[Congressional Record Volume 156, Number 43 (Sunday, March 21, 2010)]
[House]
[Pages H1854-H1890]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




SENATE AMENDMENTS TO H.R. 3590, SERVICE MEMBERS HOME OWNERSHIP TAX ACT 
OF 2009, AND H.R. 4872, HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 
                                  2010

  The SPEAKER pro tempore. Pursuant to House Resolution 1203, it is now 
in order to debate the topics addressed by the Senate amendments to the 
bill (H.R. 3590) to amend the Internal Revenue Code of 1986 to modify 
the first-time homebuyers credit in the case of members of the Armed 
Forces and certain other Federal employees, and for other purposes, and 
the topics addressed by the bill (H.R. 4872) to provide for 
reconciliation pursuant to section 202 of the concurrent resolution on 
the budget for fiscal year 2010.
  The gentleman from Maryland (Mr. Hoyer) and the gentleman from Ohio 
(Mr. Boehner), or their designees, each will control 60 minutes.
  The Chair recognizes the gentleman from California (Mr. Waxman) for 
15 minutes as a designee of the majority leader.


                             General Leave

  Mr. WAXMAN. I would like to ask unanimous consent that all Members 
have 5 days in which to revise and extend their remarks and insert 
extraneous material in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to the majority leader of 
the House of Representatives, the gentleman from Maryland (Mr. Hoyer).
  Mr. HOYER. I thank my friend for yielding.
  Today is March 21, 2010. On March 21, 1965, Martin Luther King, Jr., 
led a march across the Edmund Pettus Bridge. It was a march across that 
bridge for the vote in this democracy.

[[Page H1855]]

It was a march towards a greater freedom for many Americans. It was a 
march for a better quality of life for many Americans. Indeed, it was a 
march across the Edmund Pettus Bridge for freedom and a better 
realization of the promise of our democracy.
  Today, March 21, 2010, we will cross another bridge. It is not a 
physical bridge, but it is a bridge that too many Americans find that 
they cannot cross; a river that separates them from the security of 
having available the best health care that is available in the world 
available to them.
  We are here to conclude a day of debate, which concludes months of 
debate, in a national conversation that began more than a century ago.

                              {time}  1845

  But this much is beyond debate. American health care is on an 
unsustainable course. By the end of this debate, another family will 
have fallen into bankruptcy because someone had the bad fortune simply 
to be sick. More families will have joined them in paying more and more 
for less and less health coverage. More businesses will have weighted 
bankruptcy against cutting their workers' care and their workers will 
have lost.
  We have before us a bill to change an unsustainable course. That is 
our choice this evening. It is a historic choice. It's a choice that 
all of us volunteered to be put in the position to make. It is a choice 
that we will be honored to make this evening. We stood in this Chamber 
tonight with John Dingell, John Dingell, who stood at that rostrum with 
the gavel that the Speaker will use tonight to gavel through Medicare, 
that ensured that millions and millions and millions of seniors would 
not be crushed by poverty and put into bankruptcy by the cost of health 
care.
  Indeed, they will have been given the opportunity for a longer, 
better quality of life in America when John Dingell brought that gavel 
down on that desk and noted the passage of Medicare in 1965.
  For more than 3,000 district events, more than 100 hearings, and 
almost 2 years of public debate, health insurance reform has stood up 
to the scrutiny, to criticism, indeed, to falsehoods. But this purpose 
is older than that. Before we were born, the task of bringing 
affordable health care to every American was on our Nation's agenda, 
waiting for this day. At the beginning of this decade in 2002, George 
W. Bush said, ``All Americans should be able to choose a health care 
plan that meets their needs at affordable prices.'' George Bush was 
right.
  In 1976, Gerald Ford spoke of ``our effort to upgrade and perpetuate 
our total health care system so no individual in this country will lack 
help whenever or wherever he needs it.'' Gerald Ford was right.
  And Richard Nixon said this, ``Let us act now.'' That was in 1974, 
when there were far fewer Americans who did not have health insurance 
and where health care was less costly. Richard Nixon was right in 1974 
on this issue. Let us in 2010, in a bipartisan way, perhaps not a 
bipartisan vote, but recognizing that this has been a bipartisan 
objective, a bipartisan vision, for those Republican Presidents and 
Democratic Presidents whom I have not quoted but whom, as all of you 
know, were equally committed to that vision and that objective, 
affordable health care for all, for all Americans. It was embraced by 
both parties' nominees in the last campaign, Senator Obama and Senator 
McCain.
  But what a campaign of fear this bill has faced this last year. Its 
critics call it, without justification, and we will hear it tonight, a 
``government takeover.'' That's not true, but if you believe it's true, 
perhaps you think we ought to repeal veterans health care, which is 
clearly government-run health care. Perhaps we ought to repeal 
Medicare, government participated but private sector providers. Perhaps 
you believe Medicare should be repealed. I don't think you do; I hope 
you don't.
  It is more control, however, for whom? For consumers, and less for 
insurance companies. It is the end of discrimination against Americans 
with preexisting conditions, and the end of medical bankruptcy and caps 
on benefits. It is coverage you can rely on whether you lose your job 
or become your own boss, coverage that reaches 95 percent of all 
Americans. Its critics call it tyranny. There is none.
  It is a free, competitive, transparent marketplace where individuals 
and small businesses can pool together to buy private insurance at low 
rates. It is lower cost for the middle class and an end to the 
prescription drug doughnut hole that has faced too many struggling 
seniors. Its critics mock this as ``out-of-control government.''
  In truth, it is the biggest definite-reduction bill any of us will 
have an opportunity to vote on in this Congress and, indeed, in other 
Congresses as well. Indeed, it's the deepest definite reduction since 
the Clinton budget of the 1990s that ushered in a budget surplus and 
historic prosperity.
  According to the nonpartisan CBO, this bill is $143 billion in 
savings in the first decade and more than $1 trillion of savings in the 
second decade. We can add to those deficit savings real cost controls 
that bring down the price of the world's most expensive health care. 
Take those into account, says leading health care economist David 
Cutler, and America saves an additional $600 billion in the first 10 
years and even more in the second 10 years.
  Yet there are some who hope for the bill's defeat. They would see 
that, I think, as the defeat of one party. One Senator made that 
observation and said this might be the President's Waterloo. If this 
bill fails, the Waterloo will be that of the people who are without 
health care insurance, the people who are struggling to make sure that 
their children are healthy and well and safe. But it would be a defeat 
for them and for our country, for a healthy America is a stronger 
America.
  They saw the same thing in 1993, my Republican colleagues, when to a 
person, as I believe will happen tonight, unfortunately, in 1993, to a 
person they did the same thing. My Republican friends voted without a 
single exception against the 1993 economic reform plan of the Clinton 
administration.
  Congressman Boehner asked, ``Who does this spending stimulate except 
maybe the liberal faculty at Harvard or Berkeley?''
  Congressman Kasich said, ``If it was to work, then I'd have to become 
a Democrat. ``
  It did work, and he didn't change. It was a partisan vote, Mr. 
Speaker, a partisan vote that helped create 22.7 million new jobs, 
contrary to what so many of my Republican friends said that bill would 
do, and a record budget surplus of $5.6 trillion, contrary to the 
assertion of Mr. Armey that it would create deep debt.
  That bill passed through a gauntlet of slurs, hyperbole, and 
untruths, and so did Medicare, which Republicans called ``brazen 
socialism,'' and so did Social Security, which a Republican Congressman 
called the ``lash of the dictator.''
  I don't know whether there are any Republicans in this body tonight 
that believe that Social Security is the lash of the dictator. I hope 
not.
  Those slurs were false in 1935, they were false in 1965, and, ladies 
and gentlemen of this House, they are false in 2010. Ladies and 
gentlemen of this House, this bill, this bill will stand in the same 
company, for the misguided outrage of its opposition and for its 
lasting accomplishment of the American people.
  In closing, Mr. Speaker, I want to honor some of the ``little punk 
staffers'' who gave so much to help us bring this bill to the floor. I 
say to my friends on the other side of the aisle who did so much to 
bring your prescription drug bill to the floor, they need to be 
honored. They need to be thanked. They need to be respected for the 
work they do for this House, for each of us but, more importantly, for 
America.
  From the Legislative Counsel's Office, Ed Grossman, Jessica Shapiro, 
Megan Renfrew, Warren Burke, Larry Johnston, Henry Christrup, Wade 
Ballou and Scott Probst.


 =========================== NOTE =========================== 

  
  March 21, 2010 on H1855 the following appeared: Megan Renfrew, 
Larry Johnston, Henry
  
  The online version should be corrected to read: Megan Renfrew, 
Warren Burke, Larry Johnston, Henry


 ========================= END NOTE ========================= 

  I also want to honor, Mr. Speaker, the tireless staffs of the House 
Committees on Ways and Means, Energy and Commerce, Education and Labor, 
Rules, and the Budget, as well as the staff of the CBO, Doug Elmendorf, 
Holly Harvey, Phil Ellis, Kate Massey, Pete Fontaine and the whole CBO 
health care team, along with Tom Barthold, and everyone of the staff on 
the Joint Committee on Taxation, who contributed to their estimates.

[[Page H1856]]

  Finally, two remarkable staffers in my office have made health reform 
the cause of their lives and just about every one of their waking hours 
for the past year, Liz Murray and Ed Lorenzen. Thank you very much.
  Mr. Speaker, one of my staffers, my deputy chief of staff, has a 4-
year-old daughter. She is a beautiful young girl, she is a smart young 
girl. Her name is Colette. A few days ago a neighbor asked Colette 
where her mom was, and I am told that she answered, She's at work 
making sure everyone can go see the doctor. Thanks, Mom. Thanks to all 
the moms throughout America who, when we pass this bill, will have a 
greater sense of security for their kids, for their families, for 
themselves.
  I know this bill is complicated, but it's also very simple. Illness 
and infirmity are universal, and we are stronger against them together 
than we are alone. Our bodies may fail us; our neighbors don't have to. 
In that shared strength is our Nation's strength, and in this bill is a 
prosperous and more just future.
  Unfortunately, much of this debate has been divisive, much of it has 
been irrelevant. We have seen angry people at the doorstep of the 
Capitol. Every President in this last century has said this is 
necessary for a great Nation to do.
  My colleagues, how proud we must all be that our neighbors have 
elected us to come here in this, the people's House, to do this good 
work this night.

                              {time}  1900

  The SPEAKER pro tempore. The gentleman from Texas (Mr. Barton) is 
recognized for 10 minutes as a designee of the minority leader.
  Mr. BARTON of Texas. Madam Speaker, I yield to the gentleman from 
Alabama for a unanimous consent request.
  (Mr. ROGERS of Alabama asked and was given permission to revise and 
extend his remarks.)
  Mr. ROGERS of Alabama. Madam Speaker, I rise in opposition to this 
flawed health care bill.
  Mr. BARTON of Texas. Madam Speaker, I yield to the gentleman from 
North Carolina for a unanimous consent request.
  (Mr. COBLE asked and was given permission to revise and extend his 
remarks.)
  Mr. COBLE. Madam Speaker, I rise in opposition to this flawed health 
care bill.
  Mr. BARTON of Texas. Madam Speaker, I yield to the gentleman from 
Minnesota for a unanimous consent request.
  (Mr. PAULSEN asked and was given permission to revise and extend his 
remarks.)
  Mr. PAULSEN. Madam Speaker, I rise in opposition to this flawed 
health care bill.
  Mr. BARTON of Texas. Madam Speaker, I yield to the gentleman from 
Georgia, the ranking member of the Health Subcommittee, Mr. Deal, for 1 
minute.
  Mr. DEAL of Georgia. I thank the gentleman for yielding.
  Madam Speaker, it has been said that the problem with socialism is 
that you eventually run out of other people's money.
  Despite billions of dollars in new taxes, despite billions of dollars 
in cuts to Medicare, and despite deceptive accounting practices to hide 
the true cost of this bill, it appears that we have run out of what 
money is here in Washington, because we are seeking to impose 
unprecedented and unconstitutional mandates on our States.
  Tonight, as I cast what might be the last votes of my congressional 
career, I am pleased to say that as I pursue my full-time activity to 
become the governor of the great State of Georgia, that I will cast my 
vote in opposition to this bill.
  If this bill becomes law and I am successful in my undertakings, I 
will devote my efforts to making sure that the people of my State are 
not subjected to the unconstitutional individual mandate and that my 
State is not subject to the unconstitutional mandate to expand our 
Medicaid rolls. I know that I am not alone. Yesterday, 38 States 
indicated that they would join in suing to challenge the 
constitutionality of this statute.
  I urge my colleagues to join me on a ``no'' vote.
  Mr. WAXMAN. Madam Speaker, I yield myself 2 minutes.
  Today is a historic moment. We will take decisive votes to provide 
quality affordable health care for all Americans. This is a goal that 
Presidents of both parties have sought for 100 years. We must act. The 
status quo is unsustainable.
  This bill provides all Americans the security of knowing they will 
always be able to afford health care for themselves and their families.
  The bedrock foundation of the legislation is that it builds on what 
works today and reforms what doesn't, but we fundamentally reform the 
insurance company practices that are failing our families.
  Americans with preexisting conditions can no longer be denied 
coverage. We abolish lifetime limits on coverage. And we ban the 
practice of rescission by insurance companies when people get sick.
  We strengthen Medicare. Seniors who hit the donut hole for their drug 
coverage will get immediate help, a $250 rebate this year, a 50 percent 
discount on their brand name drugs next year, and the donut hole will 
be completely eliminated within the decade. We provide coverage to 32 
million uninsured Americans. We eliminate waste, fraud, and abuse. The 
American people will see immediate benefits.
  Today we vote to make a profound difference for the betterment of the 
American people. Under the leadership of the President and our Speaker, 
we are poised to provide access to quality health insurance for all.
  Today is a historic moment.
  We will take decisive votes to provide quality, affordable health 
care to all Americans.
  This is a goal that Presidents of both parties have sought for a 
hundred years.
  We must act. The status quo is unsustainable.
  This bill provides all Americans the security of knowing they will 
always be able to afford health care for themselves and their families.
  The bedrock foundation of this legislation is that it builds on what 
works today, and reforms what doesn't.
  If you like your doctor and your current plan, you keep them.
  But we fundamentally reform the insurance company practices that are 
failing our families:
  Americans with pre-existing conditions can no longer be denied 
coverage.
  We abolish lifetime limits on coverage.
  And your health coverage can no longer be rescinded by your insurance 
company if you get sick.
  We strengthen Medicare.
  Seniors who hit the donut hole will get some immediate help: a $250 
rebate this year, and a 50 percent discount on their brand-name drugs 
next year.
  And the donut hole will be completely eliminated within a decade.
  We provide coverage to 32 million uninsured Americans--not just those 
without insurance today but many who would otherwise be expected to 
lose their coverage in the coming years.
  We eliminate waste, fraud, and abuse and reduce the deficit by over a 
trillion dollars.
  And we eliminate the special deal for Nebraska, providing all states 
equitable treatment under Medicaid.
  The American people will see immediate benefits on enactment.
  Starting this year: Your children can stay on your policy through age 
26.
  Preventive care under Medicare is free.
  And children with pre-existing conditions cannot be denied coverage.
  Today we vote to make a profound difference for the better for the 
American people.
  Under the leadership of the President and our Speaker, we are poised 
to provide access to quality health insurance for all Americans.
  I now want to turn to some specific provisions in the Senate bill, 
H.R. 3950.


    Section 2304. Clarification of definition of medical assistance

  Section 2304 of H.R. 3590 as passed by the Senate clarifies the 
definition of medical assistance. This clarification is identical to 
that in section 1781(e) of H.R. 3962 as passed by the House and in 
section 1781(e) of H.R. 3200 as reported by the Committee on Energy and 
Commerce. The purpose of this clarification is set forth in H. Rept. 
111-299, Part 1, at pp. 649-650.


          Section 3301. Medicare coverage gap discount program

  I, on behalf of myself and Chairman Levin, express our intent 
regarding this section. Section 3301 of this legislation provides for 
50 percent discounts for brand name drugs in the Part D donut hole. It 
requires that manufacturers enter into an agreement to provide such 
discounts as a condition of participation in the Part D program.
  This section adds to the Social Security Act new Section 1860D-
43(c)(1), which provides a

[[Page H1857]]

limited exemption from the requirement to provide a discount if the 
Secretary makes a determination that the availability of the drug is 
essential to the health of beneficiaries under this part. This intent 
of this exemption, if it is used at all, is that it be used only in 
extraordinary circumstances, and that it be of limited duration. For 
example, if a new drug manufacturer without an agreement already in 
place receives a new drug application approval after the period in 
which annual agreements are supposed to be signed by the Secretary, the 
Secretary could find that the drug is essential to beneficiaries' 
health and provide a short-term exemption until an agreement with the 
manufacturer is in place. Any exemptions provided under this section 
are intended to be temporary in nature.
  Moreover, nothing in this section requires the Secretary to make a 
finding that a given drug is essential to beneficiaries' health, or 
provides a right of action for any individual or organization to force 
the Secretary to make such a finding.
  This provision also contains civil monetary penalties for 
manufacturers that fail to provide applicable beneficiary discounts. 
The civil monetary penalties specified in this provision are not the 
sole penalties that can be applied to manufacturers that violate 
requirements of this section or other provisions of law. For example, 
relevant CMPs that apply to Medicare fraud or misleading statements and 
False Claims Act penalties can also be applied to manufacturers that 
fail to provide required discounts.
  Another provision of this section states that the Secretary ``shall 
not receive or distribute any funds of a manufacturer under this 
program''. This provision refers only to manufacturer funds, not to 
other funds or information. Section 1860D-43 contains no restriction on 
the ability of the Secretary, CMS, or the Inspector General to obtain 
(from any manufacturer, PDP or MA-PD plan, or other entity) any data or 
information necessary for the purposes of program compliance and 
integrity or audit purposes, or otherwise necessary to identify and 
eliminate waste, fraud, or abuse under this section.


           Section 3403. Independent Medicare Advisory Board

  I wish to clarify certain aspects of legislative intent regarding the 
Independent Payment Advisory Board (IPAB), which is a new executive 
branch body created in the Senate passed health reform bill and charged 
with constraining Medicare spending. Section 1899A(c)(2)(A)(iii) of the 
Social Security Act, as added by Section 3403 of PPACA, states that in 
the case of IPAB proposals submitted prior to December 31, 2018, IPAB 
shall not include any recommendations that would reduce payment rates 
for providers that receive an additional market basket cut on top of 
the productivity adjustment. The rationale for this provision is that 
these providers are already facing extra downward adjustments in their 
payments and thus should not be subject to ``double jeopardy'' by also 
being subject to IPAB recommendations which will further reduce 
spending. In creating this exclusion, it is the intent of Congress to 
exclude all payment reductions applicable to providers captured by this 
language in all the relevant years. Therefore, in the case of inpatient 
hospitals, the provision excludes from IPAB recommendations payment 
reductions applicable to hospitals including payment reductions for 
indirect medical education under 1886(d)(5)(B), graduate medical 
education under 1886(h), disproportionate share hospital payments under 
1886(d)(5)(F), and capital payments, as well as incentives for adoption 
and maintenance of meaningful use of certified electronic health record 
technology under 1886(n). As part of the effort to make improvements to 
the Senate-passed bill, Members of the House and Senate, along with the 
administration, were working on a number of improvements to the IPAB 
policy. Unfortunately, the Senate parliamentarian indicated that we 
could not modify IPAB in reconciliation. Since we were not able to make 
any changes to the IPAB as part of the reconciliation bill, I look 
forward to working on these improvements in the future.


                              Section 3512

  I have spoken with several Members, including Congressman Cuellar of 
Texas, that have expressed concerns about whether the language of these 
bills may be interpreted or construed as creating a new cause of action 
or claim or would modify or impair existing state medical malpractice 
laws.
  It is not and never has been the intent of this legislation to create 
any new causes of action or claims premised on the development of 
guidelines or other standards.
  Section 10201(j) of H.R. 3590, which was part of a manager's 
amendment adopted on the Senate floor and added Section 3512 to 
Subtitle F of title III of the Act, calls for the Comptroller General 
to conduct a study of whether the development, recognition or 
implementation of any guideline or other standards under a list of 
enumerated sections of the Senate bill would result in a new cause of 
action or claim.
  Any guideline or standard created under the above enumerated sections 
should not be construed as creating any such new actions or claims, nor 
should the request for a study be construed to infer otherwise. This 
legislation should not be interpreted or construed as creating any 
inference or implication that any such guideline or other standard does 
create any new cause of action or claim.
  It is also not and never has been the legislative intent of this 
legislation to modify, impair or supersede any State medical liability 
law governing legal standards or procedures used in medical malpractice 
cases, and this legislation does not have the authority to prohibit the 
states from implementing such laws.


                  Section 6111. Civil Money Penalties

  The legislation we will pass today contains nursing home reforms that 
will make it easier to identify owners responsible for inadequate care, 
improve enforcement, and improve nursing home quality nationwide. These 
improvements represent a significant step forward. Nearly identical 
provisions were included in health care reform legislation that passed 
in the Energy and Commerce Committee, and in HR 3200 as passed by the 
House.
  Section 6111 of the legislation makes collection of civil monetary 
penalties more timely by allowing funds to be escrowed after an 
independent informal dispute resolution process until other appeals are 
concluded.
  A November 2009 GAO report found that understatement of deficiencies 
may result from ``unbalanced'' independent dispute resolution processes 
currently used. Over 40 percent of surveyors in four states told GAO 
that their states' independent dispute resolution processes favored 
nursing home operators over resident welfare.
  In order to avoid these problems, the intent of this section is that 
independent informal dispute resolution processes should be conducted 
by an independent state agency or entity with healthcare experience, or 
by the state survey agency, so long as no entity or individual who 
conducts independent informal dispute resolution has a conflict of 
interest. The Secretary's implementing regulations may address the type 
and duration of the independent informal dispute resolution processes. 
as determined by the Secretary. As under current law, facilities may 
challenge only the factual basis of the deficiency; and states and the 
Secretary retain the right to reject independent informal dispute 
resolution processes recommendations, any person shall have the right 
to attend and participate in the conference.
  I reserve the balance of my time.
  Mr. BARTON of Texas. Madam Speaker, I yield to the gentleman from 
Michigan (Mr. Upton) for 1 minute.
  Mr. UPTON. Madam Speaker, folks are scared. They are really scared. 
Debt is at a historic level, spending is out of control, the Nation's 
AAA credit rating is in jeopardy, and here we are.
  We are going to spend $1 trillion over the next 10 years for just 6 
years of benefits. Only in Washington can folks stand here and claim 
spending $1 trillion will actually cut the deficit.
  And how did we get here? Well, we are going to start by raiding $523 
billion from the Medicare checks of older Americans. Shameful.
  Whatever happened to tort reform? Not here. The lawyers are going to 
continue to get richer suing doctors and hospitals, and older Americans 
will see their benefits evaporate. Where are our priorities?
  Yesterday I introduced an amendment that would delay the bill until 
we can guarantee Medicare's solvency for at least the next 30 years, 
but it was denied. I guess they would rather spend money that we don't 
have rather than uphold our commitment to seniors. Debt continues to 
soar beyond belief. Today, every man and woman will spend $46,000 on 
the debt. Let's do better. We can.
  Mr. WAXMAN. Madam Speaker, I am proud at this time to yield 2 minutes 
to the gentleman from Michigan (Mr. Dingell), the distinguished dean of 
the House, who has championed the cause of health care in all of the 
time he has been in the Congress. And before that, his father called 
upon the Congress to adopt this legislation as well.
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Madam Speaker, I thank my colleague, Mr. Waxman, for his 
leadership and for his gracious comments. And I want to thank and 
praise our Speaker, our majority leader, and the leader in the Senate 
for the great leadership that they have given us in this great 
undertaking.
  Today is a day that is going to rank with the day we passed the civil 
rights

[[Page H1858]]

bill in 1964. Today we are doing something that ranks with what we did 
on Social Security or Medicare. This is the day on which we can all be 
proud if we vote for that legislation.
  Facts are an intransigent hard thing. And let's look at this from the 
standpoint of the facts of what it does.
  Thirty-two more million Americans are going to have health care. They 
don't now. America, which has health care of the best character in the 
world, does not make it available to 32 million people because they 
can't afford it, and Americans every day are losing their health care. 
Eighteen thousand Americans every year die for want of health care, and 
44,000 Americans also go bankrupt because of it.
  What does this bill do? It gives Americans the same health care that 
we here in the Congress have. It preserves their choice, and it sees 
that if those Americans want to change, they can do so.
  It also fixes the insurance company. And as the President has said, 
this bill is the patient's bill of rights on steroids. And as my 
colleagues who worked on this bill when we passed it years ago will 
remember, that that is legislation which protects the rights of 
citizens and ratepayers.
  And the reason that the insurance companies are so up in arms about 
it, and they are the ones that are opposing this bill, is because it is 
going to take care of their patients and because it is going to take 
care of their customers.
  What is it going to do? No more preexisting conditions. And, they 
can't cancel your policy while you are on the gurney riding into the 
operating room because you are sick.
  I want to commend my colleagues for this.
  Madam Speaker, I have much humility, joy, and pride in supporting 
H.R. 3590 and H.R. 4872.
  Madam Speaker, all the arguments, for and against, have been made. 
There have been endless hours of debate in committees, on the floor of 
this House, and in meetings throughout the country.
  We have heard innumerable stories that inspire us to act, and 
unfortunately stories that have caused us to question whether the 
civility of our discourse has reached irreversible lows.
  As the historic vote draws near, I urge my colleagues to act on 
behalf of the American people.
  Let us this day stand boldly to do what is right for the health and 
well-being of the our constituents, what is essential for the viability 
of American business, and what is necessary for our government.
  Let us resolve to do what generations before us determined needed to 
done to address one of the greatest needs in the history of our people.
  When we do this, history will smile upon us. And generations to come 
will say on this day, this President and this Congress performed 
something worthy to be remembered.
  For the sake of the American people, and in honor of my late father, 
I support the legislation before us and urge my colleagues to do the 
same.
  Mr. BARTON of Texas. Madam Speaker, I yield for a unanimous consent 
request to a member of the committee from the Keystone State of 
Pennsylvania, Dr. Murphy.
  Mr. TIM MURPHY of Pennsylvania. Madam Speaker, I rise in opposition 
to this flawed health care bill.
  Mr. BARTON of Texas. Madam Speaker, I yield for 1 minute to the 
gentleman from Florida (Mr. Stearns).
  (Mr. STEARNS asked and was given permission to revise and extend his 
remarks.)
  Mr. STEARNS. Madam Speaker, this incredibly expensive $1 trillion 
health care bill will hurt many individuals that currently have 
insurance. The bill will hurt veterans because it does not accept 
TRICARE as a qualified medical plan. It will hurt seniors by cutting 
Medicare advantage to fund these new government programs. Mr. Stupak, 
no lawyer, will argue that an Executive order is law. So the Senate 
bill starts us on a path of government-sanctioned abortion-on-demand 
paid for by taxpayers. The U.S. has a $1.5 trillion deficit, and now we 
are adding $1.2 trillion over 10 years.
  The President pledged no family making under $250,000 would face tax 
increases, yet there are 12 new tax increases violating that pledge, 
and 46 percent of families making less than $66,000 will be forced to 
pay the individual mandate.
  The bill will expand the IRS by 17,000 auditors to enforce these new 
taxes. It will hurt businesses, create health care rationing, and move 
the United States of America to further fiscal instability.
  Mr. WAXMAN. Madam Speaker, I am pleased to yield at this time to the 
chairman of the Health Subcommittee, who has played such an 
instrumental role in the legislation, the gentleman from New Jersey 
(Mr. Pallone) for 1 minute.
  Mr. PALLONE. Madam Speaker, I am amazed when I hear my colleagues on 
the other side of the aisle. They seem to ignore the fact that our 
health care system is in crisis. Millions of Americans are going 
without health insurance. Rising health care costs are bankrupting so 
many American families.
  Now, Democrats today have proposed a bill that will lower health care 
costs, give almost all Americans quality health care coverage the same 
as Members of Congress--and I am going to repeat that--the same as 
Members of Congress, and put an end to insurance company abuses.
  When we pass this bill, 32 million more Americans are going to be 
able to see a doctor on a regular basis. America's seniors are going to 
be able to get more help to afford their prescription drugs, which will 
keep them healthy and out of the hospital.
  The bottom line is that Americans will be healthier, fewer people 
will get seriously ill and incur outrageous medical bills for hospital 
and nursing home care. And, healthier people save the government and 
the health care system significant money even beyond the CBO 
projections.
  Madam Speaker, passage of this bill will lead to a healthier and a 
stronger America, and I urge my colleagues to vote ``yes.''
  Mr. BARTON of Texas. Madam Speaker, I yield 1 minute to the gentleman 
from the bluegrass State of Kentucky (Mr. Whitfield).
  Mr. WHITFIELD. Yesterday I read an article by Speaker Pelosi in which 
she said the health care bill they proposed would strengthen Medicare, 
reduce deficits, and bring the predatory practices of health insurance 
companies under control.
  How can you strengthen Medicare when you take $500 billion out of it, 
out of nursing homes, out of hospitals, and out of Medicare advantage?
  How do you claim you reduce the deficit by $138 billion when you 
include the taxes for 10 years and the expenditures for only 6 years?
  And how do you say you are going to control the insurance companies, 
and act like you are throwing them in the briar patch, when in fact 
they support this bill? They went to the White House and helped write 
this bill. Why? Because this bill requires small businesses and 
individuals to buy health insurance, and, if not, they will be subject 
to civil penalties.
  Health reform may be necessary, but this bill is the wrong bill.
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to the gentleman from 
Massachusetts (Mr. Markey), a very important member of our committee.
  Mr. MARKEY of Massachusetts. On health care, the Democratic party is 
the ``party of hope'' and the Republicans are the ``party of nope.''
  The Democratic health care bill lowers prescription drug costs for 
seniors, expands coverage to 32 million more Americans, reduces the 
deficit by $143 billion over the next 10 years, and gives middle class 
families tax credits to help pay for health coverage.
  What do the Republicans say to this plan? They say ``nope.'' Nope to 
lowering prescription drug prices, nope to expanding coverage, nope to 
health insurance tax breaks.
  GOP used to stand for Grand Old Party. Now, it stands for grandstand, 
oppose, and postpone. They grandstand with phony claims about 
nonexistent government takeovers, they oppose any real reform, and then 
they want to postpone fixing a broken health care system. GOP: 
Grandstand, oppose, and postpone.
  Today we have a choice between change and more of the same, between 
``hope'' and ``nope.'' Ted Kennedy is looking down and smiling today. 
Vote ``aye'' for John Dingell, for Ted Kennedy, and for all of those 
Americans that need health care in our country.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. The Member from Massachusetts should heed 
the gavel.

[[Page H1859]]

                              {time}  1915

  Mr. BARTON of Texas. Madam Speaker, I yield 1 minute to the gentleman 
from Arizona (Mr. Shadegg).
  (Mr. SHADEGG asked and was given permission to revise and extend his 
remarks.)
  Mr. SHADEGG. Madam Speaker, never before in the history of our Nation 
has such a massive change in policy been made on a purely partisan 
basis and in the face of such overwhelming opposition. Tragically, this 
bill will destroy freedom and do incredible damage to the very fabric 
of our society.
  This bill is a bailout for the insurance companies. They get the 
individual mandate that they wanted all along--a mandate that is un-
American and unconstitutional. Mark my words: The massive expansion of 
Medicaid in this bill will bankrupt our States. Premiums for average 
Americans will go up, taxes will go up, the deficit will go up, and the 
debt will go up. This bill is the epitome of Washington politicians 
telling the American people, We know better how to run your lives than 
you do.
  We owe the American people much better than this. We owe them real 
health care reform. We owe them the kind of reforms that will bring 
down their premiums. We owe them across-State-line purchases. We owe 
them health care pooling so that the sick and the ill and those with 
preexisting conditions can get their health care paid for.
  We owe America better than this.
  Mr. WAXMAN. Madam Speaker, I'm honored at this time to yield 1 minute 
to a senior member of our committee, the gentlewoman from California 
(Ms. Eshoo).
  Ms. ESHOO. Madam Speaker, I feel so privileged to be part of a 
Congress that is on the threshold of making history. Since Teddy 
Roosevelt and all Presidents forward, we have struggled in our country 
to provide something for our people that has eluded them. As the 
Catholic sisters said as they urged us to vote for this legislation, 
they called it ``life affirming.''
  I think the step that we take this evening will perfect the union in 
our country. Why? Because the human body holds the soul. And when we 
help to cure, when we help to heal, when we recognize the dignity of 
every single American, that they have first-class citizenship and that 
they should indeed have health care coverage.
  This is a landmark piece of legislation. I feel privileged that my 
constituents have sent me here to cast a vote for it, and I urge 
everyone to do so.
  Madam Speaker, I rise in support of the landmark comprehensive health 
care reform that is before us.
  For the first time in history, Congress will pass legislation to 
finally insure all Americans. This legislation will reduce the deficit 
by $143 billion over 10 years and $1.2 trillion over 20; eliminate 
discriminatory insurance practices, and open the insurance market to 
millions of Americans who have been priced out.
  More than a century has passed since Teddy Roosevelt first called for 
health care reform. Nineteen presidents later, we stand on the 
threshold of history as we prepare to vote on this historic 
legislation. The American people have been waiting for this. The 
American people deserve this, and the status quo is no longer 
affordable or acceptable.
  To those who say we can't afford health care reform in the current 
economy, I say we can't afford not to. We spend more on health care 
than any other country in the world and the costs are crippling to our 
economy. If we do nothing, in 2015 health care spending will jump by 34 
percent. By 2020, health care premiums will double and in 2010 alone, 
we're projected to spend more than $2.6 trillion on health care.
  A vote for this legislation is to stand on the right side of history. 
I feel privileged to serve in Congress and to participate in this 
historic effort. We stand on the shoulders of those who toiled for 
decades, including Senator Edward Kennedy, to bring us to this moment.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are reminded to please heed the 
gavel.
  Mr. BARTON of Texas. Madam Speaker, I yield 1 minute to the 
gentlewoman from California (Mrs. Bono Mack).
  Mrs. BONO MACK. Madam Speaker, I rise in very strong opposition to 
this flawed bill that imposes new taxes, increases costs to consumers, 
and adds to our already massive deficit. This bill and the outrageous 
abuse of process and all the backroom deals needed to secure passage is 
simply the wrong approach.
  My father was a teaching physician at USC-LA County Medical Center. 
He would have been appalled that a massive new bureaucracy will now be 
making the health care decisions for his patients. In my district, 
thousands of seniors will lose their preferred Medicare Advantage 
coverage that serves them so well and has saved lives.
  This bill is little more than a shell game that shifts costs, picks 
winners and losers, and does nothing to achieve real reform. The 
American people have resoundingly rejected this dangerous approach. 
True reform should be accomplished with bipartisan cooperation, not 
strong-arm tactics. The only thing that is truly bipartisan tonight is 
opposition to this deeply flawed bill. We can and must do better. I 
urge my colleagues to join me in voting ``no.''
  Mr. WAXMAN. Madam Speaker, I yield for a unanimous consent request to 
the gentlelady from the Virgin Islands (Mrs. Christensen), who's played 
a very active role in this legislation.
  (Mrs. CHRISTENSEN asked and was given permission to revise and extend 
her remarks.)
  Ms. CHRISTENSEN. Madam Speaker, I rise in strong support of the 
Patient Protection and Affordable Care Act.
  Madam Speaker, this morning the Congressional Black Caucus attended 
church together at the Mount Zion Baptist Church in Arlington, VA.
  We left there blessed, inspired and claiming the victory we are about 
to have today for the American people.
  As our Chair Barbara Lee reminded us from the Book of Esther, we are 
all here, called to service, for ``for such a time as this.'' And we 
are called to do what is right and best for the American people and for 
our country! We must pass H.R. 4872.
  With the passage of H.R. 4872, The Patient Protection and Affordable 
Care Act, we begin to guarantee that health care will be a right to all 
and not a privilege for a few.
  It has been a long road getting here, not just this past year but the 
past hundred years and thanks is due to Chairman Emeritus John Dingell, 
Speaker Nancy Pelosi, Majority Leader Steny Hoyer, Majority Whip James 
Clyburn and Chairmen Rangel, Waxman, Miller and Larson for their 
steadfast leadership, and commitment to making healthcare accessible, 
affordable and secure for all Americans across this country.
  And we could not have arrived to this day without the leadership, 
commitment and determination of our President, Barack Obama.
  We would have all wished for the perfect bill many of us envisioned 
when we started on this path. This is not it, but without question this 
bill will vastly improve the dysfunctional system we now struggle to be 
well in, and lay the foundation for the further work needed to achieve 
those things that are still needed but could not be included today.
  I want to especially thank all of our Democratic leaders for ensuring 
that the people of the Territories were not left out and my Democratic 
colleagues--especially the Congressional Black Caucus and our TriCaucus 
partners for their support and encouragement.
  They are all--including Senate Leader Reid--to be thanked and 
applauded for answering our call for prevention, nondiscrimination, 
equity and diversity in the bill's provisions and for going beyond 
insurance reforms to include measures specifically to eliminate health 
disparities for African Americans, all people of color, the poor, those 
living in rural areas and the Territories and our LGBT community.
  This is not only a historic day for our country, it is a great day.
  Today we begin to end the ``shocking and inhumane'' injustice in 
healthcare that the Rev. Dr. Martin Luther King, Jr. spoke of. Today we 
continue the march to the full greatness that is our Nation's destiny!
  I am proud to have been given the opportunity by the people of the 
Virgin Islands and our House leadership to be a part of this process, 
and though I am not able to cast a vote on this landmark legislation I 
support it fully, proudly and unreservedly.
  When the vote is called, let's do it! The victory has already been 
claimed for us and for the people of the United States--all of us.
  To God be the glory!
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to the gentleman who's 
played a very influential role in this legislation, the gentleman from 
Michigan (Mr. Stupak).
  Mr. STUPAK. I wish to engage the chairman in a colloquy, if I may.
  Throughout the debate in the House, Members on both sides of the 
abortion issue have maintained that current law should apply. Current 
law with respect to abortion services includes the Hyde

[[Page H1860]]

amendment. The Hyde amendment and other similar statutes to it have 
been the law of the land on Federal funding of abortion since 1977 and 
apply to all other health care programs--including SCHIP, Medicare, 
Medicaid, Indian Health Service, Veterans Health Care, military health 
care programs, and the Federal Employees Health Benefits Program.
  The intent behind both this legislation and the Executive order the 
President will sign is to ensure that, as is provided for in the Hyde 
amendment, that health care reform will maintain a ban on the use of 
Federal funds for abortion services except in the instances of rape, 
incest, and endangerment of the life of the mother.
  Mr. WAXMAN. If the gentleman will yield to me, that is correct. I 
agree with the gentleman from Michigan that the intent behind both the 
legislation and the Executive order is to maintain a ban on Federal 
funds being used for abortion services, as is provided in the Hyde 
amendment.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. WAXMAN. I yield the gentleman 30 additional seconds.
  Mr. STUPAK. I thank the chairman.
  I'm seeking the chairman's commitment that our conversations on this 
issue, the abortion issue, will continue.
  Mr. WAXMAN. I know that this is an issue of great concern to the 
gentleman from Michigan and many other members of the Energy and 
Commerce Committee. You have my commitment to work with you and other 
Members in the future.


                         Parliamentary Inquiry

  Mr. BARTON of Texas. Madam Speaker, I have a parliamentary inquiry.
  The SPEAKER pro tempore. The gentleman will state his inquiry.
  Mr. BARTON of Texas. It has been agreed to, I am told, by the 
Parliamentarian and others, that if I yield to Mr. Sensenbrenner 2 
minutes right now, it will come out of Leader Boehner's time.
  The SPEAKER pro tempore. The Chair has been so advised of the 
minority leader's designation of that time.
  Mr. BARTON of Texas. I yield 2 minutes to the gentleman from 
Wisconsin (Mr. Sensenbrenner).
  Mr. SENSENBRENNER. I have listened to this colloquy and, frankly, it 
doesn't state the law. The proposed Executive order, which I have a 
copy of, specifically states that nobody can force the Executive order 
in any court. So the Executive order is merely a piece of paper that 
certainly will not have any effect of law.
  Earlier today, the gentlewoman from Florida (Ms. Wasserman Schultz) 
was quoted on Fox News saying, Well, it can't be changed by Executive 
order because an Executive order can't change the law. She was right on 
in that respect. An Executive order can't change the law.
  But even on a policy question, President Obama, at a campaign rally 
when he was running for election, criticized the Bush administration's 
excessive use of Executive orders. Congress' job is to pass 
legislation. The President can veto it or sign it. Executive orders are 
not part of his power. The President also said, I'm not comfortable 
with doing something this significant through Executive orders, 
relating to trying terrorists in military commissions.
  Now, finally, it is basic law, as reiterated by the Supreme Court as 
late as 2006 in the case of Hamdan v. Rumsfeld, that an Executive order 
cannot trump or change existing law. The Executive order that is being 
talked about now is a piece of paper. It will have no force and no 
effect. If one is concerned about preventing the exchanges that are 
established under the Senate bill that we will be voting on in a few 
hours, then the only thing that one can do is vote against that Senate 
bill to preserve the Hyde amendment from being expanded to programs 
that are created under the Senate bill.
  I'm sorry, but the gentleman from Michigan and the gentleman from 
California have misstated the law. It is pretty clear. And even the 
President said it during the campaign, and the gentlewoman from Florida 
(Ms. Wasserman Schultz) said it on TV earlier today.
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to an important member of 
our committee who's played a very important role in this legislation, 
particularly as it relates to his State and other areas as well, the 
gentleman from New York (Mr. Engel).
  Mr. ENGEL. I thank the chairman for yielding to me.
  Madam Speaker, I'm proud to be a Member of Congress, but never as 
proud as I am tonight. Tonight we're finally going to pass 
comprehensive health care for the American people.
  My friends on the Republican side of the aisle keep saying the bill 
is flawed. The only flaw was when they controlled Congress and had the 
President of the United States, not once did they try pass health care, 
not even incrementally, as they say we should do now.
  No longer, when we get sick, will the insurance companies say, Sorry, 
we can't cover you. No longer, if you lose your job or change your job, 
can you not keep your health insurance. You will be able to keep it. If 
have you a preexisting condition, you won't be able to be denied it. If 
you're 26 years old, you can stay on your parents' policies. There's no 
annual cap or lifetime cap. We help seniors by closing the doughnut 
hole in Medicaid. We save money. It's CBO scored.
  Everybody wins with this bill, but especially the American people. 
I'm proud that we're passing comprehensive health care. The current 
system is not sustainable financially, and what we're doing means that 
everybody wins.
  Mr. BARTON of Texas. Madam Speaker, I would yield 30 seconds to the 
gentleman from Oklahoma (Mr. Sullivan).
  Mr. SULLIVAN. I'd like to thank Congressman Barton for yielding me 
time.
  Higher premiums, higher taxes, and cutting Medicare is not health 
care reform. Republicans care about health care, but we don't care for 
this bill. Unfortunately, the White House and congressional Democrats 
are still insisting on their massive 2,700-page bill that includes 
higher premiums, $500 billion in higher taxes, and $500 billion in cuts 
to senior Medicare.
  My son, who's here this week, Tommy Sullivan, even can consider that 
that's not reform.
  Mr. WAXMAN. Madam Speaker, I'm pleased to yield, at this time, 1 
minute to someone who's been a very active member of the Health 
Subcommittee and the vice chairman of the full committee, the 
gentlewoman from Colorado (Ms. DeGette).
  Ms. DeGETTE. Madam Speaker, when you build a house, you have to first 
put down a foundation. Today, we are laying a foundation for a health 
care system that will provide every American with access to high 
quality health care; a foundation that will immediately ban insurance 
companies from dropping people from coverage when they get sick, people 
like my childhood friend who lost his insurance when he got prostate 
cancer and later died too young; a foundation that will, beginning this 
year, give tax credits to small businesses so they can offer affordable 
coverage to their employees; a foundation that will now give parents of 
young adults the ability to keep their kids on their policies while 
they start their careers; a foundation that will finally give adults 
with preexisting conditions the ability to buy affordable insurance. 
And starting right away, insurance companies cannot exclude children, 
like my own young daughter, Francesca, who have chronic conditions such 
as diabetes or asthma, from coverage.
  Madam Speaker, this bill is just a foundation. We need to build on 
it, but it's a strong foundation.
  Mr. BARTON of Texas. I'd like to yield 1 minute to one of our best 
pro-life leaders in the House of Representatives, the gentleman from 
Pennsylvania (Mr. Pitts).
  Mr. PITTS. This bill violates the conscience of the American people. 
It violates the principle that we should not spend more than we have. 
This bill is not reform. It just makes our existing entitlement crisis 
even worse. This bill violates the belief held by more than 70 percent 
of Americans that money collected by the government should not be used 
to pay for abortion or abortion coverage, but that's what this bill 
does.
  Regardless of the colloquy, an Executive order is not a statute. It 
doesn't trump a statute. The government will end up directly paying for 
abortions at community health centers. Taxpayer subsidies will, for the 
first time in decades, subsidize insurance coverage that

[[Page H1861]]

includes abortion. The bill and the accompanying Executive order turns 
over the protection of the unborn to the most pro-abortion President in 
our history.
  This extreme legislation is being forced on an unwilling Nation. It 
is the most pro-abortion bill and the largest expansion of abortion in 
our history. No Member who votes for it will ever be able to claim 
again that they have always stood on the side of the unborn. I'm sad to 
say this. This is a career-defining vote. There will be no living it 
down.
  I urge my colleagues to vote ``no'' on this terrible bill.

                              {time}  1930

  Mr. WAXMAN. I yield 1 minute to my colleague from California (Mrs. 
Capps), who is a very active and influential member of the Health 
Subcommittee.
  Mrs. CAPPS. I thank the chairman. Madam Speaker, we've been trying to 
reform health care in this country for decades, and I've been blessed 
to participate both as a health care provider and now as a Member of 
Congress. Passing this bill is not only the right thing to do; it is 
truly a matter of life and death for the millions of Americans who 
today lack health insurance coverage, and it is critical for all who 
suffer from diseases that could have been completely preventible or 
dealt with earlier had they had access to screenings.
  One thing, our bill will now guarantee no more copays for preventive 
screenings for diseases like cervical cancer or heart disease. As a 
public health nurse with decades of experience, I know this is one of 
the most important steps we can take to improve the health of American 
families, and I stress this point because it's one that's not brought 
up all that often.
  I underscore the importance of universal access to preventive care 
because this measure will improve the lives of millions of families and 
save us all billions in avoidable health care costs. I know my 
constituents are going to appreciate these important provisions which 
will improve health care in the United States. It's one of the many 
reasons I urge my colleagues to vote ``yes'' on this bill.
  Mr. BARTON of Texas. Can I inquire as to the time remaining on each 
side for the Energy and Commerce Committee's control.
  The SPEAKER pro tempore. The gentleman from Texas controls 2\1/2\ 
minutes, and the gentleman from California controls 3 minutes.
  Mr. BARTON of Texas. I yield 45 seconds to the gentleman from 
Nebraska, the Cornhusker State, Mr. Terry.
  Mr. TERRY. We all want all people to have access to affordable health 
care, but this trillion-dollar tragedy is just bad medicine. Medical 
costs are high, but this bill does absolutely nothing to help reduce 
costs. It does take $500 billion from Medicare, resulting in cuts in 
service to seniors. It does raise taxes on many small businesses, 
including new mandates on businesses and actually increases premiums as 
much as 13 percent.
  In committee, I introduced an amendment that gives people access to 
exactly the same care that we have as Members of Congress, but Mr. 
Markey and almost all the Democrats voted against it. All Republicans 
voted for that. Last, the clear language of this bill allows abortion, 
and I encourage all Members to vote against it.
  Madam Speaker, I rise today in opposition to this unprecedented 
legislation that will affect one-sixth of our economy, saddle our 
children and grandchildren with trillions of dollars of debt, and lead 
to a government takeover of America's health care system.
  As a member of one of the House Committees with jurisdiction over 
health care, I have had a front row seat to watch a legislative process 
that has had one over-riding theme--no reform idea, bill, or amendment 
on health offered by a Republican or even a moderate Democrat was given 
any consideration. From the start this has been a process that is best 
described as, ``our way or the highway.''
  This bill will result in rising health care costs and premiums. The 
Congressional Budget Office, CBO, reported in December that if the 
Senate bill was passed, average premiums per policy would rise by 10 to 
13 percent in 2016, resulting in annual premiums of $5,500 for single 
policies and $13,100 for families.
  According to the Congressional Budget Office, CBO, the health care 
bill carries a price tag of $940 billion over 10 years. Most revenue 
raisers come from new taxes on small business, individuals, and medical 
goods. Furthermore, the health care bill includes significant payment 
changes for Medicare Advantage and $500 billion in cuts to both 
Medicare and Medicaid. A number of arbitrary cuts are made to skilled 
nursing facilities, hospice, home health, Medicaid DSH payments, and 
popular Medicare Advantage plans. Specifically, the bill reduces 
Medicare Advantage payment benchmarks over the next 7 years, resulting 
in reduced access for millions of beneficiaries currently on Medicare 
Advantage plans. The ``savings'' Democrats purport are truly cuts to 
services that our seniors need. I don't think we can afford this plan 
and it will, in time, hurt both our economy and beneficiaries.
  The scoring used by CBO and our Democrat colleagues can best be 
described as ``new math.'' For example, a 10-year fix for Medicare 
reimbursement to physicians will cost $208 billion, yet that is not 
counted in the CBO score. But a separate deal has been struck with the 
doctors to do that later this year. So by my math, the real cost of 
health care reform is closer to $1.3 trillion, not $940 billion.
  A recent New York Times article highlighted a growing trend of 
physicians dropping Medicaid patients because of low payments--and the 
Democrats' solution to our health care crisis is to expand Medicaid 
eligibility to an additional 16 million more individuals over the next 
10 years? In a letter to Congress following the Health Care Summit, 
President Obama acknowledged the need to increase Medicaid 
reimbursement to ensure future services and yet, those anticipated 
additional costs are nowhere to be found in either H.R. 3590 or H.R. 
4872.

  Another ``new math'' trick being used by the Democrats is to tell the 
American people that the Medicare Part D drug benefit ``donut hole'' 
will be closed. Yes, the ``donut hole'' is partially closed by this 
legislation, but not closed entirely until the year 2020 which is after 
the scoring period used by the CBO. Again, this ``new math'' is being 
used as a gimmick to make it appear that this bill will reduce the 
deficit. But it will not. This bill costs more than Democrats claim.
  Last year, one of my Democratic colleagues stated, ``The fact of the 
matter is that some in the Republican party don't want these problems 
fixed because they're already doing just fine. They've got choice, 
they've got the federal plan, that's what I have. Well in the 
Democratic party we're saying something else, we want the American 
people to get at least as good as my friends in the Republican party 
have. We want at least the benefits that we have here in Congress--
choice, affordability, lower cost and lower taxes for all Americans.'' 
I wholeheartedly agree with Congressman Weiner that Americans should 
have access to the same plans as their Members. Last year I offered two 
amendments to Speaker Pelosi's bill. The first was my alternative plan 
called Simple Universal Healthcare, SUH, which creates a new health 
insurance program similar to the Federal Employee Health Benefits Plan 
now available to the President, Vice President, Members of Congress and 
all federal government employees. The plan allows the uninsured and 
small businesses access to more affordable insurance with options, 
portability and no mandates. The other amendment I offered would 
require that the President, Vice President, and Members of Congress 
enroll in Pelosi's public plan. Both amendments were prevented from a 
floor vote by Speaker Pelosi's rules.
  Yesterday, I attempted to offer the Simple Universal Healthcare plan 
as an amendment in the Rules Committee, however Speaker Pelosi ordered 
the nine Democrats on the Committee to kill all Republican amendments 
and therefore my bill did not survive.
  Madam Speaker, there are some in this chamber who may consider this a 
momentous day. And that it will be if the House of Representatives 
votes to spend trillions of dollars and forwards the bill to future 
generations. While we ramp up spending, we have not dealt with the 
exploding costs of Social Security, Medicare or Medicaid. We are on a 
path of fiscal recklessness that threatens the future economic growth 
of America. So for me, this is a sad day, one that could have been 
avoided had the House worked together on a bipartisan basis to provide 
the American people greater access to health care that we can afford.
  I urge my colleagues to vote ``no.''
  Mr. WAXMAN. Madam Speaker, I am pleased to yield 1 minute to the 
gentleman from Pennsylvania (Mr. Doyle), who has played a very 
significant role in bringing us all together and I think has a great 
deal of responsibility for getting this bill to the point where it is 
today.
  Mr. DOYLE. Madam Speaker, my office got a call today from Mary Anne 
Ferguson, 91 years old from Point Breeze in Pittsburgh. She asked me to

[[Page H1862]]

vote for health reform because she wants everyone to get the coverage 
she has. She remembers before Medicare when half of our seniors worried 
about getting sick because they had no health insurance.
  Today, millions of working Americans fear getting sick because they 
don't have health coverage. One of those was Bill Koehler from Garfield 
in Pittsburgh. His sister Kitty says that Bill was a loving and 
generous man to his friends, family, and those in need. When he lost 
his job, he lost his coverage. His new job as a pizza delivery driver 
earned too much to qualify for Medicaid, and private insurance wasn't 
going to cover his preexisting heart condition--the very reason why he 
needed health insurance. He died last year from a heart attack while 
driving home.
  So when I'm called to vote tonight, I will stand on the side of Mary 
Anne Ferguson and Bill Koehler and the tens of millions of Americans 
who need us to pass this bill. ``Yes'' to health reform. ``Yes'' to 
Bill Koehler.
  Mr. BARTON of Texas. I would like to yield for a unanimous consent 
request to Mr. Rogers of Kentucky.
  (Mr. ROGERS of Kentucky asked and was given permission to revise and 
extend his remarks.)
  Mr. ROGERS of Kentucky. Madam Speaker, I rise in opposition to this 
flawed health bill.
  Mr. BARTON of Texas. Madam Speaker, I would like to yield for a 
unanimous consent request to the gentlewoman from Tennessee (Mrs. 
Blackburn), a member of the committee.
  (Mrs. BLACKBURN asked and was given permission to revise and extend 
her remarks.)
  Mrs. BLACKBURN. Madam Speaker, I rise in opposition to this flawed 
bill.
  Mr. BARTON of Texas. Madam Speaker, I would like to yield for a 
unanimous consent request to the gentleman from the Peach State of 
Georgia, Dr. Gingrey.
  (Mr. GINGREY of Georgia asked and was given permission to revise and 
extend his remarks.)
  Mr. GINGREY of Georgia. Madam Speaker, I rise in the strongest 
opposition to this flawed health care bill.
  The SPEAKER pro tempore. The gentleman will be charged.
  Mr. BARTON of Texas. Madam Speaker, I would like to yield for a 
unanimous consent request to the gentleman from the Pelican State, Mr. 
Scalise, another member of the committee.
  (Mr. SCALISE asked and was given permission to revise and extend his 
remarks.)
  Mr. SCALISE. Madam Speaker, I rise against this health care bill.
  Mr. BARTON of Texas. And, finally, Madam Speaker, I yield 45 seconds 
to another member of the committee, the distinguished Mr. Mike Rogers 
from the great State of Michigan.
  Mr. ROGERS of Michigan. Madam Speaker, if this bill is so great, why 
the deception? The lying, the stealing, the cheating? I have never seen 
such behavior in my entire time in politics. ``If you like your health 
care, you can keep it.'' Not true, if you read the bill. Ten years of 
taxes, 6 years of services, if you read the bill. They steal money from 
the Social Security trust fund and cut $500 billion from Medicare.
  And not only that, Madam Speaker, but this pits one American against 
another in the cost of health care for the first time in our history. 
If you're a Florida senior citizen, you get to keep your Medicare 
Advantage. If you're from the other 49 States, you do not. And there is 
dirty deal after dirty deal after dirty deal in the bill that this 
House will vote on. It is a disgrace. It's wrong. America deserves 
better.
  Mr. WAXMAN. Madam Speaker, I yield 1 minute to the gentlewoman from 
Illinois, Jan Schakowsky, a member of our committee and the Health 
Subcommittee.
  Ms. SCHAKOWSKY. Tonight I want to express my profound thanks to the 
people of Illinois' Ninth Congressional District, the place where I was 
born and lived nearly all my life, for the privilege of being here 
tonight to cast my vote for this historic health care measure. My 
life's work has been to answer what is at bottom a moral question: Will 
the United States of America continue to allow our people to lose their 
lives, their homes and their fundamental sense of security, or finally 
decide that a proud and wealthy country like ours has an ethical 
obligation to provide access to health care for everybody? Is it even 
credible to think that a country as rich as ours in so many ways can't 
afford to do this?
  I am so proud that today this House, under the leadership of perhaps 
the most effective Speaker in U.S. history, Nancy Pelosi, will say to 
all those parents agonizing over a sick child who is now excluded from 
insurance coverage because of a preexisting condition, Sleep well. Our 
courageous and visionary President Barack Obama, when he signs this 
law, that problem will end. This is a great day for America.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  The gentlewoman from Illinois is reminded to please heed the gavel.
  Mr. BARTON of Texas. How much time do I have remaining, please, Madam 
Speaker?
  The SPEAKER pro tempore. The gentleman has 55 seconds remaining.
  Mr. BARTON of Texas. I am going to yield to the gentleman from Texas, 
Dr. Burgess, 15 of those precious 55 seconds.
  Mr. BURGESS. I thank the gentleman for yielding. You know, it's 
really a shame we have this health care bill in front of us. We have 
provisions now for 17,000 new IRS agents but not one dollar for a new 
nurse or a new doctor. You know what, you'll have access, all right, 
but you may be getting your prenatal care from Turbo Tax.


                announcement by the speaker pro tempore

  The SPEAKER pro tempore. The Chair will remind all persons in the 
gallery that they are here as guests of the House and that any 
manifestation of approval or disapproval of proceedings or other 
audible conversation is in violation of the rules of the House.
  Mr. WAXMAN. Madam Speaker, for the purpose of a unanimous consent 
request, I yield to the gentleman from the State of Washington (Mr. 
Inslee), a member of our committee.
  (Mr. INSLEE asked and was given permission to revise and extend his 
remarks.)
  Mr. INSLEE. Madam Speaker, I rise in strong support for this American 
health care bill.
  The SPEAKER pro tempore. The gentleman will be charged.
  Mr. WAXMAN. Madam Speaker, for the purpose of a unanimous consent 
request, I yield to the gentleman from Texas (Mr. Edwards).
  (Mr. EDWARDS of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. EDWARDS of Texas. Madam Speaker, I rise in opposition to this 
bill.
  Madam Speaker, Americans need and deserve health care reform. Without 
it, the quality of our health care system will go down and costs will 
continue to go up. The present trend of fast rising health care costs 
and increasing numbers of uninsured is unsustainable. If left 
unchecked, these problems will bankrupt more businesses, hard-working 
families, hospitals, and, ultimately, state and federal budgets.
  This is why I had wanted to vote for health care reform, and this 
bill has a number of positive provisions in it that I support, such as 
providing tax cuts for small employers offering health insurance, 
creating a private health insurance exchange, helping seniors with 
their prescription drug costs and preventing discrimination against 
people with pre-existing conditions.
  However, I cannot vote for this bill, because at a time of 
unprecedented federal deficits, we simply cannot afford all of its new 
spending. I believe it would have been better to have passed a less 
expensive bill and less expansive bill, one that could have united, not 
divided, our Nation. In the long run, for health care reform to work, 
it must have the support and confidence of the American people.
  I realize it is easier to criticize than to write comprehensive 
health care reform legislation. I also realize that some of the 
criticisms lobbed at this bill are without merit, such as the false 
suggestion that it contains death panels. Nevertheless, I believe we 
could have passed a less complicated, more affordable bill this year 
that would have garnered widespread support across our country.
  Over the past year I have listened to thousands of constituents from 
all walks of life across our district on the issue of health care 
reform. What I have heard is that people generally like the quality of 
their present health care and don't want big government or big 
insurance companies to stand between them and their doctors. They also 
believe we must do something to make health care more affordable for 
families and businesses. I agree.

[[Page H1863]]

  Above all else, what I heard from my constituents is that they have 
to tighten their belts in this difficult economy, and they want the 
federal government to do a far better job of living within its means. 
There is great wisdom in that observation, and I believe we have a 
moral obligation to not drown our children and our economic future in a 
sea of national debt.
  Unlike the Medicare prescription drug bill that was passed in 2003 
without being paid for, I support the principle that health care reform 
should be paid for. I hope the Congressional Budget Office is right 
when it says this bill will reduce the deficit, but, frankly, I am 
skeptical that anyone can predict with absolute certainty the cost of 
such a complex, far-reaching bill over a period of 10 to 20 years.
  That is why I had urged that this bill include a fiscally responsible 
trigger mechanism in it that would cut spending if actual costs exceed 
projections, if cost savings are not fully realized or if projected new 
revenues are overestimated. The President mentioned such a trigger in 
his address to Congress last year, and a trigger was included in some 
parts of the bill. However, I am disappointed that my common sense 
proposal for a trigger covering all of the bill's costs and revenues 
was not included. Today, most Americans simply do not believe this bill 
will reduce the deficit and health care costs. I hope they are wrong, 
but I fear that they are right.
  A less expensive bill, with a fiscally responsible trigger in it, 
would have also reduced the need for the additional taxes and Medicare 
reductions included in this bill. Once the new revenues and Medicare 
savings have been used to pay for the new spending in this bill, it 
will be that much harder to find ways to reduce the massive federal 
deficits our Nation is facing for the foreseeable future.
  If left unchecked I believe huge federal deficits will harm our 
economic growth and our children's future. Increasing interest payments 
on our $12.7 trillion national debt will lead to higher taxes and crowd 
out vital education, health care, infrastructure, national defense and 
job training programs that are so important for hard-working families 
and our country.
  Reining in massive federal deficits will require tough choices, the 
same kind of choices families and businesses have to make every day. 
Given this year's deficit will be approximately 1.3 trillion dollars, I 
simply believe we cannot afford all of the new spending in this bill.
  If this bill becomes law, my hope is that Congress will protect its 
positive provisions but reduce its scope and costs to get our country 
back on track toward a balanced budget that can ensure economic 
opportunity for future generations of Americans.
  The SPEAKER pro tempore. The gentleman has 55 seconds remaining.
  Mr. WAXMAN. Madam Speaker, I yield the balance of my time to the 
gentlewoman from Wisconsin (Ms. Baldwin).
  Ms. BALDWIN. Madam Speaker, what this all boils down to is, Whose 
side are you on? Madam Speaker, I rise today on behalf of the 13,500 
people in my district who will finally have access to health insurance 
because of this measure. I rise for the 1,000 families in south central 
Wisconsin who will be protected from medical bankruptcy this year 
because of this effort. And I rise today because of the 539,000 
constituents who will see their coverage improve because of the work 
we've done.
  Madam Speaker, I rise with pride and hope in the promise of this 
health care reform bill. There is no doubt that powerful interests have 
strenuously opposed reform, and they've often resorted to tactics that 
could make no one proud. But nothing can sully the pride I feel today 
in taking this critical step to provide health coverage for all 
Americans. I've worked my entire career to achieve health care for all. 
Today we stand on the floor of the people's House ready to pass the 
bill.
  The SPEAKER pro tempore. The gentleman from Texas has 40 seconds 
remaining.
  Mr. BARTON of Texas. I yield myself the balance of my time.
  (Mr. BARTON of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. BARTON of Texas. Madam Speaker, this bill will not last. It is 
based on a fatal assumption that one party acting unilaterally can 
dictate the entire will of the American people on one-sixth of the 
economy. That will not happen. It reignites the abortion debate. It is 
fatally flawed in its assumptions in terms of balancing the budget and 
deficit reduction, and it will take away coverage from millions of 
people if it gets as far as 2014 and you kick in the option that puts 
all these mandates on employers.
  Please vote ``no.'' Let's go back, start over. Let's start from 
scratch and do a bill that everybody can support. Vote ``no'' on this 
bill.
  The SPEAKER pro tempore. The gentleman from Michigan (Mr. Levin) is 
recognized for 15 minutes as a designee of the majority leader.
  Mr. LEVIN. Madam Speaker, I yield myself 1 minute.
  (Mr. LEVIN asked and was given permission to revise and extend his 
remarks.)
  Mr. LEVIN. We come to the floor for thousands of votes each year, but 
no single vote comes with so many personal stories within our families 
and my own. In our districts, people have spoken out about the need for 
real reform.
  The millions and millions that have health insurance now worry about 
losing it. The average premium for employer-based insurance has more 
than doubled in the last 10 years. And I heard from a woman that had 
worked for a large company, started her own franchise, and she writes, 
``I exhausted my COBRA, then joined a group health plan. Several years 
ago, I had open heart surgery. The group disbanded. No insurance 
company would touch me with a 10-foot pole. I am uninsured and was just 
diagnosed with my second episode of breast cancer, with no insurance.''
  I heard from a young man diagnosed with leukemia at the age of 17. 
His disease went into remission. He started to work. He was laid off, 
uninsured, and when he started to get sick again, he had to turn to 
emergency rooms for care.
  The SPEAKER pro tempore. The time of the gentleman from Michigan has 
expired.
  Mr. LEVIN. I yield myself 15 additional seconds.

                              {time}  1945

  Mr. LEVIN. I yield myself 15 additional seconds.
  Republicans have turned their back on the problems. Some of them have 
taken to saying health care reform makes us a different Nation; quite 
the opposite. Today, in the tradition of America, we will pass health 
care reform, and it will make our beloved America a still better 
Nation.
  The SPEAKER pro tempore. The gentleman from Michigan (Mr. Camp) is 
recognized for 10 minutes as a designee of the minority leader.
  Mr. CAMP. Madam Speaker, I yield myself 1 minute.
  The American people have spoken. They do not want the tentacles of 
the Federal Government reaching into their lives and controlling their 
personal health care decisions. Yet that is exactly what will happen 
under the Democrats' health care bill. Federal bureaucrats will be 
making your health care choices for you and your family, and the IRS 
will be enforcing them.
  The American people know that you can't reduce health care costs by 
spending a trillion dollars or raising taxes by more than half a 
trillion dollars. The American people know that you cannot cut Medicare 
by over half a trillion dollars without hurting seniors. And the 
American people know that you can't create an entirely new government 
entitlement program without exploding the deficit. They are right, and 
the nonpartisan Congressional Budget Office has confirmed it.
  Simply put, the Democrats' bill will not only ruin our health care 
system, but the tax increases will ruin our economy and kill jobs.
  I urge my colleagues to listen to the American people and kill the 
bill.
  I reserve the balance of my time.
  Mr. LEVIN. Madam Speaker, it is now my real privilege to yield 1 
minute to the distinguished gentleman from New York (Mr. Rangel) who 
has given decades and decades of service to this Congress, to New York, 
and to the people of America.
  (Mr. RANGEL asked and was given permission to revise and extend his 
remarks.)
  Mr. RANGEL. Thank you, Mr. Chairman.
  Madam Speaker, my colleagues, one of the lowest points in my 
political career was when I asked for a leave of absence from the 
chairmanship of the Ways and Means Committee. I had thought at that 
time with my feeling about how important it would be for the entire 
Nation to have access to

[[Page H1864]]

quality health care that I did not want to do anything or be anywhere 
to distract from our leadership, Nancy Pelosi, our leader Steny Hoyer 
or Jim Clyburn, but most important, the great Members who worked so 
hard with me and our dedicated staff to get out the first bill on this 
very important subject.
  When people ask how do you feel and how are you today, I can report 
that this has been one of the most historic moments of my life, to be 
privileged to serve in this great body and to be a part of this 
legislation that I know that, no matter how long anybody has been in 
this great legislative body, people will ask, Which side have you been 
on? And thank God I am on the right side.
  Mr. CAMP. Madam Speaker, I yield 45 seconds to the gentleman from 
California (Mr. Herger), a distinguished member of the Ways and Means 
Committee.
  Mr. HERGER. Madam Speaker, the American people have spoken again and 
again. They do not want to spend nearly $1 trillion on a new government 
health care program paid for by raising taxes, and raiding the Medicare 
trust fund. They don't want to force everyone to buy government-
approved health insurance or subsidize health plans that cover 
abortion. And they don't want a 2,400-page bill riddled with backroom 
deals.
  Madam Speaker, Americans are watching and know what is at stake. 
Let's reject this destructive legislation.
  Mr. LEVIN. Madam Speaker, in terms of seniority and in recognition of 
all of his years of service, I would like to note that the gentleman 
from California (Mr. Stark) is going to be submitting a statement to 
the Record. And I am now pleased, it is a special privilege, to yield 1 
minute to the very distinguished gentleman from Georgia, Mr. John 
Lewis.
  Mr. LEWIS of Georgia. Madam Speaker, this may be the most important 
vote that we cast as members of this body. We have a moral obligation 
today, tonight to make health care a right and not a privilege.
  There are those who have told us to start over. There are those who 
have told us to wait. They have told us to be patient. We cannot wait. 
We cannot be patient. The American people need health care, and they 
need it now. On this day at this hour, stand with the American people 
and not with the big insurance companies. On this day at this moment in 
this Chamber, answer the call of history, answer the spirit of history 
and pass health care. Give the American people a victory. Give health 
care a chance.
  Mr. CAMP. Madam Speaker, I yield 45 seconds to a true American hero, 
the distinguished member of the Ways and Means Committee, the gentleman 
from Texas (Mr. Sam Johnson).
  (Mr. SAM JOHNSON of Texas asked and was given permission to revise 
and extend his remarks.)
  Mr. SAM JOHNSON of Texas. Madam Speaker, today's vote defines what 
kind of America we want to live in. I for one know exactly what that 
is; it is the America I fought and sacrificed for, and all the freedoms 
we hold dear. Freedom from a $2.6 trillion Washington takeover of 
health care; freedom from skyrocketing taxes; freedom from bureaucrats 
coming between you and your doctor; freedom from Medicare cuts to 
seniors; freedom from exploding debt; freedom from the government 
forcing you to buy health insurance.
  I ask my colleagues, what kind of legacy do you want to leave for 
your children and grandchildren? Will you cave to the demands of 
Speaker Pelosi, or will you listen to the pleas of the hardworking 
American people who elected you. Join me in this fight for freedom, 
vote ``no.''
  Mr. LEVIN. Madam Speaker, it is now my privilege to yield 1 minute to 
the very distinguished gentleman from Massachusetts (Mr. Neal).
  Mr. NEAL of Massachusetts. Madam Speaker, this is a most significant 
day. Health insurance reform has been coming for a long time, and we 
are finally here. With passage of this bill, American families are 
going to take back control of their health care.
  This bill bars insurance companies from discriminating based on 
preexisting conditions. It caps out-of-pocket expenses. Half the 
bankruptcies in America are due to health-related matters. This bill 
allows individuals and small businesses to purchase affordable 
insurance from competitive marketplaces. It contains cost controls that 
will save the taxpayer $138 billion over the next 10 years. And for 
parents that are watching tonight, your dependents can stay on your 
insurance until they are 26 years old.
  Nobody has defended Social Security and Medicare the way I have in 
this institution. And I must tell you tonight, I can't believe anybody 
who is witnessing this debate would believe for 1 minute that our 
Republican friends have been better in history on Medicare than we have 
been. It is in our DNA. This is a defining moment. The exclusionary and 
discriminatory tactics that exist in our current system tonight become 
history as well.
  Mr. CAMP. Mr. Speaker, I yield 45 seconds to the gentleman from Texas 
(Mr. Brady), a distinguished member of the Ways and Means Committee.
  Mr. BRADY of Texas. The government promised you health care. When 
forced to buy the government-approved plan or face the tax man, you 
complied. But the cost didn't go down, it went up; it's the highest 
ever. It takes now 3 months to see a doctor. And when you need care, 
the government plan denies it four times more often than your insurance 
company. Now the government is short on money. They started rationing 
care, cutting hospital payments, withdrawing coverage from some 
families, and it has just been 3 years since it all began.
  Folks, this isn't the future, this is Massachusetts today. Higher 
costs, slower care, and rationing. That is why Massachusetts said 
``no'' to Obama care. America is saying ``no'' too because bigger 
government doesn't mean better health care.
  Mr. LEVIN. Mr. Speaker, I yield to the gentleman from New York for a 
unanimous consent request.
  (Mr. MAFFEI asked and was given permission to revise and extend his 
remarks.)
  Mr. MAFFEI. Mr. Speaker, I submit the remarks for the Record that I 
delivered at the American Cancer Society in East Syracuse on Tuesday of 
this week in support of this historic health care reform bill.
  I have heard from thousands of constituents about the current health 
care reform debate. I've tried to listen to everything they've had to 
say--for and against health care reform. Their advice and their pleas 
and their stories and their criticisms have helped guide my advocacy on 
behalf of changes and improvements to proposals before Congress and my 
decision on the compromise legislation before Congress.
  Now that the President's changes will be incorporated into the final 
legislation, I will support this historic health care reform effort.
  I am voting in favor of this legislation not because I think it is 
perfect, but because I strongly believe it is in the best interests of 
my constituents--that it will make a positive difference in the lives 
of families, businesses, and hospitals in central and western New York.
  First, I'm voting for this because we need to do something to control 
rising health care costs that keep taking a bigger and bigger bite out 
of the household budgets of upstate New York. Skyrocketing health care 
costs aren't just crippling the U.S. economy--they're emptying our 
pocketbooks. My entire life is filled with stories about how people--
regular middle-class people--can't afford the health care they need. 
How insurance companies have denied needed care. How kids graduating 
from college can't find affordable coverage. How people with life 
threatening conditions need to hold bake sales and bowl-a-thons to pay 
health bills. Families go bankrupt not because they were irresponsible 
but because they trusted their insurance plans. More than 72 million 
adults currently have medical debt or problems paying their bills even 
though most of them have insurance. It has to end--and I honestly 
believe if we don't take action now it never will.
  Second, I'm voting for this because if we don't fix health care, 
businesses that are struggling to compete in a global economy will fall 
further and further behind.
  As premiums nearly double, employees in small firms will see offers 
of health insurance options almost cut in half. It is predicted the 41 
percent of firms offering insurance in 2010 will drop to 23 percent in 
2020. Not because they are bad employers but because they cannot afford 
it.
  Every industrialized nation has figured out a way to get people 
affordable coverage--the United States can, too.
  And finally, I'm voting for this bill because the county, state, and 
country are going broke due to health care costs. Sure, we could limp

[[Page H1865]]

along another few years but if we do, it will only be harder to control 
those long-term costs.
  I know many people in my district will be encouraged that we are 
finally moving forward, that we are finally taking action on an issue 
that affects us all.
  I know others will be unhappy. Many of my constituents have strong 
concerns about this legislation. In fact, I share some of those very 
same concerns. I worked very hard to improve this bill. I led the fight 
to hold down the tax on medical devices. I advocated for businesses 
with less than 25 employees to get subsidies for health insurance and 
for a reduced burden on other businesses. I fought successfully to 
raise the threshold on any benefit surcharge so that it won't affect 
middle-class people in my district.
  This is not a perfect bill. But it is an important legislation that 
we need to pass to move this country forward.
  There are several criticisms of the proposal that do come up 
certainly across the country and even here in my district that I feel 
compelled to address.
  First, many argue that this is a government take-over of health care. 
That is simply not true. In fact, except for Medicare, Medicaid, the VA 
and other already existing programs, Americans would be covered by 
private insurance plans. A public option which I support is not even 
included in this plan. There are some additional regulations that give 
more rights to patients such as not allowing health plans to deny 
coverage due to preexisting conditions. But these are widely supported 
and necessary changes. To assert that these new patient rights are some 
sort of government take-over is absurd.
  Second, some will say that large majorities of the American public 
are against the President's plan. The Post-Standard printed an AP poll 
this last weekend that did show slightly more respondents nationwide 
opposed rather than supported the health care reform plans--by two 
percentage points--43 to 41. But for many it's not that the plan went 
too far but that it did not change enough. In fact, fully 82% of the 
respondents to that same poll wanted to change the health system a 
moderate amount or more. Only 17 percent said it should be changed a 
little or not at all.
  So this idea that Americans don't want change is simply wrong. In 
this region, it is particularly misguided. While it is true that my 
office has received many calls objecting to the health care debate, a 
vast majority of them have been from out-of-state--a purposeful and 
well-funded attempt to jam our lines so that my constituents cannot get 
through. And yet thousands did and while it is clear there are diverse 
opinions and that my constituents are more divided on this than any 
other major question we've faced so far, it is also clear from our 
office communications and our research that a majority of my 
constituents want me to work as hard as I can to improve health care 
proposal and support the changes we need. And I will do just that.
  Third, that the President's proposed changes will increase costs to 
businesses and taxpayers. But I ask compared to what? The current 
trajectory is already bankrupting businesses, states, counties, cities, 
and right here in central New York leading to higher and higher 
property taxes. Under the current system, health care will consume one 
of every three dollars in the U.S. economy--twice as much as it does 
today. The President's plan gets these costs under control by 
implementing nearly every idea suggested including Republican ideas on 
medical malpractice and increasing ability to buy insurance across 
state lines. It also over time implements real cuts in government 
spending on health care including eliminating some of the waste and 
subsidies.

  I believe that many of these cost savers will work. I know that doing 
nothing will bankrupt our country and our families and our small 
businesses.
  I know the Republicans in Washington have said that they want to make 
health care the central issue in the elections this coming November. 
Thousands and thousands of dollars have already been spent on ads 
running against me here in central New York. Some of these ads have 
been proven to be false.
  Far from convincing me to oppose the health care reform, they have 
strengthened my resolve. Because when people who have that much money 
feel so strongly that they run attack ads on you, chances are that what 
you're doing is in the best interest of taxpayers and ordinary 
families.
  So what's in this proposal?
  People who have been denied coverage because of a pre-existing 
condition will finally have access to affordable coverage. Insurers 
will no longer be able to drop your coverage when you get sick and are 
in the middle of treatment.
  Never again will you lose access to insurance if you get laid off or 
switch jobs.
  Small businesses and employers getting crushed by soaring health care 
costs will see lower costs.
  Never again will you be subject to annual or lifetime limits on what 
insurance companies will pay, protecting millions of Americans from the 
threat of medical bankruptcy.
  Insurers will be required to offer free preventive care, lowering 
your out-of-pocket expenses and helping ensure that diseases or 
conditions can be caught early on.
  Seniors who fall into the Medicare Part D donut hole will see lower 
prescription drug costs as immediate steps are taken to close the donut 
hole. Employers who cover their early retirees will receive temporary 
funds to help offset the cost of expensive claims for retirees' health 
benefits--lowering premiums and protecting coverage for early retirees.
  Insurers are prohibited from charging women more than men for health 
insurance or discriminating on the basis of domestic violence as a pre-
existing condition. Required maternity services as part of the 
essential benefits package in the exchange.
  Young adults will now be able to stay on their parents' insurance 
much longer, through their 26th birthday.
  And finally, health reform will guarantee access to quality, 
affordable health insurance for 31 million Americans who don't have 
coverage today, also eliminating the annual hidden tax of $1,100 that 
American families pay to cover the cost of the uninsured. While the 
official health insurance exchanges are being created, a temporary 
insurance pool will be available for individuals with pre-existing 
conditions or chronic illnesses.
  These benefits are all vitally important. But perhaps in the end it 
comes down to this: those opposed to health care reform are concerned 
that it will cost them more. This bill saves money and the further out 
you go, the more it saves. But it also saves something more precious--
it will save lives.
  Mr. LEVIN. Mr. Speaker, it is now my real privilege to yield 1 minute 
to the distinguished gentleman from Texas (Mr. Doggett).
  Mr. DOGGETT. So very fearful of being held accountable, the giant 
insurance monopolies have spent millions spewing out anger and 
spreading fear of reform. We have not seen such outlandish, outrageous 
arguments raised since the same forces failed to block President Lyndon 
Johnson from securing approval of Medicare.
  For Republicans, our bill is too long or it is too short. It is too 
thick or it is too thin. It is never just right because their true 
answer to health insurance reform is ``never, never, never.'' Our 
determined efforts should not be derided as a four-letter word, but you 
can certainly sum up our many, many pages with four words: you've got 
health care.
  With this reform, every insured American gets valuable consumer 
protections, and every uninsured American can become insured. Thirty-
two million Americans will be protected from the risk of bankruptcy 
from health care.
  The bill restrains soaring insurance premiums and reduces Federal 
deficits.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. DOGGETT. My time has expired, but many Americans will not, as a 
result of this bill.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (Mr. Serrano). The Chair will remind all 
Members to heed the gavel.
  Mr. CAMP. Mr. Speaker, I yield 45 seconds to the distinguished 
gentleman from Georgia, Dr. Linder.
  Mr. LINDER. Mr. Speaker, I feel rude trying to inject some fact into 
this kabuki theater, but I am going to try: 85 percent of America is 
insured; 95 percent of those people are happy with their insurance. The 
other 15 percent uninsured, they consume 70 percent on average as much 
insurance as those who are insured. They are cared for. The lady in 
Cleveland who has been referred to ad nauseam is being cared for at the 
Cleveland Clinic.
  So what are we to do about those 15 percent? Why not take over 16 
percent of the economy. A $2.5 trillion program that will destroy 
health care for the 85 percent who are happy, to find health care for 
the 15 percent who are not insured. This has never been about health 
care. This is about government.
  Mr. LEVIN. Mr. Speaker, I yield 1 minute to the very distinguished 
gentleman from California (Mr. Thompson).
  Mr. THOMPSON of California. Mr. Speaker, I have worked for access to 
quality, affordable health care from day one of my very first campaign, 
and every day since.
  Today, with passage of this bill, we will be closer to that important 
goal

[[Page H1866]]

than ever before. When the President signs this bill into law, 
insurance companies won't be able to drop your coverage if you get 
sick. Kids won't be denied coverage because of preexisting conditions. 
Young adults will be able to stay on their parents' policy until they 
are 26. Small business owners will be eligible for a tax credit. 
Seniors will see the Medicare doughnut hole start to close, and 
preventive care will be covered without copay.
  The bill is paid for and will reduce our debt. In my district, 63,000 
uninsured residents will have access to coverage, and it will save my 
district $70 million in uncompensated care costs. This bill is a great 
start toward health care reform and will help millions of Americans 
afford quality health care.

                              {time}  2000

  Mr. CAMP. Mr. Speaker, I yield 45 seconds to a distinguished member 
of the Ways and Means Committee, the gentleman from California (Mr. 
Nunes).
  Mr. NUNES. Mr. Speaker, this debate is not about the uninsured; it's 
about socialized medicine. Today we are turning back the clock. For 
most of the 20th century, people fled the ghosts of communist 
dictators, and now you are bringing the ghosts back into this Chamber. 
With passage of this bill, they will haunt Americans for generations.
  Your multitrillion dollar health care bill continues the Soviets' 
failed Soviet socialistic experiment. It gives the Federal Government 
absolute control over health care in America.
  My friends, that is what this debate is really about. Today, 
Democrats in this House will finally lay the cornerstone of their 
socialist utopia on the backs of the American people.
  Say ``no'' to socialism. Say ``no'' to totalitarianism. Say ``no'' to 
this bill.
  Mr. LEVIN. It is now my privilege to yield 1 minute to the Chair of 
our caucus, the very distinguished gentleman from Connecticut (Mr. 
Larson).
  Mr. LARSON of Connecticut. I thank the chairman, and it's my honor to 
yield my time to someone who's always understood whose side he's on in 
this debate, the gentleman from Michigan, Mark Schauer.
  Mr. SCHAUER. Mr. Speaker, today I stand for the people of Michigan 
who lost their insurance when they lost their jobs--they've been 
dropped and denied coverage by insurance companies for preexisting 
conditions or because they got sick--and are going broke because of 
their medical bills.
  I stand for the elderly in my district who fall into the doughnut 
hole and must choose between food and medicine, and I stand for small 
businesses who plead for help to put an end to double-digit premium 
increases that make them choose between jobs and health care. All of 
these things will end with the passage of this bill.
  The question of the day is: Whose side are you on? I'm on the 
people's side, not on the side of the powerful special interests who've 
spent millions to kill this bill. Cutting through all of the deception, 
misrepresentation, and lies, I stand with the people.
  I urge you to do what's right and vote ``yes.''
  Mr. CAMP. Mr. Speaker, I yield 45 seconds to a distinguished member 
of the Ways and Means Committee, the gentleman from Ohio (Mr. Tiberi).
  Mr. TIBERI. Mr. Speaker, I am for health care reform, but not this 
version. This is a bad bill. It does nothing to address the cost of 
health care. This bill increases taxes on individuals and employers. It 
cuts Medicare and adds debt to future generations.
  But don't take my word for it, Mr. Speaker. My hometown newspaper, 
The Columbus Dispatch, has published three editorials this last week 
against the bill suggesting, and I quote, ``It is incredible that a 
sixth of the U.S. economy and the health of every American could be 
subjected to massive government intervention based on such fiscal 
dishonesty and secrecy.''
  Mr. Speaker, this bill does nothing to reform our health care system. 
It adds people to a broken system.

                           [From Editorials]

                               Add It Up


      on health-care vote, lawmakers should pay heed to the people

       The Obama administration and Democratic leaders in Congress 
     are pushing Democratic members of the House to pass the 
     Senate health-care overhaul in the next week or two and to 
     trust the Senate to agree to changes in follow-up bills that 
     will make the plan more amenable to House Democrats.
       This complicated approach is a parliamentary maneuver 
     intended to deny Senate Republicans the opportunity to kill 
     the bill with a filibuster.
       Of the 11 Democratic members of Ohio's congressional 
     delegation, one is opposed and eight say they are undecided 
     about how they'll vote. Among Ohio's nine Republican members 
     of Congress, there is no ambivalence. All nine plan to oppose 
     it.
       President Barack Obama is pressing hard for the overhaul 
     because it is his signature issue. He is more than a year 
     into his administration and has been handed setback after 
     setback, despite the fact that the White House, House and 
     Senate are in Democratic hands. The economy is stalled, 
     unemployment remains at punishing levels and voters are angry 
     at the lack of improvement. Not only that, but they are 
     alarmed about the serious amounts of debt the government has 
     run up in less-than-stimulating stimulus efforts. The ``blame 
     Bush'' strategy that Obama has employed to date is now a dead 
     horse, unresponsive to further lashing. In short, Obama is 
     desperate for a win.
       Ohio's Democrats must decide whether they were elected to 
     give the American people the best health-care bill possible, 
     or whether they were elected to save a president from a 
     political morass.
       The answer should be easy: they should vote for the 
     American people. That means saying no to the health-care 
     overhaul plans now before Congress. The plans so are have 
     been sold under false pretenses using accounting gimmicks 
     that lowball the costs. They contain no serious mechanisms 
     for controlling the escalation in health-care costs. And 
     extending health insurance to 31 million more Americans would 
     place demands on doctors and hospitals that will drive costs 
     through he roof or necessitate rationing whether it takes the 
     form of denying some treatments or making people wait longer 
     for care.
       The federal government already runs two of the biggest 
     medical programs in the country, Medicare and Medicaid, and 
     both are headed for insolvency. Consider that the health-care 
     overhaul calls for putting half of the 31 million uninsured 
     onto state Medicaid rolls at a time when Medicaid already is 
     driving state budgets into the red.
       If almost half of Ohio's congressional delegation is 
     undecided, the American people are not. Recent opinion 
     surveys find that half or more of Americans oppose the 
     proposed overhaul. The number favoring the plan rarely tops 
     40 percent. No proposal to make over a sixth of the U.S. 
     economy and to radically alter the health-care prospects of 
     all Americans should be rammed through in the face of such 
     opposition.
                                  ____


                              Short Takes

       Congressional Democrats celebrated on Friday after finally 
     unveiling a Congressional Budget Office estimate of the cost 
     of the latest version of their proposed health-care overhaul: 
     $940 billion over the first decade, with a deficit-reducing 
     surplus of $138 billion.
       However, as with previous CBO estimates, the key is in the 
     rules and assumptions Congress required the bean-counters to 
     follow in preparing the estimate.
       And, as before, the rules are gamed to low-ball the costs 
     with assumptions that are dishonest, such as the one that 
     says that the overhaul will be financed in part by squeezing 
     hundreds of billions of dollars in savings from Medicare.
       Everybody in Washington knows that is never going to 
     happen, and that this alone--never mind the other gimmicks in 
     the estimate--pushes the plan into deficit.
       The estimate is dishonest, as is the planned parliamentary 
     dodge the House is likely to use to pass the overhaul without 
     requiring members to directly cast a vote for the Senate bill 
     that forms the core of the plan.
       Meanwhile, President Barack Obama and his aides deny that 
     he is telling balky Democratic House members that they must 
     vote for the measure to save his presidency. But Obama's 
     cancellation of his trip to Asia, which was to begin on 
     Sunday, speaks volumes about what he thinks this vote means 
     to his presidency.
       The administration also denies that Obama has cut any 
     special deals in dozens of private meetings with individual 
     House members over the past week. But neither is the White 
     House divulging many details about these closed meetings.
       It is incredible that a sixth of the U.S. economy and the 
     health of every American could be subjected to massive 
     government intervention based on such fiscal dishonesty and 
     secrecy.
                                  ____

       To better render justice, courts should move at a 
     deliberate speed. But justice delayed is justice denied.
       So, understandably, Ohio Attorney General Richard Cordray 
     is urging the Ohio Supreme Court to move quickly in settling 
     a dispute that will decide whether the state can reclaim $260 
     million in tobacco-settlement money.
       The money, originally slated for anti-tobacco programs, 
     became the center of a legal battle almost two years ago, 
     when the governor and lawmakers sought to divert it for use 
     in an economic-stimulus plan.
       Officials of the Tobacco Use Prevention Foundation tried to 
     thwart the governor by

[[Page H1867]]

     transferring the money to the American Legacy Foundation in 
     Washington, D.C. The governor and lawmakers retaliated 
     appropriately by abolishing the Tobacco Use Prevention 
     Foundation and ever since have been fighting in court for the 
     money to be returned to the state.
       Cordray quite properly argues that as the next biennial 
     budget looms, with huge shortfalls anticipated, state and 
     local officials need to know whether Ohio will be able to 
     count on the tobacco money. Even if the answer is no, at 
     least the decision will end the uncertainty and allow budget 
     planning to proceed.
                                  ____


                      [From the Columbus Dispatch]

                                 Say No


    Health-care overhaul won't reduce costs, will drive up U.S. debt

       Democratic lawmakers in the House are under tremendous 
     pressure to approve within days a massive overhaul of health 
     care. If these members succumb to the pressure from President 
     Barack Obama and Democratic leaders, they will be approving a 
     major intervention into a sixth of the U.S. economy--a move 
     driven by the president's need for a political victory, not 
     by sound policy that serves the interests, wallets and health 
     of the American people.
       Approval of the proposed plan would guarantee that 
     Americans pay more to get less health care. Care ultimately 
     will be reduced, either by raising its cost, by limiting the 
     amount and kind of care available or by making people wait 
     longer.
       Finally, the cost of the new government spending for health 
     care will add to the annual federal deficits and increase the 
     national debt, which already surpasses $12 trillion.
       Though the president claims that the overhaul will reduce 
     the ever-mounting cost of medical care and reduce the federal 
     deficit over 10 years, his numbers are based on accounting 
     tricks, including gaming of revenue and spending estimates 
     and double-counting of various federal revenues.
       The vaunted Congressional Budget Office figures that Obama 
     points to in claiming savings are bogus. The CBO is a by-the-
     books outfit, but it prepares its estimates based on the 
     parameters and assumptions laid down by Congress. If the 
     parameters are dishonest, then the resulting estimate will 
     be, too. In its scoring of the Senate health-care bill, for 
     example, the CBO was required to base its estimate on 10 
     years of tax revenues generated under the plan, but balance 
     that against only six years of spending mandated by the plan. 
     No surprise then, that the estimate shows the cost coming in 
     at less than $1 trillion over its first decade, with a modest 
     surplus. The real question is what the program would cost 
     over a period of 10 years when taxation and spending are 
     fully under way. That number is $2.3 trillion, by one 
     estimate.
       The plan proposes to pay for itself, in part, with $500 
     billion to be cut from Medicare, but Medicare already is 
     headed for insolvency, so money taken from it simply 
     increases Medicare's $38 trillion unfunded liability.
       In December, the chief actuary for the federal Centers for 
     Medicare and Medicaid Services reported that the Senate plan 
     does nothing to curb increases in costs and actually would 
     make those costs higher than they would be without the 
     overhaul.
       Adding 31 million people to health-insurance rolls, as the 
     bill seeks to do, will increase the lines waiting to see a 
     doctor or to enter a hospital for treatment. This massive 
     increase in demand also will drive up the cost of care. The 
     president has promised that those content with their current 
     insurance coverage won't have to change it, but the 
     circumstances under which they exercise that coverage are 
     going to change significantly. Expanding to vastly the pool 
     of people with health insurance is going to mean sacrifices 
     in affordability and access for everyone.
       Half of the 31 million are to be enrolled in state Medicaid 
     programs, at a time when Medicaid has become the Pac-Man of 
     state budgets, swallowing billions in state revenues each 
     year at a accelerating rate. Meanwhile, many doctors already 
     refuse to take on additional Medicaid patients, so where will 
     the millions of new Medicaid enrollees find care?
       Under the proposal, medical costs, health-care premiums, 
     annual federal deficits and the national debt would 
     increase--the direct opposite of the president's promise that 
     it would provide Americans with affordable health care that 
     improves the government's bottom line.
       The Senate bill that the House is being asked to approve 
     also contains all the backroom political payoffs to favored 
     lawmakers that so enraged the nation when the measure was 
     passed by the Senate, such as the ``Cornhusker kickback,'' 
     negotiated by Nebraska Democratic Sen. Ben Nelson, which 
     would have the federal government pick up the increased costs 
     of Medicaid expansion in his state, while leaving Ohio and 
     other states to squeeze more revenue out of state taxpayers.
       Obama has proposed to eliminate the Nebraska giveaway and 
     have the federal government provide more but not all the 
     money states will need to cope with large Medicaid rolls. But 
     even if the Nelson bribe ultimately is nixed, news reports 
     say that more special deals were being cut this week to 
     induce House members to vote yes.
       Labor unions also have been promised a massive perk: Their 
     members would be exempt from the bill's tax on high-end 
     ``Cadillac'' health-care plans until 2018, saving unionized 
     employees $60 billion during that period. Meanwhile, nonunion 
     workers will be stiffed for an estimated $90 billion in new 
     taxes.
       Equally unsavory is the so-called ``Slaughter solution,'' a 
     parliamentary trick by which House members could approve the 
     Senate plan without casting a direct vote for it. If, as the 
     president says, the American people are clamoring for his 
     health-care overhaul, why should Democratic lawmakers fear 
     voting for it?
       The answer is that lawmakers know that the majority of the 
     American people are not clamoring for this particular 
     overhaul, as one opinion survey after another shows. 
     Americans want health-care reform, but not the sort that 
     congressional leaders and the president hope to force down 
     their throats in the next day or two.

  Mr. LEVIN. It is now my real privilege to yield to another member, an 
energetic member of our committee, the gentleman from Wisconsin (Mr. 
Kind).
  (Mr. KIND asked and was given permission to revise and extend his 
remarks.)
  Mr. KIND. Mr. Speaker, I will never forget the pride I felt as a 6-
year-old kid in Wisconsin watching Neil Armstrong and Buzz Aldrin walk 
on the moon. It was a deep and abiding belief that I live in a country 
that's capable of accomplishing anything once we put our mind to it. 
That belief is being tested throughout America today.
  People are wondering if we're still capable of doing great things. I 
believe we can, and I want my two boys to feel the same way. I believe 
our country, by working together, can ensure that all Americans have 
access to quality, affordable, and secure health care, regardless if 
they're young or old, whether they're rich or poor, and even whether 
they have a preexisting condition. And we can do this in a fiscally 
responsible manner by paying for this bill and finding savings that 
will reduce the deficit in future years.
  That national achievement can begin today, this evening, with our 
vote. I encourage my colleagues to support this health care reform for 
all Americans.
  The SPEAKER pro tempore. The Chair will note that the gentleman from 
Michigan (Mr. Camp) has 4\1/2\ minutes remaining and the gentleman from 
Michigan (Mr. Levin) has 6\3/4\ minutes remaining.
  Mr. CAMP. Mr. Speaker, I reserve the balance of my time.
  Mr. LEVIN. It is now my privilege to yield 1 minute to our vice Chair 
and the distinguished gentleman from California, Xavier Becerra.
  Mr. BECERRA. Mr. Speaker, today is a day of history. Today we will 
accomplish what 100 years of Congresses could not. We will pass health 
care reform, not just for some, but for all Americans.
  Today is also another day in America. That means that 123 Americans 
will die today because they do not have health insurance. Another 8,000 
will lose their health insurance today, and our health care system will 
cost all of us $6.8 billion this day and every day if we do not change, 
if we are content with doing nothing.
  John F. Kennedy once said, ``Change is the law of life, and those who 
look only to the past or present are certain to miss the future.'' I've 
heard it said another way: The only human institution which rejects 
progress is the cemetery.
  Today this House, the people's House, is full of life. We will make 
history, but our sights are toward the future. To every hardworking, 
taxpaying American, we say today, We hear you. We see it in your eyes. 
You want control of your health care. You want to decide who your 
doctor is. You want to choose your health plan. We will deliver today 
to all of America.
  Mr. CAMP. Mr. Speaker, at this time I yield 45 seconds to a 
distinguished member of the Ways and Means Committee, the gentlewoman 
from Florida (Ms. Brown-Waite).
  Ms. GINNY BROWN-WAITE of Florida. Mr. Speaker, the Democrats on the 
other side of the aisle believe that the American citizens can no 
longer be trusted to manage their own health care in the best way that 
they see fit. You must now do things in their socialist way or face the 
wrath of the IRS.
  Unfortunately, the size of the Federal Government isn't the only 
thing that's going to grow as a result of this bill. So will your 
insurance premiums, because the cost of insurance will

[[Page H1868]]

grow. That's right. The bill increases premiums for every American who 
has insurance. Our national debt will grow. Your taxes will grow.
  The only thing that won't grow are the benefits that the seniors who 
are in the Medicare Advantage plan have. They will be losing their 
doctors because doctors are refusing to take Medicare patients and will 
once this bill becomes law.
  Mr. Speaker, this bill cuts Medicare, raids Social Security, and we 
need to reject this bill.
  Mr. LEVIN. I now yield 1 minute to the gentleman from New Jersey (Mr. 
Pascrell).
  Mr. PASCRELL. Mr. Speaker, many things are said across the aisle in 
the heat of a debate, and if it hasn't been said yet, maybe the reason 
is it has been said by everybody.
  I believe that the ranking member is an honorable person. I believe 
my chairman is. * * * Even the President of the Vietnam Veterans of 
America said this is shameless.
  *  *  * It's not right. Tell the truth and then let the chips fall 
where it may. It is utterly * * * to suggest, Mr. Chairman, that we are 
seeking to deny any soldier the health care they deserve and the 
benefits that nearly all Republicans and Democrats have spent our 
careers in Congress working to protect and prove.
  Mr. DAVIS of Kentucky. Mr. Speaker, I ask the gentleman's words be 
taken down for the false statements that he made about this conference 
to me as an Army veteran among others in the Chamber.
  The SPEAKER pro tempore. The gentleman from New Jersey will be 
seated.
  The Clerk will report the words.
  Mr. PASCRELL. Mr. Speaker, I ask unanimous consent to remove any word 
or words that were taken as offensive.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  Mr. DAVIS of Kentucky. I accept the gentleman's apology.
  The SPEAKER pro tempore. Without objection, the words will be 
stricken.
  There was no objection.
  Mr. PASCRELL. Don't push me.
  I include the following material for the Record:


                                  Vietnam Veterans of America,

                                                   March 21, 2010.

 Vietnam Veterans of America Applauds Passage of Skelton Bill Ensuring 
  Protection of TRICARE, VA Health Care, and CHAMPUS; Decries ``Scare 
                               Tactics''

       Washington, DC.--``We thank and applaud passage of H.R. 
     4887 yesterday in the House of Representatives, by a vote of 
     403-0. Passage of this bill ensures that health care programs 
     for veterans, active duty military, retired military, and 
     their families/survivors will not be affected negatively by 
     the pending health care reform legislation.'' said John 
     Rowan, National President of Vietnam Veterans of America 
     (VVA).
       ``It is unfortunate that some continue to raise what is now 
     is even more clearly a false alarm that is apparently meant 
     to frighten veterans and their families in order to prompt 
     them to oppose the pending legislation. While there is 
     legitimate debate as to whether or not the pending health 
     care measures should become law, VVA does not appreciate 
     spreading rumors that are not accurate by any political 
     partisan from any point of the political spectrum.'' 
     continued Rowan.
       ``Last summer there was a similar incident, also involving 
     partisans in the health care reform debate that VVA soundly 
     condemned. We said then: ``It is our hope that sane minds 
     reject fear-mongering, and that veterans recognize these 
     scare tactics for what they are,'' Rowan said. Rowan 
     concluded by saying ``VVA has always worked hard for justice 
     for veterans of all generations, and their families. We have 
     always, and will continue to, work with public officials 
     representing all political parties and points of view. Issues 
     affecting veterans and their families are not, should not, 
     and must not become partisan footballs to bat around. VVA 
     decries any effort, by anyone, that would do just that.''
                                  ____


                    Department of Veterans Affairs,

                                                   March 21, 2010.

              Statement From VA Secretary Eric K. Shinseki

       As Secretary of Veterans Affairs, I accepted the solemn 
     responsibility to uphold our sacred trust with our nation's 
     Veterans. Fears that Veterans health care and TRICARE will be 
     undermined by the health reform legislation are unfounded. I 
     am confident that the legislation being voted on today will 
     provide the protections afforded our nation's Veterans and 
     the health care they have earned through their service. The 
     President and I stand firm in our commitment to those who 
     serve and have served in our armed forces. We pledge to 
     continue to provide the men an women in uniform and our 
     Veterans the high quality health care they have earned.
       President Obama has strongly supported Veterans and their 
     needs, specifically health care needs, on every major issue 
     for these past 14 months--advance appropriations, new GI Bill 
     implementation, new Agent Orange presumptions for three 
     additional diseases, new Gulf War Illness presumptions for 
     nine additional diseases, and a 16% budget increase in 2010 
     for the Department of Veterans Affairs, that is the largest 
     in over 30 years, and which has been followed by a 2011 VA 
     budget request that increases that record budget by an 
     additional 7.6%.
       To give our Veterans further assurance that health reform 
     legislation will not affect their health care systems, the 
     Chairmen of five House committees, including Veterans Affairs 
     Chairman Bob Filner and Armed Services Chairman Ike Skelton, 
     have just issued a joint letter reaffirming that the health 
     reform legislation as written would protect those receiving 
     care through all TRICARE and Department of Veterans Affairs 
     programs.
                                  ____



                                Congress of the United States,

                                   Washington, DC, March 21, 2010.
     Hon. Louise Slaughter,
     Committee on Rules, The Capitol, Washington, DC.
       Dear Chairwoman Slaughter: The House Democratic leadership 
     asked our committees to review HR 3590 and HR 4872 to assess 
     the impact of the bills on the health care provided by the 
     Department of Defense and the Department of Veterans Affairs. 
     Our reviews of HR 3590 and HR 4872 lead us to believe that 
     the intent of the bills was never to undermine or change the 
     Department of Defense and Department of Veterans Affairs 
     operation of their health care programs or interfere with the 
     care that our service members receive under TRICARE. However, 
     we commit to look into this issue further to ensure that no 
     unintended consequences may arise and to take any legislative 
     action that may be necessary.
       HR 3590, as drafted, does not specifically mention that 
     TRICARE coverage meets the individual responsibility 
     requirement, but such coverage would satisfy the requirements 
     of this bill. To affirm that this is the case, the U.S. House 
     of Representatives unanimously passed HR 4887, the TRICARE 
     Affirmation Act, which provides assurances to the American 
     people that care provided to those in the military and their 
     families, as well as military retirees under age 65 and their 
     families, would indeed meet the requirement for coverage.
       The members of our nation's military sacrifice much to 
     defend us all. We commit to these dedicated service members 
     and their families as well as our veterans that we will 
     protect the quality healthcare they receive.
           Sincerely,
     Bob Filner,
       Chairman, Committee on Veterans' Affairs.
     Ike Skelton,
       Chairman, Committee on Armed Services.
     Sander Levin,
       Chairman, Committee on Ways and Means.
     George Miller,
       Chairman, Committee on Education and Labor.
     Henry Waxman,
       Chairman, Committee on Energy and Commerce


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. The Chair reminds all Members that any 
statements should be directed through the Chair and not to others in 
the second person.


                         Parliamentary Inquiry

  Mr. TIAHRT. Parliamentary inquiry, Mr. Speaker,
  The SPEAKER pro tempore. The gentleman from Kansas will state his 
parliamentary inquiry.
  Mr. TIAHRT. Is it true that in the course of comfortable debate that 
we not question another Member's motives?
  The SPEAKER pro tempore. The Chair will affirm that Members must 
maintain proper standards of decorum.
  Mr. TIAHRT. Is it against the House rules to question another 
Member's motives?
  The SPEAKER pro tempore. A Member's remarks should avoid 
personalities toward other Members.
  Mr. TIAHRT. I thank the Speaker.
  Mr. CAMP. Mr. Speaker, I yield 45 seconds to a distinguished member 
of the Ways and Means Committee, an Army Ranger, Mr. Davis of Kentucky.
  Mr. DAVIS of Kentucky. My heart is heavy with grief tonight at this 
turning point for our Nation, Mr. Speaker. This vote will define the 
America we will have in the future: massive tax burdens, rationed care, 
and intrusive bureaucracy.
  Democrats are thwarting the will of the American people, taking them 
on a headlong rush toward socialism. This is

[[Page H1869]]

based on a false premise that every need a person could have on Earth 
can be met by government. Almost like worshipers, they carry the heart 
of our Constitution, bought in blood, and sacrifice it on the altar of 
political expediency. It raises taxes, violates your privacy, is 
policed by the IRS, intrudes on free choice, and hurts seniors.
  I stand firm in my opposition to this exercise in idolatrous statism, 
a true tyranny that is the largest legislative transfer of power to the 
executive branch in the history of this Republic.
  Vote ``no'' on this bill. Start over with real reforms that Americans 
want.
  Mr. LEVIN. It is now my pleasure to yield 45 seconds to the very 
distinguished gentleman from New York (Mr. Crowley).
  Mr. CROWLEY. Mr. Speaker, I rise in support of the Patient Protection 
and Affordable Health Care Act, a historic measure that will put 
families first when it comes to accessing health care coverage.
  American families need this bill now more than ever. In the past 
decade, the cost for health care for American families has skyrocketed. 
If we do nothing, it's only going to get worse. If we do nothing, in 10 
years small businesses will shell out $29,000 in medical costs per 
employee. If we do nothing, the costs of an employer-sponsored health 
insurance plan will increase 84 percent by 2016. And if we do nothing, 
the American economy will break under the weight of mounting debt.
  Americans may very well be tired of the endless media coverage 
regarding this debate. But they know as we do that we have a serious 
problem in our health care system that must be fixed. We on this side 
of the aisle are ready to deal with it.
  Simply put, health care reform is good medicine for America and good 
medicine for American businesses.
  The SPEAKER pro tempore. The time of the gentleman has expired.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. The Chair will remind both sides to heed the 
gavel.
  Mr. CAMP. Mr. Speaker, at this time I yield 45 seconds to a 
distinguished member of the Ways and Means Committee, the gentleman 
from Washington (Mr. Reichert).
  Mr. REICHERT. Mr. Speaker, the American people have spoken loud and 
clear. They don't want a government takeover of health care. The 
Democrats' latest plan is still a government takeover. Billions of 
dollars in new taxes on small businesses, over a trillion dollars in 
new spending, and it hurts our seniors and special-needs population by 
taxing hearing aids, pacemakers, wheelchairs.
  We've heard, ``If you like it, you can keep it.'' Not according to 
this President, who said recently, ``I think some of the provisions 
that got snuck in might have violated that pledge.''
  We need to start over, and today I stand with Americans who want the 
freedom to choose their own health care.
  Mr. LEVIN. I yield for the purpose for a unanimous consent request to 
the gentleman from North Carolina (Mr. Etheridge).
  (Mr. ETHERIDGE asked and was given permission to revise and extend 
his remarks.)
  Mr. ETHERIDGE. Mr. Speaker, I rise on behalf of a young man by the 
name of Will Privitt who tonight will be able to get insurance for the 
first time. He was born with a preexisting condition.
  Mr. Speaker, I rise today in support of health reform. I have said 
all along that there are several goals that our efforts must meet to 
improve security and stability for North Carolinians. We need to reform 
health insurance to reduce costs for people who have insurance and 
those who have been priced out of the market. We need to increase 
consumer choices and make sure that insurance companies do not deny 
coverage because of preexisting conditions or technicalities. We need 
to shore up Medicare to improve security for seniors, reducing costs 
for medications and eliminating copayments. We need to make insurance 
affordable for businesses, so that they are not faced with the choice 
of providing coverage for their employees or making payroll. Finally, 
we must put discipline back in the budget and bring down the budget 
deficit. I rise in support of H.R. 4872, the Health Care and Education 
Affordability Reconciliation Act of 2010 and H.R. 3590, the Patient 
Protection and Affordable Care Act because together they meet these 
goals.
  The working families of the Second District need solutions, not more 
fear, neither the real fears of rising cost nor the false fears spread 
by special interests. We cannot continue to allow the current system to 
kill jobs and bust the budgets of our families and our Nation. After 
reading the legislation carefully, I have concluded that it will save 
lives and save money. This is the best chance we have to reduce sky-
rocketing health care costs for North Carolina families.
  North Carolinians know that the current system is broken and that we 
need commonsense reform. For me, the effort to fix our health care 
system has always been about people not about politics. Our effort is 
about North Carolina families. We need reform for folks who are 
struggling with unbearable health care costs, rapidly rising premiums, 
bureaucratic meddling, and arbitrary denials of coverage and a system 
that is driving our Nation deeper and deeper into debt.
  Throughout this process, I have heard from thousands of folks from 
the main streets and country roads of North Carolina who are crying out 
for help. At numerous town hall meetings in North Carolina and over the 
telephone, as well as in other opportunities, I have spoken directly to 
North Carolinians. I read thousands of messages that come in by phone, 
email, fax, or letter every day. The vast majority say that change is 
needed.
  When North Carolina families are hurting, doing nothing really isn't 
an option for me. I have heard from thousands of my North Carolina 
neighbors who are suffering under the current system.
  Folks like a nurse from Sanford, North Carolina, who says that 
insurance industry bureaucrats are keeping her from providing her 
patients the care they need.
  Folks like a woman from Raleigh, who fears she will suffer the same 
fate as her sister who died from asthma because she could not get 
insurance coverage.
  Folks like a man from Louisburg, who cannot start a new business 
because he needs the insurance his current employer provides. His 
mother pleaded with me that they are not looking for a handout; just a 
fair playing field.
  Folks like a woman from Rocky Mount, who notes that the working poor, 
self-employed, part-time workers and others on the margins need relief. 
She called on me to not let the insurance companies win this time.
  These are the real people that convinced me that voting for these 
bills is the right thing to do. A lot of folks are afraid, both of the 
current system and of potential changes. Thousands of families without 
insurance, and individuals with pre-existing conditions, are an illness 
away from financial ruin. Reform needs to provide them security.
  Mr. Speaker, as we continue to address America's financial situation, 
health reform is absolutely necessary to get our economy growing again. 
This bill will reduce the stranglehold that insurance costs have on our 
small businesses and eliminate the threat of bankruptcy due to medical 
costs that hangs over so many North Carolina families. It will 
strengthen our rural communities, supporting the training of doctors 
and providing incentives for them to work in underserved areas. And the 
bill is fully paid for, so that not only will it bring down costs for 
individuals and businesses, but for the taxpayer and future 
generations.
  Mr. Speaker, making sure every American has access to affordable 
health insurance and high-quality health care is one of the most 
important challenges of our time. If we can afford to provide health 
care to Iraqi citizens, as we have over the past decade, we can afford 
a fiscally responsible reform that puts health care in reach for all 
Americans. The health reform debate is about saving money and saving 
lives. At its core, health reform is all about ensuring that American 
families and businesses have more choices, benefit from more 
competition, and have greater control over their own health care, while 
bringing down costs for individuals, our families and businesses, and 
for the Nation.
  These bills are fiscally responsible and will improve the health and 
health care of people across my district, North Carolina, and the 
country. I am pleased to be able to vote in favor of this historic 
legislation.
  The SPEAKER pro tempore. The gentleman from Michigan will be charged 
time.
  Mr. LEVIN. I yield to the gentleman from Pennsylvania (Mr. Fattah) 
for a unanimous consent request.
  (Mr. FATTAH asked and was given permission to revise and extend his 
remarks.)
  Mr. FATTAH. I rise in support of the health care reform bill in honor 
of a friend of mine, Linda Taylor, who died because of the lack of 
insurance in a breast cancer illness that she faced.
  The SPEAKER pro tempore. The gentleman from Michigan will be charged 
time consumed.
  Mr. LEVIN. I yield 45 seconds--I wish I could yield more--to our 
distinguished colleague from Maryland (Mr. Van Hollen).

[[Page H1870]]

  Mr. VAN HOLLEN. Mr. Speaker, they called it ``a dangerous device 
invented in Nazi Germany'' and a ``method of imposing Stalinism.'' 
Those were the statements made by the opponents of Medicare, Medicare 
that now provides health coverage to 45 million Americans.
  This legislation will ensure that 32 million more Americans have 
access to affordable health care and that no American is held hostage 
to the abusive practices of the insurance industry.
  As in 1965, we have the rhetoric of mass distortions. This morning, 
Republican Leader Boehner even said this bill means Armageddon. The day 
after this legislation is signed by President Obama, Americans will see 
the world is not coming to an end, that there are no death panels. They 
will begin to see a system that works for them, not the insurance 
industry who is spending millions of dollars to kill the bill.
  Mr. CAMP. At this time, Mr. Speaker, I yield 45 seconds to a 
distinguished member of the Ways and Means Committee, Dr. Boustany of 
Louisiana.
  Mr. BOUSTANY. Mr. Speaker, we all have compassion for families 
struggling, those who have lost jobs, those who lack access to health 
care. We all want to do what's right for our country. We all want to 
solve these problems. But as I look at this massive, complex and 
partisan bill, I see premiums continuing to rise for families and 
abject failure to control health care costs for families and 
businesses.
  I see huge tax increases coupled with irresponsible cuts to Medicare 
services, all to expand new coverage entitlements where physician 
access will worsen, continuing to burden our strapped emergency rooms.
  Mr. Speaker, frankly, I see a sequel to the modern Greek fiscal 
tragedy unfolding before us with a potential for default. We have a 
duty to reform health care, but an obligation to get it right.
  Mr. LEVIN. I now yield 45 seconds to a very senior member of our 
committee, Mr. McDermott of Washington.
  (Mr. McDERMOTT asked and was given permission to revise and extend 
his remarks.)
  Mr. McDERMOTT. Mr. Speaker, there are times in history that action is 
demanded. In 1935, we needed Social Security and unemployment 
insurance. The Democrats answered. In 1965, we needed health care for 
senior citizens. The Democrats answered. In 2010, the country needs 
health care reform, and the Democrats will answer tonight.
  It was never in doubt. Business wanted a change, the medical 
profession wanted a change, and labor wanted a change. And the 
Republicans brought an economic collapse to make it clear to everybody 
that we all are in danger if we don't change the health care system in 
this country.
  For me and many of my colleagues, passing a national health care 
reform bill is the culmination of a long process. In the late 1950s and 
early '60s, when I was going to medical school in Chicago, Canada's 
Tommy Douglas was beginning a national health care plan in the province 
of Saskatchewan. As I came to the end of my medical training, doctors 
began to strike in Canada because they didn't want to practice medicine 
under any system that was not totally free enterprise in nature. But as 
a new physician at the time, it seemed to me that the benefits of 
extending health coverage to everyone in Canada far outweighed the 
benefits of a free enterprise system. Between 1963 and 1970, while I 
got my training in adult and child psychiatry and served 2 years in the 
United States Navy, I had the opportunity to observe the American 
healthcare ``nonsystem'' firsthand. Every day, I watched as people fell 
through the cracks. When I entered politics in the Washington state 
legislature, I knew that it was my obligation to do all that I could to 
bring about a national system that would provide coverage for everyone. 
And during my campaign for governor in 1972, I made my first speech 
declaring my support for a single-payer system similar to Canada. Each 
year that I served in the state legislature, I faced the institutional 
resistance to the creation of a more orderly system. Yet people 
complained they couldn't get care. Hospitals complained about 
uncompensated care. People complained about cost shifting of the 
expenses of the uninsured onto the policies paid for by the insured.
  In the early 1980s, I began trying to establish an uncompensated care 
fund that would be paid into by all hospitals and the receipts would be 
given to those hospitals that took care of those in the community who 
had no health insurance. But hospitals resisted. I did a study to find 
out how many people in the state of Washington either were not covered 
by a government program or didn't have insurance through their 
employment. Unsurprisingly, we found that it was a huge number. So in 
1983, I began the process of trying to do in Washington State what 
Tommy Douglas had done a few hundred miles away in the province of 
Saskatchewan.
  As I tried to get universal coverage in the state of Washington, I 
ran into numerous obstacles. The medical establishment was more 
interested in capital investments than they were in ensuring that 
medical coverage was available to everyone in Washington. Large 
businesses were reluctant to accept any responsibility beyond what they 
were already doing for their employees. Any mandate was out of the 
question because under a technical loophole, big employers are exempt 
from many regulations that deal with insurance. So instead, I ended up 
authoring the Washington State Basic Health Plan, which is a subsidized 
health insurance program to help lower-income families afford coverage. 
But I wasn't able to get universal coverage.
  This experience taught me that it was going to be incredibly 
difficult to create a health care plan in one state that could be 
replicated across the country as had been done in Canada. I wrote the 
plan originally when the governor of the state of Washington was a 
Republican, so it didn't get anywhere until Democrat Booth Gardner was 
elected governor of Washington in 1984. The process was so frustrating 
and the final legislation so modest that I decided I'd go back to 
medicine. I went to work for the State Department in Africa, where I 
saw the beginnings of the AIDS epidemic in 1987.
  One day my brother called me when I was in Africa and told me there 
was a seat open in Congress. He suggested that I return to the U.S. to 
run for the seat and work on getting universal health care. The dream 
was not dead, it has just been dormant. So I returned, ran for Congress 
and was elected in 1988. I made the decision to get on the Ways and 
Means Committee because I thought that was where I could be most 
effective in getting a national plan established. I was appointed to 
the committee in 1991 and began working with 95 other members who were 
dedicated to a single player plan. In 1993 President and Mrs. Clinton 
came to Washington to enact a national health plan, but we were 
unsuccessful.
  The years between 1994 and 2006 were a painful period as we watched 
Republicans try to dismantle the only national health care program we 
have, Medicare. We breathed a great sigh of relief at the 2008 election 
of President Barack Obama, who stated that he wanted to enact a 
national health plan. The President was determined not to repeat the 
errors of the Clinton administration, and the process of writing the 
bill has been long and tortuous. Over the course of many months, we've 
watched this bill wind through three committees in the House and two 
committees in the Senate, which brought us to where we are today.
  I still believe that a single-payer model is the most effective to 
achieve both cost control and universal coverage. But 40 years of 
experience prevent me from being ideological about the solution to the 
problems of universal coverage. Rather than establishing a single-payer 
system, Congress has designed a less desirable model that would more 
tightly regulate private insurance companies much in the same way that 
we do with utility companies. Members of Congress have opted for a 
model that provides for insurance regulation at the national level, 
rather than the state level as it is today. It has much in common with 
the French system which provides universal coverage to the French 
people at half the cost of what we spend here in the United States. 
Their system provides a quality of care that is considered the best in 
the world according to the World Health Organization.
  I know that this bill is far from perfect and will require continued 
efforts to adjust and improve it in the years to come. But today we 
began. As the Chinese adage says, ``every journey of 1,000 miles begins 
with a single step.'' Today we have taken that step.
  Mr. CAMP. Mr. Speaker, I yield 45 seconds to a distinguished member 
of the Ways and Means Committee, the gentleman from Nevada (Mr. 
Heller).
  Mr. HELLER. I thank the gentleman for yielding.
  Thousands of Nevadans have been surveyed and an overwhelming number 
oppose the government takeover of health care. Yet two-thirds of 
Nevada's delegation will defy their constituents and vote with their 
leadership instead.
  This $2.6 trillion legislation will raise Nevada taxes, kill Nevada 
jobs, remove Nevada seniors from Medicare, and saddle the State of 
Nevada with budget-busting mandates. I urge my colleagues from Nevada 
to speak for Nevada--not their Beltway benefactors--when casting their 
vote today.

[[Page H1871]]

  Mr. LEVIN. I now yield 45 seconds to the gentleman from Oregon, a 
member of the committee, Mr. Blumenauer.
  Mr. BLUMENAUER. Today's victory for health care reform and coverage 
for 32 million Americans is not just the culmination of 15 months of 
hard work in this Congress. It represents the historic accomplishments 
sought by Presidents and Members of Congress dating back to Teddy 
Roosevelt. That the accomplishment was achieved in the midst of 
difficult economic times, a toxic political environment without any 
bipartisan support, makes it all the more remarkable.
  Passage tonight will start making a difference for our families this 
year and, most important, the bill is fully paid for. We're reforming 
Medicare, we improve the quality of health care in this country and 
reduce the deficit. Tonight's victory starts America on the road to 
better health and economic security.
  Mr. CAMP. Mr. Speaker, before I yield, I would like to remind the 
Chair that Medicare and Social Security passed with large bipartisan 
majorities.
  With that, I yield 45 seconds to the distinguished member of the Ways 
and Means Committee, the gentleman from Illinois (Mr. Roskam).
  Mr. ROSKAM. I thank the gentleman for yielding.
  Mr. Speaker, just because it's historic doesn't mean it's good. I 
think we've got to be reminded of that. I think back to history for 
something that actually was good, and that was when Alexander Hamilton 
said regarding our Constitution, ``Here, sir, the people govern.''
  We would be wise to listen to the American people. The American 
people have said ``no'' to the ABCs of PelosiCare. They have said 
``no'' to the arrogance of this bill. They have said ``no'' to the 
budget-busting nature of this bill. And they have said ``no'' to the 
crippling of the economy of this bill.
  In Illinois, a manufacturer called Caterpillar said that next year 
alone it will cost the company a hundred million dollars. What does 
that do to a State that is left roughshod by overpromises and 
underdelivering on a stimulus that failed?
  The SPEAKER pro tempore. The Chair will note that the time of the 
gentleman from Michigan (Mr. Camp) has expired. The gentleman from 
Michigan (Mr. Levin) has 1\1/2\ minutes remaining.
  Mr. LEVIN. I now yield 45 seconds to the distinguished gentleman from 
Illinois (Mr. Davis).
  (Mr. DAVIS of Illinois asked and was given permission to revise and 
extend his remarks.)
  Mr. DAVIS of Illinois. Mr. Speaker, as I was growing up, our parents 
always taught us that right was right if nobody was right and that 
wrong was wrong if everybody was wrong. Well, I can tell you it would 
be wrong to deny 32 million additional Americans the right to health 
insurance coverage. It would be wrong to keep people cooped up in 
institutions when they could live at home. It would be wrong to keep 
senior citizens struggling to try and pay for their prescriptions.
  Let's do the right thing. Let's vote for this legislation. Give 32 
million people the right to have insurance coverage. Let's do the right 
thing.
  Mr. Speaker, when I was growing up my parents taught us that right 
was right if nobody was right and that wrong is wrong is everybody is 
wrong. It would be wrong to deny 32 million people health insurance 
coverage. It would be wrong to deny millions of people with pre-
existing conditions the right to have insurance coverage.
  It would be wrong to keep filling up the emergency rooms of hospitals 
because people don't have regular doctors. It would be wrong to keep 
senior citizens struggling to pay for their prescriptions. It would be 
wrong to keep people with disabilities cooped up in institutions when 
they could live at home. It would be wrong to deny people health 
coverage because they have lost their jobs. It would be wrong to deny 
health coverage to people who work in small businesses.
  It is right to provide coverage to as many people as we can. It is 
right to reduce the deficit and save as much money as we can. It is 
right to save lives. It is right to do the right thing. It is right to 
vote to pass this bill and provide health coverage for 32 million 
additional Americans.
  It is right to do the right thing.
  Mr. LEVIN. I now yield to the gentlelady from New York for a 
unanimous consent request.
  (Mrs. MALONEY asked and was given permission to revise and extend her 
remarks.)
  Mrs. MALONEY. I thank the gentleman for yielding and for his 
leadership.
  I rise in support of the health care bill.
  Mr. Speaker, this is an historic vote. With passage of these health 
care reforms, 32 million people without insurance will get it--
including almost 2.5 million uninsured in New York State.
  It will end discrimination for preexisting conditions, make progress 
on cutting high medical costs, and reduce the deficit by over $1 
trillion over the next two decades.
  This package of reforms that will make a real difference in the lives 
of Americans, over their entire lives:
  If you're 21 and just graduating college, you'll now be included on 
your parents' coverage until your 26th birthday.
  If you're self-employed in your thirties or forties, you'll be able 
to shop for more affordable coverage on exchanges set up by states or 
the Federal Government.
  If you're 56 and have taken early retirement, you can continue to be 
covered under your employer's plan until you sign up for Medicare.
  And if you're a senior with Medicare Part D Drug Coverage, the so-
called ``donut hole'' has been closed.
  The Senate version penalized states like New York which were already 
doing more than most to provide care to the needy. And that's one of 
the things this House is fixing.
  The impact on the New York State Medicaid budget went from a 
projected increased cost of over $700 million to increased aid of $1.3 
billion in just the first year. That's a ``swing'' of over $2 billion.
  Finally, these reforms will do more for women's health despite the 
restrictive language on reproductive health services contained within 
the Senate bill--than any other legislation in my career.
  I am grateful for the opportunity to be a part of this momentous 
reform and urge my colleagues to remember that today we will make a 
lasting difference in people's lives. Today we change the overall 
health of our Nation.
  Mr. LEVIN. I yield to the gentleman from Minnesota for a unanimous 
consent request.
  (Mr. ELLISON asked and was given permission to revise and extend his 
remarks.)
  Mr. ELLISON. I rise in support of universal health care.
  Mr. Speaker, there was a time in our country's past that the 
enactment of a comprehensive civil rights law was deemed merely a 
dream.
  There was a time in our country's past that enactment of Social 
Security to guarantee the retirement security of our seniors was deemed 
merely a dream.
  There was a time in our country's past that enactment of the Medicare 
law to guarantee the health care for our nation's senior was deemed 
merely a dream.
  We now take all three--civil rights, retirement security for our 
seniors and health security--for granted in our society.
  They are all assumed as a given and as a right in our society.
  Well, Mr. Speaker, I believe when we leave this chamber tonight after 
passing this health care bill, we will forget how hard it was to pass 
this bill. And in another generation, our grandchildren will also 
assume that universal health care is a right and a given in any modern 
society.
  Mr. Speaker, tonight marks the beginning of the dream of universal 
health care becoming a reality in our society.
  It is an important beginning--
  When 40,500 uninsured Fifth District residents will have access 
health care coverage to health insurance.
  When 9,700 Fifth District residents with pre-existing conditions can 
no longer be denied coverage.
  When 57,000 Fifth District young adults can obtain coverage on their 
parents' insurance plans.
  When insurance coverage for 358,000 Fifth District residents is 
improved--and when the cost of uncompensated care for hospitals and 
other health care providers is reduced by $101 million--that is 
positive change.
  And when thirty-two million more Americans have health insurance it 
is a good beginning. At the same time, when $1.3 trillion in deficit 
spending (accumulated over the past eight years) is reduced, it is a 
good start.
  I look forward to enthusiastically casting my ``yes'' vote tonight 
for this historic legislation.
  Mr. LEVIN. I yield to the gentlelady from California for a unanimous 
consent request.
  (Ms. RICHARDSON asked and was given permission to revise and extend 
her remarks.)

[[Page H1872]]

  Ms. RICHARDSON. I rise in support of this health care reform 
legislation.

                              {time}  2030

  Mr. LEVIN. I now yield the balance of my time, 45 seconds, to the 
very distinguished gentlewoman from Florida (Ms. Wasserman Schultz).
  Ms. WASSERMAN SCHULTZ. Mr. Speaker, I rise today to cast my vote to 
end abusive insurance company practices that put doctors and patients 
in control of their health care.
  And when I do, I will cast it for the small business owner in my 
district whose health insurance premiums shot up more than 100 percent 
last year simply because one employee got sick. I will cast it for the 
135,000 people in my district who don't have health care coverage. On a 
personal note, I will cast it for the 2.5 million breast cancer 
survivors like me, who have a preexisting condition that make it next 
to impossible to obtain health insurance.
  Finally, I'll cast it for all of the moms in America with beautiful 
children like mine, but who don't have the security of health insurance 
and who die inside every time their child gets sick. Our current system 
is broken. It's un-American. The nightmare ends tonight.
  The SPEAKER pro tempore. All time has expired.
  The gentleman from California (Mr. George Miller) is recognized for 
15 minutes as a designee of the majority leader.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield 2 minutes to 
the gentleman from New Jersey (Mr. Andrews), a member of the committee.
  (Mr. ANDREWS asked and was given permission to revise and extend his 
remarks.)
  Mr. ANDREWS. I thank my chairman for yielding.
  Mr. Speaker, the ladies and gentlemen of the House should respect our 
constituents who are against the bill, who are for the bill, and those 
who are undecided; but we should respect them enough to give them an 
accurate record of what's in the bill, and I think it's time for some 
accuracy.
  We have heard repeatedly tonight that there are cuts to Medicare in 
this bill. There is not one cut to not one beneficiary anywhere in this 
bill. Medicare benefits expand for prescription drugs and expand for 
preventive care. We heard someone say that the bill increases premiums 
for Americans.
  Section 1001 of the reconciliation bill says that for a family making 
$45,000 a year, if you look at their premiums, their copays and their 
deductibles, which is what real people have to do, the bill saves them 
$7,000 a year. We have heard that the special interest provisions, that 
I think are an abomination, are in the bill. They are not. If you read 
section 1201 of the reconciliation bill, it says goodbye to the so-
called Cornhusker kickback and other special interest provisions.
  We heard that there is taxpayer funding for abortions. Read section 
10,104 of the underlying bill. There isn't. We have heard that this is 
going to add to the deficit and the debt of the country. Don't listen 
to what the Democrats say. Don't listen to what the Republicans say. 
Listen to what the nonpartisan Congressional Budget Office says, which 
is this: the bill will save $138 billion off the deficit in the first 
10 years and $1.2 trillion off the deficit in the next 10 years.
  Finally, we hear the bill will kill jobs. When the Clinton economic 
plan was on this floor, a gentleman named Dick Armey, a leader of the 
anti-movement on this bill, said it would be ``a recipe for disaster.'' 
He was wrong. That bill created 23 million new jobs and we should 
vote----
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. GEORGE MILLER of California. I yield the gentleman 15 additional 
seconds.
  Mr. ANDREWS. Finally, I heard one of our colleagues say this bill 
will create a socialist utopia. No, Mr. Speaker, it won't. It will 
create a decent society that every man, woman, and child in this 
society and this country so richly deserves. Vote ``yes'' on this bill.
  The SPEAKER pro tempore. The gentleman from Minnesota (Mr. Kline) is 
recognized for 8 minutes as a designee of the minority leader.
  Mr. KLINE of Minnesota. Mr. Speaker, I yield myself 1\1/2\ minutes.
  I came to Congress 7 years ago to do my part to make this country 
better. Every vote I cast and every policy I help shape must be judged 
by whether it achieves what my constituents sent me here to accomplish. 
As each Member of this, the people's House, prepares to vote ``yea'' or 
``nay'' tonight, we should all take a moment to remind ourselves of why 
we are here.
  Our job is to ensure American employers have the tools and the 
freedom they need to sustain jobs and create jobs. Instead, this bill 
will destroy jobs at a time when we need them the most.
  Our job is to ensure freedom, security and prosperity for future 
generations. Instead, this bill will be paid for by our children and 
our grandchildren and our great grandchildren. Our job is to legislate 
openly with integrity and fairness. Instead, this bill is full of back-
room deals negotiated behind closed doors.
  This bill is not what the American people want. They are imploring us 
to start over with reforms that will bring down health care costs while 
preserving the relationship between patients and their doctors. This is 
our last chance to stand up for the people who sent us here and display 
the courage to prove that we can do better.
  I reserve the balance of my time.
  Mr. GEORGE MILLER of California. I yield 1 minute to the gentleman 
from Connecticut (Mr. Courtney), a member of the committee.
  Mr. COURTNEY. Mr. Speaker, tonight we are going to answer a question 
which the tea party on the right to reformers on the left ask 
constantly, which is, Why can't the American people have access to the 
same type of benefit that Members of Congress have?
  It's a good question. Some of the most hysterical voices in 
opposition have access to a purchasing exchange through the Federal 
employee benefits plan that has comprehensive benefits, choice, no 
rescissions, no lifetime caps. And this bill is going to give the 
American people exactly what Members of Congress have. And in case 
there is any question about that, section 1312 will make sure that 
starting in 2014, Members of Congress have to use exactly the same 
purchasing exchange that the American people will have to use.
  No more haves and have-nots. No more tax-paying Americans who don't 
have health insurance, underwriting the health benefits of Members of 
Congress who would deny them access to quality, affordable health care. 
It is time to answer that question tonight in the affirmative by 
passing this legislation.
  Mr. KLINE of Minnesota. Mr. Speaker, I am pleased to yield 2 minutes 
to the gentleman from Georgia, the ranking member of the Health, 
Employment, Labor, and Pensions Subcommittee, Dr. Price.
  Mr. PRICE of Georgia. Mr. Speaker, health care decisions that we make 
for ourselves and for our families are some of the most important and 
personal in our lives. As a physician, early in my career of caring for 
tens of thousands of patients, I recognized that there were more folks 
in Washington who affected what I could do for and with my patients 
than anybody I ever met in residency or in medical school and that that 
was wrong.
  Health care, taking care of people, is a moral endeavor and should be 
grounded in principle. And if the principles that we hold dear for 
health care are applied to this debate and to this bill, the picture is 
not pretty: accessibility, being able to receive care; affordability, 
being able to afford care; quality, receiving the best care available; 
responsiveness, having a system that works for patients; and 
innovation, being certain that we have the newest and the best 
treatments and choices, patients being able to choose their physicians 
and how and where they are treated.
  All of these are harmed by this bill. All of these principles are 
violated. None of these principles are improved by the further 
intervention of the Federal Government.
  So you see, Mr. Speaker, mostly this is bad for patients, for all 
Americans. The trust that is necessary between caregiver and care 
receiver, between patients and their doctors, to believe that your 
health is not being undermined by the system will be permanently 
eroded, permanently damaged; and it is that trust that is the 
foundation of the morality of health care.
  So this is a sad day, yes, because there are so many wonderful and 
positive and patient-centered solutions

[[Page H1873]]

that we could have enacted. You see, we trust patients and families. 
They trust government.
  As a physician, I know that when patients and their families and 
their doctors are not allowed to decide what they receive, we lose more 
than our health care system. We lose our morality. We lose our freedom.
  The positive vote, the patient-centered vote, the bipartisan vote on 
this bill is a ``no.''
  Mr. GEORGE MILLER of California. I yield 1 minute to the gentlewoman 
from California (Ms. Woolsey), a member of the committee.
  Ms. WOOLSEY. Mr. Speaker, the whole Nation desperately needs health 
care reform, but no group of Americans needs it more than women who 
face discrimination and insult at the hand of the broken status quo 
every single day. We all know that the current system allows insurance 
companies to deny coverage based on preexisting conditions.
  But I wonder how many of my colleagues realize that essentially being 
a woman is a preexisting condition. Pregnancy, for example, or C-
sections, can be deemed preexisting conditions. Most unbelievable of 
all, insurance companies can legally turn their backs on women who 
suffered injuries due to domestic violence because that, too, can be 
defined as a preexisting condition. We should all be ashamed of a 
system that puts healthy insurance company profits ahead of healthy 
American women.
  This weekend, today, tonight, we will make history by passing a 
health care bill that will correct these injustices, and no longer will 
female be considered a preexisting condition.
  Mr. KLINE of Minnesota. Mr. Speaker, at this time it is my pleasure 
to yield 2 minutes to the gentleman from Kentucky, the ranking member 
of the Higher Education, Lifelong Learning, and Competitiveness 
subcommittee, Mr. Guthrie.
  Mr. GUTHRIE. Mr. Speaker, I have always liked to describe the process 
I have seen in the last few weeks of trying to put a bill together like 
putting a puzzle together, but forcing pieces together and trying to 
make them fit. And in the end, the puzzle doesn't have a complete 
picture. And one of the pieces they are trying to make fit to keep this 
under $1 trillion, is what the score is; but what we are not mentioning 
is the incredible unfunded mandate that we were placing on our States.
  Just a couple of years ago I was a State senator. And tonight, State 
senators in Kentucky, my former colleagues, are meeting together to try 
to close a billion-dollar budget gap. And what does this bill do? This 
bill puts a $30 billion unfunded mandate by CBO estimates onto our 
States.
  To the south of Kentucky, Phil Bredesen, a very respected Democratic 
Governor of Tennessee, says this is the mother of all unfunded 
mandates. And just to the north of me in Indiana, Governor Mitch 
Daniels said a half a million more Hoosiers will be on Medicaid, 
costing the State taxpayers billions of dollars.
  It's going to cost my State, according to the Heritage Foundation, 
$303 million from 2014 to 2019. So that's what our next budget session-
mates will be budgeting for 2014. So the State legislators tonight who 
are hoping the economy will turn around, maybe there will be a light at 
the end of the tunnel, are now having to deal with the $303 million 
freight train that's the light at the end of that tunnel.
  But on top of that, this proposed bill also takes student loan money 
to finance this bill. The government has taken over the student loan 
business; they have lower interest rates. Instead of lowering the rate 
our students are going to be paying back on our interest, we are going 
to take part of that money and fund this bill on the backs of our 
students.
  Mr. Speaker, it's unfair to put these burdens on our States and on 
our students.
  Mr. GEORGE MILLER of California. I yield 1 minute to the gentleman 
from Arizona (Mr. Grijalva), a member of the committee.
  Mr. GRIJALVA. Mr. Speaker, today I rise in full support of the 
legislation to reform health care before us. It is, indeed, a historic 
opportunity for the American people to begin the necessary process of 
fixing a failing and broken health care system that is costly and 
denies basic health care to many, to 48 million Americans in this 
country.
  It is also a tremendous building block for the care of people in this 
country in the future and to begin to rein in the greed of private 
insurance companies that continue to raise premiums at the expense of 
the American people. This legislation has very good aspects in it. One 
of them is, finally, after 10 years of neglect by a Republican majority 
and administration, Indian health care is part of this legislation, and 
this health care brings necessary and increased resources to Indian 
Country.
  We begin to deal with health disparities in this legislation, which 
we have not done in the past. I am proud to support this legislation. 
It is not just a step forward; it is a historic leap into bringing to 
the American people a necessary reality, which is health care.
  The SPEAKER pro tempore. The time of the gentleman has expired.

                              {time}  2045

  Mr. KLINE of Minnesota. Mr. Speaker, could I inquire as to the time?
  The SPEAKER pro tempore. The gentleman from California has 9\3/4\ 
minutes remaining. The gentleman from Minnesota has 3 minutes 
remaining.
  Mr. KLINE of Minnesota. Mr. Speaker, then at this time I am pleased 
to yield 1 minute to the gentlewoman from Illinois, a senior member of 
the Education and Labor Committee, Mrs. Biggert.
  Mrs. BIGGERT. Mr. Speaker, I rise today deeply troubled, not just by 
this bill, but by the historic opportunity this body has squandered. We 
had so long to get this right, so many chances to take a step back and 
listen, really listen, to what the American people were asking us.
  Instead, true leadership was cast aside in favor of backroom deals, 
partisan games, and legislative gimmicks. The best intentions on both 
sides of the aisle never had a chance to turn good ideas into great 
policy, and we were left with a bill that is so poorly crafted that we 
are voting to overhaul it the same day it is going to the President.
  But the American people still have a choice. It is not between this 
partisan bill and nothing. We can work together to deliver the 
commonsense reforms that the American people want.
  Mr. Speaker, I know many colleagues have been struggling with this 
vote. I urge them to vote ``no'' and work with us to pass reforms we 
can all be proud of, that we can all vote for.
  Mr. Speaker, I vote ``no.''
  Mr. GEORGE MILLER of California. I yield 1 minute to the gentlewoman 
from California (Ms. Shea-Porter).
  Ms. SHEA-PORTER. Tonight I vote for the middle class.
  I have heard the desperation of parents whose kids were kicked off 
their plan before they even had a job. This bill allows 30 percent of 
young Americans currently without coverage to stay on their parents' 
plans until age 26.
  I have listened as New Hampshire small business owners told me they 
were embarrassed they could no longer insure faithful employees. This 
bill is their remedy.
  I heard those who lost homes because they got sick or hurt, lost 
their insurance, and then could not pay medical bills. I listened as 
hospitals discussed the uninsured's costs to New Hampshire taxpayers. 
Here is the cure.
  For the late Donald Long of Raymond, who told me he paid $500 for 
prescriptions every 3 months because of the doughnut hole, thank you. I 
heard you and all seniors.
  I heard Sandra Gagnon of Manchester, who has a chronically ill 
daughter. Now, no more preexisting exclusions.
  For the families in New Hampshire and across America, I vote ``yes'' 
for you.
  Mr. KLINE of Minnesota. Mr. Speaker, I yield myself the balance of my 
time.
  The SPEAKER pro tempore. The gentleman is recognized for 2 minutes.
  Mr. KLINE of Minnesota. Mr. Speaker, earlier this month President 
Obama said, ``Everything there is to say about health care has been 
said, and just about everyone has said it.''
  Perhaps he is right. Perhaps everyone in Washington has said all 
there is to say. The lines have been drawn, and the number of undecided 
votes is dwindling. But perhaps it is time for Washington to stop 
talking and start listening.

[[Page H1874]]

  I am listening to the calls coming into my office, 13-1 against this 
legislation. I am listening to residents of Minnesota's Second 
Congressional District, who told me during a town hall last week 72 
percent of them are opposed to this bill. I am listening to small 
business owners in my State and around this Nation who are paralyzed by 
the fear of new mandates, job-killing taxes, crushing Federal deficits, 
and more government control.
  I am listening to the thousands of citizens who traveled to our 
Nation's capital this weekend to tell us in no uncertain terms they 
want us to kill the bill. I am listening, and what I am hearing is the 
American people shouting ``stop.''
  They want us to start over. They want health care reform we can 
afford. They want reform that will bring down costs without sacrificing 
quality or personal freedom. Mr. Speaker, they want us to say ``no'' to 
this bill today so we can come back and do better tomorrow.
  There is no question that there are Members in this body, Republicans 
and Democrats, who are ready to go to work on a much improved bill.
  The die has not yet been cast. It is not too late. I urge my 
colleagues: Listen to the American people. Vote ``no.'' Vote ``no.''
  I yield back the balance of my time.
  Mr. GEORGE MILLER of California. I recognize the gentlewoman from 
Nevada (Ms. Titus), a member of the committee, for 1 minute.
  Ms. TITUS. For over 1 year, I have listened to the voices of District 
3 and heard heartbreaking stories of children denied coverage because 
of a preexisting condition, small business owners who can't afford to 
insure their employees, and single moms who have lost their jobs and 
their insurance. They are the reasons I am voting for reform.
  In District 3 alone, reform will improve coverage for more than 
600,000 people. It will strengthen Medicare for 120,000 seniors and 
close the prescription drug doughnut hole. It will create health care 
tax breaks for over 200,000 families and 17,000 small businesses, and 
lets 72,000 young adults stay on their parents' policy.
  Insurance companies and others opposed to reform have spent over $1.3 
million in southern Nevada, but I won't be intimidated. Today, as I 
have always done, I am standing up for what I believe is in the best 
interest of my constituents. As has been said, it is the price of 
leadership to do the thing you believe has to be done at the time it 
must be done. Now is the time to get it done and pass health care 
reform.
  The SPEAKER pro tempore (Mr. Pastor of Arizona). The gentleman from 
Wisconsin (Mr. Ryan) is recognized for 10 minutes as a designee of the 
minority leader.
  Mr. RYAN of Wisconsin. I reserve the balance of my time.
  Mr. GEORGE MILLER of California. I yield 1 minute to the gentleman 
from Texas (Mr. Hinojosa), the Chair of the Higher Ed Subcommittee.
  Mr. HINOJOSA. Mr. Speaker, I rise today in full support of this 
reconciliation legislation, to say that we have an extraordinary 
opportunity today to improve the quality of life for millions of 
Americans, for the 32 million children and families who are uninsured, 
and for students and workers who dream of pursuing higher education and 
acquiring the skills needed to access 21st century jobs.
  As subcommittee chair for Higher Education, I am proud to say that 
today Congress will invest billions of dollars to increase 
accessibility and affordability in higher education for our Nation's 
students and workers. This landmark legislation provides $36 billion in 
Pell Grant scholarships over 10 years. It provides $2 billion of moneys 
for our Nation's community colleges, and $2.55 billion for our 
minority-serving institutions of higher learning, including HSIs and 
HBCUs. By moving to the Federal Government's direct loan program, we 
will put the best interests of students first and make college loans 
more reliable and affordable for students and families.
  Mr. GEORGE MILLER of California. I yield 1 minute to the gentleman 
from Massachusetts (Mr. Tierney), a member of the committee.
  Mr. TIERNEY. Mr. Speaker, today is an opportunity for this body to 
stand up for middle class families and small businesses.
  Today, by passing this bill, no family will have to worry that their 
20-something-year-old child will have a serious condition and not be 
covered or ever be refused coverage in their lifetime due to a 
preexisting condition. Insurance companies will no longer be able to 
limit coverage annually or over a lifetime just when serious conditions 
require care. They won't be able to rescind coverage in the middle of 
cancer or diabetes care, and they will have to spend a reasonable 
portion of premium dollars on actual health services.
  We will be able to see our seniors affording both their groceries and 
their prescription medicines because we will close the so-called 
doughnut hole in their current coverage, and we will extend the life of 
Medicare for 9 years even as we improve its coverage.
  Small business employers and employees will be better able to afford 
health care and will pay less in administrative costs while having the 
choices large companies and Federal employees have now.
  All this, Mr. Speaker, and we will be making the largest pay-down on 
the Federal deficit in quite some time, reducing our debt by over $1 
trillion in the next two decades.
  No bill is perfect, but this bill is an enormous improvement of the 
status quo.


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore. The Speaker would remind Members to heed the 
gavel at the expiration of their time.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield for the 
purposes of a unanimous consent request to the gentlewoman from the 
District of Columbia (Ms. Norton).
  (Ms. NORTON asked and was given permission to revise and extend her 
remarks.)
  Ms. NORTON. For the tax-paying residents of the District of Columbia, 
I rise in strong support of the health care reform bill before us 
today.
  Mr. Speaker, if I could cast a vote on behalf of the residents of the 
District of Columbia, on final passage of the health care bill before 
us today, I would cast a critical ``aye.'' Unfortunately, however, the 
D.C. Voting Rights Act, like most bills this year, is in line behind 
health care reform. Fortunately for me, however, the most important 
point of contribution to a bill is usually not when the work is done, 
and all that needs to be done is to register your vote for the 
majority. The most critical point in this legislation was when it was 
being crafted. I believe that the many hours I have put into the health 
care bill to ensure that it served D.C. residents have been more than 
worth it. For example, beyond the many benefits for all Americans in 
the bill, D.C. will be relieved of the $50 million it has generously 
used to fund its D.C. Health Alliance for people who do not qualify for 
Medicaid, but cannot afford health insurance, a cost seldom picked up 
by other states.
  Mr. Speaker, this bill specifically benefits my constituents in many 
ways, particularly the following:
  For the 62 percent of D.C. residents who already have private health 
insurance, but are facing soaring insurance costs and could be dropped 
at the whim of an insurance company, the bill will reign in insurance 
costs by restricting administrative expenses, profits, and overhead; 
prohibit insurance companies from denying coverage based on pre-
existing conditions; prohibit annual and lifetime benefit caps; and 
prohibit insurance companies from dropping coverage when a person 
becomes sick.
  For the 134,000 uninsured families and 17,300 small businesses, the 
bill will provide tax credits to buy affordable insurance at group 
rates through the new health insurance exchanges that will be 
established, or for individuals with incomes below 133 percent of the 
poverty line, through expansion of Medicaid.
  For the 75,000 seniors receiving Medicare, the bill will add free 
preventative and wellness care, improve primary, coordinated, and 
nursing home care, and provide a $250 rebate this year and 50 percent 
discounts on brand name drugs beginning next year to the 3,300 seniors 
who have fallen through the donut hole and are forced to pay the full 
cost of prescription drugs, while closing the hole within 10 years.
  For 67,000 young adults in the District, the bill will allow them to 
stay on their parents' plan until age 26 and allow them to purchase 
affordable policies until age 30.
  For the 5,600 D.C. individuals with pre-existing conditions, the bill 
will ensure they are not denied affordable coverage.
  Families who purchase insurance through the health insurance exchange 
or are insured by small businesses will no longer face bankruptcy due 
to health care costs not covered by insurance, because the bill will 
cap out-of-pocket costs at $6,200 for individuals and $12,400 for 
families.

[[Page H1875]]

  For District of Columbia health care providers, the bill will provide 
up to $54.6 million for 42 D.C. community health centers, and will 
reduce the burden on uncompensated care by $69 million at the 
District's hospitals and other health care facilities.
  I am particularly pleased about the benefits that will be available 
to my constituents as soon as the bill is signed. For individuals, 
there will be coverage for early retirees, 55-64; coverage for young 
adults up to age 26 on parents' policies; preventative care for those 
receiving Medicare and for others, now under private plans; first steps 
to close the donut hole, coverage for residents with pre-existing 
conditions; and tax credits for small business employees. For many of 
my constituents, the elimination of abuses will be the most important 
parts of the bill, including no more cancellation of policies when 
residents get sick; no discrimination against children with preexisting 
conditions; no lifetime coverage limits; no annual limits on new plans; 
and requiring 80 percent of premiums for individuals and small groups, 
and 85 percent of large plan premiums, to be spent on the insured. 
Other critical provisions that will benefit many D.C. residents are the 
funds to double the number of patients the city's 42 community health 
centers can accommodate, and funding for training more primary care 
doctors.
  The SPEAKER pro tempore. The gentleman will be charged time.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield for the 
purposes of a unanimous consent request to the gentlewoman from 
California (Ms. Zoe Lofgren).
  (Ms. ZOE LOFGREN of California asked and was given permission to 
revise and extend her remarks.)
  Ms. ZOE LOFGREN of California. Mr. Speaker, I rise in support of the 
bill.
  I'm proud to stand on the floor of the House of Representatives today 
to cast my yes vote for this historic bill. I vote yes for the nearly 
50,000 currently uninsured residents of the 16th California 
Congressional District who will now be eligible for health insurance. I 
vote yes for the 6,000 seniors in my district who will no longer be 
subject to the donut hole in Medicare Part D. I vote yes for the 55,000 
young adults in the 16th District who will now be able to extend their 
coverage under their parent's existing insurance. I vote yes for the 
roughly 15,000 small businesses in the 16th District who will be able 
to extend coverage to their employees because of the tax credits in 
this bill. I vote yes for the 800 families in the 16th District who 
every year are forced to file for bankruptcy due to medical bills. I 
vote yes because this legislation will reduce the deficit by $130 
billion over the next 10 years and by some $1.3 trillion over the 
second decade. Simply put, I vote yes because it is the right thing to 
do and because my constituents overwhelmingly demand it.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield for the 
purposes of a unanimous consent request to the gentleman from 
California (Mr. Schiff).
  (Mr. SCHIFF asked and was given permission to revise and extend his 
remarks.)
  Mr. SCHIFF. Mr. Speaker, I rise in support of this historic health 
care reform legislation.
  Two years ago, during a telephone townhall with my constituents, one 
of my neighbors in Burbank told me that her young daughter had become 
ill. Our children played together in preschool, and they lived just a 
few doors down. When her daughter became sick, they were able to get 
her the health care she needed through a program called Healthy 
Families. She was now, thankfully, all better.
  But now, my constituent told me, she herself was ill. She and her 
husband were both self-employed and could not afford health insurance, 
and she was scared to death to get her illness treated at the emergency 
room. Her question to me that night was: ``Is there any hope for 
families like mine?''
  The answer tonight is ``yes.'' There is now hope for millions of 
self-employed Americans who cannot afford health care, and millions 
more who are small business people struggling to provide health care 
for themselves and their employees. And there is hope for millions of 
others who have pre-existing conditions and cannot obtain health 
insurance. And for millions of seniors who have fallen through the 
donut hole in their prescription drug coverage. Because tonight's bill 
will address the needs of each and every one of these Americans who are 
struggling to afford the coverage they have, or find health insurance 
when they are without.
  Our health insurance system is intrinsically linked to our Nation's 
and California's economic recovery. There are now more than 30 million 
American citizens who do not have health insurance coverage, and every 
day, 14,000 Americans lose their coverage. In fact, Californians are 
more likely to be uninsured than most Americans--over 7 million 
Californians are uninsured this year.
  Millions of Americans now receive their care at the emergency room, 
and millions more must make the difficult choice of whether to pay 
their medical bills or pay their mortgage because they cannot afford to 
do both; two-thirds of all bankruptcies and half of all foreclosures 
are a result of a health care crisis in the family.
  This recession has highlighted wide and growing gaps in our health 
care system. Families lose their insurance coverage when a parent in 
the household becomes unemployed, and too many parents without 
employment are falling through those widening cracks--unable to afford 
COBRA, ineligible for public coverage, and precluded by high premiums 
and/or pre-existing conditions from obtaining private insurance.
  Collectively, as a Nation, we spend almost twice as much per person 
on health care as any other country, or about 17 percent of our gross 
domestic product, and this number is growing every year far faster than 
inflation.
  Tonight, I'm voting to pass legislation that will substantially 
reform the health insurance industry and practices, extend quality 
coverage to millions of Americans, and hold down national, public, and 
private health care costs. This bill will help provide stable coverage 
that cannot be taken away and won't be lost when you change jobs, and 
will provide additional insurance choices in an invigorated and 
competitive marketplace.
  In my district alone, this bill will provide tax credits and 
financial assistance to over 135,000 families and 15,000 small business 
owners in order to help them afford coverage, and extend coverage to 
80,000 uninsured residents. This bill will close the ``donut hole'' for 
94,000 seniors, and extend the life of Medicare. Further, we act 
tonight in a fiscally responsible manner, reducing the deficit by over 
$1.3 trillion during the next two decades.
  Tonight, we make it illegal to deny health coverage to the 15,000 
constituents in my district with pre-existing conditions. We ensure 
that the costs of health care won't threaten their family's finances, 
that their doctor is paid for making them well and not ordering 
unnecessary tests, and that their health care premiums are spent on 
actual care, not paying for paperwork and red tape.
  I have two young children, and I cannot imagine the dread that a 
parent must feel who has a sick child for whom they cannot provide 
care. That is an agony no parent should ever know. Not here. Not in 
America. I have had one steady guide through my years in Congress, and 
it is my two children. When they are old enough to know of my work in 
Congress, I want them to be proud of what their father did when he had 
a chance to serve this great Nation. And I believe they will be proud 
of me for casting my vote to provide health care for millions who do 
not have it, just as I am proud of the generation who went before and 
provided health care for millions of seniors when they had the courage 
to pass Medicare.
  I strongly believe that access to affordable, quality, stable health 
care is the key to a productive work force, small business innovation, 
and the economic as well as health security of our families and Nation, 
and I'm proud to vote for this bill.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield for the 
purposes of a unanimous consent request to the gentlewoman from 
California (Mrs. Davis).
  Mrs. DAVIS of California. Mr. Speaker, I rise in support of health 
care reform--finally.
  When people are asked why they chose their profession, so many say 
it's because they wanted to make a difference.
  We have the unique opportunity and honor to do just that.
  Passing healthcare reform will impact our constituents in almost all 
aspects of their lives.
  Good health is one of the most important things a person can have--
there is truth in the saying that it is more valuable than all the 
riches in the world.
  The bill we're passing isn't just about reducing sky-rocketing 
premiums or putting patients ahead of insurance companies--it's about 
the total outlay for families when it comes to providing for both basic 
and high risk care.
  Having affordable and certain health insurance translates not only to 
better health care but to better financial security so people can save 
money and use it for the betterment of their families.
  It means Americans can take the job they want, not just the job with 
healthcare.
  And it means they can strike out on their own and start the new 
businesses that spur our economy.
  We are making a difference as we do this for the American people.
  I truly appreciate my constituents whether they are for or against 
this measure, and I thank all of them for sharing their stories with 
me.
  Mr. RYAN of Wisconsin. Mr. Speaker, I yield 2 minutes to the vice 
ranking

[[Page H1876]]

member of the Budget Committee, the gentleman from Texas (Mr. 
Hensarling).
  Mr. HENSARLING. Mr. Speaker, the vote we take tonight very well may 
unalterably change the role of government in a society whose most 
cherished birthright is that of personal freedom.
  There are so many reasons to oppose this legislation. Taxpayer-funded 
abortions, the sleazy backroom deals that brought us the Cornhusker 
kickback, the Louisiana purchase, the pharmaceutical payoff, one-half 
trillion dollars in tax increases on an economy where millions have 
lost their jobs and can still find no gainful employment.
  As a member of the House Budget Committee, let me give you one more: 
We can't afford it. Our government can't even pay for the promises it 
has made current generations, much less future generations.
  After giving us the largest deficits in American history, after 
proposing to triple the national debt in the next 10 years, Democrats 
today want to add $2.6 trillion of new spending to the Federal budget, 
costing every household $22,000. That is more money to borrow from the 
Chinese, more bills to send to our children and grandchildren. Mr. 
Speaker, you cannot improve the health care of a Nation by bankrupting 
its children.
  I have seen the Democrats' Congressional Budget Office letter about 
cost. Garbage in, garbage out. When you put facts in, you get facts 
out. My Congressional Budget Office letter says the program will add to 
the deficit.
  But even more than cost, this is really a debate about who will 
control the health care resources of this Nation and who will control 
the health care decisions of our families. If we pass this bill, we 
will wake up one day only to find that when our loved ones become ill, 
they will wait weeks, perhaps months, to see a mediocre doctor of the 
government's choosing, only to be told by that same doctor that he 
cannot help because his treatment must be limited by the government 
protocol.
  In America, we must never confuse the social safety net with the 
slippery slope to socialism.
  When it comes to the health care of my family, when it comes to the 
health care of my country, I reject the hubris and arrogance of 
government social engineering, and I embrace the affordability and 
portability that comes by preserving the liberties of the American 
people.
  Mr. GEORGE MILLER of California. I yield 1 minute to the gentleman 
from New York (Mr. Bishop), a member of the committee.
  Mr. BISHOP of New York. Mr. Speaker, over the course of this long and 
passionate debate, amidst the angry and at times even hateful rhetoric, 
amidst the misinformation of scare tactics, there exists one simple 
truth, and that truth is that the current system is unsustainable. It 
is a system that threatens to bankrupt the Federal Government and every 
other level of government, and it is a system that is already 
bankrupting businesses, families and individuals.
  Those who stand in the way of reform are protecting this system. To 
do nothing is to ensure a future of ever escalating rates, slashed 
benefits, and, most tragically, illness and disease that go untreated.
  The bill before us is not perfect, but it does enable us to begin to 
take action on the most pressing issues that affect the hardworking 
families we represent.
  In my district alone, 24,000 uninsured individuals will get coverage, 
97,000 families will receive tax credits to defray the cost of 
coverage, 20,000 businesses will receive tax credits to provide their 
employees with coverage, and 49,000 young adults will be able to remain 
on their parents' policies.
  On behalf of these people and the millions like them, let's pass this 
bill tonight.
  Mr. GEORGE MILLER of California. I yield 1 minute to the gentlewoman 
from Wisconsin (Ms. Moore).
  Ms. MOORE of Wisconsin. As a member of the Budget Committee, I have 
had the opportunity to hear the most specious, inaccurate, 
contradictory, and downright laughable arguments against health 
insurance reform.
  Take, for example, the argument that we need to start over because 
the Congressional Budget Office score had been done 17 months earlier 
and now was old and stale. And, oh, by the way, the debate has dragged 
on for 17 months. Yet, the minority simultaneously complains that 
somehow we are hurrying and ramming the bill through.
  Once the CBO score was recalculated demonstrating phenomenal deficit 
reduction, the complaint became that the CBO is playing number tricks. 
Of course, the minority trusts CBO when the scores work for them.
  The minority's plan is to allow insurance premiums to rise 
unregulated by government intervention, let a family of four's premiums 
double every decade, and end Medicare as we know it.

                              {time}  2100

  If the health insurance reform debate wasn't so serious, these 
arguments would be laughable.
  Mr. RYAN of Wisconsin. At this time, Mr. Speaker, I'd like to yield 2 
minutes to gentleman from New Jersey (Mr. Garrett).
  Mr. GARRETT of New Jersey. Mr. Speaker, I rise in strong opposition 
to this bill for two very important reasons. First, I believe that this 
bill fundamentally violates the U.S. Constitution and it will be found 
unconstitutional once it gets its way through the courts.
  While Congress is given the power under the Constitution to regulate 
interstate activity, never before have we had to be required to 
purchase a private product--government approved--as a price of U.S. 
citizenship. This moves far beyond regulating economic activity into 
the realm of regulating inactivity.
  If we allow that Congress has this authority under the Constitution, 
then there is no limit whatsoever of Washington's ability to 
micromanage our lives. In the future, if Congress feels our car 
industry needs a boost again, they can require us all, once again, to 
purchase a car from GM. That is not exactly what our Founding Fathers 
had in mind.
  Thirty-seven States have already filed legislation to challenge this 
bill. Two States have already passed laws threatening lawsuits if this 
bill passes tonight. One State lawmaker has pointed out that that's 
two-thirds of the States of this great country, enough States to change 
the Constitution.
  In addition, there's another reason it should be rejected. It's 
because it puts us hopelessly in debt. Democrats assert that their bill 
would reduce the deficit over the next 10 years, and more thereafter. 
Utter nonsense. As the ranking member has repeatedly pointed out, there 
are budget gimmicks in here and double counting galore. Your very own 
actuaries from the HHS, what do they say about that? They say that the 
bill is ``unrealistic.'' Furthermore, it would ``jeopardize access to 
care'' for seniors citizens.
  So, then, what can we count on after this massive program passes and 
we have $2.5 trillion in additional spending at an 8 percent growth 
rate? Think about it. We can't even pay our own debts today. Please, 
don't add another unconstitutional, economic burden to this and future 
generations.
  Vote down this bill.
  Mr. GEORGE MILLER of California. I yield to the gentleman from Texas 
(Mr. Gene Green) for the purpose of a unanimous consent request.
  (Mr. GENE GREEN of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. GENE GREEN of Texas. Mr. Speaker, I rise in support of H.R. 3590 
and also H.R. 4872.
  Mr. Speaker, I rise in strong support of H.R. 3590, the Patient 
Protection and Affordable Care Act and H.R. 4872, the Reconciliation 
Act of 2010.
  We are in desperate need of health care reform in the 29th District 
in Texas. We have one of the highest number of uninsured individuals in 
our country where nearly 43 percent of the residents are uninsured. If 
enacted, H.R. 3590 and H.R. 4872 would provide insurance coverage to 95 
percent of all Americans and for 223,500 currently uninsured residents 
in the 29th district.
  It will also improve the employer based coverage for 217,000 
residents in my district. Also, approximately 177,000 families and 
14.600 small businesses will receive tax credits and other assistance 
to help them afford health insurance coverage under these bills.
  The legislation before us today will give all individuals the ability 
to access quality affordable health insurance, and approximately

[[Page H1877]]

34,500 residents in our district will no longer be denied coverage for 
preexisting conditions and their coverage cannot be capped or dropped 
when they get sick.
  The legislation before us today also ensures no more co-pays for 
preventive care, no more yearly caps on what the insurance company will 
cover, and provides premium subsidies for those who need them.
  We will also improve Medicare benefits for 56,000 seniors in our 
district by closing the Part D donut hole over time and immediately 
provide seniors who are in the donut hole with a $250 credit in 2010.
  The legislation also improves seniors' benefits under Medicare by 
providing free preventive and wellness care, improving primary and 
coordinated care, and enhancing nursing home care. The bill also 
strengthens the Medicare Trust Fund, extending its solvency from 2017 
to 2026.
  H.R. 3590 and H.R. 4872 will rein in rising health costs for American 
families and small businesses--introducing competition that will drive 
premiums down, capping out-of-pocket spending.
  According to the Congressional Budget Office, CBO, this legislation 
is fully paid for by eliminating waste, fraud, abuse, and excessive 
profits for private insurers. Nationwide, these health reform bills 
will reduce the deficit by over $130 billion over the next 10 years and 
by about $1.2 trillion over the second decade.
  Texas will also benefit from the legislation before us today. The 
Texas Department of Health and Human Services, TDHHS, released 
estimates that H.R. 3590 and H.R. 4872 will cost the State $24 billion 
over the next 10 years--this is inaccurate.
  These estimates are incorrect because they do not include the federal 
expansion and 100 percent contribution of Medicaid payments until 2018. 
Right now Texas accounts for 7 percent of Medicaid spending nationally. 
If those levels stay the same after the State-based exchanges are set 
up, the cost to the State of Texas would be $1.4 billion and not $24 
billion. Additionally, the bill will reduce the expenses related to 
uncompensated care in our State by $15 million annually.
  Currently, there are 5.9 million uninsured individuals in Texas. 
Under H.R. 3590 and H.R. 4872 nearly all of those individuals will have 
health insurance and most of it will be funded at federal expense--not 
at the expense of Texas. In fact, given the size of the State it is 
entirely possible that Texas will receive the largest amount of federal 
investment of any other State and create many new jobs in the health 
care sector.
  The time for health reform has come. Health insurance premiums are 
growing three times faster than wages and last year, more than half of 
Americans postponed medical care or skipped their medications because 
they couldn't afford it.
  I urge my colleagues to vote in favor of the legislation today not 
only for my constituents, but for all Americans.
  Mr. GEORGE MILLER of California. I yield for the purpose of a 
unanimous consent request to the gentleman from Missouri (Mr. 
Carnahan).
  (Mr. CARNAHAN asked and was given permission to revise and extend his 
remarks.)
  Mr. CARNAHAN. Mr. Speaker, I rise in support of this important health 
care package for America.
  Mr. Speaker, today, history was made.
  Today was for Sharon, from St. Louis, whose husband has Parkinson's 
Disease, and whose medication costs quadruple every May, when he falls 
into the donut hole.
  Today was for Mary, whose has lived in fear of losing her coverage 
because she knows her son will be refused coverage because of his 
preexisting condition.
  Today was for Michelle, who can't afford health coverage for the 
employees in her small bookstore.
  Today was for Stacy, whose grandmother died because she didn't have 
access to preventative care, leaving her family devastated and her 
grandfather broke from medical debt.
  An American President once said, ``There has long been a need to 
assure every American financial access to high quality health care. As 
medical costs go up, that need grows more pressing. Now, for the first 
time, we have not just the need but the will to get this job done.''
  That President was Richard Nixon in 1974.
  Indeed, the effort to make sure quality, affordable health care is 
available to all Americans dates back nearly 100 years, when Teddy 
Roosevelt called for reform, a call echoed by Democratic and Republican 
Presidents alike--Eisenhower, Kennedy, Nixon--and even Missouri's own 
Harry S. Truman.
  Today, we have finally fulfilled this century-old mission.
  No longer will older Americans face financial ruin because they can't 
afford to purchase life-saving medicine.
  No longer will parents fear that their children will be denied 
coverage because they have a preexisting condition.
  No longer will small businesses be forced to choose between health 
care or hiring additional employees.
  And no longer will people die, in the wealthiest country in the 
world, simply because they cannot afford care.
  That all ends today, with the passage of this bill to stop the 
insurance companies from denying care to people who are sick and rein 
in rising costs to make health care more affordable for families and 
small businesses, giving everyone access to the kind of health care 
choices available to Members of Congress.
  It's about time. We have a healthier America. A healthier America 
means a stronger, more productive, more competitive America.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield 1 minute to the 
gentleman from New York (Mr. Tonko).
  Mr. TONKO. Today we answer the clarion call from the American people 
to fix our Nation's broken health care system. Today is the day we 
deliver on that promise with a vote as historic as the creation of 
Social Security and Medicare.
  Today I will cast my vote in favor of putting the control back into 
the hands of American families and small businesses and their doctors. 
No longer will insurance companies be able to hold people hostage by 
raising rates and abuse sick people by dropping and denying coverage. 
Small businesses will no longer see their premiums skyrocket and will 
not have to make the painful decision to stop offering health insurance 
to their employees because the costs have climbed too high.
  Indeed, this bill is about freedom. Every American will now have the 
freedom from control of insurance companies and their record profits 
and will have the freedom to access the care they need, when they need 
it. Our seniors will have the freedom to enjoy Medicare for years to 
come, and they will have the freedom from worrying about the cost of 
their prescription drugs.
  The bottom line for me, Mr. Speaker, is whether the people in the 
capital region of New York will be better off with these reforms, and 
my answer is yes. Absolutely, yes.
  Mr. GEORGE MILLER of California. Mr. Speaker, I yield to the 
gentlewoman from Texas (Ms. Jackson Lee) for the purpose of a unanimous 
consent request.
  (Ms. JACKSON LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON LEE of Texas. In the name of my mother, Ivalita Jackson, 
I affirmatively support this bill for all of America.
  Mr. Speaker, I have the great honor and privilege to rise in strong 
support of H.R. 4872, ``The Health Care & Education Affordability Act 
of 2010,'' a bill that will make health care affordable for the middle 
class, provide security for seniors, and guarantee access to health 
insurance coverage for the uninsured--while responsibly reducing the 
federal deficit over the next decade and beyond. I would like to thank 
President Obama and the leadership in the House and Senate for guiding 
us through this journey.
  Mr. Speaker, when I stand here today and reflect upon what we are 
about to embark upon, I cannot help but think of some of the last words 
that the Great Senator Edward Kennedy shared in his letter to President 
Obama. The Senator said, ``And so because of your (Obama's) vision and 
resolve, I came to believe that soon, very soon, affordable health 
coverage will be available to all, in an America where the state of a 
family's health will never again depend on the amount of a family's 
wealth. And while I will not see the victory, I was able to look 
forward and know that we will--yes, we will--fulfill the promise of 
health care in America as a right and not a privilege. Well, Senator, 
your life's work shall today be proven to not be in vain.
  Though it has been a long journey to get to this place and many have 
suggested that we need to start over and wait until some other time in 
the future to address the health care crisis. In the words of the great 
civil rights leader, Dr. Martin Luther King, Jr., that ``we have also 
come to this hollowed spot to remind America of the fierce urgency of 
now.'' We cannot wait. We will not wait any longer to provide the 
citizens of this great Nation access to affordable, quality health 
care.
  Today when we pass this bill, it will be a historic day not only for 
tens of millions of uninsured Americans, but also for our great Nation. 
As Speaker Pelosi has reiterated, we as Members of Congress, are 
``humbled to stand here at a time when we can associate ourselves with 
the work of those who passed Social Security, those who passed 
Medicare, and now we will pass health care reform.''
  Many parallels exist between that time in history and today. 
Throughout this journey, we

[[Page H1878]]

have listened to a parade of Republicans warn that this bill will bring 
the downfall of American society, of the American way of life. This, 
however, is not the first time that the Republicans have been on the 
wrong side of history. In an interview in 1975, David L. Kopelman, who 
played a prominent role in the early administration of the Medicare 
Program, remarked that his colleagues were often criticized by 
Republicans. ``Communist,'' he recalled, ``was the designation all too 
liberally applied to anyone with a progressive idea. Well, after all, 
when we went around making contact with employers in those early years 
that was the designation not delicately applied by many, if not most of 
them, to the social security program. It must be some communist scheme 
foisted on the American people.'' Alf Landon, the Republican candidate 
for President in 1936, even campaigned on the fact that not a dollar in 
social security benefits would ever be paid.

  Mr. Speaker, unfortunately, such ad hominem attacks are as prevalent 
as ever. The Republicans want you to believe that our country is 
descending into an abyss of socialism, but nothing could be further 
from the truth. Today, I am proud to support a bill that is distinctly 
American. We the people, Thomas Jefferson wrote in the Declaration of 
Independence are endowed ``with certain unalienable Rights that among 
these are Life, Liberty and the pursuit of Happiness.--That to secure 
these rights, Governments are instituted among Men, deriving their just 
powers from the consent of the governed . . .'' I believe that it is no 
coincidence that life is listed first--for without it, the Founders 
realized, no other rights can be realized. Over many years, the 
millions of Americans who could not access medical services were denied 
their right to life--a life with access to quality and affordable 
health care.
  Let me set the record straight, this bill is good for the American 
people and will go a long way to ensuring access to quality and 
affordable care to those millions of Americans who for far too long 
have been left out of the health care equation. This health insurance 
reform legislation (the Senate bill as improved by the Reconciliation 
Bill) that the House is considering today will not only ensure that 
Americans have access to quality, affordable health care, but will also 
significantly reduce long term health care costs. The non-partisan 
Congressional Budget Office (CBO) has determined that it will provide 
coverage to 32 million more people, or more than 95% percent of 
Americans, while lowering health care costs over the long term. This 
historic legislation will reduce the deficit by $138 billion over the 
next ten years, with $1.2 trillion in additional deficit reduction in 
the following 10 years
  In the words of the great President John F. Kennedy, ``the voters 
selected us, in short, because they had confidence in our judgment and 
our ability to exercise that judgment from a position where we could 
determine what were their own best interest, as a part of the nation's 
interest.''
  Mr. Speaker, while my colleagues on the other side of the aisle claim 
that this bill will harm Americans, nothing could be further from the 
truth. This bill will:
  Make health insurance affordable for middle class and small 
businesses--including the largest middle class tax cuts for health care 
in history--reducing premiums and out-of-pocket costs.
  Strengthen consumer protections and rein in insurance company abuses.
  Give millions of Americans the same types of private insurance 
choices that members of Congress will have--through a new competitive 
health insurance market that keeps costs down.
  Hold insurance companies accountable to keep premiums down and 
prevent denials of care and coverage, including for pre-existing 
conditions.
  Improve Medicare benefits with lower prescription drug costs for 
those in the ``donut hole''; it also provides better chronic care, free 
preventive care, and nearly a decade more of solvency for Medicare.
  As President Obama says, ``we must act now'' and put American 
families and small businesses, not health insurance companies, in 
control of their own health care. This bill will do exactly that. Many 
of my colleagues on the other side of the aisle claim that we are 
passing a bill that nobody really knows what is in it. Well, Mr. 
Speaker, let me just take a minute to list a few things that are in the 
bill.
  The bill provides quality, affordable health care for all Americans 
that: a
  Bars insurance companies from discriminating based on pre-existing 
conditions, health status, and gender.
  Provides Americans with better coverage and the information they need 
to make informed decisions about their health insurance.
  Creates health insurance exchanges--competitive marketplaces where 
individuals and small business can buy affordable health care coverage 
in a manner similar to that of big businesses today.
  Offers premium tax credits and cost-sharing assistance to low and 
middle income Americans, providing families and small businesses with 
the largest tax cut for health care in history.
  Insures access to immediate relief for uninsured Americans with pre-
existing conditions on the brink of medical bankruptcy.
  Creates a reinsurance program in support of employers who offer 
retirees age 55-64 health coverage.
  Invests substantially in community health centers to expand access to 
health care in communities where it is needed most.
  Empowers the Department of Health and Human Services and state 
insurance commissioners to conduct annual reviews of new plans 
demanding unjustified, egregious premium increases.
  Expands eligibility for Medicaid to include all non-elderly Americans 
with income below 133 percent of the Federal Poverty Level (FPL).
  Replaces the so-called ``Cornhusker'' deal with fair assistance for 
all states to help cover the costs of these new Medicaid populations.
  Maintains current funding levels for the Children's Health Insurance 
Program (CHIP) for an additional two years, through fiscal year 2015.
  Increases payments to primary care doctors in Medicaid.
  The bill improves medicare by:
  Adding at least nine years to the solvency of the Medicare Hospital 
Insurance trust fund;
  Filling the Medicare prescription drug donut hole. In 2010, Medicare 
beneficiaries who go into the donut hole will receive a $250 rebate. 
After that they will receive a pharmaceutical manufacturers' 50 percent 
discount on brand-name drugs, increasing to a 75% discount on brand-
name and generic drugs to close the donut hole by 2020;
  Providing new, free annual wellness visits, and eliminates out-of-
pocket copayments for preventive benefits under Medicare, such as 
cancer and diabetes screenings;
  Providing better chronic care, with doctors collaborating to provide 
patient-centered care for the 80 percent of older Americans who have at 
least one chronic medical condition like high blood pressure or 
diabetes;
  Improving Medicare payments for primary care which will protect 
access to these vital services;
  Reduces overpayments to private Medicare Advantage plans. Medicare 
currently overpays private plans by an average of 14 percent. This 
legislation reins in those overpayments to ensure a fair payment system 
that rewards quality;
  Encouraging reimbursing health care providers on the basis of value, 
not volume. The bill includes a number of proposals to move away from 
the ``a la carte'' Medicare fee-for-service system toward paying for 
quality and value while reducing costs for America's seniors.
  The bill prevents chronic disease and improves public health that 
promotes preventive health care at all ages and improves public health 
activities that help Americans live healthy lives and retrain the 
growth of health care costs over time. The legislation eliminates cost-
sharing for recommended preventive care, provides individuals with the 
information they need to make healthy decisions, improves education on 
disease prevention and public health, and invests in a national 
prevention and public health strategy.
  The bill improves health care workforce by making key investments in 
training doctors and nurses and other health care providers. Currently, 
65 million Americans live in communities where they cannot easily 
access a primary care provider. An additional 16,500 practitioners are 
required to meet their needs. The legislation addresses shortages in 
primary care and other areas of practice by making necessary 
investments in our Nation's health care workforce. Specifically, it 
will invest in scholarship and loan repayment programs through the 
National Health Service Corps to expand the health care workforce. The 
bill also includes incentives for primary care practitioners and for 
providers to practice in underserved areas.

  The bill provides for transparency and program integrity by providing 
consumers with information about physician ownership of hospitals and 
medical equipment companies, as well as nursing home ownership and 
other characteristics. The bill also includes provisions that will 
crack down on fraud, waste, and abuse in Medicare, Medicaid, SCHIP and 
private insurance. It establishes a private, non-profit entity to 
identify priorities in patient-centered outcomes research that will 
provide doctors with information on how to best treat patients and end 
wasteful overspending.
  This bill also improves access to innovative medical therapies and 
establishes a regulatory pathway for FDA approval of biosimilar 
versions of previously licensed biological products.
  The bill also provides community living assistance services and 
support that makes long-term support and services more affordable for 
millions of Americans by providing a

[[Page H1879]]

lifetime cash benefit that will help people with severe disabilities 
remain in their homes and communities. CLASS is a voluntary, self-
funded, insurance program provided through the workplace. For those 
whose employers participate, affordable premiums will be paid through 
payroll deductions. Participation by workers is entirely voluntary. The 
Congressional Budget Office confirms that the program, which has been 
revised from earlier versions, is actuarially sound.
  The bill provides revenue provisions that:
  Reduce the deficit in the next ten years and beyond. The bill is 
fully paid for with revenue provisions that focus on paying for reform 
within the health care system.
  Tighten current health tax incentives, collect industry fees, 
institute modest excise taxes, and slightly increase the Medicare 
Hospital Insurance (HI) tax for individuals who earn more than $200,000 
and couples who earn more than $250,000. The taxable base of the HI tax 
is also broadened by including net investment income. The HI tax 
increases will not only help fund health care reform, but, when 
combined with other provisions in the bill, will also extend the 
solvency of the Medicare Trust Fund by at least nine years to 2026.
  Include a fee on insurance companies that sell high cost health 
insurance plans. The fee is designed to generate smarter, more cost-
effective health coverage choices. The reconciliation bill delays this 
new fee until 2018 so that plans have time to implement reform and 
begin to save from its efficiencies.
  Change health care tax incentives by increasing penalties on 
nonqualified distributions from HSAs, capping FSA contributions, and 
standardizing the definition of qualified medical expenses. The 
industry fees and excise taxes reflect responsible contributions from 
health care stakeholders who will benefit from the expanded coverage of 
millions of additional Americans under health care reform. The bill 
also assesses a small excise tax on indoor tanning services.
  In total, the revenue provisions in the bill represent a balanced, 
responsible package of proposals that bend the health care cost curve 
by putting downward pressure on health spending, close unintended tax 
loopholes, and promote tax compliance.
  Mr. Speaker, who among us can say with sincerity that the quality of 
one's life, which certainly includes one's health, is not heavily 
dependent upon the access to quality, affordable health care. According 
to the National Academy of Sciences, Institute of Medicine, there is a 
``consistent and statistically significant relationship between health 
insurance coverage and health outcomes for adults. These factors, in 
turn, improve the likelihood of disease screening and early detection, 
the management of chronic illness, and the treatment of acute 
conditions . . . .'' Recently, a study published in the American 
Journal of Public Health by researchers at Harvard University Medical 
School concluded that nearly 45,000 excess deaths of Americans can be 
linked each year to lack of health insurance.
  According to the U.S. Census Bureau, 27 million Americans live 
without health insurance, and an additional 1.1 million part-time 
workers lost their health insurance in 2008. Implementing this 
legislation will instantly improve the life expectancy of millions of 
Americans of all ages. It is impossible to put a price on that. When we 
talk about the right to healthcare, we are actually talking about the 
right to life--a life that includes access to quality health care.
  The bill contributes to reducing health disparities. Minority 
communities are particularly vulnerable to being left uninsured and 
underinsured. In our current system, most people do not choose to be 
uninsured but, instead, are priced out of insurance. These people 
cannot, as free market proponents often argue, ``Pull themselves up by 
their bootstraps.'' Instead, they and their families are too often 
cyclically and systemically trapped in their economic situation. As a 
result, minority communities suffer grave health disparities that would 
otherwise be limited but for lack of access to affordable and quality 
care.
  According to a 2003 National Health Disparities Report released by 
the Agency for Research Quality and Care:
  Minorities are more likely to be diagnosed with late-stage breast 
cancer and colorectal cancer compared with whites.
  Patients of lower socioeconomic position are less likely to receive 
recommended diabetic services and more likely to be hospitalized for 
diabetes and its complications.
  When hospitalized for acute myocardial infarction, Hispanics are less 
likely to receive optimal care.
  Many racial and ethnic minorities and persons of lower socioeconomic 
position are more likely to die from HIV. Minorities also account for a 
disproportionate share of new AIDS cases.
  The use of physical restraints in nursing homes is higher among 
Hispanics and Asian/Pacific Islanders compared with non-Hispanic 
whites.
  Blacks and poorer patients have higher rates of avoidable hospital 
admissions (i.e., hospitalizations for health conditions that, in the 
presence of comprehensive primary care, rarely require 
hospitalization).
  This historic bill is particularly important for minorities and 
women--who have gone without health care coverage for too long. In 
2007, only 49 percent of African-Americans in comparison to 66 percent 
of non-Hispanic whites used employer-sponsored health insurance, 
according to the Department of Health and Human Services. During the 
same year, 19.5 percent of African-Americans in comparison to 10.4 
percent of non-Hispanic whites were uninsured.
  Hispanics have the highest uninsured rates of any racial or ethnic 
group within the United States. In 2004, the Centers for Disease 
Control and Prevention reported that private insurance coverage among 
Hispanic subgroups varied as follows: 39.1 percent of Mexicans, 47.3 
percent of Puerto Ricans, 57.9 percent of Cubans, and 45.1 percent of 
other Hispanic and Latino groups.
  Health care reform also is critical to ensure that women have access 
to affordable health care coverage. An estimated 64 million women do 
not have adequate health insurance coverage. About 1.7 million women 
have lost their health insurance coverage since the beginning of the 
economic downturn. Nearly two-thirds lost coverage because of their 
spouse's job loss. And nearly 39 percent of all low-income women lack 
health insurance coverage. Women also are more likely to deplete their 
savings accounts paying medical bills than men because they are more 
likely to be poor. This bill gives women access to the health care that 
they need and deserve.

  Passage of this bill will be a critical first step in helping to 
reduce such health disparities. This bill will:
  1. Lower costs for minority families and preventive care for better 
health. Racial and ethnic minorities are often less likely to receive 
preventive care. Vietnamese women, for example, are half as likely to 
receive a pap smear, and twice as likely to die from cervical cancer as 
are Whites. Obesity rates are also high among certain minority groups. 
By ensuring all Americans have access to preventive care and by 
investing in public health, health insurance reform will work to create 
a system that prevents illness and disease instead of just treating it 
when it's too late and costs more.
  2. Provide greater choices and more affordable choices and 
competition. African Americans, Hispanics, and Asians are all more 
likely to need a referral in order to see a specialist and they are 
less likely to get coverage for seeing a doctor outside of the 
insurance network. Health insurance reform will create a health 
insurance exchange so you can compare prices and health plans and 
decide which quality affordable option is right for you and your 
family. It will include a competitive public option that increases 
choices and holds private insurers accountable.
  3. Allow for quality, affordable health care for minorities and 
eliminates discrimination in obtaining health insurance. Health 
insurance reform will prevent any insurance company from denying 
coverage based on a person's medical history, including genetic 
discrimination which can disproportionately hurt minority populations.
  4. Make health care accessible to everyone. African Americans, 
Hispanics, and Native Americans are roughly twice as likely to be 
uninsured as the rest of the population. By providing health insurance 
choices to all Americans and providing premium assistance to make it 
affordable, health insurance reform will significantly reduce 
disparities in accessing high-quality health care.
  5. Control chronic disease. Nearly half of African Americans suffer 
from a chronic disease, compared with 40 percent of the general 
population. Chronic illness is growing in other minority communities as 
well. Health insurance reform includes a number of programs to prevent 
and control chronic disease, including incentives to provide medical 
homes and chronic disease management pilots in Medicare.
  6. Promote primary care. By providing health insurance choices 
through a health insurance exchange and investing in the primary care 
workforce (including scholarships and grants to increase diversity in 
health professions), health reform will make sure that all Americans 
have access to a primary care doctor so they stay healthier, longer. It 
will also strengthen the system of safety-net hospitals and community 
health centers to ensure high-quality, accessible care.
  Health reform legislation will require any health care program to 
report on race, ethnicity, gender, and socioeconomic status in order to 
better understand health disparities, and devote funding to addressing 
these issues.
  The uninsured in Texas. The people of my home state of Texas, in 
particular, with 6 million uninsured persons, and 26 percent uninsured 
in my district, the 18th Congressional District, have been hit 
especially hard when it

[[Page H1880]]

comes to lack of access to quality, affordable care.

  And just what causes such a massive loss of health care coverage? Job 
layoffs are partially to blame especially in the face of the economic 
downturn. Yet, we know that the uninsured problems existed way before 
the devastating recession. Many Americans continue to be forced from 
their health care plans due to decisions by insurance companies to put 
profits over people. Policy cancellations rather than paying for 
expensive yet necessary medical treatment is just one of the many 
techniques used by large insurance companies to rack up huge profits 
annually.
  According to the latest figures analyzing the profits of health 
insurance companies, 10 of the country's largest publicly traded health 
insurance companies enjoyed a rise in profits of 428 percent, from 2000 
to 2007. From filings with the U.S. Securities and Exchange Commission, 
it was revealed that in 2007, these insurance companies alone generated 
$12.9 billion in profit. That same year, the chief executive officers 
at these companies collected combined total compensation packages of 
$118.6 million--an average of $11.9 million each. That is 468 times 
more than what an average American worker made that year.
  Since 2007, there has been a 10 percent increase in the uninsured 
rate in Texas alone. Today, 6,240,000 Texans are without even basic 
health insurance. And this broken health insurance system has cost the 
Texas economy dearly. This year, Texas lost $30 billion in productivity 
as a result of its millions of uninsured residents.
  Those in our state who are blessed to have insurance coverage have in 
some ways been losers as well. Specifically, the average Texan family 
pays insurance premiums of over $1000 a month. This figure is set to 
nearly double to $1920.75 per month by 2019, that is, unless we succeed 
in passing health care reform legislation. Today, when we pass this 
bill, the people of Texas and all over this nation become winners.
  We know that many of our colleagues in this body do not want to 
reform the health care system and are on the side of the big insurance 
companies. We choose to stand on the side of the Americans who need our 
help. President Franklin D. Roosevelt said it best when he said, ``the 
test of our progress is not whether we add more to the abundance of 
those who have much; it is whether we provide enough for those who have 
little.''
  While the state-wide numbers are shocking, on the local level, the 
health care figures are even worse. The 18th Congressional District and 
the rest of Houston, account for 1.1 million of the state's uninsured 
residents. Nationally, more than 15 percent are uninsured. In Texas 
it's nearly 24 percent. Here in Harris County, it's 30 percent, 
according to state figures, the highest rate among the nation's top 10 
metropolitan areas.
  So how do the million plus Houston residents without insurance 
company get health care--emergency rooms of course. Emergency rooms 
have become the health care providers of last resort for well over 100 
million Americans annually. Over a 10 year period from 1994 to 2004, ER 
visits on a national level saw an 18 percent jump, according to the 
Centers for Disease Control and Prevention. The Texas Hospital 
Association reports that ERs in the state experienced a 33 percent 
increase; in the Houston area, it was more than 50 percent. During this 
ten year period, the number of hospital emergency departments dropped 
by more than 12 percent nationally.
  Emergency rooms in Houston hospitals are routinely overcrowded and 
overused as throngs flock seeking care for ailments that may range from 
a heart attack or gunshot wound to an ear infection or toothache. 
Ambulances pile up outside emergency rooms before unloading their 
patients. It's reported that a wait of an hour or two to move a patient 
from the ambulance to the ER is common in Houston. David Persse, the 
Houston Fire Department's medical director, confided with a reporter 
recently that the record wait to unload an ambulance at Houston area 
hospital is six hours.

  Ben Taub, the Houston area's pre-eminent trauma care facility, has 
seen the brunt of the problem. In a recent USA Today article, one Ben 
Taub nurse reported arriving to work one morning to find ER patients 
waiting to be seen who arrived the day before, over 24 hours earlier. 
ER overcrowding is so bad in the Houston area, that patients have 
called 911 from one ER to get to another, according one report. When we 
pass this bill tonight, these Americans who have been flocking to 
emergency rooms for primary care will have another option--affordable 
and accessible health care.
  The benefits to the 18th congressional district: In my district, the 
health care bill will:
  Improve coverage for 279,000 residents with health insurance.
  Give tax credits and other assistance to up to 186,000 families and 
14,600 small businesses to help them afford coverage.
  Improve Medicare for 70,000 beneficiaries, including closing the 
doughnut hole.
  Extend coverage to 180,500 uninsured residents.
  Guarantee that 27,600 residents with pre-existing conditions can 
obtain coverage.
  Protect 500 families from bankruptcy due to unaffordable health care 
costs.
  Allow 62,000 young adults to obtain coverage on their parents' 
insurance plans.
  Provide millions of dollars in new funding for 20 community health 
centers.
  Reduce the cost of uncompensated care for hospitals and other health 
care providers by $27 million annually.
  As we reach this great milestone today, I am still reminded of the 
unfinished work that is left to do. We must ensure that physician-owned 
hospitals are allowed to maintain operations that allow them to serve 
the most vulnerable and underserved communities. I am committed to 
working with the Speaker's office and Senatorial leadership now that we 
are taking the first step in stemming the rising tide of the many 
uninsured. The protection of physician-owned hospitals is an issue of 
national interest. We have a lot of work to do as we move toward the 
Senate and to the conference. I was gratified to meet with the Speaker 
to discuss the continued protection of the very viable physician-owned 
hospitals and believe that we have a real opportunity to address this 
issue in the very near future.
  I offered three amendments that would have gone a long way to save 
physician-owned hospitals. My first amendment would have preserved 
physician-owned facilities that have a greater percentage of Medicaid 
inpatient admissions than the state average in operation and allows 
them to expand. My second amendment is extremely critical for minority 
communities and high poverty. This amendment would prevent physician 
safety-net hospitals from closing and preserves critical care access 
for impoverished communities and the disabled.
  My third amendment, supported by Physician Hospital Association of 
America, would effectively prevent the closure of 230 existing 
hospitals, save $2.9 billion in total payroll, $608 million in federal 
taxes, $3.5 billion in trade payables, and preserves 62,000 full- and 
part-time jobs by striking all language that prohibits grandfathered 
facilities from expanding.
  During the ongoing healthcare debate, discussions about physician 
ownership of hospitals have ignored the positive impact these 
facilities have had on minority communities and minority physicians. 
Physician-owned general acute care hospitals, who have unprecedented 
amounts of minority owners, have allowed Hispanic, Black, and Asian 
Americans to enter into the field of hospital ownership. The largest 
physician-owned hospital, Doctors Hospital at Renaissance, is over 50 
percent minority owned.

  To help my colleagues understand what is at stake, I would like to 
highlight some of these success stories:
  In Houston, St. Joseph's Hospital, a full-service general acute care 
center, is the only hospital that serves one of the most income-
challenged and African-American sections of the city. Within the last 
few years, a for-profit corporation abandoned this hospital and the 
surrounding community. Physician ownership provided an avenue for it to 
stay open and prevent a critical loss for the neighborhood.
  In South Texas, out-of-state corporations forced over 700,000 Texans 
to travel more than 250 miles to receive life-saving medical 
procedures. Decisions not to offer needed services by out-of-state 
healthcare conglomerates and the lack of public or county hospitals, 
left patients with two options: go without or to transfer to another 
facility up to 350 miles away. Income-challenged families who could not 
afford the travel were placed in great peril. Physician ownership 
enabled a group of local doctors to open a new hospital with advanced 
medical capabilities that reduced the need for travel to seek care. 
Doctors Hospital at Renaissance, a 506-bed premiere general acute care 
center, now provides some of the best care in the Nation and 
consistently has been recognized by Thompson Reuters as a Top 100 
Hospital in the Nation.
  In the Chinatown section of Los Angeles, California, the Pacific 
Alliance Medical Center (PAMC), a 142-bed full-service hospital, has 
been the community's main hospital for 140 years. This facility was 
purchased by a group of physicians 20 years ago after the existing 
hospital board planned to close and demolish the facility. Physician 
ownership once again provided an avenue for the hospital to stay open 
and serve an at-risk community.
  I will continue to work on behalf of these Americans and to to save 
physician-owned hospitals that are currently treating patients or under 
significant development, to ensure that Americans can continue to 
receive healthcare at the local hospitals they have come to depend 
upon. Physician-owned hospitals take care of patients covered by 
Medicare and Medicaid, as well as patients who are uninsured or cannot 
pay for their care. They also provide emergency departments access for

[[Page H1881]]

their communities. At a time when we are concerned about the shortage 
of hospital beds in the face of epidemics like the swine flu, my 
amendment to this landmark bill will make sure no hospital is forced to 
shut its doors or turn away Medicare or Medicaid patients. The benefits 
that will come from our efforts to protect physician-owned hospitals 
are far reaching and will prevent any further losses to local 
economies. Not only do physician hospitals deliver high-quality medical 
care to the patients they serve, they also provide much needed jobs, 
pay taxes, and generate significant economic activity for local 
businesses and communities. Existing physician-owned hospitals employ 
approximately 51,700 individuals, have over 27,000 physicians on staff, 
pay approximately $2,421,579,312 in payroll taxes and $512,889,516 in 
other federal taxes, and have approximately $1.9 billion in trade 
payables. Hospitals currently under development would employ 
approximately 21,700 more individuals. With approximately 50 physician-
owned hospitals, Texas leads the Nation in the number of physician-
owned hospitals. The Texas economy could lose more than $2.3 billion 
and more than 22,000 jobs.

  In my district, the 18th Congressional District of Houston, Texas, 
St. Joseph Medical Center is a general acute-care hospital that treats 
all patients. In fact, its 40 percent Medicaid patient population is 
double the average hospital's patient population in the entire State of 
Texas and is one of the highest in the country. St. Joseph's was 
operated by the Sisters of Charity for many years until it was 
scheduled to be closed because the order could no longer support it. 
The hospital was offered to for-profit and not-for-profit hospital 
systems but no one would accept responsibility for operating St. 
Joseph's. A plan was developed to convert the hospital into 
condominiums. I refused to allow that to happen. It was only at that 
point that the physicians who had practiced there for many years came 
together to buy the hospital to save it from closing.
  St. Joseph's takes care of patients covered by Medicare and Medicaid, 
as well as patients who are uninsured or cannot pay for their care. The 
emergency departments of many physician-owned ``specialty hospitals'' 
have been criticized for not having a true emergency department. St. 
Joseph's has a department which is open 24 hours per day, 7 days per 
week, providing an access point for patients in need of emergency 
services. In fact, St. Joseph's admissions through the emergency 
department are double the State average;
  St. Luke's hospital in Houston, which is church-owned, has three new 
facilities under development; the nonprofit religious mission has the 
controlling interest. One full-service hospital has one phase already 
operating, but would be under the growth restrictions; the hospital 
cannot be completed if the new restrictions apply. The hospital brought 
approximately 300 new jobs to the community; and
  Baylor Health Care System, based in Dallas, has found that their 
partnership with physicians has increased measurable quality, increased 
patient satisfaction, and decreased the cost in the delivery of their 
excellent care. This joint venture model has produced a heart hospital 
that has the lowest readmission rate in the entire United States. And 
yet this bill would deny Baylor Health Care System the right to add a 
single operating room or procedure room to meet its community's need. 
During the moratorium on physician-owned hospitals some years ago, 
Baylor wanted to add a badly needed OB/GYN service at its Frisco, 
Texas, hospital. This service is a money-losing service, but there was 
no such service within many miles for those people--Baylor fulfilled 
the need. It was prohibited from adding this service simply because the 
hospital had physicians holding a minority of the ownership of the 
hospital. After the moratorium was lifted, the service was added and is 
currently working at its capacity.
  Mr. Speaker, can we imagine witnessing an impact, of no patient beds, 
6- to 8-hour waiting times, to extend even to 10-hour waiting times, 
turning emergency patients away at the door? Can we imagine the 
dramatic case, when patients are not able to have access to quality 
care? This is true of the most serious trauma, of the most serious 
medical cases. Physician-owned hospitals serve in many cases at least 
40 percent of the city's population. I don't just mean the city's 
population. We are discussing a population that is between 500,000, 
which is the indigenous population, and the population of 1.5 million 
that's in the city every day.
  When a hospital downsizes in a particular city, it extends beyond the 
boundaries of that city, and in doing so, with this hospital being 
downsized, it's impacting all of the hospitals, not only in the city, 
but those hospitals in nearby jurisdictions. We're seeing the epicenter 
of a catastrophic event, and unless we realize the importance of this 
one medical facility, but look at it not from the perspective that it 
serves this city, but we have to realize that it serves the world. It 
serves the Nation. At the very least, it serves the Nation; at the very 
most, it most serves the world. So when you start looking at it from 
those perspectives, then it becomes more than just a problem 
of Houston, Texas, but a problem of this Nation. And it should be 
addressed in that manner.

  If we do not work closely together to look deeper at this issue, we 
will face a number of medical facility closures that is a disservice to 
the American people. So, we see that there seems to be a phasing-back 
or cutback in all of the major services, but the most important of 
those services, which directly affect the health and well-being of the 
citizens, or again, those 1.5 million people who visit and work in the 
city every day. So, we hear the same thing time and time again, even 
though individuals are saying that the patient caseload can be handled 
by the surrounding hospitals. You need but step into any emergency room 
on any day, at any time, and just see the impact of this one hospital 
being downsized. The impact will reach out throughout the city of 
Houston.
  Mr. Speaker, through all the debate, name-calling, threats, and fear-
mongering, we will once again be on the right side of history and put 
the American people first. In the midst of it all, some of my 
colleagues have been called derogatory names, including racial 
epitjets; have been spat on and have been threatened that there will be 
blood in the streets. But there is something that I must say to my 
fellow Americans as we stand on the threshold of the door that opens up 
to access to quality and affordable care and, in turn, a better quality 
of life for all Americans. Heeding one of this country's greatest 
leaders in history, Dr, Martin Luther King, Jr., I urge us to remember 
that ``in the process of gaining [life, liberty, and the pursuit of 
life], we must not be guilty of wrongful deeds. Let us not seek to 
satisfy our thirst for freedom by drinking from the cup of bitterness 
and hatred. We must forever conduct our struggle on the high plane of 
dignity and discipline . . . we must rise to the majestic heights of 
meeting physical force with soul force.
  Mr. Speaker, I urge my colleagues and I to stand strong, support this 
bill on behalf of all Americans.
  Mr. GEORGE MILLER of California. I yield myself the balance of my 
time.
  (Mr. GEORGE MILLER of California asked and was given permission to 
revise and extend his remarks.)
  Mr. GEORGE MILLER of California. Mr. Speaker, I rise in support of 
this truly historic and great legislation that addresses two of 
America's greatest troubles: the crushing cost and high obstacles of 
obtaining both quality health care and a quality college education. Our 
Nation has suffered from our longstanding failure to make health care 
and college accessible to all American people. Americans have waited a 
long time for health insurance reform, nearly a hundred years.
  Today, Congress and President Obama will deliver on a central 
promise, a dream deferred, and on a crucial demand. Because of this 
legislation, for the first time in America's history, never again will 
Americans have to worry about losing their health insurance if they 
change or lose their job. The insurance companies will not be able to 
jack up premiums or deny coverage because of preexisting conditions. 
They will not be able to drop people's coverage when they get sick--
when they need it the most. Our reforms will improve the lives of every 
single American, those with insurance today and those without.
  We're also pairing this historic health reform with another 
opportunity that cannot be missed, the chance to make the single 
largest investment in college affordability ever, at no cost to the 
taxpayers. We're going to take $61 billion of wasteful subsidies that 
have gone to the banks and student lenders and instead recycle that 
money on behalf of students, their families who are trying to pay for 
education, to make that education more affordable and pay down the 
deficit of this country.
  We now face a very simple choice. We can side with America's families 
and make health insurance and college more affordable and accessible 
while creating millions of jobs and reducing the deficit, or we can 
side with the insurance companies and the banks. It's a very simple 
choice. One is to stand with the families and the students of this 
country, to stand with our future, to modernize our education system, 
to make it more affordable, and to modernize and make more affordable 
our health care system.
  I suggest all my colleagues should stand with American families in 
this country.

[[Page H1882]]

  Mr. Speaker, I rise in support of this truly historic legislation 
that addresses two of America's greatest troubles--the crushing costs 
and high obstacles of obtaining both quality health care and a college 
education.
  Our Nation and its economy have suffered from our longstanding 
failure to make health care and college accessible and affordable to 
all of the American people.
  Americans have waited a long time for health insurance reform--nearly 
100 years.
  Today, Congress and President Obama will deliver on a central 
promise, on a dream deferred, on a crucial demand.
  Because of this legislation, for the first time in America's history, 
never again will Americans have to worry about losing their health 
insurance if they change or lose their job.
  Insurance companies will not be able to jack up premiums or deny 
coverage because of a pre-existing condition.
  They will not be able to drop people's coverage when they get sick--
and need it most.
  There is no other plan on the table today that offers Americans these 
vital assurances.
  Our reforms will improve the lives of every single American--those 
with insurance today and those without it.
  They will improve our economy by reducing the deficit, creating up to 
4 million jobs over the next decade, and unshackling innovative 
business decisions from crippling health insurance costs.
  Our legislation offers families and employees of small businesses 
access to choices of affordable health plans; security and control over 
their health care; vital federal and state consumer protections; 
accountability for insurance companies; and coverage for 32 million 
Americans who don't have insurance today.
  This legislation also intends to lessen and eventually eliminate the 
loopholes and inconsistencies in our current system. More specifically, 
it seeks to begin the creation of a joint national and state health 
care system. Currently, we have a fragmented and unfair set of rules.
  If you are poor you may or may not be covered by Medicaid and your 
benefits will vary depending on the state you live in.
  If you are employed, you may or may not be offered benefits by your 
employer and those benefits vary from employer to employer. As 
providers continue to increase costs year after year, insurers, 
employers and states have been unable to effectively negotiate and 
responded by cutting benefits and increasing costs for individuals and 
families.
  This bill will help change this unsustainable and unfair dynamic. 
Under this legislation, every American will have an obligation and an 
opportunity to enjoy meaningful health benefits. The Secretary of 
Health and Human Services will establish an essential benefits package 
that will provide a basic but comprehensive set of benefits for all 
Americans. Although existing employer plans are not required to provide 
this level of benefits, it is our hope that employers will meet or 
exceed this standard. However, the bill does end a wide series of 
abuses that all health plans, including employer provided plans, must 
comply with.
  These include an end to all pre-existing condition exclusions, limits 
on waiting periods for coverage, and elimination of annual and lifetime 
caps on benefits.
  In order to make health care more affordable for workers and 
employers, the bill establishes exchanges that will negotiate with 
insurers to offer health coverage to individuals in a given area or 
state. These government-sponsored exchanges will establish a level 
playing field market place that will make health benefits fairer to all 
parties.
  Insurers will get organized access to large pools of individuals who 
are required to purchase insurance with lower income individuals 
receiving federal subsidies to afford essential benefits. Employers 
will be relieved of their current burdens of designing and negotiating 
for health benefits under this new health system. Employers will simply 
facilitate the enrollment and payroll deduction of their employees in 
exchange health plans with no other responsibilities. Employers may 
select a plan level to which any employer contribution will be limited, 
but employees are free to choose plans in that or a more favorable 
level.
  The health plans offered through the exchange are state licensed 
(with the exception of the national plans) and are not ERISA plans. 
States have full authority to protect their residents and enrolled 
individuals have state law rights and consumer protections. There is no 
federal preemption of any state law that does not prevent the 
application of any of the rights and responsibilities included in Title 
I of this bill.
  Small employers that choose to offer health coverage may be eligible 
for tax credits and cannot offer health benefits that discriminate in 
favor of highly compensated employees. For employers who use employee 
payroll and similar organizations (i.e. Professional Employee 
Organizations), I expect that the U.S. Department of Treasury will 
issue rules to make clear the circumstances by which the small employer 
may take the tax credit and satisfy the prohibition against 
discrimination.
  The bill contains an individual mandate to either obtain health 
insurance or pay a penalty. This provision is grounded in Congress's 
taxing power but is also necessary and proper--indeed, a critical 
linchpin--to the overall effort to reform the health care market and 
bring associated costs under control throughout interstate commerce. 
For example, without this requirement, some reforms may create the 
opportunity for moral hazards, such as the prohibition on pre-existing 
conditions.
  Without an individual mandate, individuals could wait to purchase 
health insurance until they are sick--thereby driving up insurance 
costs and undermining the bill's efforts to bring health care costs and 
costs to the broader economy under control. This requirement spreads 
risk to ensure lower costs for everyone, prevents adverse selection, 
helps end overpayment by the government and other consumers for the 
uninsured, and makes health care reform overall sustainable.
  I also would like to address a few other important provisions in the 
bill:
  I am pleased that the essential benefits in the Patient Protection 
and Affordable Care Act include rehabilitative and habilitative 
services and devices, as these benefits are of particular importance to 
people with disabilities and chronic conditions.
  The term ``rehabilitative and habilitative services'' includes items 
and services used to restore functional capacity, minimize limitations 
on physical and cognitive functions, and maintain or prevent 
deterioration of functioning. Such services also include training of 
individuals with mental and physical disabilities to enhance functional 
development.
  The term ``rehabilitative and habilitative devices'' includes durable 
medical equipment, prosthetics, orthotics, and related supplies. It is 
my understanding that the Patient Protection and Affordable Care Act 
requires the Secretary of Health and Human Services to develop, through 
regulation, standard definitions of many terms for purposes of 
comparing benefit categories from one private health plan to another. 
It is my expectation ``prosthetics, orthotics, and related supplies'' 
will be defined separately from ``durable medical equipment.'' I also 
expect that durable medical equipment will not be limited to ``in-
home'' use only.
  Pursuant to employer requests, this bill codifies the use of wellness 
programs. Wellness programs are proving to be an emerging area of 
health care reform that holds both great promise and potential for 
abuse. The Departments of HHS and Labor will need to issue regulations 
to assure that employer wellness programs meet established standards of 
medical treatment and patient protection. It is my understanding from 
discussions with my colleagues in both the House and Senate that the 
design and implementation of voluntary wellness programs, including the 
issuance of policies and procedures and the adoption of practices and 
methods of administration, shall not have the purpose or effect of 
mandating participation in such programs or punishing, denying, 
limiting or curtailing any rights, privileges, and protections under 
the Americans with Disabilities Act, the Genetic Information 
Nondiscrimination Act, the Health Insurance Portability and 
Accountability Act, the Family and Medical Leave Act, and Title VII of 
the Civil Rights Act of 1964.
  In order to ensure existing civil rights and privacy protections, 
regulations related to wellness programs promulgated by the Secretary 
of Health and Human Services should include standards and criteria 
developed and certified by the Attorney General, the Secretary of 
Labor, and the Equal Employment Opportunity Commission. I expect that 
nothing in the Patient Protection and Affordable Care Act shall limit 
the independent authority of the Attorney General, the Secretary of 
Labor, and the Equal Employment Opportunity Commission to issue 
regulations, interpretations, and guidance regarding the applicability 
of the Americans with Disabilities Act, the Genetic Information 
Nondiscrimination Act, the Health Insurance Portability and 
Accountability Act, the Family and Medical Leave Act, and Title VII of 
the Civil Rights Act of 1964 to the design and implementation of 
wellness programs. I urge the Department of Labor and other agencies to 
monitor and ensure that health plans properly comply with the standards 
established by this Act. I also urge the Congress to continue to review 
and revisit this developing area of health care.
  The Senate bill includes provisions that would provide for a ``level 
playing field'' between private health insurance issuers and a 
competing Consumer Operated and Oriented Plan (``CO-OP''), a community 
health insurance option, or a nationwide qualified health plan. These 
provisions would prevent unfair competition within a state where these 
plans compete.
  For example, if a CO-OP is established in New York State, it would 
have to be subject to all the same federal and state laws enumerated in 
these level playing field provisions as private health insurance 
issuers in New York

[[Page H1883]]

State are. Or, for example, if a CO-OP were established in Florida and 
was exempted from a state law relating to licensure, private health 
insurance issuers in Florida would also have to be exempted from the 
same state law.
  The bill we are passing contains protections for employees who are 
retaliated against for reporting violations involving health insurance 
regulation and the operation of exchanges, and provides recourse for 
workers who are fired or otherwise discriminated against because they 
participate in the exchange and the employee receives a tax credit or a 
subsidy to purchase health insurance through an exchange. Under this 
legislation such employees can bring a complaint to and receive 
assistance from the Department of Labor.
  Section 2951 of H.R. 3590 makes an amendment to section 511 of Title 
V of the Social Security Act to require states to conduct statewide 
needs assessment and to coordinate such assessment with other 
appropriate assessments, and cross-references section 640(g)(1)(C) of 
the Head Start Act. This should not be interpreted to provide states 
with any new authority over Head Start grantees or entities applying 
for Head Start funds.
  Now, we're pairing these truly historic health insurance reforms with 
another opportunity that cannot be missed: The chance to make the 
single largest investment in college affordability ever--and at no cost 
to taxpayers.
  We are going to take tens of billions of dollars that for decades has 
gone to banks in the student loan program and instead give that money 
to students and to pay down the deficit.
  For decades, banks have enjoyed a sweetheart deal: They receive 
taxpayer money to make virtually risk-free loans to students.
  As we speak, the federal government is now funding 88 percent of all 
federal student loan volume.
  It has proven to be a more stable lender for students through shaky 
financial markets and a more cost-effective lender for taxpayers.
  Ending these subsidies is not a radical idea.
  President Clinton first identified these subsidies as wasteful in the 
1990s.
  President Bush eyed them in three of his budgets.
  And President Obama has correctly proposed ending this boondoggle 
once and for all by originating all loans through the federal direct 
lending program--saving taxpayers $61 billion over 10 years.
  And that's what our legislation accomplishes.
  Our reforms are good for students, taxpayers and American jobs.
  We will help low and middle-income students pay for college and 
invest in the support they need to graduate.
  We will be more responsible with taxpayer dollars by using $10 
billion of these savings for deficit reduction.
  And we will end the practice of banks shipping lending jobs offshore.
  This bill makes unprecedented investments to expand high-quality 
educational opportunities to all Americans. It invests in the Pell 
Grant scholarship award, strengthens Historically Black Colleges and 
Universities and minority serving institutions, and provides more 
resources to states for college access and completion efforts through 
the College Access Challenge Grant program.
  Further, these investments are paid for without increasing our 
nation's deficit, through key reforms in the federal student loan 
programs designed to provide a stronger, more reliable, and more 
efficient student loan system. The legislation directs $10 billion of 
the savings generated under this legislation to paying down the 
country's deficit.
  The education provisions of this legislation will convert all new 
federal student loans to the Direct Loan program starting in July 2010, 
saving $61 billion over the next 10 years. These changes will also 
upgrade the customer service borrowers receive when repaying their 
loans and promote jobs. The legislation will maintain jobs by 
maintaining a robust role for the private sector, allowing lenders and 
non-profits to get contracts with the Department of Education to 
service Direct Loans.
  These education provisions will convert all new federal student loans 
to the Direct Loan program starting in July 2010, saving $61 billion 
over the next 10 years. These changes will also upgrade the customer 
service borrowers receive when repaying their loans and promote jobs. 
The legislation will maintain jobs by maintaining a robust role for the 
private sector, allowing lenders and non-profits to get contracts with 
the Department of Education to service Direct Loans.
  The legislation significantly increases the federal Pell Grant award; 
the cornerstone of need-based federal student assistance since its 
creation in 1972. Investments in this program are essential to ensuring 
educational access and making college more affordable for students and 
families. Both the House and Senate authorizing and appropriating 
committees have made significant investments in increasing the maximum 
Pell Grant award in the past few years--32 percent since 2006. The 
investments in this legislation build on these commitments by indexing 
the maximum Pell Grant award to the Consumer Price Index beginning in 
the 2013-2014 academic year, to reach an estimated maximum of $5,975 in 
the 2017-2018 academic year.
  The legislation invests additional resources in the College Access 
Challenge Grant program created under the College Cost Reduction and 
Access Act of 2007 to assist states working in partnership with 
institutions of higher education, non-profit philanthropic 
organizations, and other organizations with experience in college 
access, to ensure that students have access to high-quality, affordable 
higher education.
  It is the intent of Congress that states receiving grants under the 
College Access Challenge Grant program should partner with entities, 
including guaranty agencies (including their non-profit subsidiaries), 
to provide financial literacy, delinquency and default aversion 
activities, and other loan counseling activities for borrowers.
  While this legislation seeks to ensure increased access and success 
for all students, we intend for the Secretary to work with states to 
address the unique access issues faced by underserved communities, 
including: low-income individuals, individuals with disabilities, 
homeless and foster care youth, disconnected youth, nontraditional 
students, members of groups that are traditionally underrepresented in 
higher education, individuals with limited English proficiency, 
veterans (including those just returning from active duty), and 
dislocated workers.
  The legislation also includes a continuation of funding for 
investments in Historically Black Colleges and Universities, Hispanic-
Serving Institutions, Tribal Colleges, Alaska and Hawaiian Native, 
Predominantly Black Institutions, institutions serving Asian American 
and Pacific Islanders, and institutions serving Native Americans, first 
made under the College Cost Reduction and Access Act of 2007, 
recognizing the critical role these institutions play in serving the 
nation's emerging majority populations.
  Concerning the servicing contracts with eligible not-for-profit 
servicers, this legislation recognizes that not-for-profit servicers 
play a unique and valuable role in helping students in their states 
succeed in postsecondary education and that students should continue to 
benefit from the assistance provided by not-for-profit servicers, 
including customer service, financial counseling, and college access 
and success programs.

  In addition, by including more high-quality servicers in the 
contracting process, competition will be increased thereby delivering 
better quality for student borrowers. Under the bill, not-for-profit 
servicers will be allocated a minimum of 100,000 borrower loan 
accounts. With sufficient loan volume and competitive servicing rates, 
eligible not-for-profit servicers can individually or collectively 
generate sufficient revenue to continue the valuable services they 
provide to borrowers. Because of the significant increase in loan 
volume as all federal loans are moved to the Direct Loan program, 
additional servicing capacity will be needed and is provided for 
through the contracts provision. I encourage the Secretary to implement 
these provisions so that many local not-for-profit servicers will 
continue to play a role in the student loan program.
  As more students become increasingly dependent on loans, the 
Department of Education must increasingly focus on the assistance, 
information, and repayment tools that assist students in successful 
loan repayment. When evaluating the resources and services available to 
student borrowers and schools under the Direct Loan program, I 
encourage the Secretary to use existing contracting authority to 
contract, when appropriate, with state-designated guaranty agencies for 
the delivery of services that increase student loan repayment and 
decrease default. Such agencies shall include those non-profit 
subsidiaries of guaranty agencies that were established, pursuant to 
State law, on or before January 1, 1998.
  Community colleges serve an instrumental role in both our educational 
and workforce systems, providing post-secondary education and job 
training, particularly to individuals and families hardest hit by 
difficult economic times. This includes workers eligible for training 
under the Trade Adjustment Assistance program for communities and for 
individuals who are, or may become eligible for unemployment 
compensation. To ensure that these institutions have access to the 
resources they need to develop and improve educational and career 
training programs designed to meet the needs of these communities, the 
legislation directs the Secretary of Labor to award Community College 
Career Training Grants especially to struggling 2-year public community 
colleges, (as defined in Section 101 of the Higher Education Act of 
1965). As the legislation ensures that all States benefit from these 
resources with the inclusion of a state minimum, I also encourage that 
the Secretary strive to

[[Page H1884]]

ensure a diverse geographical representation of community colleges in 
both urban and rural areas.
  I'd like to thank Ruben Hinojosa, our higher education subcommittee 
chair, Tim Bishop, and all of our committee members for their tireless 
work on student loan reform.
  Along with all the members of our committee, I'd like to especially 
thank Rob Andrews, our health subcommittee chair, for his backbreaking 
work over the last year on health reform.
  And I would like to thank the many members of my staff for their long 
hours and tremendous work over the last year on these two pieces of 
reform: Mark Zuckerman, Danny Weiss, Alex Nock, Michele Varnhagen, Jody 
Calemine, Denise Forte, Ruth Friedman, Megan O'Reilly, Julie Radocchia, 
Jeff Appel, Ajita Talwalker, Celine McNicholas, Meredith Regine, 
Lillian Pace, Kara Marchione, Helen Pacjic, Rachel Racusen, Aaron 
Albright, Melissa Salmanowitz, Andra Belknap, Betsy Kittredge, Mike 
Kruger, Amy Peake and Courtney Rochelle.
  Their commitment and expertise has been invaluable.
  We almost didn't get here today. You know that.
  Opponents of health care reform have said anything and done 
everything to distort the facts, delay the process, and try to put off 
what Americans have asked for and needed for generations. They have 
tried to sow fear into the American people.
  They cannot win on the merits. And they will continue to lie and 
distort the facts going forward. But we have made it to the final step 
in this process--despite all that noise.
  And now we face a simple choice.
  We can side with America's families and college students and make 
health insurance and college more affordable and accessible--while 
creating millions of jobs and reducing the deficit.
  Or, we can side with insurance companies and banks.
  That's it.
  That's the choice.
  I'm siding with the American people.
  I urge each of my colleagues to join me.
  The SPEAKER pro tempore. The gentleman from South Carolina (Mr. 
Spratt) is recognized for 15 minutes as a designee of the majority 
leader.
  Mr. SPRATT. I reserve the balance of my time.
  Mr. RYAN of Wisconsin. Mr. Speaker, I'd like to yield 2 minutes to 
the gentlewoman from Wyoming (Mrs. Lummis).
  Mrs. LUMMIS. The world is begging America to get its financial house 
in order. This Congress responds by doubling the debt in 5 years and 
tripling it in 10.
  Americans are begging for jobs, careers, and stability. This Congress 
responds by hiring 17,000 people at the IRS to enforce on Americans 
government-approved health insurance.
  Small business entrepreneurs beg Congress to empower them to create 
jobs. Congress responds with 20 new taxes in this health care bill, 
amounting to half a trillion dollars.
  Our military families beg us to leave TRICARE alone. This bill 
transfers TRICARE out of the Department of Defense.
  Americans are fed up with government takeovers of business, like the 
auto industry that closed dealerships and threw Americans out of work. 
This health care bill includes a government takeover of the student 
loan business, throwing 31,000 more Americans out of work.
  We Republicans implored the majority for a bipartisan health care 
reform bill. The majority party responded with special deals cut behind 
closed doors to garner votes for its most reluctant members.
  America deserves better than this. America is better than this. Let's 
listen to America. Kill this bill. Start over with health care we can 
afford. Create jobs and save our economy.
  Mr. RYAN of Wisconsin. Mr. Speaker, at this time I'd like to yield 
myself the remainder of our Budget Committee time.
  Mr. Speaker, there's a lot wrong with this bill. We know the problems 
with its costs. We know it doesn't really reduce the deficit. We know 
premiums are going to go up. The CBO has given us all this information 
and it's clear that we have a bill that is chock full of gimmicks and 
hidden mandates. I'm not going to get into all of that again, but what 
I want to ask is this: Why has this decision become so personal to our 
constituents? Why are so many people swarming the Capitol today? Why 
have we received a hundred thousand calls an hour from around the 
country? It's because health care affects every one of us. And yet, 
here we are, debating whether the government should have a bigger role 
in making those personal decisions.
  So make no mistake about it. We are not just here to pass a health 
care bill. We are being asked to make a choice about the future path of 
this country. The speakers to my left are correct: this is history. 
Today marks a major turning point in American history. This is really 
not a debate about prices, coverage, or choosing doctors. This is 
ultimately about what kind of country we are going to be in the 21st 
century.
  America is not just a nationality. It's not just a massive land from 
Hawaii to Maine, from Wisconsin to Florida. America is an idea. It's 
the most pro-human idea ever designed by mankind. Our Founders got it 
right when they wrote in the Declaration of Independence that our 
rights come from nature and nature's God--not from government.
  Should we now subscribe to an ideology where government creates 
rights, is solely responsible for delivering these artificial rights, 
and then systematically rations these rights?
  Do we believe that the goal of government is to promote equal 
opportunity for all Americans to make the most of their lives, or do we 
now believe the government's role is to equalize the results of 
people's lives?
  The philosophy advanced on this floor by this majority today is so 
paternalistic and so arrogant. It's condescending, and it tramples upon 
the principles that have made America so exceptional.
  My friends, we are fast approaching a tipping point where more 
Americans depend upon the Federal Government than upon themselves for 
their livelihoods, a point where we, the American people, trade in our 
commitment and our concern for individual liberties in exchange for 
government benefits and dependences.
  More to the point, Mr. Speaker, we have seen this movie before, and 
we know how it ends. The European-style social welfare state promoted 
by this legislation is not sustainable. This is not who we are and it 
is not who we should become.
  As we march toward this tipping point of dependency, we are also 
accelerating toward a debt crisis; a debt crisis that is the result of 
the politicians of the past making promises we simply cannot afford to 
keep. Deja vu all over again. It's unconscionable what we are leaving 
the next generation.
  This moment may mark a temporary conclusion of the health care 
debate, but its place in history has not yet been decided. If this 
passes, the request to reclaim the American idea is not over. The fight 
to reapply our founding principles is not finished. It is just a 
steeper hill to climb, and it is a climb that we will make.
  On this issue, more than any other issue we have ever seen here, the 
American people are engaged. From our town hall meetings to Scott 
Brown's victory in Massachusetts, you have made your voices heard and 
some of us are listening to you.
  My colleagues, let's bring down this bill and bring back the ideas 
that made this country great.
  Mr. SPRATT. Mr. Speaker, I first recognize the gentleman from 
California (Mr. Baca) for a unanimous consent request.
  (Mr. BACA asked and was given permission to revise and extend his 
remarks.)

                              {time}  2115

  Mr. BACA. Mr. Speaker, I rise in strong support of this legislation.
  Mr. SPRATT. I yield to Mr. Israel of New York to make a unanimous 
consent statement.
  (Mr. ISRAEL asked and was given permission to revise and extend his 
remarks.)
  Mr. ISRAEL. Mr. Speaker, I rise in support of this bill.
  Mr. Speaker, I rise in support of this bill for one fundamental 
reason. It is simply the right thing to do. Not for my Party, not for 
the President, not for the Speaker, not for me. But for the people I 
represent. The middle class and working families; the backbones of our 
economy--small businesses--challenged by rising health costs.
  Few debates have been as long and as passionate as this one. Since 
last August I

[[Page H1885]]

have heard the strong voices on both sides of this issue. I have 
listened to the angry chants of opponents of the bill at Town Hall 
meetings. I have read the mail from people who insist this is a march 
towards socialism, that it is a dangerous experiment, that it involves 
government death panels who will deny senior citizens the life-saving 
health care they need. I have watched protesters march outside my 
district office on Long Island. I have seen the repugnant signs here in 
Washington comparing health care to the Holocaust.
  I have seen and heard it all. But I have also heard others. They are 
the average Long Islanders--not rich, not poor, but usually somewhere 
in between--who live in quiet desperation and concern.
  The small business owner on Long Island who told me he just received 
a 22 percent increase in health insurance premiums and agonizes at the 
prospect of either scaling back the care he provides his workers or 
scaling back the workers he pays. Under this bill, his business will 
receive a tax credit to help him provide insurance to his workers. And 
he will be able to shop for competitive rates and services in a new 
market-driven ``Health Insurance Exchange.''
  The woman who thought health care worked pretty well for her, until 
her daughter was diagnosed with breast cancer. She's been forced to 
deal with high medical costs to care for her daughter. But, under this 
bill, she will not have to worry about an insurance company that 
refuses to pay for her chemotherapy.
  The middle class family with two kids just out of college who are 
having trouble finding a job that provides health insurance. Under this 
bill, those young adults can get coverage on their parents' plans until 
they turn 26.
  The retired plumber on the block where I live. One day he came to my 
house. I thought he wanted to debate this bill with me. Instead, he 
said: ``I wish you would pass this now. Don't these people know that if 
they lose their jobs they lose their health care?''
  And just yesterday, Mr. Speaker, a small business owner called me 
with concerns and plentiful questions about the legislation we will 
vote on today. After I explained it, he said: ``There's been too much 
confusion about this bill. I wish it had been explained.''
  He is right. This bill has changed in over a year of debate. 
Sometimes in an effort to accept bipartisan recommendations. Sometimes 
to reduce its cost. While one side has had the responsibility to 
improve the bill, the other side has taken the opportunity to brand it 
with mischaracterizations. But now the ink is dry, Mr. Speaker. And the 
dry ink of this bill represents the best hope to protect the middle 
class and working families I represent. The small business owner in 
East Northport who now has a level playing field when shopping for 
insurance. The family in Sayville who can now keep a child insured 
until the age of twenty-six. The senior in Deer Park whose drug costs 
will be covered. The accountant in Huntington who lost his job but will 
be able to shop for affordable health care.
  This bill will improve coverage for 485,000 of my constituents with 
coverage through their employer, give tax credits to as many as 81,000 
families and 21,000 small businesses to make health care affordable in 
my district, and extend coverage to 29,000 uninsured residents of the 
towns I represent.
  This bill will reduce our debt. Yesterday, the Congressional Budget 
Office certified that the bill is fully funded and will actually reduce 
federal deficits by $143 billion in the first 10 years and over a 
trillion dollars in the next 10.
  This bill is an urgent reversal from 8 years of ignoring the crisis. 
Between 2000 and 2008, health insurance premiums doubled, insurance 
company profits quadrupled, and an additional 6 million Americans 
became uninsured. As a result, the leading cause of personal bankruptcy 
today is unpaid medical bills. Without action, these trends will grow 
worse.
  These are the middle class families and businesses that have always 
expanded our economy. But rising health costs and insecurity have 
undermined the middle class. This bill will provide them with the basic 
security they need to do what they've always done: build our economy.
  This vote is no different than the 1965 vote for Medicare. Back then, 
when one quarter of American seniors were living in poverty and wracked 
with unpayable medical bills, there were loud voices that said, ``do 
nothing'' and ``start over'' and ``vote no.'' Public opinion was 
skeptical then. Had I been in Congress in 1965, and the choice was 
voting for Medicare and risking my seat, or voting against Medicare and 
saving my seat, I would have voted for Medicare. It became the backbone 
of economic security for our senior citizens and helped build a middle 
class with economic security. This is no different. No less necessary. 
No less historic.
  Mr. SPRATT. Mr. Speaker, I yield to the gentlewoman from Ohio for a 
unanimous consent request.
  (Ms. SUTTON asked and was given permission to revise and extend her 
remarks.)
  Ms. SUTTON. I rise in support of this historic legislation.
  Mr. SPRATT. Mr. Speaker, I yield myself 2 minutes.
  Congress cleared the way for health care reform in the budget 
resolution. And when we did, we stipulated that reform had to be 
deficit-neutral. We can now say that the House, Senate and President 
have all abided by this principle. The bill put before us has been 
scored by the Congressional Budget Office. In this case, CBO found that 
the 10-year cost of all the covered changes in the bill put before us 
amount to $788 billion. But the bill before us also includes 
reductions, savings, and new revenues which total $931 billion.
  When the $931 billion is netted against the $788 billion, the result 
is a net savings, which reduced on-budget deficits over the next 10 
years by $143 billion. That's CBO's estimate of the first 10 years 
under these reforms, a reduction in the deficit of $143 billion. What 
about the next 10 years? CBO estimates that these two bills together 
will save around .5 percent of GDP over the second 10 years. Now that 
may sound minimal, but during that period of time, GDP cumulatively is 
$272 trillion, so .5 percent of that easily equals more than $1.2 
trillion.
  You will hear numbers of all sorts in this debate, but remember these 
because they come from a disinterested source with a well-proven 
record. This is what CBO estimates as the effects of these bills on the 
deficit: a reduction of $143 billion over the next 10 years and a 
reduction of $1.2 trillion over the following years. We have kept the 
promise we made at the outset by keeping health care reform deficit-
neutral, and that's one more reason to vote for this bill.
  I reserve the balance of my time.
  The SPEAKER pro tempore. The gentleman from Michigan (Mr. Camp) is 
recognized for 20 minutes as a designee of the minority leader.
  Mr. CAMP. Mr. Speaker, at this time I yield 3\1/2\ minutes to the 
distinguished gentleman from Indiana (Mr. Pence), our conference 
chairman.
  (Mr. PENCE asked and was given permission to revise and extend his 
remarks.)
  Mr. PENCE. This is truly a remarkable moment in the life of this 
Nation. Some say we're making history. I say we're breaking history. 
We're breaking with our finest traditions--limited government, personal 
responsibility and the consent of the governed. The first principle of 
public service in a free society is humility. The arrogance we've 
witnessed in this institution is breathtaking. Only in Washington, 
D.C., could you say you're going to spend $1 trillion and save the 
taxpayers money. Only in Washington, D.C., could you exchange the pro-
life protections enshrined in the law for 30 years for a piece of 
paper, signed by the most pro-abortion President in American history.
  Despite overwhelming public opposition today, this administration and 
this Congress is poised to ignore the majority of the American people. 
Let me say, Mr. Speaker, this is not the President's House. This is not 
the Democrats' House. This is the people's House, and the American 
people don't want a government takeover of health care. Now I know they 
don't like us to call it that. But when you mandate every American to 
have government-approved insurance, whether they want it or need it or 
not, when you create a government-run plan, paid for with job-killing 
tax increases, and you provide public funding for abortion, that's a 
government takeover of health care, and the American people know it.
  The American people want to face our challenges in health care with 
more freedom, not more government. And this really is about freedom. 
The more I think about this debate, the more I think about what Ronald 
Reagan said in 1964. He said then and now, It's about whether we 
abandon the American Revolution and confess that a little intellectual 
elite in a far distant capital can plan our lives better than we can 
plan them ourselves.
  You know, today we gathered in the old House Chamber for a time of 
worship and prayer. Members of Congress have been doing that for about 
200 years. It's a Chamber filled with statues of great Americans: Sam 
Houston, Lew Wallace, Robert Fulton, William Jennings Bryan, soldiers, 
heroes and

[[Page H1886]]

heroines of freedoms past. As I sat there, I thought of that Bible 
verse that said, ``We are surrounded by such a great cloud of 
witnesses.'' Standing here tonight, I believe we are as well. And I 
mean, not just those that are looking in tonight from here and around 
the country, but those who have gone before. Men and women who did 
freedom's work in their time who persevered, who made this the greatest 
Nation on Earth possible.
  Now it's our turn. We can reform health care without putting our 
country on a pathway towards socialized medicine. We can reform health 
care by giving the American people more choices, not more government. 
So I say to my Democratic colleagues, stand with those who have gone 
before and made the hard choices to defend freedom in their time. Stand 
with us. Stand for freedom, and the American people will stand with 
you.
  Mr. SPRATT. Mr. Speaker, I yield for a unanimous consent request to 
Ms. Fudge of Ohio.
  (Ms. FUDGE asked and was given permission to revise and extend her 
remarks.)
  Ms. FUDGE. Mr. Speaker, I rise in support of this health care 
legislation.
  Mr. Speaker, I rise today to vote for my constituents. Ohioans want 
health care reform and they want it now. They told me: `` Now is the 
time to stand for change. Now is the moment to fight for quality 
care.''
  I'm voting for Vera--a former nurse who lost her insurance after a 
divorce, despite a lifetime of caring for others. She has over ninety 
thousand dollars in medical debt, as a result of her 3 strokes.
  I'm voting for ``Mary's'' mom, who faced cancer without health 
coverage. ``Mary's'' mom died in her daughter's arms in pain and 
without medication because she had no insurance.
  I'm voting for the father in my District, who is forced to choose 
between maintaining his child's health insurance or meeting his monthly 
bills. He shouldn't have to choose between treating his son's sickle 
cell disease and putting food on the table.
  As a pastor said this morning:
  I'm voting like unborn children depend on me.
  I'm voting like a single mom in East Cleveland depends on me.
  I'm voting like seniors in Warrensville Heights depend on me.
  I'm voting like foster youth are waiting on me.
  I'm voting for the person in Euclid who died too soon.
  I'm voting like I don't have health care insurance myself.
  I'm voting for justice and equality.
  I'm voting for health care reform, so that I can hold my head high, 
look my neighbors in the eye and tell them: ``I voted for you, and you, 
and you.''
  Mr. SPRATT. Mr. Speaker, could I inquire as to the remaining time?
  The SPEAKER pro tempore. The gentleman from South Carolina has 13\1/
2\ minutes, and the gentleman from Michigan has 16\1/2\ minutes.
  Mr. CAMP. Mr. Speaker, at this time I yield 2 minutes to the 
distinguished gentleman from California (Mr. McCarthy).
  Mr. McCARTHY of California. Mr. Speaker, this is the people's House, 
and we were sent here to represent people throughout America. Some are 
actually in the gallery, some have been marching around this building, 
some are sitting at home watching on TV. Or they're in their car 
driving back from church, and many of them have been calling this 
Congress. And they've been asking one thing, Why does Washington refuse 
to listen? They see what many on this side of the aisle see, the 
arrogance of Washington. We are here to represent our constituents, 
which is why we are asking, Why are we voting on a health care bill 
today that empowers government instead of the people?
  Survey after survey demonstrates the great unpopularity of today's 
bill. Not only the substance of it, but the trickery, the deals and the 
shortcuts that led us to where we are today. But this bill is being 
pushed through because the majority in this Congress refused to listen 
to the people. The Speaker has even said that she believes that we have 
to pass this bill so people can find out what's in it. The logic here 
is, Washington knows better than the people.
  All this at a time when Washington is borrowing 43 cents out of every 
dollar it spends, adding to our national debt, mortgaging our 
children's future. And this $2.4 trillion bill will steal even more 
money from our children's futures at a time when this administration 
and Congress are poised to run up the debt more than any other 
administrations combined. It doesn't have to be this way. We could have 
easily found a positive bipartisan agreement on commonsense health care 
reforms that reduce the costs, increase competition and increase 
access, all without raising the debt. Today is a legacy vote for 
Members of this people's House, and I urge my colleagues to start over 
and craft the bill to solve the problem.
  Mr. SPRATT. Mr. Speaker, I yield to the gentleman from North Carolina 
(Mr. Watt) for a unanimous consent request.
  (Mr. WATT asked and was given permission to revise and extend his 
remarks.)
  Mr. WATT. Mr. Speaker, I rise in support of the 32 millions Americans 
who will get insurance under this bill.


                Announcement By the Speaker Pro Tempore

  The SPEAKER pro tempore. Under clause 7 of rule XVII, Members may not 
refer to the occupants of the gallery.
  Mr. SPRATT. I now take pleasure in yielding 3 minutes to my colleague 
from South Carolina (Mr. Clyburn), the majority whip.
  Mr. CLYBURN. I thank the gentleman for yielding me the time. Mr. 
Speaker, we have come to a defining moment in our Nation's history. 
Tonight I am thinking about the woman who called in to a talk radio 
program that I appeared on last August. She called in to take issue 
with the gentleman who had just called in earlier to say that he did 
not support our efforts to reform the health care system because he 
liked the insurance he had. The caller shared her experiences of having 
been dropped from coverage by an insurance company she thought she 
liked just as she started her second treatment for breast cancer. She 
said to the gentleman that maybe he liked the insurance he had because 
he had never tried to use it.
  With these reforms, dropping people from coverage when they are 
diagnosed with catastrophic illnesses will no longer be allowed, and 
denying insurance to children with diabetes and other preexisting 
conditions will end immediately. These reforms will allow children to 
remain on their parents' insurance policies until their 26th birthday. 
This bill will immediately begin closing the doughnut hole for 
prescription medications for seniors and eliminating burdensome copays 
or deductibles for their preventive care.
  Despite deafening protests from the other side, the nonpartisan 
Congressional Budget Office says that the reforms included in this bill 
will reduce our deficit by $143 billion in the first 10 years and $1.2 
trillion in the second 10 years. This bill will also create jobs, 
400,000 good-paying jobs, reliable jobs for every year and for small 
businesses. Small businesses will get a tax break on their health care 
premiums that will free up money for them to hire 80,000 more 
employees.
  Mr. Speaker, we have debated this issue for several generations. The 
time has come to act. This is the Civil Rights Act of the 21st century, 
and tonight we will take a significant step to move our country 
forward.
  Mr. CAMP. Mr. Speaker, at this time just for the purpose of a 
unanimous consent request, I yield to the gentleman from Pennsylvania.
  (Mr. DENT asked and was given permission to revise and extend his 
remarks.)
  Mr. DENT. Mr. Speaker, I rise in opposition to this flawed health 
care bill.
  Undeniably, health care reform is needed. Families and businesses are 
struggling to keep up with rising insurance premiums. Thousands of 
constituents in my district do not have access to affordable insurance 
because of skyrocketing costs. An increasing number of Americans are 
impacted by policies that preclude individuals with pre-existing 
conditions from securing insurance. Patients are frustrated with the 
difficulty of navigating the health care system and insurance 
bureaucracy. We have all experienced our doctors practicing defensive 
medicine--ordering unnecessary tests and procedures in an effort to 
ward off frivolous lawsuits. Poor reimbursement rates mean that doctors 
cannot afford to place an emphasis on prevention and wellness.
  The consequences of reform are profound for families, our economy and 
the future of our country. Reform policies will have a direct impact on 
the lives of all Americans and the budgets of every household. These 
changes will affect one-sixth of our economy. Done

[[Page H1887]]

right, we will lift burdens that are holding employers back from 
growing and revitalizing our economy. Done wrong, jobs will be lost and 
10 percent unemployment will become the norm rather than the exception. 
Health care expenditures make up an increasing percentage of state and 
federal spending. Addressing health care costs is vital to the long-
term economic health of the United States.
  I support reform. I have advocated for deliberate policies that will 
reduce the cost and increase the quality of health care, provide all 
Americans with the opportunity to obtain affordable health insurance, 
give patients more control over their health care decisions, and 
promote innovations and wellness initiatives that lead to cures.
  I oppose the bill before us today because it will increase health 
care costs for Americans and bend the curve of health care spending in 
the wrong direction; it will create a new trillion dollar entitlement 
program that the bill does not realistically address how we will 
afford; and it will impede economic growth, particularly in our 
district.
  Above all else, health care reform must address the escalating health 
care costs that are crippling American families and overall, slow our 
nation's healthcare spending. This bill does not accomplish those 
critical objectives. According to an analysis by the Congressional 
Budget Office (CBO), premiums will increase by 10 to 13 percent for 
families who are purchasing health insurance in the individual market. 
This amounts to more than $2,000 a year for a family. In addition, the 
CBO indicates that H.R. 3590, which will be the law of the land if we 
pass it today, will increase the federal budgetary commitment to health 
care by more than $200 billion over the next decade. If the 
reconciliation package (H.R. 4872) is also signed into law, the 
combined budgetary impact on health care spending will be $390 billion. 
American families can't afford that increase and neither can our 
country.
  Moreover, this bill creates an unsustainable new entitlement program 
at the expense of seniors who will be impacted by more than half a 
trillion dollars in Medicare cuts and all Americans who will pay higher 
health care costs and more than half a trillion dollars in increased 
taxes, fees and penalties. The bill uses ten years of taxes and 
Medicare cuts in order to pay for six years of programs. Overall, in 
the first 10 years of full implementation (2014 to 2023), the health 
care package will result in more than $2.6 trillion in spending. 
Although the CBO estimated the overall deficit reduction will be $124 
billion over 10 years, in its analysis the CBO cautioned that its long-
term deficit projections ``reflect an assumption that the key 
provisions of the reconciliation proposal and H.R. 3590 are enacted and 
remain unchanged throughout the next two decades, which is often not 
the case for major legislation. For example, the sustainable growth 
rate mechanism governing Medicare's payments to physicians has 
frequently been modified to avoid reductions in those payments, and 
legislation to do so again is currently under consideration by the 
Congress.''
  House Leadership has already said it will consider a bill to address 
the physician payment issue. Just that policy alone will cost $200 
billion, which is not reflected in the CBO score.
  Finally, this bill will have an immediate impact on economic growth. 
New taxes and regulations will lead to lower wages, lost jobs and 
decreased investment. Employers with more than 50 employees who do not 
provide health insurance coverage that is deemed ``acceptable'' by 
federal standards will be saddled with a tax of up to $2,000 per 
employee. The bill will levy a tax of as much as 2.5 percent of 
household income on Americans who do not comply with the individual 
mandate, which requires all Americans to maintain acceptable coverage. 
Many investors will face a new tax of 3.8 percent on capital gains, 
dividends, interest, rents, royalties and other investment income. This 
tax coupled with scheduled rate increases will lead to a top rate of 
23.8 percent for capital gains and 43.4 percent for dividends.
  We will feel the impact close to home. A 2.3 percent medical device 
tax will increase the cost of medical devices--everything from tongue 
depressors to wheelchairs--and discourage the development of critical 
new medical innovations. Specifically, this tax will impact businesses 
in our district imperiling jobs; curtailing advanced research and 
innovation; reducing purchasing from Pennsylvania vendors; and 
hampering investment in capital equipment. The ripple effect on our 
economy and on working families will be far greater than the sum of the 
tax. And ultimately, patients will see increased costs as a result.
  Just yesterday, I offered two amendments to the Rules Committee that 
would have reduced the negative impacts of H.R. 3590. The first 
amendment would have inserted common-sense medical liability reforms. 
Specifically, the amendment would enact nationwide reforms aimed at 
ending the costly practice of defensive medicine and encourage states 
to adopt effective alternative medical liability laws that will reduce 
the number of health care lawsuits that are litigated and the average 
amount of time taken to resolve lawsuits, and reduce the cost of 
malpractice insurance. The provisions would save our country billions 
of dollars and reduce national health care spending. The second 
amendment would have struck the ill-advised medical device tax that a 
company in my district has dubbed the ``death tax'' because it will 
increase their tax burden by 77 percent, raising their effective tax 
rate to over 73 percent. This is an innovation tax that will mean less 
investment in research and development that leads to medical 
innovations. Unfortunately the leadership of the House would not allow 
these important amendments to be debated on the House floor today.
  I regret very much where we are today and wish that bipartisan 
efforts to address the shortcomings of our system--access and 
affordability--while building on our strengths--choice, quality and 
innovation had prevailed.
  Mr. CAMP. At this time, Mr. Speaker, I yield 2 minutes to the 
distinguished gentlewoman from Washington (Mrs. McMorris Rodgers).
  Mrs. McMORRIS RODGERS. Mr. Speaker, I know that some of my colleagues 
on the other side of the aisle are still undecided, and I sincerely 
urge you to vote ``no.'' This is the wrong bill at the wrong time. At a 
time when 15 million Americans are out of work, this is the wrong time 
to hit small businesses with more taxes and more requirements. At a 
time when premiums are surging for working families is the wrong time 
to pass a bill that everyone acknowledges is actually going to increase 
premiums.
  At a time that we have a $3.8 trillion budget, 40 percent of which is 
deficit spending and is being put on the credit card, this is the wrong 
time to pass a new massive government spending program. And at a time 
when Americans are losing trust in Congress, it is the wrong time to 
strike backroom deals and pass a bill over the will of the people.
  Everybody in this body acknowledges the need for real health care 
reform. But this health care reform will make things worse, not better, 
for the people we serve. We should not let the hunger to do something--
anything--trick us into passing a bill that will cripple free 
enterprise and permanently diminish the freedom of the American 
individual.
  Today I'm reminded of a quote by President Ford: ``A government that 
is big enough to give you everything you want is a government big 
enough to take it all away.'' This is a time for courage and clear 
thinking. I urge my friends on the other side of the aisle to join in 
standing with the American people and vote against this bill.

                              {time}  2130

  Mr. SPRATT. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Pennsylvania (Ms. Schwartz).
  Ms. SCHWARTZ. Mr. Speaker, health care reform represents the largest 
deficit-reduction measure in nearly a generation while controlling the 
rising cost of health care for families and businesses, and improving 
access to and quality of coverage for 95 percent of Americans.
  This plan strengthens coverage and health care for all Americans, 
including provisions that I have fought hard for: prohibiting insurance 
companies from excluding coverage for preexisting conditions for 
children and adults; prohibiting insurers from dropping coverage when 
you get sick, or placing annual or lifetime limits on benefits; 
insuring that all insurance policies use plain, easy-to-understand 
language so that consumers know what they are buying and can honestly 
compare their choices; allowing young adults up to the age of 26 to 
stay on their parents' policies; offering tax credits to small 
businesses so they can afford to provide insurance coverage for their 
employees; eliminating copayments for preventive care for seniors; 
closing the Medicare prescription drug coverage known as the doughnut 
hole, making sure that we close that doughnut hole; promoting the 
important education and research missions of our Nation's teaching 
hospitals and academic medical centers which train the next generation 
of doctors and nurses; focusing on primary care by better ensuring 
Americans, particularly those with chronic diseases, have access to 
ongoing primary care; investing in American innovation and technologies

[[Page H1888]]

by creating new incentives for the development of new cures and 
treatments; and incentivizing collaboration among health providers 
through new payment reforms that promote high quality, efficient 
delivery of care.
  These provisions, and others, in health reform ensure new consumer 
rights and protections for those with insurance. It contains costs for 
families, businesses and for our Nation. And it extends affordable, 
meaningful coverage to 32 million Americans. Health care reform is 
vital to the health of Americans and the health of our economy. The 
status quo is unacceptable and unsustainable. I urge a ``yes'' vote.
  Mr. CAMP. Mr. Speaker, for the purposes of a unanimous consent 
request, I yield to the gentleman from California (Mr. McKeon).
  (Mr. McKEON asked and was given permission to revise and extend his 
remarks.)
  Mr. McKEON. Mr. Speaker, I rise in opposition to this flawed health 
bill.
  Mr. CAMP. Mr. Speaker, I yield 3 minutes to the distinguished 
gentlewoman from West Virginia (Mrs. Capito).
  Mrs. CAPITO. Mr. Speaker, for a moment let's think of this bill as a 
blanket, a blanket of health care legislation that may be draped across 
America and its population in the coming years. Unfortunately, this 
blanket is woven not from all hands working together, but is the 
handiwork of strong-arm, political deal-making, and, perhaps most 
disheartening, a resistance to listen to the American people.
  Its cloth has been cut behind closed door, and its color is tinged by 
partisan hands. It is too short in some areas, and too long in others, 
woven to cover the winners and to leave out the losers. Once this 
blanket of legislation is laid out, those that huddle beneath it will 
find that it does not provide the real health care reform they need for 
their families. In fact, it will become a wall of government between 
them and their doctor.
  Its huge holes will not protect the cold wind of job loss, new taxes, 
government bureaucracy, and increased health care costs. And though we 
hear of coming patches in the future, in all likelihood they will be 
made of the same flimsy fabric of broken promises.
  All of America will feel the weight of this uncomfortable burden. The 
real cost of the $2.6 trillion bill will only increase in the future. 
States like mine, West Virginia, will feel the weight in huge budget 
shortfalls caused by millions of dollars in unfunded mandates. States 
must balance their budgets and will be forced to absorb the massive 
increase in Medicaid spending demanded by this bill.
  But, the full burden will be paid by those who enjoyed this beautiful 
spring day, playing outside in backyards across America. Little do they 
know as they play that we are on the cusp of burdening them with 
generational debt. The Speaker and her team will drape this legislation 
across citizens, ignoring their pleas against it. And America will 
again shake its head in disbelief and ask how Washington can turn a 
deaf ear and be so disconnected from the American people.
  If we stand here in obedience to our purpose, the Congress will be an 
effective representation of the people of the United States. We should 
stop this unfortunate endeavor, take a step back and listen, listen to 
the heartbeat of America, the beat that yearns for true health care 
reform, the beat that asks for bipartisan government committed to 
solving America's problems, the beat that asks that we put America's 
families first. America deserves this. America deserves to be heard.
  Mr. SPRATT. Mr. Speaker, I yield 2 minutes to the gentleman from 
Florida (Mr. Boyd).
  (Mr. BOYD asked and was given permission to revise and extend 
remarks.)
  Mr. BOYD. Mr. Speaker, I thank my friend, Mr. Spratt from South 
Carolina.
  Mr. Speaker, ladies and gentlemen, I heard a wise man once say that 
you never saw a great country with an uneducated and unhealthy 
population. We are headed there. Sixty-seven thousand uninsured in the 
congressional district that I represent will be helped by this bill. We 
all know the statistics about the spiraling cost of insurance and the 
ever-increasing percentage of uninsureds within our own districts and 
across this Nation. We all agree this is an unsustainable path. I have 
heard you say it many times. So I ask you, How high do these numbers 
have to go before we act?
  Earlier I heard the gentlelady from Washington State say it is the 
wrong time. For 22 years in my legislative service, as I have been 
trying to find solutions, I have heard it is the wrong time. I know 
many of you have been trying to find those solutions, too, from time to 
time; solutions for those high costs, the spiraling high costs, the 
ever-increasing number of uninsureds on an annual basis, solutions that 
would do it in a fiscally responsible way and use the good parts of our 
private-sector delivery system. Ladies and gentlemen, this bill does 
all four of those things.
  Mr. Speaker, if we fail to act now, the path we are on will create a 
society of haves and have-nots based solely on one's ability to 
purchase health insurance.
  I know this bill isn't perfect. There are some things in it that I 
don't like; but seldom are bills perfect the first time around. The 
other side has brought us no viable alternatives. So then I ask you, 
ladies and gentlemen, if not this, then what? If not now, then when?
  Mr. Speaker, I urge my colleagues to vote ``yes'' for the health of 
our people and the strength of our economy.
  Mr. CAMP. For the purposes of a unanimous consent request, Mr. 
Speaker, I yield to the gentleman from Nebraska (Mr. Smith).
  (Mr. SMITH of Nebraska asked and was given permission to revise and 
extend his remarks.)
  Mr. SMITH of Nebraska. Mr. Speaker, I rise in opposition to this 
flawed health care bill.
  Mr. CAMP. Mr. Speaker, at this time I yield 3 minutes to the 
distinguished gentleman from Tennessee, Dr. Roe.
  (Mr. ROE of Tennessee asked and was given permission to revise and 
extend his remarks.)
  Mr. ROE of Tennessee. Mr. Speaker, today we debate and vote on the 
most important piece of social legislation in decades, a massive 
expansion of government unparalleled in our Nation's history, with the 
potential to bankrupt future generations by lowering the standard of 
living for our children and grandchildren.
  For the past 30 years, I haven't been a politician, but a physician, 
treating patients and delivering babies in rural east Tennessee. And I 
can say without hesitation that we have in this country the highest 
quality of health care in the world. But I will also say that this care 
is too expensive for an increasing number of people.
  Health care should not be a partisan issue. I have never operated on 
a Republican or a Democrat cancer in my life. We have heard about how 
this is going to save money and reduce the budget deficit. Seventeen 
years ago in Tennessee we tried a plan called TennCare. It was an idea 
where different companies were going to compete and we were going to 
cut costs. What happened in that? Just 10 budget years later, our costs 
had tripled and we had to cut the rolls in Tennessee because the State 
was literally going bankrupt. And this year for the first time, we have 
had to limit patients' visits to 8 doctor visits per year, and this 
plan will only pay $10,000, I don't care what the cost of the care is, 
and those costs are shifted to private insurers. Also the physicians 
are not taking TennCare because it pays them less than 60 percent of 
their costs of actually providing the care. That approach, which is 
pretty much the same approach we are voting on here today, failed, and 
I know because I am a physician who worked in that system.
  Mr. Speaker, I have one question for every Member of this body: If we 
have seen how this Big Government scheme doesn't work, why would you 
vote for it again? Well, the States know. They are already well ahead 
of the Federal Government. Thirty-seven States, including Tennessee, 
are now proposing legislation to opt out if the ObamaCare plan should 
pass.
  So the States get it because they can't afford it. The seniors get it 
because they understand $500 billion will be cut from this program. And 
let me tell you, in the next 10 years we are going to add 35 million 
people to the Medicare rolls in this country when the baby boomers hit. 
Three things will happen when that occurs: you will decrease access; 
you will decrease quality

[[Page H1889]]

because you can't see your doctor; and costs will go up. So seniors get 
it.
  The doctors get it. They are going to work harder and get paid less. 
Also, there is no meaningful tort reform, and without that, you cannot 
reduce the cost of care. The American people get this. The people of 
Tennessee don't want this plan. The people of the United States don't 
want this plan; but the politicians who vote for it are not listening.
  I choose to listen to the American people and vote ``no,'' and urge 
my colleagues to do the same.
  Mr. SPRATT. Mr. Speaker, for the purposes of a unanimous consent 
request, I yield to the gentleman from New York (Mr. Meeks).
  (Mr. MEEKS of New York asked and was given permission to revise and 
extend his remarks.)
  Mr. MEEKS of New York. Mr. Speaker, I rise in support of this 
historic legislation.
  Mr. Speaker, I rise in support of Affordable Care for America.
  I am proud to stand with my colleagues in the U.S. House of 
Representatives in support of this critical legislation to ensure that 
each and every American has access to affordable, quality healthcare. 
This bill will put Americans and small businesses back in charge of 
their health care choices and make coverage affordable for everyone. 
Premium tax credits and cost-sharing assistance will be offered to low- 
and middle-income Americans, which will be the largest tax cut for 
health care in the history of this nation.
  My constituents in the Sixth Congressional District and across the 
country will be provided the opportunity to make informed decisions 
about their health insurance and purchase the plan of their choice.
  It is extremely important that every hard working American receives 
affordable high quality healthcare. This critical legislation will 
extend coverage to 95 percent of all Americans when passed. For the 
Sixth Congressional District this means that 54,000 residents who 
currently do not have health insurance will receive coverage.
  By passing this historical legislation we will be able to provide the 
people of the United States the proper healthcare they deserve. No 
American should be denied the right to better and affordable health 
care coverage. No American should be discriminated against by insurance 
companies based on pre-existing conditions, health status and gender. 
No American should be forced into medical bankruptcy because their 
Medicare access was terminated. I urge my colleagues in the House of 
Representatives to vote ``yes'' so no American is told ``no'' again.
  Mr. SPRATT. Mr. Speaker, for the purposes of a unanimous consent 
request, I yield to the gentlewoman from California (Ms. Roybal-
Allard).
  (Ms. ROYBAL-ALLARD asked and was given permission to revise and 
extend her remarks.)
  Ms. ROYBAL-ALLARD. I rise in strong support of this bill.
  Mr. Speaker, I rise in support of the Senate Amendments to H.R. 
3590--the Patient Protection and Affordable Care Act. This legislation 
represents a milestone in our Nation's history. Building on the promise 
that was begun with the passage of Medicare in 1965, we take an 
historic step today toward acknowledging health care as a universal 
right for everyone.
  The people of America have suffered far too long from a health care 
system that is unaffordable, discriminates on the basis of gender, 
disability, and pre-existing conditions, and frequently denies coverage 
for lifesaving services and treatments. While we pay more than any 
other country in the world for health care, we die younger with the 
highest rate of preventable deaths among 19 industrialized nations. 
Obviously this status quo is unsustainable and the time for change is 
now.
  The bill we are voting on today reflects many long months of 
discussion and compromise. Clearly it is not perfect, and many of us 
would have preferred to see the bill go much further towards granting 
universal access to health care for every man, woman and child in this 
country. But with an issue that impacts so many stakeholders, and 
involves so many competing interests, it is doubtful that any single 
legislative effort could ever satisfy everyone and address all the 
problems we face in our current system.
  So while this bill falls short of what many of us had hoped would be 
included in a final bill, I believe it is critical that we move forward 
today in response to a crippled health care system that has been 
failing our country. With the passage of this bill we will improve the 
quality and affordability of health services, prioritize prevention and 
the reduction of health disparities, and take the necessary albeit 
difficult steps to rein in the escalating costs of health care in this 
country.
  I will be voting for this bill today for the people in my 34th 
Congressional District of California. Over 23 percent of my 
constituents live below the federal poverty level, and 40 percent of 
them are uninsured. In 2008, over 1100 of my constituents faced health 
care-related bankruptcies caused primarily by health care costs that 
were not covered by their insurance. This bill will extend coverage to 
185,000 of my constituents, and will guarantee that 28,500 residents 
with pre-existing conditions can obtain coverage while protecting those 
who do have insurance from bankruptcy due to unaffordable health care 
costs.
  I will be voting for this bill today for the small businesses in my 
District. With its passage, over 16,000 small businesses in my district 
that have 100 employees or less will be able to join the health 
insurance exchange, benefiting from group rates and a greater choice of 
insurers. H.R. 3590 will also help make small businesses more 
competitive by providing tax credits that will make it more affordable 
for them to offer health insurance to their employees. In my district 
approximately 15,000 small businesses would qualify for these credits.
  As chair of the Congressional Hispanic Caucus Health Task Force, I 
will be voting for this bill today for Hispanic communities all across 
the country. It is of great concern to me that this segment of the 
population continues to face the highest uninsured rate of any racial 
or ethnic group within the United States. In fact, a recent report 
found that 42 percent of Hispanic adults lacked health insurance 
compared to the national average of 16 percent.
  This legislation will provide access to affordable health care to the 
millions of uninsured Latinos in this country through Medicaid 
expansion. The legislation will also provide access to health insurance 
exchanges and subsidies to help low- and moderate-income families. 
Additionally, the bill expands Community Health Centers which have been 
a cornerstone of primary care services in communities of color, and 
expands coverage for preventive care which has been disproportionately 
inaccessible to minorities.
  Finally, I will be voting for this bill today for the women and 
mothers in this country who have long managed the health care of their 
children, their spouses, and the elderly in their families. This 
legislation will mandate coverage for maternity care, so all women will 
be able to give their babies the healthiest start in life.
  By preventing insurance companies from dropping coverage for extended 
illness or denying coverage for pre-existing conditions, it will give 
moms the peace of mind knowing that their children and spouses will 
have the health coverage they need if they become ill or suffer from a 
genetic condition or disability. As their young adult children start 
out in life they can protect them by keeping them on their family 
insurance policy until their 26th birthday
  And who among us will not be more secure knowing that our parents 
will be protected from the Medicare Part D donut hole which has made 
life saving medications so unaffordable for those that need them most?
  Mr. Speaker, I thank you for your courage, tenacity and leadership 
throughout this year of deliberation on Health Care Reform. We owe you, 
the Majority Leader, and the Leadership team of this House a debt of 
gratitude for bringing this House to this historic day. I am proud to 
cast my vote for the passage of the Senate Amendments to H.R. 3590--the 
Patient Protection and Affordable Care Act.
  Mr. SPRATT. Mr. Speaker, I yield 2 minutes to the gentleman from 
Virginia (Mr. Scott).
  Mr. SCOTT of Virginia. Mr. Speaker, America has been debating health 
care for over 100 years, and during this debate we have heard 
complaints and blame and misrepresentations, slogans, even name-
calling. But today, we finally get to discuss the bills.
  The bills will provide affordable health care insurance to over 30 
million Americans who are uninsured today, including those with 
preexisting conditions. These bills will provide security for those who 
have insurance because 14,000 Americans will no longer lose their 
insurance every day, and others will no longer have to watch the cost 
of their insurance skyrocket every year.
  Insurance companies will no longer be able to cancel policies or stop 
making payments in the middle of an illness. No longer will those with 
health care have to make copayments for preventive services, or go 
bankrupt, because the bills provide affordable limits on copays and 
deductibles.
  And because the legislation will provide affordable insurance to 
virtually all Americans, families with insurance will not have to pay 
an extra thousand dollars a year to offset health care costs for those 
who show up at hospitals without insurance.

[[Page H1890]]

  Seniors will no longer fall into the doughnut hole.
  Our youth will be able to stay on their family policies until they 
are 26. And small businesses will see significant savings in health 
insurance costs because they will purchase insurance with the same 
price advantages as large businesses. And many small businesses will 
receive temporary tax credits.
  That's what is in the bill, and it is more than paid for. The CBO 
projects significant savings for the first 10 years, and huge savings 
for the next 10 years.
  Mr. Speaker, future generations will look back at the votes we cast 
today, just as today we look back at the votes on Social Security and 
Medicare. Those future generations will see that we proudly voted in 
favor of health care for all.
  Mr. CAMP. Mr. Speaker, for the purposes of a unanimous consent 
request, I yield to the gentleman from Colorado (Mr. Lamborn).
  (Mr. LAMBORN asked and was given permission to revise and extend his 
remarks.)
  Mr. LAMBORN. Mr. Speaker, I rise in opposition to this flawed health 
bill.



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