[Congressional Record Volume 156, Number 48 (Thursday, March 25, 2010)]
[Extensions of Remarks]
[Page E506]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                       RECONCILIATION ACT OF 2010

                                 ______
                                 

                               speech of

                          HON. HENRY A. WAXMAN

                             of california

                    in the house of representatives

                         Sunday, March 21, 2010

  Mr. WAXMAN. Mr. Speaker, regarding spiritual care: The purpose of 
health care reform has been to ensure that all Americans are covered by 
affordable, quality insurance. Some of my colleagues have raised 
concerns about how this impacts Christian Scientists who use certain 
primary care services that are currently eligible for a medical care 
tax deduction.
  Nothing in this health care reform legislation prevents insurance 
companies from covering care that is currently recognized by the 
Internal Revenue Service as eligible for a medical care tax deduction 
through health insurance plans in the Exchanges; nothing in the 
legislation is intended to have such a prohibition. Nothing in this 
legislation is intended to minimize or reduce existing provisions in 
the law that recognizes spiritual care.
  Individual responsibility: The individual responsibility requirement 
requires individuals to pay a tax on their individual tax filings or 
provide information documenting they fulfill the requirements for 
having essential minimum coverage over the past year. Congress makes 
the following findings to support this requirement:
  The individual responsibility requirement provided for in the Patient 
Protection and Affordable Care Act, and amended by Section 1002 of the 
Health Care and Education Reconciliation Act, requires individuals 
either to purchase a minimum level of insurance coverage or to make a 
payment on one's tax return to help cover the cost of uncompensated 
care. This requirement is commercial and economic in nature and 
substantially affects interstate commerce in many ways, including as a 
result of the following aggregate effects:
  (1) The requirement regulates activity that is commercial and 
economic in nature, involving the distribution and consumption of 
health care services throughout the national economy, and in particular 
economic and financial decisions about how and when health care is paid 
for and when health insurance is purchased. Some individuals currently 
make an economic and financial decision to forego health insurance 
coverage and self-insure, paying for charges for services directly to 
the provider and relying on uncompensated care. The decision by 
individuals not to purchase health insurance has many substantial 
effects on the national economy, the national marketplace for health 
insurance, and interstate commerce. In general, individuals who fail to 
purchase health insurance have a diminished capacity to purchase health 
care services, and increase overall health care costs. When such 
individuals inevitably seek medical care, the costs of that care must 
often be paid for by providers, insured individuals and businesses 
through higher premiums, or Federal, State, and local governments. The 
requirement encourages prepayment for services, and affects an 
individual's decision whether or not to purchase health insurance by 
imposing penalties on individuals who remain uninsured. Congressional 
Budget Office, Key Issues in Analyzing Major Health Insurance 
Proposals, December 2008.
  (2) The uninsured receive about $86,000,000,000 in health care, of 
which about $56,000,000,000 is uncompensated. Private spending on 
uncompensated care is $14,500,000,000, and includes profits forgone by 
physicians and hospitals. Government spending on uncompensated care is 
$42,900,000,000, and is financed by taxpayers at both the State and 
Federal levels. Jack Hadley et al., Covering the Uninsured in 2008: 
Current Costs, Sources of Payment, and Incremental Costs, Health 
Affairs, August 25, 2008.

  (3) Health care received by the uninsured is more costly. The 
uninsured are more likely to be hospitalized for preventable 
conditions. Jack Hadley, Economic Consequences of Being Uninsured: 
Uncompensated Care, Inefficient Medical Care Spending, and Foregone 
Earnings, Testimony before the Senate Subcommittee on Labor, Health and 
Human Services, Education, and Related Agencies, May 14, 2003. 
Hospitals provide uncompensated care of $35,000,000,000, representing 
on average 5 percent of hospital revenues. Health Affairs, August 25, 
2008.
  (4) Those who have private health insurance also pay for 
uncompensated care. Medical providers try to recoup the cost from 
private insurers, which increases family premiums by an average of over 
$1,000 a year. Families USA, Hidden Health Tax: Americans Pay a 
Premium, May 2009.
  (5) The decision to self-insure increases financial risks to 
households throughout the United States. Sixty-two percent of all 
personal bankruptcies are caused by illness or medical bills, and a 
significant portion of medically bankrupted families lacked health 
insurance or experienced a recent lapse in coverage. David U. 
Himmelstein et al., American Journal of Medicine, Medical Bankruptcy in 
the United States, 2007: Results of a National Study, 2009.
  (6) The national economy loses up to $207,000,000,000 a year because 
of the poorer health and shorter lifespan of the uninsured. Elizabeth 
Carpenter and Sarah Axeen, The Cost of Doing Nothing, New America 
Foundation, November 2008.
  (7) A large share of the uninsured are offered insurance at low or 
zero premiums, but choose to forego coverage. New America Foundation, 
December 6, 2007. According to one estimate, the absence of a 
requirement from health reform would leave 50 percent of the uninsured 
without coverage. Linda J. Blumberg and John Holahan, Do Individual 
Mandates Matter?, The Urban Institute, January 2008. While generous 
subsidies alone would not achieve universal coverage, the requirement 
further expands coverage. Congressional Budget Office, December 2008. 
The requirement improves budgetary efficiency by significantly lowering 
the federal cost per newly insured. Jonathan Gruber, Covering the 
Uninsured in the U.S., National Bureau of Economic Research, January 
2008. In Massachusetts, where a similar requirement has been in effect 
since 2007, the share of uninsured declined to 2.7 percent in 2009. 
Massachusetts Division of Healthcare Finance and Policy.
  (8) By regulating the decision to self-insure, and expanding 
coverage, the requirement addresses the problem of free riders who rely 
on more costly uncompensated care, including access to emergency care 
required by federal law to be provided even to the uninsured, shifting 
costs to medical providers, taxpayers, and the privately insured. It 
will also reduce the cost to the national economy of the lower 
productivity of the uninsured.
  The preceding 8 points cite numerous studies and papers which 
illustrate the extensive evidence that the Patient Protection and 
Affordable Care Act, as amended by Section 1002 of the Health Care and 
Education Reconciliation Act, substantially affects interstate 
commerce. These citations are included in their written entirety for 
the record.

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