Congressional Record, Volume 156 Issue 58 (Thursday, April 22, 2010)

[Congressional Record Volume 156, Number 58 (Thursday, April 22, 2010)]
[House]
[Pages H2827-H2834]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

HEALTH CARE

The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 2009, the gentleman from Texas (Mr. Burgess) is recognized
for 60 minutes as the designee of the minority leader.
Mr. BURGESS. I thank the minority leader for allowing me to speak
this afternoon during the leadership hour. It is always a significant
event to be asked to speak during the leadership hour, and I certainly
appreciate the confidence shown in me by the leadership.
This afternoon I thought we'd talk a little bit more about the health
care bill that was passed by this House last month because it is an
important subject and one that continues to cause problems across the
country. Almost anyplace you go, people want to ask you questions
about, Why did you do this bill, and what does it mean for me, and what
can I expect going forward?
Mr. Speaker, I know I need to confine my comments to the Chair, and I
will do so. But if I were to be able to speak to people directly, I
would encourage them to look at a health care policy Web site that my
office maintains. It's called the Congressional Health Care Caucus,
healthcaucus.org. This Web site chronicles many of the debates and
discussions that occurred over the last 14 or 15 months, encapsulating
the genesis of this health care bill that was passed last month. And
really with the passage of the bill, the health care issue does not go
away. We simply move into the second part of what is going to be the
health care discussion because after all, even as we speak, just down
the hill at the Department of Health and Human Services, they are
busily working and hiring people, people who are going to be writing
rules, writing regulations, and really dictating the policies that will
direct health care in this country not just through election day, not
just through election day 2012, but literally through the lives of the
next three generations of Americans.
So this is an important concept, and people do need to pay attention.
As the rules are written over at the Department of Health and Human
Services, there will be periods open for comment on that public
rulemaking process, and people need to visit Web sites such as
healthcaucus.org or the Health and Human Services Web site to
familiarize themselves with the rules as they are being written. If you
get the mental picture of some central planner moving data points
around on a big map or graph, that's probably the right mental image to
have right now with where we are with this health care bill.
Let's talk just a little bit about how we got to where we did with
the passage of the bill. The recognition after the presidential
election of 2008 that health care was going to be a big part of the
legislative agenda for the President's first term. There was no
question about that. And as we worked our way through the year last
year, concepts such as cost and coverage started creeping into almost
every story that was written about health care. Because it was after
Senator Kennedy's committee over in the Senate, that Health, Education,
Labor, and Pensions Committee, released a Congressional Budget Office
score on the bill that they were working on which showed a cost
significantly north of $1 trillion over 10 years and coverage numbers
of about 13 million additional people being covered, that people said,
Oh, my goodness, this costs a lot, and we don't get nearly the coverage
that we thought we did. So almost every other health care proposal that
came forward after that was subject to that same Congressional Budget
Office scrutiny and scoring. And as a consequence, it kind of got an
idea of the parameters that were being set. Those parameters were that
the bill had to be scored and costing under $1 trillion, and the bill
had to score as covering an additional 30 million people. Those were
the points on the graph that had to be satisfied at the end of the
discussion.
So if it were a question of covering everyone who makes under 150
percent of the Federal poverty level under Medicaid, as was the
directive from the bill that was passed in the House, if that made the
final number too high, then you do what they did in the Senate and say,
Well, we're only going to cover people up to 133 percent of the Federal
poverty level with Medicaid, and that money that's not spent on
covering people with Medicaid at higher income levels, we'll use that
for something else. And there was all sorts of jockeying for position
that occurred over the months during the debate last year.
We passed a bill out of committee on July 31 last summer. The bill
was actually supposed to be passed out of committee much earlier and
was supposed to come to the floor, and we were supposed to pass the
bill on the floor of the House before we went home for the August
recess. But because the Speaker of the House decided to take up the
climate change bill in June and force the passage of that bill right at
the end of June before we went home for the Fourth of July recess,
thereby causing many Members to feel some anxiety from their
constituents back home over what they had done with this large energy
tax that the House just passed, many Members of Congress were reluctant
to move with rapidity on the health care bill because they were feeling
the push-back from the energy bill that they wondered if maybe we
didn't pass this a little too quickly and maybe we should have read the
bill and studied and understood what the bill did before we voted on
it.
So the month of July was kind of a give-and-take. Really most of the
discussion was on the Democratic side of the aisle. It did not involve
Republicans. But it was moderate Democrats who were concerned about the
passage of this bill too quickly.

{time} 1415

Ultimately, the bill did pass in committee. All of the moderate
Democrats on my committee voted in favor of it and ultimately it
passed, but it didn't pass until the House had already adjourned for
the August recess on July 31. As a consequence, the bill did not come
back to the House floor until after the August recess.
Most of us know what happened during August. There was a significant
amount of anxiety exhibited across the country where people would show
up at their Member of Congress or their Senator's town hall meeting
during the summer and voice either their support or their rejection of
the concept of the health care bills that were being discussed in the
House and the Senate, and the feeling was almost uniformly negative
against what was being passed at least on the floor of the House.
The situation that occurred after the end of the summer town halls, I
thought we would come back and, perhaps with a renewed spirit of
bipartisanship, realize that we could not do something this large when
it was against the will of the American people. I thought we would come
back and hit the pause button or the reset button or maybe even the
rewind button and go back to committee and rework this bill; but that
was not to be.
The President of course came and spoke to a joint session of Congress
here in the middle of September, speaking right from the podium right
there behind me, and talked about how they were going to go forward
with their vision of health care reform, and it didn't really matter
what people said over August. Americans must have been in some sort of
fugue state because they didn't really mean what

[[Page H2828]]

they were saying when they said they did not like this bill that we,
Congress, were going to give them, we, the President, was going to give
them.
So as a consequence, in December, after the House passed--the House
did come back and pass a bill early in November. The bill had grown
from 1,000 pages at the end of July to 2,000 pages by early November.
It was interesting that the bill had grown in the number of pages
because all of the amendments that were made in order during the
committee process were all mysteriously stripped from the bill before
it came back to the floor; but the bill was much larger.
The bill came to the floor and passed by a very narrow vote. And
again, the polling done the day of that vote showed that only about
one-quarter of Americans actually supported the work we were doing,
about another 30 to 40 percent felt that we were doing the wrong thing,
and another small but significant percentage said you shouldn't even be
doing this right now because your focus should be on creating jobs in
the American economy. But we passed the bill.
What happened next was really something the likes of which I have
never seen before in my short tenure here in Congress. Between
Thanksgiving and Christmas, the Senate wrote and produced and passed a
health care bill. Now, both Senate committees, the Senate Health,
Education, Labor, and Pensions Committee and the Senate Finance
Committee, had worked on different bills through the course of the
year; but then they worked on an entirely different bill between
Thanksgiving and Christmas Eve and the ultimate passage of the bill.
The bill, interestingly enough, had a House number, it was H.R. 3590.
It had a House number because it was a bill the House of
Representatives had passed earlier in the year. It wasn't a health care
bill when we passed it, but we did pass it on the floor of this House.
It was a housing bill, not a health care bill; but that bill was picked
up over in the Senate, amended so that all of the housing language was
removed and the health care language was inserted.
But it wasn't a question of let's get the best possible health care
policy and put it in this bill. It was more a question of what will it
take to get your vote and we will put that in the bill. That process
was so unseemly. The last part of December people were engaged even
though they were concerned about the goings-on in their lives for the
holidays and the end of the year activities, but they were also
concerned about the appearance of votes being bought and sold and
people actually coming to a conclusion to vote ``yes'' for the bill
because they had gotten some special deal contained within the bill.
That process was so flawed that even though the Senate achieved that
60-vote margin on Christmas Eve, the ill will exhibited by the American
people continued for weeks after that.
Now the bill did pass on Christmas Eve; it was passed early in the
day to get Senators out of town ahead of a snowstorm. As a consequence,
the bill itself was not ready for prime time. No one, I really believe
this, no one in the Senate ever thought that would be the final
product. This was, again, simply a placeholder to get the Senators out
of town before Christmas and be able to say that they had passed a
health care reform bill before the end of the year. Everyone thought we
will come back to a conference committee or we will come back to some
type of arrangement where we meld the House and Senate products
together; maybe it won't be a formal conference committee because we
really don't want to include Republicans, but we will still work on
trying to get some of the rough edges of this thing knocked off and
include some of the House-passed principles as well.
Unfortunately for America that never happened because what did happen
is the second Tuesday of November an election held way, way up in the
State of Massachusetts, where a Republican was elected Senator in a
seat that had been held by a Democrat for literally generations, and
that happened because the appearance of passing this bill before
Christmas Eve appeared so awkward, appeared so unseemly that it looked
as if people were buying votes for the bill. The American people pushed
back, and even in Massachusetts that was too much to take and Senator
Scott Brown was elected.
As a consequence of that, it was apparently felt by leadership in the
House and the Senate that a conference committee was not a good idea
and there would not be the support for this bill on either the floor of
the House or the Senate if they were to bring it back requiring the 60-
vote margin in the Senate and of course a simple majority in the House.
The Speaker of the House at one point was asked could they just pick
up and pass the Senate bill in the House and get it down to the
President for his signature. The statement then, right after the
Massachusetts election, was that the Speaker did not believe she had
100 votes on the floor of the House for the Senate bill.
It was significant that the Senate bill had a House bill number. It
was significant that the Senate bill, although now it was a health care
bill, had passed the House previously because under the rules of
Congress if that bill would come back to the House of Representatives
with the question asked, Will the House now agree to the amendment made
in the Senate on H.R. 3590, and if that answer was ``yes'' by a simple
majority, then the bill is passed and it goes down to the White House
for signature. Well, ultimately that is exactly what happened.
During the remainder of the month of January, all of the month of
February, and much of the month of March, the same process occurred
over here where Members of Congress on the Democratic side of the aisle
were encouraged, cajoled, threatened--whatever--to change their vote or
to change their mind and vote for this health care bill.
Well, it passed. It passed and was signed into law. It required a
significantly sized fix-it bill to be passed within a week because the
bill was so flawed it really could not stand on its own. Indeed, there
have been multiple things that have been brought to people's attention
since that time about problems that existed with the bill, and I rather
suspect we are going to continue to find those problems occurring over
and over and over again in the next several months.

My opinion: this bill should be repealed, and we should actually go
back and do what the American people really were asking us to do when
they showed up at those town halls in large numbers in the month of
August. They did not want us to turn the entire system on its head in
order to help the people that legitimately needed to be helped. Yes, we
needed to provide some assistance to people with preexisting
conditions. Yes, some tort reform would be nice. Is there anything you
can do about the cost of health care in this country? But don't take
away what is working for 60 to 65 to 68 percent of the American people.
That was a message delivered loud and clear in the month of August and
has been delivered loud and clear in every poll that has been taken on
the subject since that time.
The system needed reform; the system did not need to be changed from
top to bottom. And yet over the next 8 years that is exactly what we
will see, a system that none of us will recognize by the end of 2010,
2014, 2016, 2018--pick your point on the timeline.
Currently in my State, the State of Texas, Attorney General Greg
Abbott is pursuing a court case--and joined with several other States
to do so--to argue before the Supreme Court that the bill we passed is
unconstitutional. Proponents of the bill, people who think the bill was
proper and is constitutional, argue that under the commerce clause of
the Constitution this bill will be held to be constitutional by the
Supreme Court even though the concept of universal health care is
discussed nowhere in the Constitution.
The problem with the commerce clause is that we are now, for the
first time, requiring a citizen of the United States, merely as a
condition of being a citizen of the United States, to buy a good,
service or product that they may not want, need, or feel they are able
to afford. This is the first time the commerce clause has been invoked
to protect the commerce that was essentially coerced by the Congress.
So the attorneys general of several States are now pushing that case
and are going to argue that before the Supreme Court.
One of the shortcomings of the Senate bill, one of the things that
wasn't

[[Page H2829]]

properly thought through, was the provision of what is called a
severability clause in the bill. We actually had a severability clause
in the House bill that was passed in November, but no such severability
clause was included in the Senate bill. Perhaps in their haste, just to
get something done before that snowstorm on Christmas Eve, they simply
forgot about it.
What a severability clause would do is, Congress recognizes that from
time to time we will overstep our bounds in the eyes of the courts and
the court might strike down a provision in the bill, but the
severability clause allows the rest of the bill to stay and be
enforced. Without a severability clause, this is now up to the
discretion of the court. The court could, if it agreed that the
commerce clause could not be invoked to pass this bill, strike down the
entire bill, or they might use the discretion of the court to only
strike down a portion of the bill that they deemed unconstitutional.
That drama has yet to play out, and likely it will during the summer
months or fall and we will have to see what occurs with that. But I do
support Attorney General Greg Abbott in Texas and many of the other
attorneys general across the country who are actively pursuing this
course against this bill.
What would repeal look like? Could Congress in fact repeal a bill
that had passed and been signed into law by the President? The answer
is yes, and there is actually precedent for that. In 1989, some people
will remember the name Dan Rostenkowski. He was the chairman of the
Ways and Means Committee--a Democratic chairman from the State of
Illinois, coincidentally--and passed the Catastrophic Health Care Act.
This was the Catastrophic Health Care Act for senior citizens. The bill
was actually passed in a bipartisan fashion in both the House and the
Senate. It was thought that people wanted this, but in fact it's one of
the problems that you have when you get out in front of the American
people and give them things that they don't necessarily want that
actually cost them money.
What happened with the Catastrophic Care Act was the pushback was so
intense and so immediate that when Congress came back into session,
they quickly decided that perhaps the world could live without the
Catastrophic Care Act and they repealed it. Now, this bill was passed
in the final months of the Ronald Reagan administration; it was signed
by President Reagan. The repeal was signed by President George Herbert
Walker Bush. But the concept of repeal of a bad health care entitlement
law is one that certainly has been exercised within the lifetimes of
many of us who are serving in this body today.
Since the passage of this bill in March, support across the country
has diminished, opposition has increased; and, again, that is likely to
continue as the bill will become more and more unpopular as people dig
into it and look into the provisions of the bill.
One of the other things that is working against the concept of this
bill was the absolutely poisonous process that led to its passage and
its signing. Back in May or June of last year, six stakeholders met
down at the White House to talk about health care reform. Now, there is
nothing wrong with that. That is perfectly proper that perhaps the
people who represent the doctors, the hospitals, the drug
manufacturers, the device manufacturers, America's health insurance,
and representatives from the Service Employees International Union met
down at the White House to talk about health care reform.
In a very well publicized photo op that occurred after those
meetings, the President came out before the cameras and said that he
had agreement from the six parties that were in those meetings that
they would save $2 trillion over the next 10 years in the delivery of
health care. Well, I simply asked for the notes of those meetings, the
agreements that were agreed to in those meetings so that we, as the
legislative body, could evaluate that as we were working on the
legislation, the actual law or the bill that would become law here in
the House of Representatives.
I sent letters to the White House in September. I was rebuffed
without any sort of information. Ultimately, in December, I filed
what's called a resolution of inquiry with my committee, the Committee
on Energy and Commerce. This resolution of inquiry was brought up
before the committee on, interestingly, the same day that the President
delivered the State of the Union Address in January.

{time} 1430

The resolution of inquiry was not going to pass because, obviously,
on a party line, the Democrats are in charge, and they can strike down
almost anything they want. Yet the chairman of my committee consented
to allow me to request of the White House six of the 11 things that we
had asked for in the resolution. He said some of the information is
right and proper and should go to the gentleman from Texas should he
request that information. So we re-requested the information.
Essentially, all we have received from the White House are copies of
press releases and copies of Web pages that were reproduced for us, but
there has been nothing regarding anything that was written down,
nothing regarding any arrangements that were made or any deals that
were made; there has been nothing regarding any email exchanges that
occurred resulting in the savings of $2 trillion.
Now, I will admit to sometimes being relatively naive, but it seems
to me that, if you're going to agree to a $2 trillion deal, someone, at
least on the back of an envelope somewhere, is going to kind of keep a
tally of what those numbers are--someone is going to write something
down--but the White House would have us believe that, no, there has
been nothing written down.
Is it significant? I submit that it is. There were several points
that came up during the debate of the bill, both in the House and in
the Senate, where an amendment would be offered and where the
discussion then would suddenly end with, Well, that wasn't part of the
deal.
In December, Senator McCain had an amendment over in the Senate about
drug reimportation. I don't agree with drug reimportation. I actually
think that is a bad idea, but I do think Senator McCain should have had
the ability to submit his amendment, to debate his amendment and to
have it pass or fail on the merits of the amendment. In no way should
he have not been allowed to offer that amendment because of a secret
deal that was made down at the White House with the drug manufacturers,
but that is exactly what happened. He was stopped from offering the
amendment by his committee chairman, who said, That's not part of the
deal that we have.
Another area is where the hospitals were going to be taxed as part of
the pay-for within the bill. They said, Wait. That wasn't part of our
deal.
Well, the deal may be fine, the deal may be proper, but we as
legislators should at least be privy to those decisions that were made
down at the White House. We should at least have the information about
what was agreed to and on whose behalf those agreements were made. We
never got that information, and to this day, I still await some
response from the White House.
Significantly, during the Presidential campaign, when he was a
candidate, President Obama said, and I'm quoting here: ``And that's
what I'll do, bringing all parties together, not negotiating behind
closed doors but bringing all parties together and broadcasting those
negotiations on C-SPAN so that the American people can see what the
choices are, because part of what we have to do is enlist the American
people in this process.''
I couldn't agree more. Yes, you've got to enlist the American people
when you're doing something this broad and this sweeping, but they
never bothered to do that. Yes, you do need to open those meetings up.
C-SPAN can sometimes be a trifle boring when you watch us for too long
at a time, but it's important. It's a window to the world that people
have on the legislative process.
So, when the President made that pledge no less than eight times
during the campaign, it struck a chord with people; it resonated with
people. If my Representative is involved in those meetings, I'd like to
see where he stands. The President would make this point: Does the
Representative stand on the side of the drug companies or does he stand
on the side of the people?

[[Page H2830]]

Does the Senator stand with the insurance companies or does he stand
with America's patients?
They are important concepts to know. Unfortunately, we have not yet
had the ability to know what those deals were.
I've got to believe that this is such an important point that people
got this when it was offered to them: Look, we'll make it an open and
transparent process. You can watch it on television if you don't get
too bored, but it will be your choice. You can watch it on television.
I think people picked up on that notion. Honestly, this is one of those
where, yeah, people can say things during a campaign that they actually
can't deliver on after the election is over. That happens all the time.
I understand that. But this is a ``read my lips'' moment. This is a
``read my lips: no new taxes'' moment. The President promised that all
of these negotiations would be up for purview, covered on C-SPAN, that
you would be able to watch, and that you would be able to make the
decision as to whether this process was a good one or a bad one. Again,
unfortunately, to date, that has not happened. I do hope that the White
House does at some point get us that information.
Now, one of the things that I heard over and over again during the
summer, during the town halls, is that, really and truly, if you're
going to hold prices down in the delivery of medical care, you're going
to have to do something in the realm of liability reform.
I understand this because, in my home State of Texas, we, in fact,
passed significant liability reform back in 2003, and that has made
Texas now one of the more favored places to practice medicine. There
have been doctors who have fled other parts of the country and who have
moved to Texas. In fact, one of the bigger criticisms in Texas right
now is that it takes the Texas State Board of Medical Examiners too
long to process an application because their backlog is so significant,
but it is a far cry from where we were in 2002 when we were, in fact,
labeled as one of the States in crisis in the medical liability crisis.
Now, during the 8 years since that bill passed as a State bill, Texas
has licensed over 15,000 new physicians. It is important. Texas is a
big State, and there are lots of open areas in Texas. Since the passage
of that law back in 2003, 125 Texas counties have added at least one
high-risk specialist. That's like half of the counties in Texas, and
there are 224 counties in Texas. That's over half of the counties in
Texas that have added one high-risk specialist. My home county of
Denton County is one of those. Tarrant County, another county I
represent, also is one of those.
We heard stories in 2002-2003, all over the State, of people who were
closing their medical practices--radiologists, perinatologists, doctors
who take care of the sickest of the sick pregnant moms with the sickest
of the sick newborn babies. They simply could not get liability
insurance because their risk was too great. Their risk was too high.
They were leaving the State. The State paid for their education in
State-supported schools, the State supported them during their
residency training, but the State could not offer them a place to
practice because they could not afford liability premiums in the State.
So, since that bill has passed, 125 Texas counties have added at least
one high-risk specialist.
Again, Texas is a big State. It's not hard to believe, especially in
some of the less populated areas out in West Texas, that a person might
live many, many miles from a physician, but since the passage of
this law, now 99.7 percent of Texans live within 20 miles of a
physician. That is a staggering success story with the number of
doctors who have moved into the State and who are practicing. Yes, some
are practicing in urban areas, but many are practicing in rural areas,
in rural areas that previously did not have emergency room doctors and
that previously did not have obstetricians but that now do, and that is
critical for access to care in the State of Texas.

We've talked about this health care bill, and we've talked about
access to insurance, but really, when you need health care, you're not
so much interested in an insurance policy; you're more interested in do
you have a doctor there to see you when you're sick.
There are 82 Texas counties that have seen a net gain in emergency
medicine physicians, including 43 medically underserved counties and 29
counties that are partially medically underserved. There are 33 rural
counties that have seen a net gain in ER doctors, including 26 counties
that previously had none. There are 26 counties that previously did not
have emergency room doctors which now have emergency room doctors in
the State of Texas. Such has been the effect of medical liability
reform.
In my field of obstetrics, Texas saw a net loss of 14 obstetricians
in the 2 years preceding reform. And you might say, Texas is a big
State, and 14 is not that many; so, hey, you can deal with that sort of
loss. But since the State passed the law, they've experienced a net
gain of 192 obstetricians, and 26 rural counties have added OB docs,
including in 10 counties that previously had none. I mean that's a big
deal. When you have a family member in labor who is looking for a place
to have her baby, it is important to have the care there when you need
it.
There are 12 rural Texas counties that have added an orthopedic
surgeon, including in seven counties that previously had none. Again,
that's a significant fact, particularly in areas of rural Texas where
the drive might be quite long if you're dealing with an injured loved
one and are trying to find orthopedic care.
Charity care rendered by Texas hospitals has increased by 24 percent,
resulting in almost $600 million in free care to Texas patients since
the passage of that liability reform law in 2003. Texas physicians have
saved almost $600 million in liability insurance premiums, which is a
significant savings that has allowed more doctors to stay in practice.
The Texas law has been so successful that I introduced legislation
into Congress that was modeled after the Texas law. It is H.R. 1468,
the Medical Justice Act. I offered this in the form of an amendment
when we marked up our health care bill in the House Energy and Commerce
Committee last summer. It was rejected first on a technicality and then
along a party-line vote.
If we're going to ask our doctors to be our partners in this brave
new world of health care we've constructed, the very least we can do is
give them some stability in their practices. That stability would be in
the form of some relief from the problems that they face with medical
liability.
Another problem that is faced by our Nation's doctors, which is one
of the reasons we are very likely to face a significant doctor
shortage--and again, in spite of the fact that we passed a health
insurance bill, if we do not have doctors to see those patients, then
it is not going to do much good that we passed that bill. When passing
this sweeping health care reform bill, it would have been the ideal
time to talk about things like physician workforce and how we train
doctors and how we pay for that training, but we chose to omit most of
that thinking from this bill.
Another problem that we face on almost a recurring basis here in
Congress is the fact that Medicare, by formula, ratchets down
reimbursements to physicians year over year over year. In fact, this
year, the number was to go down over 20 percent. Last week, we passed a
very small bill that extended that deadline to the end of May, so
doctors got a little bit of a reprieve, and patients got a little bit
of continued access to their physicians.
I will have to tell you, as a practicing physician, that is a
significant event when a major payor like Medicare comes in and says,
We're going to be paying you 20 percent less next month for the work
that you do for us. It is a difficult problem to fix, it is an
expensive problem to fix, but it is one that just simply must be done,
not just because it's the right thing for doctors, but because, if we
do not have doctors who commit to staying in practice and taking care
of our Medicare patients, then patient access is going to be a critical
problem. We will all stand up here and talk about how we want our
patients, our Medicare patients, to have only the best and quality
care, but it's very, very difficult to guarantee them quality care when
we can't even assure them of a doctor at the other end of the phone
line when they need one.
Now, in the health care bill that we passed, primary care physicians
do get

[[Page H2831]]

a little bit of a boost in payments for Medicaid, but that is short-
lived, and there are still going to be significant disparities between
payments of primary care and specialty care. Medicare and Medicaid
rates for primary care services will increase for primary care but only
for a very short period of time. We are very famous in Congress for
doing this. We'll say, We're going to take care of you. We're going to
actually pay you what you think you're worth for the next 18, 20 or 24
months. These things are called funding cliffs. Sure enough, there is a
big funding cliff in the health care bill that was passed, and doctors
will face falling off that funding cliff now in a little less than 2
years' time.
Fixing the Medicare payment formula, fixing the so-called SGR
formula, is going to be a tough lift. The House did pass a bill last
fall. Unfortunately, it was a bill that had already been rejected by
the Senate, so I'm not quite sure why we brought it up and voted on it
on the House side, but we did. It was a bad bill. It didn't really fix
the problem, but it was the only opportunity to pass a Medicare fix, or
an SGR fix, or a doc fix, during the calendar year 2009. So I voted in
favor of it even though the bill, itself, was a dreadful product.
Surely, we can do a much better job.
Now, I have an SGR reform bill, H.R. 3693, Ensuring the Future
Physician Workforce Act, and I would encourage Members of Congress to
look at that. This is going to come back again and again and again. We
passed a short-term extension. We now have solidified physician payment
through the month of May, but beginning June 1 or 6 or some date early
in June, that 20 percent funding cliff will still be out there, and we
are going to have to take care of that.
I rather suspect, this being an election year, we're not going to do
anything large to fix this problem. We should, but I do rather suspect
that we will do something that punts it down the road until after the
next election. It's a shame. It's a shame, because when we're doing
something as big as this fundamental health care reform that we did, it
seems like this is exactly the type of problem that you would like to
take care of.
Again, what do we hear from our folks when we go home and talk to
them about health care?
Well, I'll tell you what, Congressman. One of my biggest problems is
trying to find a doctor who will take Medicare.
If seniors change locations, if they move from one town to the next,
if they leave their towns when they retire and move to be closer to
their grandchildren, they are very likely going to experience
difficulty and delays in finding doctors who are taking new Medicare
patients.

{time} 1445

Because of what we in the United States Congress do to physicians
year in and year out, it has become so cumbersome to find physicians
who will take new Medicare patients that it has become a critical
access issue for our seniors.
Let me just talk briefly, because it is important, one of the
mistakes that was made in the bill, one of the problems that emerged
after the bill was passed and signed, and most people in the country
are not going to shed too many tears about this, but Members of
Congress actually lost their health insurance after the passage of this
bill. Or actually the way it's written, Members of Congress will now be
required to buy their insurance through the insurance exchange just as
every other American will be required to do beginning in the year 2014.
The exchanges are not going to be set up until 2014, but Members of
Congress, as of the signing of this bill, are required to buy their
health insurance through the exchange.
So we are now asked to buy insurance in a nonexistent exchange, and
that is going to make it difficult. Our staff do fall into the same
category; so I am getting many questions from staff saying, Well,
they're still taking a health insurance premium out of my paycheck, but
am I really insured or not? And there is some confusion and it needs to
be cleaned up. Again, most Americans are not going to shed too many
tears about Members of Congress being confused about their health
insurance coverage. They're going to say, Welcome to my world. But
interestingly enough, the people who wrote this bill, and that would be
committee staff, administration, staff from the White House, leadership
staff, the people who actually wrote this bill--and make no mistake
about it. Certainly no Republican was involved in writing this bill.
Most Democrats were not involved in writing this bill. In fact, I will
submit to you House Democrats especially were excluded from this
process. So who writes a bill like this? Well, it is tenured and long-
term committee staff, leadership staff. Yes, the White House was out
here big time while the bill was being hammered out during the latter
part of December and the first part of January. All of those people who
actually wrote the bill are exempt from that.
So there is one little simple fix-it bill, H.R. 4951, that would also
require committee staff, leadership staff, members of the
administration, political appointees at the Federal agencies to also be
covered under the exchange the same as Members of Congress. Now, again,
the problem is that we're required to be covered under the exchange.
The exchange is not up and running until 2014; so it remains to be seen
how that will work out. But the irony of Congress voting itself out of
health insurance because they didn't understand the bill that came over
from the Senate on Christmas Eve is just simply too important to
ignore.
One of the last things that I do want to cover this afternoon is
yesterday my committee, the Committee on Energy and Commerce's
Subcommittee on Oversight and Investigations, was going to have a
hearing on America's business that had released information that they
were going to change their earnings projections because of issues that
occurred after the passage of the health care bill.
So you see here, and this actually should be a minus sign in front of
all these numbers, a company like AT&T was going to have to write down
a billion dollars in charges because of changes to their accounting
that was now going to occur as a result of our passing the health care
bill. Well, when these companies released the press releases that they
were restating projected earnings because of what the health care bill
had done, John Deere was going to have write down $150 million; 3M
Company had to write down, again, that should be a negative $90
million.
When that occurred, the chairman of my committee, Mr. Waxman, said,
This is not right. These companies are simply doing this to embarrass
the Congress and embarrass the President. They need to come before our
committee and be held accountable for why they would release this type
of information on a day that was otherwise a day of great national joy
when the President was signing the health care bill.
Well, the companies responded that they were simply performing under
requirements like the Securities and Exchange Commission. Their
earnings were going to be affected by the passage of this bill, and
they were required to restate earnings based upon that information. And
maybe they didn't need to release it on that particular day, but
certainly that information needed to be made public. And, indeed, many
of these same companies had contacted members of the committee staff
and let them know this in advance of actually releasing the
information.
Now, interestingly enough, when it came to light that the heads of
these companies stated, Well, we're just simply doing what you told us
we had to do under the rules provided us by the Securities and Exchange
Commission, the committee decided to postpone indefinitely that
hearing.
But it was troubling. It was troubling because here we have a rather
significant subcommittee in the United States House of Representatives,
a rather significant subcommittee that can issue subpoenas if it wants.
It does take testimony under oath. This is generally not an exercise
that a company CEO will look forward with great relish to come before
our committee and have to answer questions. And some of us saw that as
actually an intimidation tactic: Don't you dare complain about what we
have done with this health care bill or we can make your life miserable
if you do.
Health care costs are going to take a toll on United States profits,
corporate

[[Page H2832]]

profits, according to estimates by a benefits consulting firm, Towers
Watson. Medtronic, a medical device maker, warned that new taxes on its
products could result in about a thousand workers being laid off. Their
accounting also estimated that there will be thousands of layoffs and
consumer-related costs.
If you came out against this bill, if you dared to speak out against
this bill, the message was loud and clear to corporate America: We're
going to call you in. We're going to question you under oath. We are
likely to embarrass you in a public forum. So don't you dare complain.
But one of the things that I have heard over and over from both large
and small business back home is this health care bill is going to have
a profound, a significant, and a deleterious effect on just simply
conducting a business. More than one small business in my community has
come back to me and said, As I run the numbers, as I look at what
happens to me through the year 2014 and the requirements that will be
upon me, it is very likely that my bottom line will go negative and
stay negative as far as I can see unless I don't expand or I don't
hire. In fact, the succinct message that the United States Congress has
sent to small and medium-sized business across the country in every
State of the Union is don't hire right now. Don't hire right now until
you know what is going to be required of you, Mr. or Mrs. Employer. We
are likely going to change the way your business works, again, in a
very profound and significant way.
Now, I also sit on the Joint Economic Committee, which is a House and
Senate committee. The first Friday morning of every month, whether
we're voting on the floor of the House or not, we need to be in town to
receive a report from the Department of Labor. And that report is the
employment report for the preceding month. It comes out the first
Friday of every month. Usually those numbers are released at about 8:30
in the morning, and our committee convenes at 9:00 or 9:30 to hear from
the head of the Department of Labor as to what the employment
statistics look like.

I joined that committee in January of 2009. We have never had, never
had in the 15 months that I have been in the committee, a good news
report. In fact, one of my constituents back home said I'm bringing
such bad luck to the committee, maybe I ought to consider some other
assignment. But the fact remains if we keep doing things in Congress,
in the House and the Senate, in the legislative branch, if we keep
doing things that send a loud and clear message to small business,
medium-sized business don't hire right now, we're not going to see the
type of employment recovery that we all feel that the economy is
capable of.
Look, whether you believe in bailouts or stimulus or not, everyone
knows that the United States economy is too vibrant not to recover.
There is almost no way that the United States Congress or the White
House, regardless of who occupies these chairs or who is down at the
other end of Pennsylvania Avenue--there is almost no way that the
Congress or the White House can keep the American economy indefinitely
suppressed. But we can really lengthen the pain, and that is one of the
things that we're doing right now.
The uncertainty we have created with health care costs, the
uncertainty we have created with energy costs, the uncertainty that we
are creating with this financial services bill that is now being argued
over in the Senate, small business, medium-sized business is looking at
what is going on in Washington right now and saying, I may need help
but I don't think so. I will either pay a little overtime or just
rachet back some of the expansion I was doing. Yet every person who
runs for office, and you can take this to the bank, is at some point
going to stand up on a stump or a chair and give a speech to a chamber
or rotary club back home and say small business is the engine that
drives our economy. And that's exactly true.
If I have one small business at home that might be looking at picking
up one or two additional people but says, Right now is not the time and
I am not going to do that, okay, that's only one or two jobs. Could
that have a profound effect on the larger economy? You bet. You bet.
When you take that one or two job growth that's not occurring in that
business and extrapolate it across the broader economy for businesses
of that size, that has a significant, a significant deleterious effect
on the growth of jobs and the economy. And yet it is the unemployment
numbers that are really the depressive part of what is happening in the
economy right now. Yes, Wall Street might look a great deal better than
it did last year. Maybe some other numbers, the gross domestic output,
may look better than it did last year. But the numbers of unemployed,
the numbers of long-term unemployed, the numbers of young people
unemployed, the numbers of minorities unemployed, those numbers are
what people are having to deal with every day. That's either them or
their friends and neighbors, and that's what they see every day. And
until we address the problems with employment, no one in this country
is going to believe that we really have the appropriate handle on the
economy or the economic direction of the country.
Again, I believe the economy will recover in spite of the United
States Congress, in spite of the White House. It almost always does.
But we can certainly make that recovery much more difficult and much
more painful and perhaps suppress it longer than it would be otherwise
suppressed by our activities here in the House of Representatives.
Suffice it to say, as we wrap this up, I believe this health care
bill to be a fiscal disaster. It is going to increase the deficit. I
don't care what anyone else says. It's $582 billion over the first 10
years, and likely as not, over the second 10 years those numbers even
become more startling. You look at how the bill is constructed. You've
got 10 years of taxes paying for 6 years of benefits. Is it any great
surprise that the next decade, which is 10 years of taxes and 10 years
of benefits, that that deficit is not likely to increase?
We also have a problem that the bill double counts Social Security
payroll tax revenues, a budgetary gimmick that made the bottom-line
number look great. Again, remember the parameters that we were working
with? You have got to have the top number less than $1 trillion. You
have got to have the coverage number over 30 million people. Move those
points around on a chessboard however you want, but those are the
parameters with which you have to work. So if you double count income
from Social Security payroll taxes, if you double count the money from
the Medicare cuts, of course your bottom line is going to look better.
We also did something in this bill that's called the CLASS Act. Most
people are not aware of it. It's thought of as a long-term care
supplemental insurance, but the reality is it's a Three-card Monte. For
a $50-a-month cost, a beneficiary may receive $50 a day in additional
long-term care costs for a long-term care hospital. Well, most of us
know that $50 a day is not going to cover your stay in a long-term care
hospital. Most of us know that the numbers on that equation really
don't work out. But what happens is since you have so many people just
joining the program at the front end, during the first years you
actually run a surplus, but then you get to the outyears and you run a
significant deficit.
The CLASS Act was literally a financial manipulation that was
introduced at the last minute, not to provide people long-term care
insurance. If we really wanted to do something with long-term care
insurance, we'd make it tax deductible. We'd make it a tax credit. We
would make it so you could pay for it out of your health savings
account. If we really wanted to help people get long-term care
insurance, there are ways to do it. The CLASS Act wasn't it. What the
CLASS Act was, was some fancy bookkeeping, some manipulation of the
books. Collect a lot of premiums up front. You don't start paying
benefits for several years. So that will score as a savings, score as a
revenue raiser during the first 10 years of this budgetary cycle, but
in the outyears it does nothing but explode the budget.
Again, in my home State of Texas, it's estimated that this bill is
going to cost the State of Texas almost $25 billion in additional
funding for Medicaid, and additionally there are going to be

[[Page H2833]]

cuts to the safety net hospitals, so-called disproportionate share
cuts.

{time} 1500

Other dates of significance in 2011, the drug makers face an annual
fee of $2.5 billion. Now, many people say, wait a minute, the drug
companies make too much money anyway so, yeah, hit them with a $2.5
billion charge beginning in 2011. Maybe they should be paying a little
bit more.
But think about it for a minute. That $2.5 billion, where is that
going to come from in the pharmaceutical manufacturing world? Is it
going to come from the CEOs' salary? Is it going to come from the
lobbyists' salary? I think you know the answer to that. Those dollars
are going to come from increased costs to the end user, the patient,
you and me.
In 2011 medical device manufacturers are going to be charged an
additional fee. It goes up to $2 billion per year. Again, that's not
going to be paid by the CEO of one of these Boston companies that is a
medical device manufacturer. That money is going to be paid by the
patient who receives that defibrillator or that artificial hip, that
vein filter for preventing blood clots. Those are the people who are
going to actually be paying that fee, not the companies themselves.
There's a health insurance provider fee, $2 billion in 2011, and it
goes up from then. Again, that money is not going to be taken from the
CEOs' salary, from the private insurance companies in this country.
Whether they are for profit or not for profit, that money is not coming
out of the CEOs' salary or the lobbyist money. That money is coming out
of the ratepayers' hide.
There's going to be a tax on wages that will increase to 2.35
percent. In 2013 there will be a new tax on unearned income on
dividends and interest, almost 4 percent.
In 2013 the excise tax of 2.9 percent is imposed on the sale of
medical devices. Now, these are class two and class three medical
devices in your doctor's office or hospital. So class one devices like
Band-Aids, tongue depressors, those won't be taxed. But class two
devices, and what are some examples of class two devices, syringe and
needle, those are going to be taxed in your doctor's office.
Now, in your doctor's office they can't charge you that 2.9 percent
tax that they have to pay on the tax on that syringe because that's a
contractual amount between the insurance company, the patient, and the
doctor. That's very difficult for a doctor's office to pass that charge
along, so actually doctors are going to bear the brunt of that.
Hospitals too are likely to bear the brunt of that. Since their
arrangements are contractual with insurance companies, they're unlikely
to be able to pass that cost along.
Other types of medical devices, type two devices--interestingly
enough, I'd like to say everything from lasers to leeches will be taxed
in your doctor's office.
Employers with more than 50 employees must pay a fine of up to $3,000
if employees receive tax credits to purchase insurance. So that's where
a lot of the small and medium-sized business is really concerned and
the arbitrary placement of those numbers, why is it 50 employees, why
not 55? Why not 45? Simply because they had to pick a number and start
somewhere.
So if there's a small business back home that has 48 employees, but
they've got so much work, as the economy recovers, that maybe they'd be
fixing to add five jobs, they're not going to do it. Let's stay under
50 employees. Our life will be a lot easier under this health care
bill. At least let's wait. At least let's wait until we see what's
going to happen.
What's up next? Well, let me say it again: I favor repeal of this
bill. Rip it out, root and branch, and get it gone, and then come back
and fix the things that people told us they wanted fix.
But what we are going to see next is just down the street at the
Department of Health and Human Services; another Federal agency called
the Office of Personnel Management, OPM; the Internal Revenue Service.
They're writing the rules and regulations that are going to dictate how
this legislation, how it now turns into the rules and regulations that
govern what happens in your doctor's office or hospital and essentially
dictates what happens in your life when you intersect with the American
health care system.
This will take some time. This is not something that is going to
occur overnight. Right now the hiring is in process, so, yeah, maybe
the administration can say we're adding a bunch of new jobs over at the
Department of Health and Human Services and IRS. But most of us would
just as soon that those IRS agents weren't hired because they generally
are not there to make our lives go smoother and easier.
Office of Personnel Management, that's an interesting phenomenon.
Many people will recall that when the Senate passed their health care
bill, Senator Lieberman said, I won't vote for a health care bill that
has a public option within it. And yet we have a bill that, in fact,
does have a public option. And it's not called a public option straight
up, but it is a public option, sure enough.
States are required to set up State exchanges. People will be
required to buy their insurance in the exchange. Some people will have
those costs subsidized; some will not.
Well, what if a State does not set up an exchange? Can the Federal
Government force it to set up an exchange? And the answer is no. The
Federal Government will set up a national exchange for those States
where no State exchange exists. Within that national exchange, under
the law, it is required that there be one insurance company that is a
for-profit company and one that is a not-for-profit. These insurance
companies, if no company signs up to do this duty, that exercise is
then taken over by the Office of Personnel Management.
So a nonprofit insurance company administered by the Office of
Personnel Management begins to look a lot like what was discussed last
July and August as the public option. It, in fact, will be a de facto
public option within a very short period of time. So those who opposed
the bill and said I couldn't support a bill that had a public option,
but now that the public option is out of it, I'm okay, I can support
the bill, guess what? They got a public option.
Let me just conclude by saying this was not a bipartisan bill. The
opposition to this bill was bipartisan. You had almost 40 Democrats and
every Republican who said, we don't want this bill.
Interestingly enough, part of the story that is yet to be told is the
effect of this bill on what happens early in November, later this year.
In USA Today, the little newspaper that comes out nationally, earlier
this week there was an article about the number of physicians who have
filed and are running races for Congress. It will be unprecedented
numbers. I think the actual number of doctors, Republican doctors who
have filed for congressional races, is just a little over 30, 32. There
are many more waiting in the wings. Some States have much later
primaries. That number will likely go higher.
Not every doctor will win their primary, unfortunately. Not every
doctor will win their congressional race. But I think it's safe to say
that the next Congress, the 112th Congress, when it convenes next
January, is likely to have more physicians within that Congress than
anytime in the previous hundred years.
This bill has had a profound effect on how Americans think about
their health care and how they think about their relationship with
their government. Is a government that is bigger better for the
individual or worse?

Many people are now having that internal discussion or that
discussion around the dinner table that never would have thought about
that in years past. But now it has become an important issue.
This next November will be a seminal time in American politics and
American governance going forward. It will dictate whether this bill
continues to exist and exert control over the people's lives, continues
to take money out of the lives of productive citizens, or whether this
bill is turned back, and then the Congress gets down to the serious
work of correcting the problems that people told us they wanted us to
correct and we ignored them consistently through the fall and through
the winter.
I think it says something that the opinion of Congress right now are
in the low double digits. Any doctor who's

[[Page H2834]]

willing to run for Congress, and I can tell you this from some personal
experience, doctors actually enjoy a fairly high approval rating. It's
in the high seventies. You come to Congress, it goes into the low
teens.
It is a significant step to run for Congress for physicians. And yet
doctors across the country are willing to give up their peace of mind
and their livelihood to come to the aid of their country in its hour of
need.

____________________