[Congressional Record Volume 156, Number 48 (Thursday, March 25, 2010)]
[House]
[Pages H2429-H2440]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010
Mr. GEORGE MILLER of California. Mr. Speaker, pursuant to House
Resolution 1225, I call up the bill (H.R. 4872) to provide for
reconciliation pursuant to Title II of the concurrent resolution on the
budget for fiscal year 2010 (S. Con. Res. 13), with the Senate
amendments thereto, and ask for its immediate consideration.
The Clerk read the title of the bill.
The SPEAKER pro tempore (Mr. Capuano). The Clerk will designate the
Senate amendments.
The text of the Senate amendments is as follows:
Senate amendments:
On page 118, strike lines 15 through 25 (and redesignate
subsequent subsections accordingly).
On page 120, strike lines 3 through 5.
Motion to Concur
Mr. GEORGE MILLER of California. Mr. Speaker, I have a motion at the
desk.
The SPEAKER pro tempore. The Clerk will designate the motion.
The text of the motion is as follows:
Motion offered by Mr. George Miller of California:
Mr. George Miller of California moves that the House concur
in the Senate amendments.
The SPEAKER pro tempore. Pursuant to House Resolution 1225, the
motion shall be debatable for 10 minutes equally divided and controlled
by the chair and ranking minority member of the Committee on Education
and Labor.
The gentleman from California (Mr. George Miller) and the gentleman
from Minnesota (Mr. Kline) each will control 5 minutes.
The Chair recognizes the gentleman from California.
General Leave
Mr. GEORGE MILLER of California. Mr. Speaker, I ask unanimous consent
that all Members may have 5 legislative days in which to revise and
extend their remarks and insert extraneous material on H.R. 4872.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mr. GEORGE MILLER of California. Mr. Speaker, at this time I yield 2
minutes to the gentleman from New Jersey (Mr. Andrews).
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. ANDREWS. Mr. Speaker, I thank my chairman for yielding.
When you take your son or daughter to the emergency room, and you're
sitting and waiting in the emergency room, you have a lump in your
throat, and you're hoping and praying that when the doctor comes back,
the news will be that it's just food poisoning and not a malignancy in
your son or daughter's stomach. For many Americans, that joyous moment
is followed by another lump in their throat, because even though you've
got the joyous news that your child is okay, you can't pay her bill
because you have no health insurance. And so many of those Americans
for so very long, since the days of Theodore Roosevelt, have looked for
the answer. What the President signed on Tuesday and what we do tonight
will finally give them that answer.
We will finally say that Americans who wait on tables and pump gas
and clean our offices at night will finally have the ability to go home
and not only thank God for the fact that their child is better but be
thankful for the fact that they live in this country where every
American finally has affordable access to health insurance. That is our
mission here tonight. Vote ``yes.''
Mr. GEORGE MILLER of California. I reserve the balance of my time.
Mr. KLINE of Minnesota. Mr. Speaker, at this time I yield myself 2
minutes.
[[Page H2430]]
It has been suggested that today's action will be the final word on
the health care debate that has consumed the attention of Washington
and America for more than a year. I would suggest instead that much
remains to be said and seen. The ink is hardly dry on the Democrats'
government takeover of health care, but already we are seeing its
devastating real-life consequences.
We discovered a loophole that leaves many young adults out of the
reach of their parents' insurance coverage, despite the President's
pledge that they will receive care today. We learned there is a gap in
the law that allows insurance companies to continue denying care to
children with preexisting conditions. Again, despite the President's
claim to the contrary. And reports continue to document what this
legislation has in store for workers at companies like Caterpillar,
John Deere, Verizon, and many others. Here's what they're telling us to
expect: $100 million or more in compliance costs this year alone for
just one of these companies, major changes to workers' current health
care coverage, and higher taxes, which will mean higher costs for
consumers.
These announcements arrived just days after the President signed his
health care plan into law. We can only imagine what's in store for the
American people as the weeks and months unfold and we begin to
experience the full impact of the government control over one-sixth of
our economy. These revelations are the obvious consequences of jamming
a flawed bill through a flawed process. Mr. Speaker, a flawed bill
jammed through a flawed process guarantees the health care debate will
go on.
{time} 2030
The American people have rejected a government takeover of health
care, so let's reject this latest fix of the bill. Let's show the
American people we will not accept even more job-killing tax hikes at a
time when almost 15 million Americans, 15 million Americans are looking
for work.
Let's show the American people we will not accept even steeper cuts
to Medicare that will leave millions of seniors less secure.
Let's show the American people we will not exploit this economic
crisis to launch a government takeover of student loans or take $9
billion from students to help fund government-run health care.
Let's show the American people we're ready to do better. Let's vote
``no.''
And now, Mr. Speaker, I am pleased to yield 2 minutes to the Chair of
the Republican Conference, the gentleman from Indiana (Mr. Pence).
(Mr. PENCE asked and was given permission to revise and extend his
remarks.)
Mr. PENCE. Well, here we go again. Last Sunday, defying the will of a
majority of the American people, House Democrats rammed their health
care bill through the Congress chock full of Big Government spending
mandates and backroom deals. Now we're being asked to fix the bill by
passing some sort of reconciliation measure.
But, Mr. Speaker, the bill before us tonight doesn't fix anything. It
doesn't fix the fact that this is a government takeover of health care
that's going to mandate that every American buy health insurance
whether they want it or need it or not. It doesn't fix the fact that it
includes about $600 billion in job-killing tax increases in the worst
economy in 30 years. It doesn't fix the fact this bill provides public
funding for elective abortion for the first time in American history.
Mr. Speaker, the American people know there's no fix for ObamaCare.
We need to repeal this law and start over. If we repeal ObamaCare, we
can start over with commonsense solutions at a lower cost and create
jobs. If we repeal ObamaCare, we can enact medical malpractice reform,
use the savings to cover Americans with preexisting conditions, and
promote pro-life protections in the law. If we repeal ObamaCare, we can
reform health care in this country without putting our Nation on a
pathway towards socialized medicine.
I urge my colleagues in both parties, heed the voice of the American
people. Reject this attempt to fix a government takeover of health
care. Work with us to repeal and start over on health care reform that
reflects the common sense and the common values of the American people.
Mr GEORGE MILLER of California. Mr. Speaker, I continue to reserve.
Mr. KLINE of Minnesota. Mr. Speaker, before I yield to the
distinguished Republican leader, can I ask the chairman of the
committee to confirm that he is the last speaker and will be closing?
All right.
Then, at this time, I am very pleased to yield the remainder of our
time to the distinguished Republican leader, the gentleman from Ohio
(Mr. Boehner).
Mr. BOEHNER. Mr. Speaker, the American people are asking: Where are
the jobs? But as we see today, the issue of government-run health care
will continue to be the focus of this body. It will remain the focus of
this body because of the unilateral, secretive, rushed process that's
been used to force this bill on the American people.
Today we're passing legislation to correct major errors in the
massive bill that was signed less than 72 hours ago. It removes some,
just some of the special interest deals that were loaded into that bill
as it moved through Congress.
And to meet the majority's targets for deficit reduction, it adds
more tax hikes on the American people and cuts more money from Medicare
to pay for a new entitlement program. We could have given the American
people a more commonsense bill that lowers the cost of health insurance
in America without all of this mess.
If you had wanted to pass reforms to ensure coverage for Americans
with preexisting conditions and ensure that parents can keep their
children on their health plans through age 25, you could have done so
in a bipartisan fashion. Instead, you decided to jam through more than
the system could handle, leaving us a sloppy mess that the majority of
the American people believe should be repealed and replaced.
And mark my word, we will be back to this bill over and over again in
the next 6 months. You all know what's going to happen. We'll be back
here to correct the mistakes that we didn't do right the first time
because of the rush that we were in to approve this massive spending
bill that was hidden from the original bill.
And I'll guarantee you, you all know we'll be back here to do a ``doc
fix'' that will cost $250 to $300 billion. And the question is: Will we
find the money to pay for it?
We'll be back here to appropriate money for a new IRS group of
individuals that we're going to need to hire to enforce this law on the
American people.
We'll be back to borrow money to lend to the States to pay for
increased costs as their Medicaid rolls begin to swell.
And then we're going to find the empty promises that were made to the
American people, because most doctors don't take Medicaid patients. And
so we're going to put all these new people on Medicaid, yet, how are
they ever going to find a doctor?
We'll be back to fix the protections for TRICARE benefits for active
duty and retired servicemembers, veterans and their families that
somehow got left on the cutting floor.
And we'll be back to deal with the unintended, but certainly
anticipated, consequences of people losing their health care because
this bill makes it too expensive for employers to keep employees on
their health plan.
Several weeks ago, more than 130 economists signed a letter to
President Obama warning that the health care bill that was being pushed
through Congress would cost Americans jobs, and sadly, we're already
seeing evidence that those economists were right.
In just the last 3 days, we've seen the stories. Major employers like
Caterpillar and John Deere talking about increases of $250 million in
their health care costs. Medical device companies in Massachusetts
talking about thousands of jobs being wiped out. The tourism industry
in New Hampshire facing millions of dollars of fines because it hires
seasonal workers.
We're going to have to come back and fix this bill time and time
again in the coming weeks and months to correct all the flaws and all
of the mistakes.
[[Page H2431]]
What we should be doing is working together to create a better
environment for America's small businesses to invest, to save, and to
rehire American workers. But, no, instead we're going to keep coming
back here fixing the flaws in this very flawed bill.
Mr. Speaker, when are we going to address the number one issue on the
minds of our fellow citizens, and that is the question of where are the
jobs? When are we going to focus on the economy and getting people back
to work instead of all of the job-killing policies that we're seeing
move through this Congress? When are we going to begin to listen, once
again, to the American people who sent us here to do their work?
Because the American people are asking the question: Where are the
jobs?
Mr GEORGE MILLER of California. I yield myself the balance of my
time.
Mr. Speaker, I rise today in support of this legislation, the last
leg of a long journey to bring historic health insurance and student
loan reforms to the American people.
Two days ago President Obama made our first piece of groundbreaking
health reforms the law of the land, a remarkable moment that will
benefit millions of American families and small businesses. Our health
insurance reforms and student loan reforms are truly historic.
But the benefits for Americans start right now. And with this law, we
make college more affordable and health care available to all
Americans. That's what we promised we would do, and that's what we did.
We voted to do what's right for the American people, not for the
insurance companies. Our reforms responded directly to what we have
been hearing from families and small businesses who are getting crushed
by today's broken and unsustainable health insurance system.
Our reforms respond to what we've been hearing from millions of
students and families, working very, very hard to try and pay for
college. And that's what we're voting on today. We're voting to make
student loan payments more manageable for new borrowers, to strengthen
community colleges, to invest in minority-serving institutions, to
embolden the programs to help students succeed at gaining a college
degree, and to reduce the deficit by $10 billion.
We're voting to restore faith in the American Dream, to ensure
quality affordable insurance for all Americans, and to invest in
students and in our economy's future strength. That's what Democrats in
Congress and President Obama are doing for the American people this
year.
I want to thank Speaker Pelosi, Majority Leader Hoyer, Majority Whip
Clyburn, and our entire leadership team for their tremendous work on
this matter.
I want to thank Chairmen Waxman, Levin, and Slaughter; the Dean of
the House, John Dingell; Representatives Rangel, Andrews, Pallone, and
Stark for their outstanding contributions to this effort. And I want to
thank my counterpart in the Senate, Senator Tom Harkin, for joining me
on insisting on doing what's right for our families and our students.
Tonight we have the ability to put in the hands of every American
family health security and a more affordable opportunity to have their
children achieve a college education. That's the road to prosperity.
That's the road to freedom for America's families, for our students,
for our economy, and for the future of this country.
Join me tonight to vote ``aye'' for our families, for our small
businesses, and for America. Vote ``aye'' tonight.
Mr. CONAWAY. Madam Speaker, today may well mark a great victory for
President Obama and the Democratic Leadership of Congress. After months
of bitterly partisan debates, massive protests, and wrenching
arguments, it appears as though they finally have the votes to bend an
unyielding electorate to their will and pass the most massive expansion
of the Federal Government in two generations. Yet, a victory today
would be a pyrrhic victory; the costs of implementing their vision for
the future of American health care will bankrupt our treasury and rob
us of our liberty.
Make no mistake, the Democrat's plan pushes our Nation down a path
from which there is no easy retreat. The changes imposed by this plan
fundamentally renegotiate the relationship between the Federal
Government and the citizens of our country, making Americans look first
to Washington to secure their health care. This bill is sweeping in
law, but revolutionary in spirit. I believe that this legislation will
be the beginning of the end of our grand American Experiment.
Many of my colleagues and I have discussed the staggering costs
imposed by this legislation. In fact, it might be the single most
expensive piece of legislation ever passed in the history of our
country. Although supporters like to point out that the Congressional
Budget Office scores this bill as one that reduces the deficit, more
realistic Members will note that CB0 does not have particularly good
marks in predicting the cost of legislation. Most recently, the CB0 was
off by almost 10% on the final cost of the Stimulus bill,
underestimating its final cost by some $80 billion.
This bill, like Social Security, Medicare, and Medicaid before it,
creates yet another massive expansion of government without a
definitive price tag. One need not do complex arithmetic to see how
underestimating the cost of this bill by 10% would cost us at least an
extra $100 billion over ten years. Unfortunately, by the time we
discover our error, it will be too late: the promises will have been
made, the money will have been borrowed, and the checks will have been
drawn.
It should come as a surprise to no one that we will pay for this bill
by borrowing. With massive deficits projected far into the future, the
cupboard is bare. We have no money to pay for this spending. We will
borrow it and continue to help ourselves to the fruits of our
children's future.
Yet, even the vast scale at which this bill borrows money and
transfers wealth, this pales in comparison to the rate at which this
legislation borrows our liberties and transfers authority to
Washington. With each new board, commission, mandate, and tax, we
surrender a small part of the authority we each hold over our own
affairs to Washington.
The Majority's bill will raise taxes, hand down mandates, and further
our culture of dependency on Washington. Granting ever more authority
to the Federal Government will continue to sever the community bonds
that hold America together. Each time we make Washington responsible
for part of our welfare, we become just a little less concerned about
the plight of our neighbors. Their trials and tribulations become
something someone in the Federal Government should do something about.
Unfortunately, it turns out that in Washington someone and something
too often means no one and nothing.
My constituents understand that a full accounting of the costs of
this bill cannot be made unless we include the intangible costs. While
many before me have recounted the massive financial charge this bill
will toll, our freedoms and our liberty will also be diminished by this
bill.
The Majority's plan offers a pathologically Washington-centered
vision of America and its passage forces us to look not first to
ourselves, our families, and our communities for support, but rather to
the Federal bureaucracy. This bill will force Americans to lobby the
Federal Government on every aspect of their health care. We will lobby
in Washington for access to medicine, procedures, and tests; our
doctors will lobby in Washington for better payments for services
rendered; our insurance companies will lobby in Washington for the
right to charge higher rates; and our families will beg in Washington
for more subsidies.
No one on my side of the aisle disputes that individuals have a moral
obligation to help those around who are less fortunate than they are.
In fact in 2008, private individuals and American companies gave over
$300 billion dollars--over 2% of GDP--to charitable causes, $21 billion
of which went to organizations involved in health care. This personal,
private giving is one of the hallmarks of our unique American ethos--we
take care of our own.
The Democrat's sweeping health care plan will destroy this core
American value and replace it with one of subservience and deference to
the governing elites. This bill goes well beyond simply assisting the
poor among us. It subsidizes middle class families with billions of
their own tax dollars. It is a vast engine of good intentions that
transfers wealth from one pocket to the other, all while binding us
ever tighter to a bureaucracy that will care for itself before the
American People.
Undoing the wrongs unleashed by this legislation will consume the
American People and this body far into the future. This November, each
Member of this House will appear before their constituents to be judged
on how well they have represented their constituents over the past two
years. Without a doubt, this health care vote will be forefront in
their minds. Some of my Democratic colleagues have said they relish the
idea of being judged on their support for this legislation. I suspect
that the American people will be all too happy to oblige them.
Mrs. CHRISTENSEN. Mr. Speaker, this is the last leg of the health
care triathlon--three committees over here; our bill, the Senate bill
[[Page H2432]]
and the White House plan; our passing ours, the senate theirs and here
we are for the finish.
And for me this is a very important part.
The Senate bill has many important provisions, some like no exclusion
for preexisting disease for children, building our health care
workforce and its diversity, expanding community health centers and
community health workers, a strong CER provision, and very importantly
the expansion of the Office of Minority Health, and the elevation of
the Center on Minority Health and Health Disparity Research to an
Institute at NIH.
But it is here that Medicaid is expanded, the exchange is set up and
the subsidies provided. It is here that we really begin to close the
donut hole and that all of the insurance reforms are finalized.
Very importantly for me and my constituents and all of the
Territorial Americans, this is where our Medicaid cap is greatly and
finally lifted, and that we are given access to the exchange.
This is not full parity but it is a major step forward towards
inclusion of loyal American citizens who live in the off shore areas
that are an integral part of the United States. It will give access to
many more of our constituents and enable us to provide prevention and
services that we intend to use to create a healthier community and a
better quality of life.
Thank you again to our President, Speaker Pelosi, Leader Hoyer, Whip
Clyburn and chairmen Rangel, Waxman and Miller, as well as my fellow
territorial delegates who all worked so hard and together to make this
day a reality.
As has been said, this bill is not perfect, and this is a major step
but just a first step in all that has to be done to create equity and
justice in our health care system. We ask our colleagues to give the
reconciliation bill a big yea vote, and begin a new, better day for our
citizens and our country.
Mr. HASTINGS of Florida. Madam Speaker, when President Harry Truman
first lobbied for health care reform, he could not have envisioned that
it would take six decades for Congress to finally have the courage to
make health care reform more than a cliche in the American lexicon.
If this bill passes, it will mean that the 46 million Americans who
have zero health care or who cannot afford what they do have, or who
suffer at the mercy of chronic illnesses like diabetes, will finally be
able to see a doctor. The over 30 percent of my constituents in South
Florida who have no health insurance will no longer have to choose
between buying food and purchasing their medicine.
This historic legislation will mean improving Medicare benefits with
lower prescription drug costs for those in the ``donut hole;''
providing better chronic care and free preventive care--including
prenatal care for working mothers; making significant new investments
in comparative effectiveness research and health information
technology; and reducing the deficit by $138 billion over the next ten
years.
In the words of Dave Snow, CEO of Medco, whose subsidiary Liberty
Medical, a health care company near my district that helps Americans
manage their diabetes, so eloquently stated: ``Forty-six million
Americans live every day without the security and peace-of-mind that
come with having health insurance.'' This bill ends that now.
Mr. Speaker, after months of discussion and indecision, the moment
that matters is now. I applaud my colleagues who refuse to yield to the
fear-mongering tactics that many have used to scare us out of doing the
right thing at the right time.
Mr. LANGEVIN. Mr. Speaker, I rise in support of the Patient
Protection and Affordable Health Care Act (H.R. 3590), with the
accompanying changes in the reconciliation bill. This Congress is being
given a once-in-a-lifetime opportunity to fix a broken health care
system that has left millions of families without the coverage and care
they deserve.
If we seize this opportunity tonight, we can ensure that tomorrow, a
working mom in West Warwick will wake up knowing she can afford her
family's health coverage; a dad in Providence will wake up knowing he
can take his daughter to the doctor when she is sick; a small business
owner in Westerly will wake up knowing he can finally give his
employees the coverage he always intended; and a cancer survivor in
Narragansett will wake up knowing she won't lose her insurance because
of a pre-existing condition or a lifetime cap.
Since coming to Congress in 2001, I have tirelessly advocated for
fundamental changes to our health care system, and my constituents have
demanded solutions. I have heard from Rhode Islanders who are
struggling to pay their health care premiums, and from small business
owners that can no longer afford to cover their employees. Families who
are fortunate enough to have access to health insurance continue to
face ever-increasing costs, while many of them are afraid they will
lose their benefits altogether.
Tonight, we begin to institute the changes necessary to provide
security and stability to Rhode Islanders who have health insurance,
guarantee coverage to the thousands who don't, and lower health care
costs for our families, businesses and taxpayers.
Beginning immediately in 2010, this landmark legislation will end
abusive health insurance practices that prevent people from purchasing
and maintaining their coverage when they are sick; it will ban yearly
and lifetime insurance caps, so individuals with chronic, disabling
conditions don't lose coverage and end up in bankruptcy; and it will
require all insurers to reinvest more of our premiums back into health
coverage through a ``medical loss ratio'' of at least 80 percent,
ensuring that no more than 20 percent of our premiums go toward
administrative expenses and windfall profits for insurance executives.
After this bill is signed into law, it will strengthen coverage for
young people by allowing them to remain on their parents' insurance
policy until they are 26 years old. It will help our seniors by
starting to close the Medicare prescription drug ``donut hole'' so they
can afford their medications. It will also provide immediate tax
credits for small businesses to make optional employee coverage more
affordable. These are only some of the changes that will take effect
this year to make insurance coverage more accessible and affordable for
everyone.
Over the longer term, this legislation will build on the strengths of
our current employer-based system by offering tax benefits to small
employers and encouraging businesses who offer their own coverage to
continue doing so. Rhode Islanders who don't have coverage through
their employer will be able to shop for their choice of a health plan
through a new ``health insurance exchange,'' modeled after the tried
and true Federal Employees Health Benefits Program, which has
successfully provided coverage for over 9 million federal employees,
retirees and their dependents, including members of Congress.
Unlike the limited options that are available to most consumers
today, the exchange will provide a more convenient, transparent and
affordable way to choose among a variety of health plans that meets
individual needs. People who cannot afford to purchase coverage within
the exchange will receive financial assistance to ensure that they can
obtain the coverage that meets their needs.
Small business owners will reap significant benefits from this
measure, both through immediate tax relief and the insurance exchange,
which will allow them to band together and get the same lower rates as
big companies. Small businesses are the back bone of the Rhode Island
economy, and preventing triple-digit rate hikes is important to
jumpstarting employment in our state.
Improving access to coverage will also require investments in our
health care workforce. Currently, our system is strained by a lack of
nurses and primary care physicians, particularly in underserved areas.
That is why this bill strengthens important workforce development
initiatives like new scholarships and loan repayment programs,
increased reimbursements and grant programs for primary care training,
as well as immediate financial support for community health centers.
These new programs and resources will allow us to build the network of
nurses, doctors and other health care professionals necessary to meet
the increased demand for services.
Since the cost of medical malpractice is a longstanding concern for
both doctors and patients, this bill establishes new grant programs
designed to encourage states to implement alternatives to traditional
medical malpractice litigation with the goal of reducing frivolous
lawsuits while allowing legitimate cases to be heard.
But this debate is not just about expanding coverage and reducing
costs for families and employers; it is also about putting our country
on a fiscally sustainable path. This bill, which is completely paid
for, will reduce our nation's deficit by $138 billion over the next 10
years and $1.2 trillion over the following decade--the largest deficit
reduction in 17 years. I cannot overlook the impact that these numbers
have on our communities, and how critical they are to moving our state
forward.
Finally, I have stated from the beginning that I would not support a
bill that funds taxpayer-subsidized abortions. I have worked tirelessly
with my friends and colleagues--both Democrat and Republican, pro-life
and pro-choice--to reach a common ground on this issue. After much
dialogue, counsel, reflection and prayer, I have concluded that the
Senate language does meet the longstanding Hyde standard of prohibiting
federal funding of abortion. This position is reaffirmed by the
Catholic Health Association, and many of my pro-life colleagues in
Congress who support this bill.
Furthermore, I remain mindful that we must not lose sight of the big
picture. Being pro-life means more than being anti-abortion. It also
means protecting the 45,000 people who die every year because they lack
proper health care. Nothing could be more pro-life than ensuring access
to lifesaving and life-improving
[[Page H2433]]
treatments for every American, not just those who can afford it. That
is what this bill begins to accomplish.
Mr. Speaker, after an injury left me paralyzed nearly thirty years
ago, the members of my community rallied behind me and my family when
we needed them the most. That support and encouragement changed my life
forever. I made myself a promise that I would devote my life to public
service so I could give back to them all that they gave to me. Tonight,
I know that by passing this legislation, which makes health care a
right, not a privilege, I am fulfilling that promise.
Mr. VAN HOLLEN. Mr. Speaker, once again the House is voting on
legislation that strengthens the new health care reform law that was
enacted earlier this week which will bring quality, affordable, and
accessible health care for all Americans.
Tonight, we bring this exhaustive, year-long process to a close. The
new health reform law will bring down health care costs for American
families and small businesses, expand health coverage to an additional
32 million Americans, and end the abusive practices of insurance
companies. By the end of this year, children with pre-existing
conditions will no longer be denied coverage, health plans will be
prohibited from placing lifetime caps on coverage, young people will be
able to remain on their parents' health insurance policies up to their
26th birthday, small businesses will get tax credits so that they can
provide affordable health coverage to their employees, and seniors will
get help in paying for their high prescription drug costs.
Mr. Speaker, I'm glad we finally got the job done on a very important
issue that so many people have fighting for over so many decades.
Mr. REYES. Mr. Speaker, today's historic passage of health care
reform legislation marks a great victory for the El Paso community.
This landmark legislation will significantly improve the quality of
life for so many residents by providing access to affordable health
care coverage to those who currently have none. It will also provide
peace of mind to those families with insurance, who will no longer have
to worry about the prospect of financial ruin due to a catastrophic
illness or accident.
Every day, thousands of families are being forced to forgo health
insurance due to rising costs, and now more than 46 million people lack
basic health coverage. This disturbing trend is particularly evident in
Texas, a state with the highest percentage of children and adults
without insurance. More than 6.1 million adults and 1.4 million
children are without basic coverage.
Sadly, Texas border communities fare even worse, and all of Texas'
congressional districts along the border rank among the top 20
districts in the nation with the highest percentage without coverage.
In El Paso alone, 230,000--1 in 3--people are without coverage.
Unfortunately, when it comes to meeting the health care needs of
predominately Hispanic communities along the border, our state has
failed. Our Governor would rather waste millions on cameras and
helicopters than on health care for border communities that need it
most.
The health care reform legislation that passed today is expected to
provide coverage to 95 percent of Americans, while lowering health care
costs over the long term. For the first time in history, insurance
companies will be prohibited from denying health coverage due to pre-
existing conditions, health status, and gender.
This legislation will provide tax credits to help individuals and
small businesses purchase private health insurance. It also sets caps
on out-of-pocket expenses for the first time ever, so families will
never have to experience financial ruin due to a serious illness.
Without these reforms, health care costs will continue to consume more
of Americans' paychecks in the years ahead. The annual average cost of
family coverage more than doubled between 1999 and 2009, from $5,800 to
$13,400, and is expected to double again over the next decade without
reform. Meanwhile, insurance companies are raising out-of-pocket
expenses for families, and covering less in health care costs.
America now spends $2.2 trillion on health care annually, more than
twice the amount per person than other nations, yet Americans aren't
any healthier for it. Without action, health care costs will consume
over 20 percent of the American economy in the next decade. This
landmark bill will significantly reduce health care costs over the long
term and will decrease the federal deficit by $143 billion over the
next 10 years and an additional $1.2 trillion in deficit reduction in
the following 10 years.
Many Americans living in the U.S.-Mexico border region used to depend
on Mexico to access cheaper medical care and prescription drugs. For
decades, El Pasoans have sought cheaper health care and prescription
drugs across the border in Ciudad Juarez, Chihuahua. A recent study
concluded that 1 in 3 people traveled to Mexico for prescription drugs,
and 7 percent sought health care in Juarez. But the devastating drug-
related violence that has ravaged Mexico for two years has prevented
many families without insurance from accessing care across the border.
While our community is spending a greater share of property taxes to
pay for individuals without health coverage, insurance companies have
continued to engage in practices that protect their bottom lines. For
too long, insurers have been the gatekeepers to our health care system,
with the power to dictate who receives health coverage and who does
not. Americans with preexisting conditions and serious illnesses are
too often denied coverage or are dropped from their existing insurance
plans for developing a serious illness or reaching their cap on
coverage, and are denied access to the medical care they need.
When people lack access to quality affordable preventative care, they
end up in our emergency rooms for ailments that could have been treated
by a family doctor or seek treatment for conditions that should have
been diagnosed earlier. When these patients fail to pay their medical
bills from publicly-financed hospitals such as University Medical
Center, local property taxes are used to cover these expenses. Since
1998, El Paso property tax payers have spent over $400 million to pay
for treatment and services for those patients who could not afford to
pay their medical bills.
As Congress debated this legislation last summer, I heard from many
El Pasoans who shared their struggles under the current broken health
insurance system. One of the stories that had the greatest impact on me
was that of Mr. and Mrs. Jacob Lopez. Their lives were forever changed
when their daughter, Danika, was born with a long list of ailments and
birth defects that required over 80 days of intensive care treatment.
While the Lopez's had insurance through their employer, the co-pay
for their daughter's treatment was more than the mortgage on their
home. They exceeded their insurer's coverage limits, and were left with
no other way to cover their daughter's medical expenses. No other
insurance company wanted to insure the Lopez family due to Danika's
pre-existing conditions. In desperation, the Lopez's had to quit their
jobs to fall into poverty so their daughter could receive the treatment
she needed under Medicaid. Last week, Mr. Lopez called my office to
tell me that his family was forced into bankruptcy.
As a grandfather, I would never want my grandchildren to endure the
hardships that Danika and her family have endured. It is for children
like Danika, and my grandchildren, Amelia, Mateo, Julian, and Orlando,
that I am proud to vote in favor of this bill.
Our local community leaders have expressed their support for health
insurance reform, and both the City and the County have passed
unanimous resolutions in support of reform. The Patient Protection and
Affordable Care Act is endorsed by over 325 national organizations and
associations, including the AARP, the American Medical Association, the
American Cancer Society, the American Heart Association, the Consumers
Union, the Catholic Health Association, the National Association of
Public Hospitals and Health Systems, the American Nurses Association,
and many other medical professional organizations.
The passage of this landmark legislation by the House of
Representatives is an historic achievement and reflects the commitment
and determined leadership of President Obama, Speaker Pelosi, and the
Democratic Congress to follow through on a key promise to help middle
class families, who have endured years of rising medical costs. I
commend my colleagues for their determination to pass this truly
historic legislation that will lower health care costs for all
Americans, and strengthen our country's financial future.
Mr. SERRANO. Mr. Speaker, I want to raise an important issue that is
affecting millions of people on the island of Puerto Rico. This issue
deserves attention; the four million residents of the Island are U.S.
citizens that pay Social Security and Medicare taxes.
However, despite this fact, senior citizens living in Puerto Rico are
not treated fairly and do not have the same benefits that a senior
living in New York, Florida, California, or any of the other States
enjoy. Under Medicare in Puerto Rico, senior citizens are not
automatically enrolled in Medicare Part B. As a result, it is more
beneficial for seniors to enroll in a Medicare Advantage plan to
receive all of their Medicare services. Compared to the 50 States where
the Medicare Advantage participation plan is 25 percent, in Puerto Rico
approximately 83 percent of eligible senior citizens opt for Medicare
Advantage.
However, the fee-for-service, FFS, cost calculation for Puerto Rico
is troubling. In fact, the Medicare Payment Advisory Commission,
MedPAC, reported to Congress that the Centers for Medicare & Medicaid
Services (CMS) ``should expeditiously use its authority to employ an
alternative calculation method . . .''
[[Page H2434]]
I couldn't agree more with that statement or the report language
included in the House Report for H.R. 4872, the Health Care and
Education Reconciliation Act of 2010. The language clearly stated:
The county FFS expenditures calculated by the Secretary are
artificially low and unstable from year-to-year. Therefore,
the Committee expects that when calculating county FFS rates
for Puerto Rico, the Secretary will use utilization and
expenditure data from MA plans under current authority and
adjust these rates and risk scores appropriately.
Mr. Speaker, I support the House Report language because the senior
citizens of Puerto Rico deserve nothing less than fair and equitable
treatment in Medicare.
Mr. CUMMINGS. Mr. Speaker, this week, I had the honor and privilege
of joining my Democratic colleagues at the White House, to witness
President Barack Obama sign into law, the Patient Protection and
Affordable Care Act (H.R. 3590)--the most significant piece of health
care legislation since the enactment of Medicare in 1965.
This legislation fulfills one of the most basic tenets of the
Declaration of Independence--the provision of our natural unalienable
rights of life, liberty and the pursuit of happiness. H.R. 3590 secures
these rights for every American by ensuring them access to quality,
affordable healthcare.
While waiting for President Obama to sign the legislation, I thought
about the thousands of families and friends who have lost loved ones
because they lacked access to basic health care coverage.
I also thought about the generations of activists and policy makers
who fought to make this monumental achievement a reality.
I have always been proud to be a Member of Congress but voting in
favor H.R. 3590 and being present at the signing ceremony was by far my
proudest moment.
By signing this legislation into law, President Obama ensured that
the United States remains a leader among industrialized nations, and
that the American people can now take comfort in knowing that an
illness will no longer wipeout their life savings and lead to
bankruptcy.
Although the idea of providing people with access to quality,
affordable health care has been around since the early 1900s, it was
the Democratic-led 111th Congress that made the historic statement that
healthcare is in fact a right, not a privilege.
We affirmed to millions of Americans that we are aware of their
struggles and that we are willing to fight for them and do what is
morally and fundamentally right.
During the November 2008 election, Americans overwhelmingly voted for
change.
They demanded a government willing to stand up to big business, and
that is transparent in its actions.
But above all else, people demanded a government that is willing to
be responsive to their needs--and we affirmed their trust in us by
passing this legislation.
Is the legislation perfect? No!
I still favor a single payer system and I was a strong supporter of
the public option.
That being said, H.R. 3590 is 100 percent better than what was
previously available in this nation.
Prior to the enactment of this legislation:
Over 47 million Americans were uninsured. In 2008, 23 million
uninsured were employed adults and 7.3 million were children;
Nearly 41 thousand people died each year because they lacked access
to quality, affordable healthcare insurance; and
Every minute, 8 people were denied coverage, charged a higher rate,
or otherwise discriminated against because of a pre-existing condition.
If Congress had not successfully passed this legislation:
Employers would be unable to afford rising health care costs, and an
additional 3.5 million people would be unemployed and without benefits
in the next 4 years.
Small businesses would lose $52.1 billion in profits to high health
care costs over the next ten years; and
By 2019, national health care expenditures would reach $4.5
trillion--more than double 2007 spending.
The American people have waited for over 100 years for this
legislation and this is what they will get immediately:
We provide tax credits to small businesses to make employee coverage
more affordable;
$250 will be provided to Medicare beneficiaries who hit the ``donut
hole'' in 2010;
Within 90 days, Americans who are uninsured because of a pre-existing
condition will be able to obtain insurance through a temporary high-
risk pool;
Within 6 months, insurance companies will be prohibited from denying
coverage to children with pre-existing conditions;
Health plans will be required to allow young people up to their 26th
birthday to remain on their parents' insurance policy;
Health plans will be prohibited from dropping people from coverage
when they get sick;
Health plans will be prohibited from placing lifetime caps on
coverage; and
Beginning January 2011, preventive services under Medicare will be
free.
To put it simply, Congress met its moral obligation in passing
healthcare reform. With our historic vote, we told future generations
that no American will suffer and die because of a lack of insurance.
We told insurance companies that, while they are a valuable part of
our nation, they will be held accountable for delivering on their
promises.
We told our elderly that our commitment to them remains strong, and
that the programs they have come to trust will continue to be deserving
of that trust.
The reform we passed will help millions of Americans.
In addition to providing access to health care coverage, H.R. 3590
goes far in addressing health care disparities in our nation's minority
communities.
Specifically, it includes language that I introduced with
Representative Jesse Jackson, Jr., (D-Ill.) H.R. 2778, the Health
Equity and Accountability Through Research Act.
This legislation sought to elevate the National Center on Minority
Health and Health Disparities (NCMHD) to the level of Institute, giving
it the authority to better address the appalling health disparities
that are plaguing our nation's minority communities.
NCMHD was created to promote minority health and to lead, coordinate,
and assess the efforts of the National Institutes of Health (NIH) in
reducing and to ultimately eliminate health disparities.
Unfortunately, the previous structure of NCMHD created confusion
regarding who has the responsibility for the coordinated minority
health disparities research conducted or supported by NIH.
Additionally, NCMHD lacked real input into and authority over all
NIH-supported health disparities activities and funds.
H.R. 3590 addressed these concerns by elevating the Center to the
level of Institute, and clarifies the role of the Director as
coordinator and manager of the NIH-wide minority health and health
disparities portfolio.
The bill also provides the new Institute with professional judgment
over NIH-wide minority health and health disparities budgets as well as
management over NIH-wide minority health and health disparities
allocations.
However, this is not the only improvement that minority and
underserved communities will see.
This comprehensive healthcare package also includes $11 billion for
community health centers, which offer comprehensive primary care and
mental health services to underserved populations. These health centers
are a critical stopgap, allowing better care for chronic conditions,
while preventing unnecessary trips to the emergency room.
Last but certainly not least, H.R. 3590 honors the life of Deamonte
Driver--a 12-year-old boy from Maryland whose life was cut drastically
short three years ago when an untreated tooth infection spread to his
brain.
Deamonte's tragic death haunts me to this day. Eighty dollars worth
of dental care might have saved his life, but he never got that care
because he lacked access to a dentist.
The health care bill that we passed will prevent others from dying in
such a tragic fashion. Under the new law:
Pediatric dentistry is covered as an essential health benefit;
Funds will be provided to launch a dental campaign to new parents and
traditionally underserved areas;
Workforce Training Grants will be available to provide technical
assistance to pediatric training programs in developing and
implementing instruction regarding the oral health status, dental care
needs, and risk-based clinical disease management of all pediatric
populations with an emphasis on underserved children; and
H.R. 3590 also includes a loan repayment program with preference
given to qualified applicants who have a record of training individuals
who are from a rural or disadvantaged background.
However, minorities and underserved communities will not be the only
populations that will benefit from our actions. Millions will be
touched by healthcare reform in their daily lives in marked, measurable
ways.
Thirty-one million Americans will have the opportunity to protect
themselves from the fear that a small injury could lead to bankruptcy;
and
147,000 families and 14,000 small businesses in my District will
receive tax credits to help cover their employees with health
insurance; and 56,000 young people in my District will be able to get
insurance, at fair prices, through policies currently owned by their
parents.
To quote the great poet Virgil, ``The greatest wealth is health.''
By passing and signing this legislation, Congress and President Obama
have provided the citizens of this nation with immeasurable wealth,
comfort and security.
[[Page H2435]]
We have firmly put the power back into the hands of the people, and
this is an experience that I will cherish long after I leave Congress.
Mr. HASTINGS of Washington. Mr. Speaker, it's past time for this
Congress to stop jamming through massive expansions of the federal
government and instead support commonsense reforms that will lower
health care costs and increase choices for all Americans.
A bipartisan coalition in Congress and a vast majority of the
American people today rejected the premise that government knows best
how to run our American health care system. While it was impossible to
stop the liberal majority from pushing through their government
takeover of health care, House Republicans will lead the effort to
repeal this legislation and replace it with real solutions to improve
our health care system, without driving our nation deeper into debt.
House Democrats today went around the regular lawmaking process and
pushed through their government takeover of health care using a closed
approach that blocked consideration of any Republican amendments.
Improvements must be made to our health care system, but I reject the
premise of this bill that government knows best how to run our health
care.
I am disappointed that House Democrats voted for the very backroom
deals and political payoffs that the American people are so tired of
and for a massive health care plan that most Americans simply don't
want.
This bill is about more spending, higher taxes, and more government
control, all without lowering health care costs. This Congress is going
in exactly the wrong direction by forcing every American to purchase
government-approved insurance only, cutting Medicare, limiting who can
own and operate hospitals, and eliminating health care choices.
There is something very wrong when this Congress is passing a bill
that arbitrarily restricts the ability of doctor-owned hospitals like
the Wenatchee Valley Medical and its clinics to grow, rather than
working to expand access to health care in areas like Central
Washington.
In the past 14 months, Democrats have given the federal government
control of our banks, our car companies, our loans for college, and now
our health care. I rejected those bills, and I oppose this government
takeover of health care because I'm deeply concerned about the
consequences that will be felt by every American.
I am committed to doing everything possible to undo this bill and get
to work on commonsense reforms that will actually lower health care
costs and increase choices.
Mr. KENNEDY. Mr. Speaker, today is a long awaited day for the
millions of tireless champions in America who have paved the way
towards health care reform. It is since Teddy Roosevelt in 1912, that
the people of this country have fought to provide quality, affordable
health care for all Americans. Today is a long awaited day for the many
tireless champions of health care reform. My father, of course, was but
one of them, committed to fight for those who voices would not be
heard. Today is a long awaited day for people like Martin Luther King,
Jr., who stood up to remind us, ``of all forms of inequality, injustice
in health care is the most shocking and inhumane.'' But most
importantly, today is the long awaited day for each and every American
who will now be treated with the dignity and respect that comes with
the equality of opportunity that affordable access to quality health
care provides.
It is the long awaited day for the estimated 32 million of our
friends and neighbors who will now have access to health care because
of this legislation. It is the long awaited day for the millions of
Americans who have been discriminated against in the past, denied
coverage by an insurance company because they have a pre-existing
condition. It is the long awaited day for the millions who are dropped
from their policy when they got sick. It is the long awaited day for
the millions who face bankruptcy and financial turmoil even though they
had health insurance, because they reach an annual or lifetime cap. It
is the long awaited day for the small business owners who have been
unable to provide their workers with health insurance or remain
competitive, and who will now receive tax credits to help them afford
to provide coverage for their employees.
I am pleased that the reconciliation package resolves a number of the
issues that are especially important to Rhode Islanders. It increases
the affordability assurances for Rhode Island families. It delays and
changes the so-called ``Cadillac tax'' to more appropriately target
high-end plans and minimizes the adverse effect on middle-class
families, older Americans, and high-risk professions. It closes the
Medicare prescription drug ``doughnut hole'' completely. It ensures our
primary care physicians are paid Medicaid rates that match Medicare
rates, and our hospitals are taking less cuts for the costs they incur
treating the uninsured. It eliminates lifetime and annual caps for all
health care plans, including grandfathered plans. And it removes
special deals for states when it comes to Medicaid costs, so that Rhode
Island will be fully reimbursed for the first two years to cover the
costs of Medicaid expansion.
A key aspect of this legislation that is of particular importance to
me is the extension of the mental health parity protections established
into law last year by my legislation, the Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act. Not only are
these protections extended to all plans in the Exchange, but mental
health and substance use benefits are a part of the essential benefits
package created by this legislation. For the 67 percent of adults and
80 percent of children who need mental health care that do not receive
it, this victory cannot be understated. Today our Nation takes a giant
leap forward towards our transition from a ``sick care'' system to one
which is preventive, collaborative, and patient-centered.
The Patient Protection and Affordable Care Act also includes a number
of other essential components which will dramatically improve the
quality and access to behavioral health care. This legislation includes
workforce development provisions by providing mental health and
behavioral health education and training grants to assist providers
specializing in and providing services to children, adolescents, and
adults and loan forgiveness to child mental health professionals. This
legislation also establishes a national network of a National Center
for Excellence in Depression, for the treatment of depression and
bipolar disorder.
I have been proud to serve the people of Rhode Island the last 16
years, helping to lead the effort in the House of Representatives to
take control of our nation's health care system away from insurance
companies and put it back the hands of patients and their doctors.
Though I wish my father could be here in body as well as spirit, I
could not be more pleased that this effort, to reform our nation's
health care system, is on the cusp of complication today, during my
tenure here.
I urge my colleagues to join me in providing quality, affordable
health care to all Americans.
Mr. CRENSHAW. Mr. Speaker, the argument has been made by my
colleagues on the other side of the aisle that the government must take
over our health care system to help control costs. Against the will of
the American people and in the dark of the night later on this evening,
the Democrat Majority is forcing a vote on a bill that will cost
American taxpayers nearly a trillion dollars.
The Democrat Majority plans to pay for their plan by cutting half a
trillion dollars in Medicare and raising taxes on American families by
over $400 billion. By taking a step back and reviewing the historical
involvement of the government in health care, we can draw two relevant
lessons.
First, government involvement in health care raises the cost of
health care. Prior to the creation of Medicare and Medicaid in 1965,
health-care inflation ran slightly faster than overall inflation. In
the years since, medical inflation has climbed 2.3 times faster than
cost increases elsewhere in the economy.
Second, more often than not, government programs exceed their
expected cost. When initially considered, the House Ways and Means
Committee estimated Medicaid's first year costs at approximately $238
million. The actual cost? Over $1 billion. Today, even after you adjust
for inflation, Medicaid costs 37 times more than it did when it was
launched.
What about Medicare? In 1965, Congressional budgeters said that it
would cost $12 billion in 1990. Its actual cost that year was $90
billion. The rate of increase in Medicare spending has outpaced overall
inflation in nearly every year (up 9.8% in 2009), so a program that
began at $4 billion now costs $428 billion.
We must take to heart that Congress historically grossly
underestimates the cost of an entitlement program. And now we are faced
with one of the newest/biggest entitlement programs in the history of
our great nation.
Any Member who votes in favor of this bill, casts a vote in favor of
increasing our national debt and inflicting higher taxes on our
children and grandchildren. That is why I will vote against H.R. 3590
and will do everything in my power to repeal and replace it with
commonsense reforms that will lower health care costs, increase access,
maintain Medicare benefits, end lawsuit abuse, and preserve the doctor/
patient relationship without raising taxes.
Mr. CASTLE. Mr. Speaker, the debate about how to reshape health
insurance in order to reduce skyrocketing costs, and increase access,
has dominated the attention of Congress for the past year. While there
are many areas of agreement, Congress and the American public remain
divided and it is easy to see why. While I am glad the ``deem and
pass'' procedure was abandoned, and the House of Reprsentatives allowed
an actual vote on the bill, I feel strongly that Congressional leaders
[[Page H2436]]
and the President have missed a real opportunity to take incremental,
bipartisan steps that recognized the concerns of Americans who feel as
though they will foot the bill for widespread reforms that they do not
embrace.
To expand access, H.R. 3590 will enact mandates for both individuals
and employers, with hefty fines for non-compliance, at a time when our
economy has already challenged cash-strapped small businesses across
the nation. This new mandate to acquire health insurance will greatly
expand the bankrolls of insurance companies without any new standards
against price fixing, or steps to encourage competition across state
lines-- both of which would create vast incentives to drive down costs.
Such giveaways to the insurance companies only reward the rising costs
of health care with higher taxpayer subsidies to cover them.
Throughout the debate, I have advocated for commonsense policies that
aim to lower costs and expand access, without compromising the quality
of American medicine or raising taxes on the American people. I have
urged leaders to consider legislation to drive down the costs of care
first, in order to increase access and coverage through affordability.
According to the Congressional Budget Office, the legislation would
cost nearly a trillion dollars, the cost of health insurance premiums
would actually rise, and it would be paid for through new taxes and
fees and nearly $500 billion in reductions in spending on Medicare.
What CBO can't accurately report, is that the bill is also littered
with budget gimmicks to cover the actual, long-term cost of the bill.
This bill pays for six years of coverage with 10 years of tax
increases and back-loads the cost in the years ahead in order to
disguise the true costs.
The proposed cuts to Medicare are unlikely to ever occur; Congress is
likely to override them.
$70 billion for the new long-term care program is spent before any
benefits are paid out.
$53 billion is taken from the Social Security Trust Fund to offset
new health care spending.
Punts the fix for Medicare reimbursements to doctors, costing $371
billion, which Congress has committed to passing.
Uses the revenues from an expansion in federally financed student
loans as offsets, instead of putting those savings back into education
or for lower payments from students.
There are many commonsense steps we could be taking, some of which
are in this bill and have widespread support: Reforms that forbid
insurance companies from denying coverage based on a pre-existing
condition or disability, and ban lifetime and annual spending caps that
put patients at risk for bankruptcy when faced with a serious illness;
allowing unmarried children to remain on their parents' insurance
through age 26; incentives for Americans to seek preventive care;
helping seniors afford prescription drugs through closing the donut
hole, and development of lifesaving drugs and therapies that protect
patient safety and innovation; an increase in support for community
health centers that provide routine care for thousands of patients in
Delaware; and provisions to address physician and nursing shortages.
These are steps we could have taken, and they should have been coupled
with increases in competition and cost-controlling measures.
Additional policies absent from the plan that deserve an up or down
vote:
Making health insurance more portable and affordable by allowing
patients to shop for health insurance plans across state lines;
Small business pooling and tax credits without mandates that threaten
jobs and productivity;
Eliminating the $60 billion in Medicare fraud each year;
Increasing efforts to enroll the 4.3 million who already qualify into
existing programs like Medicaid and SCHIP; and
Limiting abusive lawsuits, which would reduce costs of care.
While there are policies embedded in this legislation that have
bipartisan support, they are buried under budget gimmicks that threaten
the long-term solvency of Medicare, Medicaid and Social Security--the
existing entitlement programs that are draining the federal budget
based on their current obligations. Health care reform will impact the
lives of every American, our federal budget, and 1/6 of our economy.
Reform should hold insurance companies accountable, eliminate barriers
to competition and quality care, promote prevention, and drive down
health care costs. To ignore the costs and enact unrealistic and
misleading legislation will only prolong our health care challenges for
generations to come.
Mr. BILBRAY. Mr. Speaker, this week, each of us cast the most
historic vote any of us is likely to ever make. With it, revolutionary
changes have been made to the American health care system that will
forever alter its very nature. This vote was a long time coming and
much needed, unfortunately, what we did pass is long on promises of
improved care, but preciously short on reforms that the American people
really need for better and more affordable care.
It is no secret that the health care system is in need of reform. In
2007, the latest year that figures were available, total health
expenditures reached $2.2 trillion, which translates to $7,421 for
every man, woman and child; millions of Americans are without health
insurance and San Diego doctors are finding it increasingly difficult
to care for our city's most vulnerable residents. This week's debate
was full of passion over many issues and arguments over the proper
answer to health reform. While we can argue over many points, there is
one issue where there is no debate: we need health care reform.
Studies have shown that the visit rates to emergency rooms for
patients with no insurance are twice that of those with private
insurance. While I support insuring all Americans can access health
insurance and believe it must be the first priority of any health care
reform legislation, I cannot support a bureaucratic system dictated and
controlled by the Federal Government. Congress, just like the medical
profession, must adhere to the Hippocratic Oath of: ``Above all, do no
harm.''
Throughout the past year, I have supported many bipartisan issues
that will increase health quality and access for not just San Diegans
but all Americans without limiting our choice of health care options--
many of which were in the legislation we passed Sunday night. We must
first allow Americans to have the same insurance as the Congress of the
United States. It is not fair to stand here today and pontificate on
the benefits of health care if we do not allow hard working Americans
to have the same health care choices we enjoy. Citizens of this great
country must be allowed to shop wherever they want in the United States
for health insurance, free from the barriers of state lines. If New
Jersey offers a plan that is cheaper than California, Californians
should have the ability to purchase that plan. We must enact strong
medical tort reforms that can save billions of dollars--$54 billion to
be exact according to Congress' own Congressional Budget Office, CBO.
Finally, I support strong enforcement mechanisms to prevent illegal
immigrants from receiving taxpayer subsidized health care.
It is important to remember that American health care is in many ways
the envy of the world. From our first class medical facilities to our
world renowned life science enterprise, we are the leader in innovative
care and solutions. These innovations are allowing Americans suffering
from major illnesses to live longer, healthier lives. For instance, in
a single decade, from 1993-2003 U.S. heart disease deaths dropped by 22
percent. However, for all these benefits there is work to be done but
not at the expense of destroying the entire health care system.
The health care bill that was signed into law will destroy our
already fragile economy and lead to government control of health care.
Under this new law, there will be more than $520 billion in tax
increases, including a $27 billion employer mandate tax and $15 billion
individual mandate tax. With 1 in 9 San Diegans out of work, this will
exacerbate the problem.
There are many examples in this legislation of government control but
one striking example is the Independent Medicare Advisory Commission.
The creation of the so-called Independent Payment Advisory Board
(IPAB,) which for the first time will give unelected and unaccountable
bureaucrats the mandate to make important decisions about the future of
the Medicare program. The cuts they propose would be in addition to the
over half trillion dollars of Medicare and Medicaid cuts already in
this bill.
We all agree that Medicare reform is needed but the IPAB actually
carves out large areas of the Medicare budget from potential savings,
leaving draconian cuts in the reimbursement of life saving and life
enhancing drugs as a likely outcome. As Co-Chair of the House
Biomedical Research Caucus, I have seen the great promise that
developments in medical technology can mean for American seniors. Just
last summer, the existing Preventive Services Task Force changed its
recommendations on mammograms, confusing millions of Americans in the
process. Can you imagine if those recommendations had the force of law?
As science progresses to further embrace the benefits of personalized
medicine, we need to make sure that the unchecked decisions of a
federal board in Washington do not unwittingly sabotage the doctor-
patient relationship. I am very troubled by this provision, and I want
to work with my colleagues on both sides of the aisle to fix it or
repeal it before it becomes effective.
In order to pass this legislation, many back room deals were cut.
From the ``Cornhusker Kickback'' to the ``Louisiana Purchase,'' many
states were taken care of in order to secure support. However,
California was once again left on the outside looking in. This bill
does nothing to fix the Geographic Practice Cost
[[Page H2437]]
Index (GPCI), which to date finds San Diego doctors being paid at a
rate of rural practitioners; all the while they continue to practice in
a high cost area. Additionally, this legislation does nothing to fix
the sustainable growth rate problem that finds California doctors
facing continuing cuts in Medicare payment rates year after year and
threatens patient's access to care.
I was in favor of rejecting this plan and coming back to the table
and develop a proposal that fully addresses medical malpractice awards
so we can save health care costs, allow United States citizens to
purchase their health care across state lines and provide tax credits
so hard working Americans, not Washington D.C., are in charge of their
health care.
A strong and accessible health care system is one of the most
fundamental components of a strong economy. I am committed to working
in a bipartisan manner with my colleagues to put in place real reform
that will protect the doctor-patient relationship but will not bankrupt
our economy in the process. American families deserve better than
socialized health care and I plan on helping to deliver it. I will
continue to work with my colleagues to reform a broken health care
system in a way that is sustainable, protects the promises we have
already made to our nation's seniors and does not infringe on our
liberties.
Mr. COURTNEY. Mr. Speaker, I rise today to express concerns about
three outstanding issues in the final health care reform package: an
excise tax on high-cost insurance plans which will be implemented in
2018, cuts to home health care, and the formation of an Independent
Payment Advisory Board (IPAB).
Since introduction of the America's Affordable Health Choices Act in
July of 2009, my colleagues in Congress and I have been working to
craft a health insurance reform bill that creates affordable insurance
coverage, lowers costs, and improves access to stable health care that
is there when you need it. These efforts have been reflected in the
Affordable Health Care for America Act, and Senate-passed Patient
Protection and Affordable Care Act (H.R. 3590) as modified by the
Health Care and Education Reconciliation Act (H.R. 4872).
The final reform package reflects significant progress in terms of
limiting the negative impact of an excise tax on high-cost plans on
middle class Americans. The 40 percent excise tax on high-cost plans
included in the Patient Protection and Affordable Care Act included
cost thresholds that were inadequate to account for premium cost
factors independent of generosity of benefits, such as age, gender, and
region. I authored a letter, with support from 192 of my Democratic
colleagues who opposed this proposal. The Health Care and Education
Reconciliation Act made significant improvements to the excise tax,
such as adopting higher thresholds for age and gender. More
importantly, the bill delays the implementation of the tax until 2018,
which will allow ample time to better understand its impact--especially
in high-cost regions--and mitigate potential negative consequences.
Another deficit mitigation component that I have concerns about in
the reform package includes Medicare ``market basket updates'' for home
health providers. While the Patient Protection and Affordable Care Act
includes more modest cuts than what was included in the House-passed
Affordable Health Care for America Act, I remain concerned about the
aggregate size of the cuts to home health care providers. Safeguards in
H.R. 3590 such as payment adjustment review authority by the Health and
Human Services Secretary should be utilized if ``market basket
updates'' prove to be unsustainable for home health care providers in
the future. H.R. 3590 also includes provisions that guarantee Medicare
home health benefits will not be reduced, which further reiterates the
obligation of the Secretary to ensure fair reimbursements.
While I supported passing H.R. 3590 as modified by H.R. 4872 to make
significant progress in extending and strengthening current health care
coverage, I also maintain concerns about the establishment of the IPAB.
Over the course of the health care debate, the IPAB--along with the
similar proposals of the Independent Medicare Advisory Council, IMAC,
Act (H.R. 2718) and the Medicare Payment Advisory Commission, MedPAC--
have garnered attention as a mechanism to reduce aggregate health care
costs.
However, I believe that the solidification of IPAB would be a move in
the wrong direction in terms of broad health care reform. Congress has
played an integral role in shaping a Medicare system that reflects
unique care needs of varying demographics as well as need differences
between regions and states. Further, this system has been developed
with transparency and accountability in congressional debates.
Redirecting control of Medicare to the Executive branch would limit the
strengths of the current system, and would continue a disturbing trend
of ceding Congressional authority to the Executive branch.
That is why I cosigned letters in July and December 2009 opposing the
establishment of a Payment Advisory Commission. While I did not support
the inclusion of IPAB in the H.R. 3590, I am reassured that the bill
does not empower the Board to override Medicare laws. Going forward, I
urge that the IPAB conducts business transparently, with public input.
I also urge that the Board reach out to all Medicare stakeholders and
take seriously the role of the Consumer Advisory Council in the future.
Mr. KUCINICH. Mr. Speaker, each generation has had to take up the
question of how to provide for the health of the people of our nation.
And each generation has grappled with difficult questions of how to
meet the needs of our people. I believe health care is a civil right.
Each time as a nation we have reached to expand our basic rights, we
have witnessed a slow and painful unfolding of a democratic pageant of
striving, of resistance, of breakthroughs, of opposition, of
unrelenting efforts and of eventual triumph.
I have spent my life struggling for the rights of working class
people and for health care. I grew up understanding first hand what it
meant for families who did not get access to needed care. I lived in 21
different places by the time I was 17, including in a couple of cars. I
understand the connection between poverty and poor health care, the
deeper meaning of what Native Americans have called ``hole in the body,
hole in the spirit.'' I struggled with Crohn's disease much of my adult
life, to discover sixteen years ago a near-cure in alternative medicine
and following a plant-based diet. I have learned with difficulty the
benefits of taking charge personally of my own health care. On those
few occasions when I have needed it, I have had access to the best
allopathic practitioners. As a result I have received the blessings of
vitality and high energy. Health and health care is personal for each
one of us. As a former surgical technician I know that there are many
people who dedicate their lives to helping others improve theirs. I
also know their struggles with an insufficient health care system.
There are some who believe that health care is a privilege based on
ability to pay. This is the model President Obama is dealing with,
attempting to open up health care to another 30 million people, within
the context of a system run by insurance companies who make money by
denying care. There are others who believe that health care is a basic
right and ought to be provided through a not-for-profit plan. This is
what I have tirelessly advocated.
I have carried the banner of national health care in two presidential
campaigns, in party platform meetings, and as co-author of H.R. 676,
Medicare for All. I have worked to expand the health care debate beyond
the current unsustainable system, to include a robust public option and
my amendment to free the states to pursue single-payer. An early
version of the health care bill, while badly flawed, contained these
provisions which I believed made the bill worth supporting when it was
considered by the Committee on Education and Labor. I voted for it. The
provisions were taken out of the bill after it passed the Committee.
I joined with the Congressional Progressive Caucus in saying that I
would not support the bill unless it had a strong public option and
unless it protected the right of people to pursue single payer at a
state level. It did not. I kept my pledge and voted against the bill
when it was considered by the full House of Representatives. Since
then, I have continued to oppose it while trying to get the provisions
back into the bill. Some have speculated that, as the final vote on
this health care package drew closer, I might have been in a position
of casting the deciding vote. The President's visit to my district on
Monday underscored the urgency of this moment.
I have taken this fight further than many in Congress cared to carry
it because I know what my constituents experience on a daily basis.
Come to my district in Cleveland and you will understand.
The people of Ohio's 10th district have been hard hit by an economy
where wealth has accelerated upwards through plant closings, massive
unemployment, small business failings, lack of access to credit,
foreclosures and the high cost of health care and limited access to
care. I take my responsibilities to the people of my district
personally. The focus of my district office is constituent service,
which more often than not involves social work to help people survive
economic perils. It also involves intervening with insurance companies.
In the two weeks before the vote on the final health care package, it
became clear that the vote would be very close. I take this vote with
the utmost seriousness. I am quite aware of the historic fight that has
lasted the better part of the last century to bring America in line
with so many other modern democracies in providing single-payer health
care. I have seen the political pressure and the financial pressure
being asserted to prevent a real challenge to a highly profitable
system dominated by private insurance companies.
I know I have to make a decision, not on the bill as I would like to
see it, but the bill as
[[Page H2438]]
it is. My criticisms of the legislation have been well reported. I do
not retract them. I incorporate them in this statement. They still
stand as legitimate and cautionary. I still have doubts about the bill.
I do not think it is a first step toward anything I have supported in
the past. This is not the bill I wanted to support, even as I continue
efforts until the last minute to modify the bill.
However after careful discussions with President Obama, Speaker
Pelosi, my wife Elizabeth, the frequently personal and tragic stories
of my constituents and close friends, I have decided to cast a vote in
favor of the legislation. If my vote is to be counted, let it now count
for passage of the bill, hopefully in the direction of comprehensive
health care reform. We must include coverage for those excluded from
this bill. We must free the states. We must have control over private
insurance companies and the cost their very existence imposes on
American families. We must strive to provide a significant place for
alternative and complementary medicine, religious health science
practice, and the personal responsibility aspects of health care which
include diet, nutrition, and exercise.
The health care debate has been severely hampered by fear, myths, and
by hyper-partisanship. The President clearly does not advocate
socialism or a government takeover of health care. The fear that this
legislation has engendered has deep roots, not in foreign ideology but
in a lack of confidence, a timidity, mistrust and fear which post 911
America has been unable to shake.
This fear has so infected our politics, our economics and our
international relations that as a nation we are losing sight of the
expanded vision, the electrifying potential we caught a glimpse of with
the election of Barack Obama. The transformational potential of his
presidency, and of ourselves, can still be courageously summoned in
ways that will reconnect America to our hopes for expanded
opportunities for jobs, housing, education, peace, and yes, health
care.
I want to thank those who have supported me personally and
politically as I have struggled with this decision. I ask for continued
support in our ongoing efforts to bring about meaningful change. I have
taken a detour through supporting this bill, but I know the destination
I will continue to seek, for as long as it takes, whatever it takes, is
an America where health care will be firmly established as a civil
right.
Empowering individuals
Smart personal choices in areas like diet, nutrition, and exercise
are essential to a healthier world. At the same time, we must remove
the barriers and change the incentives that discourage or prevent
responsible behavior. The Institute of Medicine estimates that in 2004
approximately $10 billion was spent on food advertising directed at
children, using every method available--television, radio, the
internet, even embedded in video games. Simply put, marketing to
children works--companies would not make such a substantial investment
if it were ineffective.
Marketing directed at youth is extremely well constructed and relies
heavily on behavioral science. The developing brain of the child can
not discriminate fact from opinion and can not think critically; it is
no match for a $10 billion industry that exploits this vulnerability
using cartoons, cross branding with popular toys, giveaways, and myriad
other methods to develop brand loyalty and shape judgment as early as
possible. Established early, these affinities are the most enduring.
Astonishingly, the Federal Government subsidizes this methodical
preying on children by granting a tax write-off for expenses associated
with it. This must stop. The government must take action to protect
American children and ensure that they grow up in a healthy
environment. My bill, H.R. 4310, would eliminate the tax deductibility
of fast food and junk food advertising directed at children. H.R. 4310
has the potential to raise billions of dollars in revenue to fund child
nutrition and anti-obesity initiatives.
There is precedent: approximately 50 countries, including Sweden,
Norway, Australia, and Great Britain, have limited or prohibited food
advertising directed at youth. Additionally, recent research has
concluded that eliminating the tax deductibility of food advertising
directed at youth would reduce obesity rates. Long-term health care
reform must address the personal responsibility, the corporate
responsibility, and the government's fair share of the responsibility
for improved health. I will work to ensure that is the case.
Each generation has had to take up the question of how to provide for
the health of the people of our nation. And each generation has
grappled with difficult questions of how to meet the needs of our
people. I believe health care is a civil right. Each time as a nation
we have reached to expand our basic rights, we have witnessed a slow
and painful unfolding of a democratic pageant of striving, of
resistance, of breakthroughs, of opposition, of unrelenting efforts and
of eventual triumph.
I have spent my life struggling for the rights of working class
people and for health care. I grew up understanding first hand what it
meant for families who did not get access to needed care. I lived in 21
different places by the time I was 17, including in a couple of cars. I
understand the connection between poverty and poor health care, the
deeper meaning of what Native Americans have called ``hole in the body,
hole in the spirit.'' I struggled with Crohn's disease much of my adult
life, to discover sixteen years ago a near-cure in alternative medicine
and following a plant-based diet. I have learned with difficulty the
benefits of taking charge personally of my own health care. On those
few occasions when I have needed it, I have had access to the best
allopathic practitioners. As a result I have received the blessings of
vitality and high energy. Health and health care is personal for each
one of us. As a former surgical technician I know that there are many
people who dedicate their lives to helping others improve theirs. I
also know their struggles with an insufficient health care system.
There are some who believe that health care is a privilege based on
ability to pay. This is the model President Obama is dealing with,
attempting to open up health care to another 30 million people, within
the context of the for-profit insurance system. There are others who
believe that health care is a basic right and ought to be provided
through a not-for-profit plan. This is what I have tirelessly
advocated.
I have carried the banner of national health care in two presidential
campaigns, in party platform meetings, and as co-author of H.R. 676,
Medicare for All. I have worked to expand the health care debate beyond
the current unsustainable system, to include a robust public option and
my amendment to free the states to pursue single-payer. An early
version of the health care bill, while badly flawed, contained these
provisions which I believed made the bill worth supporting when it was
considered by the Committee on Education and Labor. I voted for it. The
provisions were taken out of the bill after it passed the Committee.
I joined with the Congressional Progressive Caucus in saying that I
would not support the bill unless it had a strong public option and
unless it protected the right of people to pursue single payer at a
state level. It did not. I kept my pledge and voted against the bill
when it was considered by the full House of Representatives. Since
then, I have continued to oppose it while trying to get the provisions
back into the bill. Some have speculated that, as the final vote on
this health care package drew closer, I might have been in a position
of casting the deciding vote. The President's visit to my district on
Monday underscored the urgency of this moment.
I have taken this fight further than many in Congress cared to carry
it because I know what my constituents experience on a daily basis.
Come to my district in Cleveland and you will understand.
The people of Ohio's 10th district have been hard hit by an economy
where wealth has accelerated upwards through plant closings, massive
unemployment, small business failings, lack of access to credit,
foreclosures and the high cost of health care and limited access to
care. I take my responsibilities to the people of my district
personally. The focus of my district office is constituent service,
which more often then not involves social work to help people survive
economic perils. It also involves intervening with insurance companies.
In the two weeks before the vote on the final health care package, it
became clear that the vote would be very close. I take this vote with
the utmost seriousness. I am quite aware of the historic fight that has
lasted the better part of the last century to bring America in line
with so many other modern democracies in providing single-payer health
care. I have seen the political pressure and the financial pressure
being asserted to prevent a real challenge to a highly profitable
system dominated by private insurance companies.
I know I have to make a decision, not on the bill as I would like to
see it, but the bill as it is. My criticisms of the legislation have
been well reported. I do not retract them. I incorporate them int this
statement. They still stand as legitimate and cautionary. I still have
doubts about the bill. I do not think it is a first step toward
anything I have supported in the past. This is not the bill I wanted to
support, even as I continue efforts until the last minute to modify the
bill.
However after careful discussions with the President Obama, Speaker
Pelosi, my wife Elizabeth, and in consideration of the frequently
personal and tragic stories of my constituents, I have decided to cast
a vote in favor of the legislation. If my vote is to be counted, let it
now count for passage of the bill, hopefully in the direction of
comprehensive health care reform. We must include coverage for those
excluded from this bill. We must free the states. We must have control
over private insurance companies and the cost their very existence
imposes on American
[[Page H2439]]
families. We must strive to provide a significant place for alternative
and complementary medicine, religious health science practice, and the
personal responsibility aspects of health care which include diet,
nutrition, and exercise.
The health care debate has been severely hampered by fear, myths, and
by hyper-partisanship. The President clearly does not advocate
socialism or a government takeover of health care. The fear that this
legislation has engendered has deep roots, not in foreign ideology but
in a lack of confidence, a timidity, mistrust and fear which post 911
America has been unable to shake.
This fear has so infected our politics, our economics and our
international relations that as a nation we are losing sight of the
expanded vision, the electrifying potential we caught a glimpse of with
the election of Barack Obama. The transformational potential of his
presidency, and of ourselves, can still be courageously summoned in
ways that will reconnect America to our hopes for expanded
opportunities for jobs, housing, education, peace, and yes, health
care.
I want to thank those who have supported me personally and
politically as I have struggled with this decision. I ask for continued
support in our ongoing efforts to bring about meaningful change. As
this bill passes I will renew my efforts to help those state
organizations which are aimed at stirring a single payer movement which
eliminates the predatory role of private insurers who make money not
providing health care. I have taken a detour through supporting this
bill, but I know the destination I will continue to seek, for as long
as it takes, whatever it takes, is an America where health care will be
firmly established as a civil right.
moving Toward True Health Care Reform
In pursuing meaningful change in the health care system, there can be
no better investment than to remove federal barriers to allowing states
to implement the only model of health care proven to cover everyone,
lower costs and increase quality: single-payer.
Systems that remove the insurance companies from care are well tested
and consistently outperform systems that rely on private insurance.
Their costs are lower, their access is universal, the coverage is
comprehensive, and their systems are far more equitable. Such a single-
payer health care system would also provide major economic stimulus.
Half of all bankruptcies in the U.S. are the result of the failure of
an insurance plan to do the very thing that drives us to buy health
insurance--protect us from catastrophic financial burdens that arise
from health care needs. Only single-payer health care can rid us of the
economic drag of medical bankruptcies by providing truly comprehensive
coverage--for less money than we are currently paying.
It is no wonder then that states are demanding single payer. Not only
does it help people stay out of poverty, but it would provide major
relief for states facing budget difficulties. The Lewin Group's
financial analysis of the California single payer bill that recently
passed the legislature twice found that ``the net cost of the program
to state and local governments is a savings of about $900 million'' in
2006 alone. There are also strong single payer movements in
Pennsylvania, New York, Illinois, Colorado, and New Mexico. In fact,
the savings to a state from a single-payer plan have been well
documented. Fourteen states are listed below, along with their savings
and the year of the applicable study. The worst-case scenario is Maine,
which would break even.
State: Annual Single-payer Savings--Year
New Mexico (Lewin Group): $151,800,000--1994
Delaware (Solutions for Progress): $229,000,000--1995
Minnesota (Lewin Group): $718,000,000--1995
Massachusetts (Lewin Group, Solutions for Progress/Boston
University School of Public Health): $1,800,000,000--
$3,600,000,000--1998
Maryland (Lewin Group): $345,000,000--2000
Vermont (Lewin Group): $118,000,000--2001
California (Lewin Group): $7,500,000,000--2002
Maine (Mathemetica Policy): $0--2002
Rhode Island (Solutions for Progress/Boston University
School of Public Health): $270,000,000--2002
Missouri (Missouri Foundation for Health): $1,700,000,000--
2003
Georgia (Lewin Group): $716,000,000--2004
California (Lewin Group): $8,000,000,000--2005
Colorado (Lewin Group): $1,400,000,000--2007
Kansas (Lewin Group): $869,000,000--2007
The Employee Retirement Income Security Act (ERISA) has been used to
thwart efforts at the state and regional level to improve health care.
Though the law was intended to protect the integrity and quality of
employee benefit plans including health care, ERISA has been used in
courts to stop or make impractical health care reform efforts in
Maryland, San Francisco, and Suffolk County, New York. It is the most
difficult federal barrier a single-payer state will face, though there
will be others.
I will continue to work to help these states. We must yield to the
wishes of those in a state who demand a health care system that is
proven to work well. It would be entirely voluntary. If a state wants
better health care than can be provided by the federal government, the
federal government should not stand in their way.
Public Option
A robust public option is not sufficient to control costs, cover
everyone, and increase quality of care. However, it is a good interim
option for those who do not want to be subject to the abuses of the
insurance companies but are required to purchase health insurance under
the health care bill we are passing today. The extreme inefficiency of
the private health insurance companies and the inefficiency they cause
throughout the health care system are well documented. Americans need
refuge because the health insurance companies are ruthlessly efficient
at one thing: denying care. They have to be because that is how they
make money.
In the short term, I will continue to fight for a strong public
option until a single payer plan is in place.
Integrative Medicine and Religious Health Care
A 2008 study by the National Center for Complementary and Alternative
Medicine at the National Institutes of Health and the National Center
for Health Statistics revealed that 38% of American adults used some
form of integrative medicine to meet their health care needs. However,
access to these services is limited because of lack of insurance
coverage of these safe, cost-effective and clinically effective medical
approaches. Some of those modalities include chiropractic care,
acupuncture and many others under study at the National Institutes of
Health.
However, some insurance companies are starting to realize that it is
beneficial to their bottom line if they cover some integrative medicine
approaches. More and more plans are covering chiropractic and
acupuncture, for example. The medical literature abounds with studies
showing that the cost-effectiveness of interventions like
transcendental meditation for hypertension and heart disease is far
better than that for conventional pharmaceutical interventions.
An early version of the health care overhaul bill included my
amendment that would guarantee that a practitioner of integrative
medicine is one of the people that decides the minimum required benefit
package. It also created a task force of integrative medicine
practitioners to help inform the decision makers about what should be
covered. Finally, it required that when a patient goes to the Exchange
website and looks up doctors, practitioners of integrative medicine are
easily identifiable. Though the language was removed before a vote on
the bill was taken by the full House of Representatives, I will
continue to work to advance integrative medicine by increasing its
accessibility and safety.
Under this bill, most Americans, including people who practice other
distinctive approaches to health care, are forced to buy private health
insurance. I recognize the difficult position for Christian Scientists
and others similarly situated. Millions opt for spiritual care that
coincides with their religion. But as of today, even though the care
they prefer is covered by Medicare, Medicaid, TRICARE and some plans
available to federal government employees, few private insurance plans
cover it. The new healthcare legislation we are considering today does
not prevent insurance companies from covering their care; it also does
not create a pathway for its serious consideration by insurance
companies. I look forward to helping to identify a way to ensure that
spiritual and integrative care get a fair chance at coverage by
insurance companies.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 1225, the previous question is ordered.
The question is on the motion by the gentleman from California.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. GEORGE MILLER of California. Mr. Speaker, on that I demand the
yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, this 15-
minute vote on the motion to concur will be followed by a 5-minute vote
on the motion to suspend the rules on House Resolution 1215.
The vote was taken by electronic device, and there were--yeas 220,
nays 207, not voting 3, as follows:
[Roll No. 194]
YEAS--220
Ackerman
Andrews
Baca
Baird
Baldwin
Bean
Becerra
Berkley
Berman
Bishop (GA)
Bishop (NY)
Blumenauer
Boccieri
Boswell
Boyd
Brady (PA)
Braley (IA)
Brown, Corrine
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Carson (IN)
Castor (FL)
Chu
[[Page H2440]]
Clarke
Clay
Cleaver
Clyburn
Cohen
Connolly (VA)
Conyers
Costa
Costello
Courtney
Crowley
Cuellar
Cummings
Dahlkemper
Davis (CA)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Dingell
Doggett
Donnelly (IN)
Doyle
Driehaus
Edwards (MD)
Ellison
Ellsworth
Engel
Eshoo
Etheridge
Farr
Fattah
Filner
Foster
Frank (MA)
Fudge
Garamendi
Giffords
Gonzalez
Gordon (TN)
Grayson
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Halvorson
Hare
Harman
Hastings (FL)
Heinrich
Higgins
Hill
Himes
Hinchey
Hinojosa
Hirono
Hodes
Holt
Honda
Hoyer
Inslee
Israel
Jackson (IL)
Jackson Lee (TX)
Johnson (GA)
Johnson, E. B.
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick (MI)
Kilroy
Kind
Kirkpatrick (AZ)
Klein (FL)
Kosmas
Kucinich
Langevin
Larsen (WA)
Larson (CT)
Lee (CA)
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lujan
Lynch
Maffei
Maloney
Markey (CO)
Markey (MA)
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McNerney
Meek (FL)
Meeks (NY)
Michaud
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy (NY)
Murphy, Patrick
Nadler (NY)
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor (AZ)
Payne
Pelosi
Perlmutter
Perriello
Peters
Pingree (ME)
Polis (CO)
Pomeroy
Price (NC)
Quigley
Rahall
Rangel
Reyes
Richardson
Rodriguez
Rothman (NJ)
Roybal-Allard
Ruppersberger
Rush
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schauer
Schiff
Schrader
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shea-Porter
Sherman
Sires
Slaughter
Smith (WA)
Snyder
Speier
Spratt
Stark
Stupak
Sutton
Thompson (CA)
Thompson (MS)
Tierney
Titus
Tonko
Towns
Tsongas
Van Hollen
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch
Wilson (OH)
Woolsey
Wu
Yarmuth
NAYS--207
Aderholt
Adler (NJ)
Akin
Alexander
Altmire
Arcuri
Austria
Bachmann
Bachus
Barrett (SC)
Barrow
Bartlett
Barton (TX)
Berry
Biggert
Bilbray
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehner
Bonner
Bono Mack
Boozman
Boren
Boucher
Boustany
Brady (TX)
Bright
Broun (GA)
Brown (SC)
Brown-Waite, Ginny
Buchanan
Burgess
Burton (IN)
Calvert
Camp
Campbell
Cantor
Cao
Capito
Carter
Cassidy
Castle
Chaffetz
Chandler
Childers
Coble
Coffman (CO)
Cole
Conaway
Cooper
Crenshaw
Culberson
Davis (KY)
Davis (TN)
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Dreier
Duncan
Edwards (TX)
Ehlers
Emerson
Fallin
Flake
Fleming
Forbes
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gallegly
Garrett (NJ)
Gerlach
Gingrey (GA)
Gohmert
Goodlatte
Granger
Graves
Griffith
Guthrie
Hall (TX)
Harper
Hastings (WA)
Heller
Hensarling
Herger
Herseth Sandlin
Hoekstra
Holden
Hunter
Inglis
Issa
Jenkins
Johnson (IL)
Johnson, Sam
Jones
Jordan (OH)
King (IA)
King (NY)
Kingston
Kirk
Kissell
Kline (MN)
Kratovil
Lamborn
Lance
Latham
LaTourette
Latta
Lee (NY)
Lewis (CA)
Linder
LoBiondo
Lucas
Luetkemeyer
Lummis
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
Matheson
McCarthy (CA)
McCaul
McClintock
McCotter
McHenry
McIntyre
McKeon
McMahon
McMorris Rodgers
Melancon
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Minnick
Moran (KS)
Murphy, Tim
Myrick
Neugebauer
Nunes
Nye
Olson
Paul
Paulsen
Pence
Peterson
Petri
Pitts
Platts
Poe (TX)
Posey
Price (GA)
Putnam
Radanovich
Rehberg
Roe (TN)
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rooney
Ros-Lehtinen
Roskam
Ross
Royce
Ryan (WI)
Scalise
Schmidt
Schock
Sensenbrenner
Sessions
Shadegg
Shimkus
Shuler
Shuster
Simpson
Skelton
Smith (NE)
Smith (NJ)
Smith (TX)
Souder
Space
Stearns
Sullivan
Tanner
Taylor
Teague
Terry
Thompson (PA)
Thornberry
Tiahrt
Tiberi
Turner
Upton
Walden
Wamp
Westmoreland
Whitfield
Wilson (SC)
Wittman
Wolf
Young (AK)
Young (FL)
NOT VOTING--3
Buyer
Davis (AL)
Reichert
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). There are 5 minutes
remaining in this vote.
{time} 2102
So the motion to concur was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________