
didn't think it could happen again here in America, but I'm reminded
that hate continues.
Why should there be ranting and raving when we're trying to cover the
38 million Americans without health care insurance? And 8 million are
in our State, California, and 6 million of them are children. I want to
say that the legislation that we are addressing will make health care
affordable for the middle class. I don't know how many people out there
ranting were middle class, but this definitely will help them. It will
provide security for our seniors and guarantee access to health
insurance for the uninsured.
I just want to very quickly mention what it will do for the 33rd
Congressional District. That is my district in Los Angeles, Culver
City, California. It will improve health insurance coverage for 304,000
residents, it will give tax credits and other assistance to up to
173,000 families and 15,100 small businesses to help them afford
coverage.
{time} 2045
It will improve Medicare for 75,000 beneficiaries, including closing
that doughnut hole. It will extend coverage to 132,000 uninsured
residents. It will guarantee that 22,200 residents with preexisting
conditions can obtain coverage, and certainly the children, starting
when the bills are signed into law. It will protect 1,100 families from
bankruptcy due to unaffordable health care costs. It will allow 66,000
young adults to obtain coverage on their parents' policies until they
are 26 years old. Isn't that exciting. It will provide millions of
dollars in new funding for five community health clinics in my district
alone. And it will reduce the cost of uncompensated care for hospitals
and other health care providers by $16 million annually.
And I want to set the record straight: this will add and protect and
supplement, not take anything away.
Mr. GARAMENDI. Representative Watson, thank you so very much. I am
appalled and personally offended and I think all owe an apology to
those Representatives who were demeaned, who were spat upon, who were
cursed, and who were called the ugliest of names. It is totally
unacceptable.
I yield to Mr. Tonko.
Mr. TONKO. Representative Garamendi, I couldn't agree more. I think
Representative Watson says it well. There is all the call for civil
discussion, exchange of information to do things analytically and
substantively when it comes to a huge industry that represents $1 of $6
in this country, and we need to do it in a way that brings together the
facts, not to deal with fiction. Emotion, obviously, is a part of this
discussion. We heard it from our friend, Representative Ryan. We are
emotionalized by this, but let's have the sort of dialogue that builds
soundness into the reforms that we desperately need as a Nation.
When we get back onto this message of freedom, the freedom to shop,
many of us understand there is a capitalist model out there. People
understand that it is good to have business be successful. And where we
can control cost and contain cost, and allow for growth of that
business so more jobs are part of that picture, all the better. So we
have the opportunity with these exchanges, developed by this reform
legislation, to allow for the freedom to shop, to find a better bargain
for health care, and as previous speakers have said, add more people
into the mix, more providers into the mix that want to fight for the
right to serve you. That is a strengthener.
And then we establish these exchanges where we require those
exchanges to have certain rules to be met, to have regulatory aspects.
We saw what happened when no regulation was part of the financial world
and the banking community; it brought us to our knees in a recession.
We need that sort of regulatory aspect, and it is part of the picture.
The medical-loss ratio, the amount of money going back directly to
consumers, to those insured, rather than into the profit column, will
be a litmus test in order to offer your services in that exchange. And
to live with the standards' minimum benefits package. These are the
improvements that we bring.
So again to Mr. Ryan's emotion, and I attach myself to that
sentiment, we are promoting freedom to shop and we are promoting
freedom from bankruptcy. These are essentials of this bill; and the
exchanges will allow for much more competition that sharpens the pencil
and drives the bottom line benefits for consumers. And the freedom to
escape restriction and bias if you have acne or are overweight, or for
women who are of child-bearing years, or those who have been violated
through domestic violence, to use that as a standard, to deny you
insurance coverage, that is the freedom you need, to escape those
biases and that prejudice and that tool that allows the industry to
grow more prosperous because it won't insure you--these are the
freedoms we are encouraging. These were the freedoms we are
guaranteeing.
So I am proud to be here tonight to work with you, Representative
Garamendi, to make certain that we share with the American public what
is really happening with this measure, and we are going to make history
by approving this package.
Mr. GARAMENDI. Representative Tonko and Representative Ryan, both of
you have spoken to the American economy in Youngstown and the effect
that 30 years of recession has had on that town. One of the fundamental
problems in the American economy is the extraordinary growth in the
health care sector.
This little chart here really explains why many parts of the American
economy are not competitive. This little red line here is the growth in
the percentage of the wealth of this Nation, the GDP, that is now in
health care. We heard earlier one-sixth. Well, it is 16, almost 17,
percent of the total wealth of the Nation that is tied up in health
care. We are growing faster in this sector than any other sector of the
American economy.
Our competitors around the world are down in the 10-11 percent range.
President Clinton, explaining this in a speech in California that I had
the pleasure of attending, indicated that this gap here between the 16-
17 percent of the American economy that goes into health care versus
the 10-11 percent that our competitors are spending is like giving a
$80 billion a year gift to our competitors around the world.
And so when the industries in the manufacturing of America go out,
the car industry, other heavy industries go out to compete, they are
saddled with this extraordinary additional cost because of the growth
in the health care sector.
The fact is the more inflation in the health care sector, the fewer
people are insured. This is why we are seeing small businesses shedding
health care, and why we see the extraordinary run up of the uninsured
as the economy goes down. It is not just losing your job; it is the
small businesses being unable to continue to purchase health care.
One of the most important things that is going to happen in this
legislation for small businesses is a specific tax reduction, a credit,
of up to 35 percent in year one and then rising to 50 percent for every
employee that they provide health care for. So it is an enormous
benefit and incentive to provide the insurance, to maintain the
insurance, and that is what is going to go on in the years ahead. So
all of the talk about this bill being bad for business, it is simply
not true. This is what is bad for business. There is serious cost
containment in this legislation through a variety of ways.
I yield to Mr. Ryan.
Mr. RYAN of Ohio. It is interesting, I was listening to my colleagues
from New York and California, I can't get over what all of the fuss is
about against this bill. This is something that Bob Dole and Senator
Chafee had worked out in the eighties. This is middle-of-the road
stuff. Many of us wanted other things in here. I am not afraid to admit
that. There is no public option in here. This is not single-payer. This
is right down the middle. This is bread and butter, all American, apple
pie and Chevrolet. This is baseball.
Look at it, tax cuts for small businesses. Many people in our
districts make $50,000 a year. Under this proposal, a family of four
making $50,000 a
[[Page H1801]]
year in Niles, Ohio, will get $5,800 worth of a tax credit. That is a
middle class tax cut. This is what is in the bill. We are regulating
and putting in new rules for the insurance companies. We are not taking
over, but this is pretty simple. And the gentleman from New York
mentioned it: this is about prevention. There is no one who can argue
with the fact, Mr. Speaker, that we have 30 million-plus people in the
United States of America who have no preventive care at all, dumped
into our emergency rooms, much sicker than they need to be. And it
doesn't take a Philadelphia lawyer to figure out that that costs a lot
of money, as opposed to giving each one of those, and they pay nothing,
they go there and they pay nothing. They don't pay anything. So it is
all free, shifted off to the next person who comes in with an insurance
card.
What we are saying is, it is cheaper for us as a country, since we
are all already paying for them anyway through higher insurance
premiums, it is cheaper for everybody if we give them an insurance card
and make them pay something. No more free riders. Everyone is going to
have to pay something, and get them to a primary care physician who
will give them a $20 prescription drug instead of going to the
emergency room a week or two later and costing us $10,000 or $15,000 or
$20,000. That is what this whole thing is about.
And when the industry is set up, as it is currently, to knock people
off the rolls and deny coverage, especially the stories we have heard
coming out about people with HIV and AIDS, you are not covered. That
gets pushed off and dumped on everybody else. We are saying this is a
pro-business bill.
I am glad, as the one gentleman said earlier, I am glad that the tea
baggers are in Washington, D.C. to watch this pass because this is
going to be the most significant tax cut for middle class people in the
history of our country, especially geared towards health care.
When I can go home and tell my folks that a family of four making
$50,000 a year, they are going to get a $5,800 tax credit for their
health insurance, they probably don't know that right now, but I am
going to spend the next 6 months making sure that every single family
in my district knows that they are going to get that tax cut, and they
are going to like what we have done here.
Mr. GARAMENDI. Thank you, Mr. Ryan.
One of the things that we have heard all day is about Medicare cuts,
somehow the Medicare system is going to be cut. I would like to get
into that a little bit because this bill specifically helps Medicare.
We have talked about the doughnut hole. This is the prescription drug
benefit which, by the way, my Republican colleagues, which I guess are
not here at the moment, when the prescription drug benefit part D was
put in place, the Republicans controlled this House with the President
and they never bothered to pay, never bothered to pay for that benefit.
And so you want to know where the deficit came from? It came from there
and it came from the two wars that the Bush administration started and
didn't bother to pay for either, so we ran up the deficit.
But here is the thing for seniors, to go back on my point here, is
that the program provides very specific benefits to seniors. It
provides $250 this year, a $250 additional benefit for seniors to pay
for drugs. Those that fall into the doughnut hole, that doughnut hole
begins to close this year, and in 5 years it is totally gone.
In addition to that, it is explicit in this legislation that the
Medicare benefits will not be reduced.
I yield to Mr. Tonko.
Mr. TONKO. I think what is important to note is the nomenclature on
this one is rather offensive. We talk about the doughnut hole as being
Medicare part D, but who is paying that? Is Medicare paying that? No,
our senior community. Our senior citizens are asked to contribute. It
is not Medicare paying for that portion.
So this one was cleverly devised. Cleverly devised. You can almost
see the game of footsie going on because somewhere people sat down and
thought, We can come up with this great, clever name, sounds
attractive, sounds tempting, a doughnut hole. I can tell you many
seniors come to me and tell me within a matter of months in any
calendar year, I am at that threshold.
For those who are not familiar with it, think of the simple doughnut
with the hole in the middle. You get covered for a while, then you
don't, and then you do. It is that threshold. Actuarial measures could
have told them right when you have to peak there to get people into
their own pocket paying for this device that is hurting our senior
community.
So when we talk again about freedom, this is freedom from the
doughnut of the worst kind. This is freedom from digging into your
pocket and paying for your pharmaceutical needs to stay well or to stay
alive. So this measure is great about freeing us from that doughnut
hole; but this is not Medicare funded, this is out of the individual's
pocket, and it is hurting our senior community. And by the year 2018,
we will close that doughnut hole completely. It is an expensive
proposition; but, again, as you pointed out, no one worried about
paying for it when they came up with the plan.
{time} 2100
Mr. GARAMENDI. I might add that between now and 2018, some of us are
going to be around here, and we are going to give the Federal
Government the power to negotiate drug prices. We are not there today.
It is one of the things that is missing in this legislation that I wish
was in it. But it will happen. No longer will they be free from
competition.
I yield to the gentlewoman from California.
Ms. WATSON. I want to set the record straight, because there have
been so many distortions. In church last Sunday, and I am Catholic, and
it is Lent, and I was going down to take communion. I was four people
before getting to the priest to get communion when someone I know
leaned over and said, ``Don't take my Medicare away.'' The distortions
that are out there have to be set straight.
I really appreciate my colleagues and you, Representative Garamendi,
for talking about closing the part D doughnut hole. I think it was
about $2,300 that you had to expend for your own prescriptions and then
you went into a period of time when you got no help and no discounts.
Now that is going to be eliminated. And I just want to say for my
friend who stopped me in church last Sunday, the legislation will allow
6,100 Medicare beneficiaries in my district who entered the part D
doughnut hole and are forced to pay the full cost of their
prescriptions, that under this bill these beneficiaries will receive a
$250 rebate in this year, 2010; 50 percent discounts on brand name
drugs beginning in 2011; and complete closure, complete closure of the
doughnut hole within a decade. A typical beneficiary who enters the
doughnut hole will see savings of over $700 in 2011 and over $3,000 by
2020. And you will be here to see that because you are from California
too.
Mr. GARAMENDI. Thank you, Representative Watson, for making it so
personal to your district. The same savings are to be found in every
one of our districts. We have different percentages of seniors in our
districts, but the fact is that there are very, very significant
savings in this.
I want to take up one other issue that has been raised over and over
again by the Republicans in the most disingenuous and I think rather
dishonest way. And that is the reduction of some $500 billion over the
10 years in Medicare expenses. Now, where do those reductions come
from? They would let us believe that those savings are from the
reduction of benefits. That is not true. There is explicit language
here that benefits will not be reduced. I will tell you where the money
is going to come from. It is going to come out of the pockets of the
insurance companies that have ripped the Federal Government off to a
fare-thee-well for the last 6 years, ever since the George W. Bush
administration created the Medicare Advantage program, which they did,
incidentally, in reconciliation.
It is abominable that this government has had to pay a bonus to the
insurance companies to provide Medicare Advantage programs when in fact
they said they could do it cheaper than the fee-for-service Medicare
program. Sixteen percent bonus over and above the
[[Page H1802]]
average cost of Medicare for seniors is given to the insurance company
for no good reason. Those days, that bonus, that unintended and
unnecessary profit is going to be over.
Secondly, there is fraud and abuse in the Medicare system not from
the seniors who are striving to get their benefits, but rather from
purveyors, doctors, medical device people, and out and out fraudsters.
We are going to be hiring. Some of those people that were talked about
earlier from the IRS and the CMS, the Medicare office, those folks are
going to be out there chasing after criminals that are ripping the
Medicare system off to a fare-thee-well. That is where the reductions
are coming from, from those two places.
I yield to the gentleman from New York.
Mr. TONKO. Representative Garamendi, again thank you for bringing us
together. I think in addition to that, and you are very right, to have
oversubsidized the Medicare Advantage programs some 12 to 14 percent,
people say where are the costs coming? Not from you, from the profit
column. And actually, we want that to be transformed to something that
is Medicare-related in terms of balancing the scales there and allowing
our seniors to still have an advantage by having that program continue,
but making certain that the oversubsidization is denied. And you are
very right about the fraud and the abuse that may be part of that
programming.
But it is also important to note, I believe, that situations like
medical home models and accountable care organizations will provide for
the collaboratives that we need to coordinate the resources, to improve
access, and to bring together the confluence of services in a way that
streamlines without really hurting--actually helping the outcome for
our seniors.
Then of course free annual wellness visits. Making certain that those
copayments, those deductibles are not going to saddle individuals,
again having to be forced to dig into your own pocket. We will now have
those free annual opportunities, screenings of essential types, the
annual checkups. These are items that will not require--actually,
copayments and deductibles will be denied and they will be disallowed.
So you go forward and you encourage the preventative and wellness
approaches to health care delivery, which is an important aspect, I
think, to the benefits of this program.
We have to remember that the $1.2 trillion that is saved in the
second 10 years out and the $138 billion that is saved in the first 10
years are just those budget-related scorings that were done by the
Congressional Budget Office. But there are those who are suggesting
that well beyond any kind of budget impact are the ripple effects of a
good kind that will come simply by instituting wellness and prevention
and access and putting clinics into the system, relieving our health
care delivery system of uncompensated care burdens. A number of these
things can't be scored by the Congressional Budget Office. So it goes
well beyond the $1.34 trillion that has been projected by a very
conservative, nonpolitical CBO group.
So I think there is reason for great hope here. And if we could
instill hope, if we could insert hope into the lives of people, into
the fabric of our health care opportunities we are achieving a great
deal. And again, because this is so critical in the lives of people and
in the profit columns of businesses that provide jobs, this is an
important discussion.
Mr. GARAMENDI. I really want to home in on what you are saying, but
let me wrap up the senior part here if I might. Let's be very, very
clear about the Medicare program. First of all, the AARP, American
Association of Retired Persons, say that this legislation is going to
lower costs and improve care for seniors.
Secondly, it is in the bill, no benefit cuts. It is in the bill. Two
hundred fifty dollars in the pocket of seniors who have got their
medical prescriptions in the doughnut hole to help pay for that. And
that is this year. Not 10 years from now, this year. Medicare part D
doughnut hole is beginning to close. It is going to take time because
it is expensive and it does take a lot of money, but it is going to
close by 2018. And there will be significant drug discounts for seniors
who use generic drugs this year, saving seniors, just as you said,
millions of dollars out of their pocket. And that is not in the CBO
score.
I yield to the gentleman from New York.
Mr. TONKO. I would have to add to your list of benefits in this
measure is the stabilization of the Medicare trust fund, providing that
trust fund as we go forward being a stronger element out there,
enabling us to again provide the Medicare benefits and services that
are required. It is an important aspect. It is important to 113,000
beneficiaries in my district. So we want to make certain it's there.
Mr. GARAMENDI. It's not on my list. Do you want to add to my list
another benefit?
Mr. TONKO. I will add to your list. And I am glad, Representative,
that you made mention that no benefit cuts are included in the language
of the bill. So these are another bit of freedoms that we are talking
about in this measure.
Mr. GARAMENDI. So we add to the bill that the Medicare trust fund is
made solvent for something either 7 to 9 years.
Mr. TONKO. Nine years.
Mr. GARAMENDI. Nine years. Okay. We added that one here. Medicare
Advantage, we talked about that. The bonus to the insurance companies
is gone. And that money is not sent off to some other program, that
savings stays in the Medicare program. Reduce senior premiums, improve
access, expanded benefits, extend Medicare's fiscal--I did have it
here. I just didn't read it. Here is the Medicare fiscal health. And
finally, the issues you were talking about, prevention, organizing the
care so we have continuity of care.
I yield to the gentleman from Ohio.
Mr. RYAN of Ohio. Just listening, I want to speak directly to Members
of the House because we've got a few minutes left tonight and some
debate tomorrow. How does this play out over the course of the next few
months? By listening to what you gentlemen have just got done saying
about Medicare, the significant improvements of strengthening Medicare,
we're going to have to run an election. And there is probably going to
be an election on this bill. What has happened over the last few months
is our friends on the other side have consistently tried to throw
arguments again the wall, and they would just fall; they wouldn't stick
because they weren't true.
We started with death panels, and illegal immigrants, and abortion,
and we went right down the line. None of them ended up working out.
``It's going to bankrupt the country.'' And then we get CBO--I mean you
just go right down the line. They said it's going to support abortion,
and then we have 60,000 Catholic nuns, 600 Catholic hospitals, 1,400
Catholic nursing homes, a bunch of Catholic theologians saying this is
not a pro-abortion bill, this is a pro-life bill. Same thing with
illegal immigrants.
Then they say it's going to spend a ton of money, and then the
Congressional Budget Office, a neutral third party, says it's going to
save $1.2 trillion, reduce the deficit by $1.2 trillion in the second
10 years, $130 billion in the first decade. That is a reduction in the
budget deficits on the backs of what President Clinton did by reducing
the budget deficit. So we have a history of doing that.
So quickly, the debate in the fall about health care is going to go
something like this. We pushed an initiative that is going to close the
doughnut hole and give our seniors 250 bucks just this year to help
close that doughnut hole. Our friends on the other side running against
us will be saying we want to repeal that. We don't want that closing of
the doughnut hole.
We're going to be campaigning on little kids who have a sickness are
now being denied insurance coverage because they have a preexisting
condition, we're going to say, we stopped that from happening in the
United States of America. Our friends on the other side are going to be
running a campaign saying we want to repeal that.
We're going to have in there we want to have a ban on preexisting
conditions for all citizens across the board. Our friends on the other
side are going to be running a campaign saying we want to repeal that.
And on and on and on.
People who are now getting kicked off the rolls, their insurance
rolls, because they got sick, we're saying that
[[Page H1803]]
could never happen again in the United States of America. And next fall
our friends on the other side of the aisle are going to say, no, no, we
want to repeal that ban. We want to continue that practice of the
insurance industry being able to kick people off of their insurance
because they got sick.
We're going to be saying, hey, your kid that just went on the
insurance rolls because they were 24 years old and we allowed that to
happen because of the health care reform bill. Our friends on the other
side are going to be saying they want to repeal that provision that
allows young people to stay on their parents' insurance until they're
26 years old.
Very clear. The family in my district, your district in New York,
your district in California, your district in California, all across
the country, those families of four making $50,000 a year who are going
to get a $5,800 tax cut that we put in because of this reform, our
friends on the other side are going to say we want to run this election
about repealing that tax cut.
Same with the 35 percent and then up to 50 percent tax cut for small
businesses. Our friends on the other side are going to say, we want to
repeal that. This is a referendum on health care reform. I say I want
to have that debate day and night for the next 6 or 7 months because
that is a debate, Mr. Speaker, we can win and we shall win. The only
issue now is a lot of people do not know all of these benefits that
have been itemized here tonight. They will know in the next 6 months.
I yield back to my friend.
{time} 2115
Mr. GARAMENDI. We've got about 6 minutes left, so let's each take
about 2 minutes.
Mr. Tonko.
Mr. TONKO. Thank you very much for bringing us together.
There is so much to talk about with this bill, but you know, as what
has been mentioned with Representative Ryan, a family living on an
annual income of $50,000 gets the $5,800 tax credit. Well, you know, it
doesn't end there. It goes all the way up to the threshold of $88,000
for annual household incomes whereby families are going to receive some
sort of benefit.
This is an extraordinary opportunity to provide for middle-income
America, to provide income for them so that they can promote wellness
within their individual families. Absolutely tremendously strong idea.
It empowers the middle class, the working families of this country.
It empowers our small businesses. Representative Watson talked about
the benefits in her district to small businesses. In my district,
between 14,000 and 15,000 businesses will be given the opportunity for
tax credits to help purchase the employer-based plans for their given
employees. And don't they prosper from a sound and well workforce? I
think that is important. They also will have the benefits of shopping
within an exchange if they so choose.
So there is all of this effort made to make certain that we advantage
people in a way that will promote wellness, provide health care in an
affordable and accessible fashion.
We also do know that the benefits to our senior community, with all
of the strengthening of Medicare without reducing those benefits,
promoting their pharmaceutical needs being addressed fully in the near
future so that they are not avoiding those pharmaceuticals simply
because they cannot afford them; that is bad policy.
So what we have here is freedom galore, freedom galore to be able to
stay well, to stay strong, to grow and prosper, to be hopeful. This is
a golden moment. This is a wonderful moment that we will share tomorrow
as we come out to this floor and address this health care reform
measure.
And thank you Representative Garamendi for bringing us to together.
Thank you for the opportunity.
Mr. GARAMENDI. I appreciate your passion on this no less than Mr.
Ryan's.
Ms. WATSON. And very quickly I, too, want to add my thanks to my
colleagues for providing this time.
I want to remind our country that in this legislation, we have
community health centers. And I remember in the beginning some people
were very disturbed because their districts--and they feel that they
have areas that are so remote, how will this health insurance plan
cover them.
They need to know that nationwide the legislation will provide $11
billion in new funding for these health clinics. And they'll be in
rural areas; they will be in suburban areas. Those people who are not
in the urban core will be provided with health care. And if the
community health centers in the district, your district, receive the
average level of support, these centers will receive millions of
dollars in new assistance so that we can cover as many of the uncovered
as possible.
And I want to remind the viewers that if you have insurance and you
like your insurance, you can keep your insurance. If you love your
doctor or your health care provider, government does not come in
between that relationship. And I want the viewing public to know that.
And then I want to end by saying there is no deficit spending. I sat
in my office and heard the opposition say, It's going to rob my
children, you know, and, it's going to wreck their children, and it
will rob them because they'll have to pay off the deficit.
The cost of health care reform under the legislation proposed is
fully paid for in large part by eliminating, and you mentioned it,
waste, fraud, and abuse and excessive profits for private insurers.
The legislation will reduce the deficit by over a hundred billion
dollars over the next 10 years and by about $1 trillion over the second
decade.
So thank you, Representative Garamendi for allowing us this time to
set the record straight.
Onward to victory.
Mr. GARAMENDI. Thank you very much, Representative Watson. It has
been a joy to work with you these 35 years and work with you this
evening.
This is a historic moment. This is something you and I and many
others have worked to try to provide health insurance for all
Americans. Some 32 million Americans will receive health insurance as a
result of this. There will be the incredible tax cuts for working men
and women. For small businesses, they, too, will receive significant
tax credits so that they can provide insurance for their employees. And
there will be programs to promote wellness. There will be programs to
create better information technology so that we don't have to waste
money every time you present yourself with a different doctor. And you
have the freedom to choose your own health insurance company, and your
health insurance company no longer has their freedom to deny you
benefits and coverage. There are serious insurance reforms in this.
Finally, I just want to add, I have seen this sign so many times
around the Capitol, so many times, and it says, ``We the people.''
Those are the first three words of the preamble of the United States
Constitution. And it goes on to say, ``We the people of the United
States, in order to form a more perfect union.'' That is what we're
doing here. A more perfect union within our families so that we don't
have to fear bankruptcy and the loss of health because we have no
health insurance; a more perfect union in our communities so that
everyone in our communities has health care and access to health
insurance.
It establishes justice.
Thank you so very much.
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